Prevention Programs Research Articles

Process evaluation findings from Strong Hearts, Healthy Communities 2.0: a cardiovascular disease prevention intervention for rural women

BackgroundStrong Hearts, Healthy Communities 2.0 (SHHC-2.0) was a 24-week cardiovascular disease prevention program that was effective in improving physical activity and nutrition behaviors and clinical outcomes among women in 11 rural New York, USA towns. This study evaluated the delivery of SHHC-2.0 to prepare the intervention for further dissemination.MethodsThis process evaluation was guided by the Medical Research Council recommendations and engaged program leaders and participants (i.e., women over age 40) using quantitative and qualitative methods. The quantitative evaluation included examination of enrollment and retention data, a participant survey, and a fidelity checklist completed after classes. Descriptive and comparative statistics were used to assess implementation measures: program reach, participant attendance, dose delivered, program length, perceived effectiveness, fidelity, and participant satisfaction. The qualitative evaluation included focus groups (n = 13) and interviews (n = 4) using semi-structured guides; audio was recorded and transcripts were deductively coded and analyzed using directed content analysis and iterative categorization approaches. Comparisons across towns and between intervention and waitlist control groups were explored.ResultsAverage reach within towns was 7.5% of the eligible population (range 0.7-15.7%). Average attendance was 59.8% of sessions (range 42.0-77.4%). Average dose delivered by leaders was 86.4% of curriculum components (range 73.5-95.2%). Average session length was 51.8 ± 4.8 min across 48 sessions. Leaders’ perceived effectiveness rating averaged 4.1 ± 0.3 out of 5. Fidelity to curricular components was 81.8% (range 67.4-93.2%). Participants reported being “more than satisfied” with the overall program (88.8%) and the health benefits they obtained (72.9%). Qualitative analysis revealed that participants: (1) gained new knowledge and enjoyable experiences; (2) perceived improvements in their physical activity, nutrition, and/or health; (3) continued to face some barriers to physical activity and healthy eating, with those relating to social support being reduced; and (4) rated leaders and the group structure highly, with mixed opinions on the research elements.ConclusionsSHHC-2.0 had broad reach, was largely delivered as intended, and participants expressed high levels of satisfaction with the program and its health benefits. Our findings expand on best practices for implementing cardiovascular disease prevention programs in rural communities.Clinical trials Registrationwww.clinicaltrials.gov #NCT03059472.

Learning by Doing: The Potential for Experiential Education in Health Promotion

Background: Rural populations face significant health disparities (e.g., high rates of chronic diseases) and unique accessibility barriers (e.g., limited healthcare facilities). Training higher education students to serve as facilitators for chronic disease prevention programs may address rural health promotion needs. Purpose: The purpose of this pilot, exploratory study was to create an experiential learning opportunity for students and examine their experiences. Methodology/Approach: Project leaders completed a Diabetes Prevention Program Lifestyle Coach training and, based on their experiences, created training program goals, content, and schedule. Undergraduate students in health-related programs or courses were recruited to participate. Four students completed a 4-week experiential training program and, at the end of the program, participated in an individual qualitative interview for researchers to understand their experiences. Findings/Conclusions: Data were analyzed through a qualitative-descriptive approach. The main theme, experiential learning, branched into two subthemes: (a) professional development and (b) program implementation and future program directions. Students’ experiential learning influenced their personal and programmatic views of prevention training. Implications: The benefits of experiential learning in prevention will enhance students’ education and future employment experiences. Future studies should improve upon training delivery and examine the acceptability of this method of delivery in the rural population.

Effectiveness of Home-Based Self-monitoring of Blood Pressure in a Primary Care set-up of India (EASE-BP): Protocol for an Open-Label Randomized Controlled Trial.

Rising hypertension from inadequate detection, noncompliance with treatment, and poor control presents a major public health challenge. Previously, adopting the strategy of self-monitoring of blood pressure (SMBP) showed better hypertension detection, control, and medication adherence. However, evidence from India is scarce. Here, we present the trial protocol for the effectiveness of SMBP intervention in hypertension detection, blood pressure (BP) control, and medication adherence in a primary care set-up. EASE-BP is an open-label randomized trial in two distinct adult populations - part-A self-reported non-hypertensive population (total sample size: 400) and part-B known hypertensive population (total sample size: 332). The two populations will be sampled from two separate villages under the Ballabgarh Health and Demographic Surveillance System. In both the populations, participants randomized in the intervention arm will receive a validated electronic BP device and will be advised to self-monitor BP for at least twice a month (or more). Those in the control arm will be advised to monitor BP for at least twice a month (or more) at the nearby health center. Participants in both arms will receive education on hypertension and atherosclerotic disease. In addition, adult family members in the households of randomized participants will be encouraged to monitor their BP. All participants and family members will be instructed to maintain a log of BP recordings in a diary that will be provided to them. Data will be collected at baseline and then every month for three-months. The primary outcome in part-A will be the incidence of new cases of hypertension during 3 months follow-up and in part-B will be the difference in SBP and rate of medication adherence at 3 months follow-up. Secondary outcomes will include (1) uptake of the intervention, (2) any stroke, myocardial infarction, or death, (3) additional yield of new cases of hypertension among the family members, and (4) integrating the intervention into the national programs for long-term noncommunicable disease goals. EASE-BP will help understand if SMBP improves hypertension detection, BP control, and medication adherence. Consequently, this will appraise policymakers on whether provision of BP instruments may be added to the national program for hypertension prevention and control. This trial was registered under Clinical Trial Registry - India with reference number CTRI/2023/02/049949.

Effectiveness of Injury Prevention Program Using a Global Systems Approach on High-Risk Movement Mechanics for Noncontact ACL Injury.

Injury prevention training using a global systems approach was designed to develop integrated trunk-lower extremity neuromuscular control using whole-body, rotational forces about the vertical Z-axis during simulated sports movements. Compared with traditional hip-focused exercises, injury prevention training using a global systems approach could improve kinetic and kinematic measures related to anterior cruciate ligament injury. Controlled laboratory study. Level 3. A total of 39 male and female athletes received 6 weeks of either global systems approach (n = 20), or hip-focused strengthening, balance, and plyometrics training (n = 19) exercises. Before and after the training program, participants performed a single-leg vertical drop jump task on their dominant leg. Peak vertical ground-reaction forces (GRFs), peak knee abduction, internal rotation moments, peak hip flexion, hip adduction, knee flexion, knee abduction, contralateral pelvic drop, and lateral trunk flexion angles were assessed. Biomechanical data were compared between the 2 groups using a random-intercept linear mixed-models analysis. A significant group × time interaction effect was found for vertical GRFs (P = 0.01; change difference relative to baseline: 4.5%), knee abduction moment (P = 0.01; 14.8%), hip adduction (P < 0.01; 16.7%), knee abduction (P < 0.01; 13.8%), contralateral pelvic drop (P < 0.01; change difference: 26.6%), and lateral trunk flexion (P = 0.04; 20.37%) angles, favoring the global systems approach group after 6 weeks of training. Participants who trained using the global systems approach had significantly decreased lateral trunk flexion, hip adduction, knee abduction and contralateral pelvic drop angles, peak vertical GRFs, and peak knee abduction moment during a single-leg vertical drop jump compared with participants who trained with hip-focused exercises. Incorporating additional external resistance at the proximal trunk results in improved biomechanics compared with conventional hip-focused exercises.

Prevalence and Molecular Characterization of β-Thalassemia in Kirkuk Province of Northern Iraq

To determine the prevalence and molecular basis of β-thalassemia in the Northeastern Iraqi province of Kirkuk, a total of 3954 individuals attending the provincial premarital screening center were recruited. The prevalence of β-thalassemia minor among the screened individuals was found to be 3.0%, while those of Hemoglobin E, and δβ-thalassemia carrier states were 0.05%, and 0.03% respectively. Molecular characterization of the β-thalassemia mutations was achieved by multiplex PCR and reverse hybridization, followed by next generation sequencing for those left uncharacterized by the former technique. Among 19 β-thalassemia mutations identified, seven were the most frequent, namely: IVS-II-1 (G > A), codon 8/9 (+G), IVS-I-6 (T > C), IVS-I-110 (G > A), IVS-I-I (G > A), IVS-I-5 (G > C) and codon 44 (-C) accounting for 78.5% of the mutations. This study further illustrates the heterogeneity of the spectrum of β-thalassemia in different parts of Iraq, and provides an essential step to facilitate prenatal diagnosis in the setting of a future national thalassemia prevention program.

Body mass index trajectories and time in target range after delivery and long-term type 2 diabetes risk in women with a history of gestational diabetes mellitus.

This study aims to determine whether postpartum body mass index (BMI) trajectories and its time in target range (TTR) are associated with long-term type 2 diabetes risk in women with a history of gestational diabetes mellitus (GDM). The present study included 1057 women with a history of GDM who participated in the Tianjin Gestational Diabetes Mellitus Prevention Program (TGDMPP). Oral glucose tolerance tests or physician-diagnosed information were used to diagnose type 2 diabetes after a median follow-up period of 8.47 years. Latent class modelling was applied to identify trajectories of BMI after delivery. TTR was defined as the proportion of time that BMI was within the standard range (18.5 ≤ BMI < 24.0 kg/m2). The associations of BMI trajectories and TTR with type 2 diabetes risk were analysed using multivariable Cox modelling. Five distinct trajectories of postpartum BMI were identified. Compared with low-stable class, the multivariable-adjusted hazard ratios of type 2 diabetes were 2.02 (95% confidence interval 0.99-4.10) for median-stable class, 3.01 (1.17-7.73) for high-stable class, 2.15 (0.63-7.38) for U-shape class and 7.15 (2.08-24.5) for inverse U-shape class (p for trend = 0.012), respectively. Multivariable-adjusted hazard ratios of type 2 diabetes associated with postpartum BMI TTR of 100%, >43.4%-<100%, >0%-≤43.4% and 0% were 1.00, 1.84 (0.72-4.73), 2.75 (1.23-6.15) and 2.31 (1.05-5.08) (p for trend = 0.039), respectively. Postpartum BMI trajectories of high-stable and inverse U-shape class as well as lower TTR were associated with an increased risk of type 2 diabetes among women with a history of GDM. Reducing BMI to a normal range in the early postpartum period and maintaining stable over time could attenuate the development of long-term type 2 diabetes.

Social Frustration Level Questionnaire: Substantiation, Design, and Probation

The current preventive trends in clinical examination draw attention to the role of the external factors and stressful circumstances in psychodiagnostic research. Social frustration is an incapacity to fulfill relevant social needs because of a current situation. This term makes it possible to qualify criteria for the potential stress related to social functioning among family members, colleagues, and peers. The authors rationalized and tested a formalized questionnaire of Social Frustration Level developed at Bekhterev National Medical Research Centre for Psychiatry and Neurology in 2004 for patients with social adjustment disorders. The experiment justified the criterion validity of the Social Frustration Level Questionnaire. The article describes the structure of social frustration regarding the key spheres of activity attributed to internal and external frustration. The pilot study involved 45 patients with adjustment disorders, who showed significant frustration related to health problems and socio-economic status accompanied with relative satisfaction with interpersonal relations, i.e., family, friends, colleagues, and strangers. The research relied on the method of clinical psychological interview, as well as the Questionnaire of Social Frustration Level and the Integrative Anxiety Test. Personal anxiety and actual anxiety experiences proved to correlate with social frustration. The internal social frustration prevailed over the external one. The Questionnaire of Social Frustration Level proved to be an efficient practical tool to be used in systematic medical psychodiagnostics research, programs of disorder prevention, and psychotherapy.

Is Weight Loss the Most Effective Method for the Prevention of Type 2 Diabetes? A Discussion in View of Evidence from Landmark Studies

Type 2 Diabetes mellitus (T2DM) and obesity are a continuum and intertwined in a complex way. Both these chronic conditions pose a significant challenge to the global health system, if the current trend continues, it is estimated that by 2045 the number of people affected globally will increase by almost 700 million. Considering the above, effective strategies have to be implemented to tackle this global pandemic. The main strategies discussed in the literature are lifestyle intervention (ESI) with or without weight loss and medication. This article looked at the evidence from the various landmark studies which include the Diabetes Prevention Program (DPP) and Diabetes Prevention Study (DPS) Outcomes of these studies suggest that ELSI with loss is superior to ELSI without weight loss and metformin in risk reduction of T2DM. The evidence from the Swedish obese subject study also concludes that weight loss achieved through bariatric surgery reduces the risk. Lifestyle modification programmes even without weight loss have greater health benefits but as far as risk reduction for T2DM the evidence is not conclusive. This review article concludes that reducing weight is paramount for preventing T2DM, especially in high-risk individuals, compliance plays a vital role in overcoming these challenges and stresses the importance of tailored strategies for person-to-person characteristics to overcome those challenges.

Child Abuse Incidences Per Child Year Predicted from the Available Average Incidence Combined with Foreign Incidences Per Child Year: Towards a New Policy

Child abuse is a worldwide recognized serious problem. Reliable child abuse incidences, preferably per child year, are fundamental for a sound detection and prevention program. Unfortunately, in most countries where child abuse data is available, incidences are not determined per child year but as an average over the child age range. In this paper we suggest a possible &amp;quot;next-best&amp;quot; solution for deriving child abuse incidences per child year when only an average value is available in an area or country. As method, we combined the country&amp;apos;s measured average incidence with available (foreign) incidences per child year. The country&amp;apos;s next-best incidences per child year will be estimated from its average, multiplied by the foreign incidences per child year divided by the foreign average. As results, we calculated the next-best Dutch age-dependent incidences by combining the Dutch average value with US and Ontario age-related incidences. We found comparable results for infants above 1 year and marked differences for children &amp;lt;1 year, likely due to cultural differences between the US and Ontario. In conclusion, next-best age-related child abuse incidences are obtainable in large areas or countries by choosing a smaller but representative region, the latter estimated from Ontario-data as ≥210,000 inhabitants, and establishing as perfectly as possible the optimal infra structure. A future perspective towards a new policy could be to initiate and stimulate this approach in the various European Union and United Nations Convention on the Rights of the Child member states.

The FRIENDS preventive programme for reducing anxiety symptoms in children and adolescents: A systematic review and meta‐analysis

AbstractBackgroundAnxiety and stress responses are often considered normative experiences, and children and adolescents may benefit from anxiety prevention programmes. One such programme is FRIENDS which is based on a firm theoretical model which addresses cognitive, physiological and behavioural processes. FRIENDS is manualised and can, thus, easily be integrated into school curriculums.ObjectivesWhat are the effects of the FRIENDS preventive programme on anxiety symptoms in children and adolescents? Do the effects differ between participant age groups, participant socio‐economic status, type of prevention, type of provider, country of implementation and/or implementation issues in relation to the booster sessions and parent sessions?Search MethodsThe database searches were carried out in September 2023, and other sources were searched in October 2023. We searched to identify both published and unpublished literature. A date restriction from 1998 and onwards was applied.Selection CriteriaThe intervention was three age‐appropriate preventive anxiety programmes: Fun FRIENDS, FRIENDS for Life, and My FRIENDS Youth. Primary outcome was anxiety symptoms and secondary outcome was self‐esteem. Studies that used a control group were eligible, whereas qualitative approaches were not.Data Collection and AnalysisThe number of potentially relevant studies was 2865. Forty‐two studies met the inclusion criteria. Twenty‐eight studies were used in the data synthesis. Four studies had a critical risk of bias. Six studies did not report data that enabled calculation of effect sizes and standard errors. Two studies had partial overlap of data to other studies used, and two were written in Persian. Meta‐analyses were conducted on each outcome separately. All analyses were inverse variance weighted using random effects statistical models.Main ResultsStudies came from 15 different countries. Intervention start varied from 2001 to 2016. The average number of participants analysed was 240, and the average number of controls was 212. Twenty‐five comparisons reported on anxiety symptoms post‐intervention. The weighted average standardised mean difference (SMD) was 0.13 (95% CI 0.04 to 0.22). There was some heterogeneity. Twelve comparisons reported on anxiety symptoms at 12 months follow‐up. The weighted average SMD was 0.31 (95% CI 0.13 to 0.49). There was a large amount of heterogeneity. Five comparisons reported on self‐esteem post‐intervention with a weighted average SMD of 0.20 (95% CI −0.20 to 0.61) and a large amount of heterogeneity. At follow‐up, we found evidence that programmes implemented by mental health providers appears to perform better than programmes implemented by teachers. The evidence was inconclusive beyond 12 months follow‐up.Authors' ConclusionsOur results indicate that the FRIENDS intervention may reduce anxiety symptoms in children and adolescents when reported by children and adolescents themselves. The majority of trials employed a wait‐list design, implying only a few studies reported on the long‐term effects of the FRIENDS intervention. Our findings suggest that the FRIENDS intervention may increase the reduction in anxiety symptoms 12 months after the intervention. This emphasises the need for future research that apply designs that allows for long‐term follow‐up. We are uncertain about the effects on self‐esteem. The overall certainty of evidence varied from low to very low. There is a need for more rigorously conducted studies.

Preventing cardiovascular disease in at-risk patients: Results of a pilot behavioural health programme in general practice

Background The ‘High-Risk Prevention Programme’ (HRPP) involved a six-week health behaviour change programme based in general practices and aimed to address cardiovascular disease (CVD) risk in disadvantaged Irish communities. Objectives This pilot study aimed to establish the HRPP’s likely effectiveness and acceptability to inform the development of a future definitive trial. Methods The HRPP was conducted at six general practices in disadvantaged areas in the Ireland East region. Patients with high CVD risk were recruited by participating practices and were allocated to either a General Practice Nurse (GPN) or Health Promotion Professional (HPP) led programme focusing on positive health behavioural change. Baseline and 12-month follow-up data were collected to capture the HRPP’s likely effectiveness in promoting health outcomes and health behavioural change. Results The HRPP programme was completed by 270 patients. Out of these 270 patients, 245 (90.74%) completed baseline assessments, and 176 (65.19%) completed follow-up assessments at 12 months. Baseline data indicated a high level of CVD risk among patients and follow-up demonstrated positive change in several areas, especially weight (−1.95 kg, p < 0.001), BMI (−0.72, p < 0.001), exercise during the last week ( p <0.001), and consumption of healthy fats in the HPP group (+60%, p < 0.001). Conclusion The HRPP was a much-needed pilot intervention, and positive results were seen in both GPN and HPP arms, especially with regards to weight loss, exercise, and dietary improvements. Future definitive trials of the HRPP are likely to be effective and acceptable in terms of combatting these issues among high-risk patients.

The Online Health Information-Seeking Behaviors of People Who Have Experienced Stroke: Qualitative Interview Study.

Stroke is a leading cause of death and disability worldwide. As health resources become digitized, it is important to understand how people who have experienced stroke engage with online health information. This understanding will aid in guiding the development and dissemination of online resources to support people after stroke. This study aims to explore the online health information-seeking behaviors of people who have experienced stroke and any related barriers or navigational needs. Purposeful sampling was used to recruit participants via email between March and November 2022. The sampling was done from an existing cohort of Australian stroke survivors who had previously participated in a randomized controlled trial of an online secondary prevention program. The cohort consisted of people with low levels of disability. Semistructured one-on-one interviews were conducted via phone or video calls. These calls were audio recorded and transcribed verbatim. The data were analyzed by 2 independent coders using a combined inductive-deductive approach. In the deductive analysis, responses were mapped to an online health information-seeking behavior framework. Inductive thematic analysis was used to analyze the remaining raw data that did not fit within the deductive theoretical framework. A sample of 15 relatively independent, high-functioning people who had experienced stroke from 4 Australian states, aged between 29 and 80 years, completed the interview. A broad range of online health information-seeking behaviors were identified, with most relating to participants wanting to be more informed about medical conditions and symptoms of their own or of a family member or a friend. Barriers included limited eHealth literacy and too much generalization of online information. Online resources were described to be more appealing and more accessible if they were high-quality, trustworthy, easy to use, and suggested by health care providers or trusted family members and friends. Across the interviews, there was an underlying theme of disconnection that appeared to impact not only the participants' online health information seeking, but their overall experience after stroke. These responses were grouped into 3 interrelated subthemes: disconnection from conventional stroke narratives and resources, disconnection from the continuing significance of stroke, and disconnection from long-term supports. People who have experienced stroke actively engage with the internet to search for health information with varying levels of confidence. The underlying theme of disconnection identified in the interviews highlights the need for a more comprehensive and sustained framework for support after stroke beyond the initial recovery phase. Future research should explore the development of tailored and relatable internet-based resources, improved communication and education about the diversity of stroke experiences and ongoing risks, and increased opportunities for long-term support.

Preventing and responding to violence against women: A case study from Vietnam

Violence against women (VAW) has significant detrimental effects on the daily lives of women and the overall development of society. Addressing VAW poses a considerable challenge for nations striving to achieve sustainable development goals (SDGs). Vietnamese society, deeply influenced by Confucianism and Buddhism, continues to perpetuate male preferences. The persistence of gender stereotypes and discrimination shaped by societal norms serves as an underlying cause of VAW in Vietnam. Despite the Vietnamese government&amp;rsquo;s efforts since 2010 to implement prevention and response programs for gender-based violence, the alarming reality is that nearly 63% of women report experiencing at least one form of violence in their lives. However, various obstacles prevent many of these women from seeking legal protection. These obstacles include inadequate support services, burdensome proof requirements, and fear of re-victimization. Thus, the crucial question of how to effectively eliminate VAW in Vietnam remains a major concern, influencing the nation&amp;rsquo;s progress toward achieving the SDGs and upholding its commitment as a member country of the Convention on the Elimination of All Forms of Discrimination against Women. This paper analyzes the obstacles Vietnam faces in its efforts to prevent and respond to VAW, aiming to safeguard women&amp;rsquo;s rights and advance gender equality.

Risk factors associated with consumption of alcohol among Turkish older men and women

ABSTRACT Objectives This study aims to examine the factors associated with alcohol use among individuals aged 60 and above in Türkiye. Methods The microdata obtained from the Türkiye Health Survey conducted by the Turkish Statistical Institute (TSI) in 2019 and 2022 were used in this study. Binary logistic regression analysis was employed to identify variables associated with alcohol use in older adults. Results The analysis revealed that gender, age, education level, employment status, marital status, health condition, lung disease, history of heart attack, kidney disease, Alzheimer’s disease, difficulty in carrying or holding items, and tobacco use significantly influence alcohol use among older individuals. Conclusion The study concludes that older males are at a higher risk of alcohol use. It is recommended to develop preventive health programs tailored to address the specific reasons for alcohol initiation and use among men. Aging is a period characterized by reduced activity in both work and social life due to retirement, leading some older individuals to turn to alcohol consumption as a coping mechanism. To promote active aging, it is suggested that the number of senior clubs and elderly solidarity centers affiliated with municipalities should be increased.

Second Victims Among Austrian Nurses (SeViD-A2 Study).

Background: The Second Victim Phenomenon (SVP) significantly impacts the well-being of healthcare professionals and patient safety. While the SVP has been explored in various healthcare settings, there are limited data on its prevalence and associated factors among nurses in Austria. This study investigates the prevalence, symptomatology, and preferred support measures for SVP among Austrian nurses. Methods: A nationwide, cross-sectional, anonymous online survey was conducted September to December 2023 using the SeViD questionnaire (Second Victims in German-speaking Countries), which includes the Big Five Inventory-10 (BFI-10). Statistical analyses included binary logistic regression and multiple linear regression using the bias-corrected and accelerated (BCa) bootstrapping method based on 5000 bootstrap samples. Results: A total of 928 participants responded to the questionnaire with a response rate of 15.47%. The participants were on average 42.42 years old and were mainly women (79.63%). Among the respondents, 81.58% (744/912) identified as Second Victims (SVs). The primary cause of becoming an SV was aggressive behavior from patients or relatives. Females reported a higher symptom load than males, and higher agreeableness was linked to increased symptom severity. Notably, 92.47% of SVs who sought help preferred support from colleagues, and the most pronounced desire among participants was to process the event for better understanding. Conclusions: The prevalence of SVP among Austrian nurses is alarmingly high, with aggressive behavior identified as a significant trigger. The findings emphasize the necessity for tailored support strategies, including peer support and systematic organizational interventions to mitigate the impact of SVP on nurses and to improve overall patient care. Further research should focus on developing and implementing effective prevention and intervention programs for healthcare professionals in similar settings.

Non-alcohlic Fatty Liver Disease (NAFLD): Is it a Dormant Volcano or Tip of an Iceberg?

Non-alcoholic fatty liver disease (NAFLD), a major cause of chronic liver disease, is known to affect a quarter of the global adults. Natural history of NAFLD shows interindividual variation, traditionally it progresses from simple steatosis to steatohepatitis to fibrosis/cirrhosis and finally yet rarely to hepatocellular carcinoma. It is largely a lifestyle-related disease and is often labeled as the hepatic manifestation of metabolic syndrome. Both prevention and control of NAFLD include controlling risk factors (obesity, diabetes mellitus, hypertension and dyslipidemia), through lifestyle modification and medications. Drug therapy for NAFLD per se is still evolving and till date, no drugs are approved. It is clinically silent, especially in the early stages, and is a diagnosis of exclusion. Certain easily calculated indices can stratify cases into high or low risk for advanced fibrosis, thereby dictating appropriate monitoring and treatment measures. In addition to complications specific to liver disease in those who do progress to advanced fibrosis or cirrhosis, an increased risk of nonliver disease-related morbidity and mortality is also present. Challenges are manifold and include rising burden due to ever-growing epidemic of diabetes and obesity, low public awareness, fragmented healthcare, no approved drugs, and dearth of data on magnitude and epidemiology of the disease. The recent integration of NAFLD into the National Program for Prevention and Control of Non-Communicable Diseases (NPCDCS) by the Ministry of Health and Family Welfare of India is a welcome step in this direction as the contributory factors are mostly the same for all diseases and controlling any one or all of them will have a desired impact on the prevalence of all the diseases under this program.

Alexithymia-A Neglected Factor Influencing Educational Satisfaction and Psychological Wellbeing in Medical Students.

Alexithymia presents a reduced ability to identify, express, and describe one's own emotions. In medical professionals, alexithymia is associated with increased burnout and substance use, as well as reduced altruistic behavior. Our aim was to examine the association between alexithymia and different sociodemographic, psychological, and somatic parameters among medical students. Participants included 186 third- and sixth-year students of the Faculty of Medicine in Belgrade, Serbia. Data were collected through an online survey, composed of 1) a general questionnaire (sociodemographic data, education satisfaction, grade point average, presence of psychological and somatic disorders), 2) Twenty-Item Toronto Alexithymia Scale, 3) Patient Health Questionnaire-9, and 4) Beck Anxiety Inventory. Third-year students had significantly higher rates of alexithymia compared with sixth-year students. Negative correlation was found between alexithymia and educational satisfaction (r = -0.276**) and alexithymia and grade point average (r = -0.186*). A positive correlation was found between alexithymia and depression (r = 0.424**) and alexithymia and anxiety (r = 0.338**). The negative impact of alexithymia on educational satisfaction and psychological health is pronounced in the population of medical students, indicating a need for preventive programs aimed in medical schools.

A Comprehensive Intervention Program for Postoperative Delirium Prevention in Elderly Patients Undergoing Cardiac Surgery

PurposeTo explore the application effect of a comprehensive intervention program for postoperative delirium (POD) prevention. DesignDescriptive and comparative study. MethodsThis study included 82 elderly patients who underwent cardiac surgery as the control group to receive routine perioperative care. Seventy seven elderly patients who underwent cardiac surgery were selected as the observation group and received a comprehensive intervention program for POD prevention. This study further compared the length of stay in the hospital, nutritional status, pain score, and sleep quality between the two groups after intervention. FindingsThe postoperative length of stay in the hospital of the observation group was shorter than that of the control group (12.60 ± 2.97 vs 17.30 ± 7.10), and the incidence of POD was lower than that of the latter group (24.68% vs 47.56%, X2 = 8.976, P = .003). The pain scores of the observation group were lower than those of the control group (F = 195.381, P < .001). There was significant difference that the sleep quality score of the observation group was higher than that of the control group (F = 219.20, P < .001). The levels of albumin and hemoglobin in the observation group were higher than those in the control group (54.38 ± 5.87 vs 38.40 ± 3.11; 124.64 ± 13.18 vs 109.00 ± 10.20). The observation group had shorter mechanical ventilation duration, intensive care unit stay, and lower total hospital expenses compared with the control group (P < .05). ConclusionsThe comprehensive intervention program for POD prevention based on evidence-based medicine has a positive effect. In addition, it can also improve patients' pain, sleep quality, and nutritional status.

Multivariate Bayesian Analyses in Nursing Research: An Introductory Guide.

In the era of precision health, nursing research has increasingly focused on the analysis of large, multidimensional data sets containing multiple correlated phenotypes (e.g., symptoms). This presents challenges for statistical analyses, especially in genetic association studies. For example, the inclusion of multiple symptoms within a single model can raise concerns about multicollinearity, while individual SNP-symptom analyses may obscure complex relationships. As such, many traditional statistical approaches often fall short in providing a comprehensive understanding of the complexity inherent in many nursing-focused research questions. Multivariate Bayesian approaches offer the unique advantage of allowing researchers to ask questions that are not feasible with traditional approaches. Specifically, these methods support the simultaneous exploration of multiple phenotypes, accounting for the underlying correlational structure between variables, and allow for formal incorporation of existing knowledge into the statistical model. By doing so, they may provide a more realistic view of statistical relationships within a biological system, potentially uncovering new insights into well-established and undiscovered connections, such as the probabilities of association and direct versus indirect effects. This valuable information can help us better understand our phenotypes of interest, leading to more effective nurse-led intervention and prevention programs. To illustrate these concepts, this paper includes an application section covering two specific multivariate Bayesian analysis software programs, bnlearn and mvBIMBAM, with an emphasis on interpretation and extension to nursing research. To complement the paper, we provide access to a detailed online tutorial, including executable R code and a synthetic data set, so the concepts can be more easily extended to other research questions.

Promoting Resilience in Healthcare Workers: A Preventative Mental Health Education Program.

Healthcare workers face greater risks for mental health conditions and chronic stress due to the demanding nature of their roles. The COVID-19 pandemic exacerbated these challenges and increased vulnerabilities to long-term mental health conditions. The present study adapts an existing resilience-based educational workshop program to address the time constraints and unique needs of the healthcare workforce in a post-COVID-19 world. Expanded from its initial focus on resilience, the workshop curriculum incorporates psychoeducation on common mental health issues. Between July 2022 and June 2024, a 15 min "huddle" format offered on-site training to equip HCWs in a large urban health system with coping strategies to prevent, manage, and recover from stress. Attendance and anonymous feedback were collected at each session via brief electronic surveys. Participant responses (n = 1403) obtained immediately post-huddle suggested positive impact on stress management, perceived leadership support, and resilience. Findings show the potential of brief huddles to improve mental health and resilience in healthcare workers and similar workforces. Our findings support the efficacy of brief, evidence-based educational huddles in enhancing resilience, mental health awareness, and coping skills among HCWs. This model holds significant potential for widespread implementation across healthcare and other high-stress workplaces.