Priority Interventions Research Articles

Intervention for school anxiety and absenteeism in children (ISAAC): Co-designing a brief parent-focused intervention for emotionally-based school avoidance.

Emotionally-based school avoidance (EBSA) is an important driver of persistent school absenteeism and may have worsened in the context of COVID-19. This paper describes the development of a brief parent-focused psychosocial intervention with the goal to address the lack of accessible early interventions for EBSA. The developmental process used a person-based approach with two phases. In Phase 1, qualitative data were collected about intervention preferences and priorities from N = 10 parents and N = 7 practitioners in a series of co-design workshops. Phase 2 refined an intervention blueprint based on iterative consultations with N = 4 parents and N = 3 practitioners. Framework analysis was used to organise findings around key intervention parameters, including relevant mechanisms, content, and delivery methods needed to provide effective, acceptable and feasible support for families affected by EBSA. The resulting blueprint incorporates three online modules to be delivered over three weeks with each module consisting of psychoeducational videos, self-completed learning tasks and a corresponding coaching session. Respective module content includes: (i) self-care strategies to increase parent wellbeing and self-efficacy; (ii) parenting strategies to change behavioural patterns that maintain child distress and avoidance of school; and (iii) strategic communication strategies to increase the quality of home-school relationships. The blueprint has been developed into a full prototype for a forthcoming feasibility study.

EMBOLDEN: CATALYZING RESEARCH FOR OLDER ADULTS THROUGH CO-DESIGNED MOBILITY-PROMOTING INTERVENTION RESEARCH

Abstract Mobility and social participation are requisites for optimizing health, independence, and quality of life in older populations. Most mobility-enhancing interventions for older adults have been designed by researchers alone, which often experience implementation challenges and limited effectiveness when translated to real-world contexts. The EMBOLDEN research program aims to i) partner with older adults and service providers to co-design, implement, and evaluate a mobility-promoting intervention and ii) enhance physical and mental health, foster social connections, and support system navigation among older adults living in neighbourhoods with health inequities. EMBOLDEN has completed two phases: (1) intervention co-design based on evidence reviews, environmental scan, qualitative study, and strategic guiding council expertise; (2) a mixed-methods pilot randomized controlled trial. Twenty-seven local older adults (≥55y) and 34 service providers contributed to Phase 1, co-designing an integrated health and social care intervention delivered through collaboration with primary care, public health, and recreation. The three-month community-based program includes a weekly interactive group program of physical activity, healthy eating, socialization, and individual system navigation support. The co-design determined priority intervention features (e.g., addressing social determinants of health, assets-based approaches) and implementation strategies. The pilot study evaluated quantitative and qualitative participant outcomes and experiences and intervention team experiences. The pilot study demonstrated intervention feasibility and acceptability to participants and interventionists, informing a larger pragmatic hybrid implementation-effectiveness trial that is currently underway. EMBOLDEN’s partnership engagement was critical to successfully co-designing intervention research to address identified health, mobility, and social needs of older adults living in neighbourhoods with significant health inequities.

Early Intervention Programs for Adolescents and Young Adults With Eating Disorders

What Is the Problem? How Might Early Intervention Help Fix the Problem?
 
 The number of adolescents and young adults living with eating disorders is on the rise. This increase was especially noticeable during the height of the COVID-19 pandemic, with more than a 50% increase in the number of young women being hospitalized with an eating disorder.
 Early intervention programs are those delivered by community or health care–based organizations that offer interventions to treat adolescents and young adults living with eating disorders within the first 3 years of diagnosable disorder, with the intention of providing earlier access and preventing disease progression.
 
 What Did We Do?
 
 Advisors with lived experience of eating disorders shared their perspectives and priorities to help reviewers contextualize the evidence and interpret the findings in the literature. Advisors highlighted their treatment experiences and priorities for early intervention, highlighting equity considerations and challenges.
 We conducted a literature search to identify, gather, synthesize, and summarize relevant evidence to inform our understanding of the clinical effectiveness and clinical harms of early intervention programs.
 A search of the economic literature was conducted to identify economic evaluations of early intervention programs to treat adolescents and young adults living with eating disorders. Based on an assessment of the clinical evidence, the uncertainty and heterogeneity of the information precluded a de novo cost-effectiveness analysis (CEA). As such, a narrative summary of the health care resources required to implement an early intervention program for adolescents and young adults living with eating disorders was conducted.
 
 What Did We Find?
 
 Advisors with lived experience of eating disorders described a need for greater access to specialized services focused on eating disorder treatment, equity, capacity building, and culture change. Specific treatment approaches mentioned included family-based treatment, cognitive behavioural therapy, peer support, and group therapy.
 We identified 14 studies related to the clinical effectiveness of early intervention programs. We did not identify any studies evaluating clinical harms.
 The findings from included studies suggest that earlier engagement and access to eating disorder support could have clinical benefits; however, interpretation of these findings are uncertain due to various factors.
 No evidence was identified in the search for information on the cost-effectiveness of early intervention programs for the treatment of adolescents and young adults living with an eating disorder.
 The resources needed to run early intervention programs (or other similar interventional programs) to treat eating disorders may include administration, staffing, training, IT support and infrastructure, and other overhead costs related to the location in which the service is provided.
 
 What Does This Mean?
 
 The clinical evidence suggests that investment of health care resources into early intervention programs shows potential for overall benefit and may help address challenges with access to treatment, which was identified as an issue by those with lived experience.
 The human and financial resources required to implement early intervention programs will vary depending on the treatment options and treatment frequency chosen.
 The demands on an already limited pool of specialized health care resources in eating disorder care are important considerations when choosing whether to implement any new eating disorder treatment programs. Training and recruiting of specialized health care providers will be a key implementation consideration for any new early intervention program for the treatment of eating disorders.
 Further consultation with a diverse group of adolescents and young adults with lived experience with eating disorders might be beneficial to inform implementation of early intervention programs within the Canadian context.

Wildfire Risk Assessment for Strategic Forest Management in the Southern United States: A Bayesian Network Modeling Approach

Wildfire occurrences have increased and are projected to continue increasing globally. Strategic, evidence-based planning with diverse stakeholders, making use of diverse ecological and social data, is crucial for confronting and mitigating the associated risks. Prescribed fire, when planned and executed carefully, is a key management tool in this effort. Assessing where prescribed fire can be a particularly effective forest management tool can help prioritize efforts, reduce wildfire risk, and support fire-resilient lands and communities. We collaborated with expert stakeholders to develop a Bayesian network model that integrated a large variety of biophysical, socioecological, and socioeconomic spatial information for the Southeastern United States to quantify where risk is high and where prescribed fire would be efficient in mitigating risk. The model first estimated wildfire risk based on landscape-scale interactions among the likelihoods of fire occurrence and severity and the people and resources potentially exposed—accounting for socioeconomic vulnerabilities as well as key ecosystem services. The model then quantified the potential for risk reduction through prescribed fire, given the existing fuel load, climate, and other landscape conditions. The resulting expected risk estimates show high risk concentrated in the coastal plain and interior highland subregions of the Southern US, but there was considerable variation among risks to different ecosystem services and populations, including potential exposure to smoke emissions. The capacity to reduce risk through fuel reductions was spatially correlated with risk; where these diverged, the difference was largely explained by fuel load. We suggest that both risk and the capacity for risk reduction are important in identifying priorities for management interventions. The model serves as a decision support tool for stakeholders to coordinate large-landscape adaptive management initiatives in the Southern US. The model is flexible with regard to both empirical and expert-driven parameterizations and can be updated as new knowledge and data emerge. The resulting spatial information can help connect active management options to forest management goals and make management more efficient through targeted investments in priority landscapes.

Measuring societal attitudes and behaviours towards radon indoors: A case study of Slovenia

Public opinion surveys play a crucial role in assessing public awareness, knowledge, and radon risk perception in the context of national Radon Action Plans. However, many of these surveys are constructed without a solid foundation in behavioural theories, health protection theory, or social science methodology. This lack of foundation can lead to misguided priorities in radon mitigation interventions and ineffective communication strategies, ultimately resulting in low compliance with testing and mitigation in private homes. By developing and testing scales that measure a wide range of theory-based socio-psychological concepts influencing protective behaviour of individuals facing radon risk, this study provides researchers, authorities, and practitioners with a useful and versatile survey tool to explore the complexity of human behaviour in the context of radon. The results of this survey, conducted in Slovenia with a representative sample of respondents from low, middle, and high radon risk areas (N = 2012), offer a foundation for assessing gaps and strategies to increase testing and remediation of homes. The findings suggest that communication interventions need to be more precisely tailored to specific population groups and should go beyond enhancing awareness, knowledge and radon risk perception. Effective strategies should evoke emotions, share personal stories, highlight successful mitigation cases, and use personal testimonies from individuals affected by lung cancer. Moreover, incorporating positive social norms can inspire more individuals to engage in testing and mitigation measures. Assessing theory-driven socio-psychological concepts through a survey allows researchers and policymakers to craft more effective strategies aimed at promoting radon testing and mitigation, thereby enhancing overall public health.

A control banding method for chemical risk assessment in occupational settings in France.

This study describes a method whose aim is to help companies assess the chemical occupational risks related to labeled products and industrial chemical emissions. The method is intended to be used by industrial hygienists at the scale of one company. Both inhalation and cutaneous exposure routes are taken into account. The method relies on a control-banding scheme. A work situation is described by exposure parameters such as the process or the local exhaust ventilation and by the hazard of the product. Each possible value of the parameters is associated with a "band," which is associated with an integer value. The multiplication of these values results in a score, which represents a priority for intervention. The higher the score, the more the situation warrants investigation for implementing prevention measures, such as chemical substitution and the addition of local exhaust ventilation. To simplify communication, the priority is associated with a colored priority band: red for "very high priority," orange for "high priority," and green for "moderate priority." The priority bands are computed for all work situations performed in a company. An example of the use of this method is described in a French façade insulation company. A tool named Seirich was developed to implement this method and promote good practices for helping industrial hygienists in the prioritization of interventions for reducing chemical risk in France.

Clinicians’ Evaluation of Lung Cancer Clinical Quality Indicators and Comparative Performance Data in Practice

Objective. Lung cancer is commonly diagnosed and is the leading cause of cancer-related death, morbidity, and burden of disease globally. There is an ongoing need to ensure patients receive optimal evidence-based care and to identify and reduce unwarranted clinical variation to achieve best possible outcomes. The EnRICH program has developed evidence-based clinical quality indicators to measure processes and outcomes of lung cancer care, and a feedback dashboard to report comparative performance data, which highlight variation in both care and outcomes. The aims of this study were to evaluate the acceptability and utility of the quality indicators and feedback dashboard and identify benchmarks for performance monitoring and priorities for future quality improvement interventions to address observed clinical variation. Method. Clinicians from lung cancer multidisciplinary teams (MDTs) at six tertiary clinical sites across regional and metropolitan NSW were invited to participate in evaluation interviews. Interviews were conducted via videoconference and recorded with consent. Data were analysed thematically using framework methods. Results. Thirteen clinicians participated in interviews, with representation from each clinical site and specialty. All participants considered the quality indicators to be clinically meaningful. Three main themes were identified: (i) the importance of timely, local, quality data; (ii) implementable versus nonimplementable clinical practice changes; and (iii) the need for ongoing performance monitoring. Clinicians prioritised two areas of unwarranted clinical variation that could be immediately addressed through easily implementable quality improvement interventions to positively impact patient care: (i) a process to ensure that all stage III patients are discussed by a multidisciplinary team prior to commencing treatment; (ii) a referral pathway to palliative care within eight weeks for patients diagnosed with stage IV disease. The importance of lung cancer nurse specialists for improved care coordination was highlighted. Conclusion. Clinicians would like to continue to receive close-to-real-time quality data for ongoing performance monitoring to identify and address unwarranted clinical variation.

Development of a school-based programme for mental health promotion and prevention among adolescents in Nepal and South Africa

IntroductionAdolescence is a critical time for mental health promotion and prevention and establishing healthy behaviours. Implementing universal, school-based psychosocial interventions can improve short- and long-term health trajectories for adolescents. While these interventions may offer important opportunities for fostering skills and relationships, few school-based interventions have been developed for and tested in low- and middle-income countries (LMICs) where adolescent mental health needs may be significant and under-served. This manuscript details the development of a multi-component, universal school-based intervention, Health Action in ScHools for a Thriving Adolescent Generation (HASHTAG), for adolescents aged 12–15 years in Nepal and South Africa. Methods and resultsWe describe HASHTAG's development over four phases, combining methods and results as each phase was iteratively conducted between 2018 and 2021. Phase 1 included a systematic review and components analysis, building from WHO guidelines for adolescent mental health. Seven components were strongly supported by the evidence: emotional regulation, stress management, mindfulness, problem-solving, interpersonal skills, assertiveness training, and alcohol and drug education. Phase 2 encompassed site selection, theory of change development, and formative research engagements; research teams in each site engaged adolescents and key adult stakeholders to identify priorities for intervention. Stakeholders voiced preferences for external facilitators and key content and delivery for intervention sessions. These findings informed Phase 3, a draft manual of HASHTAG, including a whole-school component, called Thriving Environment in Schools, and a classroom-based, six-session component, Thrive Together. In Phase 4, participants engaged in consultative workshops to review and contextualise content by country, preparing HASHTAG for implementation in a feasibility trial. Minor adaptations were made in Nepal, including using school nurses and adjusting take-home materials; both country's workshops identified practical considerations for implementing activities. ConclusionsHASHTAG was designed around core evidence-based components to increase translatability across LMICs, while enabling country-specific tailoring to enhance feasibility. Future research will test whether this multi-component, whole-school approach can improve adolescent mental health.

Ethical Challenges of Virtual Reality Technology Interventions for the Vulnerabilities of Patients With Chronic Pain: Exploration of Technician Responsibility.

Chronic pain, a common disease, is a crucial global public health concern. Approximately 20% of the worldwide population is affected by chronic pain, which accounts for 15% to 20% of hospital visits. In Canada, approximately 7.6 million people-or 1 in 5 people-experience chronic pain. Among this population, 60% has either lost their employment or experienced a reduction in income as a result of their pain. The proportion of older people (aged ≥65 years) with chronic pain is high, comprising one-third of the total older population. In addition, the causes of chronic pain and its cures are unknown, and treatment is limited by these unknowns and the dangers of opioids. These essential factors make patients with chronic pain one of the most vulnerable populations. The use of emerging virtual reality (VR) technology as an intervention for chronic pain has consistently demonstrated early effectiveness and has been termed as a "nonpharmacological analgesic." Nevertheless, we must remain vigilant about the potential ethical risks of VR interventions, as inappropriate VR interventions may exacerbate the vulnerabilities of patients. Currently, a central challenge for VR developers is the ambiguity of patient vulnerability and the unpredictability of ethical dilemmas. Therefore, our paper focused on the vulnerability and ethical dilemmas faced by patients with chronic pain in VR interventions. Through an experience-based, prospective ethical examination, we have identified both existing and potential new vulnerabilities and specific manifestations that patients with chronic pain may encounter in VR interventions. Our aim was to highlight the ethical risks that may be present in VR interventions. On one hand, this can help raise awareness among technology developers regarding the vulnerabilities of patients with chronic pain and mitigate technological ethical risks. In addition, it can assist technology developers in determining the priorities for VR technology interventions. These efforts collectively lay a solid foundation for the comprehensive realization of responsible VR technology interventions.

Detecting, mapping and digitising canopy geometry, fruit number and peel colour in pear trees with different architecture

Increasing farm labour and input costs and the requirement for more orchard data are leading to rapid advances in technology to improve management systems in fruit production. The study aimed to (i) validate a sensorised platform to estimate fruit number, peel colour and blush coverage in pear orchards with different pear selections and tree architectures, (ii) establish relationships between fruit number, peel colour and canopy geometry features, and (iii) evaluate the platform for mapping and digitising orchard features. The study was carried out over two years in an experimental ‘ANP-0131′ orchard and in one year in two commercial pear orchards (‘ANP-0131′ and ‘PremP009’). Predictions of fruit number and blush coverage were compared in traditional three-dimensional (3D) and modern high-density two-dimensional (2D) training systems. Overall, prediction errors for fruit number were < 6.5 % in all the training systems, but improved performance was achieved in vertical 2D configurations (% standard errors = 2.2 %). Fruit number and blush coverage per unit of leaf area were higher in 2D compared to 3D training systems. Blush coverage predictions in ‘ANP-0131′ were reliable (R2 = 0.67, RMSE = 3.70 %). Accurate predictions of blush coverage classes were achieved by modifying sample variance. Fruit number and blush coverage were negatively affected by increasing canopy size. The platform proved useful for mapping and digitisation. Spatial heatmaps of orchard features provided a valuable visual aid to identify zones for priority interventions for peel colour enhancement.

Comparative performance of national civil registration and vital statistics systems: a global assessment.

To assess the current state of the world's civil registration and vital statistics systems based on publicly available data and to propose strategic development pathways, including priority interventions, for countries at different levels of civil registration and vital statistics performance. We applied a performance assessment framework to publicly available data, using a composite indicator highly correlated with civil registration and vital statistics performance which we then adjusted for data incomparability and missing values. Globally, civil registration and vital statistics systems score on average 0.70 (0-1 scale), with substantial variations across countries and regions. Scores ranged from less than 0.50 in emerging systems to nearly 1.00 in the most developed systems. Approximately one fifth of the world's population live in the 43 countries with low system performance (< 0.477). Irrespective of system development, health sector indicators consistently scored lower than other determinants of civil registration and vital statistics performance. From our assessment, we provide three main recommendations for how the health sector can contribute to improving civil registration and vital statistics systems: (i)enhanced health sector engagement in birth and death notification; (ii) a more systematic approach to training cause of death diagnostics; and (iii) leadership in the implementation of verbal autopsy methods. Four different civil registration and vital statistics improvement pathways for countries at different levels of system development are proposed, that can constitute a blueprint for regional civil registration and vital statistics strengthening activities that countries can adapt and refine to suit their capabilities, resources, and particular challenges.

P57: The ENGAGED study: dementia prevention co-design for people living with depression

Background:People living with depression are at increased risk of poor health outcomes, including dementia. Interventions to reduce dementia risk (dementia risk reduction (DRR)), include physical activity, diet and vascular health interventions. These can also benefit depressive symptoms and broader health, making DRR an important part of holistic mental health care for depression. However, enabling engagement and adherence, and embedding interventions in mental health clinician practice are ongoing challenges that limit the impact of interventions and implementation in clinical practice. Improved intervention tailoring and new approaches to intervention design and implementation are urgently needed. Co-design approaches have been shown to improve engagement and the impact of complex interventions in diverse fields, but have not previously been used in DRR.Objective:The ENGAGED study will examine DRR intervention needs specifically for people living with depression, then co-design a tailored DRR intervention for use in mental health clinical settings.Methods:The study will adapt a co-design model for mental health settings that emphasizes lived-expertise, and incorporate processes and evidence from behavioral science. Participants will include middle-aged and older people living with depression, and mental health clinicians.Semi-structured interviews with both participant groups will examine unmet intervention needs. Illuminated shared experiences and themes will be explored further through focus group discussions to develop consensus intervention priorities. They will also be analyzed to produce a contextualized model of relevant behavior change. Participants and researchers will then work together to co-design intervention components and refine prototypes. Finally, mixed methods survey will evaluate the co- design process and participant experiences.Results:This study will provide two key outputs to enhance future intervention tailoring and engagement: 1.1) a pragmatic blueprint for DRR intervention with people experiencing depression across diverse mental health clinical settings, ready for evaluation and implementation2.2) a model of DRR behavior change that is specified to this population.Evaluation findings will support methods development for applying co-design to cognitive and mental health research.Conclusion:This research addresses the need for new approaches to tailored, integrated mental, physical and cognitive healthcare for people living with depression that emphasize stakeholder expertise and engagement to facilitate holistic support.

A method for estimating physical and economic food access at high spatial resolution

Physical and economic access to food vary spatially. Methods to map that variability at high levels of spatial detail over large areas are scarce, even though suitable datasets and methods exist. Using open-access data for Ethiopia, we developed a method to map the disparities in physical and economic food access at 1-km resolution. We selected 25 access-related variables for 486 geo-located communities from the 2018 Ethiopian Living Standards Measurement Study to create a food access index (FAI). The index was based on a weighted summation of the 25 variables from a principal component analysis (PCA). We then extrapolated the FAI to the rest of Ethiopia using a generalized additive model (GAM) to produce a 1-km resolution FAI map and used that to describe the spatial variability of food access. Economic access had a heavier weight than physical access in the FAI reflecting the fact that proximity to food markets alone is insufficient if one cannot afford food. The GAM had an R2 of 0.57 and a normalized root mean square error of 22.2% which are comparable to measures of model performance in studies that provided micro-level estimates of relative wealth. Peri-urban areas, representing 67% of the population, had relatively low food access, suggesting that these areas should be a priority for infrastructure or economic intervention. The scarcity of detailed spatial information on food access may limit the effectiveness of targeted policymaking to improve food security. The methodology developed in this study uses widely available and carefully selected datasets and can contribute to more spatially detailed estimates of food access in other countries.

Drivers of food and nutrition security during the lean period in southeastern Madagascar

The rural population in southeastern Madagascar faces widespread poverty and weak resilience to frequent climate shocks, both contributing to severe food and nutrition insecurity. For effective policy responses and tailored interventions, development stakeholders need to know which factors determine household food and nutrition security status. In particular, the relative contributions of on-farm production diversity versus cash income are of importance since they would suggest different intervention priorities. We collected survey data on household food security and women's diets during the lean season, where improvements are most needed, as well as on households' agricultural activities, market participation, and sources of cash income from 413 randomly sampled households. Regression results suggest that frequent market participation and cash income from non-farm self-employment improve food security, but on-farm diversity does not. Other determinants of household food security include livestock assets and maternal education. Women's dietary diversity, in contrast, is associated only with market participation. The importance of market participation for food and nutrition security reflects the situation in the lean period, when farm production is low and many households' food supply relies, in part, on market purchases enabled by non-agricultural income. Our findings imply that a focus on developing food markets and enabling opportunities for income generation are likely viable strategies for improving the rural food and nutrition security situation during the lean period in southeastern Madagascar. Relatively food- and nutrition-secure households are characterized by their ability to mobilize cash (e.g., from non-farm self-employment) to purchase food.

Multi-temporal analysis to support the management of torrent control structures

In the last decade with increasing frequency of extreme weather events, an accurate, sustainable, and effective planning of torrent control structures has become essential to reduce hydro-geomorphic risk. Quite often in planning interventions, there is a lack of information on the effectiveness of existing structures, the evolution of the ongoing hydro-geomorphic process, and a priori in-depth study to analyze the sediment morphology dynamics and the interaction with possible existing torrent control structures.Nowadays, High-Resolution Topography data (HRT) greatly simplifies the monitoring of sediment morphology dynamics and the understanding of the interaction with torrent control structures over time. Therefore, thanks to repeated HRT surveys, it is possible to derive multi-temporal Digital Terrain Models (DTMs), and DTMs of Difference (DoDs) to quantify the morphological changes and study continuously the catchment morphodynamics. This information can be very valuable to support watershed management plans if combined with up-to-date field surveys that identify the existing torrent control structures, and asses their current status and functionality.The present work aims at introducing a methodological approach based on the integration of the sediment morphology dynamics data over large time spans (e.g., from 2003 to 2022), obtained by multi-temporal DoDs (realized from three DTMs at 1 m resolution), with an updating cadastre of torrent control structures enriched by a very simple, quick, and user-friendly Maintenance Priority index (MPi). The proposed workflow proved to be very useful in the test basins analysed, providing more complete data on torrent control structures and sediment dynamics evidence to stakeholders compared to the past. Moreover, it served as a proxy to assess the long-term effectiveness of the management interventions. The approach also helped to constantly identify the areas most prone to hazards, improve the intervention planning, and find more appropriate solutions or direct the maintenance works.Finally, the suggested workflow could be the starting point to outline up-to-date guidelines to be used in other catchments equipped with torrent control structures, emphasizing possible intervention priorities on where decision-makers could better invest resources. By providing current information and accurate tools to realize a more complete decision-making chain, which is often neglected, it is certainly possible to support more sustainable and effective risk management decisions.

Suicide risk among racial minority students in a monoethnic country: A study from South Korea: Suicide risk among racial minority students

BackgroundSuicide is one of the leading causes of death among adolescents. Students from intercultural families (ICFs) are hypothesized to be vulnerable to suicide. This study aimed to identify the current status of depression and suicide in students from ICFs and the risk of suicide according to family type. MethodsData from the Korea Youth Risk Behavior Web-based Survey (KYRBS) were used for this study. We selected 586,829 participants from 2011 to 2020. We analyzed the statistical differences between groups using the chi-square and Bonferroni tests. Last, multiple logistic regressions were performed. ResultsRegarding experiencing extreme sadness/desperation and suicidal ideation, the group with both parents born outside Korea had the highest rate (37.1 % and 24.7 %, respectively), followed by the father-only, non-ICF, and mother-only groups. The both-parents group had the highest risk for suicidal plan and attempts, and for suicidal attempts after hospital visits (17.2 %, 14.9 %, and 59.5 %, respectively), followed by the father-only, mother-only, and non-ICF groups. In particular, the both-parents group had 1.74, 3.40, 4.56, and 6.44 times higher odds for suicidal ideation, suicidal plan, and suicidal attempt, and hospital visit after suicidal attempt than the non-ICF group, respectively. ConclusionsICF students were more vulnerable to suicide than the non-ICF group, particularly the both-parents and father-only groups. Thus, adolescents from ICFs are a high-risk group for suicide and should be a top priority for intervention.

Development of a risk stratification model for pharmaceutical care in HIV patients

BackgroundThe increasing number of HIV-patients and their complexity makes it necessary to develop risk classification tools to improve the optimization of resources. ObjectiveTo design a risk-stratified model for pharmaceutical care (PC) in HIV-patients. MethodsA cross-sectional, multicenter study. An expert panel was created by Hospital Pharmacist experienced in PC for HIV-patients. The study was designed in 4 phases. The first phase included a review of literature and the development of a summary of the scientific evidence available. According to their score, patients were stratified into three levels of PC. In the second and third phases, a sample of patients was assessed and data information was recorded. The overall analysis also allowed pharmacists to define the actions to be applied at each level of priority.Finally, each stratification model was applied to a new sample of patients to verify their applicability and usefulness. ResultsAll variables included in the model were weighted in terms of their relative relevance compared to the rest. A sample of 215 patients was evaluated to obtain their score and distribution: Priority-1: score ≥ 32 and 10% of the sample; Priority-2: 18-31.9 and 30%; Priority-3: ≤ 17 and 60%.The PC interventions corresponding to each level of priority were classified into “pharmacotherapeutic monitoring”, “training, education and patient tracking” and “coordination of all the healthcare team members”. ConclusionsThis study supported the design and adaptation of a selection and stratification model for PC in HIV-patients as a tool to identify those who may benefit from priority intervention.

Modeling post-fire regeneration patterns under different restoration scenarios to improve forest recovery in degraded ecosystems

BackgroundChanges in disturbance regimes triggered by land use and climate change can significantly alter forest ecosystems by modifying the distribution of some species and hindering post-disturbance tree regeneration dynamics. Applied nucleation (AN) could be a valuable active restoration approach for promoting natural recovery in forest ecosystems affected by stand-replacing disturbances as it improves seed availability and microsite conditions. ObjectivesThe study aimed to investigate the potential of AN under different scenarios in a mountain forest ecosystem of the Northwestern Italian Alps dominated by Scots pine (Pinus sylvestris L.). The area was affected by a large stand-replacing fire in 2005 and post-fire salvage logging that amplified ecosystem degradation and dampened natural tree regeneration. MethodsWe assessed the main drivers guiding natural post-fire natural recovery and identified suitable sites for tree regeneration through a machine learning correlative model (Bayesian Additive Regression Tree, BART). Specifically, we used several environmental predictors (e.g., topography, wind direction, and distance from seed trees) to model the occurrence of natural tree regeneration. We predicted the probability of tree regeneration presence at landscape scale under the current situation (fire followed by salvage logging) and a set of AN scenarios characterized by an increase in nuclei density, since distance from seed trees emerged as the most important driver for natural tree regeneration. Starting from the situation 16 years after the fire, we reclassified the prediction raster into a binary map of intervention priority (priority and non-priority patches), using the probability value that maximized the model accuracy (true skill statistic; TSS) as threshold. Patches with scarce pine regeneration were considered as high intervention priority sites for AN. These predictions made it possible to assess the most efficient active management scenario in terms of promoting forest recovery. ConclusionsThe simulations showed the positive effects of AN on natural tree regeneration and the importance of site selection for plantations, proving that AN could be a promising post-fire management technique that can minimize human interventions and their associated economic and ecological costs. To our knowledge, this work is the first AN simulation in a temperate mountain ecosystem. The selection of favorable sites can be further improved by considering fine-scale characteristics through field experiments and cross-scale integration.

Effect of Aging on Movement Quality in Australian Urban Firefighters.

Redshaw, AS, Carrick-Ranson, G, Bennett, H, Norton, KI, and Walker, A. Effect of aging on movement quality in Australian urban firefighters. J Strength Cond Res 37(11): e601-e608, 2023-Adequate levels of movement quality (MQ) are required to safely perform occupational tasks in physically demanding and hazardous professions such as firefighting. Although it is well established that MQ deteriorates with age in population studies, there is conflicting evidence in older tactical populations. This study sought to examine the relationship between age and MQ in Australian urban firefighters. The impact of physical activity, injury history, and body mass index on MQ were also explored. The MQ of 324 professional Australian urban firefighters was assessed using MovementSCREEN MQ assessment tool. Scores of whole-body MQ ranged from 35.3 to 82.6 (0-100 scale), with a mean score of 59.2 ± 10.0. There was a moderate, negative association between MQ and age (r = -0.500; p ≤ 0.001), with those older than 50 years of age having significantly lower scores of MQ than their younger counterparts (p ≤ 0.001). Secondary analysis found that higher body mass index (r = -0.285; p ≤ 0.001), lower habitual physical activity levels (r = 0.165; p ≤ 0.003), and the presence of any musculoskeletal injury in the previous 12 months (p = 0.016) had significant negative effects on composite MQ. Firefighters older than 50, obese, and engaging in low levels of physical activity should be considered a high priority for functional strength training interventions to maintain adequate MQ throughout their careers.

Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis

ObjectiveThis study aims to estimate the prevalence of neural tube defects (NTDs) and to identify potential risk factors in the Ethiopian context.Study designSystematic review and meta-analysis.Study participantsA total of 611...