Participation Rates In Programs Research Articles

The role of digital health intervention in improving physical activity in cardiac rehabilitation center: a randomised controlled trial

Abstract Background Physical activity plays a crucial role in cardiac rehabilitation for secondary prevention. Despite its importance, participation rates in cardiac rehabilitation programs remain low. Telemedicine, particularly telerehabilitation, presents a viable solution by offering remote access to cardiac rehabilitation services. This innovative approach has the potential to significantly enhance patient outcomes. Purpose This study aimed to assess the effectiveness of digital health intervention in improving physical activity in cardiac rehabilitation center. Methods A prospective randomised controlled trial was conducted, enrolling 80 eligible cardiac rehabilitation patients. Participants were 1:1 randomised into two groups: a 12-week center-based cardiac rehabilitation program (control group), and a 12-week center-based cardiac rehabilitation program combined with a digital health intervention (intervention group). This digital health intervention consists of smartphone, web, and tablet applications to monitor physical activity outside of rehabilitation sessions and motivate patients to engage in more physical activities. Results Of the initial 80 patients, 70 completed the study, and the results are presented in Table 1. In the intervention group, there was a statistically significant improvement in peak rate of oxygen consumption (VO2 peak) (p < 0.01) and peak power output (W peak) (p < 0.01), as measured by cardiopulmonary exercise testing between the end and the beginning of the study at the significance level of 0.05. Similar improvements were also observed in the control group (p = 0.0002 for VO2 peak and p < 0.01 for W peak). After 12 weeks of intervention, significant between-group differences were found: We observe a greater improvement in VO2 peak, on average 1.39 (95% CI: 0.23-2.54) ml/kg, and in W peak, on average, 12.29 (95% CI: 4.12-20.45), higher in the intervention group compared to the control group. Regarding physical activity, the intervention group showed a significant improvement in step count (P = 0.002), measured by an accelerometer, whereas no significant improvement was observed in the control group (P = 0.9714). There is a statistically significant difference in the change of step count between the intervention and control group at the significance level of 0.05. We observe a greater improvement, on average 14 788 steps (95% CI: 4 246 – 25 331), in the intervention group compared to the control group. Conclusion This study shows that a combination of a digital health intervention based telerehabilitation with a center-based cardiac rehabilitation is more effective in increasing patient’s exercise capacity and physical activity compared with a center-based cardiac rehabilitation.Table 1:results

Vaginal self-sampling for HPV in the context of cervical cancer screening

Abstract Background Effective cervical cancer screening programme has the potential to improve disease outcomes, yet women’s participation rates in Latvia remain suboptimal. Utilizing vaginal self-sampling for HPV, a convenient method, has demonstrated efficacy in boosting participation in under-screened populations. We analysed sociodemographic factors, as well as health behaviours with the preference for vaginal self-sampling procedures for early detection of cervical cancer. Methods Cross-sectional survey (2021-2022) included 1313 women in Latvia. Sampling was done in the colposcopy clinic and among GP practices. In the univariate analysis cervical cancer examination preference (self-test or by a physician) was analysed in association sociodemographic factors, participation in the screening, HPV status, study group, and health-related behaviour. Financed by “Internal consolidation of RSU and external consolidation of RSU with LSPA” (No. 5.2.1.1.i.0/2/24/I/CFLA/005), The EU Recovery and Resilience plan and the state budget, Grant Nr. RSU-PAG-2024/1-0016. Results 48.6 % (n = 538) of the women would prefer to use a vaginal self-test. Higher odds of the vaginal self-test preference were observed among Latvian (OR = 1.4 (1.1-1.8) vs other nationality women, but no other sociodemographic factors showed statistically significant associations. Women in the colposcopy study group (vs GP practices) were more likely to utilize self-sampling (OR = 1.8 (1.4-2.5). Non-participation in cervical cancer screening was related to 2.4 (1.6-3.6) higher odds of self-test preference, but knowledge about screening was related to 1.5 (1.1-2.0) times higher odds. Women who were HPV-negative were more likely to prefer vaginal self-test for HPV (OR = 1.4 (1.1-1.8) in comparison to HPV-positive women. Health-related behaviour did not show any associations. Conclusions Vaginal self-test for HPV can be effectively used to reach under-screened populations and enhance cervical cancer screening coverage. Key messages • The implementation of vaginal self-sampling for HPV testing has the potential to improve participation rates in cervical cancer screening programs among under-screened populations. • Outreach and education activities tailored to specific target groups in population could enhance level of the cervical cancer screening uptake.

Lifestyle of primary healthcare professionals (nutrition, tobacco, sexual health): a cross-sectional survey

Introduction. Healthcare workers (HCWs) should theoretically have the necessary education and environment to adopt a healthy lifestyle, and they supposedly also should have a higher participation rate in WHP programmes. HCWs are, for several reasons, considered to be a key group in health promotion, especially due to the fact that the healthcare system reaches a substantial number of people in need of lifestyle changes such as increased physical activity (PA) [5]. Furthermore, healthcare professionals are considered to be the most credible source of health information [6]. HCWs' lifestyles can play an important role in increasing awareness among patients regarding lifestyle changes, because HCWs' own lifestyle habits and interests in lifestyle behaviour have been shown to positively influence their counselling practices and attitudes [6–7]. The international movement 'Health Promoting Hospitals and Health Services', which was initiated by the World Health Organization (WHO), highlights the importance of also focusing on the health and lifestyle of the employees. Methods. We conducted survey based on a standardized and adapted questionnaire that included socio-demographic data and points related to healthy lifestyle. We adhered to the latest recommendations on designing and reporting survey studies. Before conducting the study, the questionnaire was pretested among 5 experts and revised twice. The survey was conducted in Kazakh / Russian for respondents who speak two languages fluently at the choice of participants. The filling of the questionnaire took on average 45 minutes. We reported absolute numbers and percentages. Chi-square tests were used to compare responses between groups. Results were considered significant at a P value of < 0.05. Statistical analyses were performed using the application SAS OnDemand for academia (version 3.81, Carry, North Carolina, USA). Results. Our data revealed that nurses were more likely to adhere to healthy eating principles and to have a regular diet at home. GPs were more likely to consume fast food and add salt when food is not salted enough. Nurses were more likely to eat greens regularly. GPs had a stronger belief in the impact of diet on health. More nurses rated their diet as healthy. Media promotion significantly influenced GPs for changing diet towards healthier options. Eating patterns vary according to the risk of stress. Research shows that chronic stress influences the amount and types of consumed food, contributing to both overeating and malnutrition, and that stress hormones can lead to the development of obesity. GPs are more likely to have used tobacco products compared to nurses. GPs are more likely to smoke more than 10 cigarettes per day. GPs have a slightly higher belief in the necessity of a healthy lifestyle compared to nurses. GPs and nurses have different testing frequencies for Hepatitis B and C, with nurses testing more frequently. GPs are more likely to have sexual activity after drinking alcohol. Conclusion. It is known that a healthy lifestyle of doctors affects the attitude of patients and their motivation to change their lifestyle. Thus, the lifestyle patterns of health workers, as well as the understanding of the motivation of these patterns, are more likely to affect public health.

Changes in the attractiveness of medical careers and career determinants during the bachelor’s program at Zurich medical schools

BackgroundMonitoring the career intentions of medical students during their undergraduate studies could help to address the shortage of physicians, particularly in general practice. This study aimed to investigate changes in medical students' career openness, attractiveness and determinants of medical career choice during their bachelor’s studies.MethodsThe design was cross-sectional, recruiting all medical students who started a bachelor’s program in one of the four different educational tracks in Zurich, Switzerland, in the fall of 2019 (first survey) and completed it in the summer of 2022 (second survey). Students’ perceptions of the attractiveness and determinants of different medical career options were assessed using a structured online questionnaire. Absolute changes between the two-time points were reported in percentage points overall and by educational track. Regression analysis was used to examine the association of student characteristics and determinants of career options with the attractiveness of each option.ResultsWe surveyed 354 medical students at the beginning and 433 at the end of the bachelor’s program (participation rate: 71.1% and 86.9%, respectively). Overall, the proportion of students open to all proposed medical career options decreased (from 52.8% to 43.8%, p = 0.004). The attractiveness of outpatient gynecology or pediatrics increased (from 27.4% to 43.4%, p < 0.001), whereas the attractiveness of both general and specialized inpatient care decreased (from 47.8% to 40.3%, p = 0.05 and from 71.1% to 61.1%, p = 0.006 respectively). There was an increase in the proportion of students who perceived part-time work, autonomy and relationships with patients as important career determinants (from 47.3% to 64.7%, p < 0.001; from 63.3% to 77.8%, p < 0.001; from 80.8% to 89.3%, p = 0.002 respectively), while the importance of reputation and career opportunities decreased (from 42.6% to 26.2%, p < 0.001; from 79.2% to 63.6%, p < 0.001 respectively). The importance of part-time work and relationships with patients were positively associated with the attractiveness of general practice.ConclusionsDuring the bachelor’s program, the attractiveness of a career in general practice tended to decrease, but the importance of part-time work, autonomy and relationships with patients as career determinants increased. Helping students understand how these determinants relate to general practice may increase their interest in the profession.Trial registrationNot applicable.

Impact of different age ranges on the benefits and harms of the breast cancer screening programme by the EU-TOPIA tool.

The recommendation for the implementation of mammography screening in women aged 45-49 and 70-74 is conditional with moderate certainty of the evidence. The aim of this study is to simulate the long-term outcomes (2020-50) of using different age range scenarios in the breast cancer screening programme of the Valencia Region (Spain), considering different programme participation rates. Three age range scenarios (S) were simulated with the EU-TOPIA tool, considering a biennial screening interval: S1, 45-69 years old (y); S2, 50-69 y and S3, 45-74 y. Simulations were performed for four participation rates: A = current participation (72.7%), B = +5%, C = +10% and D = +20%. Considered benefits: number (N°) of in situ and invasive breast cancers (BC) (screen vs. clinically detected), N° of BC deaths and % BC mortality reduction. Considered harms: N° of false positives (FP) and % overdiagnosis. The results showed that BC mortality decreased in all scenarios, being higher in S3A (32.2%) than S1A (30.6%) and S2A (27.9%). Harms decreased in S2A vs. S1A (N° FP: 236 vs. 423, overdiagnosis: 4.9% vs. 5.0%) but also benefits (BC mortality reduction: 27.9% vs. 30.6%, N° screen-detected invasive BC 15/28 vs. 18/25). In S3A vs. S1A, an increase in benefits was observed (BC mortality reduction: 32.2% vs. 30.6%), N° screen-detected in situ B: 5/2 vs. 4/3), but also in harms (N° FP: 460 vs. 423, overdiagnosis: 5.8% vs. 5.0%). Similar trends were observed with increased participation. As the age range increases, so does not only the reduction in BC mortality, but also the probability of FP and overdiagnosis.

A multi-component intervention increased access to smoking cessation treatment after hospitalization for atherosclerotic cardiovascular disease: a randomized trial.

To evaluate the effects of a multi-component intervention for smokers hospitalized for atherosclerotic cardiovascular disease (ASCVD) on the participation rate in community-based cessation programmes and the use of cessation drugs. Additionally, to explore the impact on the cessation rates at 6 months. A randomized parallel-group study was conducted at a Norwegian secondary care hospital in 2021. The intervention group was: (i) counselled using motivational interviewing techniques during hospitalization; (ii) given an information leaflet, detailing the cessation programme; and (iii) referred to the community-based smoking cessation treatment including a post-discharge pro-active telephone invitation. The control group received usual care and the same information leaflet containing clear contact details for initiating participation. Data were collected at baseline, 1, 3, and 6 months. Among 99 smokers hospitalized with ASCVD, 40 were excluded. Of 59 randomized patients, 4 were lost to follow-up and 55 completed the study. The mean age was 65.1 (standard deviation 9.3) years, 35% were female, and 88% had smoked >20 years. Co-morbidity was prevalent (mean Charlson score 4.8). The intervention group was more likely to participate in the smoking cessation treatment {48 vs. 7%, difference: 41% [95% confidence interval (CI): 14%, 63%]} and used cessation drugs more frequently [59 vs. 21%, difference: 38% (95% CI: 17%, 59%)]. At the 6 months point prevalence, we observed notable between-group differences in self-reported cessation rate (48 vs. 25%). The intervention significantly increased the participation rate at community-based smoking cessation programmes and the use of cessation drugs among multi-morbid smokers hospitalized for ASCVD.

Engagement in Sedentary and Physically Active After-School Programs Among African American Children with ADHD and Disruptive Behavior Disorders.

Sport and physical activity (PA) programs are an important developmental resource for youth with Attention Deficit Hyperactivity Disorder (ADHD) and Disruptive Behavior Disorders. The purpose of this study is to assess sport participation rates, PA participation, and after-school supervision rates among African American children with ADHD and/or Disruptive Behavior Disorders. In this cross-sectional study, parents of African American children with elevated symptoms of ADHD, oppositional defiant disorder, and/or conduct disorder (N = 175, 6- to 12-y-old, 31% female) reported after-school program participation over the past year. Logistic regression analyses tested relationships between ADHD symptoms, oppositional defiant disorder symptoms, and conduct disorder symptoms, likelihood of regular participation (≥2d/wk) in sport, PA, and sedentary after-school programs, and likelihood of being supervised and unsupervised after school. All regressions controlled for age, sex, income, and medication status. Sample participation rates were descriptively compared with participation rates of same-aged peers regionally, and nationally, reported in 3 national surveys. Parents in the local sample reported higher rates of sedentary after-school program participation (54%) but lower rates of PA program participation (31%), and sport participation (12%) compared with same-aged peers. The local sample was less likely to be unsupervised after-school compared with same-aged peers with only 27% of parents reporting that their child was unsupervised ≥ 2days per week. Children endorsing oppositional defiant disorder (odds ratio = 2.05; P < .05) and conduct disorder (odds ratio = 5.74; P < .05) were more likely to be unsupervised more frequently after-school as compared with those not meeting endorsement. Given demonstrated benefits of youth sport programming and observed inequities in participation, there is a need to develop support models that connect parents, coaches, and social services agencies to facilitate inclusion. Sports medicine professionals are uniquely positioned to contribute to these efforts, as they are often key opinion leaders in both the youth sport and health care contexts.

Assessment of Public Financing on Participation Rates in Adult Literacy Programs in Nairobi County Kenya.

The purpose of this paper was to examine the influence of public financing on participation rates in adult literacy programs in Nairobi County. Kenya. The study sought to establish how financing influenced the running of the adult education centres. The study adopted a mixed method design whereby both qualitative and quantitative methods was utilized in this research. The study was guided by the Human capital theory as advocated by Adam smith. The target population comprised of 30 adult education centres in Nairobi County. The research targeted one adult education officer, 30 principals, one hundred and twenty (120) adult literacy teachers and four hundred (400) learners. Therefore, out of the targeted 30 principals a total of 3 principals were interviewed. Out of the 120 adult literacy teachers a sample equivalent to 30% or 36 teachers were selected randomly. Out of the target population of 400 adult learners, 120 adult learners which forms 30% of the population was randomly selected. Questionnaires were administered to the teachers and the adult learners. While interviews were conducted on the county director, and on the principals. The findings established that most of the adult education centres in Nairobi County received inadequate direct funding from the government, thereby making the centres to have a challenge in running the centres leading to low assess and participation of the learners. There is a significant relation between the funding of adult education centres and the participation rates of adults in the adult education centres. Based on the study findings it can be recommended that the Government of Kenya and other public financing agencies should increase their funding allocation to the adult education centres in order to increase and sustain assess and participation.it was concluded that the funding in adult education centres should be increased so that more adult learners can be able to assess and benefit more by them participating in the learning programs offered at the adult education centres.

Tailored recruitment interventions to improve bowel cancer screening in Arabic and Mandarin speaking groups: Modelled cost-effectiveness.

Effective bowel cancer screening is freely available in Australia, however, there are inequities in utilisation amongst non-English speakers at home. This study estimates the health impacts and cost-effectiveness of recruitment interventions targeted at Arabic and Mandarin speaking populations in Victoria, Australia to increase bowel cancer screening participation. A Markov microsimulation model simulated the development of bowel cancer, considering National Bowel Cancer Screening Program participation rates. Culturally specific recruitment interventions e.g., community education and tailored paid media for 50-74-year-olds were compared to usual practice. A cost-utility analysis was conducted over a 50-year time horizon from a healthcare perspective, to estimate the cost per quality-adjusted life year (QALY) based on plausible effectiveness levels. Costs are in 2019 Australian dollars. Intervention costs were $6.90 per person for the Arabic speaking group and $3.10 for Mandarin speakers. The estimated cost/QALY was $2,781 (95% uncertainty interval [UI]: $2,144─$3,277) when screening increased by 0.2% in the Arabic group, and an estimated 5-6 additional adenoma and cancer cases were detected. In the Mandarin group, the estimated cost/QALY was $1,024/QALY (95%UI: $749─$1,272) when screening increased by 1.1%, and an estimated 18-23 additional adenoma and cancer cases were detected. Culturally specific recruitment interventions to increase bowel cancer screening are inexpensive and likely to be cost-effective. Improvements in capturing language spoken at home by the National program would facilitate more precise estimates of the effectiveness and cost-effectiveness of these interventions.

Arkansas Transitional Employment Assistance (TEA) Program: Barriers to Aid for Low-Income Families

Literature reviews and secondary data analysis of the Arkansas Transitional Employment Assistance (TEA) program show systemic issues in its mission to serve low-income families. This review analyzes the program’s design, processes, and long-term trends which may contribute to barriers in accessibility and enrollment. Recommendations for improving program participation rates include increasing income eligibility standards, adopting nudge techniques, and simplifying the enrollment and benefits issuance process to overcome its structural barriers.

Bridging and bonding social capital for sustainable technology adoption, the Landcare program in the resource poor rural town of Claveria, Philippines

The important role of bonding and bridging social capital in technology adoption has been well documented. This holds true in the dissemination of soil conservation technologies in the town of Claveria under the Landcare program. Past studies unanimously attribute high adoption rates to the formation of farmer Landcare groups, which is a form of bonding social capital, and to the provision of human and physical resources through external networks, a form of bridging social capital. After more than 20 years since the project ended in the town, this study unpacks this relationship and illustrates how the two types of social capital are complementary for sustained technology adoption. Data from household surveys, focus group discussions, and key informant interviews illustrate that the training and physical resources provided through external organizations and partnerships greatly contributed to program participation and high adoption rates of technologies. When such external organizations left the town, adoption rates fell and some farmers reverted to their traditional farm practices. These findings contribute to the debate on the complementation of the two types of social capital in sustaining adoption as well as illustrate how the two types relate to each other for sustainable rural development programs.

Strengthening the Equity in Athletics Disclosure Act to Improve Gender Equity Transparency &amp; Institutional Accountability in the Future

In 1994, the United States Congress enacted The Equity in Athletics Disclosure Act (EADA). The EADA requires colleges and universities receiving federal financial assistance to provide an annual public report on the number of athletic participation opportunities provided to men and women athletes at the varsity level and the allocation of resources and personnel made in support of those opportunities. The passage of the EADA occurred on the heels of the 20th anniversary of Title IX of the Education Amendments Act, a time marked by the realization that the vast majority of schools around the country were not in compliance with Title IX’s requirements as applied to athletic departments two decades after its passage (NCAA Staff, 1993). The purpose of the EADA when initially proposed in 1993 was to provide accessible information to stakeholders, most specifically prospective students, the public, and the U.S. Congress, that would allow interested parties to raise questions regarding the fair and equitable treatment of women athletes in the nation’s intercollegiate athletic programs. The annual report, colloquially referred to as the EADA report, is officially called The Report on Athletic Program Participation Rates and Financial Support Data. Three decades after the passage of the EADA and five decades after the passage of Title IX, there is reason to question whether the EADA has served its purpose. During Title IX’s 50th anniversary year, researchers and journalists uniformly reported a systemic failure to comply with Title IX in the area of athletics (Staurowsky et al., 2022; USA Today Staff, 2022; Wilson, 2022). Over the years, some have argued that the EADA should be eliminated (Keen, 2007), others have documented how valuable the information from the EADA is to researchers, journalists, and litigators (Tatos, 2019); others have recommended changes that would strengthen the data collection required under the EADA (Staurowsky et al, 2022); and others have argued that something akin to an EADA requirement needs to be adopted nationwide to help address sweeping gender inequities in athletics at the high school level (Green, 2008). This essay begins with an overview of the current state of Title IX compliance and gender equity in college sport, revisits the history of the EADA, provides an overview of what the EADA covers and who uses it, explores the criticisms and limitations of the EADA, and concludes with recommendations for making the EADA a more effective tool.

Using the RE-AIM framework to evaluate the feasibility of a parent-focused intervention targeting childhood obesity

BackgroundChildhood obesity remains a serious public health concern. Community-based childhood obesity treatment interventions have the potential to improve health behaviors and outcomes among children, but require thorough evaluation to facilitate translation of research into practice. The purpose of the current study was to determine the feasibility of a community-based, parent-focused childhood obesity intervention (“C.H.A.M.P. Families”) using the RE-AIM framework, an evaluation tool for health interventions.MethodsA single-group, non-randomized, repeated measures feasibility study was conducted. Participants (n = 16 parents/caregivers of 11 children with obesity) completed a 13-week parent-focused education intervention. The intervention consisted of three main components: (a) eight group-based (parent-only) education sessions; (b) eight home-based (family-centered) activities; and (c) two group-based follow-up support sessions for parents and children. The five dimensions of RE-AIM—reach, effectiveness, adoption, implementation, and maintenance—were assessed using various measures and data sources (e.g., child, parent/caregiver, costing, census) obtained throughout the study period. Outcome variables were measured at baseline, mid-intervention, post-intervention, and at a 6-month follow-up.ResultsOverall, the C.H.A.M.P. Families intervention reached approximately 0.09% of eligible families in London, Ontario. Despite the small number, participants were generally representative of the population from which they were drawn, and program participation rates were high (reach). Findings also suggest that involvement in the program was associated with improved health-related quality of life among children (effectiveness/individual-level maintenance). In addition, the intervention had high fidelity to protocol, attendance rates, and cost-effectiveness (implementation). Lastly, important community partnerships were established and maintained (adoption/setting-level maintenance).ConclusionsBased on a detailed and comprehensive RE-AIM evaluation, the C.H.A.M.P. Families intervention appears to be a promising parent-focused approach to the treatment of childhood obesity.Trial registrationISRCTN Registry, Study ID ISRCTN 10752416. Registered 24 April 2018.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Changes in Body Mass Index Among School-Aged Youths Following Implementation of the Healthy, Hunger-Free Kids Act of 2010

The prevalence of obesity among youths 2 to 19 years of age in the US from 2017 to 2018 was 19.3%; previous studies suggested that school lunch consumption was associated with increased obesity. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) strengthened nutritional standards of school-based meals. To evaluate the association between the HHFKA and youth body mass index (BMI). This cohort study was conducted using data from the Environmental Influences on Child Health Outcomes program, a nationwide consortium of child cohort studies, between January 2005 and March 2020. Cohorts in the US of youths aged 5 to 18 years with reported height and weight measurements were included. Full implementation of the HHFKA. The main outcome was annual BMI z-score (BMIz) trends before (January 2005 to August 2016) and after (September 2016 to March 2020) implementation of the HHFKA, adjusted for self-reported race, ethnicity, maternal education, and cohort group. An interrupted time-series analysis design was used to fit generalized estimating equation regression models. A total of 14 121 school-aged youths (7237 [51.3%] male; mean [SD] age at first measurement, 8.8 [3.6] years) contributing 26 205 BMI measurements were included in the study. Overall, a significant decrease was observed in the annual BMIz in the period following implementation of the HHFKA compared with prior to implementation (-0.041; 95% CI, -0.066 to -0.016). In interaction models to evaluate subgroup associations, similar trends were observed among youths 12 to 18 years of age (-0.045; 95% CI, -0.071 to -0.018) and among youths living in households with a lower annual income (-0.038; 95% CI, -0.063 to -0.013). In this cohort study, HHFKA implementation was associated with a significant decrease in BMIz among school-aged youths in the US. The findings suggest that school meal programs represent a key opportunity for interventions to combat the childhood obesity epidemic given the high rates of program participation and the proportion of total calories consumed through school-based meals.

Improving colonoscopy prioritisation and promoting the National Bowel Cancer Screening Program: keys to reducing bowel cancer burden.

Australia's National Bowel Cancer Screening Program (NBCSP) has the potential to prevent almost 84 000 bowel cancer deaths if 60% program participation rates could be reached and maintained over the next two decades. Immunochemical faecal occult blood test (iFOBT) is used as an initial screening tool. Participants who test positive are referred for colonoscopy for diagnostic assessment. Concerns about colonoscopy capacity and lengthy wait times between positive iFOBT and colonoscopy have hampered efforts to promote the program. However, a separate research paper published in this issue of PHRP shows that only an estimated 10-14% of Medicare-funded colonoscopies (almost 75% of all colonoscopies) in Australia are generated by the NBCSP. Inappropriate use of colonoscopy as a primary screening tool and failure to prioritise NBCSP participants may be the main reasons for long colonoscopy wait times associated with the program. Promoting clinical practice guidelines, and the Direct Access Colonoscopy initiative for priority patients, are key to reducing colonoscopy wait times and proactive promotion of the NBCSP.

New South Wales sheep producers’ perceptions regarding lamb mortality and the adoption of pregnancy scanning

Context Proven strategies to address lamb mortality include pregnancy scanning and the differential management of single- and twin-bearing ewes. However, current adoption rates of this best-practice management by Australian producers remain low at ~20%. Aims We explored producer perceptions about lamb mortality and the adoption of pregnancy scanning, and analysed whether producer characteristics, demographics, beliefs or management practices have an influence on perceptions towards pregnancy scanning or lamb survival. Methods Data were collected through an on-line self-administered survey of lamb producers in New South Wales, Australia. Descriptive and inferential statistics were used to summarise the data and test for interdependence of variables. Key results The survey results revealed that New South Wales sheep producers have low participation rates in extension programs and low engagement in record-keeping practices. Only 4% of respondents considered current lamb mortality rates acceptable and the majority agreed that lamb mortality poses a threat to Australia’s sheep industry. Findings identified numerous significant relationships between producer characteristics, demographics, beliefs, management practices, non-participation in extension programs, and perceptions towards pregnancy scanning, lamb mortality and sheep welfare. Survey participants were more likely to have adopted pregnancy scanning if they had participated in extension programs. Conclusions Further extension efforts should be focused on producers who have not adopted any record-keeping practices or previously participated in extension programs. Extension should be tailored to different enterprises, owing to the influence of enterprise focus on beliefs, while also considering producer demographics. Implications A strong case exists for continued investment in future marketing, education, and research, development and extension to increase the capacity of Australia’s sheep industry and, in particular, to increase the adoption of pregnancy scanning.

Sustaining telehealth among cardiac and pulmonary rehabilitation services: a qualitative framework study.

Semi-structured interviews (n = 8) and focus groups (n = 7) were conducted with 27 cardiac and pulmonary clinicians and managers from health services across Queensland between June-August 2021. Interview questions were guided by Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Hybrid inductive/deductive framework analysis elicited six main themes: 1. Variable levels of readiness; 2. Greater telehealth uptake in pulmonary versus cardiac rehabilitation; 3. Safety and risk management; 4. Client willingness - targeted support required; 5. Equity and access; and, 6. New models of care. We found sustained integration of telehealth in cardiac and pulmonary rehabilitation will require contributions from all stakeholders: consumers (e.g., co-design), clinicians (e.g. shared learning), health services (e.g., increasing platform functionality), and the profession (e.g., sharing resources). There are opportunities for telehealth programs servicing large geographic areas, and to increase program participation rates more broadly. Centralised models of care serving large geographic areas could maximise sustainability with current resource limitations; however, realising the full potential of telehealth will require additional funding for supporting infrastructure and workforce. Individuals and organisations both have roles to play in sustaining telehealth in cardiac and pulmonary services.

Health of the Food Environment Is Associated With Heart Failure Mortality in the United States.

Food environment factors contribute to cardiovascular disease, but their effect on population-level heart failure (HF) mortality is unclear. We utilized the National Vital Statistics System and USDA Food Environment Atlas to collect HF mortality rates (MR) and 2 county food environment indices: (1) food insecurity percentage (FI%) and (2) food environment index (FEI), a scaled index (0-10, 10 best) incorporating FI% and access to healthy food. We used linear regression to estimate the association between food environment and HF MR Results: Mean county FI% and FEI were 13% and 7.8 in 2956 included counties. Counties with FI% above the national median had significantly higher HF MR (30.7 versus 26.7 per 100 000; P<0.001) compared with FI% below the national median. Counties with HF MR above the national median had higher FI%, lower FEI, lower density of grocery stores, poorer access to stores among older adults, and lower Supplemental Nutrition Assistance Program participation rate (P<0.001 for all). Lower county FI% (β=-1.3% per 1% decrease) and higher county FEI (β=-3.6% per 1-unit increase in FEI) were significantly associated with lower HF MR after adjustment for county demographic, socioeconomic, and health factors. This association was stronger for HF MR compared with non-HF cardiovascular disease MR and all-cause MR The relationship between food environment and HF MR was stronger in counties with the highest income inequity and poverty rate. Healthier food environment is significantly associated with lower HF mortality at the county level. This reinforces the role of food security on cardiovascular outcomes.

A Review of Interventions to Increase WIC Enrollment and Participation.

Our goal was to identify strategies aimed at increasing Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment and participation rates. The WIC program provides many health benefits for pregnant women, mothers, and children. WIC offers nutrition education, formula, fruits and vegetables, and other food to pregnant and postpartum women and their children until they reach the age of five. Despite the availability of this program nationwide, enrollment and participation rates remain low across the country. Several states have tried various interventions to combat this deficiency of engagement with the goal of increasing WIC enrollment and participation. We conducted a scoping review to identify articles based on pre-specified inclusion and exclusion criteria. Two reviewers independently identified and screened articles. Subsequently, three reviewers independently extracted study details and outcomes related to WIC enrollment and participation rate changes. We included 14 studies reporting on 12 interventions from 3945 citations reviewed. Seven of these were published papers, while the others were final reports of USDA WIC Special Grant Projects. All the observed interventions had some success increasing WIC participation. Virtual interventions demonstrated the most success based on preliminary evidence. Successful interventions showed percentage gains in enrollment close to 8% and changes in participation over 9%. Overall, the literature surrounding WIC enrollment interventions reveal a mixed impact on improving participation. Many successful interventions involve an online or virtual engagement component which can provide educational resources on WIC benefits, nutrition, and living a healthy lifestyle.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10900-022-01131-2.