Program Intervention Research Articles

Prehabilitation of Patients With Oesophageal Malignancy Undergoing Peri-Operative Treatment (Pre-EMPT): Outcomes From a Prospective Controlled Trial.

The Pre-EMPT study aimed to determine if structured exercise could reduce length of stay, post-operative complications and improve fitness and health-related quality of life (HQRL) in patients undergoing neoadjuvant chemotherapy (NAC) and oesophagectomy. A prospective non-randomised trial compared a standard care pathway (control) to a structured prehabilitation exercise programme (intervention) commenced before NAC and surgery for oesophageal adenocarcinoma. Length of hospital stay and post-operative complications were recorded. Cardiopulmonary exercise testing (CPEX), body composition analyses, lymphocyte levels and HRQL questionnaires were performed at multiple time points. Median length of stay was similar in both groups. There were 6 versus 11 complications observed (intervention vs control p = 0.086). Cardio-pulmonary fitness (VO2peak) declined after NAC, but less in the intervention group (intervention -13.54% vs control -21.40%, p = 0.02). Body composition improved in the intervention group (FMi/FFMi -5.5% intervention, 10.7% control p = 0.043). Performance, cognitive, sleep and emotional function scores improved following NAC in the intervention group. Lymphocyte subsets increased in the intervention group compared to the control group after chemotherapy (p = 0.034). Chemotherapy response was improved in the intervention group (p = 0.022). A structured exercise programme may mitigate cardiopulmonary deconditioning, reduce sarcopenia and offset lymphopenia, during chemotherapy, in patients undergoing NAC and oesophagectomy.

Longitudinal Reliability of Milestones Learning Trajectories during Anesthesiology Residency.

Longitudinal Milestones data reported to the Accreditation Council for Graduate Medical Education (ACGME) provide a structured framework for assessing the developmental progression of residents in key competencies and subcompetencies. This study aims to investigate the previously underexplored longitudinal reliability of Milestones data, with the goal of identifying patterns in learning trajectories that can inform targeted interventions for residents and programs. We conducted a retrospective cohort study with national anesthesiology Milestones data collected from 2014 to 2020. Mixed-effects growth curve models were fit to model residents' growth trajectories. Longitudinal reliability was assessed using the indices of growth rate reliability (GRR) and growth curve reliability (GCR). We also examined variance components attributable to the factors at both the learner and program levels. Latent class growth analyses (LCGA) were performed to identify latent groups of learners with different learning trajectories. The study included a total of 682,475 ratings for 4976 learners in 140 programs. Growth curve model results indicated that the mean baseline Milestone rating across the 25 subcompetencies was 2.05 (95% CI: 1.96-2.14), with an average increase of 0.49 (95% CI: 0.48-0.51) units per reporting period. The GRR (mean ± SD, 0.58 ± 0.03) suggested a moderate capability of anesthesiology Milestones to detect individual differences in the growth of latent competency. GCR estimates (mean ± SD, 0.76 ± 0.02) suggested acceptable overall reliability of Milestones across all the six assessment points. Significant variability was observed at both the program and learner levels (P < 0.001). LCGA identified 3-4 latent groups of learners with distinct learning trajectories across the 25 subcompetencies. Our study indicated that the anesthesiology Milestones provides moderately reliable information for tracking individual progress over time. The findings underscore the importance of using a multi-faceted approach to assessment and providing individualized learning plans to support resident development.

The Moderating Effect of Internet Ethics on the Relationship Between Cyberbullying Victimization and Perpetration Among Korean Adults

Objective Cyberbullying is increasing every year and poses a serious problem worldwide; although the rate of adult cyberbullying is increasing every year, still cyberbullying studies mainly focused on youths. This study examined the moderating effect of Internet ethics on the relationship between cyberbullying victimization and perpetration among adults.Methods An online self-report survey was conducted with 601 participants aged 20 to 59. A final total of 593 participants were included in the analysis. Confirmatory factor analysis of the Internet Ethics Scale was performed using AMOS 22.0, and the moderating effect was verified using PROCESS Macro v3.5.Results First, cyberbullying victimization was found to positively predict perpetration. These results indicate that the higher the cyberbullying victim experience, the more the cyberbullying behavior increases. Second, the moderating effect of Internet ethics on the relationship between cyberbullying victimization and perpetration was significant. Third, in the relationship between cyberbullying victimization and perpetration, the moderating effects of respect, responsibility, justice, and non-maleficence, which are subfactors of Internet ethics, were found to be significant.Conclusion This study demonstrated the preventive effect of Internet ethics on the relationship between cyberbullying victimization and perpetration among adults. Based on this, a theoretical basis for the intervention of education and programs for adult cyberbullying prevention was provided.

SCHOOL-BASED LITERACY PROGRAM TO IMPROVE STUDENTS’ READING COMPETENCIES IN EARLY YEARS OF PRIMARY EDUCATION IN RURAL AREAS

Improving literacy for early-grade children in primary schools in rural areas in Indonesia is a complex task due to the limited availability of reading resources and the varying teachers’ pedagogy competencies to teach students. This study aims to explore how school-based literacy programs by enhancing teachers’ teaching practices and improving the literacy learning environment at schools may improve students reading competencies, especially in lower grades. Using mixed methods, this study explains how students improve their reading competencies and this study also explores supporting factors and challenges to improve students' literacy. The sample of the study is 800 students and 92 teachers or principals in 28 primary schools in a district in West Kalimantan, Indonesia. The proportion of students who can read (categorized as a reader) improved after the program intervention. Several supporting factors that contribute to the improvement of student reading competencies have been identified such as teachers' motivation, teaching strategies, the availability of print-rich learning materials, and the support of school principals in literacy programs.

Cognitive Outcomes and Delirium After Cardiac Neurodevelopmental Program Implementation for Children With Congenital Heart Disease

A recent advisory from the American Heart Association delineated the potential benefits of developmental care for hospitalized children with congenital heart disease (CHD) and a critical gap in research evaluating the association of such inpatient programs with neurodevelopmental outcomes. To investigate associations between the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program interventions, delirium, and neurodevelopment in young children (newborn through age 2 years) hospitalized with CHD. This cohort study used quality improvement data from inpatient cardiac units at a tertiary care children's hospital in the US. Participants were children aged 0 to 2 years who were admitted for at least 7 days from September 1, 2018, to September 1, 2023. The CINCO program was implemented on September 1, 2020, in 6-month plan-do-study-act phases. The 5 CINCO interventions were medical and/or nursing order panels, developmental kits, bedside developmental plans, caregiver mental health support handouts, and developmental care rounds. Number of days with delirium per patient, which was measured using the Cornell Assessment of Pediatric Delirium (a score higher than 9 indicated delirium). Neurodevelopment was measured using the Bayley Scales of Infant and Toddler Development, Fourth Edition (BSID-4). The full sample included 1331 qualifying admissions for 1019 unique pediatric patients (median [range] age at admission, 3.65 [0-34.62] months; 771 males [57.9%]), with a subcohort of 121 unique patients (median [range] age at admission, 0.00 [0-9.85] months; 77 males [63.6%]) whose initial hospitalization occurred before age 10 months and who underwent BSID-4 evaluation at age 12 months or older. The mean (SD) number of days with delirium per patient was stable for 2 years prior to CINCO implementation, decreased by 54.0% between phases 1 and 2 of the CINCO program (from 3.05 [0.60] to 1.38 [0.21]), and then remained stable over time. Each of the 5 CINCO interventions was associated with lower delirium after false discovery rate (FDR) correction (eg, medical and/or nursing order panel: B = -1.376 [95% CI, -1.767 to -0.986]; F2,1273 = 47.767; partial η2 = 0.036; P < .001). Mean (SD) BSID-4 cognitive index scores were stable for 2 years prior to implementation, higher between phases 1 and 2 of the program (from 81.67 [14.14] to 93.92 [19.43]), and then remained stable over time. Four of the 5 interventions were associated with higher BSID-4 cognitive scores after FDR correction (eg, bedside developmental plans: B = 8.585 [95% CI, 2.247-14.923]; F5, 101 = 7.221; partial η2 = 0.067; P = .008). Delirium was associated with lower BSID-4 cognitive scores. There were no associations between delirium and BSID-4 language or motor scores. This cohort study found that among hospitalized children with CHD, the implementation of an inpatient developmental care program was associated with reduced incidence of delirium and higher cognitive scores. Pediatric cardiac centers may consider adopting these low-cost, low-risk, generalizable program interventions.

Age- and sex-specific care cascades to detect gaps in the care of children with tuberculosis in Bangladesh: a cohort study.

Programmatic interventions to increase the detection of children with tuberculosis (TB) are rarely evaluated to understand age- and sex-specific completion rates. We applied modified TB screening and treatment cascade frameworks to assess indicators of effective implementation by age and sex of a TB screening program for children (zero to 14 years) in Bangladesh. We implemented an intensified screening program for paediatric TB detection in 119 health care facilities (2018-21). We followed systematic verbal screening by referral for full evaluation for children who reported symptoms or contact history with a patient with TB. Further, we linked children to treatment if diagnosed and followed for outcomes. We calculated the percentage of children, by age and sex, progressing through each step of the care cascade and compared the frequency of step completion by sex using χ2 tests. In total, we screened 552 182 males and 461 419 females for TB. 2.8% of males and 2.6% of females screened positive (P < 0.001). 74.2% of males and 73.9% of females underwent appropriate evaluation (P = 0.560). 10.3% of males and 11.5% of females were diagnosed with TB (P = 0.008). 100% of children initiated treatment, and 97.6% of males and 97.1% of females achieved a successful treatment outcome (P = 0.428). The percent of children screening positive on verbal screen, who were clinically evaluated for TB, and who were diagnosed with TB generally increased with age, with some variability throughout (ranges: 1.2-9.1%, 59.8-88.5%, 6.5-21.9%, respectively). The largest gap observed for both sexes and among all ages was children who were not appropriately evaluated for TB despite screening positive. In our research, we highlight the value of identifying gaps in paediatric TB care to inform innovative, age- and sex-tailored interventions to improve future care in children.

A socioeconomic disadvantage index for informing policy, systems, and environmental change interventions for senior nutrition programs

Identifying socioeconomic disparities within a local area is critical for tailoring policy solutions to older adult populations. However, a comprehensive index for characterizing socioeconomic disadvantage for older adult households in the U.S. is yet to be developed. This study is the first of its kind and used secondary data from the U.S. Census to develop a new socioeconomic disadvantage index for adults older than 60 years, with a focus on food insecurity, for a large region in Central Texas. The Older Adult Socioeconomic Disadvantage Index (OASDI) includes 12 variables related to unmet needs for food, housing, healthcare access, and transportation, and others at the census tract level. For each variable, the values were ranked based on quintiles using ArcGIS Pro 3.2. An unweighted sum was used to create the OASDI, where a higher score indicated greater socioeconomic disadvantage. Choropleth maps were used to visualize the OASDI and persistent poverty for all census tracts within the study area. The OASDI was used to statistically compare two local policy regions for senior nutrition programs in the Austin and San Antonio, Texas metro areas. Results showed a greater socioeconomic disadvantage in the San Antonio region compared to the Austin region (Mann-Whitney-U = 198,303; p &amp;lt; 0.0001). The statistical analysis identified an area with extreme disadvantage relative to the local policy region and confirmed with member checking. Findings provided insights into local socioeconomic disparities at different levels and can be applied to advocate for policies, systems, and environmental changes for senior nutrition.

Exploring the landscape of mindfulness practice in early childhood education in Ireland

ABSTRACT Previous studies of mindfulness practice to promote child well-being in early childhood education have focused on programme outcomes and interventions. Little research has explored the lived experiences of early childhood educators asking if, how and why they use mindfulness practice with young children. This article presents the findings from an online questionnaire conducted with 744 early childhood educators in Ireland. The results indicate that while many educators are using formal and informal mindfulness practices with children, their constructions and rationale for its use differed. Barriers to using mindfulness practice with young children included a lack of understanding or understanding of how to use mindfulness within existing curricula, and the absence of available training. Nevertheless, the findings suggest that early childhood educators are eager for mindfulness practice to be incorporated in a more integrated manner to benefit both the children and the educators.

Differences between Recidivists and Non-recidivists Attending a community-based Domestic Violence Perpetrator Program in the Dominican Republic: A Brief Report

Abstract Purpose Previous research in Western samples has found differences between recidivists and non- recidivists among individuals who attended intervention programs designed to reduce intimate partner violence (IPV) offending. However, the extent to which similar characteristics differentiate these groups in a non-Western sample is unknown. Methods This brief report includes data collected by psychologists from men referred to a cognitive behavioral program (n = 1,380) in the Dominican Republic. Bivariate and multivariate logistic regression analyses were conducted on the data. Results Although specific IPV-related factors such as attitudes towards women and jealousy were significantly associated with recidivism at the bivariate level, these effects disappeared when they were controlled by other relevant predictors in the multivariate model. Instead, general criminogenic factors such as employment status, alcohol consumption, relationships with parents and violent offending towards others were the key factors explaining IPV recidivism. Conclusions IPV recidivism is best explained by accounting for those factors which are common to violent re-offending in general. The implications of these findings are discussed in terms of theory and program intervention practices.

Regional Variations in the Prevalence of Risk Factors and Non-Communicable Diseases in Papua New Guinea: A Scoping Review.

Often referred to as 'the last unknown', Papua New Guinea's largely unexplored environments across its four distinct regions, the Highlands, New Guinea Islands, Momase, and Southern, exhibit remarkable diversity. Understanding this diversity is significant in contextualising the risk factors associated with developing non-communicable diseases. This review aims to map and summarise the literature to provide region-specific prevalence data for risk factors and non-communicable diseases. Four databases and grey literature were searched. Two reviewers completed the screening and data extraction. Twenty-one studies were included, with five reporting the data by region and the remaining reporting the data nationwide. Six studies reported on risk factors, thirteen reported on non-communicable diseases, and two reported on risk factors and non-communicable diseases. The Southern region, which includes the Capital, Port Moresby, reported the highest prevalence for most risk factors: anthropometric (overweight, obesity, and waist circumference), lifestyle (betel nut, alcohol, unhealthy diet, and stress), and biochemical (cholesterol, triglycerides, HbA1c, and metabolic syndrome). The findings of this review highlight the limited evidence base for region-specific risk factor data and the lack of objective diagnosis of non-communicable diseases. There were variations in the prevalence of specific risk factors by region; however, the Southern region stands out as requiring immediate attention for health promotion program interventions.

A scoping review of interventions on middle school students' attitudes towards science.

The aim of the study was to review the scientific literature on educational interventions to promote positive attitudes towards science in middle school students. Due to the decline in positive attitudes towards science observed in this critical age group of students and the implementation of training programmes aimed at changing this situation, we sought to identify components of training proposals that have received attention from researchers. This paper presents a scoping review of 37 papers published in English and Spanish over the last 10 years. The review aims to describe the research outputs and analyse the effectiveness and characteristics of program interventions, drawing from various databases. The results show the need to examine the operational definition of the constructs used in the programmes, to focus attention on the influence of intrinsic variables on middle school students' attitudes towards science, such as racial group or self-efficacy, and to conduct follow-up evaluations to assess the permanence of attitudes. While acknowledging limitations related to construct clarity or language restrictions in the search process the findings suggest that middle school students' attitudes towards science remain an open area of research, as there is no consensus on the characteristics of effective programmes.

Scaling up of parenting support to prevent violence against children in Tanzania: insights from policymakers and service providers

BackgroundEvidence shows that parenting behaviours, including the use of violent discipline, can be changed through programmatic interventions. This study seeks to examine how policymakers and service providers in Tanzania perceive the provision of parenting support as a strategy to prevent violence against children and what the enabling and hindering factors are for the scale-up of existing evidence-based parenting supports. It does this by applying Daly’s analytical framework for parenting support.MethodsQualitative research was undertaken, with interviews conducted with 20 key informants consisting of purposively sampled policymakers and service providers. The interview data were analysed using inductive and deductive coding and analysis.ResultsThe most prominent enabling factors noted for the scale-up of parenting support interventions in Tanzania include the existing supportive political commitment, the interventions currently on offer at the programmatic level, and the perceived understanding of Tanzanian caregivers of the importance of parenting and, thereby, a willingness to change. Current factors hindering the scale-up include the lack of a common understanding of what evidence-based parenting programmes entail, inadequate provision of human and financial capital to implement the programmes using community resources and deeply engrained social norms around adultism and gender.ConclusionDaly’s analytical framework allowed us to examine barriers and facilitators to scale-up the provision of parenting support to prevent violence against children, based on the viewpoints of policymakers and service providers. Understanding these barriers and facilitators will allow Tanzanian policymakers and service providers to further close the gap between the policies and the actual implementation of evidence-based parenting support programmes aimed at preventing violence against children.

What Should Primary Prevention in Burnout Look Like? Promoting Attributes, Roles and Social Networks with Instrumental Outcomes

AbstractBurnout remains a vexing issue for healthcare workers, educators and policy makers. Continuing high prevalence rates have focused the need for new and innovative approaches. The deleterious personal and professional consequences of burnout when it does develop place this focus on primary prevention. Yet despite its benefits, primary prevention initiatives have several barriers to engagement which impact their effectiveness. In this article, the authors explore potential barriers to engagement with primary level prevention of burnout amongst physicians-in-training, many of which are rooted in the social and professional contexts of training. Understanding the motivations of physicians-in-training should be used to guide the development of initiatives which combine protection against burnout with relevant goal-directed, instrumental outcomes. Three principles which can guide initiatives combining these features are explored. Promoting curiosity and curiosity-led enquiry combines a well-established protective attribute with educational and professional benefits. Curiosity-led endeavours can be developed into areas of special interest and competence, harnessing the protective benefits of self-efficacy and peer acknowledgement. Finally, special interests and the professional roles to which they lead foster the development of professional social networks and mentorship relationships. These are protective, particularly for physicians-in-training navigating role and organisational transitions. Supporting interventions with instrumental outcomes is both beneficial in engaging investment and also sustainable across the career-span. Burnout remains a challenging issue, and while programmatic interventions continue to have a role, the benefits of broader primary preventative approaches should be considered in terms of the potential engagement and sustainability advantages they confer.

Does Caregiver Engagement Predict Outcomes of Adolescent Wilderness Therapy?

Existing research shows some links between wilderness therapy outcomes and familial functioning. However, wilderness therapy programs do not agree on what kind of caregiver involvement is required to improve adolescent program outcomes, nor has research examined different types of family engagement and their impact on adolescent treatment outcomes. Thus, the present study explored the research question: Does caregiver engagement in adolescent wilderness therapy foster improved outcomes? The study sample consisted of 4067 adolescent wilderness therapy clients from 12 different wilderness therapy programs. Using standardized measures and multilevel structural equation modeling, the authors found that caregiver program participation significantly predicted adolescent mental health outcomes of the program, suggesting that the more caregivers were involved in family interventions during the program, the more likely their adolescent child was to improve in the program. The study also found that greater caregiver effort predicted greater mean change in adolescent mental health outcomes of wilderness therapy. This study suggests the importance of enhancing familial interventions in adolescents' wilderness therapy programs in order to improve adolescent outcomes. Given findings from this study, wilderness therapy programs should consider expanding the ways that they involve families in treatment in order to optimize adolescent outcomes.

Radiology resident competency in orthopedic trauma detection in simulated on-call scenarios.

To evaluate radiology residents' ability to accurately identify three specific types of orthopedic trauma using radiographic imaging within a simulated on-call environment. We utilized the Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) to assess residents' preparedness for independent radiology call. The simulation included 65 cases, with three focusing on orthopedic trauma: sacral ala, femoral neck, and pediatric tibial/Toddler's fractures. Faculty graded residents' responses using a standardized 10-point rubric and categorized errors as observational (failing to identify key findings) or interpretive (incorrect conclusions despite correct identification of findings). 321 residents evaluated sacral ala fracture radiographs and received an average score of 1.29/10, with 8.71 points lost to observational errors. Only 6% produced effective reports (scores ≥ 7), while 80% made critical errors (scores < 2). For femoral neck fracture CT images (n = 316 residents), the average score was 2.48/10, with 6.71 points lost to observational errors. 25% produced effective reports, and 66% made critical errors. Pediatric tibial/Toddler's fracture radiographs (n = 197 residents) yielded an average score of 2.94/10, with 6.60 points lost to observational errors. 29% generated effective reports, while 71% made critical errors. Radiology residents demonstrated significant difficulty in identifying these orthopedic trauma cases, with errors primarily attributed to observational deficiencies. These findings suggest a need for targeted educational interventions in radiology residency programs to improve the identification of these fractures.

A meta-analysis of the effect of physical activity programs on fundamental movement skills in 3-7-year-old children.

This study aimed to systematically review the effects of different physical activity programs on the fundamental movement skills of 3 - 7-year-old children. For this review, the databases of CNKI, Web of Science, and PubMed were searched to collect relevant literature on the effects of different physical activity program interventions on fundamental movement skills, and a total of 10 articles with 1,121 subjects were included. The Cochrane Risk of Bias Assessment Tool was used to assess the quality of the literature, and meta-analysis was performed using Review Manager 5.4 software. Physical activity significantly influenced children's running ability, horizontal jump, dribbling the ball, kicking ability, catching ability, overhand throwing, striking a stationary ball, and dynamic balance. However, the intervention effect was insignificant for the hop and underhand throwing abilities. The intervention effects for running ability, horizontal jump, kicking ability, and catching ability were better at less than 12 weeks than at 12 weeks and above. In addition, an intervention duration of 90 min or more was better than less than 90 min for running ability and horizontal jump. Future research is recommended to focus on the common factors of the intervention effects of physical activity programs to develop more precise and effective intervention practices to further improve children's fundamental movement skill levels.

Private, non-profit, and plantation: Oil palm smallholders in management-assistance programs vary in socio-demographics, attitudes, and management practices.

Smallholder farmers produce over 40% of global palm oil, the world's most traded and controversial vegetable oil. Awareness of the effects of palm oil production on ecosystems and human communities has increased drastically in recent years, with ever louder calls for the private and public sector to develop programs to support sustainable cultivation by smallholder farmers. To effectively influence smallholder practices and ensure positive social outcomes, such schemes must consider the variety in perspectives of farmers and align with their priorities. We conducted social surveys on smallholder farmers in Indonesia and Malaysia with varying degrees of participation in programs that offer advice and support with plantation management ("management-assistance programs") led by an industrial palm oil producer in Indonesia and a conservation-focused NGO in Malaysia. We surveyed farmers on their demographics, attitudes, and management decisions. Our analyses act as case studies to investigate the similarities and differences between smallholder palm oil producers involved in different schemes, allowing us to determine the alignment between the intentions of partnership programs and the current realities of smallholder plantations. The relationship between heterogeneity of social factors and management decisions and degree of program involvement differed across different groups and region: Indonesian smallholders most closely partnered with the private sector were the most varied in socio-demographics and attitudes but showed little variation in management inputs, while Malaysian smallholders most closely partnered with an NGO were the most heterogenous across all survey sections. Specifically, Indonesian farmers partnered with the private sector used less herbicide, more fertilizer, and had higher yield and total household income than farmers completely uninvolved with management assistance programs. In Malaysia, farmers partnered with an NGO also had higher yield and fertilizer application than independent farmers, however they used significantly more herbicide and had lower total household income. Our findings demonstrate the wide variety of smallholder farmers in both regions, directly opposing a 'one-size-fits-all' approach to sustainability. The wide variety of existing management practices also provides a potentially valuable natural experiment to identify high-yield, environmentally-friendly management approaches. When taken in context, our findings may inform the interventions of management-assistance programs, ensuring they are approaching the most relevant farmer groups in the most effective way.

A Vision for Advancing Nutrition Science in the United States

The President's Council of Advisors on Science and Technology published its findings and recommendations for improving the nation's health through nutrition science. The report recommends that the President give priority to equity in the design and conduct of nutrition research to provide a foundation for continued improvements to public health and to reduce inequities in the burden of diet-related diseases like heart disease, obesity, diabetes, and cancer. It also recommends strengthening the evidence base for future public and private sector actions. The President's Council of Advisors on Science and Technology emphasizes that the epidemic of diet-related diseases can be diminished but it will require combined efforts of public and private sectors, investment in implementation science to develop effective interventions for government programs, a diverse nutrition workforce, and a strong evidence base to inform changes to the food environment.

Evaluation and adaptation of a two-way text messaging intervention in the WIC breastfeeding peer counseling program: A qualitative analysis.

Breastfeeding (BF) is vital for maternal and infant health, yet post-hospital discharge support remains a challenge. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides BF peer counseling prenatally and up to 1-year postpartum among low-income women in the United States. The Lactation Advice Through Texting Can Help (LATCH) intervention is an evidence-based two-way text messaging intervention that provides BF education and support in the WIC peer counseling program. The intervention is implemented by peer counselors (PCs) in the WIC program, with the supervision and support of a lactation consultant. The aim of this qualitative study was to assess the barriers and facilitators to the implementation of LATCH during the feasibility trial and to investigate strategies for adapting and scaling up the intervention. In-depth interviews with LATCH and PC program key informants aimed to evaluate the intervention and explore its adaptation and scale-up. Interviews were analyzed using line by line inductive thematic analysis. Findings were mapped to the Model for Adaptation Design and Impact (MADI) framework to describe the proposed adaptations, and to the Program Impact Pathways (PIP) framework to identify causal pathways and critical quality control points. Results demonstrate that LATCH facilitates continued engagement between PCs and WIC mothers; however, implementation feasibility issues remain. Suggested adaptations to LATCH include the use of an integrated comprehensive platform, ensuring continuity of care through an expanded spectrum of communication options, the need to develop a PC support model for "off hours" (non-business hours), and the need to obtain local WIC office management's buy-in for the communications platform and the off-hours PC model. Critical quality control points were identified when results were mapped to the MADI and PIP frameworks. Implementing these changes has the potential to expand access to BF peer counseling support and improve BF equity among low-income women.

Early intervention in psychosis programs in Africa, Asia and Latin America; challenges and recommendations.

While early intervention in psychosis (EIP) programs have been increasingly implemented across the globe, many initiatives from Africa, Asia and Latin America are not widely known. The aims of the current review are (a) to describe population-based and small-scale, single-site EIP programs in Africa, Asia and Latin America, (b) to examine the variability between programs located in low-and-middle income (LMIC) and high-income countries in similar regions and (c) to outline some of the challenges and provide recommendations to overcome existing obstacles. EIP programs in Africa, Asia and Latin America were identified through experts from the different target regions. We performed a systematic search in Medline, Embase, APA PsycInfo, Web of Science and Scopus up to February 6, 2024. Most EIP programs in these continents are small-scale, single-site programs that serve a limited section of the population. Population-based programs with widespread coverage and programs integrated into primary health care are rare. In Africa, EIP programs are virtually absent. Mainland China is one of the only LMICs that has begun to take steps toward developing a population-based EIP program. High-income Asian countries (e.g. Hong Kong and Singapore) have well-developed, comprehensive programs for individuals with early psychosis, while others with similar economies (e.g. South Korea and Japan) do not. In Latin America, Chile is the only country in the process of providing population-based EIP care. Financial resources and integration in mental health care, as well as the availability of epidemiological data on psychosis, impact the implementation of EIP programs. Given the major treatment gap of early psychosis in Africa, Latin America and large parts of Asia, publicly funded, locally-led and accessible community-based EIP care provision is urgently needed.