Participation Rate Research Articles

LEGAL IMPLICATIONS OF REGIONAL HEAD ELECTIONS WITH A SOLE CANDIDATE: A PERSPECTIVE OF STATE ADMINISTRATIVE LAW

The phenomenon of sole-candidate regional head elections in Indonesia has posed several challenges to democratic principles, particularly with regard to legitimacy, accountability, and public participation. This research aims to analyze the legal implications of regional head elections with sole candidates from the perspective of Administrative Law and evaluate their impact on democracy. The method used in this study is normative legal research, employing a legal and conceptual approach that includes a detailed analysis of election regulations, legal doctrines, and relevant literature studies. This method provides a robust framework for understanding the interplay between regulatory frameworks and democratic principles. The research findings indicate that elections with a sole candidate have the potential to undermine the legitimacy of the elected leader, reduce political accountability, and decrease voter participation rates. As a result, there is an urgent need to reform the electoral regulatory framework in Indonesia. Key recommendations include lowering the nomination threshold to foster competition, increasing transparency in the nomination process to ensure fairness, and strengthening political education to encourage public participation. These steps aim to enhance the quality of democracy and prevent the recurrence of sole-candidate elections in the future.

Collection of household used cooking oil in urban areas of Greece: Opinions and practices of local inhabitants

Abstract The implementation of household-level used cooking oil collection systems in the EU is still in its early stages of development, and the level of households’ participation remains low. Limited literature is available on this subject. Our study aims to contribute to the current literature by filling the knowledge gap from the viewpoint of the system user, the inhabitant. We conducted, in 2023, an online qualitative survey to explore the current state, habits, practices, and opinions of the inhabitants of the Thessaloniki Urban Area regarding used cooking oil handling. The findings, from the 1,429 participants in our survey, showed a significant lack of knowledge regarding the recycling of used cooking oil (33.6% unaware) and a low participation rate (20.9%), even among those who typically recycle (24%). The dumping of used cooking oil into a sink (48.1%) or toilet (22.3%) is the prevailing method of disposal for UCO non-recyclers. Lack of knowledge (67.2%) is the most frequent reason for not recycling, followed by inadequate organisation of the collection programs (11.3%) and the inconvenience of collection sites being far from the residences (6.7%). Almost all the residents were dissatisfied with the state and municipalities’ attempts to advertise and inform them of this issue. Our findings demonstrate the urgent need to address the issue of collecting used cooking oil from households to protect the environment and meet the EU goal of incorporating renewable sources in its overall energy consumption until 2030.

The Effects of a Universal, School‐Based Mental Health Literacy Program to Improve Resilience and Self‐Efficacy Among 5–6th Grade Students From Three, Title 1 School in Rural Alabama: Advocates 4 All Youth

ABSTRACTAdvocates 4 ALL Youth (ALLY) is a universal, 6‐week mental health literacy program, implemented in schools during the school day by community volunteers. The aim of this study was to determine the efficacy of the ALLY program on youth who endorsed negative affect (i.e., self‐reported symptoms of both depression and anxiety). Using a randomized controlled trial design, 5–6th grade students (11–13 years) attending three rural elementary schools in low‐income and predominant African American communities were invited to participate. A total of 109 students (91% African American/Black) participated in the program (91% participation rate) and were randomized into treatment group—who received ALLY (n = 57) or control group (n = 52). All students completed a pre–post‐assessment (baseline and post‐program). A total of 58% youth in the treatment group endorsed negative affect at baseline and this was reduced to 53% post‐program delivery (p < 0.01). No change in negative affect was reported in control group (44% pre and 44% post with self‐reported negative affect). These results suggest that participants at greatest risk for mental health issues may benefit from ALLY.

Abstract 17: The Effectiveness of a Community Health Worker-Led Intensive Blood Pressure Intervention on Stroke

Background: Hypertension is the most important modifiable risk factor for stroke, a leading cause of death in China. Despite national efforts, stroke incidence and mortality rates remain high in China, with significant urban-rural disparities. Objectives: We aimed to examine the effectiveness of non-physician health worker-led antihypertensive interventions on the risk of stroke in rural China. Methods: We included 33,995 hypertensive participants from 326 villages in rural China using 48-month follow-up data from the China Rural Hypertension Control Project (CRHCP). In the CRHCP trial, non-physician healthcare workers initiated and titrated antihypertensive medications using a simple stepped-care protocol recommended by clinical guidelines. The primary outcome was total stroke during the 48-month follow-up period. Secondary outcomes included fatal and nonfatal strokes. We conducted a secondary analysis adjusted for pre-defined baseline covariates to examine the robustness of the intervention effect on stroke. Safety outcomes were also assessed at 48 months. Results: During a median of 48.2 months of follow-up, 1,151 strokes (1.7% yearly rate) occurred in participants in intervention villages compared to 1,484 strokes (2.4% yearly rate) in participants in usual care villages. The non-physician health worker-led intervention reduced stroke by 28% (hazard ratio = 0.72; 95% CI: 0.67, 0.77) in intervention compared to usual care participants. Similar reductions were also observed for fatal (hazard ratio = 0.74; 95% CI 0.63, 0.87) and nonfatal stroke (hazard ratio = 0.71; 95% CI 0.66, 0.78). Participants in intervention villages had a significantly lower rate of hospitalizations and deaths compared to usual care participants (risk ratio = 0.94; 95% CI 0.91, 0.98). There were no significant differences in rates of injurious falls, symptomatic hypotension, or syncope between the intervention and usual care villages. Conclusion: This study shows that a nonphysician health worker-led intensive BP control was effective at reducing stroke among rural residents in China. The non-physician community health worker-led intervention should be scaled up in China and other low- and middle-income countries to reduce the burden of stroke.

Experience of childhood adversity and maladaptive personality traits: Magnitude and specificity of the association in a clinical sample of adult outpatients.

The relationship between the experience of childhood adversity (CA) and the development of personality disorders (PDs) has been well documented. The dimensional PD alternative model (AMPD) has been introduced in nosography in 2013, and so far it is been used for CA research mostly on non-clinical samples. We included in our study 137 psychiatric outpatients who were screened for history of maternal antipathy (MA), paternal antipathy (PA), maternal neglect (MN), paternal neglect (PN), maternal physical abuse (MPA), paternal physical abuse (PPA) and sexual abuse (SA) using the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and underwent personality assessment using the Personality Inventory for DSM-5. Applying CECA.Q cut-off scores, rates of participants reporting CA were as follows: 14.6% MA; 13.9% PA; 13.1% MN; 10.2% PN; 25.5% MPA; 24.8% PPA; and 22.6% SA. In multivariate regression models, accounting for age, gender and exposure to other types of CA, exposure to MA was associated with increased negative affect, detachment, disinhibition and psychoticism; exposure to PA with increased disinhibition; and exposure to SA with increased antagonism, disinhibition and psychoticism. All effect sizes were small, except for a moderate effect of SA on psychoticism. Results pointed to a small but specific and independent effect of MA on most maladaptive personality traits; a possible specific role of the paternal figure for externalizing traits; and a moderate effect of SA on psychoticism. The cumulative exposure to multiple CAs significantly predicted all maladaptive personality traits, with much larger effect sizes compared to those calculated for single CAs. CA explained the higher proportion of variance for antagonism and psychoticism. In conclusion, exposure to specific forms of childhood abuse was associated with specific maladaptive traits in psychiatric outpatients, even if the effect of cumulative multiple CAs was larger.

Reduced healthcare costs for patients with screen-detected colorectal cancer: A Danish nationwide cohort study.

This Danish nationwide retrospective register-based cohort study investigated healthcare costs for patients with screen-detected colorectal cancer (SD-CRC) compared to non-screen-detected CRC (NSD-CRC). Nationwide cohort study. Quarterly healthcare costs including costs of hospital care, out-of-hospital medication, and primary sector contacts were compared between the two groups from two years before diagnosis of CRC until two years after. A quasi-experimental difference-in-differences analysis was performed to estimate the differences per patient in total quarterly healthcare costs between the groups. A total of 13,852 patients were included, 4703 with SD-CRC, 7420 with NSD-CRC, and 1,729 with interval- or post-colonoscopy CRC (I-PC-CRC). The total quarterly healthcare costs per patient were significantly higher in the NSD-CRC group than in SD-CRC. This was consistent across the total period and in 6-month analyses, accruing additional €16,600 of costs for patients with NSD-CRC over two years after diagnosis. Total healthcare costs were significantly higher for patients with NSD-CRC as compared to patients with SD-CRC across all Union for International Cancer Control (UICC) stages, except for UICC stage I. Correspondingly, total costs associated with I-PC-CRC were significantly higher than for SD-CRC. Apart from improving post-treatment outcomes, higher participation rates in the CRC screening programmes present an opportunity for reducing healthcare costs related to patients diagnosed with CRC.

Challenges and barriers to WIC participation vary by participation status and language: Findings from focus groups in Missouri.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the largest federal food and nutrition program serving women and young children and has a low coverage rate of about 50 percent. There is no peer-reviewed article that compares maternal perceptions of challenges and barriers to WIC participation by language and participation status. We compare challenges and barriers faced by English-speaking mothers to those faced by Spanish-speaking mothers to enrollment and retention in WIC within each group: current participants (n=43), prior participants (dropouts; n=27), and eligible non-participants (n=18), using focus groups we conducted in Missouri in 2021-2023. We used thematic analysis to generate core themes in NVivo 14. We find heterogeneous barriers to WIC participation by participation status and language spoken by the mother. While all participants identified the difficulty in attending WIC appointments as a top barrier, a higher percentage of Spanish-speaking mothers in comparison to English-speaking mothers reported it more frequently. Only eligible non-participants identified lack of information on the WIC program, its benefits, and certification requirements as barrier. Unlike common belief, language was not considered a barrier, but rather a challenge exhibited among Spanish-speaking mothers. While dissatisfaction with food alternatives is a top challenge for current WIC participants, it only becomes a barrier for Spanish-speaking mothers but not for English-speaking ones. Findings highlight the importance of designing creative ways to inform WIC-eligible mothers about the program's benefits and enrollment requirements, and to consider differences by maternal tongue and culture. Increases in food amount and variety may lead to higher participation rates. Moreover, extending hours of operation at the WIC clinics and providing virtual meetings may lead to increasing retention rates and benefits redemption.

The prevalence and 6-year incidence of myopic tessellation in a Chinese rural adult population: the Handan Eye Study

PurposeTo describe the prevalence and the cumulative 6-year incidence of fundus tessellation in a rural Chinese adult population.MethodsThe Handan Eye Study was a population-based longitudinal study, with 6830 eligible subjects included in the baseline period, and 5394 subjects (follow-up rate: 85.3%) took part in the follow-up study. Participants had detailed eye examinations and physical examinations; a detailed questionnaire was also well administered. Fundus tessellation was defined as well-defined choroidal vessels that can be observed clearly around the fovea as well as around the arcade vessels.ResultsAmong 6830 subjects who participated in the baseline study, the prevalence of fundus tessellation was 9.89% (95%CI: 9.22-10.58%). The prevalence of fundus tessellation increased with age; that of subjects aged younger than 50 years and those aged 50 years or older was 2.5% and 14.5%, respectively. Six years later, the cumulative 6-year incidence of fundus tessellation was 1.21% (95%CI: 1.03-1.40%). Similarly, the incidence of fundus tessellation also increased with age; that of participants aged younger than 50 years and those aged 50 years or older was 0.20% and 1.86%, respectively. The progression rate of fundus tessellation in those with fundus tessellation at baseline was 1.5% (95% CI: 0.82%, 2.38%). By multivariable analysis, subjects being older (OR: 1.079, P < 0.001) and havingβ-parapapillary atrophy at baseline (OR: 2.657, P = 0.002) were associated with a higher risk of incidence of fundus tessellation.ConclusionsThe prevalence and 6-year incidence of fundus tessellation were 9.89% and 1.21% in rural Chinese adults aged 30 + years, respectively. The progression rate in participants with fundus tessellation indicates the importance of regular follow-up for these patients.

Assessing the effectiveness and the feasibility of a group-based treatment for self-stigma in people with mental disorders in routine mental health services in North-East Italy: study protocol for a pragmatic multisite randomized controlled trial

BackgroundSelf-stigma refers to the process whereby individuals with mental disorders internalize negative societal attitudes and misconceptions about mental health conditions, potentially affecting their sense of self-worth and identity. This internalization can significantly impact various aspects of life, including treatment engagement, personal relationships, and overall well-being. Narrative Enhancement and Cognitive Therapy (NECT) was developed in the United States to counteract self-stigma and has been supported by multiple randomized controlled trials. However, NECT has not yet been implemented in Italy or within a public mental health system grounded in community psychiatry. This study aims to evaluate the efficacy and feasibility of the Italian version of the NECT within the public mental health sector in a large part of North-East Italy.Methods and analysisThis pragmatic, multisite, superiority, randomized, wait-list controlled trial with two parallel arms will recruit over four hundred patients with severe mental disorders from 26 public community-based mental health centers in North-East Italy. The experimental intervention, NECT, consists of 20 group-based sessions to reduce self-stigma. The study will assess NECT’s impact on several psychological dimensions, including self-stigma levels (primary outcome), self-esteem, hope, empowerment, recovery perception, mental well-being, and stigma stress (secondary outcomes). Feasibility will be evaluated by collecting data on participant adherence and treatment implementation, including eligibility screening, participation rates, intervention completion, exposure levels, and reasons for dropout.DiscussionThe findings of this research are expected to contribute to the understanding of effective treatments for patients with mental disorders, particularly those burdened by high levels of self-stigma, and to improve their recovery outcomes.Trial registrationClinicalTrials.gov; Identifier: NCT06567145.

Quantifying the Relationship Between At-Home Shoulder Physiotherapy Participation and Outcome: What can a Watch Tell Us?

Exercise-based physiotherapy is an established treatment of rotator cuff injury. Objective assessment of at-home exercise is critical to understand its relationship with clinical outcomes. This study uses the Smart Physiotherapy Activity Recognition System to measure at-home physiotherapy participation in patients with rotator cuff injury based on inertial sensor data captured from smart watches. Relationships between participation and clinical outcomes, long-term durability of outcome improvements, and factors predictive of participation were evaluated. Patients participated in a 12-week rotator cuff physiotherapy program in a prospective single-center study. Patients wore smart watches during supervised weekly in-clinic physiotherapy sessions and while performing exercises at home. Demographic information and rotator-cuff diagnosis were collected at baseline and assessed as predictors of physiotherapy participation. Outcome measures (pain, disability [Disabilities of the Arm, Shoulder and Hand], strength, range of motion) were collected over duration of treatment and at 12-month follow-up (pain and disability). Machine learning algorithms identified and classified periods of exercise to evaluate participation and adherence. One hundred ten patients enrolled and initiated treatment, with 92 patients included in the analysis. All outcomes showed significant improvements from baseline at each time point. Mean total weekly at-home participation decreased from 35.6 ± 28.9 minutes in weeks 0 to 4 to 28.9 ± 25.7 minutes in weeks 8 to 12 (t = 2.23, P = 0.023). For the full cohort, significant relationships were found between physiotherapy participation and disability, manual strength, external rotation, internal rotation, and abduction. Significant predictors of participation included greater age, being unmarried, diagnosed rotator cuff tear, and measures of self-efficacy, social support, and comorbidity. Higher participation rates led to significant improvements in outcomes for partial thickness/no-tear patients but not for full-thickness tears. Machine learning methods applied to data collected from smart watches enabled objective assessment of physiotherapy participation in the home setting. Although most patients improved with physiotherapy, patients with full-thickness rotator cuff tears were not similarly responsive to higher exercise volumes.

Post COVID-19 infection and quality of life of healthcare workers at Sahloul University Hospital of Sousse in Tunisia.

Since the COVID-19 pandemic, health care workers (HCWs) faced an enormous physical and mental burden, sometimes altering their quality of life due mainly to persistent challenges stemming from their frontline position. Todetermine the prevalence of post-COVID-19 syndrome, and its impact on the Health-Related Quality of Life (HRQoL) among HCWs. This is an exhaustive cross-sectional study with analytical scope, conducted among all HCWs of the University Hospital Sahloul of Sousse, Tunisia, who have contracted COVID-19 between September 2020 and 30 March 2021 (N=529 cases).The post-covid medical check-up was carried out three months after the acute phase of the COVID-19 infection (December 2020 to June 2021). HRQoL was assessed using the SF-12 (12-item Short Form Health Survey) questionnaire. Bivariate study and multiple linear regressions were performed to identify the different factors influencing the quality of life of HCWs. During the study period, 529 HCWs were diagnosed with SARS CoV-2 infection, out of them 249 participants were included (47% participation rate). Post covid-19 syndrome was reported in 65% of cases. A low overall quality of life (QoL) score was reported in 28.6% of cases. Low physical and mental composite scores were reported in 34.3% and 29.4% of cases respectively. In the multiple linear regression analysis, gender, post COVID-19 syndrome and time off work were significantly associated with SF12 scores. In our study, HCWs experienced a significant deterioration in HRQoL after COVID-19 with a high incidence of post-COVID-19 syndrome. The need of long-term follow-up after SARS-CoV-2 infection remains essential to support HCWs and mitigate long-term impacts.

East Asian expatriate football players and national team success: Chinese, Japanese, and South Korean players in Europe (2000–2024)

This study investigated the influence of Chinese, Japanese, and South Korean football players’ participation in European leagues on their national teams’ FIFA rankings from 2000 to 2024. Utilizing data from 22,972 matches featuring 392 players across 36 European leagues and 12 tournaments or cup competitions, survival and conditional process analyses were conducted to explore the relationships between expatriate player counts, appearances, playing time, and FIFA rankings. The results demonstrated a significant correlation between the number of expatriate players, particularly in top-tier leagues, and national team rankings. Notably, Japanese and South Korean players exhibited longer durations of participation and higher rates of advancement to elite European leagues compared to Chinese players. Furthermore, the conditional process analysis revealed an indirect effect of expatriate player count on FIFA rankings, mediated by increased appearances and playing time, with the strongest influence observed in the Big Five leagues. These findings underscore the importance of international exposure for advancing East Asian football and provide insights for policymakers on effectively nurturing young talents for international careers.

Developing a set of key principles for care planning within older adult care homes: study protocol for a modified Delphi survey

BackgroundOlder adult care homes in England are required to develop care plans on behalf of each of their residents and to make these documents available to those who provide care....

CONSUMERS' SELF-IDENTITY PERSPECTIVES ON BRAND PREFERENCES AND BOYCOTT BEHAVIOUR: AN APPLICATION OF A BLIND TASTE TEST

This research aims to reveal the relationship between the self-identity of modern individuals, who seek to find themselves by consuming in a consumer society, and their consumption preferences and behaviours through boycott behaviour. For this purpose, a study was conducted in 2024 with 322 university students in Istanbul, utilizing a blind taste test involving two products (cola and coffee) from one global and one local brand (Pepsi/Cola Turka and Starbucks/Kahve Dünyası) regarding the boycott against brands supporting Israel. According to the research findings, the participation rate in the boycott is 57%. Regardless of participation in the boycott, no statistically significant difference was found in brand preferences during the blind test among all participants. However, it was revealed that the preferences for products related to Starbucks significantly decreased among participants who supported the boycott. Although not statistically significant, a decrease was also observed for Pepsi. The primary reasons affecting participation in the boycott are emotional factors, such as a reaction to crimes against humanity and support for the oppressed. Those who did not participate in the boycott expressed their belief that the boycott or their participation would have no impact. No significant relationship was identified between the phenomenon of self-identity, which is the research's main subject, consumer preferences (participation in the boycott), and indirectly, brand preferences. The self-identity preferences of participants and non-participants in the boycott were similar, with the most commonly expressed identity definition being "human."

Enhancing individuals’ engagement in marine recreational sport activities: from an institutional perspective

IntroductionEncouraging consumer participation in marine recreational sport activities is recognized as a key strategy for boosting both local and regional economies. However, compared to other traditional outdoor activities, participation rates in marine recreation remain relatively low. Two major barriers to participation are consumers' concerns about whether marine recreational sport activities are interesting and suitable for themselves, which can be summarized into product quality uncertainty and product fit uncertainty.MethodsTo address this issue, this paper, grounded in institutional theory, investigates how different institutional environments influence consumers' product certainty and their behavioral engagement in marine recreational sport activities—an area previously underexplored in the literature.Results and discussionsBy collecting 292 survey responses and utilizing ordinary least squares (OLS) regression analysis, we found that both product quality certainty and product fit certainty have a significant positive effect on consumers' behavioral engagement. Additionally, both the regulatory-normative and cognitive institutional environments were shown to significantly enhance consumers' product quality and fit certainty. Moreover, age was found to moderate these effects, with a positive influence on the relationship between the regulatory-normative environment and product certainty, while only affecting the relationship between the cognitive institutional environment and product fit certainty.

Functional independence trajectories over 5 years in older veterans with traumatic brain injury: A model systems study.

Research on older adults who sustain a traumatic brain injury (TBI) has predominantly been on civilian, nonveteran populations. Military populations experience higher rates of TBI and often experience the additive effects of TBI and other comorbid disorders, including posttraumatic stress disorder and/or substance use that may increase disability over time. To investigate predictors of functional independence trajectories over the 5 years after TBI in veterans 55 years or older at injury. Five Veterans Affairs (VA) polytrauma rehabilitation center (PRC) inpatient rehabilitation programs. Veterans who experienced their TBI at 55 years or older and had completed one or more Functional Independence Measure (FIM) Motor and Cognitive measure at 1, 2, or 5 years after TBI (n = 184) from the VA TBI Model Systems national database. Retrospective analysis of observational data using hierarchical linear models. FIM Motor and Cognitive scores at 1, 2, and 5 years after TBI. Motor and cognitive functioning decreased over time. Lower FIM Motor trajectories occurred in participants who had pre-TBI functional limitations in going out of the home and with longer posttraumatic amnesia (PTA). FIM Motor scores decreased over time, and the decrease was steeper for those with a moderate or severe injury. Lower FIM Cognitive trajectories occurred in participants who had problematic substance use at baseline and among those with longer PTA. FIM Cognitive scores decreased at a steeper rate for participants with greater injury severity. Similar to previously published studies in civilian populations, older veterans with TBI may be at risk for functional and cognitive decline. This study's findings increase the field's understanding of functional trajectories after TBI in older adults and may help identifty those who are at risk for lower functional outcomes.

My IRA: Making Up Ground or Cashing It in?

We interpret participation in Individual Retirement Accounts (IRAs) in the United States over time from both an economic and socio-behavioral perspective. We report an IRA plateau with about 33% of families aged 30-64 participating during 1999 – 2007. The participation rate has fallen steadily to about 23% in recent years. From an economic perspective, expectations of greater non-pension retirement resources appear to induce a decline in IRA participation. Greater current resources lead to more persistent pension participation. In terms of social factors, we observe notable gender differences in the composition of IRAs.

Safety and Efficacy of Fecal Microbiota, Live-jslm (REBYOTA®), for the Prevention of Recurrent Clostridioides difficile Infection in Participants With Inflammatory Bowel Disease in PUNCH CD3-OLS.

Fecal microbiota, live-jslm (RBL; REBYOTA®), is the first single-dose, broad consortia, microbiota-based live biotherapeutic approved by the US Food and Drug Administration to prevent recurrent Clostridioides difficile infection (rCDI) in adults following standard-of-care antimicrobials. Inflammatory bowel disease (IBD) is a common risk factor for rCDI, yet patients with IBD are often excluded from prospective trials. This subgroup analysis of PUNCH CD3-OLS (NCT03931941) evaluated the safety and efficacy of RBL in participants with rCDI and IBD. Participants with IBD (ulcerative colitis [UC], Crohn's disease [CD], or unspecified) who had rCDI were included. Treatment-emergent adverse event (TEAE) data were collected for up to 6 months following RBL administration. Efficacy outcomes included treatment success at 8 weeks and sustained clinical response at 6 months. Overall, 793 participants were enrolled, and 697 received RBL; 74 had IBD (UC: n = 45; CD: n = 25; unspecified IBD: n = 4). TEAEs within 8 weeks of administration were reported by 45.9% and 47.5% of participants with and without IBD, respectively; most were mild or moderate gastrointestinal symptoms. Serious TEAEs within 8 weeks of administration were reported by 1.4% and 4.2% of participants with and without IBD, respectively. The treatment success rate at 8 weeks was 78.9%, and the sustained clinical response rate at 6 months was 91.1% in participants with IBD, similar to rates in participants without IBD (73.2% and 91.0%, respectively). The results of this subgroup analysis of PUNCH CD3-OLS suggest RBL is safe and efficacious in patients with IBD.

Referral for Diabetes Self-Management Education and Support in Adult Primary Care: An Integrative Review.

The purpose of this integrative review was to identify effective diabetes self-management education and support for increasing adult primary care referrals, participation rates and improving health outcomes for persons with diabetes. Integrative review. A systematic literature search of PubMed/MEDLINE, Embase and CINAHL was performed by applying the PRISMA guidelines. Following Whittemore and Knafl's method, 11 papers were included for review. Integration of diabetes self-management education and support in primary care clinics and a multifaceted approach resulted in improved referral and participation rates, ameliorated glycated haemoglobin A1C and boosted patient, provider and staff satisfaction. Patient-centred multifaceted interventions can boost current diabetes self-management education referrals and participation rates and enhance health outcomes for persons with diabetes. Nurses in their role as primary care providers, diabetes educators and clinic staff are well-positioned to undertake this intervention. Further investigation is needed to explore the impact of these interventions among individuals with type 1 diabetes, gestational diabetes and those living across various global regions. Along with other healthcare providers, nurses are qualified to advocate for, and lead programmes that increase referrals for persons with diabetes to improve health outcomes. Additionally, as primary care providers, nurse practitioners are well placed to positively impact the outcomes of individuals with diabetes by referring them to diabetes self-management education. Nurses, as diabetes educators, are well positioned to implement diabetes self-management education which can improve patient outcomes. Improved referral of persons with diabetes to diabetes self-management education and increased participation have the propensity to contribute to the achievement of positive health outcomes for individuals living with Type 2 Diabetes. There is no patient or public contribution for this review.

On-TRACC Pilot Study: A Novel Intervention for Persistent Post-Concussive Cognitive Symptoms.

To present the results of a pilot study of On-TRACC (Tools for Recovery and Clinical Care), a novel intervention for individuals experiencing persistent cognitive difficulties after mild traumatic brain injury (mTBI). On-TRACC is a 5-session, 1:1 manualized treatment that integrates psychoeducation, cognitive rehabilitation strategies, and self-management skills to target symptoms and increase understanding of the interaction between cognitive difficulties, injury history, and comorbid medical and psychological conditions. The primary study goals were to evaluate the feasibility, acceptability, and preliminary effectiveness of On-TRACC. Veterans Affairs medical center and an academic medical center. Veterans and civilian adults (n=28) >3months post-mTBI with current self-reported cognitive difficulties. In this single-group, open-label pilot study, all participants received On-TRACC (5 sessions) via video-based telehealth. Primary measures were feasibility (eg, session attendance and homework completion rate, dropout rate, and treatment fidelity) and acceptability (treatment satisfaction/helpfulness ratings). Preliminary effectiveness was explored by measuring pre- to post-intervention change in cognitive symptom level and attribution, perceived self-efficacy, use of compensatory strategies, daily functioning, quality of life, and planned future engagement in health care. The On-TRACC completion rate for all enrolled participants was 79% (with 88% treatment completion rate for participants who started On-TRACC); homework was fully or partially completed for 98% of attended sessions. Treatment satisfaction ratings were high, with 95% satisfied with the information and skills learned. There were no adverse events. Positive pre- to posttreatment changes were seen in cognitive self-efficacy, symptom attribution, functional status, quality of life, and planned engagement in care for comorbid conditions. On-TRACC was a feasible and acceptable intervention for individuals with chronic cognitive difficulties following mTBI. Additional research, including a randomized clinical trial, is needed to evaluate the efficacy of this intervention and its long-term impact on outcomes in this clinical population.