Rounds Of Surveys Research Articles

Multistate Markov chain modeling for child undernutrition transitions in Ethiopia: a longitudinal data analysis, 2002-2016.

The use of the multistate Markov chain model is a valuable tool for studying child undernutrition. This allows us to examine the trends of children's transitions from one state to multiple states of undernutrition. In this study, our objective was to estimate the median duration for a child to first transition from one state of undernutrition to another as well as their first recurrence of undernutrition and also to analyze the typical duration of undernourishment. This involves understanding the central tendency of these transitions and durations in the context of longitudinal data. We used a longitudinal dataset from the Young Lives cohort study (YLCS), which included approximately 1997 Ethiopian children aged 1-15years. These children were selected from five regions and followed through five survey rounds between 2002 and 2016. The surveys provide comprehensive health and nutrition data and are designed to assess childhood poverty. To analyze this dataset, we employed a Markov chain regression model. The dataset constitutes a cohort with repeated measurements, allowing us to track the transitions of individual children across different states of undernutrition over time. The findings of our study indicate that 46% of children experienced concurrent underweight, stunting, and wasting (referred to as USW). The prevalence of underweight and stunted concurrent condition (US) was 18.7% at baseline, higher among males. The incidence density of undernutrition was calculated at 22.5% per year. On average, it took 3.02months for a child in a wasting state to transition back to a normal state for the first time, followed by approximately 3.05months for stunting and 3.89months for underweight. It is noteworthy that the median duration of undernourishment among children in the US (underweight and stunted concurrently) state was 48.8months, whereas those concurrently underweight and wasting experienced a median of 45.4months in this state. Additionally, rural children (HR = 1.75; 95% CI: 1.53-1.97), those with illiterate fathers (HR = 1.50; 95% CI: 1.38-1.62) and mothers (HR = 1.45; 95% CI: 1.02-3.29), and those in households lacking safe drinking water (HR = 1.70; 95% CI: 1.26-2.14) or access to cooking fuel (HR = 1.95; 95% CI: 1.75-2.17) exhibited a higher risk of undernutrition and a slower recovery rate. This study revealed that rural children, especially those with illiterate parents and households lacking safe drinking water but cooking fuels, face an increased risk of undernutrition and slower recovery.

Use of mobile phones to collect data on COVID-19: phone access and participation rates, in Rakai, Uganda

ABSTRACT During the COVID-19 pandemic lockdown, we deployed a rapid, mobile phone-based survey to assess access and participation rates when using mobile phones to collect data on COVID-19 in Rakai, south-central Uganda. We sampled prior Rakai Community Cohort Study (RCCS) participants based on HIV status using mobile phone contacts. We administered a 30-minute phone-based interview to consenting participants to assess their knowledge about different aspects of COVID-19 and their access to care. Our analysis compares the mobile phone survey participation rates with historic participation rates in regular RCCS face-to-face interviews. We supplemented phone survey data with demographic, behavioral, and HIV status data from prior face-to-face RCCS surveys. Phone access in Round 19 of the RCCS was found to be 90.2%, with lower access among older people, and people living with HIV. When including only individuals who participated in the previous RCCS survey round, participation in the face-to-face survey (81.9%) was higher than participation in our phone survey (74.8%, p < .001). Survey participation was higher among people living with HIV compared to HIV-negative individuals (84.0% vs 81.4%, p < .001) in the face-to-face survey, but in the phone survey the reverse was found, with participation rates being higher among HIV-negative individuals compared to people living with HIV (78.0% vs 71.6%, p < .001). It was possible to collect data from an existing population cohort during the lockdown using phones. Phone access was high. Overall participation rates were somewhat lower in the phone survey, notably in people living with HIV, compared to the face-to-face survey.

Political interest, political ideology, and attitudes toward immigration

Although much research has been devoted to how political interest is related to different political outcomes, little is known about its influence on attitudes toward immigration. In line with deliberative theory, political interest should facilitate greater exposure to various perspectives via political discussions and other forms of political engagement that, in turn, should contribute to more positive attitude toward those with differing views or backgrounds. Using data from the European Social Survey, including 39 countries across 10 survey rounds 2002–2021, this study shows that political interest is positively related to immigrant acceptance. However, there is moderation effect of conservative values. Being politically interested is associated with a higher probability of holding pro-immigrant attitudes among weak conservatives, while there is no significant association among strong conservatives. This finding can be explained by the motivated cognition theory, which states that individuals tend to seek out and pay more attention to information that supports their strong pre-existing ideologies. For individuals with ideologies that predispose them to adopt very negative attitudes toward immigration (strong conservatives), being politically interested might entail a greater exposure and attention to ideology-congruent perspectives and, as a result, confirmation of initial predispositions.

Identifying the Needs of Paediatric-Friendly Care in Emergency Department: A Delphi Study.

To systematically analyse expert perspectives on paediatric-friendly care in the emergency department and establish specific indicators. With an increasing number of children seeking emergency care, nurses must understand the specific needs of paediatric patients and their families. A two-round modified Delphi method was used in this study. In this study, experts from clinical practice and academia assessed 56 paediatric-friendly care criteria in the emergency department. Data were collected to establish a consensus and ensure content validity. Thirty experts completed two survey rounds with response rates of 100% and 93.3%, respectively. In the initial survey, no consensus was reached for eight items. After the items were consolidated, 37 paediatric emergency-friendly care needs were identified. For each need, the item-level content validity index exceeded 0.79 for importance and feasibility. The average scale-level content validity index values were 0.95 and 0.92 for importance and feasibility. These needs were categorised into six dimensions: timely comfort (3 items), emotional care (5 items), frontline safety (11 items), emergency response (10 items), human resources support (5 items) and treatment efficiency (3 items). Paediatric emergency nurses play a vital role in caring for children, improving soft skills through compassion and training and ensuring a well-equipped, safe environment in the emergency department. This study offers valuable insights for emergency department nurses on the needs of children and their families, emphasising the importance of patient and family education, environmental considerations and the role of certified child life specialists in supporting the emergency healthcare team and ensuring appropriate paediatric care. No direct patient, service user, caregiver or public involvement existed in this study.

From subsidies to nutrition: Investigating effects among cohort children from the Subsidy Reinvestment programme in Nigeria

This study investigates the effect of a nationwide maternal health programme that targets both demand- and supply-side factors on the nutritional status of children under five years old whose mothers were potentially exposed to the programme. We employed a difference-in-differences approach by matching programme beneficiary facilities to the districts and communities where households reside. The data are drawn from the 2008, 2013, and 2018 rounds of Nigeria's Demographic and Health Surveys (DHS), comprising responses for approximately 120,000 children. Our findings reveal a significant increase in child dietary diversity, particularly in districts with two beneficiary facilities, suggesting stronger effects with expansive programme implementation. Additionally, we observed positive effects on children's consumption of various nutritious foods for those children in districts with two beneficiary facilities. This study investigates a potential mechanism by which expanding access to healthcare facilities, through funding two clinics per district, may contribute to improved child dietary diversity. Our findings suggest that, unlike districts with one beneficiary facility, those with two funded clinics have a higher likelihood of women engaging in work outside the home and earning cash for it. As shown in the analysis, this mechanism is likely due to easier access to health facilities and better contact with health officers, which facilitate quicker reintegration into the labour market for mothers after childbirth and, in turn, could lead to better maternal earnings and potentially enable a more diverse diet for children. The findings suggest that SURE-P's expansive implementation strengthens child nutrition outcomes and supports maternal economic empowerment. In areas with multiple SURE-P facilities, increased access to healthcare enables mothers to reintegrate into the labor market more quickly, facilitating cash income and fostering a reinforcing cycle of improved child dietary diversity and economic benefits for families. This highlights the potential of scaling such programs to maximize both health and economic outcomes in similar contexts.

Market Introduction and Sensory Evaluation of a Traditional, Revitalized “Back to the Future” Greek Cheese (Kashkaval Pindou)

Kashkaval Pindou is a traditional semi-hard cheese produced in Greece since the beginning of last century. Its production was halted in the last decades but has recently been revitalized using modern techniques. In this study, the quality and organoleptic criteria for this “recently introduced to the market” cheese in the dishes of selected restaurants and hotels was studied. Research was conducted in the city of Ioannina, Greece using two types of questionnaires via a survey which was carried out in person between September and December 2023, distributed to 18 experts, chefs, and owners of restaurants utilizing the Kashkaval Pindou cheese. The statistical analysis used was an approach of the Delphi methodology, which seeks consensual agreement within a group of experts. Following the two rounds of survey, the experts evaluated the 11 quality criteria for the use of the cheese in order of their preference (10–9 mean values): “Greek Tradition”, “ease of consumption”, “quality, healthy and safe properties”, “easy to be used product” and “ease of integration in the menu”. Of medium preference (9–8 mean values) was the cheese’s “geographic origin”, “producers’ and suppliers’ capacity”, “enhancement of the kitchen’s creativity”, and “value for money”. Last in the order of selection (8–7 mean values) was the cheese “reputation in the market” and “attractive packaging”. Regarding the organoleptic evaluation, the experts indicated the cheese’s pleasant taste, creamy texture, uniformity of the color, and buttery, milky foam aroma as high in their preference. These results, in agreement with findings in the existing literature, prove that Kashkaval Pindou fulfils the required quality and organoleptic criteria to become an appealing new cheese in the global market.

Association of fear of falling and low physical activity with fall risk among older Taiwanese community-dwellers

Background and purposeFear of falling and low physical activity become prevalent in an aged society, but their association with fall risk warrants further investigation.MethodsOur study involved 600 individuals aged 70.8–96.1 years who completed two rounds of community surveys. During the second survey, we analyzed the correlations between fall incidents and a range of factors, including age, sex, gait maneuverability, vision, comorbidity count, depressive symptoms, cognitive function, history of falls, fear of falling, and physical activity level. The chi-square test and univariate and multivariate logistic regression models were used, with further analyses either adjusted for or stratified by the full-factor combinations of fear of falling (with versus without) and low physical activity (low versus moderate-to-high).ResultsFalls exhibited a prevalence rate of 13.8%. A fall risk gradient by the full-factor combinations was observed. Multivariate logistic regression modeling identified independent risk predictors for falls, including the number of comorbidities, depressive symptoms, a history of falls, and fear of falling. Fear of falling and low physical activity presented a synergistic effect to increase the fall risk by two- and one-third times (adjusted odds ratio: 2.35, 95% confidence interval: 1.12–4.91). Depressive symptoms, cognitive impairment, and a history of falls remained as significant risk predictors for older adults with both factors, those with fear of falling only, and those with neither, respectively, when the models were further stratified.ConclusionFear of falling and low physical activity presented likely synergism to increase the fall risk. Those older community-dwellers with both risk factors warrant fall prevention resources as a priority over those with either or neither.

Sociodemographic and health disparities in self-care difficulties among older individuals: Evidence from South Africa

BackgroundAs South Africa’s population rapidly ages, the burden of non-communicable diseases and the challenges of performing daily care activities among older individuals are increasing. This study investigates trends in self-reported difficulties with daily care activities among older adults in South Africa and examines the association between these difficulties, sociodemographic factors, and chronic conditions.MethodsThe study used cross-sectional data from ten rounds of South Africa General Household Survey (2012–2021). Sample population included 26,362 men and 42,400 women aged 60 years and above. The outcome measure was assessed by self-reported difficulty in performing basic care activities such as washing or dressing.ResultsBetween 2012 and 2021, the percentage of participants reporting “A lot of difficulty” increased by 79.75%, “Some difficulty” increased by 112.11%, while “Unable to do” decreased by 8.97%. The risk of self-care difficulties was higher for men (RR = 1.11, 95% CI = 1.02, 1.20) and increased with age: RR = 1.24 (95% CI = 1.08, 1.42) for ages 65–69; RR = 2.27 (95% CI = 2.00, 2.58) for ages 70–74; and RR = 5.65 (95% CI = 5.08, 6.28) for ages 75+. Not being currently married (RR = 1.65, 95% CI = 1.51, 1.79), being of African/Black (RR = 1.21, 95% CI = 1.06, 1.38) or Coloured race (RR = 1.41, 95% CI = 1.21, 1.65), and having diabetes (RR = 1.44, 95% CI = 1.34, 1.55), hypertension (RR = 1.35, 95% CI = 1.26, 1.45), or asthma (RR = 1.30, 95% CI = 1.14, 1.48) were also associated with a higher risk of self-care difficulties.ConclusionThere was a notable increase in the proportion of participants reporting significant difficulty and some difficulty in performing self-care tasks, while a decrease was observed in the category of participants unable to do such tasks. Health policies should prioritize the specific needs of vulnerable sociodemographic and health groups, considering their increased risk of self-care difficulties.

Trend of immunization &amp; gap in vaccine doses as observed in National Family Health Survey rounds in India

Background &amp; objectives Immunization is an efficient and cost-effective way of lowering the infectious disease related morbidity and mortality in the community. The current study reviewed the trend of immunization, gaps in doses of vaccine given at the same time and gaps between the doses of same vaccine from National Family Health Survey (NFHS 1-5) rounds. Methods The current study extracted data from all five NFHS rounds conducted from 1992-93 to 2019-21. The study analyzed the State-wise and demography-wise distribution of trends of immunization from NFHS-1 to NFHS-5. State wise distribution of change in vaccination coverage between NFHS-4 and 5 was analyzed. The study also assessed the State-wise trends of fully vaccinated and unvaccinated children from NFHS 1-5. Results The northeastern States had maximum gap between the vaccination given at birth i.e., 47.3 per cent between BCG and Hepatitis B, and 32.8 per cent between BCG and birth dose of OPV in Manipur in NFHS -5. A gradual rise in the percentage of male (40.2%) and female (41.9%) childrens’ vaccination was found across the NFHS rounds with reduction in gap between the male and female vaccination from NFHS-1 (2.6%) to NFHS-5 (0.9%). The percentage of vaccination decreased proportionately with birth order. The vaccination coverage has increased in both urban and rural population, but the rise was higher in rural (45.9%) areas than urban (24.8%). An increase in percentage of fully vaccinated children by 41.2 per cent and decrease in percentage of non-vaccinated children by 26.4 per cent was observed from NFHS-1 to NFHS-5. Interpretation &amp; conclusions Our analysis clearly suggests that immunization coverage has improved over a period of time but the variability in vaccine coverage across States and gap in vaccine doses needs attention of the policy makers to cover this for achieving our national immunization goals.

Policy options to address the effectiveness of health service management graduates in solving Iranian health system challenges: a mixed scoping review and policy Delphi approach

Iran's healthcare system is grappling with multifaceted challenges, including financial constraints, staffing shortages, infrastructural deficiencies, legal hurdles, and cross-sectoral coordination issues. The integration of health service management graduates into the healthcare workforce is vital to tackle these obstacles effectively. However, the lack of skilled managers can exacerbate problems, leading to inflated costs, and wasted resources. This study aims to propose policy options to improve the effectiveness of healthcare management graduates in exposure to the challenges of Iran's health system. The study used a mixed-methods design that combined a scoping review and interviews with academics specializing in healthcare management and hospital management, as well as key informants of the Ministry of Health and Medical Education (MoHME), the vice chancellor and deans of faculties of management and paramedicine (December 1, 2022 to February 30, 2023), and a policy Delphi technique (April 1, 2023 to Jun 30, 2023). In the scoping review, we searched PubMed, Web of Science Platform, MEDLINE, Scopus, Google Scholar/Academia, and ERIC for articles published from the inception of each database until August 10, 2022, with an update on October 6, 2022. The search terms included "health services," "healthcare organizations," "healthcare management," "health management education," "Iran," "challenges," "issues," "policy," "interventions," "policy options," "solutions," "policy-making," "effectiveness," "efficacy," and similar terms. We incorporated scholarly articles that presented instances or resolutions demonstrating the impact of health service management graduates in addressing the issues encountered by Iran's healthcare system. Non-English research papers, except Persian, were excluded due to translation resource limitations. Articles from peer-reviewed journals were included based on their publication type, while conference abstracts, book reviews, commentaries, and editorial pieces were considered for review. In the present study, the first step of the modified Delphi methodology involved conducting interviews and qualitative content analysis. Then, through two rounds of online surveys, the policy Delphi technique engaged experts and stakeholders in reviewing and prioritising policy options. In the scoping review, our initial search of the main databases retrieved 553 articles, with an additional 14 articles from gray literature and 5 studies from local databases, totaling 572 references. 426 studies remained after removing duplicates and reviewing them. We excluded 339 studies that did not align with our study's objectives, leaving us with 87 articles. We had access to the full text of 63 of these studies and ultimately selected 31 for review and thematic analysis. The study involved 21 participants, with a 100% response rate in the interview phase. In the Delphi phase, 64 experts were invited, with 41 participating in Round 1 (64% response rate) and 32 in Round 2 (78% response rate). The scoping review identified eleven policy options, followed by designing an interview guide and presenting nine more options based on expert insights from the interviews. We evaluated twenty policy options using a 5-point Likert scale and modified Delphi methodology to assess their effectiveness, feasibility, relevance, and acceptance cost. The study produced four policy options that were culturally and ethically appropriate, as well as compatible with the context and target population. These options were: 1) training and capacity building based on Iran's health system model; 2) development of the framework of Entrustable Professional Activities (EPAs) for healthcare management graduates; 3) determining the career pathways of healthcare management graduates and reviewing the job categories approved by the Ministry of Health and Medical Education (MoHME); and 4) providing effective collaboration between healthcare management graduates and professionals, policymakers, and stakeholders for integrated health system improvement. The study provides evidence-based recommendations for improving the education, training, and professional deployment of healthcare management graduates in Iran. This work was supported by the National Agency for Strategic Research in Medical Education (NASR) (Grant Number 4020159).

A Delphi study on identifying environmental risk factors in the construction of China-Pakistan Economic Corridor (CPEC)

Abstract The China-Pakistan Economic Corridor (CPEC) represents a monumental initiative aimed at enhancing economic cooperation between China and Pakistan. However, the construction and operational phases of CPEC are fraught with numerous environmental risks that could impede its successful implementation. This study employs the Delphi method to systematically identify and evaluate the environmental risk factors associated with CPEC. A panel of experts from diverse fields, including environmental science, engineering, and regional planning, participated in multiple rounds of surveys to reach a consensus on the most critical environmental threats. Various studies have addressed general environmental impacts of large-scale projects, there is a gap in targeted research that systematically identifies and evaluates specific environmental risk factors associated with CPEC. This study aims to fill this gap by providing a detailed and consensus-based understanding. The findings highlight key risk areas such as carbon emission, climate change, air quality deterioration, and biodiversity loss. By providing a comprehensive risk assessment, this research offers valuable insights for policymakers, stakeholders, and project managers to develop robust mitigation strategies, ensuring the sustainable development of CPEC. The study underscores the importance of proactive environmental management in large-scale infrastructure projects within ecologically sensitive regions.

The future of public health in Europe

Abstract EuroHealthNet - in collaboration with the Copenhagen Institute for Futures Studies - has conducted a Foresight study to collect insights and identify risks and opportunities. The study investigates the role of public health by 2035 in achieving health equity through health promotion and prevention, in the context of the digital and green transition. The multi-round study ran from June to November 2023. It consisted of a workshop, a kick-off meeting, two rounds of surveys using the Delphi method, and a final back-casting expert panel. The Foresight exercise involved 35 experts across Europe and covered six themes: public health policy and governance; public health financing and spending; sustainability and the green transition; health promotion and disease prevention; equity and society; digitalisation in public health. The presentation will highlight some of the outcomes, recommendations as well as experiences from this Foresight exercise and how it can be applied in practice.

Defining medical deserts—an international consensus-building exercise

Abstract Background Medical deserts represent a pressing public health and health systems challenge. The COVID-19 pandemic further exacerbated the gap between people and health services, yet a commonly agreed definition of medical deserts was lacking. This study aims to define medical deserts through a consensus-building exercise, explaining the phenomenon to its full extent, in a manner that can apply to countries and health systems across the globe. Methods We used a standard Delphi exercise for the consensus-building process. The first phase consisted of one round of individual online meetings with selected key informants; the second phase comprised two rounds of surveys when a consensus was reached in January 2023. The first phase-the in-depth individual meetings-was organized online. The dimensions to include in the definition of medical deserts were identified, ranked and selected based on their recurrence and importance. The second phase-the surveys-was organized online. Finally, external validation was obtained from stakeholders via email. Results The agreed definition highlights five major dimensions: ‘Medical deserts are areas where population healthcare needs are unmet partially or totally due to lack of adequate access or improper quality of healthcare services caused by (i) insufficient human resources in health or (ii) facilities, (iii) long waiting times, (iv) disproportionate high costs of services or (v) other socio-cultural barriers’. Conclusions The five dimensions of access to healthcare: insufficient human resources in health or; facilities; long waiting times; disproportionate high costs of services and; other socio-cultural barriers, ought to be addressed to mitigate medical deserts. The term medical deserts might not be the most appropriate term for defining areas with insufficient access to health services as it excludes essential domains, such as access to public health and preventive services. Key messages • Medical deserts directly and negatively impact the health outcomes of the people living in it. • Medical deserts might not be the most appropriate term for defining areas with insufficient access to medical services, as it excludes public health and preventive services.

Quantifying Turkana’s wild edible plants’ contribution to critical micronutrient and dietary diversity among women of reproductive age

ABSTRACT This study explored wild edible plants’ (WEPs) contribution to dietary diversity and micronutrient intakes of women in Turkana County using a multi-method quantitative research design. In addition to the nutrient composition analysis of four vegetable plants and one edible fruit collected from the wild, two survey rounds were conducted – in 2020 during COVID (n = 360) and in 2022 during extreme drought (n = 600), to collect dietary intake data of women using 24-h recall. The study revealed that WEPs contribute 12% to 30% of the total daily food intake among women, and 0.6 to 1.4 food groups to dietary diversity, depending on the season. All the five WEPs tested contained on average 0.5 mg zinc, 6.4–25.5 mg iron, and 97.8–330.8 mg calcium per 100 g edible portion. This study demonstrates the significance of WEPs’ nutritional contribution to the Turkana communities’ diets, and their pivotal role during times of food scarcity, and recommends their promotion alongside measures to prevent their overexploitation.

Digital and other forms of contact between older European parents and children: the role of internet use, digital skills, emotional and geographical distance

ABSTRACT Guided by the intergenerational solidarity model and leveraging rich data from the European Social Survey round 10 (2020–2022), we examine the role of internet use, digital skills, emotional and geographical distance in influencing various forms of contact between parents aged 60 or above and their children. Emotional closeness emerges as a universal driver of contact of all forms. Geographical proximity is positively associated with face-to-face interactions, but negatively with video calls. Internet use and digital skills positively associate with digital contact. Our findings suggest that fostering digital inclusion among older adults is crucial, emphasizing the role of digital literacy in maintaining family connections in a digital world. Overall, our study provides insights into adapting familial bonds amidst the digital transformation.

01 Vaping, mental and physical health in adolescents in a COMPASS-Quebec cohort

Abstract Background Better knowledge of the association between vaping and youth’s health would help raise awareness among adolescents, parents, professionals and decision-makers on the likely threat it represents. Objectives Our objective is to examine the association between vaping, its frequency, and adolescent health. Design/Methods This observational study is based on data from the 2022-23 survey round of COMPASS-Quebec school cohorts through self-reported measures. It includes 45,203 respondents aged from 12 to 18 years old from 99 schools of Eastern Quebec. A four-modality variable depicts the vaping frequency in the last twelve months (abstinence, &amp;lt; once/month, ≥ once/month, ≥ once/week, daily). The measurement of health states is based on 5 dichotomous indicators: (i) good vs poor physical health (excellent, very good, good, vs fair, poor), (ii) maximum oxygen consumption considered at risk for health vs not (estimated VO2max, calculated using Léger’s equation); (iii) good vs poor mental health (excellent, very good, good, vs fair, poor); (iv) the presence vs absence of moderate to severe anxiety (GAD7, score ≥10/30) and; (v) the presence vs absence of significant depressive symptoms (CESD-R, score ≥10/21). Sex, age and family material deprivation level are taken into account as confounding factors. Results The proportion of adolescents who have vaped in the last 12 months is 26.8%. After adjustment, daily vaping is associated with poor physical health, a VO2max considered at risk for health, poor mental health, moderate to severe anxiety and significant depressive symptoms, compared to abstinence (adjusted relative risk [aRR] 2,46 [95%CI: 2,05-2,88]; 1,66 [95%CI: 1,44-1,89]; 1,88 [95%CI: 1,66-2,11]; 1,75 [95%CI: 1,53-1,97]; 1,55 [95%CI: 1,40-1,70]). A gradient in the associations between vaping frequency and lower mental health indicators has been observed. Adolescents who have vaped &amp;lt;once/month, ≥once/month, ≥once/week and daily have more risk of presenting moderate to severe anxiety (aRR 1,21 [95%CI: 1,09-1,33]; 1,44 [95%CI: 1,27-1,61]; 1,54 [95%CI: 1,37-1,72]; 1,75 [95%CI: 1,53-1,97]). Regarding significant depressive symptoms, aRR are 1,23 [95%CI: 1,14-1,32], 1,39 [95%CI: 1,27-1,51], 1,49 [95%CI: 1,36-1,62], 1,55 [95%CI: 1,40-1,70]. Regarding poor mental health, aRR are 1,29 [95%CI: 1,17-1,42], 1,61 [95%CI : 1,43-1,79], 1,63 [95%CI : 1,45-1,81], 1,88 [95%CI: 1,66-2,11]. Conclusion This study suggests a consistent association between health, both physical and mental, and use of electronic cigarettes in adolescents. Longitudinal studies would help clarify possible causal influence of vaping on youth's health.

Toward a Consensus on Strategies to Support Opioid Use Disorder Care Transitions Following Hospitalization: A Modified Delphi Process.

Despite proliferation of acute-care interventions to initiate medications for opioid use disorder (MOUD), significant challenges remain to supporting care continuity following discharge. Research is needed to inform effective hospital strategies to support patient transitions to ongoing MOUD in the community. To inform a taxonomy of care transition strategies to support MOUD continuity from hospital to community-based settings and assess their perceived impact and feasibility among experts in the field. A modified Delphi consensus process through three rounds of electronic surveys. Experts in hospital-based opioid use disorder (OUD) treatment, care transitions, and hospital-based addiction treatment. Delphi participants rated the impact and feasibility of 14 OUD care transition strategies derived from a review of the scientific literature on a scale from 1 to 9 over three survey rounds. Panelists were invited to suggest additional care transition strategies. Agreement level was calculated based on proportion of ratings within three points of the median. Forty-five of 71 invited panelists participated in the survey. Agreement on impact was strong for 12 items and moderate for 10. Agreement on feasibility was strong for 11 items, moderate for 7, and poor for 4. Strategies with highest ratings on impact and feasibility included initiation of MOUD in-hospital and provision of buprenorphine prescriptions or medications before discharge. All original 14 strategies and 8 additional strategies proposed by panelists were considered medium- or high-impact and were incorporated into a final taxonomy of 22 OUD care transition strategies. Our study established expert consensus on impactful and feasible hospital strategies to support OUD care transitions from the hospital to community-based MOUD treatment, an area with little empirical research thus far. It is the hope that this taxonomy serves as a stepping-stone for future evaluations and clinical practice implementation toward improved MOUD continuity and health outcomes.

Expert consensus on the clinical application of cortical bone trajectory for lumbar pedicle screws: results from a modified Delphi study.

A modified Delphi study. This study sought to establish expert consensus on the use of cortical bone trajectory (CBT) for lumbar pedicle screws. The CBT technique is widely used in the treatment of various degenerative lumbar diseases because it reduces surgical time, soft tissue exposure, and blood loss; improves biomechanical stability; and allows for faster patient recovery. However, as an emerging surgical technique, CBT remains controversial in terms of preoperative evaluation methods, key surgical techniques, complication prevention and treatment, postoperative follow-up, and other aspects, resulting in unclear indications and contraindications for some doctors and posing great challenges to the steady promotion of this technique. From May 2021 to August 2021, panelists were chosen to collect expert feedback using the modified Delphi method, and 74 spine surgeons from across China agreed to participate. Four rounds were conducted: one in-person meeting and three subsequent survey rounds. Each question received at least 70.0% agreement, indicating a consensus. The grade A, B, and C recommendation were defined as having ≥90.0%, 80.0%-89.9%, and 70.0%-79.9% agreement on each question, respectively. The panelist group consisted of 74 experts, and 72, 70, and 69 questionnaires were collected in three rounds, respectively. In total, 24 questions with 59 options reached consensus after the Delphi rounds, including indications (adjacent vertebral diseases after lumbar internal fixation) and contraindications (previous surgery or bone destructive diseases lead to the destruction or absence of bone in the lamina or isthmus); advantages (intraoperative traction of paravertebral soft tissue is small) and disadvantages (not three-column fixation.); preoperative evaluation; complications; and postoperative follow-up evaluation, of CBT. The modified Delphi method achieved expert consensus on the clinical use of CBT for lumbar pedicle screws. This consensus document establishes clear guidelines for indications, contraindications, surgical techniques, and postoperative management, thereby enhancing clinical decision-making and promoting the safe and effective use of CBT. While the initial study focused on Chinese surgeons, future research will seek to validate and expand these findings from a broader international perspective.

COVID-19 and protection measures adopted in rural amazon communities during the first months of the pandemic.

Motivation for the study. To document the evolution of COVID-19 in rural Amazonian populations, which are still little known. Main findings. COVID-19 spread rapidly through rural communities, initially spreading to mestizo hamlets and later affecting indigenous communities. Rural mortality varied by region and ethnicity. Social distancing was difficult, and travel to receive government vouchers contributed to contagion. Implications. Identifying the factors that contributed to contagion and the barriers to the adoption of protective measures in rural Amazonian populations will help to face future pandemics. To analyze the evolution of COVID-19 in rural populations of Loreto and Ucayali in the early stage of the pandemic. A community-level longitudinal observational study was conducted and based on two rounds of telephone surveys with local authorities of more than 400 indigenous and non-indigenous rural communities in Loreto and Ucayali, in July and August 2020. We collected information on cases and deaths by COVID-19 in their communities, protective measures adopted and if state assistance was received in the early stage of the pandemic. Descriptive statistics allowed us to evaluate the evolution of the pandemic after the initial outbreak and compare the trends of the two regions, as well as between indigenous and non-indigenous populations. In July 2020, COVID-19 had reached 91.5% of the communities, although deaths from COVID-19 were reported in 13.0% of the communities, with rural mortality being higher in Ucayali (0.111%) than in Loreto (0.047%) and in non-indigenous communities. By August, prevalence decreased from 44.0% to 32.0% of communities, but became more frequent in indigenous communities, and those in Ucayali. Traveling to the city to receive state bonuses and difficulties maintaining social distancing contributed to the spread. Our findings show the evolution of COVID-19 in rural communities and point to important areas of attention in future public policies, for the adoption of protective measures and reconsidering strategies for the distribution of assistance in the face of future pandemics. Motivation for the study. To document the evolution of COVID-19 in rural Amazonian populations, which are still little known. Main findings. COVID-19 spread rapidly through rural communities, initially spreading to mestizo hamlets and later affecting indigenous communities. Rural mortality varied by region and ethnicity. Social distancing was difficult, and travel to receive government vouchers contributed to contagion. Implications. Identifying the factors that contributed to contagion and the barriers to the adoption of protective measures in rural Amazonian populations will help to face future pandemics.

The knowledge and skills needed for forensic social work in Australia: A Delphi study

Summary Forensic social work is the application of social work knowledge, skills, values and ethics within a legal and criminal justice context. Globally, social workers play an integral role in the criminal justice system but in many countries, including Australia, there is limited conception of the competencies needed for this specialist practice. Australia serves as an example of forensic social work regulated through a generalist social work competency framework, where specialist skills and knowledge are not distinctly outlined or assessed. The purpose of this study was to identify the knowledge and skills used by forensic social work practitioners in Australia. This study used a 3-round Delphi method with an expert panel of social workers working in forensic practice across Australia. It consisted of a 1-hour semi-structured individual interview followed by 2 rounds of online surveys. Findings Consensus was obtained for 30 skill and knowledge items for Australian forensic social work. The panel identified these competencies as specialist, meaning requiring further training beyond generalist proficiency. Of these, eight of the skill and knowledge items were seen as essential for graduates entering forensic social work. Applications The findings from this study contribute to an evidence-based model of forensic social work competency. In Australia, they can be used to consider potential gaps between current generalist mechanisms and specialist practice expectations. With further research, these findings can be used to inform professional standards for forensic social work in Australia and potentially internationally.