Secondary Data Analysis Research Articles

Associations between lifestyle and well-being in early and late pregnancy in women with overweight or obesity: Secondary analyses of the PEARS RCT.

The associations between individual lifestyle behaviours and well-being are still poorly understood, particularly in the antenatal period when women are exposed to physiological changes and increased psychological distress. A healthy lifestyle score (HLS) comprising protective lifestyle behaviours may be useful for studying links between overall lifestyle and psychosocial outcomes. This study aimed to examine bidirectional associations between a HLS and its components and psychological well-being in pregnant women with overweight/obesity. Secondary analyses of data from the PEARS trial. Healthy lifestyle scores (scored 0-5) based on maternal diet (AHEI-P), physical activity (MET-minutes), alcohol consumption, smoking, and sleep habits were created for 330 and 287 mothers with overweight/obesity in early (14-16 weeks gestation) and late pregnancy (28 weeks gestation), respectively. Psychological well-being was measured with the WHO-5 well-being index. Cross-lagged path models (crude/adjusted) tested the directionality of relationships between lifestyle (composite score/individual components) and well-being cross-sectionally and over time in pregnancy. The mean early pregnancy BMI was 29.2 kg/m2. The mean well-being score was 56.3% in early and 60.7% in late pregnancy. Significant autoregressive effects were observed for the HLS, all individual components, and well-being from early to late pregnancy. Well-being was positively correlated with the HLS, physical activity, and sleep variables within time points (in early and/or late pregnancy). Sleep and no smoking in early pregnancy predicted higher well-being in late pregnancy. Overall healthy lifestyle, physical activity, and especially sleep duration and quality are associated with psychological well-being in pregnancy, and should be promoted antenatally.

The Role of Negative Affect and Experiential Avoidance in Postsurgical Pain and Fatigue Among Norwegian Women With Breast Cancer.

Women undergoing breast cancer surgery frequently experience postsurgical pain and fatigue, which reduces their quality of life. Although psychological factors have been shown to play a role in predicting postsurgical outcomes, the subacute recovery phase often remains underexplored. In this secondary analysis of data from a randomised controlled trial, we sought to investigate the predictive role of negative affect and experiential avoidance on postsurgical symptoms during both acute and subacute recovery. From the initial sample, 189 women who met the inclusion criteria completed the Acceptance and Action Questionnaire (AAQ-II) before surgery to assess levels of negative affect and experiential avoidance. Postsurgical pain and fatigue were measured at hospital discharge and again 3-4 weeks later using a 100 mm Visual Analogue Scale (VAS). Bivariate linear regression analyses revealed that higher presurgical negative affect and experiential avoidance significantly predicted increased levels of all acute and subacute postsurgical symptoms (all p ≤ 0.027). After adjusting for covariates in multivariate regression analyses, the AAQ-II remained a predictor of acute pain unpleasantness (p = 0.011) and fatigue (p = 0.048), although the effect estimates were modest. These findings underscore the need to take psychological factors into account in treatment planning for acute postsurgical symptoms in order to develop more individualised approaches to optimise recovery for women undergoing breast cancer surgery. Women with higher levels of negative affect and experiential avoidance before undergoing breast cancer surgery appear to be at greater risk for experiencing heightened acute postsurgical pain and fatigue. The identification of these psychological predictors can help clinicians recognise individuals at risk for severe postoperative symptoms and develop targeted preventive and curative interventions to mitigate these symptoms and prevent them from becoming chronic.

Two minutes is sufficient to characterize the viscoelastic properties of the human lower birth canal during the first stage of labor.

The lower birth canal is the final constriction through which a fetal head must pass for delivery. Unfortunately, injuries to the lower birth canal tissues occur in up to 19% of first-time vaginal deliveries due to the 300% stretch required. This is a secondary analysis of data from 56 healthy nullipara recorded by a lower birth canal dilator during the first stage of labor. A four parameter Fractional Zener rheological Model was used to characterize the canal viscoelastic properties during the first stage of labor. We tested the (null) hypothesis that the Model constants identified during the initial 20s ramp-and-5-min-hold dilation from 40 to 55mm will not accurately predict the final hoop tension after 60min of slower dilation. The null hypothesis was rejected in that when the four Model parameters were calculated for all nullipara from the 20-s-ramp-and-5-min-hold data, the relative fit error was 8±4%, and the relative prediction error after 60min of dilation was 10±5%. Furthermore, when the Model constants were instead calculated from the 20s ramp and only the initial 90s of the 5-min-hold, the error was still acceptable: 13±4% for relative fit and 13±18% for relative prediction. Two minutes is sufficient to characterize canal viscoelastic properties during the first stage of labor and identify those with stiffer tissues at higher risk for a pelvic floor injury during delivery. This could form the basis for a clinical test predicting injury.

COVID-19 policy response: Perspectives of key stakeholders in Mexico's health system and implications for resilience

PurposeThis study aims to analyze the perspectives of key stakeholders within Mexico's health system regarding the policy response to COVID-19 in 2020 to inform future policy formulation. MethodsThis qualitative study is based on a secondary data analysis (SDA) derived from a broader primary research on governance in Mexico during the COVID-19 pandemic. The analysis adopted a grounded theory approach to examine 15 semi-structured interviews with prominent figures in the health system between June and November 2020. The interviews were audio-recorded and analyzed through the lens of the Health Policy Triangle which includes context, key actors, and the Mexican health policy process. Moreover, the analysis was enriched by incorporating the framework outlined in the World Health Organization's COVID-19 Strategic Preparedness and Response Plan (SPRP). ResultsThe findings indicate that key stakeholders perceived a centralized approach to policymaking with a strong emphasis on cross-sector communication, expert panels, equity-focused measures, accessibility to healthcare services (promoting portability), and improvements in the health information system. ConclusionKey stakeholders recognized the response to COVID-19 was complex, involving multiple dimensions and levels of action. The importance of preparedness and response in building health system resilience is emphasized. Recommendations include explicitly integrating resilience into national and local policy agendas, addressing systemic structural deficiencies, promoting equity in the pandemic response, improving risk governance, strengthening coordination mechanisms, ensuring supply chain resilience, improving personnel training, and enhancing local diagnostic capacity to better prepare for future public health emergencies.

The Predictors of Dietary Supplement Use Among Women With Musculoskeletal Disease: A Population-Based Complex Sample Designed Study.

Supplement use is influenced by personal factors such as sex, knowledge, health status, and sociocultural factors. Korean women with musculoskeletal disease commonly use dietary supplements for purposes such as symptom relief. This study aimed to identify the differences in demographics, health status, and functional health literacy depending on the use of dietary supplements in Korean women with musculoskeletal disease. A cross-sectional study and secondary data analysis were designed using a representative, multilevel stratified cluster sample from the 8th wave (2019) of the National Health and Nutrition Examination Survey, a national statistical survey encompassing health status, health behaviors, and food and nutrient consumption. Data on 804 women aged 20 years or older with musculoskeletal disease were included. A complex samples χ2-test was conducted to compare all variables such as demographics, health status, and functional health literacy. As results, significant differences were found between the dietary supplement user and non-user groups in terms of age (χ2 = 12.21, P = .009), type of health insurance (χ2 = 4.01, P = .049), education level (χ2 = 42.86, P < .001), and presence of diabetes mellitus (χ2 = 9.16, P = .005). Functional health literacy was higher in the user group than in the non-user group (χ² = 5.48, P = .050). We found that younger individuals with health insurance, higher educational levels, and functional health literacy, and who do not have diabetes are likely to use dietary supplements. Healthcare providers should continue to monitor the use of dietary supplements among women with musculoskeletal diseases to ensure their safe and effective use.

Cost-effectiveness of NALIRIFOX compared to other first-line treatments for metastatic pancreatic cancer.

733 Background: NALIRIFOX was recently approved for first-line treatment of metastatic pancreatic cancer, where combination chemotherapy remains the main treatment modality. We conducted a cost-effectiveness analysis of NALIRIFOX compared to both FOLFIRINOX and gemcitabine/protein-bound paclitaxel (GP). Methods: A partitioned survival model with three health states (progression-free, post-progression and death) was constructed to model the disease course. Using published data from NAPOLI-3, parametric survival curves were generated for NALIRIFOX, from which survival curves for FOLFIRINOX and GP were extrapolated using pooled efficacy data reported by a network meta-analysis of clinical trials. Model inputs were retrieved from the literature or other publicly available resources. Specifically, drug acquisition costs were from average wholesale prices in the Red Book while administration, disease monitoring and supportive care costs were from the CMS Physician Fee Schedule. Utility values to estimate quality-adjusted life years (QALY) were from the CALGB80303 trial. Adverse effects that were considered included anemia, neutropenia, febrile neutropenia, thrombocytopenia, diarrhea, peripheral neuropathy, nausea and vomiting, and fatigue. Adverse effect rates were based on data pooled from clinical trials while costs and disutility were obtained from a secondary analysis of claims data and a clinician survey, respectively. The time horizon was 5 years and utilized a third-party payer perspective. Both costs ($USD 2024) and outcomes were discounted at 3% annually. A probabilistic sensitivity analysis was conducted by varying model parameters based on 95% confidence intervals if known or 10% in both directions otherwise. Results: The overall cost associated with NALIRIFOX was $129,314, followed by GP ($104,593) and FOLFIRINOX ($41,528). Among the 3 regimens, NALIRIFOX incurred the highest treatment-related cost ($105,533) but the lowest adverse effects management cost ($16,541). On average, patients on NALIRIFOX gained a total of 1.14 life years (LY) or after adjusting for utility, 0.86 QALY. FOLFIRINOX led to 1.09 LY or 0.82 QALY while GP resulted in 0.99 LY or 0.75 QALY. Due to its higher cost and lower survival benefit, GP was dominated by FOLFIRINOX. Compared to FOLFIRINOX, the incremental cost-effectiveness ratio (ICER) of NALIRIFOX was $1,952,062/QALY. In our sensitivity analysis, the probability of NALIRIFOX being cost-effective was 0% at all conventional ICER thresholds up to $200,000/QALY. Conclusions: Due to the high drug acquisition cost, the ICER of NALIRIFOX far exceeds currently acceptable thresholds for economic value and NALIRIFOX is considered not cost-effective. This is despite that in our model among first line treatments for metastatic pancreatic cancer, NALIRIFOX was associated with reduced costs for managing adverse effects.

Differences in Emotional Awareness Moderate Cytokine-Symptom Associations Among Breast Cancer Survivors.

Cancer survivors have elevated levels of proinflammatory cytokines, which could be associated with cancer-related symptoms. Given that proinflammatory cytokines heighten negative affect by directly affecting the brain, we explored these direct associations and whether differences in levels of emotional awareness moderate the associations between proinflammatory cytokines and cancer-related symptoms. This cross-sectional, secondary analysis of baseline data was collected from 162 female breast cancer survivors (aged 36-70years), who were enrolled 6±4 months after completing cancer treatment. We tested cytokines in serum (IL-1β, IL-6, IL-8, TNF-α, IL-4, IL-10, and TGF-β) and assessed depression, cancer-related fatigue, pain intensity, and pain interference. Emotional awareness was assessed using a performance measure, the Levels of Emotional Awareness Scale. In participants with high but not average or low levels of emotional awareness, positive associations were found for IL-1β, IL-6, and TNF-α with depression and between IL-6 and TNF-α with pain intensity. In addition, IL-6 had a positive association with pain intensity at average levels of emotional awareness. These results suggest that women with high or in some cases average, but not low, emotional awareness reported depression and pain as being positively associated with their cytokine levels. By using emotional awareness as a cognitive resource to promote emotion regulation and distress transformation, interventions may be able to counteract heightened sensitivity to the mood-altering effects of cytokines.

Discussing Weight in Real World GP Consultations: A Video Recording Analysis Study.

GPs have a complex role in obesity management due to patients' individualized experience of living with obesity, coupled with the challenge to deliver healthcare messages in non-stigmatizing ways. This study aimed to explore who initiatesthe topic of weight and how weight was discussed in real-world GP-patient consultations. A multi-disciplinary team, including obesity lived experience experts, undertook a secondary data analysis of 43 Australian video recorded consultations and patient surveys from The Digital Library using descriptive content analysis. 17/43 consultations included the topic of weight in the discussion. 15 were initiated by the GP and 2 by the patient. 14/17 used a structured approach. All GPs asked for consent to discuss weight or gave patients space to decline the discussion. No overt stigmatizing language was identified. A post-consultation survey found 15/17 patients (2 unanswered) felt listened to and respected during consultations. This study identified the intricate ways GPs approach weight discussions in consultations. GPs navigated weight discussions in ways that made patients feel respected and listened to and related weight to health concerns relevant to each patient. The findings in this study can serve as a foundation for establishing education and training resources for GPs and can be utilized as a way of continuing professional development. Any future communication technique resources for GPs should be co-designed with obesity lived experience experts to ensure appropriateness and avoid potential stigma and harm.

Who participates in the 'Celebrate Recovery' mutual-help organization? Results from a National US Investigation.

Celebrate Recovery (CR) is a new, rapidly growing mutual-help organization (MHO) based on Christian principles and is the largest religious MHO in the US. However, very little is known about CR empirically. Secondary data analysis of the National Recovery Study (NRS) (Kelly et al., 2017) compared CR attendees to lifetime MHO attendees with non-CR attendance on survey-weighted estimates of 1) demographic and substance use characteristics, 2) treatment and recovery support service histories, and 3) current recovery-related functioning. Compared to non-CR MHO participants (49 years), the mean age for CR participants (43 years) was younger (d = -0.32; p = 0.008). Relative to participants with alcohol as their primary substance, participants identifying methamphetamines as their primary substance had 5.12 times greater odds of being in CR versus non-CR MHO (p = 0.002). Participants reporting 15 + years (vs. 0-5 years) since alcohol/drug problem resolution had 60 % lower odds of being in CR versus non-CR MHO (p = 0.029). Participants attending other faith-based recovery meetings had 11 times greater odds of being in CR than non-CR MHOs (p < 0.001). CR and non-CR MHO participants did not differ in current quality of life, happiness, self-esteem, psychological distress, and recovery capital. Compared to non-CR MHO attendees, CR attendees may be slightly younger and earlier in their recovery, have primary stimulant drug problems, and are more likely to have tried other faith-based services. CR's widespread and growing availability suggests it may offer an alternative recovery support resource, particularly for Christians.

Which factors influence emotional overeating among workers and students? Is online food delivery consumption involved? Results from the DELIvery Choice In OUr Society (DELICIOUS) cross-sectional study.

Emotional overeating (EO) is a complex behavior that involves consuming excessive food in response to emotions, presenting health risks due to poor dietary choices. Research indicates a notable prevalence of EO, especially among females, and its association with disordered eating behaviors like binge eating (BE). The rise of online food delivery (OFD) services has raised questions about their potential role in exacerbating EO. This study aimed to explore EO behaviors among Italian workers and students, assessing the influence of various personal, socio-demographic, and lifestyle factors, including OFD. This study is a secondary data analysis utilizing the DELICIOUS survey data, conducted nationwide through social media platforms from July 12, 2022, to February 1, 2023. Participants completed validated questionnaires, including the EO Questionnaire (EOQ-5). The sample was stratified according to worker/student status. Statistical analyses, including descriptive statistics (chi-squared tests, Mann-Whitney tests) and multivariable logistic regression, were performed to assess the influence of key variables on EO. The sample comprised 2853 workers and 898 students, with almost 75% exhibiting EO behavior above the threshold. Several factors were significantly related to a higher occurrence of EO. Positive associations included bad health literacy, female gender, occasional smoking, higher BMI, depression risk for students, and low work-life balance, job dissatisfaction, screen time while eating, and depression risk for workers. Surprisingly, OFD usage showed no relationship with EO. While some findings align with previous research, like the depression-EO link, others, such as the absence of a link between OFD and EO, were unexpected. The results suggest that personal, socio-demographic, and lifestyle factors significantly influence EO, with OFD serving more as a means of food access influenced by individual characteristics, rather than a direct EO risk factor.

Under nutrition among low-income Guatemalans

This study examines the dietary and health difficulties encountered by impoverished communities in Guatemala, with the goal of gaining a thorough understanding of the intricate elements that affect health outcomes in these marginalized people. The study used a mixed-methods approach, integrating quantitative analyses of secondary and primary data with qualitative insights obtained through interviews and focus group discussions. The research findings emphasize a substantial prevalence of moderate health problems among the communities under study, as seen by the concentration of health outcomes around a value of 70. The consumption of nutrients has been identified as a critical factor in determining health outcomes, since a lower intake is linked to inferior health. Positive associations were observed between socioeconomic level, access to healthcare services, and health outcomes. These findings add to the wider discussion on health inequalities and the factors that influence health in low-income environments. The study emphasizes the significance of focused interventions, advocating for dietary programs, poverty reduction initiatives, and enhanced healthcare access. It highlights the importance of empowering the community, encouraging their involvement, and adopting comprehensive strategies to tackle the complex issues faced by these communities.

National critical infrastructure protection via supply chain security in the United States of America

The protection of critical infrastructure in the United States is vital for ensuring national security, economic stability, and public safety. As sectors such as energy, transportation, water, and communications become increasingly reliant on globalized supply chains, vulnerabilities to cyberattacks, natural disasters, and geopolitical tensions have heightened. This study examines the role of secure supply chain practices, including vendor screening, technology integration, and adherence to regulatory frameworks, in mitigating risks to critical infrastructure. Through content and thematic analysis of secondary data, this research identifies key security measures, such as blockchain, artificial intelligence (AI), and real-time monitoring, which enhance the resilience of supply chains. The study highlights the importance of cybersecurity, intermodal coordination, and geopolitical risk management in safeguarding infrastructure. Case studies, particularly the 2021 Colonial Pipeline ransomware attack, emphasize the need for proactive security measures, such as continuous monitoring, regular cybersecurity assessments, and improved stakeholder collaboration. The study provides strategic recommendations for strengthening supply chain security, including prioritizing vendor screening, adopting advanced technologies, enhancing intermodal coordination, and diversifying supply networks to mitigate geopolitical risks. These measures are essential for reinforcing the resilience, efficiency, and continuity of critical infrastructure in the face of evolving threats.

Financial literacy and data analysis impacts on business sustainability

Financial literacy and data analysis have emerged as critical drivers of business sustainability in an increasingly complex and competitive global economy. This study explores the interplay between financial literacy and data analytics, examining their combined impact on enhancing profitability, operational resilience, and long-term sustainability. Financial literacy equips business leaders with the knowledge and skills to make informed decisions, manage resources effectively, and mitigate financial risks. Meanwhile, data analysis provides actionable insights that bridge gaps in financial decision-making, enabling businesses to forecast trends, optimize operations, and adapt to dynamic market conditions. By integrating these capabilities, organizations can foster a culture of data-driven decision-making that enhances resource efficiency and supports sustainable growth. This research employs a mixed-methods approach, utilizing quantitative surveys and secondary data analysis to evaluate the relationship between financial literacy and data analytics in small and medium enterprises (SMEs). The findings highlight actionable strategies for improving financial literacy, adopting analytics tools, and overcoming barriers to integration. This study contributes to the theoretical understanding of financial literacy and data analytics synergy and offers practical recommendations for fostering sustainability in modern business practices.

Incidence and treatment of anastomotic leakage after esophagectomy in German acute care hospitals: a retrospective cohort study.

Anastomotic leakage (AL) is a major concern following esophagectomy due to the associated morbidity and mortality. The impact of hospital volume on postoperative outcomes after esophagectomy has previously been reported. The aim of this study was to analyze the current trends in postoperative anastomotic leakage and associated failure-to-rescue after esophagectomy in relation to hospital volume in German acute care hospitals using real-world data from the German Diagnosis-Related Groups (G-DRG) database. A retrospective secondary data analysis of the G-DRG database was performed for all in-hospital cases of patients undergoing esophagectomy from 2013 to 2021. AL and in-house mortality rates were assessed in relation to hospital case volume and endoscopic treatment modalities. The study included 32335 cases. The mean reported AL rate was 17.1% with a mean failure-to-rescue rate of 18.9%. AL rates did not differ between hospitals with an annual case-volume ≤ 25 procedures/year vs.>25 procedures/year (16.8% vs. 17.6%, OR 1.06, P =0.07). However, in high-volume centers (> 25 procedures/year), in-hospital mortality for cases with AL (failure-to-rescue) was lower compared to medium-volume (10-25 cases/year) and low-volume (1-9 cases/year) centers (14.2% vs. 21.5% vs. 25.1%). The use of EVT increased over time, reaching 58.1% of AL cases in 2021 compared to 14.2% in 2013, while the use of self-expanding metal stents (SEMS) decreased from 37.0% in 2013 to 9.3% in 2021. AL rates after esophagectomy remain high. In-house mortality is significantly lower in high-volume hospitals highlighting the importance to consider improvements in centralization of procedures. Further efforts are needed to reduce AL rates and improve outcomes after esophagectomy.

Sex Differences in Circadian Timing and Biological Night in Adolescents.

Circadian rhythms, intrinsic 24-h cycles that drive rhythmic changes in behavior and physiology, are important for normal physiology and health. Previous work in adults has identified sex differences in circadian rhythms of melatonin, temperature, and the intrinsic period of the human circadian timing system. However, less is known about sex differences in circadian rhythms at other developmental stages. To address this gap, we considered a secondary analysis of sleep and circadian data from two studies involving adolescent participants during the academic year: (n = 32, 15 females). We collected 1 week of in-home actigraphy data to calculate sleep-wake parameters and in-laboratory salivary melatonin data collection in dim-light conditions was used to compute dim-light melatonin onset (DLMO) and offset (DLMOff) using a threshold of 4 pg/mL. We found that DLMO was an average of 96 min earlier, the time between DLMO and bedtime was an average of 56 min greater, and the biological night (time between DLMO and DLMOff) was 60 min longer in females compared to males, even though bedtimes and waketimes were not statistically different between the groups. In addition, after accounting for differences in bedtime, sex was still a significant predictor of DLMO. Conversely, no evidence was found indicating a difference in DLMOff or the phase angle between DLMOff and waketime by sex. These findings suggest that sex differences in circadian rhythms are present in adolescents and may have implications for circadian health during this important developmental period.

Neurobehavioral Symptoms Partially Mediate the Effects of Depression and PTSD on Participation for Veterans With Mild Traumatic Brain Injury: A Cross-Sectional Study.

To examine whether neurobehavioral symptoms mediate the relationship between comorbid mental health conditions (major depressive disorder [MDD] and/or posttraumatic stress disorder [PTSD]) and participation restriction among Veterans with mild traumatic brain injury (mTBI). Veterans Health Administration (VHA). National sample of Veterans with mTBI who received VHA outpatient care between 2012 and 2020. Secondary data analysis of VHA clinical data. We specified a latent variable path model to estimate relationships between: (1) comorbid mental health conditions and 3 latent indicators of neurobehavioral symptoms (vestibular-sensory; mood-behavioral; cognitive); (2) latent indicators of neurobehavioral symptoms and 2 latent indicators of participation restriction (social and community participation; productivity); and (3) comorbid mental health conditions and participation restriction. International Classification of Diseases codes, Neurobehavioral Symptom Inventory, and Mayo-Portland Adaptability Inventory Participation Index to measure mental health conditions, neurobehavioral symptoms, and participation restrictions, respectively. Indirect effect estimates indicated that comorbid MDD and/or PTSD was associated with greater social and community participation restrictions, as mediated by mood-behavioral (β=.22-.33; 99% CI 0.18-0.4; small to medium effect) and cognitive symptoms (β=.08-.13; 99% CI 0.05-0.18; small effect), and with greater productivity restrictions, as mediated by vestibular-sensory (β=.06-.11; 99% CI 0.04-0.15; small effect) and cognitive symptoms (β=.08-.13; 99% CI 0.05-0.18; small effect). Direct effect estimates indicated that comorbid MDD and/or PTSD was associated with greater challenges with both social and community participation (β=.19-.40; 99% CI 0.12-0.49; small to medium effect) and productivity (β=.08-.44; 99% CI-0.02 to 0.55; small to medium effect). Neurobehavioral symptoms partially mediated the impact of MDD and/or PTSD on participation restrictions among Veterans with mTBI. These findings advance the understanding of explanatory mechanisms underlying participation challenges among Veterans with comorbid mTBI and mental health challenges, thereby informing the development of tailored intervention strategies.

Engagement With an Internet-Administered, Guided, Low-Intensity Cognitive Behavioral Therapy Intervention for Parents of Children Treated for Cancer: Analysis of Log-Data From the ENGAGE Feasibility Trial.

Parents of children treated for cancer may experience psychological difficulties including depression, anxiety, and posttraumatic stress. Digital interventions, such as internet-administered cognitive behavioral therapy, offer an accessible and flexible means to support parents. However, engagement with and adherence to digital interventions remain a significant challenge, potentially limiting efficacy. Understanding factors influencing user engagement and adherence is crucial for enhancing the acceptability, feasibility, and efficacy of these interventions. We developed an internet-administered, guided, low-intensity cognitive behavioral therapy (LICBT)-based self-help intervention for parents of children treated for cancer, (EJDeR [internetbaserad självhjälp för föräldrar till barn som avslutat en behandling mot cancer or internet-based self-help for parents of children who have completed cancer treatment]). EJDeR included 2 LICBT techniques-behavioral activation and worry management. Subsequently, we conducted the ENGAGE feasibility trial and EJDeR was found to be acceptable and feasible. However, intervention adherence rates were marginally under progression criteria. This study aimed to (1) describe user engagement with the EJDeR intervention and examine whether (2) sociodemographic characteristics differed between adherers and nonadherers, (3) depression and anxiety scores differed between adherers and nonadherers at baseline, (4) user engagement differed between adherers and nonadherers, and (5) user engagement differed between fathers and mothers. We performed a secondary analysis of ENGAGE data, including 71 participants. User engagement data were collected through log-data tracking, for example, communication with e-therapists, homework submissions, log-ins, minutes working with EJDeR, and modules completed. Chi-square tests examined differences between adherers and nonadherers and fathers and mothers concerning categorical data. Independent-samples t tests examined differences regarding continuous variables. Module completion rates were higher among those who worked with behavioral activation as their first LICBT module versus worry management. Of the 20 nonadherers who opened the first LICBT module allocated, 30% (n=6) opened behavioral activation and 70% (n=14) opened worry management. No significant differences in sociodemographic characteristics were found. Nonadherers who opened behavioral activation as the first LICBT module allocated had a significantly higher level of depression symptoms at baseline than adherers. No other differences in depression and anxiety scores between adherers and nonadherers were found. Minutes working with EJDeR, number of log-ins, days using EJDeR, number of written messages sent to e-therapists, number of written messages sent to participants, and total number of homework exercises submitted were significantly higher among adherers than among nonadherers. There were no significant differences between fathers and mothers regarding user engagement variables. Straightforward techniques, such as behavioral activation, may be well-suited for digital delivery, and more complex techniques, such as worry management, may require modifications to improve user engagement. User engagement was measured behaviorally, for example, through log-data tracking, and future research should measure emotional and cognitive components of engagement. ISRCTN Registry 57233429; https://doi.org/10.1186/ISRCTN57233429.

The Strategy of Content Marketing to Increase The Revenue of Fundamental Hypnosis Training at Course Institute and Indonesian Hypnosis Centre Training in Mataram City

This research aims to identify and analyze the content marketing strategies employed by the Indonesian Hypnosis Centre (IHC) to enhance revenue from the Fundamental Hypnosis training in Mataram City, West Nusa Tenggara Province. The primary issue under investigation is revenue instability, with a focus on utilizing unpaid content marketing strategies on Instagram as an alternative solution. Through a qualitative approach involving in-depth interviews and secondary data analysis, this study reveals that before 2018, IHC relied solely on paid marketing methods such as purchasing provider numbers and distributing brochures. However, since its introduction in 2018, Instagram content marketing has proven effective starting in 2019. A consistent, though modest, increase in participant contributions from Instagram has been observed. Additionally, the research explores the use of editing tools such as CapCut, CorelDRAW, and Filmora, and the benefits of microblogging and Instagram Reels within the content marketing strategy. The findings are expected to provide significant contributions to the development of content marketing strategies for training institutions, particularly in the field of hypnosis, to address the challenge of unstable revenue

The The Potential of Pantai Indah Kemangi for Marine Tourism in Kendal

Background: Kendal Regency has significant potential in the tourism sector, particularly in marine tourism. One of the iconic beaches is Pantai Indah Kemangi, located in Jungsemi Village, Kangkung District. Pantai Indah Kemangi needs to be developed to maximize its potential as a tourism industry hub. Objective: The purpose of this research is to analyze the potential of Pantai Indah Kemangi as a marine tourism destination in Kendal. This study identifies the factors that support the development of this beach as a potential tourist destination. Method: This research employs a descriptive qualitative research method, with data collected through interviews, secondary data analysis, and field observations. Result: Pantai Indah Kemangi has great potential to develop as a leading marine tourism destination in the North Coast region. This area can stimulate local economic growth, especially with the development of Micro, Small, and Medium Enterprises (MSMEs) in Jungsemi Village. The local government has also undertaken reforestation around the beach by planting sea pines, emphasizing environmental sustainability and the coastal ecosystem. Discussion: Pantai Indah Kemangi has significant potential to become an iconic marine tourism destination in the North Coast (Pantura) area. However, to optimize this potential, the road access needs to be revitalized to accommodate larger vehicles, and adequate lighting should be added. Conclusion: Pantai Indah Kemangi has made a substantial contribution to the development of marine tourism in Kendal, attracting both local and out-of-town tourists. Therefore, to ensure the continued growth of this tourist area, more effective promotion and improved services that do not disadvantage consumers are necessary

Antenatal care and breastfeeding practices in Sub-Saharan Africa: an analysis of demographic and health surveys

BackgroundThe World Health Organization (WHO) recommends immediate breastfeeding (within the first hour after birth) and exclusive breastfeeding (for the first six months of life), particularly in low-resource settings such as sub-Saharan Africa. In 2016, WHO updated its antenatal care (ANC) guidelines, recommending at least eight (8+) ANC contacts during pregnancy to improve maternal and child health outcomes. This study investigates i) trends in breastfeeding practices across sub-Saharan Africa following the rollout of the revised WHO 2016 ANC policy and ii) the relationship between ANC uptake and exclusive or early breastfeeding.MethodsWe performed a secondary analysis of Demographic and Health Survey data from 19 countries, from 2018-2023. Key variables included exclusive breastfeeding, early initiation of breastfeeding (within one hour of birth), and the number of ANC contacts (categorized into 0-3, 4-7, and 8 + visits) among mothers with a live birth in the six months preceding the survey.ResultsExclusive breastfeeding rates ranged from 19% in Gabon to 81% in Rwanda (median = 53%), while early initiation of breastfeeding ranged from 32% in Senegal to 85% in Rwanda (median = 60%). The percentage of women with 8 + ANC contacts ranged from 0.3% in Rwanda to 39% in Ghana (median = 4%). Women with 8 + ANC contacts did not show increased odds of early initiation (aOR: 0.94; 95% CI: 0.84, 1.05) or exclusive breastfeeding (aOR: 0.85; 95% CI: 0.76, 0.94) compared to women with 4-7 contacts.DiscussionThese findings reveal low rates of 8 + ANC contacts against a backdrop of suboptimal breastfeeding practices across sub-Saharan Africa. Furthermore, the results suggest limited additional benefits of 8 + ANC contacts over 4-7 contacts in promoting immediate and exclusive breastfeeding, as recommended by the WHO 2016 ANC policy. Urgent efforts are needed to promote ANC uptake and improve the quality of ANC contacts through behavior change interventions and complementary health service delivery. Sub-national, national, and global stakeholders should prioritize these interventions.