Education Sessions Research Articles

Nursing students' knowledge and related factors towards palliative care: A systematic review

The objective of this systematic review is to assess the extent of nursing students' knowledge concerning palliative care and identify potential factors that may impact it. To carry out their comprehensive and review research, items were searched from the starting point to March 1, 2023, applying keywords gathered from Medical Subject Headings such as "knowledge", "palliative care", and "nursing students" in global online databases involving Scopus, PubMed, Web of Science, and Iranian electronic library including Iranmedex and Scientific Information Database. Using the assessment instrument for cross-sectional studies (AXIS tool), the quality of the studies included in this systematic review was determined. In total, 4,320 nursing students participated in eleven cross-sectional studies. The age mean of the students was 21.48 (standard deviation [SD]=2.32) years. The study comprised 71.43% female participants and 97.92% single. The average nursing student's knowledge of palliative care was 8.94 (SD=3.57) out of 20; the results have shown an insufficient level of knowledge. Factors such as age, female gender, encounter with terminally ill patients, receiving a non-university educational session, year of study, being mature, and receiving a university educational session have a potential positive correlation with nursing students' knowledge of palliative care. Furthermore, the investigation revealed that the following variables had a statistically significant association with nursing students' level of knowledge in palliative care: academic year, perception of death as the cessation of life, receipt of university educational sessions, teaching content related to palliative care, type of university, academic grade, gender, place of birth, monthly family income, religious beliefs, and experience of providing care to a dying family member. The outcomes of this review suggest that nursing students possess inadequate knowledge in the domain of palliative care. Thus, it is recommended that future studies focus on implementing appropriate interventions for nursing students to enhance their level of knowledge regarding palliative care.

Feasibility and pilot study of Indonesia’s first telehealth support program for gynecological cancer survivors undergoing chemotherapy

Most Indonesian gynecological cancer survivors experience chemotherapy side effects on their physical and mental health as they face unmet needs of supportive care, which increases the likelihood of discontinuing treatment. Interventions in telehealth assist survivors in resolving these issues. The aim of this pilot study was to determine the feasibility of fighting distress, self-efficacy, health effects, and sexual (FoRSHE-X) interventions and evaluate their potential impact on distress level, side effects knowledge and management, self-efficacy, and sexual quality of life. The study involved gynecological cancer survivors who underwent chemotherapy and participated in ten weeks of individual social media-based education, tele-coaching, and teleconsultations, from September 2023 to June 2024. The study feasibility and pilot outcomes were evaluated using descriptive statistics and qualitative thematic analysis. Of the twelve women recruited, six (50%) completed the study, filled out pre- and post-intervention questionnaires, and participated in interviews. Fifty-four virtual education, coaching, and consultation sessions were performed individually. The statistical results indicated that participants were highly satisfied with the telehealth program, which significantly increased their knowledge (p=0.02), health practices (p=0.04), and self-efficacy (p=0.01). The qualitative analysis highlighted participants' and coaches' perspectives on the study’s acceptance, barriers, and recommendations. In conclusion, this pilot study suggests that a definitive trial to assess the FoRSHE-X interventions is feasible, acceptable, and can be applied not only to gynecological cancer survivors but also to other types of cancer, thereby broadening the potential impact of the study.

Effect of a single-session mindfulness-based intervention for reducing stress in family caregivers of people with dementia: study protocol for a randomized controlled trial

BackgroundCaregiver stress can pose serious health and psychological concerns, highlighting the importance of timely interventions for family caregivers of people with dementia. Single-session mindfulness-based interventions could be a promising yet under-researched approach to enhancing their mental well-being within their unpredictable, time-constrained contexts. This trial will evaluate the effectiveness and feasibility of a blended mindfulness-based intervention consisting of a single session and app-based follow-up in reducing caregiver stress.Methods/DesignThe study is a single-blinded randomized controlled trial with two arms (intervention versus an education session on dementia care) and assessments at baseline, 8 weeks, and 6 months. The eligibility criteria include: family caregivers aged 18 years or older; providing care for an individual with a confirmed medical diagnosis of dementia for at least 3 months prior to recruitment, with a minimum of 4 hours of daily contact; and exhibiting a high level of caregiver stress. The intervention comprises a 90-minute group-based session with various mindfulness practices and psychoeducation. Participants will receive a self-practice toolkit to guide their practice over a duration of 8 weeks. Sharing activities will be implemented through an online social media platform. The primary outcome is perceived caregiving stress. The secondary outcomes include depressive symptoms, positive aspects of caregiving, dyadic relationship, trait mindfulness, and neuropsychiatric symptoms of care recipients. The feasibility outcomes include eligibility and enrollment, attendance, adherence to self-practice, and retention, assessed using mixed methods.DiscussionThe study will contribute to the evidence base by investigating whether a single-session mindfulness intervention is effective and feasible for reducing caregiver stress among family caregivers of people with dementia.Trial registrationClinicalTrials.gov, NCT06346223. Registered on April 3, 2024.

Trial of an Inexpensive Training Simulation Model for Laparoscopic Appendicectomy.

Introduction Laparoscopic surgery is now the gold standard for many common procedures; however, there has been a lack of emphasis on laparoscopic training at the junior level. Simulation is an effective form of training in surgery, but surgical simulation models and courses can be expensive and inaccessible to medical students and foundation doctors. With procedures becoming more minimally invasive, it is key that we train laparoscopic skills at an earlier stage; and to do so, we need to remove the barriers of cost and accessibility. Our study aims to develop and assess the effectiveness of a simulated laparoscopic appendicectomy training model in developing laparoscopic knowledge, skills, and confidence in a cohort of foundation doctors. Methods A simulated mesoappendix model was fashioned from supermarket chicken wings with the bone removed, and it was put inside a laparoscopic box trainer with laparoscopic tools and equipment. This was trialed in a surgical-themed hub day for foundation doctors in the East of England Deanery, UK, and the simulated model was set up as a workshop following a teaching session detailing the steps of a laparoscopic appendicectomy. Participants completed questionnaires pre- and post-session to assess perceived skills, experience, and confidence in laparoscopic surgery, laparoscopic skills, and the usefulness of this training model. Results A total of 29 foundation doctors with limited formal surgical training completed the survey. The model is quick to prepare and assemble, costing around £0.30 ($0.40). Trainees found the model acceptable and helpful in developing their laparoscopic skills and knowledge of laparoscopic surgery. There was also an increase in self-perceived confidence in performing laparoscopic procedures under supervision. Discussion This modification to the model allows the dissection and division of a simulated mesoappendix using only laparoscopic scissors and forceps in a box trainer. This simulation model is a promising and inexpensive tool which can be used for early-stage laparoscopic training for medical students and junior doctors.

Evaluation of the efficacy of preventive therapy in chronic migraine with or without medication overuse headache: data from a prospective study

Chronic migraine (CM) affects three out of every hundred people. As the frequency of attacks increases, so does the frequency of painkillers usage, and 85% of patients with CM are also diagnosed with medication overuse headache (MOH).Objective: to investigate the efficacy of preventive therapy of CM with or without MOH.Material and methods. The study involved 117 patients with CM and MOH (group 1) and 23 patients with CM without MOH (group 2), patients were examined at the initial visit and after 3 and 9 months of follow-up. All patients in the 1st group (CM+MOH) received a 7-day "detoxification" therapy. Patients in both groups were given an educational and information session on the type of their diagnosis, treatment methods and lifestyle correction. The choice of a preventive treatment in both groups was based on the current clinical recommendations, algorithms of modern international guidelines, concomitant pathology, the presence of contraindications in a particular patient, tolerability, as well as territorial and economic factors.Results. A positive effect was found in both groups, regardless of the presence of MOH. The lack of significant differences between the groups of CM with/without MOH is probably due to the use of "detoxification" therapy and the cessation/restriction of the use of the drug of abuse in all patients with CM and MOH, although a more pronounced positive dynamics is observed in patients of the 2nd group (CM without MOH), which in turn emphasizes the severity of the disease, the greater disability and the poorer prognosis for response to preventive treatment in the presence of MOH. It was found that one third of patients in the study favored monoclonal antibodies (mAbs) due to convenience, rapid onset of action and tolerability. In the group of patients with MOH, the best results were obtained when using injection methods of treatment (anti-CGRP mAbs, botulinum therapy) or when using combined therapy compared to monotherapy with venlafaxine or topiramate.Conclusion. All first-line drugs for the CM prophylactic treatment according to the clinical guidelines of the Ministry of Health of Russia are clearly effective, including cases with both CM and MOH. The use of combined therapy in CM with/without MOH can be effective even with a low initial response to one of the monotherapies.

Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial

BackgroundWe previously performed a pragmatic cluster randomized controlled trial (RCT) in general practices and older adult care organizations in Poland, the Netherlands, Norway, and Sweden. We found that a multifaceted antibiotic stewardship intervention (ASI) substantially reduced antibiotic use for suspected urinary tract infections (UTIs) in frail older adults compared with usual care. We aimed to evaluate the implementation process of the ASI to provide recommendations for clinical practice.MethodsWe conducted a process evaluation alongside the cluster RCT. The ASI consisted of a decision-tool and a toolbox, which were implemented using a participatory-action-research (PAR) approach with sessions for education and evaluation. We documented the implementation process of the intervention and administered a questionnaire to health care professionals (HCPs) from participating organizations in the intervention and usual care clusters. We evaluated the multiple components of the intervention and its implementation following a structured framework.ResultsThe questionnaire was completed by 254 HCPs from the 38 participating clusters. All components were largely delivered according to plan and evaluated as useful. The decision-tool and toolbox materials were reported to facilitate decision-making on UTIs. Regarding the PAR approach, educational sessions focusing on the distinction between UTIs and asymptomatic bacteriuria were held in all 19 intervention clusters. In 17 out of these 19 clusters, evaluation sessions took place, which were reported to help remind HCPs to implement the ASI. During both sessions, HCPs valued the reflection that took place and the resulting awareness of their behavior. It allowed them to explore implementation barriers and to tailor their local implementation process to overcome these. For example, HCPs organized extra educational sessions or revised local policies to incorporate the use of the decision-tool. Various HCPs took key roles in implementation. Staff changes and the COVID-19 pandemic were important contextual barriers.ConclusionsWe found each component of the multifaceted ASI and its implementation to have added value in the process to improve antibiotic prescribing for suspected UTIs in a heterogeneous older adult care setting. We recommend using a multifaceted, multidisciplinary approach that enables HCPs to reflect on their current practice and accordingly tailor local implementation.Trial registrationClinicalTrials.gov NCT03970356. Registered on May 31, 2019.

Facial trauma education in radiology: using surgeon feedback as the benchmark for success.

Interpreting CT studies of facial trauma is challenging, and there are often substantial differences in the characterization of complex facial trauma between radiologists and surgeons. We designed a collaborative multidisciplinary project to reconcile differences in facial fracture interpretation through an educational intervention. The effectiveness of this intervention was evaluated through surgeon feedback on radiology reports. Radiology residents, neuroradiology fellows, and neuroradiology attendings were recruited as participants at a single tertiary care academic center. Otolaryngology residents were recruited as evaluators. Participants completed surveys and provided preliminary reports for example cases of facial trauma before and after attending an educational session. Evaluators performed a blinded review of these preliminary reports based on ideal reports developed by surgical and neuroradiology attendings. 26 participants (20 residents, 1 neuroradiology fellow, 5 neuroradiology attendings) completed the study. Six otolaryngology residents participated as evaluators. To assess interrater reliability, three evaluators graded a shared set of 15 reports and demonstrated substantial agreement with a Kendall's W of 0.71. Participants demonstrated significant improvement in overall report accuracy, clarity, and organization. In subunit analysis, there were significant improvements in reporting Le Fort, nasoseptal, and nasoorbitoethmoid fractures. No significant improvements occurred in the reporting of upper face, zygomaticomaxillary complex, or mandibular fractures. In contrast, survey analysis demonstrated significantly improved confidence in interpreting trauma involving all facial subunits. Compared with survey results, surgeon assessment of radiology reports better demonstrated areas of improvement after an educational intervention. A multidisciplinary approach to assessing educational efforts may better evaluate the practical effectiveness of educational interventions.

Convolution neural network based multi-class classification of rehabilitation exercises for diastasis recti abdominis using wearable EMG-IMU sensors

PurposeGlobally, postnatal women endure a prominent issue caused by midline separation of abdominal recti muscles, characterized by a sagging and pouch-like appearance of the belly termed as Diastasis Recti Abdominis (DRA). The necessity of ensuring the efficacy of rehabilitative workouts for individuals with DRA cannot be overstated, as inaccurate exercises can exacerbate the condition and deteriorate the health of affected women. The purpose of these exercises is to specifically focus on the rectus abdominis muscles to facilitate the reapproximation of the linea alba. The primary aim of this research work is to assess the effectiveness of rehabilitation exercises for DRA women obtained from Inertial Measurement Unit (IMU) and Electromyography (EMG) sensors.Design/methodology/approachConvolutional neural networks (CNN) employs convolutional activation functions and pooling layers. Recently, 1D CNNs have emerged as a promising approach used in various applications, including personalized biomedical data classification and early diagnosis, structural health monitoring and anomaly detection. Yet another significant benefit is the feasibility of a real-time and cost-effective implementation of 1D CNN. The EMG and IMU signals serve as inputs for the 1D CNN. Features are then extracted from the fully connected layer of the CNN and fed into a boosting machine learning algorithm for classification.FindingsThe findings demonstrate that a combination of sensors provides more details about the exercises, thereby contributing to the classification accuracy.Practical implicationsIn real time, collecting data from postnatal women was incredibly challenging. The process of examining these women was time-consuming, and they were often preoccupied with their newborns, leading to a reluctance to focus on their own health. Additionally, postnatal women might not be fully aware of the implications of DRA and the importance of rehabilitation exercises. Many might not realize that neglecting DRA can lead to long-term issues such as back pain, pelvic floor dysfunction, and compromised core strength.Social implicationsDuring our data collection camps, there were educational sessions to raise awareness about the DRA problem and the benefits of rehabilitation exercises. This dual approach helped in building trust and encouraging participation. Moreover, the use of wearable sensors in this study provided a non-invasive and convenient way for new mothers to engage in rehabilitation exercises without needing frequent visits to a clinic, which is often impractical for them.Originality/valueThe utilization of discriminating features retrieved from the output layer of 1D CNN is a significant contribution to this work. The responses of this study indicate that 1D convolutional neural network (1D CNN) and Boosting algorithms used in a transfer learning strategy produce successful discrimination between accurate and inaccurate performance of exercises by achieving an accuracy of 96%.

Creative Pedagogy in Information Literacy

Creative pedagogy is not well defined and has not yet received much attention in the field of library and information science. This research employed constructivist grounded theory, through semi-structured interviews conducted with library information literacy instructors, to better understand the role of creative pedagogy in information literacy. The aim of the research was to synthesize findings into a theory to better understand how and to what extent creative pedagogy is being applied in the teaching of information literacy. The findings show that although they do not necessarily use the language of creativity, many library instructors are integrating elements of creative pedagogy into their teaching. Perceived challenges, such as being a guide or guest in someone else’s classroom and in connecting with students around information, as well as opportunities in both the physical and virtual classroom spaces, seem to require a shift in the way information literacy engagement takes place. Library instructors recognize the need for these shifts but many struggle to implement an alternative approach in the information classroom. At the same time, library instructors face several barriers, including a lack of preparation for their teaching role and the limitations of the one-shot instruction session.

From Insight to Impact: Improving Mesorectal Evaluation Standards through Resident Educational Intervention

Abstract Introduction/Objective The completeness of total mesorectal excision (TME) and involvement of the circumferential radial margin (CRM) significantly impact local recurrence and survival rates in rectal cancer. Accurate gross examination to assess mesorectal status is crucial, not only for patient prognosis but also for evaluating surgical quality. Methods/Case Report We implemented a quality assurance initiative to enhance mesorectal quantification and CRM assessment by pathology trainees. Low anterior resection specimens received between January 2022 and December 2023 were included, with 2022 as the pre-intervention period and 2023 post-intervention. In December 2022, an educational session was conducted, emphasizing rectal resection specimens’ types and the importance of mesorectal and CRM assessment. Periodic reminder emails reinforced these concepts. Results (if a Case Study enter NA) We identified a total of 35 cases in the study: 20 pre-intervention arm and 15 post-intervention arm. Mesorectal quantification and CRM assessment and documentation improved significantly post- education, rising from 70% (14 of 20 cases) to 93% (14 of 15 cases) (p < 0.0001). Conclusion In conclusion, our study underscores the critical role of meticulous gross examination in assessing mesorectal status, serving not only as a prognostic indicator but also in guiding surgical precision and rectal cancer management. Further, our findings emphasize the transformative potential of education-driven interventions in enhancing the quality of mesorectal evaluation, reinforcing the pivotal role of pathologists and pathology trainees in shaping therapeutic strategies and ultimately improving rectal cancer patient care.

Psychological safety in students’ clinical learning environment – thematic analysis of open-ended questions and DREEM questionnaire assessment

Introduction: The learning environment impacts students’ motivation, success and fulfilment, and central to this is the psychological safety of students. Psychologically safe environments lead to collaboration, positive learning experiences and effective practitioners. This study assessed the perception of clinical learning environments of medical and nursing students (NSs) using the Dundee Ready Education Measure (DREEM) and with two open-ended questions (OEQs): their memorable learning experience and the effect of being in medical school on their lives. Methods: This was a cross-sectional study using validated DREEM questionnaires and two OEQs: ‘tell us about a memorable learning experience in medical/nursing school’ (MLE) and ‘what impact has your time in medical/nursing school had on your life’ (IoL). Data were collected from fourth- to sixth-year clinical medical, and first- to third-year NSs. Questionnaire data were analysed using the Statistical Package for Social Sciences. For the OEQs, an inductive approach was used for coding and thematic analysis. Coding was both semantic and interpretive. Results: One hundred and ninety-three students completed the validated questionnaires. Fifty-seven (29%) and 59 (30%) answered the OEQs MLE and Impact IoL, respectively. Thirty-four per cent of medical and 7% of NSs had a negative response to one of the two OEQs. Six themes emerged from the memorable learning experience question, three of which centred around student-centred teachings and two around emotional responses and psychological safety. ‘I reviewed my materials over and over, ate well, put on my best clothes and went to present. It was beautiful’, a third-year medical student. ‘The tutor was a great teacher who, when he teaches, students learn’, an NS. There were four themes on the impact on life questions, and these centred around personal development, social awareness, aspirations and psychological safety. ‘It has made me see that broken people break others’, a third-year medical student. The mean total DREEM score was 111 ± 10.2, interpreted as more positive than negative. In only two of the five DREEM domains, perception of the atmosphere and social self-perception were more negative than positive findings. Whilst there was near unanimity about their teachers being knowledgeable, and most students felt teachers were well-prepared for their teaching sessions, complaints about behaviours that adversely affected learning because of their negative impact on psychological safety in the clinical learning environment were very common. Conclusion: Despite the overall positive picture of clinical learning environments, there are significant areas of students’ welfare that need addressing to ensure psychologically safe clinical learning environment. Students’ feedback feeding into annual appraisals, and pedagogic courses are means to achieving students-centred learning environments.

Evaluation of a distribution, education and awareness intervention for child passenger safety in Lebanon: a low-income and middle-income country setting

BackgroundThe Eastern Mediterranean Region suffers disproportionately from paediatric traffic-related injuries. Despite governmental laws, Lebanon—an eastern Mediterranean country—has low child restraint (CR) use prevalence. This study examined the impact of using...

Introduction to the Principles of Artificail Intellengence: Bias and Ethical Considerations

Abstract What evidence demonstrates a need for this educational session among pathologists and/or laboratory professionals? (1,250 character limit): n/a

Benefits of Practicing Teaching as a Resident: A Single Institute Experience of a Formal Teaching Curriculum for Pathology Residents

Abstract Introduction/Objective The practice of near-peer teaching, both in lecture style and small group formats, has been shown to have benefits for the educator in improving communication skills, gaining knowledge in a subject, and providing a tangible experience that may aid in applying for employment. The purpose of this study is to present the current curriculum and teaching opportunities at the Medical University of South Carolina (MUSC) and their impacts on developing pathology residents’ teaching skills and perceptions of their growth as educators. Methods/Case Report Data regarding curriculum format and learner surveys for various teaching programs at MUSC was gathered from residency program leadership and the MUSC College of Medicine. An anonymous survey was distributed to current MUSC pathology residents to assess their participation, current comfort level, and comfort level prior to the start of residency in regard to various teaching modalities. Results (if a Case Study enter NA) The resident curriculum offers teaching modalities such as small group co-leader for medical students, didactic presentations, and on-the-job teaching. On a Likert scale of 1 to 5, with 5 being very comfortable, residents reported an average comfort level with teaching before starting residency as 2.11 and a current comfort level with teaching as 2.67. Residents were split on their perception of what affect residency has had on their comfort in teaching. Medical student evaluations of their small group teaching sessions co-led by pathology residents averaged 77.6% approval per course. Conclusion Through providing an overview of required and voluntary teaching opportunities offered at one institute and residents’ perceptions on their experiences while teaching there, we hope to both provide curriculum examples for other institutions and to advocate for placing greater importance on providing opportunities for residents. Such opportunities to practice teaching help them develop skills to benefit them as pathologists and in their future employability.

Study protocol of the safe driving program for the prevention of car accidents: A randomized controlled trial protocol.

Driving cessation is strongly associated with adverse health outcomes in older adults. Although numerous studies have focused on driving skill interventions for safe driving, the effects of interventions on car accidents remain unclear. We designed a randomized controlled trial to examine the effects of driving skill training on the prevention of car accidents among community-dwelling older adults using on-road training. A total of 1408 community-dwelling older drivers aged ≥65 years participated in the randomized controlled trial with blinded endpoint assessment. Participants randomized to the intervention group (n = 697) underwent four sessions, with 200 min re-training focused on the problem of driving in the older people. Controls (n = 697) received one classroom education session. On-road driving performance was assessed by certified driving school instructors in a driving school. The primary endpoint is an incident car accident, which will be detected based on the Japanese national car accident report data, after 24 months. This study has the potential to provide the first evidence of the effectiveness of on-road driving skill training regarding the prevention of car accidents. If our trial results show a lower number of car accidents due to driving skill training, this kind of intervention will provide an effective method for maintaining safe driving. These results will be disseminated to the appropriate national transportation agencies to improve or modify safe driving policies and possibly extend the validity of driver's licenses for older adults. UMIN-CTR (identification number: UMIN000034709). Registered 31 October 2018. Geriatr Gerontol Int 2024; ••: ••-••.

Factors impacting curricula in maritime simulator-based education

AbstractThe International Convention on Standards of Training, Certification, and Watchkeeping for Seafarers (STCW) provides a foundational framework for maritime education and training (MET). However, variations in its interpretation across different nations and institutions lead to diverse teaching practices and strategies. This diversity stems from differences in national regulations, resources, cultures, and the perspectives of institutions and instructors. This study introduces a concept map to scaffold the key concepts influencing maritime simulator-based education. By examining both the education system and student factors, the concept map offers insights into these various factors through observations from simulator-based teaching sessions and discussions with maritime educators and students. This tool can help identify differences and highlight good practices. It is a valuable resource for stakeholders, promoting a novel approach to developing an effective, comprehensive, coherent maritime simulator-based education.

Comparing the effectiveness of a blended video plus face-to-face educational program with a face-to-face educational program on quality of life among adolescents undergoing hemodialysis in Palestine.

Hemodialysis is frequently used as a primary treatment for individuals with end-stage kidney disease (ESKD), and it significantly impacts the quality of life in adolescents undergoing this procedure. Providing a hemodialysis education to these patients is a valuable strategy for enhancing their well-being. The aim of the study is to assess the effect of the video-assisted educational program on the quality of life among adolescents undergoing hemodialysis in Palestine. This study employed a quasi-experimental design, a pre-test-post-test interventional study, involving a sample of 68 adolescent patients between the ages of 13 and 18 diagnosed with ESKD. The quality of life level was assessed in both groups using an Arabic version of the Pediatric Quality of Life Inventory™ version 3.0 ESKD Module survey. The study was conducted at the dialysis units in four hospitals associated with Augusta Victoria Hospital, An-Najah University Hospital, Palestine Medical Complex/Ramallah, and Beit Jala (Al Housain) Hospital. The study involved providing tailored face-to-face educational sessions with video assistance to the experimental group, while the control group received regular face-to-face education. The Generalized Estimating Equation analysis revealed no significant differences in quality of life between the experimental and control groups over time, across pre-test, post-test, and follow-up periods (p ≥ 0.05). However, within the experimental group, there was a significant improvement in total quality of life scores between the pre-test, post-test, and post-test follow-up (p ≤ 0.001), although the difference between the pre-test and follow-up approached significance but was not statistically significant (p = 0.056). In contrast, the control group showed significant differences in quality of life across the pre-test, post-test, and follow-up time points (p ≤ 0.05). Implementing suitable interventions can potentially enhance the quality of life for individuals undergoing hemodialysis. Consequently, we suggest using video-based education as a cost-effective, uncomplicated, and engaging approach for educating hemodialysis patients.

Pathways to Sustainability: Empowering Indigenous Communities through Recycling Education

Recycling is a critical component of sustainable waste management, helping to conserve resources, reduce pollution, and mitigate climate change. Despite its importance, awareness, and participation in recycling activities remain low, particularly among indigenous populations who often have limited exposure to modern environmental practices. This study investigates the impact of a recycling awareness program conducted within an indigenous community in Cameron Highlands, Pahang, Malaysia. The program included a pre-program survey to assess participants' awareness, understanding, and participation in recycling activities, followed by an educational session on general recycling practices and e-waste management. A post-program survey was conducted to measure the effectiveness of the program. The use of paired sample t-tests reveals significant improvements in participants' knowledge and attitudes toward recycling. The findings provide compelling evidence that targeted educational programs can significantly enhance recycling awareness and participation within Indigenous communities, contributing to broader environmental sustainability goals. The study underscores the need for the implementation of similar programs in other less exposed communities as well as continuous engagement and collaboration with local authorities to sustain and expand recycling initiatives.

Understanding the mechanisms of change in social norms around tobacco use: A systematic review and meta-analysis of interventions.

Tobacco use spreads through social networks influencing social norms around tobacco use. However, the social norms scholarship is extremely diverse and occasionally conflicting, complicating efforts to understand how best to leverage social norms to reduce tobacco use. This study systematically reviewed and meta-analyzed this vast terrain by focusing on social norms measurement and mechanism, and intervention effectiveness and modality aimed at changing social norms around tobacco use and actual tobacco use. We searched Scopus, PubMed, PsycInfo, Clinicaltrials.gov, ProQuest Dissertations, the Cochrane Trial Registry, as well as the websites of the Society for Research on Nicotine and Tobacco, the Open Science Framework, medrXiv and the Truth Initiative for experimental and quasi-experimental evaluation studies of interventions designed to shift tobacco use. We included studies written in English from inception to 30 May 2024. We only included studies which noted social norms or social influence as part of the intervention design or set of measured variables. We excluded studies with only one time point, without an intervention being evaluatedand those not published in English. Study screening followed the PRISMA 2020 guidelines, and was conducted by at least two independent reviewers who resolved discrepancies through discussion and consensus. All included studies were analyzed in a narrative synthesis, and those providing sufficient statistics for tobacco and social norms outcomes were included in meta-analyses, which were performed separately for tobacco outcomes and social norms outcomes. Study outcomes were transformed into a standardized mean difference (Hedges' g) and several meta-regressions were fit to explore sources of heterogeneity using a robust variance estimation specification to handle effect size dependency. A total of 95 studies met inclusion criteria for the narrative synthesis, 200 effect sizes from 86 studies were included in the tobacco outcomes meta-analysis, and 66 effect sizes from 29 studies were included in the social norms outcomes meta-analysis. Nearly 90% of included studies were conducted in high-income settings, with the remainder conducted in middle-income settings. No studies were conducted in Latin America or on the African continent. Social norms change interventions had a statistically significant effect on reducing tobacco use and pro-tobacco social normative perceptions [g = 0.233, 95% confidence interval (CI) = 0.166, 0.301, P < 0.001 and g = 0.292, 95% CI = 0.090, 0.494, P = 0.007, respectively]. Interventions were commonly conducted among schoolchildren in classrooms through multicomponent education sessions, often coupled with regular 'booster' sessions over time. Among adult populations, motivational interviewing and other counselling approaches were used in some cases, and few interventions leveraged digital technologies to change social norms. Social norms change interventions appear to be effective for reducing tobacco use and pro-tobacco social normative perceptions. In particular, leveraging role models appears to be the most effective social norms change mechanisms for tobacco control.

Development and feasibility testing of a time-restricted eating intervention for women living with overweight/obesity and HIV in a resource-limited setting of South Africa

BackgroundHuman Immunodeficiency Virus (HIV) and type 2 diabetes (T2D) are amongst the leading causes of death in South Africa. The preferred first-line anti-retroviral treatment contains dolutegravir (DTG), shown to increase body weight, may compound the already high rates of obesity and associated risk for T2D. South Africa has widespread food insecurity, making traditional dietary strategies difficult to implement. Time-restricted eating (TRE) may be an appropriate intervention in resource-limited communities.MethodsThis article outlines the development and feasibility testing of a TRE intervention to inform the design of a TRE randomised controlled trial in women (20–45 years old) living with overweight/obesity and HIV, receiving DTG-based treatment from a resource-limited community in Cape Town, South Africa. Factors influencing TRE adoption were identified using the Capability, Opportunity, Motivation – Behaviour model and the Theoretical Domains Framework, combining in-depth interviews (IDIs) and focus group discussions. Participants from the IDIs went on to participate in a single arm 4-week TRE pilot trial where feasibility was explored in terms of reach, acceptability, applicability, and implementation integrity. An iterative, thematic analysis approach was employed to analyse the qualitative data.ResultsParticipants included 33 isiXhosa-speaking women (mean age 37.1 years, mean BMI 35.9 kg/m2). Thematic analysis identified psychological capability (knowledge of fasting), social influences (cultural preferences, family support), and reflective motivation (awareness of weight, health impact, motivation for TRE) as key factors influencing adoption of TRE for weight management. In a 4-week TRE pilot trial (n = 12), retention was 100%. Positive outcomes perceived included improved energy, appetite control and weight loss. TRE was perceived as acceptable, easy, and enjoyable. Family support facilitated adherence, while habitual and social eating and drinking practices were barriers. Compliance was high, aided by self-selected eating times, reminders, and weekly calls. Recommendations included the incorporation of dietary education sessions and text messages to provide additional support and reminders.ConclusionsThis study indicates that TRE is a feasible weight management strategy in women living with overweight/obesity and HIV, receiving DTG-based treatment in a resource-limited community. These findings will ensure that the forthcoming TRE randomised controlled trial is adapted and optimised to the local South African context.