Health Programs Research Articles

Age-Related Differences in Body Fat and Fitness of Firefighters Participating in a Health and Wellness Program.

Lockie, RG, Dulla, JM, Higuera, D, Ross, K, Orr, RM, Dawes, JJ, and Ruvalcaba, TJ. Age-related differences in body fat and fitness of firefighters participating in a health and wellness program. J Strength Cond Res 38(6): 1127-1135, 2024-Fitness tends to decline, whereas body fat increases, with age, which could impact firefighter occupational performance later in their careers. Health and wellness program participation could reduce these age-related changes. Archival data from 270 firefighters (258 men and 12 women) from a health and wellness program were analyzed. Data included body mass index; body fat percentage (BF%); waist circumference (WC); waist-to-hip ratio (WHR); sit and reach; grip strength; absolute and relative predicted 1 repetition maximum (1RM) leg press; crunches; push-ups; and estimated maximal aerobic capacity (V̇o2max). Firefighters were grouped by age ≤29 (n = 29); 30-34 (n = 44); 35-39 (n = 38); 40-44 (n = 39); 45-49 (n = 48); 50-54 (n = 42); and 55+ (n = 30) years. A univariate analysis of covariance, with sex as a covariate and Bonferroni's post hoc adjustment, determined between-group differences. Effect sizes (d) were calculated. Key results included that the 55+ group had higher BF% and WC compared with the 3 youngest groups (p ≤ 0.002; d = 0.86-1.08). The 50-54 group had higher BF% than the 30-34 group (p = 0.010; d = 0.77). The 55+ group had a greater WHR, lower grip strength, and completed fewer crunches and push-ups than most younger groups (p ≤ 0.05; d = 0.60-1.32). The 50-54 and 55+ groups had a lower 1RM leg press and V̇o2max compared with the younger groups (p ≤ 0.009; d = 0.77-1.79). The program appeared generally effective, with limited differences in groups below 49 years of age. Greater disparities in fat mass and fitness tended to occur in the older groups (50-54, 55+ groups). The data highlighted that older firefighters were participating in the optional program, which could lead to better health outcomes.

Psychometric properties of a questionnaire on medical students’ satisfaction with a community health program

Changes in the learning modes during the recent COVID-19 pandemic has provided a need to construct a feedback questionnaire to measure medical students’ satisfaction with community-based health programs. A total of 551 forms which has a 5-point Likert scale were submitted by the medical students upon concluding the public health program in 2018-2021 (which includes face-to-face and virtual learning). Reliability coefficients were estimated for each factor (domain) with values >0.70. Exploratory factor analysis (EFA) was used to assess the validity of the instrument, using principal components analysis with varimax rotation. EFA identified two factors; the first included 6 items (67.031%) of the total variance, the second explained 4 items (10.114%) and together explained 77.15%. root mean squared error of approximation (RMSEA): 0.074; normed fit index (NFI): 0.975; comparative fit index (CFI): 0.981; incremental fit index (IFI): 0.981; goodness of fit index (GFI): 0.956; Tucker Lewis index (TLI): 0.972. The overall students’ satisfaction had a Cronbach’s alpha test of 0.945 with a 95% confidence interval (0.938-0.952), and a reliability using Guttman Split-Half for overall was 0.894. Students’ satisfaction questionnaire with the public health program has a good reliability and validity in contrasting educational situations and it is worthwhile to include as part of the quality improvement.

Scaling up One Health: A network analysis in Lao PDR

BackgroundOne Health focuses on sustainable health for humans, animals, and ecosystems. The approach has been well demonstrated, yet most efforts have not been scaled up. Understanding the organisations involved in scaling up processes is critical to translating research into practice. The Lao People's Democratic Republic has successfully implemented One Health projects for multiple decades; however, the organisational network has not been described and scaling up efforts have been limited. MethodsData from organisations involved in One Health projects over the past five years were collected by key-informant interview or workshop. The network was investigated using a mixture of quantitative network analysis and qualitative thematic analysis. ResultsThe organisational network was quantitatively described as sparse and centralised. Organisations were required to harness pre-existing relationships to maximise scarce resources and make co-ordination and alignment of priorities more efficient. A lack of international organisations in the top 10% of resource sharing metrics suggests a potential disconnect between donors. This was reflected in the challenges faced by national organisations and a feeling of being stretched thin over numerous externally funded projects with donor-driven priorities. ConclusionsIt appears that high-level political support for country ownership of development and aid priorities remains unrealised. Developing network capacity and capability may assist scaling up efforts and build resilience in the network and its core organisations. This may allow for the inclusion of more development, education, environment, and water, sanitation, and hygiene organisations that were perceived to be lacking. Future One Health programmes should focus on practical activities that do not overload staff capacity. There is much for One Health to learn about the art of scaling up and organisations are encouraged to include implementation science in their research to inform future scaling up efforts.

Factors associated with medical consumable availability in level 1 facilities in Malawi: a secondary analysis of a facility census.

Medical consumable stock-outs negatively affect health outcomes not only by impeding or delaying the effective delivery of services but also by discouraging patients from seeking care. Consequently, supply chain strengthening is being adopted as a key component of national health strategies. However, evidence on the factors associated with increased consumable availability is limited. In this study, we used the 2018-19 Harmonised Health Facility Assessment data from Malawi to identify the factors associated with the availability of consumables in level 1 facilities, ie, rural hospitals or health centres with a small number of beds and a sparsely equipped operating room for minor procedures. We estimate a multilevel logistic regression model with a binary outcome variable representing consumable availability (of 130 consumables across 940 facilities) and explanatory variables chosen based on current evidence. Further subgroup analyses are carried out to assess the presence of effect modification by level of care, facility ownership, and a categorisation of consumables by public health or disease programme, Malawi's Essential Medicine List classification, whether the consumable is a drug or not, and level of average national availability. Our results suggest that the following characteristics had a positive association with consumable availability-level 1b facilities or community hospitals had 64% (odds ratio [OR] 1·64, 95% CI 1·37-1·97) higher odds of consumable availability than level 1a facilities or health centres, Christian Health Association of Malawi and private-for-profit ownership had 63% (1·63, 1·40-1·89) and 49% (1·49, 1·24-1·80) higher odds respectively than government-owned facilities, the availability of a computer had 46% (1·46, 1·32-1·62) higher odds than in its absence, pharmacists managing drug orders had 85% (1·85, 1·40-2·44) higher odds than a drug store clerk, proximity to the corresponding regional administrative office (facilities greater than 75 km away had 21% lower odds [0·79, 0·63-0·98] than facilities within 10 km of the district health office), and having three drug order fulfilments in the 3 months before the survey had 14% (1·14, 1·02-1·27) higher odds than one fulfilment in 3 months. Further, consumables categorised as vital in Malawi's Essential Medicine List performed considerably better with 235% (OR 3·35, 95% CI 1·60-7·05) higher odds than other essential or non-essential consumables and drugs performed worse with 79% (0·21, 0·08-0·51) lower odds than other medical consumables in terms of availability across facilities. Our results provide evidence on the areas of intervention with potential to improve consumable availability. Further exploration of the health and resource consequences of the strategies discussed will be useful in guiding investments into supply chain strengthening. UK Research and Innovation as part of the Global Challenges Research Fund (Thanzi La Onse; reference MR/P028004/1), the Wellcome Trust (Thanzi La Mawa; reference 223120/Z/21/Z), the UK Medical Research Council, the UK Department for International Development, and the EU (reference MR/R015600/1).

Implementing an evidence-based behavioral weight-loss program in community mental health centers: A randomized pilot study.

Obesity is a leading cause of preventable death among individuals with serious mental illness (SMI). A prior randomized controlled trial demonstrated the efficacy of a lifestyle style intervention tailored to this population; however, such interventions need to be adapted and tested for real-world settings. This study evaluated implementation interventions to support community mental health program staff to deliver an evidence-based lifestyle intervention to clients with obesity and SMI. In this cluster-randomized pilot trial, the standard arm combined multimodal training with organizational strategy meetings and the enhanced arm included all standard strategies plus performance coaching. Staff-coaches delivered a 6-month group-based lifestyle intervention to clients with SMI. Primary outcomes were changes in staff knowledge, self-efficacy, and fidelity scores for lifestyle intervention delivery. Linear mixed-effects modeling was used to analyze outcomes, addressing within-site clustering and within-participant longitudinal correlation of outcomes. Three sites were in the standard arm (7 staff-coaches); 5 sites in the enhanced arm (11 staff-coaches). All sites delivered all 26 modules of the lifestyle intervention. Staff-coaches highly rated the training strategy's acceptability, feasibility and appropriateness. Overall, mean knowledge score significantly increased pre-post by 5.5 (95% CI: 3.9, 7.1) and self-efficacy was unchanged; neither significantly differed between arms. Fidelity ratings remained stable over time and did not differ between arms. Clients with SMI achieved a mean 6-month weight loss of 3.8 kg (95% CI: 1.6, 6.1). Mental health staff delivering a lifestyle intervention was feasible using multicomponent implementation interventions, and preliminary results show weight reduction among clients with SMI. The addition of performance coaching did not significantly change outcomes. Future studies are needed to definitively determine the effect on client health outcomes.

Literature review: Work music in reducing work stress

High productivity allows companies to produce goods and services at lower costs, so they can offer more competitive prices in the market. Productivity may experience a decline which can have a negative impact on organizational performance. Decreased productivity can be caused by prolonged work stress. This research aims to analyze the role of work music in reducing work stress. This research was carried out using the method literature review by determining inclusion and exclusion criteria using PICOS (Problem, Intervention, Comparison, Outcome, and Study design) from 7 articles that met the eligibility criteria, then data extraction was carried out by evaluating work music in reducing work stress. Based on the results of a systematic review conducted, it shows that the occupational safety and health program in the form of providing work music is able to increase worker productivity found in various types of work so that it can optimally increase the profits of the employing agency.

Assessing Weekly Wellness Sessions: Cordillera Administrative Region's Social Welfare Impact

This literature review examines the efficacy of workplace wellness initiatives, focusing on the Weekly Wellness Sessions (WWS) conducted by the Department of Social Welfare and Development (DSWD) Field Office Cordillera Administrative Region. The study evaluates staff participation rates, the effectiveness of wellness programs, and challenges encountered in availing the WWS. Primary and secondary sources materials were used in the analysis of this literature review. Casual observations were also integrated. Findings reveal coffee sessions as the most popular activity, while limited facilities and costs hindered participation in other activities. The WWS were perceived as highly effective across multiple dimensions of well-being, with minimal variation based on gender or age. However, differences in effectiveness were noted among different positions and offices/divisions. Common challenges included time constraints, financial limitations, and personal barriers. Recommendations include enhancing financial accessibility, tailoring interventions, offering flexible scheduling, promoting awareness, and cultivating a culture of health and wellness. Addressing these recommendations can optimize the impact of the WWS and contribute to a healthier, more productive workforce within DSWD FO CAR.

Implementation and adaptation of a hub-based psychiatric and primary care program: A qualitative descriptive analysis of The Seamless Care Optimizing the Patient Experience (SCOPE) Mental Health program.

The Seamless Care Optimizing the Patient Experience (SCOPE)-Mental Health program is a comprehensive case management and psychiatric care initiative that supports primary care physicians in independent medical practices. This program offers a range of services that aims to enhance primary care capacity for mental health and provide accessible clinical care for patients. With its flexible hub-based approach, this program allows participating sites to tailor their implementation based on their available resources and specific needs within their community. The aim of this quality improvement initiative was to investigate the evolution of this collaborative mental health model, focusing on specific site adaptations, local implementation challenges, and opportunities for ongoing development and sustainability across SCOPE sites in the Greater Toronto Area. This evaluation employed a qualitative descriptive design where semi-structured interviews, guided by the Reach Effectiveness Adoption, Implementation, and Maintenance framework were conducted with staff from all 8 SCOPE-Mental Health sites. Site representatives were interviewed virtually between March and July 2023 and data were analyzed using qualitative content analysis. The SCOPE-Mental Health model permits flexibility through specific local adaptations led by community need that leverage existing assets either at the site or within the individual community. Adoption by primary care physicians was crucial to program success and facilitated efficiency and interprofessional collaboration. Maintenance efforts included pathway refinement, and marketing and funding considerations. Challenges to program development included continuity of staff, physician compensation issues, and electronic health record interoperability. The SCOPE-Mental Health program fosters linkages among unaffiliated primary care offices, hospitals, and community-based resources to improve mental health care. Key recommendations include advocating for sustainable funding and facilitated mechanisms for psychiatric consultations. This initiative offers valuable insights for healthcare organizations seeking to develop similar programs, emphasizing the need for tailored approaches and ongoing evaluation to ensure a lasting impact in underserved communities.

Spatial variation and predictors of incomplete pneumococcal conjugate vaccine (PCV) uptake among children aged 12–35 months in Ethiopia: spatial and multilevel analyses

BackgroundDespite the Ethiopian government included the Pneumococcal Conjugate Vaccine (PCV) in the national expanded program for immunization in 2011, only 56% of children aged 12–23 months received the full dose of PCV. Despite some studies on PCV uptake in Ethiopia, there was a dearth of information on the geographical distribution and multilevel factors of incomplete PCV uptake. Hence, this study aimed to identify the spatial variations and predictors of incomplete PCV uptake among children aged 12–35 months in Ethiopia.MethodsThe study was based on an in-depth analysis of 2016 Ethiopia Demographic Health Survey data, using a weighted sample of 3,340 women having children aged 12–35 months. Arc-GIS version 10.7 and SaTScan version 9.6 statistical software were used for the spatial analysis. To explore spatial variation and locate spatial clusters of incomplete PCV, the Global Moran's I statistic and Bernoulli-based spatial scan (SaTScan) analysis were carried out, respectively. A multilevel mixed-effect multivariable logistic regression was done by STATA version 16. Adjusted odds ratio (AOR) with its corresponding 95% CI was used as a measure of association, and variables with a p < 0.05 were deemed as significant determinants of incomplete PCV.ResultsThe overall prevalence of incomplete PCV in Ethiopia was found to be 54.0% (95% CI: 52.31, 55.69), with significant spatial variation across regions (Moran's I = 0.509, p < 0.001) and nine most likely significant SaTScan clusters. The vast majority of Somali, southeast Afar, and eastern Gambela regions were statistically significant hot spots for incomplete PCV. Lacking ANC visits (AOR = 2.76, 95% CI: 1.91, 4.00), not getting pre-birth Tetanus injections (AOR = 1.84, 95% CI: 1.29, 2.74), home birth (AOR = 1.72, 95% CI: 1.23, 2.34), not having a mobile phone (AOR = 1.64, 95% CI: 1.38, 1.93), and residing in a peripheral region (AOR = 4.63; 95% CI: 2.34, 9.15) were identified as statistically significant predictors of incomplete PCV.ConclusionThe level of incomplete PCV uptake was found to be high in Ethiopia with a significant spatial variation across regions. Hence, the federal and regional governments should collaborate with NGOs to improve vaccination coverage and design strategies to trace those children with incomplete PCV in peripheral regions. Policymakers and maternal and child health program planners should work together to boost access to maternal health services like antenatal care and skilled delivery services to increase immunization coverage.

Impact of a School Trachoma Program Emphasizing Facial Cleanliness and Environmental Improvement in Amhara, Ethiopia.

The SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy is the WHO's endorsed approach for eliminating trachoma as a public health problem; however, not all components have been treated equally. Historically, the F and E components have not been prioritized owing to their perceived complexity. With school enrollment increasing in Ethiopia, development of a national school health program that is focused on the F and E components represents an opportunity to strengthen the SAFE strategy in the country. In 2016, the Trachoma Control Program in Amhara, Ethiopia, along with its partners, developed a School Trachoma Program (STP) that offers grade-specific lessons to improve sanitation and hygiene knowledge and practices among primary school-aged children. To assess its impact, schools were sampled before implementation and then up to 1 year after STP rollout. The aim of this report is to detail STP outcomes and the associations between outcomes and school-level variables. By 2018, adoption of an STP was strong within Amhara, with 85% of the 137 surveyed schools completing their quarterly reports and nearly 80% having at least one teacher trained in the STP. By the end of the third quarter, nearly all schools (86%) had access to a latrine, and 89% of students had a clean face. A schoolwide orientation was associated with increased STP lessons and activities (P = 0.01). Development of an STP, with buy-in from principals and teachers, represents a promising approach for the adoption of a new F- and E-specific curriculum and may help advance efforts to eliminate trachoma.

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research.

Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating). This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges.

Physical and Psychological Impact of the Covid-19 Pandemic on Healthcare Workers, Including End of Life Care Providers.

The COVID-19 pandemic has not only caused unprecedented distress in the community but has also resulted in significant physical and psychological exhaustion among healthcare workers (HCWs). This exhaustion could potentially lead to serious effects on our healthcare system. The aim of this study was to gain more insight on the effect of COVID-19 on burnout among oncologists and other healthcare professionals at a large academic center. A 10-minute electronic questionnaire was distributed to actively employed physicians, APRNs, and PAs affiliated with the University of Miami. The survey encompassed a range of personal and professional characteristics, including stress related to COVID-19. The survey was distributed to a total of 739 HCWs, with 182 respondents (24.6%) completing the entire survey. The impact of the pandemic on these professionals included increased workload (59.5%), reduced leadership opportunities (32.2%), job insecurity (28.6%), and rescheduling of professional activities (22.2%). Out of the 182 respondents, 70 were primarily from the fields of Oncology and Palliative Care. Several factors have contributed to increased physical and psychological stress among HCWs, such as extended working hours, sleep deprivation, job insecurity, the shift to telemedicine, the risk of contracting the virus and endangering their families, lack of childcare options, and the added pressure of homeschooling. This study serves as a foundation for more comprehensive research aimed at elucidating and guiding the development of wellness programs crucial for the overall well-being of HCWs.

Translating Interprofessional Education to Social Work & Other Behavioral Health Disciplines: Curricular Evaluation Using an Implementation Science Approach

ABSTRACT Evidence-informed, interprofessional education (IPE) programs in behavioral health are an important part of reform efforts to reduce fragmentation and increase quality of mental health and substance use disorder treatment. The aim of this study is to document an implementation science approach to translation of IPE, grounded in Interprofessional Education Collaborative competencies, to social work and other behavioral health graduate students and to evaluate selected implementation outcomes. Select implementation strategies from the “Expert Recommendations for Implementing Change” were used to guide implementation of our behavioral health IPE training. A mixed-methods design, including survey, observational, and focus group data, was used to evaluate select implementation outcomes of the IPE training program. Data indicate positive perceptions of feasibility, acceptability, adoption, appropriateness, and fidelity of the IPE training program, with mean scores ranging from 4.25 to 4.45 (5-point likert scale) on items related to acceptability, appropriateness and adoption. Themes that emerged from qualitative data included recommendations of relational and experiential strategies to improve fidelity. Evaluation of implementation outcomes identifies additional strategies to enhance learning and fidelity to IPEC competencies. Implementation science offers a helpful framework for carrying-out trainings in higher education and beyond.

The Prevalence and Risk Factors of Low Bone Mineral Density in the Population of the Abay Region of Kazakhstan

Osteoporosis is considered a serious public health problem that particularly affects the postmenopausal period. In 2018, in the Republic of Kazakhstan, the prevalence of osteoporosis was 10.0, and the incidence was 3.7 new cases, per 100,000 adults, respectively. The objective of this study was to assess the prevalence of osteoporosis and indicate the main factors affecting low bone mineral density by screening the adult population of the Abay region, Kazakhstan. The target group comprised 641 respondents aged between 18 and 65 years old, from a Kazakh population, who had been living in the Abay region since birth. All participants filled out a questionnaire and were subjected to a bone mineral density measurement by means of dual-energy X-ray absorptiometry (DXA) between 15 July 2023 and 29 February 2024. Logistic regression analysis was conducted to assess the association between low bone mineral density and key demographic characteristics, such as lifestyle factors and nutritional habits. We identified the prevalence of low bone mass (osteopenia) and osteoporosis to be 34.1%, with the highest prevalence of 48.3% being found in the older population group (50+ years). The regression analysis revealed a number of indicators associated with the likelihood of bone sparing. However, only four of these showed significance in the final multivariate model (R2 = 22.4%). These were age (adjusted odds ratio (AOR) 1.05) and fracture history (AOR 1.64) directly associated with the likelihood of low bone density. Meanwhile, the body mass index (AOR 0.92) and the consumption of nuts and dried fruits (AOR 0.48) reduced the chance of bone tissue demineralization. Additional studies examining the prevalence and any emerging risk factors for osteoporosis are needed to advance clinical epidemiological knowledge and implement public health programs.

Exploration of Social Work Intervention Models in College Students' Youth Health Education—Taking University X as an Example

Based on the youth health program of colleges and universities, we carry out youth health education for X-school students based on the group work method of social work. It explores the practical path of youth health education in colleges and universities and develops a "trinity" youth health education model for colleges and universities, which promotes the organic integration of professional social work education, student peer education, community practice education, and youth health education, and finally provides suggestions for future youth health education in colleges and universities.

Sex Differences, Age, and Burn Size Contribute to Risk of PTSD and Depression After Burn Injury.

The prevalence of psychological symptoms in burn survivors has been well documented; however, the role of biological sex requires further investigation. This study explored sex differences among burn survivors and examined the impact of sex, age, and total body surface area (TBSA) of the burn injury on (1) the risk of developing PTSD and depression and, subsequently, (2) the influence of initial risk on symptom outcomes 30 days post-injury. Participants included 374 adult patients enrolled in the Burn Behavioral Health program at a regional Burn Center. T-tests and chi-square tests were conducted to determine differences between sexes on outcome measures. A path analysis was conducted to evaluate relationships between variables of interest. Findings revealed significant sex discrepancies in risk and symptom outcomes. Compared to men, women reported greater total risk scores of developing PTSD and depression (p = .005) early after their burn injury. A subscale analysis showed that women reported greater risk scores on depression (p < .001), but not on PTSD. Women did not report higher depression scores 30 days post-injury compared to men but did report higher PTSD scores than men (p = .020). When sex, age, and TBSA were included in a path analysis, female sex (p=.001), younger age (p<.001), and larger TBSA of the burn injury (p=.024) were associated with greater risk. Additionally, risk scores significantly predicted PTSD (p<.001) and depression (p<.001) symptoms 30 days post-injury. Our research shows how sex, age, and TBSA affect the risk of PTSD and depression among burn survivors. It underscores the importance of accounting for sex and age differences in mental health risk, especially in women and younger patients. This emphasizes the urgency of early screening and intervention.

Evaluating a New Digital App-Based Program for Heart Health: Feasibility and Acceptability Pilot Study.

Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting a significant proportion of adults. Digital health lifestyle change programs have emerged as a promising method of CVD prevention, offering benefits such as on-demand support, lower cost, and increased scalability. Prior research has shown the effectiveness of digital health interventions in reducing negative CVD outcomes. This pilot study focuses on the Lark Heart Health program, a fully digital artificial intelligence (AI)-powered smartphone app, providing synchronous CVD risk counseling, educational content, and personalized coaching. This pilot study evaluated the feasibility and acceptability of a fully digital AI-powered lifestyle change program called Lark Heart Health. Primary analyses assessed (1) participant satisfaction, (2) engagement with the program, and (3) the submission of health screeners. Secondary analyses were conducted to evaluate weight loss outcomes, given that a major focus of the Heart Health program is weight management. This study enrolled 509 participants in the 90-day real-world single-arm pilot study of the Heart Health app. Participants engaged with the app by participating in coaching conversations, logging meals, tracking weight, and completing educational lessons. The study outcomes included participant satisfaction, app engagement, the completion of screeners, and weight loss. On average, Heart Health study participants were aged 60.9 (SD 10.3; range 40-75) years, with average BMI indicating class I obesity. Of the 509 participants, 489 (96.1%) stayed enrolled until the end of the study (dropout rate: 3.9%). Study retention, based on providing a weight measurement during month 3, was 80% (407/509; 95% CI 76.2%-83.4%). Participant satisfaction scores indicated high satisfaction with the overall app experience, with an average score of ≥4 out of 5 for all satisfaction indicators. Participants also showed high engagement with the app, with 83.4% (408/489; 95% CI 80.1%-86.7%) of the sample engaging in ≥5 coaching conversations in month 3. The results indicated that participants were successfully able to submit health screeners within the app, with 90% (440/489; 95% CI 87%-92.5%) submitting all 3 screeners measured in the study. Finally, secondary analyses showed that participants lost weight during the program, with analyses showing an average weight nadir of 3.8% (SD 2.9%; 95% CI 3.5%-4.1%). The study results indicate that participants in this study were satisfied with their experience using the Heart Health app, highly engaged with the app features, and willing and able to complete health screening surveys in the app. These acceptability and feasibility results provide a key first step in the process of evidence generation for a new AI-powered digital program for heart health. Future work can expand these results to test outcomes with a commercial version of the Heart Health app in a diverse real-world sample.

Randomised experimental evaluation of a social media campaign to promote COVID-19 vaccination in Nigeria.

The coronavirus disease 2019 (COVID-19) pandemic has challenged public health and behaviour change programmes, and has led to the development of innovative interventions and research. In low -and middle-income countries (LMICs) such as Nigeria, new strategies to promote vaccination, increase pro-vaccination social norms, and reduce vaccine hesitancy have been deployed through social media campaigns and evaluated using digital media platforms. We conducted two randomised experimental evaluations of social media content designed to promote COVID-19 vaccination and to complement research on a nationwide vaccination promotion campaign in Nigeria run in 2022. We conducted two studies in March and August 2022 among Nigerians drawn from 31 states that had not been targeted in the aforementioned nationwide campaign. We randomised the participants to either receive the pro-vaccination social media campaign or not and collected data at pre- and post-test time points to evaluate psychosocial predictors of vaccination and vaccination outcomes following the Theory of Change based on Diffusion of Innovations; the Social Norms Theory, and the Motivation, Opportunity, Ability (MOA) framework. Data were collected through a novel intervention delivery and data collection platform through social media. We found that pro-vaccination social norms and vaccination rates increased, while vaccine hesitancy decreased among participants randomised to the social media intervention study arm. Social media campaigns are a promising approach to increasing vaccination at scale in LMICs, while social norms are an important factor in promoting vaccination, which is consistent with the Social Norms Theory. This study demonstrates the capability and potential of new social media-based data collection techniques. We describe implications for future vaccination campaigns and identify future research priorities in this area. Pan African Clinical Trial Registry: PACTR202310811597445.

Comparing the effectiveness of narrative therapy and EMDR-GTEP protocols in the treatment of post-traumatic stress in children exposed to humanitarian crises

BackgroundThe mental health of children living in humanitarian crisis situations is a major issue. Post-traumatic stress disorder (PTSD) causes great psychological suffering and has negative consequences on children's development. The aim of the study was to analyze retrospective data collected in a mental health and psychosocial support program for children in the Central African Republic, and to compare results of two trauma-focused treatment interventions: the narrative protocol Action contre la Faim (ACF)/KONO; and the EMDR-based Group Trauma Episode Protocol (G-TEP). Both protocols are proposed in a group setting and led by paraprofessionals.MethodsIn the program, 884 children attended a psychoeducation session and after that, 661 children (290 for ACF/KONO and 371 for G-TEP) benefited from all treatment sessions. PTSD was measured by the Children's Revised Impact of Event Scale (CRIES-8). General distress was measured by the Child Psychosocial Distress Screener (CPDS). Data were collected before and after treatment, and measured 5 months after the end of treatment for 185 children.ResultsParticipants in the ACF/KONO group show a significant reduction on CRIES-8 (t = 44.8; p &amp;lt; 0.001, effect size = 2.63) and CPDS (t = 38.2; p &amp;lt; 0.001, effect size = 2.24). Participants to the G-TEP protocol show a significant effect with reduced scores on the CRIES-8 (t = 49.2; p &amp;lt; 0.001, effect size = 2.55) and CPDS (t = 57.2; p &amp;lt; 0.001, effect size = 2.97). A Student's t-test comparing the ACF/KONO and G-TEP groups shows no significant difference between the two types of treatment between pre- and post-treatment CRIES-8 scores (t = 1.744; p = 0.514, effect size = 0.040) and CPDS scores (t = 1.688; p = 0.092, effect size = 0.323). An analysis of the follow-up data for the 185 children shows that the effects of both protocols are maintained over time with mean scores after treatment and follow-up below the clinical cut-off for both CPDS (&amp;lt;8) and CRIES-8 (&amp;lt;17).ConclusionsBoth protocols have been shown to be effective in reducing traumatic symptoms in children exposed to conflict; they can be conducted by paraprofessionals and used in humanitarian crisis situations.

Musculoskeletal Diseases as the Most Prevalent Component of Multimorbidity: A Population-Based Study

Background/Objectives: Due to their high frequency, common risk factors, and similar pathogenic mechanisms, musculoskeletal disorders (MSDs) are more likely to occur with other chronic illnesses, making them a “component disorder“ of multimorbidity. Our objective was to assess the prevalence of multimorbidity and to identify the most common clusters of diagnosis within multimorbidity states, with the primary hypothesis that the most common clusters of multimorbidity are MSDs. Methods: The current study employed data from a population-based 2019 European Health Interview Survey (EHIS). Multimorbidity was defined as a ≥2 diagnosis from the list of 17 chronic non-communicable diseases, and to define clusters, the statistical method of hierarchical cluster analysis (HCA) was performed. Results: Out of 13,178 respondents, multimorbidity was present among 4398 (33.4%). The HCA method yielded six multimorbidity clusters representing the most common diagnoses. The primary multimorbidity cluster, which was prevalent among both genders, age groups, incomes per capita, and statistical regions, consisted of three diagnoses: (1) lower spine deformity or other chronic back problem (back pain), (2) cervical deformity or other chronic problem with the cervical spine, and (3) osteoarthritis. Conclusions: Given the influence of musculoskeletal disorders on multimorbidity, it is imperative to implement appropriate measures to assist patients in relieving the physical discomfort and pain they endure. Public health information, programs, and campaigns should be utilized to promote a healthy lifestyle. Policymakers should prioritize the prevention of MSDs by encouraging increased physical activity and a healthy diet, as well as focusing on improving functional abilities.