Development and psychometric testing of a scale for diet self-management among urban residents in China: a cross-sectional study.

OBJECTIVE: DESIGN: The diet self-management scale (DSE-MS) items were identified and evaluated by literature and guideline review, expert consultation and pilot testing. Factor structure was tested by randomly dividing the sample into two equal groups for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The scale was further tested for internal consistency, convergent validity, discriminant validity and known-group validity. SETTING: A city in China. PARTICIPANTS: A total of 724 urban residents from a city in China participated in this study in 2023. RESULTS: The final DSE-MS included 45 items and showed good internal consistency with a Cronbach's alpha coefficient of 0.961. EFA identified 6 dimensions explaining 67.89% of the total variance: cognition (11 items), microenvironment (12 items), macroenvironment (4 items), safety management (7 items), nutrition management (6 items) and environment management (5 items). The CFA showed a good model fit of the six-dimension scale: χ2/df=1.8878, root mean square error of approximate=0.0496, Comparing Fit Index=0.9425, Incremental Fit Index=0.9428, Tucker-Lewis Index=0.9369 and standard root mean square residual=0.0525. Convergent validity was supported by high composite reliability (CR=0.89-0.96) and average variance extracted (AVE=0.58-0.72), while discriminant validity was confirmed by higher AVE estimates than the squared interconstruct correlations. The DSE-MS scores varied by various sample characteristics, verifying the known-group validity. CONCLUSION: The 6-factor 45-item DSE-MS had good psychometric properties assessing diet self-management among urban citizens. The scale can guide future intervention programmes to improve diet self-management and evaluate the intervention effect. Further validation of the DSE-MS in other populations in other areas is needed to verify its wide application.

Jenner's Legacy: How Edward Jenner's Smallpox Vaccine Changed Public Health.

Edward Jenner who discovered immunology and the smallpox vaccine conducted a smallpox vaccination test in 1796, which is considered a landmark in the history of modern immunization. This review focuses on describing Jenner and his accomplishments highlighting his discovery as a shift in the approaches toward disease control and prevention as well as the basis for further eradicating smallpox globally. Jenner's use of cowpox to protect people from smallpox was a revolution from other essential procedures such as variolation. His vaccine demonstrated how immunization could be used to combat diseases, and over the years the idea began to be deployed to other vaccines and other diseases. Besides the given medical profession, the work of Jenner was relevant to the changes or even enhancements of health policies and health systems globally. His vaccine provided not only the means to arrest a wide disease that could easily eliminate many human beings but also initiated procedures of disease prevention and control. Another important type of immunity, herd immunity, which determines an approach to managing specific diseases in the present, as well as knowledge of the degree of protection provided by the antigen in terms of the overall immune status of a population, was also achieved based on the actions taken after Jenner's procedure. As our society searches for vaccines for emergent diseases to date, this review reveals that Jenner's accomplishments are still relevant. In this article, analyzing Jenner's approach and the role of society and science at the time, along with the consequences of his work, the reader sees how Jenner changed the world of public health and laid a foundation for today's vaccination. Such an approach allows considering the changes and evolution of the topic that Jenner studied and contributed to and how people fight infections today.

Facial Lacerations Related to Recreational Activities: A National 10-Year Evaluation From US Emergency Departments.

Study Design: This study serves as a nationally representative retrospective cohort of U.S emergency department visits related to facial lacerations caused by recreational activities. Objective: The aim of this work is to offer a representative sample of facial laceration and identify the recreational activities associated with the highest risk of such injuries. Methods: We conducted a retrospective study of patients reported to the National Electronic Injury Surveillance System (NEISS) which collects information on injuries related to consumer products. Patients were included in our dataset from the time period of 2012 to 2021 if they sustained a facial laceration that was caused by a recreational activity. Results: Our findings reveal 2,383,761 facial lacerations between the study period examined. Young male white adults were more likely to sustain a facial laceration related to recreational activities. Injuries related to exercise equipment were also more likely seen in male patients. The most common cause of facial lacerations was associated with bicycles and basketball. Conclusions: This study found that young white adults are notably prone to facial lacerations, with recreational activities such as bicycling and basketball accounting for the majority of cases. Understanding these statistics is pivotal for implementing targeted strategies to prevent these injuries and their associated consequences.

Adherence to recommended follow-up in opportunistic versus non-opportunistic cervical screening: a registry-based cohort study from Denmark.

AIM: Organised cervical screening programmes often allow for opportunistic screening. Previous studies have shown that adherence to follow-up protocols after cervical screening is poor. This study aims to investigate if non-adherence to recommended screening intervals - that is, opportunistic screening, is associated with adherence to follow-up after non-negative cervical screening. METHODS: Using national registries we included 42,399 Danish women with a non-negative screening result from 2015 to 2017. Non-adherence was divided into insufficient and excessive follow-up. We calculated relative risks (RRs) of adherence to follow-up among different groups of opportunistically screened women, representing both too frequent and delayed screening participation, compared with non-opportunistically screened women. RESULTS: Compared with non-opportunistically screened women, opportunistically screened women who were delayed 1-3 years on their screening schedule had a higher risk of no follow-up (RR 1.99) and insufficient follow-up (RR 1.10). Women who were delayed 3-7 years on their screening also had a higher risk of no follow-up (RR 1.92). Women who attended screening up to 6 months too early had a higher risk of insufficient follow-up (RR 1.08) as well as excessive follow-up (RR 1.39). Finally, women screened more than 6 months too early had a higher risk of all deviations, but most pronounced was the risk of excessive follow-up (RR 1.67). CONCLUSIONS: We found a higher risk of insufficient follow-up among women delayed in their screening schedule, and a higher risk of excessive follow-up among those with frequent screening. Screening participation behaviour seems to transfer to follow-up adherence. This underscores the important role of general practitioners in acting as gatekeepers in cervical screening follow-up.

Importance of strength training for sustaining performance and health in military personnel.

The physical capacity of male and female warfighters is challenged on the modern battlefield by heavy loads and high-intensity work. When designing training programmes for warfighters, approaches for developing strength and power alongside endurance must be considered. Strength training often requires facilities that may not be available during deployments while multiple stressors may impair or decrease overall performance. Understanding the effect of military environments on warfighter performance and acknowledging the variation in demands for individuals during field training and deployments, including possible sex differences, is essential to promote the development of adequate physical reserves (strength, power and endurance), attenuate risk for injury and promote health during and after military careers. The purpose of this narrative review is to discuss considerations for programming physical training in a military environment where 'one size does not fit all'. In addition, a brief description of physiological contributions (neural and muscular) to strength development is included.

Association between physical activity and diabetes control: multiple cross-sectional studies and a prospective study in a population-based, Swiss cohort.

INTRODUCTION: Physical activity (PA) is recommended in patients with type 2 diabetes mellitus (T2DM) to improve their glycaemic control. We aimed to assess PA levels among participants with controlled and uncontrolled T2DM. RESEARCH DESIGN AND METHODS: Three cross-sectional analyses of a prospective cohort conducted in Lausanne, Switzerland. PA levels (sedentary, light, moderate and vigorous) were either self-reported via questionnaire (first and second survey) or objectively assessed using accelerometry (second and third survey). T2DM control was defined as glycaemia <7.0 mmol/L or glycated haemoglobin <6.5% (48 mmol/mol). RESULTS: Data from 195 (30.3% women), 199 (30.1% women) and 151 (44.4% women) participants with T2DM were analysed in the first (2009-2012), second (2014-2017) and third (2018-2021) surveys. Approximately half of the participants did not have controlled glycaemia. Using subjective data, over 90% (first survey) and 75% (second survey) of participants reported moderate and vigorous PA >150 min/week. After multivariable adjustment, no differences were found regarding all types of self-reported PA levels between controlled and uncontrolled participants. Objective assessment of PA led to considerable differences according to the software used: 90% and 20% of participants with moderate and vigorous PA >150 min/week, respectively. After multivariable adjustment, no differences were found for all PA levels between controlled and uncontrolled participants, irrespective of the analytical procedure used. Using glycated haemoglobin, almost two-thirds of participants were considered as uncontrolled, and no differences were found for objectively assessed PA between controlled and uncontrolled participants. CONCLUSIONS: No differences in PA levels were found between participants with controlled and uncontrolled T2DM.

Health impact of urban green spaces: a systematic review of heat-related morbidity and mortality.

OBJECTIVES: The objective of this review was to scrutinise the impact of urban green spaces on heat-related morbidity and mortality. DESIGN: This systematic review was meticulously carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines DATA SOURCES: A comprehensive search was conducted across PubMed, Scopus and Google Scholar including studies from January 2000 to December 2022. ELIGIBILITY CRITERIA: Studies that examined the influence of urban green spaces on heat-related morbidity and mortality, including randomised controlled trials, observational and modelling studies, were included. DATA EXTRACTION AND SYNTHESIS: A total of 3301 publications were initially identified, out of which 12 studies met the inclusion criteria and were selected for analysis. The selected studies were predominantly from high-income and upper-middle-income nations (95%). RESULTS: The research points towards a pattern where regions abundant in green spaces report lower rates of heat-related morbidity and mortality in contrast to those with sparse greenery. Additionally, urban vegetation appears to exert a positive influence on mental health and well-being, potentially aiding in offsetting the adverse health repercussions of high temperatures. CONCLUSION: Urban green spaces play a vital role in mitigating heat-related health risks, offering a potential strategy for urban planning to address climate change and enhance public health. Additional research is required to thoroughly comprehend the magnitude of urban greenery's impact on heat-related morbidity and mortality, as well as its interplay with other variables, including air pollution, socioeconomic status, among others.

Evaluating physical activities in clinical diabetes: lifestyle scores hypothesis.

BACKGROUND: The concept of lifestyle-based risk scores is known but not evaluated in most rural communities of low- to mid-income countries. This study investigated the correlation of lifestyle scores with health indices. METHODS: This was a descriptive cross-sectional investigation. A total of 203 participants (141 females and 62 males), 18-90 years, had anthropometric assessments and lifestyle scores determined from a 12-item framework. Data analysis included average age in different health conditions, lifestyle scores in age groups, and correlations with age. RESULTS: Average age of healthy subpopulation was 39 years while diabetes, hypertension, and obesity subpopulations were 58, 64, and 56 years, respectively. The percentage of participants whose activities of daily living (ADL) were unaffected by ill-health decreased with age (P < 0.0001), and lifestyle scores also decreased with age (P < 0.01) and negatively correlated with physical activities. CONCLUSION: This report contributes to diabetes cardiovascular complications management. Sedentary ADL factors need integration in healthy lifestyle education especially among the elderly.

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

AIM: 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. METHODS: 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. DISCUSSION: 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. TRIAL REGISTRATION: UMIN-CTR (identification number: UMIN000034709). Registered 31 October 2018. Geriatr Gerontol Int 2024; ••: ••-••.

Longitudinal changes in self-reported medication adherence and beliefs about post-stroke medicines in Sweden: a repeated cross-sectional study.

OBJECTIVES: To explore changes in beliefs about medicines and self-reported medication non-adherence between 3 and 24 months after stroke and to investigate associations between beliefs about medicines and non-adherence at 24 months after stroke. DESIGN: Longitudinal questionnaire survey. SETTING: Patients treated for acute stroke in 25 Swedish hospitals. PARTICIPANTS: Only patients living at home were included. Of the 594 individuals who answered the 3 month questionnaire, 401 were included at 24 months; among the remainder, 34 (5.7%) had died, 149 (25,1%) did not respond or had incomplete information on adherence and 10 (1.7%) were not living at home. MEASURES: The primary outcome was self-reported medication adherence as measured with the Medication Adherence Report Scale (MARS). The Beliefs about Medicines Questionnaires (BMQ) was used to assess personal beliefs about medicines. Background and clinical data were included from the Swedish national stroke register. RESULTS: According to dichotomised MARS sum scores, more individuals were classified as non-adherent at 24 months after stroke (n=63, 15.7%) than at 3 months after stroke (n=45, 11.2%) (p=0.030). For BMQ, the only difference over time was an increase in the Necessity subscale (p=0.007). At 24 months, in comparison to adherent patients, non-adherent patients scored statistically significant higher on negative beliefs about medicines, such as Concern (OR 1.17, 95% CI: 1.09 to 1.25), Overuse (OR: 1.37, 95% CI: 1.21 to 1.54) and Harm (OR: 1.24, 95% CI: 1.11 to 1.39), and lower on positive beliefs about medicines, namely, Necessity (OR: 0.88, 95% CI: 0.80 to 0.96) and Benefit (OR: 0.85, 95% CI: 0.74 to 0.98). CONCLUSIONS: Stroke patients' beliefs about medicines were associated with adherence, and over time beliefs remained stable across all domains, except for an increased perception of medications as being necessary. Despite this, more patients became non-adherent over time. To counteract non-adherence, interventions targeted to improve intentional adherence as well as non-intentional adherence should be investigated and implemented.

An expert consensus on the most effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: protocol for an online modified Delphi study.

INTRODUCTION: Behaviour change interventions are advocated as a key approach to manage behavioural risk factors such as insufficient physical activity, poor diet and smoking. Integrated motivational interviewing and cognitive behavioural therapy (MI-CBT) interventions have become increasingly popular to promote behaviour change; however, there is a lack of agreement as to what constitutes necessary components of MI-CBT interventions for lifestyle behaviour change. The primary objective of this study is to use a consensus method to develop guidelines to design and deliver MI-CBT interventions for lifestyle behaviour change. METHODS: A three-round modified Delphi study will be conducted with an expert, international panel of clinicians and researchers. An online survey will be developed from assessments of key MI-CBT literature and practice guides to identify commonly used components of individually delivered MI and CBT interventions. In each round, participants will rate the extent to which they agree with each component using a Likert scale. Responses from Rounds 1 and 2 will be presented to participants in subsequent rounds. Responses will be represented using bar graphs and include the median and IQR of participants' responses. To encourage consensus, participants will be asked to consider the group responses before finalising their opinion to the statements. If at least 80% of the experts agree to a statement in Rounds 2 or 3, it will be included in a final list of necessary statements. DISCUSSION: This modified Delphi process will help transparency in the design and implementation of MI-CBT interventions. The consensus statement will also help reporting and comparability among effectiveness studies for MI-CBT intervention studies, and help inform research, policy and practice. ETHICS AND DISSEMINATION: Ethical approval has been granted by the La Trobe University Human Research Ethics Committee (approval number HEC24066). The results will be disseminated via peer-reviewed publications, conferences and international professional associations.

Participation, barriers, facilitators and bullying experiences of trans people in sport and fitness: findings from a national community survey of trans people in Australia.

OBJECTIVES: This study aimed to assess participation rates of transgender and gender diverse (trans) people in sport/fitness activities, compare mental health outcomes for trans people participating in sport/fitness with those who do not and explore internal/external barriers and bullying experiences faced by trans people in sport/fitness contexts. METHODS: A cross-sectional online survey open to trans people aged ≥16 years living in Australia was conducted between February and April 2023 and it assessed rates of sport/fitness participation, barriers to participation and bullying experiences through multiple-choice questions. Mental health measures comprised the Kessler Psychological Distress Scale (K10) and self-reported history of self-harm and suicidality. Covariate-adjusted binary logistic regression models tested associations between interpersonal factors, sport/fitness variables and mental health outcomes. RESULTS: Of 664 respondents (median age 32 years), around one-third (32.8%) regularly participated in sport/fitness. Common internal barriers to participation included anxiety about others' reactions (63.9%), body dissatisfaction/dysphoria (56.5%) and fears about feeling accepted/affirmed by others (54.7%). Respondents commonly reported experiencing inadequate bathroom/changing facilities (44.4%), exclusionary rules and regulations surrounding gender (36.7%), and invasive or uncomfortable policies or procedures (23.3%). Over one-third (34.4%) of trans people had experienced gender-based bullying or exclusion. Regular sport/fitness participation was associated with significantly lower K10 scores (mean difference=-4.4, 95% CI-5.8, -2.9, p<0.001) and a 40% reduction in odds of recent thoughts of self-harm and suicide (aOR 0.6, 95% CI 0.5, 0.9, p=0.01; aOR 0.6, 95%CI 0.4, 0.9, p=0.02). CONCLUSION: Trans people face significant barriers to sport/fitness despite experiencing significant mental health and personal benefits from participation. Affirming and including trans people in sport and fitness should be a key priority for sport and fitness federations, organisations and policy-makers.

Mechanical Mapping of the Common Carotid Artery in Healthy Individuals Aged 2 to 40 Years.

(1) Background: In 2022, the World Stroke Organization said there were more than 12.2 million new cases of stroke each year, between all ages and sexes. Six and a half million people die each year from stroke. Ischemic stroke accounts for 7.6 million (62%) cases, with 3.3 million (51%) deaths. Stroke is mainly linked to the atherosclerosis of a large artery. (2) Objective: Since the carotid artery directly supplies the brain, we used age-dependent mechanical mapping on the healthy common carotid artery (CCA) with the aim of being able to predict and thus potentially prevent ischemic stroke. (3) Methods: We assessed the CCA stiffness of 95 healthy control (CTL) females (2.23-39.46 years) and 107 healthy CTL males (2.85-40 years). Cine-loops of B-mode CCA data were digitally recorded with conventional medical ultrasound devices. Arterial wall elastic moduli were estimated offline using a proprietary non-invasive imaging-based biomarker algorithm (ImBioMark). Statistical analyzes were carried out with Excel software. (4) Results: Females showed a linear regression profile of CCA elastic moduli ranging from 41 ± 2 kPa to 54 ± 17 kPa (R2 = 0.88), while males showed one ranging from 38 ± 5 kPa to 63 ± 22 kPa (R2 = 0.83). For qualitative and quantitative illustrations, the elastic modulus data of CTLs were compared with those of subjects with Kawasaki disease and subjects born prematurely, respectively. (5) Conclusions: This study introduced some fundamental features of the mechanical evolution of the CCA as a function of age (2-40 years). Since atherosclerotic arteriopathy starts early in life, this gives the ability to predict risks of stroke and other cardiovascular diseases with the possibility of applying a more comprehensive range of potential preventive measures early in life. This is consistent with preventive medicine objectives which aim to be more predictive to implement pre-emptive measures as opposed to diagnostic and curative approaches.

Comparing Cancer Primary and Secondary Prevention Documentation Between Different Digital Health Approaches in the Emergency Department.

Background: Decreasing primary care access and increasing emergency department (ED) usage is a potential contributor to declining cancer screening prevalences in those facing barriers to health care access. The ED is a non-traditional yet potentially high-yield setting for implementation of interventions to monitor and increase cancer screening. Methods: An ED-administered survey in July 2022 gathered data on breast, cervical, and colorectal cancer screening, as well as human papillomavirus (HPV) vaccination status of females presenting to the ED for care. This was compared with electronic health record (EHR) data extraction of all ED patients during the same timeframe. Primary outcome was proportion of cancer screening and HPV vaccination not up to date in each group. Results: ED survey was administered to 101 individuals; EHR data was extracted on 2934 patients. Survey versus EHR, respectively, found cervical cancer screening was not up to date in 6.2% vs. 77.6%, breast cancer screening in 14.3% vs. 73.4%, colorectal cancer screening in 22.9% vs. 56.5%, and HPV vaccination in 33.3% vs. 57.8%. p value was < 0.001 for all screening category comparisons between survey and EHR. Discussion: Our data indicate significant discrepancies between self-reported screening history and EHR data. ED survey results were more in line with the observed screening rates in various surveillance systems and published in the literature. This suggests that point-of-care ED survey administration may be more effective in identifying those needing preventative cancer screening, especially in individuals with less access to routine health care.

Novel Variant in ANO5 Muscular Dystrophy: Identification by Whole Genome Sequencing and Quad Analysis.

BACKGROUND: The phenotypic spectrum of ANO5 muscle disease ranges widely from elevated creatine kinase (CK) levels in the serum of asymptomatic individuals to progressive muscular dystrophy. Due to overlapping clinical features among muscular dystrophies, the diagnosis of ANO5 muscle disease is established by molecular genetic tests. Early diagnosis is crucial for the clinical management of symptoms and to mitigate cardiac and musculoskeletal complications. METHODS: Quad-joint analysis was performed on whole genome sequencing (WGS) data obtained from an 18-year-old female with mild myalgia and elevated CK and her unaffected parents and sister. The phenotype-driven analysis was performed to prioritize genomic alterations related to the phenotype. The zygosity-based analysis investigated compound heterozygous and de novo status for all variants. RESULTS: The quad-joint WGS analysis revealed a novel pathogenic heterozygous variant, ANO5:c.1770_1773del (p.Phe593Metfs*15), that was paternally inherited. A second and known pathogenic heterozygous variant, ANO5:c.148C>T (p.Arg50*), was also present that was maternally inherited. The genome finding led to the diagnosis of autosomal recessive ANO5 muscle disease and an early personalized clinical management for the patient regarding her cardiac and musculoskeletal health. CONCLUSIONS: This is the first report of the ANO5:c.1770_1773del variant in the literature. This report highlights the spectrum of ANO5 muscle disease and describes the role of quad-joint WGS in the early diagnosis and preventive clinical management of ANO5 muscle disease.

Methotrexate, blood pressure and arterial function in rheumatoid arthritis: study protocol.

This article discusses the rationale and design of the study "Methotrexate, blood pressure, and arterial function in rheumatoid arthritis". The recognition that immune activation and excess inflammation favor atherosclerosis has stimulated a significant body of research not only to identify new drugs targeting these pathways but also to repurpose (reposition) existing immunomodulatory medications as atheroprotective agents. Observational studies in patients with rheumatoid arthritis have reported that treatment with methotrexate, a traditional disease-modifying antirheumatic drug, is associated with a significantly lower risk of cardiovascular morbidity and mortality when compared with other disease-modifying antirheumatic drugs. One potential mechanism accounting for the reduced cardiovascular risk associated with methotrexate is the lowering effect on arterial blood pressure. However, such effect has only been observed in cross-sectional and observational studies. Given the established role of hypertension as a leading cardiovascular risk factor, these observations justify an intervention comparison study, the focus of this article, investigating the temporal effects of methotrexate on blood pressure and various surrogate markers of atherosclerosis in patients with rheumatoid arthritis. The results of this study might lead to the repurposing of methotrexate for cardiovascular prevention in patients with and without autoimmune disorders.Clinical Trial Registration: NCT03254589 (ClinicalTrials.gov).

This article describes a research study looking at the effects of a well-established antirheumatic drug, methotrexate, on blood pressure and blood vessels in patients with rheumatoid arthritis, a disabling condition affecting the joints as well as other organs and tissues. Methotrexate is commonly used in rheumatoid arthritis, given its ability to suppress inflammation and the activation of the immune system. However, excessive inflammation and immune activation are linked to atherosclerosis, a condition characterised by the build-up of plaques in blood vessels and the development of clots. Therefore, methotrexate might also be helpful in combating atherosclerosis because of its ability to suppress inflammation and immune system activation. We have previously observed that patients with rheumatoid arthritis receiving methotrexate have lower blood pressure when compared with patients receiving other antirheumatic drugs. However, in this study we could not prove that methotrexate directly reduces blood pressure. Given that high blood pressure is well known to damage the blood vessels and promote atherosclerosis and its devastating manifestations, for example, heart attack and stroke, this article will discuss a new study that compares blood pressure for individuals assigned to different treatments to assess whether methotrexate can lower blood pressure over time and exert additional beneficial effects on blood vessels in patients with rheumatoid arthritis. The results of this study will be helpful in determining whether methotrexate can be routinely used to combat atherosclerosis and consequently reduce the risk of heart attack and stroke in patients with rheumatoid arthritis and, potentially, other patient groups.

Protocol for a community-based, household-randomised, dose-response trial to assess the acceptability, nutritional effects and safety of double-fortified salt containing iodine and folic acid compared with iodised salt among non-pregnant Ethiopian women of reproductive age (DFS-IoFA).

INTRODUCTION: The prevalence of neural tube defects (NTDs) is higher in Ethiopia than most other countries, and ~84% of Ethiopian women of reproductive age (WRA) have folate insufficiency, a major risk factor for NTDs. Salt fortification with folic acid is a potential strategy to improve women's folate status, but data are needed on the acceptability, nutritional impact and safety of folic acid fortification of iodised salt. METHODS AND ANALYSIS: The study is designed as a community-based, household-randomised, dose-response trial. A total of 360 non-pregnant WRA 18-49 years of age will be randomly assigned to one of three intervention arms: (1) iodised salt fortified with 30 ppm folic acid to provide ~200 µg folic acid/day; (2) iodised salt fortified with 90 ppm folic acid to provide ~600 µg folic acid/day; or (3) iodised salt (comparator). The preweighed salts will be delivered to participants' homes biweekly for 26 weeks; unused salt will be collected and weighed. Fasting, venous blood samples will be collected at baseline, end line and a randomly assigned intermediate time point for assessment of folate, iodine, vitamin B12 and other micronutrient status biomarkers. Women's dietary intakes, including discretionary salt consumption, will be measured using weighed food records; 24-hour urine specimens will be analysed for sodium and iodine excretion. Primary outcomes are women's consumption of study salts, change in biomarkers of folate and iodine status and prevalence of adverse events. Results will be analysed using analysis of covariance models to estimate group mean differences for continuous outcomes, controlling for baseline measurements, and log-binomial or modified Poisson regressions for categorical outcomes. Prespecified effect modifications will be explored. ETHICS AND DISSEMINATION: The study has been approved by the Ethiopian Public Health Institute's Institutional Review Board, and the protocol has been registered with ClinicalTrials.gov (registration number NCT06223854). Study results will be published in open access scientific journals and disseminated nationally in Ethiopia. TRIAL REGISTRATION NUMBER: NCT06223854.

Oral Health Problems Among Flemish and Dutch Nursing Home Residents Assessed by Nondental Caregivers Using the Novel Oral Health Section for Inclusion in interRAI.

Background and Objectives: Oral health of older adults in nursing homes is poor, which can negatively affect general health and well-being. Most oral health problems are preventable with good oral hygiene and regular dental check-ups. Caregivers can help improve residents' oral health through regular oral health assessments. The interRAI instrument used in Long-Term Care Facilities to evaluate older adults' health and well-being, has the potential to integrate oral care into general care planning. The recently optimized Oral Health Section for inclusion in the interRAI instruments (OHS-interRAI) enables nondental caregivers to identify residents requiring help with oral hygiene and/or a dental referral. This study reports the first data obtained using the OHS-interRAI, describing the oral health situation of older adults in Flemish and Dutch nursing homes. Research Design and Methods: In this cross-sectional study, interRAI Long-Term Care Facilities data, including OHS-interRAI data, were collected from October 2020 to January 2023 and analyzed from 417 and 795 persons aged 65 years or older in Flemish and Dutch nursing homes, respectively. Results: Most common oral health problems were poor oral hygiene and compromised teeth. Differences in oral health were found between Flemish and Dutch residents. Flemish residents had significantly more problems with chewing, dry mouth, oral and denture hygiene, and tongue condition than their Dutch counterparts. They also had a higher need for help with oral hygiene (19.4% vs 14.0%), and a dental referral (36.8% vs 20.9%). Older adults in Flemish nursing homes (20.3%) had significantly fewer dental check-ups than those in Dutch nursing homes (73.5%). Discussion and Implications: The use of the OHS-interRAI by nondental caregivers identified at least one-third of the residents requiring help with oral hygiene and/or a dental referral. By means of trigger algorithms (Collaborative Action Points), the OHS-interRAI enables the integration of oral care into general care planning.

Virtual care is a double-edged sword: Adjusting preventive care service delivery in community health clinics during COVID-19.

Purpose: Qualitatively examine how community health clinics delivered cardiovascular disease (CVD) preventive care during COVID-19 using virtual care and related adaptations. Methods: Semi-structured interviews were conducted in 2021-2022 with nine clinician leaders from four clinics across the country that share an electronic health record. Interviews covered: (1) the pandemic's impact on preventive care delivery, (2) the adaptation and role of virtual care, and (3) management of CVD risk in this context. Collected data were analyzed using a thematic analysis approach. Results: Staff reported substantial pros and cons to virtual care for CVD risk management. It was seen as useful for general check-ins with patients. However, without current laboratory results and vital measurements, providers found it challenging to assess patient CVD risk and direct care accordingly. Conclusion: Findings add to the evolving evidence base that the necessary pivot to virtual care during the pandemic spurred innovations but also created limitations and delays in delivering appropriate preventive care.