The Need for Responsive Workforce Development During the Pandemic and Beyond: A Case Study of the Regional Public Health Training Centers.

CONTEXT: The COVID-19 pandemic underscored the importance of a strong public health infrastructure for protecting and supporting the health of communities. This includes ensuring an adaptive workforce capable of leading through rapidly changing circumstances, communicating effectively, and applying systems thinking to leverage cross-sector partnerships that help promote health equity. The 10 Regional Public Health Training Centers (PHTCs) advance the capacity of the current and future public health workforce through skill development and technical assistance in these and other strategic areas. PROGRAM: This study examines activities through which the Regional PHTCs and their partners supported the public health workforce during the pandemic. Representatives of the 10 Regional PHTCs completed a survey in the spring of 2022. The survey included (1) pulling trends in training usage from 2018-2021 annual performance reports and (2) questions assessing the type, content, and reach of training needs assessments, training and technical assistance, student placements, and PHTC Network collaborative activities that occurred from January 1, 2020, to December 31, 2021. Respondents also reflected on trends in use, challenges, lessons learned, stories of impact, and future PHTC practice. EVALUATION: During the pandemic, the Regional PHTCs engaged in numerous efforts to assess needs, provide training and technical assistance to the practice community, facilitate projects that built student competency to support public health agency efforts, and collaborate as the PHTC Network on national-level initiatives. Across these activities, the Regional PHTCs adjusted their approaches and learned from each other in order to meet regional needs. DISCUSSION: The Regional PHTCs provided student and professional development in foundational public health knowledge and skills within their regions and nationally while being flexible and responsive to the changing needs of the field during the pandemic. Our study highlights opportunities for collaboration and adaptive approaches to public health workforce development in a postpandemic environment.

Effectiveness of an oral health promotion training program among school nurses in India.

BACKGROUND: Schools are a valuable platform for oral health promotion and the role of school nurse is critical in promoting oral health of children. A training program was carried out to assess its effectiveness in promoting oral health among school nurses of Navodaya Vidyalaya Samiti (NVS), one of the largest groups of central schools in India. METHODOLOGY: A total of 557 school nurses of Navodaya Vidyalaya schools participated in the training program. The training was delivered virtually using didactic teaching methods based on a conceptual framework. Pre and post knowledge scores were assessed for all the participants. RESULTS: A total of 451 pre-post complete responses were received during training program, with a response rate of 81 %. There was significant improvement in the overall knowledge scores (p < 0.001) of school nurses. After the training program was completed, oral health screening and education for students was conducted by these trained nurses in coordination with teachers in their respective schools. CONCLUSION: The present training program was effective in addressing the gaps in oral health knowledge of the school nurses and significantly improving their oral health knowledge.

Impact of updated hypertension guideline on eligibility for an employee wellness program.

BACKGROUND: Pharmacists reduce overall healthcare spending in employee wellness programs (EWP). Employers implementing disease state management in an EWP must define the eligibility criteria. Clinical practice guidelines establish diagnostic criteria; therefore, updated guidelines have the potential to change the number of eligible beneficiaries in an EWP. No studies have analyzed the effects of using updated guideline-recommended criteria on the change in eligibility, enrollment, and indirectly, workload for program practitioners which may impact program administration cost. OBJECTIVES: The objective was to determine the impact of changing the blood pressure (BP) threshold for eligibility on the number of eligible beneficiaries in an EWP to that recommended by the ACC/AHA 2017. METHODS: Balls Food Stores (BFS) provides services within an EWP called Start Now including annual biometric screenings, a health risk assessment (HRA), and pharmacist-led disease-state coaching for select beneficiaries with diabetes, cardiovascular disease, or both (SN-DM and SN-CV, respectively). Enrollment in SN-CV is offered to beneficiaries if they have a qualifying diagnosis or biometric screening result. To determine the process for evaluating the effect of new eligibility criteria on potential enrollment in SN-CV, a retrospective evaluation was conducted using 2018 beneficiary data. The primary outcome measure was the difference in number of beneficiaries identified using current eligibility criteria (based on JNC8) and those potentially eligible using ACC/AHA 2017. RESULTS: There were 1427 beneficiaries, of which 309 beneficiaries were eligible for disease-state coaching prior to 2018 and 187 beneficiaries were identified in 2018 using current eligibility criteria. Using proposed ACC/AHA 2017 criteria, 113 additional beneficiaries would potentially be eligible for SN-CV. CONCLUSION: The effect of the change in SN-CV eligibility criteria would increase effort to determine eligibility, number of beneficiaries eligible for the program, and labor cost.

Acceptability of Intergenerational Physical Activity Programming: A Mixed Methods Study of Latino Aging Adults in Nebraska.

Objective: This study explored Hispanic/Latino aging adults' interest in and preferences for intergenerational physical activity programming. Methods: We used an exploratory sequential (Qual-QUAN) mixed methods design consisting of three focus groups (N = 13 participants; M age = 62.5 years old) and a quantitative survey (N = 105 participants; M age = 57.3 years old). Results: We found that most participants were interested in intergenerational physical activity programs: (1) to promote overall health and well-being, (2) increase opportunities for socialization and relationships, and (3) foster motivation and energy. Preferences for programming included cultural tailoring, bilingual and Spanish-language offerings, and being conducted in-person. Barriers to physical activity included cost, scheduling, transportation, and limited awareness of community resources. Discussion: Innovative public health initiatives incorporating an intergenerational approach may promote physical activity among aging adults. This study has implications for developing and refining intergenerational programming with Hispanic/Latino communities.

How nurses contribute to the elimination of hepatitis B? A systematic review and meta-analysis.

BACKGROUND: With approximately one-third of the global population exhibiting serological evidence of exposure, the hepatitis B virus remains a serious public health threat. Elimination of hepatitis B faces enormous challenges, from prevention to diagnosis, treatment, and long-term monitoring. Nurses are pivotal in optimising the hepatitis B care continuum; however, their contributions have been neglected. OBJECTIVE: To identify the role of nurses in the elimination of hepatitis B and to synthesise the effectiveness of interventions with nursing roles in approaching the elimination target. DESIGN: A systematic review and meta-analysis. SETTING(S): Thirteen databases (EMBASE, MEDLINE via OvidSP, Ovid Emcare, Ovid Nursing Database, British Nursing Index, APA PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, Web of Science Core Collection, China National Knowledge Internet, SinoMed, and Wanfang Data) were searched from their inception to 6 December 2022. METHODS: Interventional studies examining the contribution of nursing roles towards elimination targets were included. Content analysis was used to extract and map the nursing roles based on the nursing interventions classification system. Random-effects meta-analyses were conducted to examine the effectiveness of the intervention in improving hepatitis B screening, detection, and vaccination rates. RESULTS: The synthesis from 16 studies identified 13 nursing roles that primarily involved (1) health education and counselling for informed patient decision-making regarding hepatitis B prevention, vaccination, screening, and disease monitoring; (2) case management and health promotion to advocate elimination services at multiple levels and enable equitable access among marginalised communities; and (3) running specialist clinics to lead advanced practices in prescribing and carrying diagnostic tests, formulating evidence-based individualised care plans, and coordinating care throughout the disease process. Interventions with these roles achieved pooled hepatitis B screening and detection rates of 64 % (95 % confidence interval [CI] = 0.44, 0.84) and 2 % (95 % CI = 0.00, 0.05), respectively, increased the odds of hepatitis B virus vaccination by 2.61 times (95 % CI = 1.60, 4.28), improved immunity rate, and enhanced patient adherence to antiviral treatment and monitoring of liver comorbidities. However, their effects on hepatitis B virus DNA-negative conversion rates and hepatocellular carcinoma incidence were not significant. CONCLUSIONS: Nurses play multifaceted roles in advocating hepatitis B screening and vaccination, initiating outreach efforts in marginalised communities, and leading advanced practices that effectively contribute to the elimination of hepatitis B. Policymakers should consider how nurses may help the achievement of the elimination target. REGISTRATION: PROSPERO (CRD42022380719) registered on December 12, 2022. TWEETABLE ABSTRACT: Nurses raised awareness, initiated outreach efforts, addressed inequalities, and led advanced practices-effectively contributing to eliminating hepatitis B.

Supporting and implementing the beneficial parts of the exposome: The environment can be the problem, but it can also be the solution.

In 2005, Christopher P. Wild introduced the exposome concept, encompassing the biochemical changes in the organism in response to the totality of all environmental exposures throughout the entire lifespan and their association with health outcomes. The exposome concept also aimed at to completing the genome, that describes the genetic predisposition as a determinant of disease and death as well as potential targets of intervention. The exposome can be subdivided into multiple pollutomes related to specific chemical and physical pollutants (or other forms of environmental risks), periods of life (infancy, childhood, adolescence, adulthood, and old age) or geographical locations. While exposome research and, in general, health research of the last decades has predominantly focused on what factors contribute to and initiate morbidity and mortality, little is done on factors that will help to develop, maintain, or even increase human health. We want to contribute to this reorientation by supporting and implementing the beneficial exposome, comprising all environmental exposures with the potential to promote health.

Effect of a behaviour change intervention on household food hygiene practices in rural Bangladesh: A cluster-randomised controlled trial.

INTRODUCTION: Behavioural interventions could improve caregivers' food hygiene practices in low-resource settings. So far, evidence is limited to small-scale and short-term studies, and few have evaluated the long-term maintenance of promoted behaviours. We evaluated the effect of a relatively large-scale behaviour change intervention on medium and long-term maintenance of household food hygiene practices in Bangladesh. METHODS: We analyse a secondary outcome of the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomised trial and its sub-study Food Hygiene to reduce Environmental Enteric Dysfunction (FHEED), conducted in Habiganj district, Sylhet division, Bangladesh. The FAARM trial used a 1:1 parallel arm design and included 2705 women in 96 settlements: 48 intervention and 48 control. Women in the intervention settlements received training in homestead gardening, poultry rearing and nutrition over three years (2015-2018), complemented by an eight-month (mid-2017 to early-2018) behaviour change component on food hygiene using motivational drivers. Nested within the FAARM trial, the FHEED sub-study evaluated several outcomes along the hygiene pathway. For this article, we evaluated household food hygiene behaviours by analysing structured observation data collected in two cross-sectional surveys, four and 16 months after the food hygiene promotion ended, from two independent subsamples of FAARM women with children aged 6-18 months. We assessed intervention effects on food hygiene practices using mixed-effects logistic regression, accounting for clustering. In exploratory analyses, we further assessed behaviour patterns - how often critical food hygiene behaviours were performed individually, in combination and consistently across events. RESULTS: Based on the analysis of 524 complementary feeding and 800 food preparation events in households from 571 participant women, we found that intervention households practised better food hygiene than controls four months post-intervention, with somewhat smaller differences after 16 months. Overall, the intervention positively affected food hygiene, particularly around child feeding: using soap for handwashing (odds ratio 5·8, 95% CI 2·2-15·2), cleaning feeding utensils (3·8, 1·9-7·7), and cooking fresh/reheating food (1·8, 1·1-2·8). However, the simultaneous practice of several behaviours was rare, occurring in only 10% of feeding events (intervention: 15%; control: 4%), and the practice of safe food hygiene behaviours was inconsistent between events. CONCLUSION: Our findings suggest that a motivational behaviour change intervention encouraged caregivers to maintain certain safe food hygiene practices in a rural setting. However, substantial physical changes in the household environment are likely needed to make these behaviours habitual. TRIAL REGISTRATION NUMBER: NCT02505711.

Tecnologias educacionais direcionadas ao aleitamento materno produzidas na pós-graduação em enfermagem brasileira / Educational technologies directed to breastfeeding produced in brazilian nursing graduate / Tecnologías educativas orientadas a la lactancia materna producidas en programas de posgrado en enfermería brasileños

Objetivo: Conhecer as tecnologias educacionais voltadas à prática do aleitamento materno desenvolvidas por enfermeiros. Método: Revisão Integrativa realizada nas bases de dados da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e Biblioteca Digital Brasileira de Teses e Dissertações, em dezembro de 2021. Inicialmente foram identificados 313 trabalhos, após aplicados critérios de inclusão e exclusão foram selecionados 13 estudos para a amostra. Resultados: Verificou-se as seguintes tecnologias: álbum seriado, iconografia 3D, rádio, telefone, literatura de cordel, websites e simuladores realísticos de baixa fidelidade. Os estudos visaram desenvolver, avaliar ou validar tecnologias educacionais voltadas para o aleitamento materno no que diz respeito aos benefícios quando se trata do manejo correto. Conclusão: As tecnologias educacionais têm sido alvo no desenvolvimento de pesquisas em Enfermagem, contribuindo para a promoção do aleitamento materno, beneficiando mães e bebês e dinamizando o processo de cuidar.

Objective: To learn about educational technologies related to breastfeeding practice. Methods: Integrative Review conducted in the Coordination for the Improvement of Higher Education Personnel (CAPES) and Brazilian Digital Library of Theses and Dissertations (BDTD) databases, from December 2019 to December 2021. Initially, 313 studies were identified, and after applying the inclusion and exclusion criteria, 13 studies were selected for the sample. Results: The following technologies were verified: serialized album, 3D iconography, radio, telephone, string literature, websites, and low fidelity realistic simulators. The studies aimed to develop, evaluate, or validate educational technologies focused on breastfeeding with regard to the benefits when it comes to the correct management. Conclusion: Educational technologies have been a target in the development of nursing research, contributing to the promotion of breastfeeding, benefiting mothers and babies and streamlining the care process.

Objetivo: Conocer las tecnologías educativas orientadas a la práctica de la lactancia materna. Métodos: revisión integradora realizada en las bases de datos Coordinación para el Perfeccionamiento del Personal de Educación Superior (CAPES) y la Biblioteca Digital Brasileña de Tesis y Disertaciones (BDTD), desde diciembre de 2019 hasta diciembre de 2021. Inicialmente se identificaron 313 estudios, luego de aplicar los criterios de inclusión y exclusión, se seleccionaron 13 estudios para la muestra. Resultados: se verificaron las siguientes tecnologías: álbum en serie, iconografía 3D, radio, teléfono, literatura de cuerdas, sitios web y simuladores realistas de baja fidelidad. Los estudios tuvieron como objetivo desarrollar, evaluar o validar tecnologías educativas orientadas a la lactancia materna en cuanto a beneficios en cuanto a un correcto manejo se refiere. Conclusión: Las tecnologías educativas han sido un objetivo en el desarrollo de la investigación en enfermería, contribuyendo a la promoción de la lactancia materna, beneficiando a madres y bebés y agilizando el proceso de atención.

Health Disparities, Clinical Trials, and the Digital Divide.

In the past few years, there have been rapid advances in technology and the use of digital tools in health care and clinical research. Although these innovations have immense potential to improve health care delivery and outcomes, there are genuine concerns related to inadvertent widening of the digital gap consequentially exacerbating health disparities. As such, it is important that we critically evaluate the impact of expansive digital transformation in medicine and clinical research on health equity. For digital solutions to truly improve the landscape of health care and clinical trial participation for all persons in an equitable way, targeted interventions to address historic injustices, structural racism, and social and digital determinants of health are essential. The urgent need to focus on interventions to promote health equity was made abundantly clear with the coronavirus disease 2019 pandemic, which magnified long-standing social and racial health disparities. Novel digital technologies present a unique opportunity to embed equity ideals into the ecosystem of health care and clinical research. In this review, we examine racial and ethnic diversity in clinical trials, historic instances of unethical research practices in biomedical research and its impact on clinical trial participation, and the digital divide in health care and clinical research, and we propose suggestions to achieve digital health equity in clinical trials. We also highlight key digital health opportunities in cardiovascular medicine and dermatology as exemplars, and we offer future directions for development and adoption of patient-centric interventions aimed at narrowing the digital divide and mitigating health inequities.

Breastfeeding support and avoiding inappropriate breast milk substitute marketing in a neonatal ward in the Czech Republic: a best practice implementation project.

OBJECTIVES: The aim of this implementation project was to improve breastfeeding support, and more specifically, to increase compliance with the Baby-Friendly Hospital Initiative (BFHI) and the requirements of the International Code of Marketing of Breastmilk Substitutes (the Code). INTRODUCTION: The Ten Steps to Successful Breastfeeding of the BFHI have been shown to improve breastfeeding outcomes at target hospitals. The Code is a minimum standard for the regulation of marketing practices related to breastfeeding support. METHODS: We used the JBI evidence implementation model to identify a group of stakeholders in a hospital in the Czech Republic and carried out a best practice implementation project from January 2021 to May 2022. After conducting a baseline audit, the clinical team and external breastfeeding experts discussed challenges and devised an implementation plan using the JBI Getting Research into Practice framework. Follow-up audits were undertaken from January to December 2021 and in May 2022. RESULTS: Compliance improved across all audited criteria, namely, to fully comply with the Code (0% to 100%); to have a written infant feeding policy (0% to 100%); to ensure staff have skills to support breastfeeding (0% to 100%); to discuss breastfeeding with pregnant women (0% to 100%); to facilitate skin-to-skin contact (67.86% to 83.58%); to support and provide help with breastfeeding (67.86% to 82.09%); to not provide fluids other than breast milk (50% to 58.21%); to practice rooming-in (57.14% to 61.19%); to respond to infant cues (50% to 64.18%); to provide information about community support services (32.14% to 62.69%); and to coordinate discharge and ongoing care (0% to 100%). CONCLUSIONS: Breastfeeding support requires a sustained long-term effort before it can become fully established. The involvement of national-level policy makers is needed.

Platform for Better Oral health in Europe / La plateforme pour la santé orale en Europe

The Platform for Better Oral Health in Europe brings together five European organizations (Council of European Chief Dental Officers, Association for Dental Education in Europe, European Association of Dental Public Health, Pan European-International Association For Dental Research, Oral Health Foundation-UK) along with eighteen other associated European or national organizations. The platform aims to encourage oral health promotion and the prevention of oral diseases as fundamental components of good general health. The aim is thus to strengthen oral health promotion in Europe through integrating oral health into the relevant public health policies. It also aims to address the issue of oral health inequality, particularly among vulnerable populations such as children and adolescents, older adults, and people with particular needs. The platform is therefore a European-level resource for providing evidence-based information on best practice in oral health promotion and for guiding oral health policies. It also works to reinforce communication at the European level between stakeholders, policy makers, health professionals, and the public, in order to improve awareness of oral health issues.

La « plateforme pour une meilleure santé orale en Europe ¼ réunit six associations européennes (Council of European Chief Dental Officers, Association for Dental Education in Europe, European Association of Dental Public Health, Pan European-International Association For Dental Research, Oral Health Fondation-European Federation of Periodontology) en lien avec dix-neuf organisations européennes ou nationales associées. Elle a pour objectif d'encourager la promotion de la santé orale et la prévention des maladies bucco-dentaires en tant qu'éléments fondamentaux d'une bonne santé générale. L'objectif est aussi de renforcer la politique de promotion de la santé orale en Europe, y compris par l'intégration de la santé orale dans des politiques de santé publique pertinentes. Il s'agit également de prendre en compte la question des inégalités en matière de santé orale, notamment au sein des populations vulnérables comme les enfants et les adolescents, les personnes âgées et les personnes ayant des besoins spécifiques. La plateforme constitue ainsi une ressource au niveau européen pour fournir des informations fondées sur des preuves concernant les meilleures pratiques en promotion de la santé orale et pour l'orientation des politiques en matière de santé orale. Elle travaille aussi à développer les relations au niveau européen avec les parties prenantes, les décideurs politiques, les professionnels de santé, le public, afin d'améliorer la prise en compte des enjeux concernant la santé orale en Europe.

Therapeutic patient education in dental practice: For a pedagogical commitment / Du concept d'éducation thérapeutique du patient à la pratique des chirurgiens-dentistes : pour un engagement pédagogique

The exponential development of chronic noncommunicable diseases requires a rethinking of health systems, which are commonly focused on the curative management of diseases. There is a need to reinvent them to involve lifelong health promotion. For patients, it is no longer just a matter of surviving an acute disease, but also of avoiding its occurrence, and even more often, learning to live and age with it. This is where therapeutic patient education (TPE) plays a role. Supporting this paradigm shift in practice requires a commitment through initial training to help the student­ future dentist­to acquire the knowledge, skills, and attitudes relevant and easily applicable to the field of oral medicine, even in independent practice. Integrating TPE teaching into the curriculum is undeniably a challenge, but also a chance for students to develop a different stance and become conscious, competent, and committed professionals.

Le développement exponentiel des maladies non transmissibles à caractère chronique oblige à repenser les systèmes de santé, communément centrés sur une prise en charge curative des maladies. Ils doivent se réinventer pour y associer la promotion de la santé tout au long de la vie. Pour les patients, il ne s'agit plus seulement de survivre à une maladie aiguë, mais aussi d'en éviter la survenue, et encore plus souvent d'apprendre à vivre et à vieillir avec celle-ci. La prévention et la stabilisation de nombreuses maladies bucco-dentaires requièrent l'adoption et le maintien tout au long de la vie de comportements adaptés. L'éducation thérapeutique du patient (ETP) trouve alors toute sa place. Soutenir ce changement de paradigme dans les pratiques nécessite de s'engager dans la formation initiale pour aider l'étudiant ­ futur chirurgien-dentiste ­ à acquérir des connaissances, des savoir-faire et savoir-être pertinents et facilement applicables dans le champ de la médecine bucco-dentaire, et ce, même en pratique libérale. Intégrer l'enseignement de l'ETP au curriculum constitue indéniablement un défi, mais aussi une chance pour les étudiants de développer une autre posture et de devenir des professionnels conscients, compétents et engagés.

Oral health, a public health issue in 2023: Reflections and actions of the ASPBD / La santé orale, un enjeu de santé publique en 2023 ­ Réflexions et actions de l'ASPBD

The first Dental Public Health Day, in 2001, was not only the starting point for the creation of the Association des Acteurs de la Santé Publique Bucco-Dentaire (ASPBD), but also for the recognition of this specialty in France, even though it had already been recognized by the American Dental Association as early as 1950. Every year, the ASPBD organizes a national oral health day. The ASPBD brings together the vast majority of French odontologists and academic researchers in the field, as well as other French-speaking academics. Throughout the year, we work to bring together the dental and non-dental worlds, mainly the institutional and non-profit sectors with users, freelancers, and employees, the World Health Organization, and the French Public Health Society. This is in keeping with the partnership approach taken by the association for the past twenty-two years. Our aim is to bring together all the actors concerned to work toward integrating oral health into all health policies and health promotion and prevention schemes. We believe it is vital to provide oral health training for medical and paramedical staff, as well as for those working in education and outreach. Likewise, we are working to ensure that prevention is organized on a territorial level, involving local people as closely as possible and focusing on their needs. This is why we are actively involved in the fight against social and territorial inequalities in health, oral health being a strong indicator of these inequalities.

La première Journée de santé publique dentaire, en 2001, a été non seulement le point de départ de la création de l'association des Acteurs de la santé publique bucco-dentaire (ASPBD), mais aussi celui de l'identification en France de cette spécialité, alors qu'elle était déjà reconnue comme telle par l'Association dentaire américaine dès 1950. L'ASPBD organise, depuis annuellement une journée nationale de santé publique bucco-dentaire. L'ASPBD rassemble la grande majorité des odontologistes, enseignants-chercheurs hospitalo-universitaires français, mais aussi les autres hospitalo-universitaires francophones. Nous œuvrons tout au long de l'année à faire travailler ensemble le dentaire et le non-dentaire, principalement le monde institutionnel et associatif avec les usagers, les libéraux et les salariés, l'Organisation mondiale de la santé et la Société française de santé publique. À l'image du binôme qui préside chacune de nos journées depuis vingt-deux ans. Notre association a pour vocation de rassembler tous les acteurs concernés pour œuvrer à l'intégration de la santé orale dans toutes les politiques de santé et dispositifs de promotion de la santé et de prévention. Nous pensons qu'il est indispensable de former à la santé orale tant les personnels médicaux et paramédicaux que ceux de l'éducation et de l'animation. De même, nous agissons pour que la prévention s'organise à l'échelon territorial, au plus près des populations en fonction de leurs besoins. C'est le sens de notre participation active à la lutte contre les inégalités sociales et territoriales de santé, la santé orale étant un marqueur fort d'inégalités sociales de santé.

Humor-Based Messaging in Testicular Cancer Awareness Campaigns: A Comparative Critical Review.

Extensive research showcases the extent and efficacy of humor-based messaging in general health promotion. However, the work describing humor's use within testicular cancer (TC) awareness is less developed. The aim of this comparative critical review was to determine the impact of using humor-based messaging in TC awareness campaigns to achieve a baseline assessment from which future research can be modeled. A literature search was conducted using seven databases to locate relevant literature. Three research questions guided this investigation: (1) To what extent has humor been used in TC awareness campaigns? (2) What does the literature reveal about the use of humor-based messaging on relevant health outcomes? (3) What are the limitations within current TC awareness strategies? Six studies were included in the review, of which three directly assessed the use of humor in TC awareness vis-à-vis intervention designs. Humor-based strategies were implemented to enhance knowledge of TC and testicular self-examination (TSE) procedures, reduce anxiety surrounding detection threat, and promote TSE. The rhetoric provided to men via various health interventions relied on humor and slang to promote TSE among males. Despite the small sample size of the included studies, this review determined that humor may be useful in reducing uncomfortable feelings surrounding TSE, increasing awareness of TC, and promoting TSE. When using humor-based messaging, however, the audience and type of humor implemented must be considered. Limited research exists assessing the long-term impact humor in TC promotion on health behavioral changes, easing anxieties related to detection, and increased self-efficacy surrounding TSE.

The impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by Medicaid in Delaware.

BACKGROUND: The Baby Friendly Hospital Initiative was created to enhance breastfeeding, although its impact on infant healthcare utilization is unclear. Breast feeding infants are vulnerable to readmission soon after birth secondary to dehydration and hyperbilirubinemia. Breastfeeding can also protect infants from unnecessary health care utilization later in life by preventing infection. The objective of this study was to examine the impact of the Baby Friendly Hospital Initiative on readmissions and emergency department utilization among Medicaid births in Delaware. METHODS: The study was a quasi-experimental design. Medicaid claims files were used to study births at five hospitals in Delaware born between January 1, 2014, and December 31, 2018, and covered under Medicaid at time of birth. Three hospitals were designated Baby Friendly, two were not and served as controls. Outcomes included Emergency Department (ED) utilization and readmissions within 30 days and one-year of birth hospitalization. Exposure to the Baby Friendly Hospital Initiative was determined by year and hospital of birth. Logistic regression and interrupted time series segmented regression analysis with controls were used to assess the effect of Baby Friendly Hospital Initiative on healthcare utilization. RESULTS: In total, 19,695 infants were born at five hospitals with 80% (15,939) born at hospitals that were designated Baby Friendly. ED utilization and readmissions over the 1st year of life for breastfeeding related diagnosis at the Baby Friendly hospitals occurred in 240 (1.5%) and 226 (1.4%) of infants, respectively. Exposure to the Baby Friendly Hospital Initiative was associated with increased odds of all cause 30-day readmission (AOR: 1.15; 95% CI: 1.03-1.28) but not readmissions over the 1st year of life. While 30-day ED visits did not change after BFHI, one-year ED visits were reduced (0.91, 95% CI 0.86-0.97). A significant negative trend was seen over time for ED utilization post BFHI compared to controls (B: -5.90, p < 0.01). CONCLUSION: There was a small observed increase in the odds of all cause 30-day readmissions with no change in one-year readmissions after BFHI in Delaware. Although there were no observed changes in 30-day ED utilization, there was a reduction in one-year ED utilization following the implementation of the Baby Friendly Hospital Initiative in Delaware birth hospitals. Our data help to inform policy and decision making for statewide systems of care that may be used to support breast feeding.

Reducing intervention- and research-induced inequalities to tackle the digital divide in health promotion.

Social inequalities are an important contributor to the global burden of disease within and between countries. Using digital technology in health promotion and healthcare is seen by some as a potential lever to reduce these inequalities; however, research suggests that digital technology risks re-enacting or evening widening disparities. Most research on this digital health divide focuses on a small number of social inequality indicators and stems from Western, educated, industrialized, rich, and democratic (WEIRD) countries. There is a need for systematic, international, and interdisciplinary contextualized research on the impact of social inequality indicators in digital health as well as the underlying mechanisms of this digital divide across the globe to reduce health disparities. In June 2023, eighteen multi-disciplinary researchers representing thirteen countries from six continents came together to discuss current issues in the field of digital health promotion and healthcare contributing to the digital divide. Ways that current practices in research contribute to the digital health divide were explored, including intervention development, testing, and implementation. Based on the dialogue, we provide suggestions for overcoming barriers and improving practices across disciplines, countries, and sectors. The research community must actively advocate for system-level changes regarding policy and research to reduce the digital divide and so improve digital health for all.