Economic evaluations of eHealth interventions targeting mental health problems in the workplace: a systematic review.

BACKGROUND: Work-related mental health problems impose significant economic and personal burdens. eHealth interventions may offer low-cost, practical solutions, but guidance on their cost-effectiveness in workplace mental health is limited. OBJECTIVE: The objective of this study was to systematically review economic evaluations of workplace eHealth interventions for mental health, offering insights into methodologies and cost-effectiveness outcomes. METHODS: Adhering to PRISMA guidelines, searches were conducted in Embase, MEDLINE, Web of Science, Google Scholar, Cochrane library, PsycInfo and EconLit databases in May 2022, selecting peer-reviewed papers that performed economic evaluations on workplace eHealth interventions for adult mental health. Quality was assessed using the Drummond checklist. RESULTS: From 3213 references, eight met the inclusion criteria. These studies varied in economic perspective, types of economic analysis type, primary outcome measures, intervention focus (e.g. stress, alcohol, insomnia & return-to-work) and direct non-medical costs. Five eHealth interventions were found to be cost-effective and/or have a positive return on investment, with seven studies rated as high quality according to the Drummond checklist. CONCLUSIONS: The study outcomes unveiled the potential cost-effectiveness of eHealth interventions targeting mental health issues, particularly these focusing on workplace stress. However, generalization is challenging due to variations in the methodologies across studies.

Fostering Digital Life Skills Through Social Media With Adolescents in 6 German States: Protocol for an Accessibility Study According to the RE-AIM Framework.

BACKGROUND: Social media is essential in the lives of adolescents, with 97% of US teenagers engaging daily. While it facilitates communication, learning, and identity development, it also poses risks like harmful content exposure and psychological distress, particularly for adolescents in their critical developmental stage. Teaching digital life skills innovatively counters these risks, adapting traditional competencies such as decision-making, problem-solving, creative and critical thinking, communication, interpersonal skills, self-awareness, empathy, and emotional and stress management to digital challenges. OBJECTIVE: This study evaluates the accessibility of the "leduin" program, a novel intervention designed to impart digital life skills through Instagram. The program aims to leverage social media's educational potential, focusing on effective strategies to engage adolescents. Emphasizing accessibility is crucial, as it determines the program's overall impact. METHODS: The leduin program, developed through intervention mapping, applies behavior change techniques via social media for 9th and 10th graders. It is a 14-week spaced learning curriculum with daily sessions <5 minutes. Emphasizing the "reach" aspect of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) model, the recruitment targets diverse educational settings across 6 German states, aiming for inclusivity. Recruitment will involve schools, youth centers, and therapeutic facilities. The study seeks at least 128 participants, a calculated minimum to detect medium-sized effects in the quasi-experimental design and explore varying engagement levels and program responses. Data collection includes preintervention, postintervention, and 6-month follow-up surveys, using multilevel regression, latent growth models, and qualitative analysis to extensively assess reach and gain first insights on effectiveness, acceptance, implementation, and maintenance. The study aims to reveal key factors influencing program participation and interaction; a detailed analysis of engagement patterns will reveal the effectiveness of the recruitment strategies and barriers to participation. Additionally, initial indications of the program's impact on life skills, social media-related skills, health status, risk behaviors, and academic performance will be analyzed. RESULTS: Recruitment was planned from May 2023 until the beginning of the leduin program in October 2023. As of March 2024, we have recruited 283 participants. CONCLUSIONS: The leduin program stands as an innovative and essential initiative in adolescent health promotion, harnessing the power of social media to teach important digital life skills. This study highlights the critical role of accessibility in the success of social media interventions. Effective adolescent engagement strategies are imperative, as they dictate the overall impact of such interventions. The insights gained from this study will be instrumental in shaping future programs, laying groundwork for a subsequent, more comprehensive cluster-randomized controlled trial. The study's design acknowledges the limitations of the current quasi-experimental approach, including the anticipated sample size and the absence of a control group, and aims to provide a foundational understanding for future research in this field. TRIAL REGISTRATION: Deutsches Register Klinischer Studien DRKS00032308; https://drks.de/search/de/trial/DRKS00032308. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/51085.

Moms in the NICU: developing a pilot to engage and empower women who have delivered a prematurely born infant.

BACKGROUND: Mothers spend long hours at their preterm infant's bedside in the Neonatal Intensive Care Unit (NICU), giving clinicians the opportunity to engage mothers in caring for their own health. OBJECTIVE: To develop a NICU based intervention to reduce the risk of a future premature birth by engaging and empowering mothers to improve their own health and identify barriers to implementing their improvement. DESIGN: Development based on a framework of narrative discourse refined by the Quality Improvement Plan Do Study Act Approach. SETTING: Level II Stepdown Neonatal Intensive Care Unit. PARTICIPANTS: 14 mothers of preterm infants, ages 24-39 years. METHODS: A team of Maternal Fetal Medicine Physicians, obstetricians, neonatologists, neonatal nurses, and parents developed guidelines to elicit the mother's birth story, review the story with a clinical expert to fill in knowledge gaps, identify strategies to improve health to reduce the risk of future preterm birth, and facilitate mother developing an action plan with specific six week goals. A phone interview was designed to assess success and identify barriers to implementing their health plan. The protocol was modified as needed after each intervention to improve the interventions. RESULTS: "Moms in the NICU" toolkit is effective to guide any clinical facilitator to engage, identify health improvement strategies, and co-develop an individualized health plan and its take home summary reached stability after the 5th mother. Mothers reported experiencing reassurance, understanding, and in some cases, relief. Participants were enthusiastic to inform future quality improvement activities by sharing the six week barriers faced implementing their health plan. CONCLUSION: Engaging in the NICU provides an opportunity to improve mothers' understanding of potential factors that may be linked to preterm birth, and promote personally selected actions to improve their health and reduce the risk of a future preterm birth.

The Caregiver Pathway, a Model for the Systematic and Individualized Follow-up of Family Caregivers at Intensive Care Units: Development Study.

BACKGROUND: Family caregivers of patients who are critically ill have a high prevalence of short- and long-term symptoms, such as fatigue, anxiety, depression, symptoms of posttraumatic stress, and complicated grief. These adverse consequences following a loved one's admission to an intensive care unit (ICU) are also known as post-intensive care syndrome-family. Approaches such as family-centered care provide recommendations for improving the care of patients and families, but models for family caregiver follow-up are often lacking. OBJECTIVE: This study aims to develop a model for structuring and individualizing the follow-up of family caregivers of patients who are critically ill, starting from the patients' ICU admission to after their discharge or death. METHODS: The model was developed through a participatory co-design approach using a 2-phased iterative process. First, the preparation phase included a meeting with stakeholders (n=4) for organizational anchoring and planning, a literature search, and interviews with former family caregivers (n=8). In the subsequent development phase, the model was iteratively created through workshops with stakeholders (n=10) and user testing with former family caregivers (n=4) and experienced ICU nurses (n=11). RESULTS: The interviews revealed how being present with the patient and receiving adequate information and emotional care were highly important for family caregivers at an ICU. The literature search underlined the overwhelming and uncertain situation for the family caregivers and identified recommendations for follow-up. On the basis of these recommendations and findings from the interviews, workshops, and user testing, The Caregiver Pathway model was developed, encompassing 4 steps: within the first few days of the patient's ICU stay, the family caregivers will be offered to complete a digital assessment tool mapping their needs and challenges, followed by a conversation with an ICU nurse; when the patient leaves the ICU, a card containing information and support will be handed out to the family caregivers; shortly after the ICU stay, family caregivers will be offered a discharge conversation by phone, focusing on how they are doing and whether they have any questions or concerns; and within 3 months after the ICU stay, an individual follow-up conversation will be offered. Family caregivers will be invited to talk about memories from the ICU and reflect upon the ICU stay, and they will also be able to talk about their current situation and receive information about relevant support. CONCLUSIONS: This study illustrates how existing evidence and stakeholder input can be combined to create a model for family caregiver follow-up at an ICU. The Caregiver Pathway can help ICU nurses improve family caregiver follow-up and aid in promoting family-centered care, potentially also being transferrable to other types of family caregiver follow-up.

Donor-side and user-side evaluation of the Atlantic blue crab invasion on a Mediterranean lagoon.

The recent invasion of Callinectes sapidus in the Lesina Lagoon has raised great concern about its potential impacts on the ecosystem and on local fisheries. The effects of the blue crab presence on the receiving ecosystem were evaluated from both a donor-side perspective, through the application of emergy analysis, and a user-side perspective, by means of interviews to the local fishermen. While emergy analysis showed that C. sapidus brings to an increase of both natural capital and ecosystem functions values, results from interviews highlighted that the major problem caused by the presence of the blue crab in the lagoon concerned the local economy. As the first quantitative assessment of the ecological and economic impact of C. sapidus in invaded habitats, the present investigation provided original and useful information for a comprehensive risk assessment of the species in European waters and in Mediterranean Sea.

The experiences of caring for disabled older adults in long-term: A qualitative study from the perspective of spousal caregivers.

OBJECTIVE: To explore the care experiences of spouses as long-term and primary caregivers for disabled older adults in China. METHODS: A descriptive phenomenological method was used in this study, as well as purposive and convenient sampling. Semi-structured interviews were conducted with 15 spousal caregivers in Guangdong, China, from March to December 2021. Interview audio-recordings were transcribed verbatim and data were analyzed using Colaizzi's phenomenological analysis method. RESULTS: We identified four themes from the data: spousal care motivation; sacrifices in caregiving; obstacles in caregiving; spousal caregivers' positive experiences. CONCLUSIONS: Spouses took responsibility for providing care for their disabled partners regardless of their willingness. They had positive experiences while providing care, but negative experiences were dominant, especially for spouses of severely disabled older adults. Spouses are always perfect in caregiving roles, although they may also need medical assistance. To prevent a decline in spousal caregivers' quality of life and relieve their care burdens, health care providers should support them as soon as possible or offer formal care for disabled older adults. It is necessary to intervene considering disabled older adults and their spousal caregivers as a unit to empower their confidence in coping with life together.

Stability Indicating RP-HPLC and Spectrophotometric Methods for Simultaneous Estimation of Sodium Benzoate and Cefdinir in the Presence of its Degradation Products-Application to Blank Subtraction Method.

Objectives: Empower 3 software is important in modeling, optimization, and reducing the time of manual calculation of related substance by subtracting the baseline of a blank chromatogram from the unknown sample automatically; so, the major objective of the developed method is to introduce a new, selective, and economical high performance liquid chromatography (HPLC) and spectrophotometric method for simultaneous estimation of sodium benzoate (SDB) and cefdinir (CFR) in the presence of its degradation products. Materials and Methods: Chromatographic separation is optimized and adjusted using two methods; method (I) is characterized for separation of active pharmaceutical ingredient (CFR) in pure and dosage forms using Atlantis dC18 column [4.6 mm x 250 mm (5 µm particle size or equivalent)] with a mobile phase consisting of methanol: 0.02 M phosphate buffer solution pH 3.0 (40:60 v/v) at a flow rate of 1.0 mL/minute, injection volume 10 µL and wavelength 254 nm. Method (II) is identified for related substances in a Hichrom C18 column (15 x 0.46 cm), 5 µm particle size or equivalent, using a binary gradient consisting of solution A [0.1% tetramethylammonium hydroxide solution (pH: 5.5) with 0.1 M EDTA (1000:0.4 v/v)] and solution B (0.1% tetramethylammonium hydroxide solution (pH 5.5): acetonitrile: methanol : 0.1 M EDTA (500:300:200:0.4 v/v) using injection volume 10 µL for reversed-phase HPLC with a wavelength equals to 254 nm and flow rate 1.0 mL/min. Two ecofriendly spectrophotometric methods were successfully used to resolve the spectral overlap of drugs. Results: Method A, the first derivative of ratio spectra spectrophotometric method (1stDD) where CFR was determined at two wavelengths 283.5 nm, 313.4 nm and SDB was determined at 216.7 nm, 235.5 nm. Method B, ratio subtraction method is performed to overcome the interference between CFR and the preservative SDB. The ultraviolet spectrum of the laboratory mixture is divided by that of CFR (20 µg/mL) as a divisor then subtracting the amplitudes in the plateau region at 250-315 nm (the constant) from that of the ratio spectrum. The zero-order spectra of SDB were obtained at 225 nm by multiplying the resulting ratio spectra by the divisor (CFR), zero order of CFR was been estimated at a wavelength value of 283 nm after multiplication of the divisor by the obtained constant. Conclusion: The optimized method was adjusted and validated as per International Conference on Harmonization guidelines and could be easily utilized by quality control laboratories and for laboratory-prepared mixtures.

A protocol for a randomized controlled trial comparing Sleepwell, EMPOWER, and treatment-as-usual for benzodiazepine receptor agonist discontinuation in older adults: the your answers when needing sleep in New Brunswick (YAWNS NB) study.

Background: Chronic benzodiazepine receptor agonist (BZRA) use among older adults is a public health concern given cognitive and physical risks. One in four older adults in New Brunswick, Canada, is a long-term user of BZRAs. Previous studies using a direct-to-patient approach as the primary intervention target have shown promise in reducing BZRA use. The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study aims to reduce the long-term use of BZRAs in older adults and increase the use of cognitive behavioural therapy for insomnia (CBTi), which is the recommended first line treatment. Methods: The trial (ClinicalTrials.gov registration NCT04406103) is a three arm, open-label, parallel randomized controlled trial in NB, Canada. Eligible participants 65 years and older using BZRAs long-term will be randomly allocated to: the Eliminating Medications through Patient Ownership of End Results (EMPOWER) information package group; the Sleepwell information package group; or treatment-as-usual (TAU). Information packages will be mailed via Canada Post. The primary outcome of BZRA discontinuation at 6 months will be compared across groups. Secondary outcomes include participants with ≥25% BZRA dose reduction, and switching to newly prescribed alternate sedative-hypnotics. Several exploratory outcomes will also be examined. Discussion: Targeting participants with information packages informing them of appropriate use, dangers, and approaches to reducing BZRA use and increasing CBTi use may be beneficial in a region of Canada with the highest rate of chronic BZRA use in older adults. Comparing information packages and TAU will provide insights into the effectiveness of direct-to-patient interventions for BZRA reduction.

The Effect of Peer-to-Peer Education about the Significance of Specialty Certification on Empowering Nurses Working in Dialysis.

Specialty certification demonstrates knowledge and expertise in an area of nursing practice resulting in significant benefits to nurses, patients, public, and hiring organizations, empowering professional practice, and improving nurse retention and patient outcomes. However, a large majority of nurses working in dialysis have never validated their knowledge and skills through specialty certification. A one-group pre- and post-intervention study was conducted, with a sample group of registered nurses working in dialysis, using an asynchronous peer-to-peer education regarding empowering practice through specialty certification. The effect on psychological empowerment was measured using a 2-tailed t test with a comparison of enrollments in pre-certification courses. Results showed a 25% increase in course enrollments, but no statistical significance in psychological empowerment. Future study is needed on how nephrology nursing certification impacts patient outcomes, empowerment, workplace environment, and staff retention in nephrology.

Using the Transformative Storytelling Technique to Generate Empowering Narratives for Informal Caregivers: Semistructured Interviews, Thematic Analysis, and Method Demonstration.

BACKGROUND: The transformative storytelling technique is an innovative top-down approach to narrative therapy that aims to provide building blocks for creating flourishing narratives for target groups or populations. This approach acts as a facilitator for implementing the human-centered design in developing digital self-help tools for larger samples or target groups. OBJECTIVE: This study applied the transformative storytelling technique, as a new approach in mental health, to develop empowering audio narratives for informal caregivers. METHODS: A narrative inquiry was conducted with 17 informal caregivers (16 women and 1 man) who completed a semistructured interview, "Caregiver Life Story," acquiring information about the beginning of the role, rising action, and critical point of the role. The participants' ages ranged from 41 to 84 years, with all participants providing care for at least a 6-month period. This inquiry was guided by the transformative storytelling technique, and aimed to collect data relevant to creating fictional stories based on real-life themes. RESULTS: Twenty-five overall themes were distinguished across three a priori-set categories, providing narrative building blocks for the informal caregiver life stories. The final empowering caregiver life story was created as an example for this study, demonstrating the application of the transformative storytelling technique in an informal care context. CONCLUSIONS: The creation of empowering stories for populations or target groups in mental health care requires a unified and guided approach that will follow clear guidelines and storytelling principles. The transformative storytelling technique is a first of its kind in the mental health context, representing an initial step in enabling and supporting the creation of meaningful stories and the development of relatable, but productive, narratives. Such narratives have the potential to serve across media and digital platforms for supporting and improving well-being, and potentially triggering self-change in the target group or population.

Affecting behavioural change through empowerment: conceptual insights from theory and agricultural case studies in South Asia.

Affecting behavioural change is a common underlying goal across environmental and agricultural sciences, from climate change mitigation and adaptation, biodiversity conservation, water management, to crop diversification. However, many projects fail to drive or sustain change despite sound science and good intentions. This paper draws on existing theories of behavioural change to construct a conceptual framework that explores pathways to initiate and sustain change through the lens of empowerment, self-efficacy and agency. The framework is demonstrated with case studies from a project in India and Bangladesh that examined social inclusion of marginalised and poor farmers in the context of intensifying agriculture. The framework and case studies highlight that a number of conditions are needed to affect meaningful change including that target beneficiaries are suitably motivated, believe in their own capability and power to enact change and have access to the necessary resources. We propose the framework as a tool to help project teams explore the underlying elements of the process of change when designing, implementing and assessing agricultural or environmental projects and interventions. We contend that behavioural and social change needs to be explicitly fostered in such endeavours to achieve better and longer-term outcomes for the people and environment. Supplementary Information: The online version contains supplementary material available at 10.1007/s10113-022-01939-7.

Fostering and sustaining transnational solidarities for transformative social change: Advancing community psychology research and action.

As we planned this special issue, the world was in the midst of a pandemic, one which brought into sharp focus many of the pre-existing economic, social, and climate crises, as well as, trends of widening economic and social inequalities. The pandemic also brought to the forefront an epistemic crisis that continues to decentre certain knowledges while maintaining the hegemony of Eurocentric ways of knowing and being. Thus, we set out to explore the possibilities that come with widening our ecology of knowledge and approaches to inquiry, including the power of critical reflective praxis and consciousness, and the important practices of repowering marginalised and oppressed groups. In this paper, we highlight scholarship that reflects a breadth of theories, methods, and practices that forge alliances, in and outside the academy, in different solidarity relationships toward liberation and wellbeing. Our desire as co-editors was not to endorse the plurality of solidarities expressed in the papers as an unyielding methodological or conceptual framework, but rather to hold them lightly within thematic spaces as invitations for readers to consider. Through editorial collaboration, we arrived at the following three thematic spaces: (1) ecologies of being and knowledge: Indigenous knowledge, networks, and plurilogues; (2) naming coloniality in context: Histories in the present and a wide lens; (3) relational knowledge practices: Creative joy of knowing beyond disciplines. From these thematic spaces we conclude that through repowering epistemic communities and narratives rooted in truth-telling, a plurality of solidarities are fostered and sustained locally and transnationally. Underpinned by an ethic of care, solidarity relationships are simultaneously unsettling dominant forms of knowledge and embrace ways of knowing and being that advances dignity, community, and nonviolence.

Bridging Connectivity Issues in Digital Access and Literacy: Reflections on Empowering Vulnerable Older Adults in Singapore.

This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives.

Change in Objectively Measured Activity Levels Resulting from the EMPOWER Study Lifestyle Intervention.

Purpose: To examine changes in physical activity (PA) during a behavioral weight-loss intervention and determine baseline factors associated with PA goal achievement. Methods: Overweight/obese community-dwelling adults with valid PA accelerometer data (N=116; mean age 51.7 years; 89% female; 83% non-Hispanic White) were recruited into a single-arm prospective cohort study examining the effects of a 12-month intervention that included 24 in-person group sessions, weight-loss, calorie, fat gram, and PA goals, self-monitoring, and feedback. Minutes of moderate-to-vigorous (MV) PA and steps were measured using a waist-worn accelerometer (ActiGraph GT3x) at baseline, 6 months, and 12 months. Achievement of the 150 minute/week MVPA goal was examined using total minutes and bout minutes (i.e., counting only PA occurring in bouts ≥10 minutes in length). Change in PA was analyzed using non-parametric tests for multiple comparisons. Associations of factors with meeting the PA goal were modeled using binary logistic regression. Results: At 6 months, there were increases from baseline in MVPA (median [p25, p75]: 5.3 [-0.9, 17.6] minutes/day) and steps (863 [-145, 2790] steps/day), both p<0.001. At 12 months, improvements were attenuated (MVPA: 2.4 [-2.0, 11.4] minutes/day, p=0.047; steps: 374[-570, 1804] p=0.14). At 6 months, 33.6% of individuals met the PA goal (using total or bout minutes). At 12 months, the percent meeting the goal using total MVPA [31%] differed from bout MVPA [22.4%]. Male gender (OR=4.14, p=0.027) and an autumn program start (versus winter; OR=3.39, p=0.011) were associated with greater odds of goal achievement at 6 months. Conclusions: The intervention increased PA goal achievement at 6 and 12 months with many making clinically meaningful improvements. Our results suggest female participants may require extra support toward improving PA levels.

Get up and Get Moving: a nutrition and physical activity after-school program for Latino adolescents of Erie Neighborhood House.

Obesity among Latino children in the United States is a serious health concern that poses a risk to develop other chronic illnesses such as Type 2 Diabetes, cancer, and heart disease. The following paper is focused on a 6-week health education intervention that was developed for 12- to 14-year-old Latino youth of an after -school program at a social service agency in the West Town neighborhood of Chicago. Within Chicago, childhood obesity rates in children of all ages were shown to be the second highest among Latino communities for both boys and girls. Implications from this article will provide insight into the need for public health professionals to further research and use that information to formulate ideas to create nutrition and physical activity programs that will address obesity among Latino and other ethnic youth populations-to promote and encourage them to adopt and maintain a healthy lifestyle.

Impact of the treatment crossover design on comparative efficacy in EMPOWER-Lung 1: Cemiplimab monotherapy as first-line treatment of advanced non-small cell lung cancer.

Objectives: In randomized-controlled crossover design trials, overall survival (OS) treatment effect estimates are often confounded by the control group benefiting from treatment received post-progression. We estimated the adjusted OS treatment effect in EMPOWER-Lung 1 (NCT03088540) by accounting for the potential impact of crossover to cemiplimab among controls and continued cemiplimab treatment post-progression. Methods: Patients were randomly assigned 1:1 to cemiplimab 350 mg every 3 weeks (Q3W) or platinum-doublet chemotherapy. Patients with disease progression while on or after chemotherapy could receive cemiplimab 350 mg Q3W for ≤108 weeks. Those who experienced progression on cemiplimab could continue cemiplimab at 350 mg Q3W for ≤108 additional weeks with four chemotherapy cycles added. Three adjustment methods accounted for crossover and/or continued treatment: simplified two-stage correction (with or without recensoring), inverse probability of censoring weighting (IPCW), and rank-preserving structural failure time model (RPSFT; with or without recensoring). Results: In the programmed cell death-ligand 1 ≥50% population (N=563; median 10.8-month follow-up), 38.2% (n=107/280) crossed over from chemotherapy to cemiplimab (71.3%, n=107/150, among those with confirmed progression) and 16.3% (n=46/283) received cemiplimab treatment after progression with the addition of histology-specific chemotherapy (38.7%, n=46/119, among those with confirmed progression). The unadjusted OS hazard ratio (HR) with cemiplimab versus chemotherapy was 0.566 (95% confidence interval [CI]: 0.418, 0.767). Simplified two-stage correction-the most suitable method based on published guidelines and trial characteristics-produced an OS HR of 0.490 (95% CI: 0.365, 0.654) without recensoring and 0.493 (95% CI: 0.361, 0.674) with recensoring. The IPCW and RPSFT methods produced estimates generally consistent with simplified two-stage correction. Conclusions: After adjusting for treatment crossover and continued cemiplimab treatment after progression with the addition of histology-specific chemotherapy observed in EMPOWER-Lung 1, cemiplimab continued to demonstrate a clinically important and statistically significant OS benefit versus chemotherapy, consistent with the primary analysis.

Firefighter Occupational Cancer Risk: Starting the Conversation.

This study was conducted to determine if an educational session would increase the firefighter's knowledge of their occupational cancer risk and increase their motivation and confidence to have a conversation with their primary care provider (PCP) in regard to their occupational cancer risk. This study was an exploratory descriptive interventional pilot study. Firefighters self-reported using a pre-/post-educational intervention survey. Results were analyzed using a paired t test in IBM SPSS Version 23 to compare the pre-/post-test mean scores. There were statistically significant differences noted in the mean scores of the pre-/post-interventional survey tool. It seems an educational intervention can motivate and increase the firefighter's confidence to have a conversation with their PCP in regard to their occupational cancer risk. Firefighter perceptions of their "lived" care experience at the PCP level shared during study sessions also contributed to some key conclusions. These conclusions lead to the development of an informational wallet card for the firefighter to use as a conversational tool during a visit with their PCP. Motivating firefighters to have a conversation with their PCP in regard to their occupational cancer risk could potentially increase firefighter occupational cancer awareness at the PCP level and result in earlier detection of cancers in firefighters leading to decreased firefighter cancer mortality rates. Increasing informed firefighter conversations at the PCP level in regard to their occupational cancer risk could potentially increase appropriate cancer prevention guidance and earlier cancer screenings at the primary care level.

Concurrent Validity of Power From Three On-Water Rowing Instrumentation Systems and a Concept2 Ergometer.

Purpose: Instrumentation systems are increasingly used in rowing to measure training intensity and performance but have not been validated for measures of power. In this study, the concurrent validity of Peach PowerLine (six units), Nielsen-Kellerman EmPower (five units), Weba OarPowerMeter (three units), Concept2 model D ergometer (one unit), and a custom-built reference instrumentation system (Reference System; one unit) were investigated. Methods: Eight female and seven male rowers [age, 21 ± 2.5 years; rowing experience, 7.1 ± 2.6 years, mean ± standard deviation (SD)] performed a 30-s maximal test and a 7 × 4-min incremental test once per week for 5 weeks. Power per stroke was extracted concurrently from the Reference System (via chain force and velocity), the Concept2 itself, Weba (oar shaft-based), and either Peach or EmPower (oarlock-based). Differences from the Reference System in the mean (representing potential error) and the stroke-to-stroke variability (represented by its SD) of power per stroke for each stage and device, and between-unit differences, were estimated using general linear mixed modeling and interpreted using rejection of non-substantial and substantial hypotheses. Results: Potential error in mean power was decisively substantial for all devices (Concept2, -11 to -15%; Peach, -7.9 to -17%; EmPower, -32 to -48%; and Weba, -7.9 to -16%). Between-unit differences (as SD) in mean power lacked statistical precision but were substantial and consistent across stages (Peach, ∼5%; EmPower, ∼7%; and Weba, ∼2%). Most differences from the Reference System in stroke-to-stroke variability of power were possibly or likely trivial or small for Peach (-3.0 to -16%), and likely or decisively substantial for EmPower (9.7-57%), and mostly decisively substantial for Weba (61-139%) and the Concept2 (-28 to 177%). Conclusion: Potential negative error in mean power was evident for all devices and units, particularly EmPower. Stroke-to-stroke variation in power showed a lack of measurement sensitivity (apparent smoothing) that was minor for Peach but larger for the Concept2, whereas EmPower and Weba added random error. Peach is therefore recommended for measurement of mean and stroke power.

Nontransvenous Cardiovascular Implantable Electronic Device Technology-A Review for the Anesthesiologist.

There has been a recent shift in bradycardia pacing and defibrillation therapy to leadless pacemakers and extrathoracic cardioverter-defibrillator technology due to complications associated with transvenous devices. These innovations have implications for anesthesia care, as these novel devices have design and functionality features different from transvenous devices. Current perioperative guidelines do not address management of leadless pacemakers and the subcutaneous implantable cardioverter-defibrillator, although implantation rates are increasing globally. This article addresses the features and capabilities of nontransvenous cardiac implantable electronic devices, such as the Micra and the subcutaneous implantable cardioverter-defibrillator, and provides guidance for perioperative management.

Impact of oral hygiene training to Anganwadi and Accredited Social Health Activist workers on oral health of young children in tribal regions of Rajasthan State, India.

CONTEXT: Early childhood caries is one of the most widespread diseases affecting children in urban and rural India. Community health workers can bring about a quantum of change in improving the oral health in children. AIMS: The aim of the study was to assess the impact of oral health training imparted to Anganwadi and accredited social health activist (ASHA) workers on improving the oral hygiene of 148 children aged 1-6 years. SETTINGS AND DESIGN: The preintervention followed by oral health training and postintervention assessment were done at three Anganwadi and ASHA centers of Rajasthan. METHODOLOGY: The preintervention data included Decayed, Missing, and Filled Teeth/decayed, extracted, and filled teeth, oral hygiene indices (Oral Hygiene Index-Simplified [OHI-S] and Oral Hygiene Index Simplified-Modified [OHIS-M]), plaque index, and caries activity using Oratest. The oral health training consisted of PowerPoint presentations, video presentations, live demonstrations on brushing technique, rinsing, plaque disclosure, and flossing technique. They were enlightened on deleterious oral habits, emergency protocol on trauma, etc. The postintervention data included outcome measures consisting of oral hygiene indices (OHI-S and OHIS-M), plaque index, and Oratest after 2 months to evaluate the impact of training. STATISTICAL ANALYSIS USED: The data were analyzed using Chi-square test, Fisher's exact test, independent t-test, paired t-test, and one-way analysis of variance test. RESULTS: There was a significant improvement in toothbrushing practices and rinsing (P < 0.05). There was a significant difference in debris index, calculus index, OHI-S/OHIS-M, plaque index, and Oratest after intervention (P < 0.05). CONCLUSION: Empowering Anganwadi and ASHA workers can be a feasible approach in India, where oral health is not a priority in primary health care as yet.