Effectiveness of an online intervention for parents/guardians of children aged 4-7 years who are concerned about their child's emotional and behavioural development: protocol for an online randomised controlled trial (EMERGENT study).

INTRODUCTION: The demand for resources to support emotional and behavioural development in early childhood is ever increasing. However, conventional interventions are lacking in resources and have significant barriers. The Embers the Dragon programme helps address the growing unmet need of children requiring support. The delivery of the current project seeks to help support parents, reduce the burden placed on pressed services (eg, Child and Adolescent Mental Health Services) and to help improve the emotional and behavioural development of children. METHODS AND ANALYSIS: This project aims to investigate the efficacy and acceptability of Embers on parenting and children's psychosocial outcomes. 364 parents/guardians of children aged between 4 and 7 will be recruited via the internet, schools and general practitioners (GPs). This is an online waitlist-controlled trial with three arms: (1) control arm, (2) access to Embers arm and (3) access to Embers+school. Participants will be randomised (1:1) into (1) or (2) to evaluate the use of Embers at home. To evaluate scalability in schools, (3) will be compared with (2), and (1) to test efficacy against treatment as usual (not receiving the intervention). Qualitative interviews will also be conducted. Primary outcomes are the Parental Self-efficacy Scale, Strengths and Difficulties Questionnaire and qualitative interviews. Outcomes will be compared between the three groups at baseline, 8, 16 and 24 weeks. ETHICS AND DISSEMINATION: Ethical approval has been granted by the London South Bank University ethics panel (ETH2324-0004). To recruit via GPs, NHS ethical approval has been applied for, and the IRAS (331410) application is under consideration by the Central Bristol REC. The results of the project will be submitted for publication in a peer-reviewed journal. Parents/guardians will provide informed consent online prior to taking part in the study. For the interviews, assent will be taken from children by the researchers on the day. TRIAL REGISTRATION NUMBER: ISRCTN58327872.

Development of a Mobile App for Self-Care Against COVID-19 Using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) Model: Methodological Study.

BACKGROUND: Mobile apps have been shown to play an important role in the management, care, and prevention of infectious diseases. Thus, skills for self-care-one of the most effective ways to prevent illness-can be improved through mobile health apps. OBJECTIVE: This study aimed to design, develop, and evaluate an educational mobile-based self-care app in order to help the self-prevention of COVID-19 in underdeveloped countries. We intended the app to be easy to use, quick, and inexpensive. METHODS: In 2020 and 2021, we conducted a methodological study. Using the ADDIE (analysis, design, development, implementation, and evaluation) educational model, we developed a self-care management mobile app. According to the ADDIE model, an effective training and performance support tool is built through the 5 phases that comprise its name. There were 27 participants who conducted 2 evaluations of the mobile app's usability and impact using the mobile health app usability and self-care inventory scales. The study design included pre- and posttesting. RESULTS: An Android app called MyShield was developed. The results of pre- and posttests showed that on a scale from 0 to 5, MyShield scored a performance average of 4.17 in the physical health dimension and an average of 3.88 in the mental well-being dimension, thereby showing positive effects on self-care skills. MyShield scored highly on the "interface and satisfaction," "ease of use," and "usefulness" components. CONCLUSIONS: MyShield facilitates learning self-care skills at home, even during quarantine, increasing acquisition of information. Given its low development cost and the ADDIE educational design on which it is based, the app can be helpful in underdeveloped countries. Thus, low-income countries-often lacking other tools-can use the app as an effective tool for fighting COVID-19, if it becomes a standard mobile app recommended by the government.

Our experience with 80 cases of SARS-CoV-2-Clostridioides difficile co-infection: An observational study.

Beside the changes in the gut microbiota in context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the increased use of high-risk broad-spectrum antibiotics during the actual pandemic raises concerns about a possible increase of Clostridioides difficile infections (CDIs). We retrospectively analyzed 80 consecutive patients, with SARS-CoV-2 pneumonia and CDI. The mean length of hospitalization was 19.63 days. The mean time of the onset of the digestive symptoms related to CDI was 5.16 days. Patients with an onset of the digestive symptoms from hospital admission have a significantly lower median length in hospital stay. The recovered patients present a statistically significant decreased median age. coronavirus disease 2019 (COVID-19) cured patients present CDI symptoms much earlier than the deceased patients, when comparing the median days before the occurrence of any digestive symptoms regarding CDI. Among the patients that prior to their hospitalization for COVID-19 were exposed to antibiotics, 54.7% presented CDI digestive symptoms during their hospitalization and 65.6% had a severe or critical COVID-19 form. Although the incidence of CDI in the pandemic is lower compared to the period before the pandemic, the severity of cases and the death rate increased. In the actual setting clinicians need to be aware of possible CDI and SARS-CoV-2 co-infection.

Smartphone-Based Healthcare Apps for Older Adults in the COVID-19 Era: Heuristic Evaluation.

Many national governments have attempted to prevent and combat COVID-19 using mobile health (mHealth) technologies during the epidemic. During this time, governments began developing smartphone-based apps for prevention, call tracking, and monitoring people with COVID-19. An important question is, does everyone benefit from these technologies equally and fairly? To answer this question, we evaluated the user interface of smartphone-based apps developed during the COVID-19 era by considering their design for older adults, in order to determine whether social justice has been considered in the development of these apps.

Changes in disease burden in Poland between 1990-2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Systematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990-2017, and compare Poland with other Central European (CE) countries. METHODS: The results of GBD 2017 for 1990 and 2017 for Poland and CE were used to assess rates and trends in years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs). Data came from cause-of-death registration systems, population health surveys, disease registries, hospitalization databases, and the scientific literature. Analytical approaches have been used to adjust for missing data, errors in cause-of-death certification, and differences in data collection methodology. Main estimation strategies were ensemble modelling for mortality and Bayesian meta-regression for disability. RESULTS: Between 1990-2017, age-standardized YLL rates for all causes declined in Poland by 46.0% (95% UI: 43.7-48.2), YLD rates declined by 4.0% (4.2-4.9), DALY rates by 31.7% (29.2-34.4). For both YLLs and YLDs, greater relative declines were observed for females. There was a large decrease in communicable, maternal, neonatal, and nutritional disease DALYs (48.2%; 46.3-50.4). DALYs due to non-communicable diseases (NCDs) decreased slightly (2.0%; 0.1-4.6). In 2017, Poland performed better than CE as a whole (ranked fourth for YLLs, sixth for YLDs, and fifth for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In 2017 and 1990, the leading cause of YLLs and DALYs in Poland and CE was ischaemic heart disease (IHD), and the leading cause of YLDs was low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although in different order. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990-2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65, and 2.03, respectively). CONCLUSIONS: There was relatively little geographical variation in premature death and disability in CE in 2017, although some between-country differences existed. Health in Poland has been improving since 1990; in 2017 Poland outperformed CE as a whole for YLLs, YLDs, and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. The shift to NCDs and chronic disability, together with marked between-gender health inequalities, poses a challenge for the Polish health-care system. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining. To further reduce disease burden, an integrated response focused on NCDs and population groups with disproportionally high burden is needed.

Effect of religious rules on time of conception in Romania from 1905 to 2001.

STUDY QUESTION: Does the interdiction of sexual intercourse during Nativity and Lent fasting periods have any effect on when babies are conceived in Romania, in the 20th century? SUMMARY ANSWER: Based on date of birth records from the 20th century, Lent had a greater effect than the Nativity fast on conception within the Eastern Orthodox (ORTHD) population. WHAT IS KNOWN ALREADY: Seasonality of births (and therefore of conception) is affected by geographical factors (latitude, weather, day-length). Other demographic, economic and socio-cultural characteristics (education, ethnicity, religion) have been proved to have an influence on conception. STUDY DESIGN, SIZE, DURATION: The analyzed data consists of registered daily birth records for a long time series (35 429 points = 365 (days/year) × 97 years + 24 leap years), with 24 947 061 births in Romania over the period 1905-2001. The data were obtained from the 1992 and 2002 censuses. PARTICIPANTS/MATERIALS, SETTING, METHODS: Based on the reported birth date of each person, the estimated date of conception is computed using a standard gestation period of 280 days. The population was grouped into two categories (ORTHD and Non-Orthodox (NORTHD)) based on religious affiliation. Data analysis is performed in the same manner for both groups. Preliminary data analyses regarding seasonal variations in conception are considered first. Econometric models are applied and tested. The dependent variable in these models is the calculated date of conception, while the independent variables are: (i) religious affiliation; (ii) dates of Nativity and Lent fasts (the latter varies slightly from year to year); (iii) rural versus urban residence; (iv) length of day-light; (v) non-working days and (vi) trend. The models are tested for validity using analysis of variance while the regression coefficients are tested by the Student t-test. MAIN RESULTS AND THE ROLE OF CHANCE: All models are statistically valid (P < 0.01); all regression coefficients for the ORTHD group are valid (P < 0.01, except for rurality between 1990 and 2001, with P < 0.05). The data analysis indicates smaller standard error bars on the parameters for the ORTHD group as compared with the NORTHD group. The conclusion is that religious affiliation is an important factor in date of conception. LIMITATIONS, REASONS FOR CAUTION: The data do not refer to all births during the analyzed period, but only to those persons still alive at the 1992 and 2002 censuses. The date of conception was estimated assuming 280 days for gestation, which is a medically accepted time interval but will undoubtedly vary. However, the primary independent variables (Lent and Nativity fast at 48 and 40 days, respectively) are long enough to overlap the uncertainty in the conception date following the sexual intercourse event. We also must assume that the religious affiliation of the parents is well defined, based on the information given by their offspring at census time, and is the same for both parents. WIDER IMPLICATIONS OF THE FINDINGS: Our findings are consistent with other studies, which show differences between religious groups on date of conception, although we reach different conclusions regarding the influence of weather on fertility in Romania. STUDY FUNDING/COMPETING INTERESTS: B.V.I., M.A. and G.R. have no competing interests to declare. There is no connection to the current paper, but C.H. declares that (i) he is currently conducting a research titled 'Chronic Diseases' Direct Costs within the Romanian Health System' funded by Local American Working Group; (ii) his wife is employed to a Romanian company (A&D Pharma) that does business in the pharmaceutical sector. This paper is a part of G.R. and M.A. scientific activities in COST Action TD1210. This work by C.H. was co-financed by the European Social Fund through project number POSDRU/1.5/S/59184.