How Gender-Sexuality Alliances cultivate a sense of school belonging from week to week for LGBTQ+ youth.

School belonging can facilitate positive youth development and educational outcomes. Given that LGBTQ+ youth face marginalization in schools, there is a need to identify school supports that could still promote their sense of school belonging. We considered Gender-Sexuality Alliances (GSAs) as LGBTQ+ affirming school clubs. Among 92 LGBTQ+ student members of GSAs in nine states who completed weekly diary surveys over an 8-week period (Mage = 15.83 years, SD = 1.29; 50% youth of color; 51% trans or non-binary), we considered whether a youth's GSA experiences from meeting to meeting predicted their relative levels of school belonging in days following these meetings. There was significant within-individual (37%) and between-individual (63%) variability in youth's sense of school belonging during this time. Youth reported relatively higher school belonging on days following GSA meetings where they perceived greater group support (p = .04) and took on more leadership (p = .01). Furthermore, youth who, on average, reported greater advisor responsiveness (p = .01) and leadership (p = .01) in GSA meetings over the 8-week period reported greater school belonging than others. Findings showcase the dynamic variability in LGBTQ+ youth's sense of school belonging from week to week and carry implications for how schools and GSAs can support LGBTQ+ youth and sustain their ties to school.

GENESIS-Guidance, Education, Networking, and Empowerment-based Smart Initiative for Students research in health care: A research modeling experience from a newly established medical college.

The importance of undergraduate medical research has been undermined in Indian medical education. Various studies show there is a drastic difference between the research output of Indian medical graduates in comparison to Western counterparts. With all the challenges identified, a student-oriented research committee was formed -Guidance, Education, Networking, and Empowerment-based Smart Initiative for Students (GENESIS) research in health care - A research modeling experience from a newly established medical college. The structure was established to serve the needs of students in the field of research. Problems were identified with the help of a survey, and steps were taken to address the issues through its 4-pronged strategy that includes conducting regular journal clubs. Journal clubs follow a peer-to-peer learning strategy and provide an open stage for discussion. Second, a research tracker which helps in increasing the sustainability of a research project. The third strategy includes a research live matchmaker which helps in bridging the gap between the students and the faculties. Lastly, involving alumni in the initiative will help students get guidance and acts as a gateway to opportunities at the national level. For maintaining the integrity and sustainability of the initiative, the involvement of students from all the batches is made sure. Inputs from faculties and administration are taken on a regular basis. Interinstitutional collaborations and regular assessment and evaluation are done to ensure positive outcomes. With its focus on peer-to-peer mentoring and attempt to eliminate the barriers for research enthusiasts, GENESIS has the potential to make a lasting impact in promoting research culture in colleges.

Complicating critical discussions in gender sexuality alliances: Youth desire for intersectional conversations and the experience of fragmentation.

Gender sexuality alliances (GSAs) represent consciousness-raisings that hold potential for critical consciousness development in youth. In this study, we focus on critical reflection-the understanding that oppression is structured and maintained by human action. We engage intersectionality as our analytical framework and analyze both student interview data (n = 38) and advisor closed-ended and open-ended survey data (n = 58) to examine: (1) the nature/content of critically reflective discussions in GSAs and (2) how advisors support critically reflective discussions in GSAs and their role in these discussions. Our findings suggest that (1) conversations centering race and its intersections with other socio-structural axes occur, albeit infrequently; (2) youth recognize and understand the concept of intersectionality in nuanced ways, desire to have critical intersectional conversations, and experience fragmentation from conversations around race, sexuality, and gender if they are situated at privileged locations on those axes; and (3) students want advisors to engage in critically reflective discussions in GSAs. The findings suggest that interventions and programming are needed that could cultivate advisors' and youth leaders' skills in facilitating intersectional dialogues for critical reflection among members.

Experiences of transfer of care among postpartum women living with HIV attending primary healthcare services in South Africa.

Transfers between health facilities for postpartum women living with HIV are associated with disengagement from care. In South Africa, women must transfer from integrated antenatal/HIV care to general HIV services post-delivery. Thereafter, women transfer frequently e.g. due to geographic mobility. To explore barriers to transfer, we conducted in-depth interviews >2 years post-delivery in 28 participants in a trial comparing postpartum HIV care at primary health care (PHC) antiretroviral therapy (ART) facilities versus a differentiated service delivery model, the adherence clubs, which are the predominant model implemented in South Africa. Data were thematically analysed using inductive and deductive approaches. Women lacked information including where they could transfer to and transfer processes. Continuity mechanisms were affected when women transferred silently i.e. without informing facilities or obtaining referral letters. Silent transfers often occurred due to poor relationships with healthcare workers and were managed inconsistently. Fear of disclosure to family and community stigma led to transfers from local PHC ART facilities to facilities further away affecting accessibility. Mobility and the postpartum period presented unique challenges requiring specific attention. Information regarding long-term care options and transfer processes, ongoing counselling regarding disclosure and social support, and increased health system flexibility are required.

Pilot study of a health promotion intervention in sports clubs / Étude pilote d'une intervention de promotion de la santé au sein de clubs de sport.

Sports clubs (SCs) are an ideal setting for promoting health. However existing health promotion (HP) interventions in SCs mainly target a single health behavior and men who do sports, and evaluations of such interventions provides little information about their deployment. To overcome these limitations, the PROSCeSS intervention was co-constructed based on the theoretical model of the health-promoting SC and multi-level, multi-determinant health strategies. The aim of this pilot study was to evaluate the deployment of the PROSCeSS intervention and identify the factors influencing its deployment. A qualitative study, using recordings of meetings, email and telephone exchanges, and interviews with project leaders of fourteen SC, was carried out. Although a low number of SCs had completed the intervention, they all considered that they have a role to play in helping their members maintain good health. Their ability to develop HP activities and to implement the intervention was influenced by the resources available, the support they received from their sports federation, and the ability of each project leader to get involved in the intervention. The SCs that deployed the intervention implemented several strategies enabling them to integrate health into the organizational, social, economic, and environmental habits of the SCs and to develop new HP activities, such as adapted sports activity sessions and activities to teach members about first aid, nutrition, and good practices for warming up. This study highlights the importance of understanding the specificities of the contexts in which HP interventions are deployed. Having led to a reworking of the intervention steps and the development of an appropriate evaluation design, it also highlights the essential role of pilot studies in the development and evaluation of interventions.

Le club de sport (CS) est un milieu de vie privilégié pour promouvoir la santé. Cependant, les interventions de promotion de la santé (PS) existantes dans les CS ciblent majoritairement un seul comportement de santé et des pratiquants sportifs masculins, et leurs évaluations renseignent peu leurs déploiements. Pour dépasser ces limites, l'intervention PROSCeSS a été co-construite à partir du modèle théorique du CS promoteur de santé et de stratégies multi-niveaux et multi-déterminants de santé. L'objectif de cette étude pilote était d'évaluer le déploiement de l'intervention PROSCeSS et d'identifier les facteurs influençant son déploiement. Une étude qualitative comprenant des enregistrements de réunions, des échanges par e-mails et par téléphone, et des entretiens avec les référents de 14 CS a été réalisée. Même si le nombre de CS qui sont allés au bout de l'intervention est faible, ceux-ci considèrent qu'ils ont un rôle à jouer dans la santé de leurs membres. Leur capacité à développer des activités de PS et à déployer les étapes de l'intervention est influencée par les ressources disponibles, le soutien qu'ils reçoivent de leur fédération sportive et la capacité d'un porteur de projet (référent) à s'impliquer. Les CS qui ont déployé l'intervention ont mis en place plusieurs stratégies qui leur permettent d'intégrer la santé dans les habitudes organisationnelles, sociales, économiques et environnementales du CS et de développer de nouvelles activités de PS, telles que des sessions d'activités sportives adaptées et des activités de sensibilisation à l'échauffement, à l'alimentation et aux gestes de premier secours. Cette étude montre qu'il est important de comprendre les spécificités des contextes dans lesquels les interventions de PS sont déployées. Parce qu'elle a conduit à retravailler les étapes de l'intervention et à développer un nouveau design d'évaluation, elle met en évidence le rôle essentiel des études pilotes pour le développement et l'évaluation des interventions.

Citizen science mitigates the lack of distributional data on Nigerian birds.

Citizen science projects are expanding globally, with the African continent, particularly Nigeria, registering significant growth. Here, we document and analyse novel operations of the Nigerian Bird Atlas Project (NIBAP), 2015-2022. This project has employed the use of ornithologists, mainly trained at the A. P. Leventis Ornithological Research Institute (APLORI) located in Jos, Nigeria, and its 28 bird clubs established across Nigeria to enlist 827 bird enthusiasts that contribute regular and near real-time data about bird distribution and relative abundance in the country. Interestingly, NiBAP has recorded about 75% of the bird species known from Nigeria in only about 50% of Nigeria's total surface area, including 39 nationally threatened species. The Common Bulbul Pycnonotus barbatus, Laughing Dove Spilopelia senegalensis, and Grey-backed Camaroptera Camaroptera brevicaudata were the most commonly recorded species, while Amurum Forest Reserve, Rennajj Fish Farm, and Obudu Cattle Ranch were the most surveyed sites during the period. Thus, our approach reveals how to increase involvement of nature enthusiasts, ornithologists, and a regional research institute to build local capacity and contribute rich information necessary to alleviate the lack of distributional data about Afrotropical avifauna. We strongly recommend our approach to boost other citizen science projects across Africa and beyond to address the huge lack of biodiversity data, create public awareness, and foster conservation education.

Evolution of journal clubs: fostering collaborative learning in modern research.

Journal clubs have been a staple in scientific communities, facilitating discussions on recent publications. However, the overwhelming volume of biomedical information poses a challenge in literature selection. This article provides an overview of journal club types and their efficacy in training potential peer reviewers, enhancing communication skills, and critical thinking. Originating in the 19th century, journal clubs have evolved from traditional in-person meetings to virtual or hybrid formats, accelerated by the COVID-19 pandemic. Face-to-face interactions offer personal connections, while virtual events ensure wider participation and accessibility. Organizing journal clubs demands effort, but it has several benefits, including promoting new publications and providing a platform for meaningful discussions. The virtual CardioRNA J-club experience exemplifies successful multidisciplinary collaboration, fostering international connections and inspiring new research. Journal clubs remain a vital component of academic research, equipping senior researchers with the latest developments and nurturing the next generation of scientists. As millennial and Gen Z researchers join the scientific field, journal clubs continue to evolve as a fertile ground for education and collaborative learning in an ever-changing scientific landscape.

The effects of diabetes clubs on peer-support, disclosure of diabetes status, and sources of information regarding diabetes management: results of a pilot-intervention in rural Vietnam.

OBJECTIVES: To measure the effects of diabetes clubs on peer support, disclosure of diabetes status, and the source of information regarding the management of diabetes among persons living with type-2 diabetes (T2D) in rural Vietnam. STUDY DESIGN: A pre- and post-pilot intervention study was carried out in Thai Binh Province, Vietnam (n = 222). RESULTS: Post-intervention, 57.7 % reported using experiences shared by other persons with T2D during the diabetes club sessions. Compared to pre-intervention, there was an increase in the proportion of persons with T2D who disclosed their diabetes status to friends and/or community members (an increase of 15.3 and 13.8 percentage points, respectively). The proportion of persons who reported gathering their own information regarding diabetes management without any support from others decreased from 15.7 % to 6.3 %. Those who reported a relative inside their home or a relative outside their household as their primary source of T2D-relevant information increased from 10.8 % to 18.6 % and from 2.7 % to 9.5 %, respectively. Persons who mentioned that they did not have a need for further support for their diabetes care increased from 18.5 % to 32.0 %. Specific support regarding diabetes-related knowledge received from family members, friends, and/or community members increased from 27.5 % to 62.2 % CONCLUSIONS: These findings suggest a promising potential for the implementation of diabetes clubs to enhance diabetes-relevant knowledge and the quality of self-management among persons living with T2D diabetes in rural areas of Vietnam.

The contribution of Dutch municipalities to stimulate smoke-free outdoor sports clubs: a qualitative study.

Local governments may play a key role in making outdoor sports clubs smoke free. This study aims to assess the activities, motives, challenges and strategies of Dutch municipalities regarding stimulating outdoor sports clubs to become smoke free. Semi-structured interviews were conducted with 19 policy officers of different municipalities in the Netherlands. The included municipalities varied in terms of region, population size and degree of urbanization. Data were analyzed using content analysis. Municipalities stimulated sports clubs to become smoke free by providing information and support and, to a lesser extent, by using financial incentives. Motives of municipalities varied from facilitating a healthy living environment for youth, responding to denormalization of smoking and aligning with goals formulated in national prevention policy. Policy officers faced several challenges, including limited capacity and funds, a reluctance to interfere with sports clubs and little support within the municipal organization. These challenges were addressed by employing various strategies such as embedding smoke-free sports in a broader preventive policy, setting a good example by creating outdoor smoke-free areas around municipal buildings, and collaborating with stakeholders in the municipality to join forces in realizing smoke-free sports clubs. Municipalities demonstrated evident motivation to contribute to a smoke-free sports environment. Currently, most municipalities fulfil an informative and supportive role, while some municipalities still explore their role and position in relation to supporting sports clubs to become smoke free. Other municipalities have established, according to them, effective strategies.

Valuing the contribution of sport volunteering to subjective wellbeing: evidence from eight European countries.

Introduction: Volunteering is a prominent and integral aspect of the activities undertaken by sports clubs in Europe. However, even with its growing importance, quantifying the monetary worth of this nonmarket activity, in terms of wellbeing, can present certain difficulties. Traditional approaches to valuing volunteering (i.e., replacement and opportunity cost approaches) do not fully capture the value of volunteering to individuals, as they do not consider the intangible benefits that individuals may derive from their participation. Methods: This research provides added value to the monetisation of volunteering in sport by applying the wellbeing valuation approach (WVA) for the first time to a cross-sectional data in eight European countries. A double instrumental variable approach was developed to correct for unobservable variables that may influence the pairs: income and subjective wellbeing (SWB), and volunteering and SWB. This allows to estimate the causal impact of volunteering and income on SWB more accurately and assign a reasonable monetary value to this non-market activity. Results: The results, based on a sample size of 1,091, show an income compensation for a volunteer, devoting on average 8.7 hours during a four-week period of €16 to €50 per hour, equivalent to between € 1,700 and € 5,200 per year, depending on the nationality of the volunteer. Discussion: With these estimations insights into the value of volunteering in sports are provided, contributing to a better understanding of how this activity can be valued and supported. By recognising and accurately valuing the contributions of volunteers, sport organizations and policymakers can develop more effective strategies for promoting and supporting volunteering in sports.

Implementation of the GAA 'healthy clubs project' in Ireland: a qualitative study using the Consolidated Framework for Implementation Research.

The sports clubs' role in promoting health has been acknowledged by policy makers and researchers, but there is little evidence on how sports clubs implement health-related interventions. The present article investigates the Gaelic Athletic Association Healthy Club Project (HCP) implementation process (mechanisms, barriers, leverages) over a 10-year timeframe. A case study design helped to produce and compare a data synthesis for five clubs involved since 2013. A qualitative iterative data collection, including document analysis was conducted through 20 focus groups with Healthy Club Officers, coaches, participants and members. The Consolidated Framework for Implementation Research was used in the deductive analysis process, conducted by the first author. Results have shown the success of the HCP in placing health promotion on the agenda of sports clubs leading to informal policy for health promotion, even if activities and recognition are directed toward and coming from the community. This study also underlines the virtuous cycle of the settings-based approach in enhancing membership and volunteer recognition through health promotion actions, and the importance of social good and corporate social activities for sports clubs. Nevertheless, the HCP still relies on limited human resources, is not recognized by competitive oriented adult playing members. and acknowledged as a resource by some coaches, limiting its rootedness in the core business of sports clubs. Future research should empower the HCP community to focus on organizational changes and develop outcomes for individuals, for the club as a whole as well as for the local community.

Swingers and swinging: a critical review of early and current literature and theory.

The last literature review on swingers was written by Richard J. Jenks in 1998, and for the past 25 years, no review has been published with a focus solely this group. Some individual studies have analysed swinging together with other consensual non-monogamies, while other research has looked at swinging in the context of sexual health. This paper presents early and recent literature on swinging, highlighting some of the directions taken in swinger research, and addressing the challenges of finding a theoretical framework suitable to explain swingers, swinger settings, and swinging.

A health promoting sports club framework: strategies from the field.

The application of the settings-based approach to sports clubs requires a context-specific framework to develop and operationalize health promotion interventions. Incorporating top-down and bottom-up perspectives into interventions increases their efficiency, success and sustainability. In 2020, the health promoting sports club (HPSC) model and intervention framework were created, including strategies and intervention components. A subsequent concept mapping study generated 35 statements from sports club stakeholders highlighting their needs when developing health promotion initiatives. This commentary integrates the concept mapping results into the HPSC model and intervention framework. The process added new sports club levels, updated existing and developed new intervention components, then classified them into the framework. The revised HPSC model has seven levels while the revised intervention framework includes 13 strategies and 69 intervention components. This revised HPSC framework provides sports club stakeholders, public health experts and researchers a means to develop and implement targeted health promotion interventions.

Assessment of indoor air quality in health clubs: insights into (ultra)fine and coarse particles and gaseous pollutants.

Introduction: Exercising on regular basis provides countless health benefits. To ensure the health, well-being and performance of athletes, optimal indoor air quality, regular maintenance and ventilation in sport facilities are essential. Methods: This study assessed the levels of particulate, down to the ultrafine range (PM10, PM2.5, and particle number concentration in size range of 20-1,000 nm, i.e., - PNC20-1000 nm), gaseous pollutants (total volatile organic compounds - TVOCs, CO2, and O3) and comfort parameters (temperature - T, relative humidity - RH) in different functional spaces of health clubs (n = 8), under specific occupancy and ventilation restrictions. Results and Discussion: In all HCs human occupancy resulted in elevated particles (up to 2-3 times than those previously reported), considering mass concentrations (PM10: 1.9-988.5 µg/m3 PM2.5: 1.6-479.3 µg/m3) and number (PNC 1.23 × 103 - 9.14 × 104 #/cm3). Coarse and fine PM indicated a common origin (rs = 0.888-0.909), while PNC showed low-moderate associations with particle mass (rs = 0.264-0.629). In addition, up to twice-higher PM and PNC were detected in cardiofitness & bodybuilding (C&B) areas as these spaces were the most frequented, reinforcing the impacts of occupational activities. In all HCs, TVOCs (0.01-39.67 mg/m3) highly exceeded the existent protection thresholds (1.6-8.9 times) due to the frequent use of cleaning products and disinfectants (2-28 times higher than in previous works). On contrary to PM and PNC, TVOCs were higher (1.1-4.2 times) in studios than in C&B areas, due to the limited ventilations combined with the smaller room areas/volumes. The occupancy restrictions also led to reduced CO2 (122-6,914 mg/m3) than previously observed, with the lowest values in HCs with natural airing. Finally, the specific recommendations for RH and T in sport facilities were largely unmet thus emphasizing the need of proper ventilation procedures in these spaces.

A Practical Framework for Delivering Strength-Based Technology Clubs for Autistic Adolescents.

Autistic individuals experience poor vocational outcomes internationally. Transition planning and interventions during adolescence may assist in improving outcomes in adulthood. Strength-based technology clubs show promise in improving outcomes for autistic adolescents by developing skills specific to the Information and Communication Technology industry, and fostering positive traits, such as self-determination. Although strength-based technology clubs have been examined with autistic adolescents, to date, no framework has been proposed to underpin their design and delivery. In this conceptual analysis, we propose a practical framework for delivering strength-based technology clubs for autistic adolescents. The framework builds on work from a previous systematic review of qualitative research and a realist evaluation study of technology clubs for autistic adolescents, combined with theoretical understandings from three health models. The new framework comprised the components of interests, value, autonomy, and requirements, forming the acronym IVAR. Interests refer to strategies drawing on adolescents' areas of interest. Value represents a culture of valuing autistic adolescents as individuals for their unique strengths and skills. Autonomy refers to providing opportunities for adolescents to make decisions, and Requirements refers to aspects of the social and physical environment. Practical recommendations of the framework are discussed, including design and delivery of future strength-based technology clubs, facilitator training, and design activities. The proposed IVAR framework may be useful in guiding the development of strength-based technology clubs. Future research is needed to validate the feasibility and efficacy of the IVAR framework in underpinning the delivery of strength-based technology clubs to autistic adolescents.

Why is this topic important?: The shift from adolescence to adulthood can be challenging for young people on the autism spectrum, and opportunities for employment may be limited. Modern approaches to improving employment outcomes for autistic youth highlight the importance of adopting a strength-based framework, such as matching the strengths and interests of autistic young people to future career pathways. The strengths of many autistic individuals are considered beneficial for employment in the Information and Communication Technology (ICT) sector. Strength-based technology clubs provide opportunities for autistic young people to develop their technological and social skills, meet role models working in the ICT industry, and help them to find work experience. What was the purpose of this article?: The purpose of this article was to develop a new framework for delivering strength-based technology clubs to autistic adolescents. The development of this framework was guided by the authors' earlier work in this area. What do the authors conclude?: The authors proposed a new framework for delivering strength-based technology clubs to autistic adolescents. The framework contains four components, creating the acronym IVAR: Interests, Value, Autonomy, and Requirements. The component, Interests, refers to strategies that draw on adolescents' areas of interest, such as changing activities to include adolescents' focused interests. Value represented a culture of valuing autistic adolescents as individuals for their unique strengths and skills. Autonomy refers to providing opportunities for adolescents to make decisions during the program, and Requirements refers to the design of the social and physical environment. What do the authors recommend for future research on this topic?: The authors recommend that future research should focus on exploring how practical and appropriate the IVAR framework is in supporting the delivery of strength-based technology clubs for autistic adolescents. The four IVAR components are potentially applicable to other areas of community focus to guide strength-based approaches more generally within autism research. How will this analysis help autistic adults now and in the future?: This analysis and discussion will provide researchers, autistic individuals, and the community with practical examples of how service providers can apply IVAR to design and deliver strength-based technology programs for autistic adolescents.

Percepción de la calidad y fidelidad en servicios deportivos privados / Percepçã de qualidade e lealdade nos serviços desportivos privados / Perception of Quality and Loyalty in private sports services

Actualmente las instituciones deportivas se enfrentan a nuevos retos, que los impulsan a realizar cambios constantes con la finalidad de introducirse y posicionarse como instituciones competitivas del sector deportivo privado, al mismo tiempo que buscan nuevos enfoques para atraer la atención de antiguos y nuevos consumidores orientados en perspectivas como; la calidad y la fidelidad, por lo cual, el objetivo de este estudio es analizar la percepción de la calidad y fidelidad en instituciones deportivas privadas respecto a la edad, género y tiempo de permanencia de los usuarios. Para dicho análisis se recabó una muestra de 347 voluntarios, pertenecientes a tres clubes deportivos privados (108 mujeres y 239 hombres), a la cual se le realizaron análisis de fiabilidad descriptivos y comparativos. Los resultados en las variables de calidad y fidelidad muestran diferencias significativas con respecto a la edad y género de los consumidores, contrario a lo obtenido en el tiempo de permanencia, donde los resultados no muestran una diferencia importante. (AU)

Currently, sports institutions are facing new challenges, which drive them to make constant changes in order to introduce and position themselves as competitive institutions in the private sports sector, while seeking new approaches to attract the attention of old and new consumers oriented inperspectives such as; quality and loyalty, therefore, the objective of this study is to analyze the perception of quality and loyalty in private sports institutions with respect to age, gender and time of permanence of the users. For this analysis, a sample of 347 volunteers belonging to three private sports clubs (108 women and 239 men) was collected and subjected to descriptive and comparative reliability analyses. The results for the quality and loyalty variables show significant differences with respecttothe age and gender of the consumers, in contrast to the results obtained for the time spent, where the results do not show a significant difference. (AU)

Atualmente, as instituições desportivas enfrentam novos desafios, que as impulsionam a realizar constantes mudanças para se apresentarem e se posicionarem como instituições competitivas no setor desportivo privado, ao mesmo tempo em que buscam novas abordagens para atrair a atençãode antigos e novos consumidores orientados em perspectivas como qualidade e fidelização, portanto, o objetivo deste estudo é analisar a perceção de qualidade e fidelização em instituições desportivas privadas em relação à idade, sexo e tempo de permanência dos usuários. Para esta análise, foi recolhida uma amostra de 347 voluntários de três clubes desportivos privados (108 mulheres e 239 homens), que foi submetida a análises descritivas e de fiabilidade comparativa. Os resultados para as variáveis qualidade e lealdade mostram diferenças significativas em relação à idade e ao género dos consumidores, ao contrário dos resultados obtidos para o tempo de permanência, onde os resultados não mostram uma diferença significativa. (AU)

The Lindsay Leg Club® Well Leg Regime: an evidence review.

This article aims to review the scarce available evidence on the effectiveness of the Well Leg Programme within the Lindsay Leg Clubs in terms of preventing wound recurrence and improving members' wellbeing. It collates the numerical data on members' wounds and healing rates from the Lindsay Leg Club relational database and members' narratives from a qualitative service evaluation of the Lindsay Leg Clubs. Findings of the review suggest that remaining within the Well Leg regime for several months (or longer) after having had a healed ulcer seems to provide further opportunity to prevent recurrence, and may also provide non-clinical benefits, such as improved wellbeing. Based on the review of available published evidence into the effectiveness of the Well Leg regime, we conclude that there is scope for further studies, including a comparison with other existing treatment and prevention protocols.

Exploring the feasibility of using evidence-based feeding practices to promote children's healthy eating in holiday clubs.

OBJECTIVE: Encouraging healthy eating is a public health priority in the United Kingdom (UK), given the high prevalence of poor diet and overweight/obesity among school-aged children. Holiday clubs are organisations providing childcare and activities during the school holidays and frequently provide food to children at risk of food insecurity, primarily through government-funded programmes like the Holiday Activities and Food programme. However, the research suggests that holiday clubs could do more to maximise opportunities to promote children's healthy eating by using evidence-based feeding practices. DESIGN: During August-September 2020, video-based interviews were conducted exploring staff perceptions of the feasibility of using four evidence-based feeding practices to promote children's healthy eating: modelling; involvement in food choice; involvement in food preparation and cooking and involvement in meal planning. Feasibility was assessed using four dimensions of a feasibility framework (acceptability, demand, practicality and implementation). SETTING: UK holiday clubs. PARTICIPANTS: Twenty-five staff actively involved in delivering UK holiday clubs (project leaders, coordinators, cooks and coaches/youth workers). RESULTS: Staff generally reported good acceptability (dimension 1) and demand (dimension 2) for the feeding practices. However, the practicality (dimension 3) of using the practices was dependent on various factors (logistics, resources, staff readiness, children, peers and parents). Promisingly, in the fourth feasibility dimension (implementation), staff provided numerous practical solutions to overcome these barriers. CONCLUSIONS: Evidence-based feeding practices can be implemented in numerous ways and are therefore generally feasible in holiday clubs. Holiday clubs should be empowered to use evidence-based feeding practices through training resources, sharing networks and provision of sustainable funding.

Impact of differentiated service delivery models on retention in HIV care and viral suppression among people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis of randomised controlled trials.

Differentiated service delivery (DSD) models, such as adherence clubs (ACs), are client-centred approaches where clinically stable people living with HIV (PLHIV) meet to receive various services, including psychosocial support, brief symptoms screening, and refills of antiretroviral medications, among others. We conducted a review to assess the impact of DSD models, including ACs, on sustaining retention in care (RC) and achieving viral suppression (VS) among PLHIV in sub-Saharan Africa. The review protocol was registered in PROSPERO (CRD42023418988). We searched the literature from PubMed, Scopus, Web of Science, Embase and Google Scholar from their inception through May 2023. Eligible randomised controlled trials of adherence clubs were reviewed to assess impact on retention and viral suppression. Random effect models were used to estimate the risk ratios (RR) and 95% confidence intervals (CI). The literature search yielded a total of 1596 records of which 16 randomised clinical trials were determined to be eligible. The trials were conducted in diverse populations among adults and children with a total of 13,886 participants. The RR between any DSD models and standard of care (SoC) was 1.09 (95% CI: 1.08-1.11, I2 : 0%, p: <0.96) and 1.01 (95% CI: 1.00-1.02, I2 : 0%, p: <0.85) for RC and VS, respectively. The RR between ACs and SoC was 1.01 (95% CI: 0.96-1.07, I2 : 84%, p: <0.01) and 1.02 (95% CI: 0.98-1.07, I2 : 77%, p: <0.01) for RC and VS, respectively. DSD models, including ACs, show comparable effectiveness to SoC in maintaining care and achieving viral suppression for stable PLHIV. To maximise adoption, an implementation science approach is crucial for designing effective strategies and overcoming challenges.

Sustainability capacity and health worker normalisation of a successful non-communicable disease (NCD) health systems intervention within primary care settings in Uganda: a quantitative approach to a qualitative question.

BACKGROUND: Interventions for non-communicable diseases are increasingly implemented and evaluated in sub-Saharan Africa, but little is known about their medium- to long-term sustainability beyond the end of research funding. A cluster randomised trial conducted between 2013 and 2016 in Uganda and Tanzania showed that an intervention package to improve hypertension (HT) and type-2 diabetes mellitus (DM) care was highly effective in increasing service readiness and quality of care. The present study assesses the sustainability of the intervention 4 years after the trial in Uganda. METHODS: The study was conducted in 2020 in 22 primary care health facilities (HFs) (3 referrals and 19 lower-level units) that had received the intervention package until trial end (2016), to assess their current capacity and practice to sustain ongoing intervention activities for HT and DM care. Through a cross-sectional survey, 4 pre-defined domains (i.e., cognitive participation, coherence, collective action, and reflexive monitoring) were examined with regard to health worker (HW) normalization and 8 pre-defined domains for intervention sustainability (i.e., organisational capacity, local environment, funding stability, partnerships, communication, evaluation, adaptation, and strategic planning), using the normalisation tool and the program sustainability tool (PSAT). Summary scores were assessed by domains and facility level. RESULTS: Overall normalization strength was adequate at 4.0 (IQR: 3.8, 4.2) of a possible 5 with no evidence of association with HF level (p = 0.40); cognitive participation (buy-in) and reflexive monitoring (appraisal) were strongest at > 4 across all HF levels. All HF levels were weak (< 4) on collective action (teamwork) and coherence (sense-making). Only collective action differed by level (p < 0.002). Overall intervention sustainability was suboptimal at 3.1 [IQR: 1.9, 4.1] of a possible 7 with weak scores on funding stability (2.0), supportive partnerships (2.2), and strategic planning (2.6). Domain differences by HF level were significant for environmental support (p = 0.02) and capacity in organisation (p = 0.01). Adequate strength at a cut-off mean of ≥5 did not differ by HF level for any domain. CONCLUSIONS: Four years after their introduction, practice-dependent intervention elements e.g., local organisational context, HW knowledge or dedication were sustained, but external elements e.g., new funding support or attracting new partners to sustain intervention efforts were not. Whenever new interventions are introduced into an existing health service, their long-term sustainability including the required financial support should be ensured. The quality of services should be upheld by providing routine in-service training with dedicated support supervision.