Gerontological educational interventions for student nurses: a systematic review of qualitative findings.

OBJECTIVES: This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing. METHODS: Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screened to include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies, and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies. CONCLUSIONS: Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated.

In-office Laryngeal Procedures: a Modern Perspective for Vocal Fold Interventions

Introduction: The purpose of this article is to discuss in-office laryngeal procedures as an alternative to surgical intervention under general anesthesia. In-office procedures have become more common due to technological advancements. As a result, these approaches are less invasive and more patient-friendly, with increased pain tolerance and reduced procedure time and cost. Methods: We conducted a thematic analysis of published reports regarding the best known and performed in-office laryngeal interventions. Three questions guided our analysis: What laryngological procedures can be performed in the office setting? What are the advantages of in-office laryngology procedures compared to operating room surgical procedures? Why aren't more in-office procedures performed in some Latin American countries? Discussion: Despite being performed more frequently, there is still controversy whether in-office procedures should be performed as often due to the risk of complications. Furthermore, procedures that are done in the office setting are more popular in some countries than in others, even though their benefit has been well demonstrated. This article describes various in-office procedures, including biopsy, vocal fold injections, and laser surgery. We also discuss what factors might contribute to having office-procedures being performed more frequently in some countries than others. Conclusion: Awake interventions offer numerous benefits, including shorter procedure time, reduced costs, and lower patient morbidity. These advantages have significantly transformed the treatment of laryngeal diseases in modern laryngology practice in a global manner.

Introducción: El propósito de este artículo es discutir los procedimientos laríngeos en el consultorio como una alternativa a la intervención quirúrgica bajo anestesia general. Los procedimientos en consultorio se han vuelto más comunes debido a los avances tecnológicos. Como resultado, estos enfoques son menos invasivos y más amigables para el paciente, con mayor tolerancia al dolor y reducción del tiempo y costo del procedimiento. Métodos: Realizamos un análisis temático de los informes publicados sobre las intervenciones laríngeas más conocidas y realizadas. Tres preguntas guiaron nuestro análisis: ¿Qué procedimientos laringológicos se pueden realizar en el consultorio y cuales sin los más frecuentes?, ¿cuáles son las ventajas de los procedimientos laringológicos fuera del quirófano frente a los que se realizan bajo anestesia general?, ¿por qué no se realizan más procedimientos laringológicos en el consultorio en la mayoría de los países en Latinoamérica? Discusión: A pesar de que se realizan con mayor frecuencia, aún existe controversia sobre si los procedimientos en consultorio deben realizarse con tanta frecuencia debido al riesgo de complicaciones. Además, los procedimientos que se realizan en el consultorio son más populares en algunos países que en otros, aunque sus beneficios han sido bien demostrados. Este artículo describe varios procedimientos en el consultorio, incluida la biopsia, las inyecciones de cuerdas vocales y la cirugía con láser. También se discutieron los factores que podrían contribuir a que los procedimientos en el consultorio se realicen con más frecuencia en algunos países que en otros. Conclusión: Las intervenciones con pacientes despiertos ofrecen numerosos beneficios, incluido un tiempo de procedimiento más corto, costos reducidos y una menor morbilidad para el paciente. Estas ventajas han transformado significativamente el tratamiento de las enfermedades laríngeas en la práctica de la laringología moderna a nivel mundial.

Comparative efficacy of seven nonpharmacological interventions on global cognition in older adults with and without mild cognitive impairment: a network meta-analysis of randomized controlled trials.

To maintain current cognitive function and access greater cognitive reserves, nonpharmacological interventions may be a viable alternative for older adults with or without cognitive impairment. This study aimed to compare different nonpharmacological interventions for enhancing global cognition, including mind-body exercise, physical exercise, non-invasive brain stimulation, cognitive training intervention (CTI), acutherapy (ACU), meditation, and music therapy, by applying a network meta-analysis (NMA). Sixty-one randomized controlled trials evaluating the efficacy of interventions on global cognition in older adults with or without mild cognitive decline were selected. An NMA was conducted to compare the efficacy of different nonpharmacological interventions. The NMA revealed that mind-body exercise (standardized mean difference, 1.384; 95% confidence interval, 0.777-1.992); ACU (1.283; 0.478-2.088); meditation (0.910; 0.097-1.724); non-invasive brain stimulation (1.242; 0.254-2.230); CTI (1.269; 0.736-1.802); and physical exercise (0.977; 0.212-1.742), showed positive effects compared to passive controls. There were no significant differences between the efficacies of other interventions. Nonpharmacological interventions may potentially enhance and maintain global cognition through various pathways, such as memorizing movements and enhancing brain plasticity by reducing stress in the older adult population. Additional studies are needed to clarify the impact of other variables, including intervention methods or psychological variables.

Alerta Cannabis: A Tailored-Computer Web-Based Program for the Prevention of Cannabis Use in Adolescents: A Cluster-Randomized Controlled Trial Protocol.

BACKGROUND: The growing use of cannabis in adolescence is a public health problem that must be addressed through prevention. In Spain, the average age of initiation of cannabis use in the adolescent population is 14.8 years. At 14 years, the lifetime prevalence of cannabis use is 11.7%, which increases to 51.,5% at the age of 18; the prevalence of cannabis use in the population aged 14 to 18 years is 28.6%, a figure that must be tried to reduce, that is why this school prevention program is proposed: Alerta Cannabis. METHODS: The Alerta Cannabis research project consists of design, implementation, and evaluation. In the first phase, a computer-tailored eHealth program (Alerta Cannabis) is developed based on the I-Change Model, an integrated model based on three main behavioral change processes: awareness, motivation, and action. This program consists of four 30-minute sessions that will provide culturally adapted and personalized advice to motivate students not to use cannabis through text feedback, animations, and gamification techniques. This phase will also include usability testing. In the implementation phase, secondary school students from Western Andalusia, Spain (Seville, Cádiz, Huelva, and Córdoba) and Eastern Andalusia (Jaén, Málaga, and Granada) will be randomized to an experimental condition (EC) or a control condition (CC) for a cluster randomized clinical trial (CRCT). Each condition will have 35 classes within 8 schools. GI will receive the online intervention Alerta Cannabis. EC and CC will have to fill out a questionnaire at baseline, six months, and twelve months of follow-up. In the last phase, the effect of Alerta Cannabis is evaluated. The primary outcomes are the lifetime prevalence of cannabis use and its use in the last 30 days and at 6 months. At 12 months of follow-up, the prevalence in the last 12 months will also be assessed. The secondary outcome is the intention to use cannabis. DISCUSSION: The study tests the effect of the innovative program specifically aimed to reduce the use of cannabis in the adolescent population through eHealth in Spain. The findings aim to develop and implement evidence-based cannabis prevention interventions, which could support school prevention, for instance, the assistance of school nurses. If the program proves to be effective, it could be useful to prevent cannabis use on a national and international scale. TRIAL REGISTRATION: NCT05849636. Date of registration: March 16, 2023.

The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial.

BACKGROUND: Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. OBJECTIVE: This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. METHODS: This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. RESULTS: No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. CONCLUSIONS: Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. TRIAL REGISTRATION: German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110.

A Quality Improvement Project to Increase Compliance With a Facility Protocol on Surgical Antimicrobial Prophylaxis.

Surgical site infections (SSIs) contribute to negative outcomes for patients and health care organizations. Compliance with clinical practice guidelines likely can help prevent SSIs. An interdisciplinary team at a regional referral center in Michigan sought to reduce SSIs by improving compliance with the facility's preoperative antibiotic selection, dosing, timing, and redosing protocol. The interventions for the quality improvement project included adding the preprocedural antibiotics and doses to the master OR schedule; holding an education session for all preoperative nurses, intraoperative nurses, and anesthesia professionals; and posting a reference guide in the preoperative and intraoperative areas. Compliance with the facility's protocol for antibiotic selection, dosing, and timing significantly improved. However, SSI rates and compliance with redosing recommendations did not change significantly. The team decided to add the antibiotic order information to the master OR schedule permanently. The team plans to consider providing education sessions on administering preprocedural antibiotics outside the OR.

A Scoping Review of Dementia Interventions in Home-Based Primary Care.

OBJECTIVES: Home-based primary care (HBPC) provides interdisciplinary, longitudinal, comprehensive care at home to homebound older adults. The prevalence of dementia among HBPC recipients is approximately 50%. To date, little research has been performed to determine whether dementia-specific interventions have been conducted in HBPC or their efficacy. We performed a scoping review to assess the landscape of dementia interventions in HBPC. DESIGN: Systematic scoping review. SETTING AND PARTICIPANTS: Care delivery programs for patients or caregivers of patients with dementia for the purpose of improving the management of dementia in the setting of HBPC. METHODS: The PRISMA-ScR protocol was followed. Literature searches were performed using PubMed, Embase, and Scopus for articles on dementia-focused interventions implemented in HBPC. Articles were excluded if they consisted of abstracts only, were not in English, or were not dementia interventions in HBPC. RESULTS: A total of 1657 unique titles and abstracts were screened. Overall, 1584 titles and abstracts were excluded, resulting in 73 full-text studies to assess for eligibility. Of these 73 full-text studies, 1 study met criteria for inclusion, an observational study assessing the implementation of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in Veterans Affairs HBPC. That study found the intervention to be effective in reducing caregiver burden, with a decrease of 2 hours on duty per day, trending toward significance. Among the excluded 72 full-text studies, some studies included potentially relevant interventions that could be translated into HBPC care, including dementia interventions that targeted long-term services and supports, office-based primary care and other nonhome settings such as nursing homes, and home-based palliative care. CONCLUSIONS AND IMPLICATIONS: Despite high prevalence of dementia among homebound older adults receiving HBPC, there are a dearth of studies on HBPC-specific dementia interventions. Future studies should consider adapting and testing interventions found to be effective in other settings to HBPC.

Organizational Context and Facilitation Interactions on Delirium Risk in Long-Term Care: A Cross-Sectional Study.

OBJECTIVES: Organizational context (eg, leadership) and facilitation (eg, coaching behaviors) are thought to interact and influence staff best practices in long-term care (LTC), including the management of delirium. Our objective was to assess if organizational context and facilitation-individually, and their interactions-were associated with delirium in LTC. DESIGN: Retrospective cross-sectional analysis of secondary data. SETTING AND PARTICIPANTS: We included 8755 residents from 281 care units in 86 LTC facilities in 3 Canadian provinces. METHODS: Delirium (present/absent) was assessed using the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS 2.0). The Alberta Context Tool (ACT) measured 10 modifiable features of care unit organizational context. We measured the care unit's total care hours per resident day and the proportion of care hours that care aides contributed (staffing mix). Facilitation included the facility manager's perception of RAI-MDS reports' adequacy and pharmacist availability. We included unit managers' change-oriented organizational citizenship behavior (OCB) and an item reflecting how often care aides recommended policy changes. Associations of organizational context, facilitation, and their interactions with delirium were analyzed using mixed-effects logistic regressions, controlling for covariates. RESULTS: Delirium symptoms were prevalent in 17.4% of residents (n = 1527). Manager-perceived adequacy of RAI-MDS reports was linked to reduced delirium symptoms (odds ratio [OR] = 0.63). Higher care hours per resident day (OR = 1.2) and an available pharmacist in the facility (OR = 1.5) were associated with increased delirium symptoms. ACT elements showed no direct association with delirium. However, on care units with low social capital scores (context), increased unit managers' OCB decreased delirium symptoms. On care units with high vs low evaluation scores (context), increased staffing mix reduces delirium symptoms more substantially. CONCLUSIONS AND IMPLICATIONS: Unit-level interactions between organizational context and facilitation call for targeted quality improvement interventions based on specific contextual factors, as effectiveness may vary across contexts.

Psychometric Property Examination of a Self-Assessment Fear Scale in Turkish Children Aged 4-12 Years: A Methodological Study.

Background: Given the lack of validated tools to assess fear in Turkish children, this research aims to address this gap by conducting a methodological study to examine the validity and reliability of the Fear Scale, thereby providing health care professionals and researchers with a reliable instrument to evaluate fear levels in this population. Methods: The research was conducted on 150 children aged 4-12 years and their parents who applied to the pediatric blood collection unit of Koç University Faculty of Medicine Hospital. In the study, the "Sociodemographic Characteristics Form," "Fear Scale," and "Child Fear Scale" were used for data collection. Results: A very high statistically significant positive relationship was obtained between the Fear Scale and the Child Fear Scale (r = .973; p < .001). The high correlation value between the two forms indicates that the child form is valid. The content validity index and item content validity index values of the scale were found to be 0.98. A very good level of statistically significant agreement was achieved between the Fear Scale and the Child Fear Scale (κ = .878; p < .001). Conclusion: It was found that the Turkish psychometric properties of the Fear Scale are valid and reliable for children aged 4-12 years. It is suggested that pediatric nurses use the scale in clinics to evaluate their fear about procedural operations.

Effects of microbiome-based interventions on neurodegenerative diseases: a systematic review and meta-analysis.

Neurodegenerative diseases (NDDs) are characterized by neuronal damage and progressive loss of neuron function. Microbiome-based interventions, such as dietary interventions, biotics, and fecal microbiome transplant, have been proposed as a novel approach to managing symptoms and modulating disease progression. Emerging clinical trials have investigated the efficacy of interventions modulating the GM in alleviating or reversing disease progression, yet no comprehensive synthesis have been done. A systematic review of the literature was therefore conducted to investigate the efficacy of microbiome-modulating methods. The search yielded 4051 articles, with 15 clinical trials included. The overall risk of bias was moderate in most studies. Most microbiome-modulating interventions changed the GM composition. Despite inconsistent changes in GM composition, the meta-analysis showed that microbiome-modulating interventions improved disease burden (SMD, - 0.57; 95% CI - 0.93 to - 0.21; I2 = 42%; P = 0.002) with a qualitative trend of improvement in constipation. However, current studies have high methodological heterogeneity and small sample sizes, requiring more well-designed and controlled studies to elucidate the complex linkage between microbiome, microbiome-modulating interventions, and NDDs.

Effects of Different Physical Therapy Interventions in Improving Flexibility in University Students with Hamstring Tightness - A Systematic Review and Network Meta-analysis.

The aim of the present study was to identify the different interventions for hamstring flexibility among university students with hamstring tightness and to determine the better treatment method. Design: Systematic review and network meta-analysis. An electronic search of the databases: Medline, Pubmed, Cochrane, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) was conducted. A total of 11 articles were included in the review. Of these articles, 02 were case-control studies, 02 were interventional pre-post studies and 07 were RCTs. The 07 RCTs were included for network meta-analysis. The findings of the initial network meta-analysis (NMA) which compared control i.e., no intervention with other interventions revealed that all the physical therapy interventions: stretching, electrotherapy combined with stretching, massage, dry needling and neurodynamic exercises combined with stretching and neurodynamics alone were superior to control. Since most studies included stretching as an intervention, a second NMA was conducted to compare the different physical therapy interventions with stretching. The results suggested that US-guided neuromodulation (WMD: -5.80, CI: -12.11, 0.51) had large effects on hamstring flexibility compared to stretching and stretching combined with electrotherapy i.e., cryotherapy and ultrasound (WMD: 0.25, CI: -1.14 to 1.64), MET (WMD: 3.10, CI: -3.28 to 9.48) and massage (WMD: 8.05, CI: -11.90 to 27.18) were inferior to stretching. To further investigate the effects of these interventions three meta-analysis were performed. The results revealed that stretching was more effective (SMD 2.27, 95% 0.72 to 3.81, p < 0.01) compared to control (no intervention). Neurodynamic exercises combined with stretching and neurodynamics alone were found to be superior to stretching alone ((SMD -0.69, 95% -1.35 to -0.03, p < 0.01) and stretching combined with electrotherapy was not significantly better than stretching alone ((SMD -0.07, 95% -1.00 to 0.87, p=0.88). Neurodynamic exercises combined with stretching and neurodynamics alone showed to be superior to the other physical therapy interventions in improving hamstring flexibility for hamstring tightness among university students, however, the reliability of the evidence is low.

Perceptions of Mental Health Professionals on Nutritional Psychiatry as an Adjunct Treatment in Mainstream Psychiatric Settings in New South Wales, Australia.

Background Nutritional psychiatry refers to the practice of using food, or nutrition, as alternative or complementary treatment for mental health disorders. It is a growing area of research that has shown links between the biological processes in the gut and how the food we consume can impact cognitive function, which then can impact our mood and behaviour. However, there is a lack of understanding on the knowledge and education of nutritional psychiatry in mental health clinicians, and further, how nutritional psychiatry, if at all, is practised in psychiatric clinical settings. Therefore, this study aims to investigate the perceptions, knowledge, and education of mental health professionals within the state of New South Wales, Australia regarding their clinical practice and knowledge of nutritional psychiatry.  Methods In this cross-sectional study, a self-administered structured questionnaire created by the authors was successfully completed by 40 mental health professionals (mental health nurses, occupational therapists, psychologists, medical officers, and other allied health workers) who were working in New South Wales, Australia. 49 questionnaires were attempted with nine excluded due to these being predominantly incomplete, including demographic data only or empty, ensuring integrity of the remaining data and analysis. The questionnaire aimed to uncover their perceptions, knowledge, and education in nutritional psychiatry and its role in mental health settings. The questionnaire included 16 questions that covered various themes such as the frequency and importance of discussing nutrition with patients, nutrition referrals for issues regarding nutrition, the value of including nutritional psychiatry in their clinical practice, and clinician training and willingness to train or gain further education in nutritional psychiatry. Data was analysed through a series of frequency tables to categorise patterns and identify patterns through the use of descriptive statistics in our analysis of the distribution of attitudes and practices among mental health professionals regarding nutritional psychiatry.  Results A total of 40 mental health clinicians successfully completed the survey and their results were analysed. The results suggest that most clinicians (85% to 93%) recognised the importance of nutrition in mental health, however, revealed various barriers which hindered their clinical practice such as a lack of time, knowledge, and access to nutritional services. Further, 54% of clinicians rated their knowledge of nutritional psychiatry as low, however, 92% revealed that they would attend nutritional psychiatry training if given the opportunity. Additionally, the clinicians reported varied levels of education in nutrition, with 43% reporting no education at all on nutrition in their preclinical studies.  Conclusions Clinicians recognise the importance of nutrition in mental health settings, but revealed lack of time, knowledge, and nutritional services as barriers in clinical practice. Further, clinicians reported a lack of pre-clinical education on nutrition together with an overwhelming interest in engaging with nutritional psychiatry education if it were made available. These conclusions provide important insights for higher education and health policy.

Health effects of holistic housing renovation in a disadvantaged neighbourhood in the Netherlands: a qualitative exploration among residents and professionals.

BACKGROUND: Holistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting social cohesion). In a deprived neighbourhood in Utrecht, the Netherlands, this paper examined residents' and professionals' experiences, ideas, and perceptions regarding holistic housing renovation, its health effects, and underlying mechanisms explaining those effects. METHODS: Semi-structured in-depth interviews were conducted with 21 social housing residents exposed to holistic housing renovation, and 12 professionals involved in either the physical renovation or social interventions implemented. Residents were interviewed in various renovation stages (before, during, after renovation). Transcripts were deductively and inductively coded using qualitative software. RESULTS: Residents experienced and professionals acknowledged renovation stress caused by nuisance from construction work (noise, dust), having to move stuff around, and temporary moving; lack of information and control; and perceived violation of privacy. Involvement in design choices was appreciated, and mental health improvement was expected on the long term due to improved housing quality and visual amenity benefits. Social contact between residents increased as the renovation became topic for small talk. Few comments were made regarding physical health effects. The interviews revealed a certain amount of distrust in and dissatisfaction with the housing corporation, construction company, and other authorities. CONCLUSIONS: Renovation stress, aggravated by lack of information and poor accessibility of housing corporation and construction company, negatively affects mental health and sense of control. Potential stress relievers are practical help with packing and moving furniture, and increased predictability by good and targeted communication. Social interventions can best be offered after renovation, when residents live in their renovated apartment and the nuisance and stress from the renovation is behind them. Social partners can use the period leading up to the renovation to show their faces, offer practical help to reduce renovation stress, and increase residents' trust in their organization and authorities in general. This might also contribute to residents' willingness to accept help with problems in the social domain after renovation.

Female genital mutilation: trends, economic burden of delay and basis for public health interventions.

BACKGROUND: The practice of female genital mutilation (FGM) is a health and social problem. Millions of girls and women have undergone FGM or will soon, and more information is needed to effectively reduce the practice. The aim of this research is to provide an overview of the FGM trendlines, the inequality of its prevalence, and the economic burden. The findings shed light on 30-year trends and the impact of the pandemic on planned efforts to reduce FGM which helps with public health interventions. METHODS: Temporal trend analysis, and graphical analysis were used to assess the change and inequality over the last 30 years. We included 27 countries in which FGM is prevalent. We calculated the extra economic burden of delayed interventions to reduce FGM like COVID-19. RESULTS: For the 27 countries analyzed for temporal trendlines, 13 countries showed no change over time while 14 had decreasing trends. Among the 14, nine countries, Uganda, Togo, Ghana, Benin, Kenya, Nigeria, Central African Republic, Chad, and Ethiopia had high year-decrease (CAGR - 1.01 and - 10.26) while five, Côte d'Ivoire, Egypt, Gambia, Djibouti, and Mali had low year-decrease (CAGR>-1 and < 0). Among these five are the highest FGM prevalence similar distribution regardless the wealth quintiles or residence. There is an economic burden of delay or non-decline of FGM that could be averted. CONCLUSION: Findings indicate that some countries show a declining trend over time while others not. It can be observed that there is heterogeneity and homogeneity in the FGM prevalence within and between countries which may indicate inequality that deserves further investigation. There is considerable economic burden due to delays in the implementation of interventions to reduce or eliminate FGM. These insights can help in the preparation of public health interventions.

Addressing the Challenge: A Review of Effective Prevention Strategies for Childhood Obesity in India.

Childhood obesity is a growing public health concern in India, with rising prevalence rates and associated health risks. This review examines effective prevention strategies for addressing this issue. Through a comprehensive analysis of research findings, policy initiatives, and community-based interventions, the review identifies critical components of successful prevention efforts. These include multi-sectoral collaborations, tailored interventions addressing socioeconomic and cultural factors, and the involvement of families and healthcare professionals. The importance of addressing childhood obesity in India is underscored, given its significant impact on health outcomes, healthcare costs, and quality of life. The review concludes with a call to action for stakeholders and policymakers to prioritise prevention efforts, allocate resources, and implement evidence-based interventions to combat childhood obesity effectively. By working together, India can mitigate the adverse effects of childhood obesity and promote a healthier future for its children.

Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital.

Introduction: The intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. Methods: A retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. Results: The study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. Conclusion: This study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.

Brief interventions 2.0: a new agenda for alcohol policy, practice and research.

BACKGROUND: Alcohol problems are increasing across the world and becoming more complex. Limitations to international evidence and practice mean that the screening and brief intervention paradigm forged in the 1980s is no longer fit for the purpose of informing how conversations about alcohol should take place in healthcare and other services. A new paradigm for brief interventions has been called for. BRIEF INTERVENTIONS 2.0: We must start with a re-appraisal of the roles of alcohol in society now and the damage it does to individual and population health. Industry marketing and older unresolved ideas about alcohol continue to impede honest and thoughtful conversations and perpetuate stigma, stereotypes, and outright fictions. This makes it harder to think about and talk about how alcohol affects health, well-being, and other aspects of life, and how we as a society should respond. To progress, brief interventions should not be restricted only to the self-regulation of one's own drinking. Content can be orientated to the properties of the drug itself and the overlooked problems it causes, the policy issues and the politics of a powerful globalised industry. This entails challenging and reframing stigmatising notions of alcohol problems, and incorporating wider alcohol policy measures and issues that are relevant to how people think about their own and others' drinking. We draw on recent empirical work to examine the implications of this agenda for practitioners and for changing the public conversation on alcohol. CONCLUSION: Against a backdrop of continued financial pressures on health service delivery, this analysis provokes debate and invites new thinking on alcohol. We suggest that the case for advancing brief interventions version 2.0 is both compelling and urgent.

The Impact of Behavioral Lifestyle Intervention on Inflammatory Cytokines in Older Adults Living With Type 2 Diabetes: A Feasibility Study.

OBJECTIVE: This study investigates the effects of a behavioral lifestyle intervention on inflammatory cytokines and frailty in older adults (≥ 65 years) with type 2 diabetes (T2D). METHOD: We conducted a single-arm, 6-month intervention supplemented with diet and activity self-monitoring technology. We assessed frailty using Fried criteria and quantified inflammatory cytokines (interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating-factor [GM-CSF], interferon [IFN-γ], tumor necrosis factor [TNF-α]) using a multiplex assay. We used paired t-tests with significance at P < .05. We calculated the Spearman correlation and evaluated the relationship between frailty, BMI, and inflammatory cytokines. RESULTS: Eighteen participants completed the study (mean ± SD: 71.5 ± 5.3 years; BMI: 34 ± 6 kg/m2). At baseline, we had 4 frail, 13 pre-frail, and 1 non-frail participant. At 6 months, we observed the therapeutic effects of the intervention on frailty score, BMI, IL-2, IFN-y, and GM-CSF. DISCUSSION: The study highlights the importance of behavioral lifestyle intervention in improving inflammatory cytokines and frailty in older adults.

Racial and ethnic disparities in access to community-based perinatal mental health programs: results from a cross-sectional survey.

BACKGROUND: Perinatal mental health is a major public health problem that disproportionately affects people from racial and ethnic minority groups. Community-based perinatal mental health programs, such as peer support groups, are essential tools for the prevention and treatment of perinatal depression. Yet, little is known about racial and ethnic disparities in accessibility and utilization of community-based perinatal mental health programs. METHODS: We conducted a cross-sectional study using an online survey with program administrators representing perinatal mental health community-based services and support programs throughout New Jersey. Descriptive analysis and mapping software was used to analyze the data. RESULTS: Thirty-three program administrators completed the survey. Results showed substantial racial and ethnic disparities in availability and utilization of community-based programs. In the majority of programs, Black, Hispanic, and Asian individuals made up less than 10% of total annual participants and less than 10% of facilitators. There were also geographic disparities in program accessibility and language availability across counties. Program administrators identified mental health stigma, lack of support from family, fear of disclosure of mental health challenges, social determinants, lack of language-concordant options in programs, and limited awareness of programs in the community as significant barriers to participation of racial and ethnic minorities. Strategies to address barriers included adding language options, improving program outreach, and increasing diversity of facilitators. CONCLUSIONS: This study provides new evidence on racial and ethnic disparities in access to community-based perinatal mental health programs. Efforts to build the resources and capacities of community-based programs to identify equity gaps, increase diversity of staff, and address barriers to participation is critical to reducing racial and ethnic inequities in perinatal mental health.

Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Hazardous Alcohol Use Among Sexual Minority Cisgender Men and Transgender Individuals: Protocol for a Randomized Controlled Trial.

BACKGROUND: Sexual minority cisgender men and transgender (SMMT) individuals, particularly emerging adults (aged 18-34 years), often report hazardous drinking. Given that alcohol use increases the likelihood of HIV risk behaviors, and HIV disproportionately affects SMMT individuals, there is a need to test interventions that reduce hazardous alcohol use and subsequent HIV risk behaviors among this population. Ecological momentary interventions (EMIs), which use mobile phones to deliver risk reduction messages based on current location and behaviors, can help to address triggers that lead to drinking in real time. OBJECTIVE: This study will test an EMI that uses motivational interviewing (MI), smartphone surveys, mobile breathalyzers, and location tracking to provide real-time messaging that addresses triggers for drinking when SMMT individuals visit locations associated with hazardous alcohol use. In addition, the intervention will deliver harm reduction messaging if individuals report engaging in alcohol use. METHODS: We will conduct a 3-arm randomized controlled trial (N=405 HIV-negative SMMT individuals; n=135, 33% per arm) comparing the following conditions: (1) Tracking and Reducing Alcohol Consumption (a smartphone-delivered 4-session MI intervention), (2) Tracking and Reducing Alcohol Consumption and Environmental Risk (an EMI combining MI with real-time messaging based on geographic locations that are triggers to drinking), and (3) a smartphone-based alcohol monitoring-only control group. Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks per drinking day, binge drinking episodes, and HIV risk behaviors. Additional assessments at baseline, 3 months, 6 months, and 9 months will evaluate exploratory long-term outcomes. RESULTS: The study is part of a 5-year research project funded in August 2022 by the National Institute on Alcohol Abuse and Alcoholism. The first 1.5 years of the study will be dedicated to planning and development activities, including formative research, app design and testing, and message design and testing. The subsequent 3.5 years will see the study complete participant recruitment, data collection, analyses, report writing, and dissemination. We expect to complete all study data collection in or before January 2027. CONCLUSIONS: This study will provide novel evidence about the relative efficacy of using a smartphone-delivered MI intervention and real-time messaging to address triggers for hazardous alcohol use and sexual risk behaviors. The EMI approach, which incorporates location-based preventive messaging and behavior surveys, may help to better understand the complexity of daily stressors among SMMT individuals and their impact on hazardous alcohol use and HIV risk behaviors. The tailoring of this intervention toward SMMT individuals helps to address their underrepresentation in existing alcohol use research and will be promising for informing where structural alcohol use prevention and treatment interventions are needed to support SMMT individuals. TRIAL REGISTRATION: ClinicalTrials.gov NCT05576350; https://www.clinicaltrials.gov/study/NCT05576350. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55166.