Barriers and Facilitators of Surrogates Providing Consent for Critically Ill Patients in Clinical Trials: A Qualitative Study.

BACKGROUND: Enrollment into critical care clinical trials is often hampered by the need to rely on surrogate decision-makers. To identify potential interventions facilitating enrollment into critical care clinical trials, a better understanding of surrogate decision-making for critical care clinical trial enrollment is needed. RESEARCH QUESTION: What are the barriers and facilitators of critical care trial enrollment? What are surrogate decision-makers' perspectives on proposed interventions to facilitate trial enrollment? STUDY DESIGN AND METHODS: We conducted semistructured interviews with 20 surrogate decision-makers of critically ill patients receiving mechanical ventilation. The interviews were recorded and transcribed verbatim, and analyzed for themes using an inductive approach. RESULTS: Twenty surrogate decision-makers of critically ill patients participated in the semistructured interviews. Thematic analysis confirmed previous research showing that trust in the system, assessing the risks and benefits of trial participation, the desire to help others, and building medical knowledge as important motivating factors for trial enrollment. Two previously undescribed concerns among surrogate decision-makers of critically ill patients were identified, including the potential to interfere with clinical treatment decisions and negative sentiment about placebos. Surrogates viewed public recognition and charitable donations for participation as favorable potential interventions to encourage trial enrollment. However, participants viewed direct financial incentives and prioritizing research participants during medical rounds negatively. INTERPRETATION: This study confirms and extends previous findings that health system trust, study risks and benefits, altruism, knowledge generation, interference with clinical care, and placebos are key concerns and barriers for surrogate decision-makers to enroll patients in critical care trials. Future studies are needed to evaluate if charitable giving on the patient's behalf and public recognition are effective strategies to promote enrollment into critical care trials.

Mindfulness-Based Cognitive Therapy-Taking it Further (MBCT-TiF) compared to Ongoing Mindfulness Practice (OMP) in the promotion of well-being and mental health: A randomised controlled trial with graduates of MBCT and MBSR.

OBJECTIVE: To evaluate the effectiveness and acceptability of Mindfulness-Based Cognitive Therapy-Taking it Further (MBCT-TiF), as an adapted programme for graduates of MBCT and Mindfulness-Based Stress Reduction (MBSR). MBCT-TiF sits within a global mental health approach, which aims to help shift a wider distribution of the population towards mental well-being and away from mental ill health using a family of MBCT curricula. The primary hypothesis was that MBCT-TiF, compared to Ongoing Mindfulness Practice (OMP), would help MBCT/MBSR graduates improve their mental well-being. METHOD: A parallel RCT with repeated measures was conducted. 164 graduates of MBCT/MBSR were randomly assigned (1:1) to either MBCT-TiF or OMP. REGISTRATION: ClinicalTrials.gov (NCT05154266). RESULTS: Of the 164 graduates recruited, 83 were randomly assigned to MBCT-TiF and 81 to OMP. MBCT-TiF was significantly more effective than OMP at improving mental well-being, with large effects post-intervention (B = 6.25; 95% CI = [4.20, 8.29]; Cohen's d = 0.78). No serious adverse effects were reported. CONCLUSIONS: The findings support MBCT-TiF, in the context of the proposed global mental health approach, to help MBCT/MBSR graduates sustain mental health benefits and experience further gains in mental well-being after completing an introductory MBCT/MBSR programme. Future work should consider mechanisms and longer follow-up measurements.

Utilizing Advocacy to Promote the Adoption and Implementation of Medicaid Policies That Increase Insurance Coverage Among Adolescents.

PURPOSE: The Promise of Adolescence: Realizing Opportunity for All Youth report recommends several Medicaid policies to increase insurance coverage among adolescents: approve Medicaid expansion; eliminate the 5-year Medicaid waiting period for lawfully present adolescent immigrants; increase Medicaid reimbursement rates for adolescent health services to the level of Medicare; and ensure coverage and sufficient reimbursement of comprehensive health services. We designed this study to identify key advocates and factors relevant to adoption and implementation of the recommended Medicaid policies in Nebraska to highlight opportunities for additional advocacy. METHODS: We conducted semistructured interviews January 2022 with 28 adolescent health and health-care access experts in Nebraska, including representatives from health care, education, government, and nonprofit sectors. We recorded the interviews and transcribed them verbatim, then coded data using NVivo software and identified key themes. RESULTS: Participants were unable to identify any Medicaid advocates or advocacy work focused on adolescents, but they did identify 35 organizations working to improve insurance coverage in Nebraska. Coordinated multisector, statewide coalitions secured the adoption of Medicaid expansion through a citizen-supported ballot initiative. Barriers to successful implementation include limited Medicaid outreach to citizens and lawfully present immigrants. Low state government support for increasing Medicaid reimbursement rates and providing comprehensive health services, coupled with the absence of coordinated advocacy, hinder the adoption of these recommendations. DISCUSSION: Advocacy efforts should be implemented to increase adoption and implementation of Medicaid policies recommended to increase adolescents' insurance coverage. These efforts must be built on a foundation of knowledge of state government practices and must utilize sustained partnership among multisector advocates, including adolescent-serving professionals.

Pathways to mental well-being for graduates of mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR): A mediation analysis of an RCT.

OBJECTIVE: To explore mediated effects of Mindfulness-Based Cognitive Therapy-"Taking it Further" (MBCT-TiF) on mental well-being through changes in mindfulness, self-compassion, and decentering. METHOD: A secondary analysis of an RCT using simple mediation, with 164 graduates of MBCT and mindfulness-based stress reduction (MBSR), was implemented whereby MBCT-TiF (vs ongoing mindfulness practice; OMP) was the independent variable; changes in mindfulness, self-compassion, and decentering during the intervention were the mediators; and mental well-being at post-intervention, whilst controlling for baseline, was the dependent variable. Secondary outcomes included psychological quality of life, depression, and anxiety. RESULTS: Compared to OMP, MBCT-TiF experienced significant improvements in mental well-being through changes in all three mediators (mindfulness: ab = 0.11 [0.03, 0.25]; decentering: ab = 0.16 [0.05, 0.33]; self-compassion: ab = 0.07 [0.01, 0.18]). A similar pattern was demonstrated for depression, but only mindfulness and decentering mediated effects on psychological quality of life and anxiety. CONCLUSION: The findings provide preliminary support for all three mediators in driving change in mental well-being in a sample of MBCT/MBSR graduates. Future work must be theory-driven and powered to test all mediators in parallel and alongside other potential mediators (e.g., equanimity) to further understand independent contributions and interacting effects.Trial registration: ClinicalTrials.gov identifier: NCT05154266.

The State- and Trait-Level Effects and Candidate Mechanisms of Four Mindfulness-Based Cognitive Therapy (MBCT) Practices: Two Exploratory Studies.

Objectives: The primary aim was to explore state- and trait-level effects and candidate mechanisms of four Mindfulness-Based Cognitive Therapy (MBCT) practices. Method: One hundred sixty adults self-selected from the general population were randomized to one of four mindfulness practices: body scan, mindful movement, breath and body, and befriending. Study 1 explored state-level self-compassion, mindfulness, decentering (mechanisms), and pleasantness of thoughts, emotions, and body sensations at multiple time points using two single mindfulness sessions. Study 2 explored trait-level self-compassion, mindfulness, decentering, interoceptive awareness, attentional control (mechanisms), anxiety, depression, and psychological quality of life pre-post 2 weeks of daily practice. Results: In study 1, state-level effects were demonstrated in all candidate mechanisms and outcomes within the whole sample across time points (d = 0.27 to 0.86), except for state decentering. After controlling for pre-scores and additional covariates, no between-group effects were found (p = 0.050 to 0.973). In study 2, trait-level effects were demonstrated in psychological quality of life and most candidate mechanisms within the whole sample (d = 0.26 to 0.64) but no between-group effects were found (p = 0.080 to 0.805). Within the whole sample, after controlling for pre-scores, changes in mindfulness, self-compassion, decentering, and interoceptive awareness (i.e. body listening) were associated with improvements in psychological quality of life (r = 0.23 to 0.40) and self-led mindfulness practice (r = 0.18 to 0.23). Conclusions: Future research should test the generated hypotheses using well-designed, adequately powered, and theory-driven studies that address universal and specific mechanisms in different populations and contexts. Pre-registration: This study is not pre-registered. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-023-02193-6.

Mindfulness skills and experiential avoidance as therapeutic mechanisms for treatment-resistant depression through mindfulness-based cognitive therapy and lifestyle modification.

Background/objective: The COVID-19 pandemic and consequent physical distancing has made it difficult to provide care for those with Treatment-Resistant Depression (TRD). As a secondary analysis of a clinical trial, the aim of this study was to explore potential mechanisms through which three online-delivered approaches, added to treatment as usual, improve depressive symptoms in TRD patients. Methods: The three approaches included (a) Minimal Lifestyle Intervention (MLI), (b) Mindfulness-Based Cognitive Therapy (MBCT), and (c) Lifestyle Modification Program (LMP). Sixty-six participants with TRD completed assessments pre-post intervention (mindfulness skills [FFMQ]; self-compassion [SCS]; and experiential avoidance [AAQ-II]) and pre-intervention to follow-up (depressive symptoms [BDI-II]). Data were analyzed using within-subjects regression models to test mediation. Results: Mindfulness skills mediated the effect of MBCT on depressive symptoms (ab = -4.69, 95% CI = -12.93 to-0.32), whereas the lack of experiential avoidance mediated the effect of LMP on depressive symptoms (ab = -3.22, 95% CI = -7.03 to-0.14). Conclusion: Strengthening mindfulness skills and decreasing experiential avoidance may promote recovery in patients with TRD, MBCT, and LMP have demonstrated that they may help increase mindfulness skills and decrease experiential avoidance, respectively. Future work will need to unpick the components of these interventions to help isolate active ingredients and increase optimization.

Retrospective Study of Healthcare Resources Developed for Patients by Interprofessional Teams.

Wayne State University (WSU) emphasizes the importance of interdisciplinary education by having students participate in an Interprofessional Team Visit (IPTV) program. A 60-minute virtual visit is conducted to assess adults aged over 50 years within the Detroit Metropolitan Area (Metro Detroit) community. This project was designed to prepare healthcare students in evaluating the mental, physical, and social health aspects of assigned patients based on specific disciplinary assessments. Upon completion of assessments, the interdisciplinary team provided the patient with resources based on the team and the patient's agreed-upon area of concern. Twenty-eight IPTV teams, consisting of a medical and occupational therapy student and a healthcare professional student from another discipline studying at WSU, were randomly created. The IPTV resource guides created by each team were reviewed and sorted into two categories based on the health or social need of the individual patient. The data identified three main areas of interest, which included medication management, diet and exercise plans, and the use of technology to stay connected to medical professionals, friends, and family. The purpose of this report is to assess the IPTV program's findings and analyze patients' concerns based on health or social needs and the resources presented to them.

Universal Mindfulness Training in Schools for Adolescents: a Scoping Review and Conceptual Model of Moderators, Mediators, and Implementation Factors.

There is evidence that universal school-based mindfulness training (SBMT) can have positive effects for young people. However, it is unknown who benefits most from such training, how training exerts effects, and how implementation impacts effects. This study aimed to provide an overview of the evidence on the mediators, moderators, and implementation factors of SBMT, and propose a conceptual model that can be used both to summarize the evidence and provide a framework for future research. A scoping review was performed, and six databases and grey literature were searched. Inclusion and exclusion criteria were applied to select relevant material. Quantitative and qualitative information was extracted from eligible articles and reported in accordance with PRISMA-ScR guidelines. The search produced 5479 articles, of which 31 were eligible and included in the review. Eleven studies assessed moderators of SBMT on pupil outcomes, with mixed findings for all variables tested. Five studies examined the mediating effect of specific variables on pupil outcomes, with evidence that increases in mindfulness skills and decreases in cognitive reactivity and self-criticism post-intervention are related to better pupil outcomes at follow-up. Twenty-five studies assessed implementation factors. We discuss key methodological shortcomings of included studies and integrate our findings with existing implementation frameworks to propose a conceptual model. Widespread interest in universal SBMT has led to increased research over recent years, exploring who SBMT works for and how it might work, but the current evidence is limited. We make recommendations for future research and provide a conceptual model to guide theory-led developments.

Patient suitability for free water protocols in acute stroke and general medicine: a qualitative study of clinician perceptions.

BACKGROUND: The free water protocol (FWP) is an alternate management strategy for patients with dysphagia, who would otherwise be nil by mouth or prescribed thickened fluids, allowing them to drink and potentially aspirate water under strict guidelines to minimize the risk of adverse consequences. The FWP is not widely implemented in acute settings, and it is unclear whether this is due to the complexity of patient presentations, clinician decision-making or barriers related to the setting. AIMS: To explore the perceptions and decision-making process of clinicians about using FWPs to manage dysphagia for patients admitted to acute stroke and general medicine. METHODS & PROCEDURES: A qualitative, critical realist approach was adopted to allow for in-depth exploration of the perspectives of four dietitians, seven medical officers, eight registered nurses and 17 speech and language pathologists (SLPs) from three hospitals in a capital city of Australia. Data from semi-structured interviews were analysed using the Situated Clinical Decision-Making Framework (CDF). OUTCOMES & RESULTS: Participants were cautious about FWP for patients with neurological conditions, head and neck cancer, dementia, poor immunity, chronic or recurrent respiratory illness, and certain types of stroke. Medical status and the implications for aspiration were paramount, particularly respiratory status, oxygen supplementation, cognitive status, fatigue and mobility. Participants considered patient quality of life, preferences and choices for care, but indicated that factors influencing safety often outweighed patient preference for water. Indirect factors affecting decision-making included the roles of the multidisciplinary team, individual clinical experience and attitude to risk, and availability of supervision. CONCLUSIONS & IMPLICATIONS: Despite the benefits of FWPs in other settings, in acute stroke and general medicine, clinicians erred on the side of safety and, in most cases, would not implement an FWP. Future clinical research is needed to systematically design high-quality and feasible clinical trials to determine the benefits and safety of FWPs for patients with dysphagia in these settings. This would lay the foundations for guidelines to support the complex clinical decision-making regarding patient suitability for FWPs. WHAT THIS PAPER ADDS: What is already known on the subject FWPs are an alternate management strategy for patients with dysphagia, with systematic reviews recommending their use for adults in inpatient rehabilitation with a low risk of pneumonia. However, evidence from the acute setting is sparse, leaving clinicians unsure about which patients might benefit and which may inadvertently be exposed to increased risk by an FWP. What this paper adds to existing knowledge Participants from all interviewed disciplines agreed that SLPs lead the decision-making process and as such act as 'gatekeepers' for access to an FWP. The decision-making process is complex, and participants acknowledged that disease conditions and illnesses were often used as exclusionary criteria. Although participants reported favourably on the benefits of FWPs, their decision-making privileged risk aversion over patient preference in most settings, except for palliative care. Lack of clinical guidelines and research evidence in acute care settings, as well as the focus on risk aversion, appear to perpetually reinforce the avoidance of FWP in these settings. Of note, more senior clinicians acknowledged being more deliberately guided by patient preference; hence, leadership by senior clinicians appears critical for change in practice in this space. What are the potential or actual clinical implications of this work? If evidence about the safety of FWP in the acute settings is to be collected, a systematic approach to addressing the present barriers is warranted. This may allow rigorous clinical trials to proceed and potentially lead to best-practice guidelines for dysphagia management options for wider populations of patients.

Experiential Avoidance in Primary Care Providers: Psychometric Properties of the Brazilian "Acceptance and Action Questionnaire" (AAQ-II) and Its Criterion Validity on Mood Disorder-Related Psychological Distress.

BACKGROUND: A sizeable proportion of Brazilian Primary Care (PC) providers suffer from common mental disorders, such as anxiety and depression. In an effort to cope with job-related distress, PC workers are likely to implement maladaptive strategies such as experiential avoidance (EA). The Acceptance and Action Questionnaire (AAQ-II) is a widely used instrument that evaluates EA but has shown questionable internal consistency in specific populations. This study assesses the psychometric properties of the AAQ-II among Brazilian PC providers, evaluates its convergence and divergence with self-criticism and mindfulness skills, and explores its criterion validity on anxiety and depressive symptoms. METHODS: A cross-sectional design was conducted in Brazilian PC services, and the sample included 407 PC workers. The measures evaluated EA, self-criticism, mindfulness, depression, and anxiety. RESULTS: The one-factor model of the AAQ-II replicated the original version structure. The AAQ-II presented good internal consistency among Brazilian PC providers. A multiple regression model demonstrated higher relationships with self-criticism than mindfulness skills. The criterion validity of the AAQ-II on anxiety and depression was stronger in the context of more severe symptoms. CONCLUSIONS: The AAQ-II is an appropriate questionnaire to measure the lack of psychological flexibility among Brazilian PC workers in the sense of EA.

The Most Important Skills Required by Local Public Health Departments for Responding to Community Needs and Improving Health Outcomes.

In 2017, Public Health 3.0 was introduced, providing recommendations that expand traditional public department functions and programs. Operationalizing the framework requires that local health departments invest in the requisite professional skills to respond to their community's needs. The purpose of this paper is to determine the professional skills that are most important for local health departments to respond to large public health issues and challenges that are having a major impact on their communities. The study used a cross-sectional assessment of the education and training needs of local public health departments in Nebraska following the principles of practice-based systems research. The assessment was designed to assess the training and education needs of local health department staff members. The questions measured the perceived importance of and respondent's capacity across 57 core competencies for public health professionals modified from the Council on Linkages Between Academia and Public Health Practice. A total of 104 staff members from seven local health departments were requested to complete the assessment and 100% of the individuals responded to and completed the assessment. Twenty-eight skills were identified as the most important skills needed for local health departments. The skills were themed and categorized into four domains. (1) Data, Evaluation, and Quality Improvement, (2) Community Engagement and Facilitation, (3) Systems Thinking and Leadership, and (4) Policy and Advocacy. The results from this analysis provide direction to strengthen and transform the public health system into one that is connected, responsive, and nimble. Additionally, it also highlighted a glaring omission that Equity, Diversity, and Inclusion should be included as the fifth domain.

Factors associated with giving birth at advanced maternal age in the United States.

OBJECTIVE: In 2018, 17 percent of all births in the United States occurred to women of advanced maternal age (AMA.) While the outcomes of AMA pregnancies have been examined extensively, the drivers behind increasing rates of AMA pregnancies in the United States are less understood. Some scholars have asserted that women are increasingly delaying their first birth in favor of educational and career aspirations. Yet birth trends in the United States do not support this as the primary explanatory factor of AMA births. Other factors may also contribute to high rates of AMA in the United States. This study sought to identify main predictors of AMA birth using a cross-sectional retrospective sample. DESIGN: We employed a multivariate logistic regression analysis on a cross-sectional retrospective sample to identify significant independent predictors of giving birth at advance maternal age (AMA) in the United States. SETTING: Data was obtained from the Unites States Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7 Core Questionnaire and linked birth certificates. Questions are designed to assess maternal attitudes and experiences before, during and just after pregnancy. Surveys for Phase 7 were completed in 2017 and 2018. The study population represents mothers from 34 states that met the CDC's 55% response rate threshold and Puerto Rico. PARTICIPANTS: The PRAMS dataset comprises self-reported data and linked birth certificate data from women who recently gave birth. A total of 38,549 mothers are included in the Phase 7 dataset. State sample sizes ranged from 503 mothers in Wyoming to 1,897 mothers in Michigan. All mothers gave birth in the year 2017. MEASUREMENTS AND FINDINGS: The outcome of interest was AMA birth, defined as conceiving and subsequently giving birth to a baby at age 35 or older. Predictors for AMA birth were selected a priori and included: pregnancy intention, history of previous live birth, insurance status, income, education, race/ethnicity, marital status, and urban location. Previous live birth to at least one child was a significant independent predictor for AMA birth. Mothers with high parity, defined as 6 or more previous live births, were 17 times more likely to give birth at advanced maternal age. Mothers with an unwanted pregnancy were 1.9 times more likely to have an AMA birth. College attainment, high income, marital status, urbanicity, and race/ethnicity were also independent predictors of AMA birth. Health insurance was not a significant predictor of AMA birth after accounting for other factors. KEY CONCLUSIONS: Delayed and late childbirth may not be intentional for a significant group of older mothers. Converse to popular assumptions that women delay childbearing in favor of career aspirations, the majority of AMA mothers have previous children. Half of AMA mothers have two or more previous children. The findings in this paper suggests that multiple factors predict AMA births. There may be several subtypes of women who enter pregnancy at advanced maternal age. IMPLICATIONS FOR PRACTICE: As women weigh personal desire to bear children against competing social expectations, they may find themselves navigating their own unique path shaped in part by the region in which they live. Better characterization of the circumstances that lead to advanced maternal age in the United States, including exploration of unintended and unwanted AMA pregnancy, is necessary to develop policies and interventions that meet women's needs. This work should utilize a reproductive justice framework to ensure that women's preferences, particularly women of color, are upheld while promoting health and wellbeing for women.

Health Professions Students' Assessment of an Interprofessional Rural Public Health-Focused Rotation: A Pilot Study Based on the Community-Oriented Primary Care Approach.

Using a community-oriented primary care (COPC) approach, the format for this interprofessional rural rotation was a public health focused team project based in a local health department and primary care setting. The target audience included fourth-year dental students, fourth-year undergraduate students in imaging science, second-year master of public health students, third-year medical students enrolled in the MD/MPH program, second-year nurse practitioner students, fourth-year pharmacy students, second-year MSN nursing students, and first-year PhD students. The specific learning objectives of the curriculum were drawn from emphasis areas of the Interprofessional Education Collaborative's competency domains and included the development of students' knowledge to function as a member of an interprofessional team to (1) engage diverse health care professionals, (2) communicate with team members to clarify each member's responsibility in executing components of a public health intervention, (3) choose effective communication tools and techniques, (4) integrate knowledge and experience of other professions, and (5) engage themselves and others to constructively manage disagreements. Additional learning objectives centered on 10 competencies from the Master's Degree in Public Health Core Competency Project. Assessment of 13 student participants, as a group, showed increased perceived knowledge in 4 out of 5 selected interprofessional emphasis areas and 9 out of 10 public health competencies. Our curriculum provides promising evidence for one interprofessional rural education model with proven short-term effectiveness among six health professions disciplines, in increasing student knowledge in interprofessional emphasis areas and public health competencies.

The impact of body mass index and sociodemographic factors on moderate-to-vigorous physical activity and sedentary behaviors of women with young children: A cross-sectional examination.

OBJECTIVES: Moderate-to-vigorous physical activity provides multiple benefits to women after childbirth. To achieve these benefits, the recommendation that adults obtain, 150 min of moderate-to-vigorous physical activity per week and reduce sedentary behaviors, also applies to women in the post-partum phase of the life span. However, research examining the moderate-to-vigorous physical activity and sedentary behaviors of women with young children (0-2 years) is limited. A greater understanding of these behaviors from a nationally representative sample is needed. Therefore, the primary objective of this study was to determine the levels of moderate-to-vigorous physical activity and sedentary behaviors of a nationally representative sample of women with young children within the United States. A secondary objective was to examine the influence of body mass index and sociodemographic factors on these behaviors. METHODS: Cross-sectional data from four cycles of the National Health and Nutrition Examination Survey (2007-2008, 2009-2010, 2011-2012, and 2013-2014) were used for analysis. Descriptive statistics were calculated and a generalized linear model was used to investigate associations between mean minutes of moderate-to-vigorous physical activity, sedentary activity, body mass index, and sociodemographic variables. DISCUSSION: Women with young children (n = 477) obtained 634 min in moderate-to-vigorous physical activity per week and this was positively associated with having a higher income (p < 0.001) and the number of children in the home (p < 0.001). In total, 62% of women were meeting the World Health Organization guidelines for aerobic activity. Lower odds of achieving guidelines was associated with being Black (p = 0.004), Mexican American (p = 0.009), or married (p = 0.042) compared with being White or not married. Finally, women accumulated ~5 h of sedentary activity per day, with higher levels associated with race (p = 0.005), education (p = 0.022), and number of children within the home (p < 0.001). Research efforts should continue to focus on strategies to help non-adhering women with young children achieve the physical activity recommendations and reduce time spent in sedentary behaviors.

Awareness and Attitudes of Nigerian Men Living in Abuja on Prostate Cancer and Screening.

Prostate cancer (PCa) is the most commonly diagnosed cancer among Nigerian men. The prevalence of PCa varies within Nigeria, with the highest prevalence of 1046 per 100,000 in men over the age of 40 reported in Lagos. Unfortunately, 40% of these men are diagnosed with locally advanced disease and 35% with metastatic disease. Given the ability to screen for PCa among high-risk individuals, late stage diagnosis of PCa could be potentially reduced through education of men so that they seek screening. Along these lines, it is important to assess a population's knowledge and awareness on PCa and screening. Our study addresses this issue by evaluating awareness and attitudes of Nigerian men in Abuja on PCa and screening. Our results revealed gaps in awareness and perception of susceptibility to PCa and low levels of PCa screening. Factors such as age, education level, and income affected PCa awareness. In conclusion, our study points to the need to educate younger men of lower education and socioeconomic status in Nigeria with the aim to increase screening and earlier detection of PCa.

Nurse and physician reflections on the application of a quality standards training program to reduce maternal mortality.

OBJECTIVE: High rates of maternal mortality persist in Low and Middle Income countries, despite increasing rates of facility-based births, suggesting a need to focus on quality of maternity care. The purpose of the current study was to evaluate provider perspectives on the implementation of material taught during an evidence-based medical education session aimed at reducing common causes of maternal death in government hospitals in India. DESIGN: Several months after the training, labor room nurses and physicians from twenty-two hospitals participated in semi-structured focus group discussions. SETTING: Training sessions were held in an off-site location in each of fourteen districts across Kerala, India. PARTICIPANTS: Nurses and physicians working in labor and delivery wards within government hospitals. INTERVENTION: Participants were trained on evidence-based practices to treat and prevent common causes of maternal death. Training was a combination of lecture and hands-on practice, conducted over a single working day in a classroom setting. MEASUREMENTS AND FINDINGS: Main items of discussion were challenges to implementing material taught in the training session and identification of successful strategies to adopt the recommended standards of care. Primary barriers to implementation of quality standards were provider unwillingness to apply new techniques, inadequate infrastructure, challenges with staffing capacity and lack of required materials and equipment. Facilitators to implementing standards of care included staff motivation, supportive leadership and co-training of nurses and doctors. KEY CONCLUSIONS: In international settings, clinical uptake of evidence-based material taught in a classroom format may differ by physician attitude and may be moderated by external factors such as infrastructure quality and equipment availability. In some circumstances, highly motivated staff may overcome external barriers through effort and persistence. IMPLICATIONS FOR PRACTICE: Continuing medical education aimed to improve utilization of evidence-based maternity care in low- and middle-income countries may have limited effect without complementary support from hospital administration and provision of adequate infrastructure, equipment and materials to support evidence-based practice.

Socioeconomic status and cigarette expenditure among US households: results from 2010 to 2015 Consumer Expenditure Survey.

OBJECTIVES: To examine (1) the association between household socioeconomic status (SES) and whether a household spends money on cigarettes and (2) socioeconomic variations in proportion of total household expenditure spent on cigarettes among smoking households. METHODS: We pooled data from six consecutive years, 2010-2015, of the Consumer Expenditure Interview Survey. The interviews involved a structured questionnaire about household income, demographics and expenditures including expenditure on cigarettes. Households that reported cigarette expenditure in the previous 3 months were distinguished as smoking households. SES indicators were household poverty status, education and occupation of the head of household. Logistic regression was used to assess the association of household smoking status with SES. Fractional logistic regression was used to assess the association of cigarette expenditure as a proportion of total household expenditure with SES. The analysis sample size was 39 218. RESULTS: The probability of spending money on cigarettes was higher among lower SES households. Households in poverty compared with those above 300% of poverty threshold had 1.86 (95% CI 1.61 to 2.16), households headed by a person with less than high school education compared with those headed by a person with at least a bachelor's degree had 3.37 (95% CI 2.92 to 3.89) and households headed by a blue-collar work compared with those headed by a person in a managerial occupation had 1.45 (95% CI 1.26 to 1.66) higher odds of spending money on cigarettes. Similarly, the proportion of total household expenditure spent on cigarettes was higher among lower SES smoking households. CONCLUSION: Lower SES households are more likely to spend money on cigarettes and spend a larger proportion of their total expenditure on cigarettes. We recommend strategies effective in reducing smoking among low SES smokers.

Impact of the Community-Wide Adolescent Health Project on Sexually Transmitted Infection Testing in Omaha, Nebraska.

We describe the impact of the Adolescent Health Project on sexually transmitted infection (STI) testing in Omaha, NE, during phase 1 (media campaigns) and phase 2 (free STI testing). To assess the impact of each phase on STI testing, we examined monthly data from January 2013 to April 2017 via interrupted time series analyses. There was an immediate and statistically significant increase in testing during phase 2. Expanding and advertising free STI testing is a promising approach to increasing testing.

The effect of an affordable daycare program on health and economic well-being in Rajasthan, India: protocol for a cluster-randomized impact evaluation study.

BACKGROUND: The provision of affordable and reliable daycare services is a potentially important policy lever for empowering Indian women. Access to daycare might reduce barriers to labor force entry and generate economic opportunities for women, improve education for girls caring for younger siblings, and promote nutrition and learning among children. However, empirical evidence concerning the effects of daycare programs in low-and-middle-income countries is scarce. This cluster-randomized trial will estimate the effect of a community-based daycare program on health and economic well-being over the life-course among women and children living in rural Rajasthan, India. METHODS: This three-year study takes place in rural communities from five blocks in the Udaipur District of rural Rajasthan. The intervention is the introduction of a full-time, affordable, community-based daycare program. At baseline, 3177 mothers with age eligible children living in 160 village hamlets were surveyed. After the baseline, these hamlets were randomized to the intervention or control groups and respondents will be interviewed on two more occasions. Primary social and economic outcomes include women's economic status and economic opportunity, women's empowerment, and children's educational attainment. Primary health outcomes include women's mental health, as well as children's nutritional status. DISCUSSION: This interdisciplinary research initiative will provide rigorous evidence concerning the effects of daycare in lower-income settings. In doing so it will address an important research gap and has the potential to inform policies for improving the daycare system in India in ways that promote health and economic well-being. TRIAL REGISTRATION: (1) The ISRCTN clinical trial registry (ISRCTN45369145), http://www.isrctn.com/ISRCTN45369145 , registered on May 16, 2016 and (2) The American Economic Association's registry for randomized controlled trials (AEARCTR-0000774), http://www.socialscienceregistry.org/trials/774 , registered on July 15, 2015.

Priorities for Investments in Children and Families in Caddo and Bossier Parishes: Application of a Unique Framework for Identifying Priorities.

In Louisiana, the Community Foundation of Shreveport-Bossier pools funds from sources in Caddo and Bossier Parishes, manages the funds, and allocates the funding within the two-parish region. (The City of Shreveport is in Caddo Parish; the city of Bossier City is in Bossier Parish.) In 2008, the foundation selected education, health, and poverty as priority areas for its investments in children and families, and it asked the RAND Corporation to assist the community in identifying priority strategies within these three focus areas. RAND researchers developed a unique framework based on the intersection of needs, assets, and best practices. Applying this framework to the Shreveport-Bossier community, they identified health care providers, public school teachers, and Barksdale Air Force Base as strong assets that can help the community address three high-need areas: infant health, child maltreatment, and educational attainment. The "Needs-Assets-Best Practices" framework developed to assist the Shreveport-Bossier community can be applied in many other settings; this article can be viewed as a case study of the application of the framework.