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Background: In many Westernised countries, children do not consume a sufficient amount of vegetables for optimal health and development. Child-feeding guidelines have been produced to address this, but often only promote offering vegetables at midday/evening meals and snack times. With guidance having limited success in increasing children's vegetable intake at a population level, novel approaches to address this must be developed. Offering vegetables to children at breakfast time in nursery/kindergarten settings has the potential to increase children's overall daily vegetable consumption as children typically attend nursery/kindergarten and many routinely eat breakfast there. However, the feasibility and acceptability of this intervention (Veggie Brek) to children and nursery staff has not been investigated. Methods: A feasibility and acceptability cluster randomised controlled trial (RCT) was undertaken in eight UK nurseries. All nurseries engaged in one-week baseline and follow-up phases before and after an intervention/control period. Staff in intervention nurseries offered three raw carrot batons and three cucumber sticks alongside children's main breakfast food each day for three weeks. Control nurseries offered children their usual breakfast. Feasibility was assessed by recruitment data and nursery staff's ability to follow the trial protocol. Acceptability was assessed by children's willingness to eat the vegetables at breakfast time. All primary outcomes were assessed against traffic-light progression criteria. Staff preference for collecting data via photographs versus using paper was also assessed. Further views about the intervention were obtained through semi-structured interviews with nursery staff. Results: The recruitment of parents/caregivers willing to provide consent for eligible children was acceptable at 67.8% (within the amber stop–go criterion) with 351 children taking part across eight nurseries. Both the feasibility and acceptability of the intervention to nursery staff and the willingness of children to consume the vegetables met the green stop–go criteria, with children eating some part of the vegetables in 62.4% (745/1194) of instances where vegetables were offered. Additionally, staff preferred reporting data using paper compared to taking photographs. Conclusions: Offering vegetables to children at breakfast time in nursery/kindergarten settings is feasible and acceptable to children and nursery staff. A full intervention evaluation should be explored via a definitive RCT. Trial registration: NCT05217550. [ABSTRACT FROM AUTHOR]

Background: Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women's groups suggests that group care models may both improve access to care and the quality of care delivered through women's empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. Methods: The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. Results: A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1–91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics. Conclusion: Group antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system. Trial registration: ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered. [ABSTRACT FROM AUTHOR]

Background: Family caregivers (FCs) encounter a variety of health problems in older people with chronic illness, necessitating a certain level of health literacy to access, understand, appraise and apply health information and services. This study aimed to develop and validate a scale for measuring health literacy among FCs of older people with chronic illness. Methods: Concept mapping was first employed to develop a conceptual model of health literacy of FCs. Scale domains were derived from the conceptual model, and item generation was performed using deductive and inductive methods. Quantitative methods, including merging scale dimensions and items, expert reviews, cognitive interviews, and item reduction analysis, were used to refine the scale. Confirmatory factor analysis was employed to validate the scale's structure. Concurrent validity, internal consistency, and test-retest reliability were also examined. Results: A 20-dimension conceptual model was developed, and 60 items were generated for the scale. Expert review (content validity index > 0.85) and cognitive interview with FCs confirmed the relevance and clarity of the majority of the generated scale items. Confirmatory factor analysis with 451 FCs of older people with chronic illness supported a 5-factor structure (symptom management, daily personal care and household tasks, care coordination, communication and relationship with the care recipient, and self-care of caregivers) with 42 finalized scale items, including four levels of health literacy skills (accessing, understanding, appraising and applying health information). Concurrent validity with the European Health Literacy Questionnaire (HLS-EU-Q47) was satisfactory (r = 0.67, p < 0.01). The Cronbach's α coefficient of the scale was 0.96, with subscales ranging from 0.84 to 0.91. The two-week test-retest reliability was 0.77 (p < 0.01). Conclusion: This study developed a conceptual model explaining the concept and factors of health literacy among FCs of older people with chronic illness that could provide the groundwork for future studies in developing relevant evidence-based interventions. A new Health Literacy Scale-Family Caregiver (HLS-FC) with satisfactory psychometric properties was developed in this study, which can be utilized to identify caregivers with insufficient health literacy and facilitate timely interventions by healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: Self-management education programmes are cost-effective in helping people with type 2 diabetes manage their diabetes, but referral and attendance rates are low. This study reports on the effectiveness of the Embedding Package, a programme designed to increase type 2 diabetes self-management programme attendance in primary care. Methods: Using a cluster randomised design, 66 practices were randomised to: (1) a wait-list group that provided usual care for nine months before receiving the Embedding Package for nine months, or (2) an immediate group that received the Embedding Package for 18 months. 'Embedders' supported practices and self-management programme providers to embed programme referral into routine practice, and an online 'toolkit' contained embedding support resources. Patient-level HbA1c (primary outcome), programme referral and attendance data, and clinical data from 92,977 patients with type 2 diabetes were collected at baseline (months − 3–0), step one (months 1–9), step 2 (months 10–18), and 12 months post-intervention. An integrated ethnographic study including observations, interviews, and document analysis was conducted using interpretive thematic analysis and Normalisation Process Theory. Results: No significant difference was found in HbA1c between intervention and control conditions (adjusted mean difference [95% confidence interval]: -0.10 [-0.38, 0.18] mmol/mol; -0.01 [-0.03, 0.02] %). Statistically but not clinically significantly lower levels of HbA1c were found in people of ethnic minority groups compared with non-ethnic minority groups during the intervention condition (-0.64 [-1.08, -0.20] mmol/mol; -0.06% [-0.10, -0.02], p = 0.004), but not greater self-management programme attendance. Twelve months post-intervention data showed statistically but not clinically significantly lower HbA1c (-0.56 [95% confidence interval: -0.71, -0.42] mmol/mol; -0.05 [-0.06, -0.04] %; p < 0.001), and higher self-management programme attendance (adjusted odds ratio: 1.13; 95% confidence interval: 1.02, 1.25; p = 0.017) during intervention conditions. Themes identified through the ethnographic study included challenges for Embedders in making and sustaining contact with practices and providers, and around practices' interactions with the toolkit. Conclusions: Barriers to implementing the Embedding Package may have compromised its effectiveness. Statistically but not clinically significantly improved HbA1c among ethnic minority groups and in longer-term follow-up suggest that future research exploring methods of embedding diabetes self-management programmes into routine care is warranted. Trial registration: ISRCTN23474120, registered 05/04/2018. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to assess attitudes toward premarital dating and sexual encounters in individuals aged 15-49 years in Tehran. Methods: Utilizing the attitudes section of an original cross-sectional study (n = 755) aimed at assessing sexual health needs of adults, this paper examined personal attitudes towards premarital dating, non-sexual relationships and sexual encounters in both male and female adults aged between 15-49 years. Multi-stage cluster random sampling and a validated/reliable questionnaire were used. Descriptive, bivariate and multivariate analyses were conducted using statistical software. Results: The results indicated that the majority of the participants were supportive of dating. Almost three-fourths of the males were more positively inclined towards non-sexual, yet tactile, affectionate interactions between unmarried males and females as opposed to only half of the females (70 % vs. 50.5 %). Also, males held significantly more liberal attitudes than females in their acceptance of premarital sex. On preserving virginity prior to marriage, 43 % of the males felt that it was important for a female to be a virgin, whereas only 26 % felt it was important for males to remain a virgin. Interestingly, more females (61 %) supported the importance of a female's virginity compared with the importance of males' virginity (48 %). This study showed that, being a male, of a younger age, single, and being less religious or being secular were important determinants of a liberal sexual attitude. Conclusion: These results might reflect a socio-cultural transition in the sexual attitudes of different age groups of participants - a phenomenon that will need empirical studies to unpack in the Iranian socio-cultural context. [ABSTRACT FROM AUTHOR]

Background. The implementation of a complex intervention is heavily influenced by individual context. Variation in implementation and tailoring of the intervention to the particular context will occur, even in a trial setting. It is recognised that in trials, evaluating the process of implementation of a complex intervention is important, yet process evaluation methods are rarely reported. The WAVES study is a cluster randomised controlled trial to evaluate the effectiveness of an obesity prevention intervention programme targeting children aged 6–7 years, delivered by teachers in primary schools across the West Midlands, UK. The intervention promoted activities encouraging physical activity and healthy eating. This paper presents the methods used to assess implementation of the intervention. Methods. Previous literature was used to identify the dimensions of intervention process and implementation to be assessed, including adherence, exposure, quality of delivery, participant responsiveness, context, and programme differentiation. Results. Multiple methods and tools were developed to capture information on all these dimensions. These included observations, logbooks, qualitative evaluation, questionnaires and research team reflection. Discussion. Data collection posed several challenges, predominantly when relying on teachers to complete paperwork, which they saw as burdensome on top of their teaching responsibilities. However, the use of multiple methods helped to ensure data on each dimension, where possible, was collected using more than one method. This also allowed for triangulation of the findings when several data sources on any one dimension were available. Conclusions. We have reported a comprehensive approach to the assessment of the implementation and processes of a complex childhood obesity prevention intervention within a cluster randomised controlled trial. These approaches can be transferred and adapted for use in other complex intervention trials. [ABSTRACT FROM AUTHOR]

Background: Children aged 6–9 years are vulnerable to dental caries due to age-related limitations and a lack of adequate knowledge regarding oral health and hygiene practices. This study aimed to establish a cohort of children aged between 6 and 9 years and conducted a 12-month follow-up to examine the combined effect of pit and fissure sealant (PFS) application and oral health education on their oral health status. Methods: A cohort study with 12-month follow-up was conducted in Liaoning province, China. A multi-stage stratified cluster sampling approach was employed in the study. The enrolled 6- to 9-year-old children were all from the selected primary schools, who had resided in the designated area for at least 6 months. Children who were unable to cooperate with the examiner or without informed consent from their guardians were excluded. Experienced dental professionals examined the oral health status of primary school children aged 6–9 years. All children and their guardians were mandated to complete a questionnaire (qualitative data) at the beginning of the study. In the experiment group, children underwent PFS application and chairside oral health education. Clinical examinations and questionnaire surveys were repeated at the 12-month follow-up. The chi-square test and binary logistic regression were conducted to investigate the potential risk factors associated with dental caries prevalence (dependent variable). Independent variables were items from the questionnaire (such as living place, parents' education level and children' birth weight). The significant variables identified in the chi-square tests were subsequently included in the binary logistic regression analysis. Results: A total of 4,085 children aged 6–9 years were included in the study, with 1805 participants assigned to the experiment group and 2280 to the control group. At baseline, the caries rates of the experimental and control group were 77.95% and 80.35%, respectively without any statistically significant differences. However, at the 12-month follow-up, the caries rate in the experimental group (83.65%) was significantly lower than that in the control group (86.62%) (P < 0.05). The results from the binary logistic regression analysis indicated that parents with a college degree and children in the experimental group exhibited lower caries rates. Conversely, higher caries rates were associated with the consumption of sweet beverages and foods more than once a day and a lack of knowledge regarding the causes of caries (P < 0.05). Conclusions: In Liaoning, China, children aged 6 to 9 years exhibited a high prevalence of dental caries. Several factors, including the parent's education level, the frequency of consuming sweet beverages and foods, and the children's understanding of the cause of caries, significantly affected the caries prevalence rates. The implementation of PFS application and oral health education effectively reduce the caries rate among the surveyed children. [ABSTRACT FROM AUTHOR]

Background: Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the population into subgroups (segments) with similar sociodemographic characteristics, is a useful approach for allocating support resources to the targeted segments. Clustering is a commonly used statistical method of segmentation in a data-driven marketing approach. This explanatory sequential mixed methods study applied a clustering technique, aiming to identify segments among older public assistance recipients quantitatively, and assess the meaningfulness of the identified segments in consultation and support activities for older recipients qualitatively. Methods: We identified the segments of older recipients in two municipalities using probabilistic latent semantic analysis, a machine learning-based soft clustering method. Semi-structured interviews were subsequently conducted with caseworkers to ask whether the identified segments could be meaningful for them in practice and to provide a reason if they could not think of any older recipients from the segment. Results: A total of 3,165 older people on public assistance were included in the analysis. Five distinct segments of older recipients were identified for each sex from 1,483 men and 1,682 women. The qualitative findings suggested most of identified segments reflected older recipients in practice, especially two of them: female Cluster 1 (facility residents aged over 85 years with disability/psychiatric disorder), and female Cluster 2 (workers). Some caseworkers, however, did not recall older recipients in practice when working with certain segments. Conclusions: A clustering technique can be useful to identify the meaningful segments among older recipients and can potentially discover previously unrecognized segments that may not emerge through regular consultation practices followed by caseworkers. Future research should investigate whether tailored support interventions for these identified segments are effective. [ABSTRACT FROM AUTHOR]

Background : Chronic renal disease is considered a main public health problem due to its high prevalence in the population. The solution of choice currently available is kidney transplantation but when this option is not available, blood purification treatments, notably haemodialysis (HD), are necessary. The presence of chronic renal disease combined with this demanding medical procedure leads to a hard symptomatology. To face this situation, HD patients often resort to complementary and alternative medicines (CAM) as they perceive that the healthcare professionals aren't paying enough attention to their quality of life. Given this background, we aim to describe the prevalence and the type of the CAM used among HD patients and their possible relations with patients' symptomatology and quality of life. Methods: We interviewed 88 patients, undergoing hemodialysis in three hemodialysis centers in French-speaking Switzerland, about the presence of symptoms, their quality of life, and the possible use of CAM. Cluster analysis was used to create patients' profiles about CAM use and regression analysis to explore the links between symptoms' presence, patients' quality of life, and CAM use. Results: Our results show a large use of CAM: almost two HD patients out of three uses at least one CAM. Using cluster analysis, we were able to identify five patients' profiles: non-users (37.5% of our sample), users of herbal medicine (20.5%), users of prayer-based practices (18.2%), people mainly using massages (9.1%), and a residual group including the users of other CAMs, with a predominance of meditation (14.8%). As expected, we observe a negative relation between the number of declared symptoms and patients' quality of life. Contrarily, we observe no relation between the use of CAM and the presence of symptoms. Our results show a positive relationship between the use of CAM and patients' overall perception of health as well as the psychological dimension of their quality of life. No relationship is observed with other dimensions of quality of life, notably the physical dimension. Conclusions: Our results suggests that CAMs aren't used as a substitute of official medicine but as a parallel support to HD patients' quality of life. [ABSTRACT FROM AUTHOR]

Background: Ethiopia, sub-Saharan Africa's second most populous country has seen improvements in women's reproductive health. The study objectives are (1) using mixed methods research, to identify determinants of contraceptive use in four regions of Ethiopia, and (2) to explore the relationship between social norms, gender equitable norms, couple communication and contraceptive use. Methods: The study includes both quantitative and qualitative methods. Researchers interviewed a total of 2770 women of reproductive age (15–49 years) in 2016 using a structured survey covering six health areas. Eligible households were identified using a multi-stage cluster-sampling technique. Using probability proportionate to size sampling, the researchers selected 10% of the proposed target woredas (24 of 240 woredas). The qualitative study included 8 rapid assessments, 16 in-depth interviews, 24 key informant interviews, and 16 focus group discussions. Qualitative data were analyzed using NVivo version 8. Results: Adjusted odds ratios were estimated for current modern family planning use among married women with logistic regression. The primary influencing factors for contraceptive use are gender equitable norms, high self-efficacy, and weekly exposure to the radio. Qualitative data indicate that the timing of contraceptive use is linked to the social norm of the desired family size of 4–5 children. Gender inequity is evident in couple communication with men controlling decision making even if women initiated conversations on family planning. A key finding based on an inductive analysis of qualitative data indicates that the micro-processes of couple communication and decision making are often dictated by male advantage. The study identified six micro-processes that lead to gender inequity which need to be further examined and researched. Conclusions: Barriers to contraceptive use include unequal couple communication and compromised decision making. Inequitable gender norms are also barriers to modern contraceptive use. The study recommends using a gender lens to study couple communication and decision making, with the goal of making both processes more equitable to accelerate the adoption of modern family planning methods in Ethiopia. Plain Language summary: A reproductive health study involving mixed quantitative and qualitative methods was conducted in Ethiopia in 2016–2017. The overall objectives of the study are (1) to use mixed methods research to identify determinants of contraceptive use in four regions of Ethiopia, and (2) to explore the relationship between social norms, gender equitable norms, couple communication, and contraceptive use. The survey identified gender inequitable norms as a major barrier to contraceptive use. The qualitative study further examined the gender dimension and the interlinkages between gender norms, couple communication, and decision making for contraceptive use. Data showed that gender norms related to the daily living dimension of the gender equitable men (GEM) scale are significantly associated with current contraceptive use. The qualitative component provides us with in-depth data on the daily experiences of rural Ethiopian women in the context of modern contraceptive use. We learned that social norms related to the desired number of children and the timing of first contraceptive use are interlinked. Specifically, both women and men told us that most couples do not use contraceptives until their family size is complete, after 4–5 children. Similarly, couples who opt for 2 or fewer children are termed "selfish" and "not interested in children." Couple communication occurs within the context of decision making where men's decisions are usually accepted, and women's decisions are often deferred or rejected. Programs should promote respect for women's decision-making abilities and equitable couple communication. Notably, this study finds that microprocesses of couple communication and decision making are gendered, featuring female disadvantage. Further research is required on these microprocesses of gendered couple communication. [ABSTRACT FROM AUTHOR]

Background: Mushrooms are important forest resources, mostly as food, despite the serious health threat posed by toxic species. In the Highlands of Chiapas, numerous wild mushroom intoxications have been registered. While Chiapas has been vastly studied from an ethnomycological perspective, no certainty exists as to how nomenclature systems differentiate edible and toxic species, which species are most culturally significant, and whether sociodemographic factors relate to how well-known they are in the Highlands of Chiapas. This paper evaluates which are the most culturally significant edible and toxic wild mushroom species in seven Tsotsil communities from this region and whether differences exist in their knowledge relating to different sociodemographic subsets (gender, schooling, and occupation). The hypothesis that there is a difference in the number of species that people mention, as well as the number of times each ethno-taxon is mentioned, between people from different social groups was tested. Methods: With consent, 133 Tsotsil people from seven communities were interviewed. Interviews focused on local systematics and free listings of edible and toxic mushrooms. Qualitative and quantitative analyses were performed, including multivariate methods and non-parametric statistics. Results: Twenty-five edible and 15 toxic taxa were mentioned. Some directly correspond to Linneanean species, while others are subdifferentiated or supradifferentiated. Only 62% of the interviewees named toxic mushrooms. The most frequently mentioned edible taxa were Amanita hayalyuy and A. jacksoniii, Agaricus spp., and Armillaria mellea. The most frequently mentioned toxic species were Amanita muscaria, Suillellus luridus, and Russula emetica. Significant differences in the number of mentioned edible ethnotaxa were found only among different occupations and schooling. The models including schooling interacting with either gender or occupation are better supported. Significant differences in the number of times toxic ethnotaxa are mentioned were found only between men and women. Conclusions: The Tsotsil region of the Highlands of Chiapas is where the most average mushroom species are recognized state-wide. Schooling and occupation seem most determinant for people to know more or less species of mushrooms, while gender appears irrelevant. People with no studies and field-related occupations name more species. Identification criteria to distinguish edible from toxic species seem to rest not on detailed recognition of the second set but precise knowledge of the first. [ABSTRACT FROM AUTHOR]

Background: Ethnic groups throughout the world have developed their own cultures expressed in the form of customs, taboos, and traditional healthcare systems. Traditional medicine system is one of the widespread cultures known throughout the world which is very much tied to cultural practices of the community or ethnic group. Medicinal plant treasure found in Gurage and Silti zones remained poorly characterized and understood. Therefore, this study was conducted in four ethnic groups: three from Gurage zone (Gurage, Qebena, and Mareqo) and one from Silti zone (Silti) which have lived in close proximity and contact for many centuries in the respective zones. In the present study, unique and shared cultural elements in connection to traditional herbal medicine were examined through investigation of the diversity of medicinal plants. Moreover, attempts have been made to determine similarities among the society in the medicinal plants they have used in general and in medicinal plant species considered culturally most important. Methods: In a study that involved 320 randomly sampled informants, semi-structured interviews, focus group discussions, and participant observation were used and qualitative and quantitative data were collected. Descriptive statistics, rank order priority (ROP), informant consensus factor, Jaccard similarity coefficient, and clustering were used for data analysis. Results: A total of 244 medicinal plant species and a fungal species used to treat human and/or livestock ailments were documented. The number of plants (80 plants, 33 %) with ROP value greater than 50% were considerably fewer than that of plants with ROP < 50% (164, 67 %). Jaccard similarity index and clustering analysis for all cited plants, among the respective studied districts, indicated that grouping generally followed the existing ethnic origin. On the contrary, clustering based on culturally important medicinal plant species (80 plant species, score ROP ≥ 50%) showed the influence of proximity and geographical orientation rather than ethnic relation. Conclusions: Culturally, most important plants (80 spp.) are widely used and best shared with nearby communities and this could imply current (new) knowledge being practiced in the communities. This knowledge must be documented and better utilized in a modern way including modernized use of traditional medicinal plants. [ABSTRACT FROM AUTHOR]

Background: Childhood rubella infection is a mild, self-limiting illness. Rubella infection among pregnant women however, is a major public health concern. Depending on gestation age, it may result in fetal death, stillbirth or a new-born with congenital rubella syndrome (CRS). Maternal antibodies protect young infants from rubella infection and lifelong immunity is acquired by vaccination or post-rubella infection. This study aims at characterizing rubella infection and its epidemiology in the Kilimanjaro region, prior to the introduction of the rubella vaccine in Tanzania. Methods: This was a population based cross-sectional study, covering all the seven districts in Kilimanjaro region, North-eastern Tanzania. The study population included children of 0 to 36 months of age and their mothers/primary caretakers. A multistage sampling method was used to obtain a representative sample of the children. Interviews were conducted using a structured questionnaire. Dried blood spot (DBS) samples were taken from eligible children. Rubella specific IgG antibodies were detected from eluted serum by enzyme-linked immunosorbent assay (ELISA). Descriptive statistics were used to summarize the data, the difference between groups was tested by Fishers exact test or chi square test as appropriate. Univariate and multivariate analysis was used, with rubella sero-positive groups as dependent variables and the socio-demographic, children, paediatric and parental factors as independent variables, the Odds ratio and their 95% confidence intervals were calculated to assess the strength of association between the dependent and independent variables. A p value less than 0.05 was considered significant. Results: The overall rubella sero-prevalence was 1.8%. Rural residence was associated with greater risk for rubella infection. Other family characteristic did not predict rubella infection. Conclusions: This study highlights the low natural immunity to rubella among children prior to the introduction of rubella vaccine in Tanzania. Our research underscores the need for an effective rubella vaccination program to prevent CRS. More epidemiologic and immunologic studies are needed to guide the vaccination deployment and administration strategy in Tanzania. [ABSTRACT FROM AUTHOR]

Background: In response to increasing policy action and public concern about the negative health effects of sugar-sweetened beverages (SSBs), there is increased promotion of artificially sweetened beverages (ASBs). These have been linked with obesity and diabetes in recent experimental work. This study examined associations between SSB and ASB consumption and changes in adiposity in a nationally representative sample of UK children. Methods: We conducted a longitudinal study of 13,170 children aged 7-11 years in the UK Millennium Cohort Study, collected in 2008 and 2012. Logistic regression was used to assess socio-demographic and behavioural correlates of weekly SSB and ASB consumption at 11 years. Linear regression examined associations between SSB/ASB consumption and changes in adiposity measures between 7 and 11 years. Results: Boys were more likely to consume SSBs weekly (62.3 % v 59.1 %) than girls at age 11 years. South Asian children were more likely to consume SSBs weekly (78.8 % v 58.4 %) but less likely to consume ASBsweekly (51.7 % v 66.3 %) than White children. Daily SSB consumption was associated with increases in percentage body fat between ages 7 and 11 (+0.57 %, 95 % confidence intervals 0.30;0.83). Daily ASB consumption was associated with increased percentage body fat at age 11 (+1.18 kg/m², 0.81;1.54) and greater increases between ages 7 and 11 (+0.35 kg/m², 0.09;0.61). Conclusion: Consumption of SSBs and ASBs was associated with BMI and percentage body fat increases in UK children. Obesity prevention strategies which encourage the substitution of SSBs with ASBs may not yield the adiposity benefits originally intended and this area should be a focus for further research. [ABSTRACT FROM AUTHOR]

Background: Linkages between HIV and reproductive health (RH) among female entertainment workers (EWs) have not been addressed well in most developing countries. In Cambodia, there has been considerable research on HIV epidemiology among EWs. However, there have been limited studies on RH and specifically factors related to abortion. We examine socio-behavioral characteristics, and RH practices as determinants of abortion among Cambodian EWs. Methods: A survey was conducted in Siem Reap and Battambang and Phnom Penh provinces/city among EWs in September 2012. Trained female interviewers administered the survey to 595 EWs. Two-stage cluster sampling was used to select EWs. Bivariate associations were examined using chi-squares; univariate and multivariate logistic regression were used to assess factors independently associated with reporting having at least one abortion while working as an EW. Results: Three-quarters (75 %) of EWs were sexually active, of which nearly one third reported at least one abortion while working as an EW. About 40 % of EWs reported recent an abortion in the past six months. Contraceptive use in the past year was low. Factors found to be independently associated with reporting a recent abortion included: ages 25-29 (OR = 2.2, 95 % CI: 1.2-4.0), living with spouse/cohabitated partner (OR = 2.2, 95 % CI: 1.1 -4.2), longer duration of entertainment work (OR = 4.8, 95 % CI: 2.5-9.2), higher number of partners (OR = 4.4, 95 % CI: 2.2-8.7) and being a karaoke worker (OR = 2.2, 95 % CI: 1.1 -4.4). Conclusion: This study highlights a high proportion of EWs reporting abortion. While HIV vulnerability of EWs has been clearly established, broader RH needs have gone largely unrecognized and not prioritized. Though HIV/RH integrated initiatives have been introduced by the HIV program, challenges for EWs with multiple risks from professional and partners are profound. Therefore, there is an urgent need for practical programmatic approaches to help address their RH needs. [ABSTRACT FROM AUTHOR]

Background: Unacceptably high maternal mortality rates remain a challenge in developing countries such as Tanzania. Birth Preparedness and Complication Readiness is among the key interventions that can reduce maternal mortality. Despite this, its status in Tanzania is not well documented. We assessed the practice and determinants of Birth preparedness and complication readiness among recently delivered women in Chamwino district, Central Tanzania. Methods: A community based cross-sectional study was conducted to women who delivered two years prior to survey in January 2014 at Chamwino district, Tanzania. Woman was considered as prepared for birth and its complication if she reported at least three of these; know expected date of delivery, saved money, identified a skilled birth attendant/health facility, mode of transport and Identified two compatible blood donors. Descriptive, bivariate and multivariable logistic regression analyses were performed at P value < 0.05 level of significance. Results: We interviewed 428 women whose median age (IQR) was 26.5 (22-33) years. About 249 (58.2 %) of the respondents were considered as prepared for birth and its complications. After controlling for confounding and clustering effect, significant determinants of birth preparedness and complication readiness were found to be maternal education (AOR = 2.26, 95 % CI; 1.39, 3.67), spouse employment (AOR = 2.18, 95 % CI; 1.46, 3.25), booking at ANC (AOR = 2.03, 95 % CI; 1.11, 3.72), Four or more antenatal visits, (AOR = 1.94, 95 % CI; 1.17, 3.21) and knowledge of key danger signs (AOR = 4.16, 95 % CI; 2.32, 7.45). Prepared for birth was found to be associated with institutional delivery (AOR = 2.45, 95 % CI; 1.12, 5.34). Conclusion: The proportion of women who prepared for birth and its complications were found to be low. District reproductive and child health coordinator should emphasis on early and frequent antenatal care visits, since they were among predictors of birth preparedness and complication readiness. [ABSTRACT FROM AUTHOR]

Background: Diagnostic coding has several potential benefits, including improving the feasibility of data collection for research and clinical audits and providing a common language to improve interdisciplinary collaboration. The primary aim of this study was to determine the views and perspectives of chiropractors about diagnostic coding and explore the use of it in a chiropractic setting. A secondary aim was to compare the diagnostic coding undertaken by chiropractors and an independent coder. Method: A codin exercise based on the International Classification of Primary Care version 2, PLUS extension (ICPC- 2 PLUS) provided the 14 chiropractors with some experience in diagnostic coding, followed by an interview on the topic. The interviews were analysed thematically. The participating chiropractors and an independent coder applied ICPC-2 PLUS terms to the diagnoses of 10 patients. Then the level of agreement between the chiropractors and the coder was determined and Cohen's Kappa was used to determine the agreement beyond that expected by chance. Results: From the interviews the three emerging themes were: 1) Advantages and disadvantages of using a clinical coding system in chiropractic practice, 2) ICPC-2 PLUS terminology issues for chiropractic practice and 3) Implementation of a coding system into chiropractic practice. The participating chiropractors did not uniformly support or condemn the idea of using diagnostic coding. However there was a strong agreement that the terminology in ICPC-2 PLUS would not be applicable or desirable for all practice types. In the coding exercise the chiropractors in total coded 202 diagnoses for 135 patients. The overall percentage agreement between the chiropractors and the coder was 52% (17% expected by chance) with a Kappa score of 0.4 (95% CI 0.3-0.7). Agreement was lower for more detailed coding (percentage agreement 35%; Kappa score of 0.3 (95% CI 0.2-0.5)). Conclusion: It appears that implementation of diagnostic coding would be possible in the majority of the chiropractic practices that participated in this study. However for those chiropractors who do not focus on symptoms in their approach to clinical care, it could be challenging to use the ICPC-2 PLUS coding system, since ICPC-2 PLUS is a symptom-based classification. [ABSTRACT FROM AUTHOR]

Background There is scarce information available on oral health service utilization patterns and common oral hygiene practices among adult Nigerians. We conducted the 2010-2011 national oral health survey before the introduction of the national oral health policy to determine the prevalence of oral health service utilization, patterns of oral hygiene practices, and self reported oral health status, among adults in various social classes, educational strata, ethnic groups and geopolitical zones in Nigeria. Methods We conducted a cross-sectional survey in North-Central, North-West, South-East, South- South and South-West geopolitical zones of Nigeria. Multi-stage cluster sampling method was used for the sample selection. We administered a structured questionnaire to a total of 7,630 participants. Information on the socio-demographic characteristics, oral hygiene practices and oral health services utilization pattern of participants was obtained. Results We interviewed 7, 630 participants (55.6% female). The participants ages ranged between 18 and 81 years, mean age was 37.96 (SD = 13.2). Overall 21.2% of the participants rated their oral health status as very good, 37.1% as good and 27.4% as fair. Only 26.4% reported having visited the dentist at least once prior to the conduct of the survey. More than half of these visits (54.9%) were for treatment purpose. Utilization of oral health services was significantly (p < 0.05) associated with being older, more educated and being engaged in a skilled profession. More educated persons, females and younger persons used toothbrushes for daily tooth cleaning. Age, sex, marital status, level of education and occupation were significantly related to daily frequency of tooth cleaning (p < 0.05). Conclusion Our results show that while most Nigerian adults have a positive view of their oral health status, majority reported poor oral health utilization habits. Older persons resident in the northern zones of the country and less educated persons displayed poorer oral hygiene practices. The study findings suggest that there is low oral health service utilization among adult Nigerians and that socio-demographic variables influence oral health utilization habits and oral hygiene behavior among adult Nigerians Further studies to identify other factors influencing oral health behavior are suggested. [ABSTRACT FROM AUTHOR]

Background. Extracurricular programmes could provide a mechanism to increase the physical activity (PA) of primary-school-aged children. The aim of this feasibility study was to examine whether the Action 3:30 intervention, which is delivered by teaching assistants, holds promise as a means of increasing the PA of Year 5 and 6 children. Methods. A cluster randomised feasibility trial was conducted in 20 primary schools. Ten schools received the Action 3:30 intervention and 10 schools were allocated to the control arm. The intervention was 40 one-hour sessions, delivered twice a week by teaching assistants. The proportion of participants recruited per school was calculated. Session delivery and session attendance was calculated for intervention schools. Weekday and after-school (3.30 to 8.30 pm) moderate to vigorous intensity physical (MVPA) was assessed by accelerometer at baseline (T0), during the last few weeks of the intervention (T1) and four months after the intervention had ended (T2). The costs of delivering the intervention were estimated. Results. Five intervention schools ran all 40 of the intended sessions. Of the remaining five, three ran 39, one ran 38 and one ran 29 sessions. Mean attendance was 53%. The adjusted difference in weekday MVPA at T1 was 4.3 minutes (95% CI −2.6 to 11.3). Sex-stratified analyses indicated that boys obtained 8.6 more minutes of weekday MVPA than the control group (95% CI 2.8 to 14.5) at T1 with no effect for girls (0.15 minutes, 95% CI −9.7 to 10.0). There was no evidence that participation in the programme increased MVPA once the club sessions ceased (T2). The indicative average cost of this intervention was £2,425 per school or £81 per participating child during its first year and £1,461 per school or £49 per participating child thereafter. Conclusions. The effect of the Action 3:30 interventions was comparable to previous physical activity interventions but further analysis indicated that there was a marked sex difference with a positive impact on boys and no evidence of an effect on girls. The Action 3:30 intervention holds considerable promise but more work is needed to enhance the effectiveness of the intervention, particularly for girls. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is an increasing problem, leading to increased morbidity and mortality, especially in older, multimorbid patients. Consequently, there is a need for reduction of polypharmacy. The aim of this study was to explore attitudes, beliefs, and concerns towards deprescribing among older, multimorbid patients with polypharmacy who chose not to pursue at least one of their GP's offers to deprescribe. Methods: Exploratory study using telephone interviews among patients of a cluster-randomized study in Northern Switzerland. The interview included a qualitative part consisting of questions in five pre-defined key areas of attitudes, beliefs, and concerns about deprescribing and an open explorative question. The quantitative part consisted of a rating of pre-defined statements in these areas. Results: Twenty-two of 87 older, multimorbid patients with polypharmacy, to whom their GP offered a drug change, did not pursue all offers. Nineteen of these 22 were interviewed by telephone. The 19 patients were on average 76.9 (SD 10.0) years old, 74% female, and took 8.9 (SD 2.6) drugs per day. Drugs for acid-related disorders, analgesics and anti-inflammatory drugs were the three most common drug groups where patient involvement and the shared-decision-making (SDM) process led to the joint decision to not pursue the GPs offer. Eighteen of 19 patients fully trusted their GP, 17 of 19 participated in SDM even before this study and 8 of 19 perceived polypharmacy as a substantial burden. Conservatism/inertia and fragmented medical care were the main barriers towards deprescribing. No patient felt devalued as a consequence of the deprescribing offer. Our exploratory findings were supported by patients' ratings of predefined statements. Conclusion: We identified patient involvement in deprescribing and coordination of care as key issues for deprescribing among older multimorbid patients with polypharmacy. GPs concerns regarding patients' devaluation should not prevent them from actively discussing the reduction of drugs. Trial registration: ISRCTN16560559. [ABSTRACT FROM AUTHOR]

Background: Home gardens are an integral part of many traditional land use systems around the world. They are subject to various conversion processes and undergo a variety of changes. We were interested if change is an ongoing process in farmers' home gardens of Eastern Tyrol (Austria). Methods: In Sillian, 16 farmers' home gardens (FHGs) were studied. They had been studied in 1998 and were revisited in 2013 including again a botanical inventory of cultivated and non-cultivated plants, and structured interviews on appearance, management and plant use. In 2017, all the 16 gardens were visited again to verify whether any visible change on spatial configuration had occurred. Results: The home garden size had decreased between 1998 and 2013. A wider range of sizes was observed. The occurrence of plant taxa per garden was the same but an increase in the standard deviation of occurrence is seen. Plant diversity (occ./m2) increased between 1998 and 2013. Seventy-nine plant taxa were no longer cultivated in 2013, but 95 new plant taxa were being cultivated. The correlation between garden size and occurrence was not significant, i.e. small gardens might host many different plant taxa or large gardens might have fewer plant taxa. The occurrence for certain use categories was not significantly different between the years, except for the increase in the occurrence of plant taxa used as food and the food subcategory spice. The mean abundance of individuals for all plant taxa showed a significant decrease between the years. In 2013, an increase in standard deviation of abundance is seen. The variation in the different use categories expressed in abundance between the years was not significantly different, except for the decrease in the abundance of plant taxa used as food. Between 1998 and 2017, six home gardens showed a change of their spatial configuration (replacement by raised beds; merging with other structures; conversion to lawn). One FHG shows signs of abandonment. Conclusions: In Sillian, gardens are by no way static agroecological units, but are dynamic and individual in their appearance, composition and function. Farmers' home gardens in Sillian show a trend towards becoming more individual, i.e. conversion from being a product of a homogenous local cultural script of the community into an area where gardeners define more individually the role that farmers' homegardens are expected to play for them or their family. [ABSTRACT FROM AUTHOR]