Search

Introduction: Over 100 million displaced people rely on health services in humanitarian contexts, defined as unstable or transitory settings created in response to complex emergencies. While services are often described, there is a dearth of evidence on best practices for successful implementation to guide efforts to optimize health delivery. Implementation science is a promising but underutilized tool to address this gap. This scoping review evaluates implementation science in health services for forced migrants in humanitarian settings., Methods: We conducted a scoping review according to JBI methodologies. A search of eight databases yielded 7,795 articles, after removal of duplicates, that were screened using PRISMA-ScR guidelines. Data extraction assessed study descriptors, implementation objects, barriers, facilitators, implementation strategies, and use of implementation frameworks in service delivery., Results: Data from 116 studies represented 37 countries and 11 topic areas. Methods were mainly cross-sectional with low-medium evidence rigor. Mental health programs (25%) and vaccination services (16%) were the most common objects of implementation. Thirty-eight unique barriers were identified including resource limitations (30%), health worker shortages (24%), and security risks (24%). Among 29 facilitators, the most common were health worker availability (25%), pre-existing partnerships (25%), and positive perceptions towards the intervention (20%). More than 90% of studies collectively identified 35 implementation strategies, the most common being capacity building (44%), stakeholder engagement (35%), information dissemination (38%), and feedback mechanisms (25%). Only 10 studies used formal implementation models, with RE-AIM (n = 3) and Intervention mapping (n = 2) being most frequent., Conclusions: In this scoping review, we found similar barriers, facilitators, and implementation strategies across diverse humanitarian migrant settings and services. However, the use of rigorous methods and formal implementation models was rare. Frameworks included RE-AIM, CFIR, and Precede-Proceed. Increased use of implementation science frameworks and methods will help humanitarians more rigorously and systematically evaluate and develop best practices for implementation of health services for migrants in humanitarian settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Reynolds et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Sexual and reproductive health (SRH) research capacity strengthening (RCS) programs in low- and middle-income countries (LMICs) are needed to foster the discovery of context-specific solutions to improve patient outcomes and population health. There remains a limited understanding of SRH research strengthening programs to raise skill sets, publications, and infrastructure and ultimately influence health policy and patient outcomes in LMICs. More information is needed to understand how SRH research is sustained after program completion. To inform efforts to implement programs that strengthen SRH research and foster sustainability, we conducted a scoping review to identify and synthesize strategies used in SRH research strengthening programs in LMICs. A literature search of nine scholarly databases was conducted. We synthesized data extracted from included articles and presented results highlighting the format, duration, and topics covered of program interventions to strengthen SRH research in LMICs. We organized information about primary outcomes into themes and summarized how SRH research capacity was sustained after program completion. Twenty-four articles were included in the scoping review. The articles generally focused on outcomes within the themes of advocacy/capacity, education, policy, project life cycle, and writing/publication. Few articles reported metrics or other evidence of long-term program sustainability of SRH RCS projects in LMICs. Results from this scoping review can be used to strengthen SRH research programs in LMICs. More energy must be directed toward correcting power imbalances in capacity strengthening initiatives. To address additional gaps, future directions for research should include an exploration of SRH research mentorship, the cost of SRH RCS interventions, and how to foster institutional support., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Buser et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Family planning (FP) is an essential component of public health programs and significantly impacts maternal and child health outcomes. In Uganda, there is a need for a comprehensive review of the existing literature on FP to inform future research and programmatic efforts. This scoping review aims to identify factors shaping the use of FP in Uganda. We conducted a systematic search of eight scholarly databases, for qualitative studies on FP in Uganda. We screened the titles and abstracts of identified articles published between 2002-2023 and assessed their eligibility based on predefined criteria. We extracted data from the 71 eligible studies and synthesized the findings using thematic analysis and the Ecological Systems Theory (EST) individual, interpersonal, community, institutional, and policy-level determinants. Findings reveal the interplay of factors at different socio-ecological levels influencing family planning decisions. At the individual level, the most common determinants related to the EST were knowledge and attitudes of FP. Interpersonal dynamics, including partner communication and social support networks, played pivotal roles. Community-level factors, such as cultural norms and accessibility of services, significantly influenced family planning practices. Institutional and policy-level factors, particularly a healthcare system's quality and policies, also shaped use. Other themes included the intersection of HIV/AIDS on FP practice and Ugandan views of comprehensive abortion care. This scoping review underscores the intricate socio-ecological fabric shaping FP in Uganda. The findings highlight the need for targeted interventions to increase knowledge and awareness of FP, improve access to services, and address social and cultural norms that discourage contraceptive use. Policymakers and program implementers should also consider gender dynamics and power imbalances in FP programs to ensure they are equitable and effective., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Buser et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: While several studies have examined the effectiveness of librarian interactions with clinicians and impact of librarians on patient care, no studies have explored a library's effects on population care. The goal of this study was to investigate the library's impact on both patient and population care., Methods: Using a sequential exploratory mixed-methods design, we first interviewed a small set of clinicians and researchers active in patient and population care. Based on the themes that we discovered through coding the interviews, we created a survey that was sent to faculty in the health sciences and the health system., Results: We collected data from a representative sample of our population. We discovered that all respondents value the library and informationists, using our services most for teaching, publishing, presenting, and professional development., Conclusion: We now have data to support our value to our population and to show where we can do more work to improve the use of our services. Our study shows the value of doing a mixed-methods sequential exploration in which themes that are important to our user community were identified prior to launching a large-scale survey., (Copyright © 2024 Carol Shannon, Jacqueline L. Freeman, Mark MacEachern, Gurpreet K. Rana, Craig Smith, Judith E. Smith, Jean Song.)

Background: Uganda is burdened by high unintended and teen pregnancies, high sexually transmitted infections, and harm caused by unsafe abortion., Objectives: Explore factors influencing sexual and reproductive health and rights (SRHR) in Uganda by synthesizing evidence from qualitative studies using a scoping review., Eligibility Criteria: Original qualitative peer-reviewed research studies published between 2002 and 2023 in any language exploring factors influencing SRHR in Uganda., Sources of Evidence: Eight databases searched using qualitative/mixed methods search filters and no language limits., Charting Methods: Information extracted included author, article title, publication year, study aims, participant description, data collection type, sample size, main findings, factors at the individual, interpersonal, community, and policy levels, implications for SRHR in Uganda, and study limitations. Quality of the selected articles was assessed using the Critical Appraisal Skills Programme tool., Results: One hundred seventy-three studies met inclusion criteria. At the individual level, knowledge and attitudes toward SRHR, risky sexual behavior, and access to maternal SRHR services were identified as critical factors influencing health outcomes. Interpersonal factors included communication with sexual partners and relationships with family, school, and community members. Healthcare organization factors included adolescent access to education, SRHR services, and HIV prevention. Cultural and social factors included gendered norms and male involvement in SRHR. Policy-level factors included the importance of aligning policy and practice., Conclusions: Multiple factors at individual, interpersonal, community, healthcare, cultural, and policy levels were found to influence SRHR in Uganda. The findings suggest that interventions targeting multiple levels of the socio-ecological system may be necessary to improve SRHR outcomes. This review highlights the need for a holistic approach that considers the broader socio-ecological context. Reducing identified gaps in the literature, particularly between policy and practice related to SRHR, is urgently needed in Uganda. We hope this review will inform the development of policies and interventions to improve SRHR outcomes.

The removal of non-pathogenic foreskin from the penis of healthy neonates and infants for non-religious reasons is routinely practiced in many parts of the world. High level data from well-designed randomized controlled trials of circumcision in neonates and infants does not guide clinical practice. Reliable counts of immediate and short term circumcision complications are difficult to estimate. Emerging evidence suggests routine neonatal circumcision could lead to long term psychological, physical, and sexual complications in some men. The stigma associated with discussing circumcision complications creates a prevalence paradox where the presence of significant circumcision complications is higher than reported. Prior to the Internet, there were very few forums for men from diverse communities, who were troubled about their circumcision status, to discuss and compare stories. To investigate the long term consequences of circumcision, we reviewed 135 posts from 109 individual users participating in a circumcision grief subsection of Reddit, an internet discussion board. We identified three major categories of complications: physical such as pain during erections and lost sensitivity, psychological such as anxiety and violation of autonomy, and sexual such as feeling that the sexual experience was negatively altered or being unable to complete a sexual experience. We also identified a "discovery process" where some men described coming into awareness of their circumcision status. These findings suggest that neonatal circumcision can have significant adverse consequences for adult men. The removal of normal foreskin tissue should be limited to adult men who choose the procedure for cosmetic reasons or when medically indicated., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Research efforts in Rwanda to improve sexual and reproductive health and rights (SRHR) are increasing; however, comprehensive literature reviews on SRHR are limited. This scoping review examines individual and contextual factors shaping knowledge, attitudes, and practices in the domains of: 1) family planning, 2) abortion care, and 3) other SRHR in Rwanda. Recognizing that individual, community, and societal factors influence RH, this review is guided by Bronfenbrenner's Ecological Systems Theory., Methods: Eligible studies were conducted in Rwanda, included males and/or females of any age, and were published within the past 20 years. Studies reporting views of only healthcare or other professionals were excluded., Results: Thirty-six studies were included. The majority addressed individual and contextual considerations. At the individual level, studies explored knowledge about SRHR problems while at the interpersonal level, the support and attitudes of men and community members for adolescent SRHR were investigated. In terms of healthcare organization, maternal health practices, increased access to family planning programs, and the need for sexually transmitted infection programs was explored. At the social and cultural level, researchers investigated beliefs and traditional gender roles. Regarding public health policy, studies mentioned promoting and increasing funding for SRHR and reducing gender inequities., Conclusion: Our findings can inform SRHR research programs, public health campaigns, and policy advances in Rwanda., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Buser et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: A scoping review was undertaken to understand the extent of literature on librarian involvement in competency-based medical education (CBME). Methods: We followed Joanna Briggs Institute methodology and PRISMA-ScR reporting guidelines. A search of peerreviewed literature was conducted on December 31, 2022, in Medline, Embase, ERIC, CINAHL Complete, SCOPUS, LISS, LLIS, and LISTA. Studies were included if they described librarian involvement in the planning, delivery, or assessment of CBME in an LCME-accredited medical school and were published in English. Outcomes included characteristics of the inventions (duration, librarian role, content covered) and of the outcomes and measures (level on Kirkpatrick Model of Training Evaluation, direction of findings, measure used). Results: Fifty studies were included of 11,051 screened: 46 empirical studies or program evaluations and four literature reviews. Studies were published in eight journals with two-thirds published after 2010. Duration of the intervention ranged from 30 minutes to a semester long. Librarians served as collaborators, leaders, curriculum designers, and evaluators. Studies primarily covered asking clinical questions and finding information and most often assessed reaction or learning outcomes. Conclusions: A solid base of literature on librarian involvement in CBME exists; however, few studies measure user behavior or use validated outcomes measures. When librarians are communicating their value to stakeholders, having evidence for the contributions of librarians is essential. Existing publications may not capture the extent of work done in this area. Additional research is needed to quantify the impact of librarian involvement in competency-based medical education. [ABSTRACT FROM AUTHOR]

In clinical clerkship (CC), medical students can practice evidence-based medicine (EBM) with their assigned patients. Although CC can be a valuable opportunity for EBM education, the impact of EBM training, including long-term behavioral changes, remains unclear. One hundred and nine fourth- and fifth-year medical students undergoing CC at a medical school in Japan attended a workplace-based learning program for EBM during CC (WB-EBM), which included the practice of the five steps of EBM. The program's effect on the students' attitudes toward EBM in CC was assessed through questionnaires. A total of 88 medical students participated in the program. Responses to the questionnaire indicated high satisfaction with the WB-EBM program. The most common theme in students' clinical problems with their assigned patients was the choice of treatment, followed by its effect. Based on the responses in the post-survey for the long-term effects of the program, the frequency of problem formulation and article reading tended to increase in the 'within six months' group comprising 18 students who participated in the WB-EBM program, compared with the control group comprising 34 students who did not. Additionally, the ability to self-assess problem formulation was significantly higher, compared with the control group. However, among 52 students who participated in the WB-EBM program more than six months later, EBM-related behavioral habits in CC and self-assessments of the five steps of EBM were not significantly different from those in the control group. The WB-EBM program was acceptable for medical students in CC. It motivated them to formulate clinical questions and enhanced their critical thinking. Moreover, the WB-EBM program can improve habits and self-evaluations about EBM. However, as its effects may not last more than six months, it may need to be repeated across departments throughout CC to change behavior in EBM practice. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has underscored the need for innovative solutions in rural healthcare, revealing critical gaps in access and quality. This article examines the transformative potential of telehealth and digital tools in overcoming the unique challenges faced by rural healthcare systems, particularly in India. With a shortage of healthcare providers and limited access to specialized care, rural communities have historically been underserved. The pandemic exacerbated these challenges, but it also accelerated the adoption of technologies like telemedicine, remote patient monitoring, mobile health apps, and electronic health records (EHRs). Telemedicine has proven to be a game-changer, enabling healthcare providers to deliver care remotely, reducing travel time and costs for patients. Remote patient monitoring and mobile health apps further extend the reach of healthcare services, allowing continuous monitoring and management of chronic conditions. EHRs improve communication and coordination of care, particularly in areas where multiple providers serve a dispersed population. The article highlights successful examples of technology integration, such as the Apollo Telemedicine Networking Foundation and the Sehatvan mobile telemedicine service in India, which have expanded access to healthcare for millions. International examples like Mercy Virtual Care Center in Missouri and the Veterans Health Administration's telemedicine program also demonstrate the global relevance of these innovations. However, the potential of these technologies is contingent on reliable internet connectivity, a challenge in many rural areas. The Bharat Net project aims to address this by providing high-speed internet to India's rural regions. The future of rural healthcare lies in the continued integration of digital tools, supported by improved connectivity, to ensure equitable access and better health outcomes for rural populations globally. [ABSTRACT FROM AUTHOR]

Objective: The article reports on an assessment of the effectiveness of the MLA Research Training Institute (RTI) for the years 2018 and 2019. The RTI is a year-long continuing education research methods training and support program for health sciences librarians. The study focuses on assessing RTI participants' research confidence after program completion and compares these results with their perceptions of workshop/program performance and learning outcomes. In addition, the authors discuss how the findings were applied to inform and improve the program. Methods: The study used a 26-item questionnaire, RTI Research Confidence Questionnaire, to gather information on participants' self-reported research confidence before the workshop, immediately after the workshop, and one year after the workshop to determine statistically significant differences. Differences in research confidence were identified by using three nonparametric statistical tests. Additional workshop and program surveys were used to corroborate the research confidence findings. Results: Post-workshop and one-year-after-workshop research confidence ratings were significantly higher than preworkshop levels for years 1 and 2. A comparison of median ratings between years 1 and 2 showed significant increases in research confidence for nine items in year 2. Participants' positive perceptions of workshop/program effectiveness and learning outcomes corroborated these findings. Conclusion: Overall assessment findings indicated that RTI training helped participants understand, use, and apply research skills to conduct research. Findings also revealed that participants' heightened research confidence persisted at least 12 months postintervention. The RTI Research Confidence Questionnaire proved effective for rigorously assessing and improving the RTI program. This study enhances the currently limited evidence on evidence-based approaches for assessing and improving research instruction for librarians. [ABSTRACT FROM AUTHOR]

Background: Young working women who devote most of their time to jobs and household chores may experience conflicts when faced with a cervical cancer screening decision. This study aimed to assess the acceptability and feasibility of a Web-based decision aid on cervical cancer screening by young working women, and to preliminarily examine the effects of the decision aid on the knowledge level, risk perception, decisional conflicts, screening decision and screening uptake., Method: This was a pilot randomised controlled trial. A total of 158 working women aged 25-44 years who had not undergone cervical cancer screening in the past 3 years were recruited. The recruited women allocated to the intervention group received a Web-based decision aid with information about the Papanicolaou test and HPV test, whereas the control group received usual care, i.e. a fact sheet about a healthy living., Results: A total of 138 of them (72 in the intervention group and 66 in the control group) completed the study and the screening uptake assessment. The intervention group showed greater improvement in the subscale scores and the overall scores for decisional conflicts (effect size, 0.71-0.90), and a statistical significantly larger proportion of the intervention group had undergone cervical cancer screening when compared to the control group (31.9% vs 6.1%). Most interviewees were satisfied with the intervention., Conclusion: It was feasible and acceptable to implement the Web-based decision aid to young working women. The preliminary findings suggest that the decision aid could help to reduce decisional conflicts and encourage uptake of screening. Full-scale studies are needed to confirm these findings., Trial Registration: This study was registered at the International Standard Randomised Controlled Trial Number Registry (ISRCTN59163820) on 4 August 2022., Competing Interests: Declarations. Ethics Approval: All of the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Informed Consent: Informed consent was obtained from all individual participants included in the study. Conflict of Interest: The authors declare no competing interests., (© 2024. The Author(s).)

Residue studies were conducted in bell pepper crops (green and yellow bell pepper) to ensure the safe use of fenvalerate, profenofos, and novaluron (under open field and protected conditions) in randomized block design (RBD) following three applications at a 10-day interval over two consecutive years, 2021 and 2022. A robust analytical method was developed using quick, easy, cheap, effective, rugged, and safe (QuEChERS) extraction and gas chromatography-tandem mass spectrometry (GC–MS/MS) for the determination of pesticide residues in bell pepper samples. The half-lives for fenvalerate were 2.47–2.87 and 2.50–3.03 days on bell pepper under open field conditions, whereas the corresponding values for bell pepper under protected conditions were 3.84–4.58 and 4.17–4.71 days, during 2021 and 2022, respectively. Profenofos displayed half-lives of 2.03–2.65 and 2.15–2.77 days in open field conditions and 3.05–3.89 and 3.16–3.78 days in protected conditions during 2021 and 2022, respectively. Similarly, novaluron had half-lives of 2.87–3.49 and 3.24–3.75 days under protected conditions in 2021 and 2022, respectively. The maximum residue limits (MRLs) were calculated to be 0.6 mg/kg for fenvalerate, while for profenofos it was 0.7 mg/kg on bell pepper under open field conditions at double doses, at the proposed pre-harvest interval (PHI) of 3 days. Likewise, for bell peppers grown under protected conditions, MRLs at the PHI of 3 days were determined to be 0.8 mg/kg for fenvalerate, 0.3 mg/kg for novaluron, and 1.5 mg/kg for profenofos. A dietary risk assessment study indicated that the percentage of acute hazard index (% aHI) was significantly lower than 100, and hazard quotient (HQ) values were below 1, signifying no acute or chronic risk to consumers. These findings underscore the safety of consuming bell peppers treated with fenvalerate, profenofos, and novaluron under the protected and open field conditions. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review seeks to integrate scholarly discussions of nonconsensual medicalized genital procedures, combining insights from the literature on obstetric violence with critiques based on children's rights. In both literatures, it is increasingly argued that such interventions may constitute, or be experienced as, violations of patients' sexual boundaries, even if performed without sexual intent. Recent Findings: Within the literature on obstetric violence, it is often argued that clinicians who perform unconsented pelvic exams (i.e., for teaching purposes on anesthetized patients), or unconsented episiotomies during birth and labor, thereby violate patients' bodily integrity rights. Noting the intimate nature of the body parts involved and the lack of consent by the affected individual, authors increasingly characterize such procedures, more specifically, as sexual boundary violations or even "medical sexual assault." Separately, critics have raised analogous concerns about medically unnecessary, nonconsensual genital cutting or surgery (e.g., in prepubescent minors), such as ritual "nicking" of the vulva for religious purposes, intersex genital "normalization" surgeries, and newborn penile circumcision. Across literatures, critics contend that the fundamental wrong of such procedures is not (only) the risk of physical or emotional harm they may cause, nor (beliefs about) the good or bad intentions of those performing or requesting them. Rather, it is claimed, it is wrong as a matter of principle for clinicians to engage—to any extent—with patients' genital or sexual anatomy without their consent outside of certain limited exceptions (e.g., is not possible to obtain the person's consent without exposing them to a significant risk of serious harm, where this harm, in turn, cannot feasibly be prevented or resolved by any less risky or invasive means). Summary: An emerging consensus among scholars of obstetric violence and of children's rights is that it is unethical for clinicians to perform any medically unnecessary genital procedures, from physical examination to cutting or surgery, without the explicit consent of the affected person. "Presumed" consent, "implied" consent, and "proxy" consent are thus argued to be insufficient. [ABSTRACT FROM AUTHOR]

Background: Decision aids have been shown to be effective in assisting the decision-making process in healthcare settings. This study aimed to examine the feasibility and acceptability of a linguistically appropriate printed decision aid for cervical cancer screening in South Asian women and to preliminarily estimate its effects on decisional conflicts, clarity of values, risk perception, the screening decision and screening uptake. Methods: This was a pilot randomised controlled trial. Forty-eight South Asian women aged 25 to 64 years were recruited and allocated to either the intervention group or control group. The participants in the intervention group read a linguistically appropriate printed decision aid. Results: All of the participants in the intervention group agreed that the decision aid was useful in aiding their decision-making. These participants showed significantly greater improvement in decisional conflicts, clarity of values and risk perceptions than those in the control group (all p < 0.05). The screening uptake rate was significantly higher in the intervention group than in the control group (p < 0.001). Conclusions: The decision aid was feasible and acceptable among South Asian women, and it resulted in reduced decisional conflict and increased screening uptake compared with usual care. To improve the convenience of using decision aids, they could be developed in various forms, such as printed and mobile application forms, to meet individual requirements. Trial Registration: The trial was registered at the Chinese Clinical Trial Registry on 23 October 2021 (ChiCTR2100052225). [ABSTRACT FROM AUTHOR]

The Fall armyworm (FAW), Spodopterafrugiperda, was first reported in a few regions of Burkina Faso in 2017. Since then, it has continued to spread and damage maize crops in the country, thereby threatening food security. This study, conducted three years later, aimed to assess the pest status on major rainy season crops, and the effects of cropping systems, crop diversity, and phenology in 11 localities of Sudanian and Sudano-Sahelian zones in Burkina Faso. Two sampling periods, the first conducted at the beginning of the rainy season and the second at the end of the season, were considered. Maize was the most FAW-infested crop, mainly as monocrops (84–88% of surveyed fields). Sorghum, pearl millet, cowpeas, and peanuts were the secondary infested crops, more infested when intercropped with maize. Maize fields were more FAW-affected in the Sudanian zone, whereas the secondary infested crops were significantly more affected in the Sudano-Sahelian zone. The highest field infestation rates were recorded during the second survey period, coinciding in most cases (> 90%) with the flowering and post-flowering of maize. Then, FAW attacks were found in vegetative, flowering, and post-flowering cereal organs. Despite the technical recommendations, most farmers (57.30 ± 10.34 and 66.78 ± 6.74% in the Sudanian and Sudano-Sahelian zones, respectively) did not apply insecticide in infested maize fields. Thus, in 3 years, the FAW has become an important pest of cereals, specifically maize, in the main agricultural zones of Burkina Faso. These results should be taken into account to develop effective control actions against FAW. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this systematic review is to assess the effectiveness of evidence-based healthcare (EBHC) educational interventions on healthcare professionals' knowledge, skills, attitudes, behaviour of EBHC, clinical process and care outcomes. A secondary aim of the review is to assess the effects of important pedagogical moderating factors for EBHC educational interventions., Method: This systematic review used a forward and backward citation search strategy on the Web of Science platform (date of inception to 28 April 2023). Only randomised controlled trials (RCTs) and cluster RCTs which compared EBHC educational interventions for healthcare professionals were included. A random effects meta-analysis was undertaken for EBHC compared with an active and nonactive control for all outcomes., Results: Sixty-one RCTs were identified which included a total of 5208 healthcare professionals. There was a large effect for EBHC educational interventions compared with waiting list/no treatment/sham control on knowledge (SMD, 2.69; 95% CI, 1.26-4.14, GRADE Low), skills (SMD, 0.88; 95% CI, 0.25-1.73, Very Low Certainty), attitude (SMD, 0.81; 95% CI, 0.16-1.47, Very Low Certainty) and behaviour of EBHC (SMD, 0.82; 95% CI, 0.25-1.40, Very Low Certainty). Over time the effect of EBHC educational interventions substantially decreased with no evidence of effect at 6 months for any outcome except behaviour (SMD,1.72; 95% CI, 0.74-2.71, Low Certainty). There was some evidence that blended learning, active learning and consistency in the individual delivering the intervention may be important positive moderating factors., Conclusion: These findings suggest that EBHC educational interventions may have a large short-term effect on improving healthcare professionals' knowledge, skills, attitude and behaviour of EBHC. These effects may be longer-lasting regarding EBHC behaviour. In terms of pedagogy, blended learning, active learning, and consistency of the individual delivering the intervention may be important positive moderating factors., (© 2024 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Background: Chronic kidney disease (CKD), a leading public health problem, has potential risks and serious implications on the health of individuals and society at large. Few studies explored the factors that influence access to CKD care at the community level in rural areas of West Bengal. A qualitative study was planned among key stakeholders to explore their views and experiences and to identify the barriers and potential facilitators that influence access to CKD care at the primary care level. Methods: Total 23 stakeholders participated in the study. Seventeen in-depth interviews (IDIs) were conducted on a purposive sample of stakeholders (CKD patients, healthcare providers (HCPs) and health planners) and one focus group discussion (FGD) among six community health workers. The audio-recorded interviews were transcribed verbatim. The Lévesque's framework for access to care as modified by Jodie Bailie et al. was employed to construct interview guides and structure the initial codes. Thematic analysis was undertaken using QSR NVivo version 11 using both inductive and deductive approaches. Results: The major barriers to CKD care at patient level were poor knowledge and awareness of CKD and at the health system level was shortage of skilled staffs, diagnostics and medicines and fragmented referrals. The potential facilitators identified were educational activities to increase the awareness of CKD among HCPs and patients; provision of CKD-related supplies and a system-level approach to care coordination along with m-health-based care. Conclusions: Targeted CKD screening programs and CKD specific trainings may improve awareness of CKD. Additionally, stronger primary care infrastructure, availability of essential drugs and diagnostics and creating an efficient referral process for the quality CKD care are the need of the hour. [ABSTRACT FROM AUTHOR]

The benefits of mHealth interventions in uncontrolled hypertension are unclear. To determine whether mHealth effectively improves the control rate of uncontrolled hypertension. PubMed, Web of Science, EMBASE, Scopus, and Cochrane Library were searched for randomized controlled trials (RCTs) from January 2007 to September 2022. The intervention group consisted of mHealth intervention, and the control group was usual care. Random‐effects meta‐analysis models were used to assess pooled mHealth intervention effects and CIs. The primary outcome was the blood pressure (BP) control rate of uncontrolled hypertension. The secondary outcome was the change of BP. Thirteen RCTs were included in this meta‐analysis, of which eight reported the successful BP control rate, 13 reported the change of systolic blood pressure (SBP), and 11 reported the change in diastolic blood pressure (DBP). The mean age of trial participants ranged from 47.7 to 66.9 years old, with a female composition ratio of 40.0%–66.1%. The duration of follow‐up ranged from 3 to 18 months. This study showed a more robust effect size for improving BP control rate by mHealth interventions than usual care (57.5% vs. 40.8% of successful control rate; odds ratio [OR], 2.19 [95% CI, 1.32—3.62]). Furthermore, mHealth significantly reduced SBP by 4.45 mm Hg and DBP by 2.47 mm Hg, and subgroup analysis did not observe the major source of heterogeneity. This meta‐analysis found that mHealth could significantly improve the uncontrolled hypertension control rate and might be a feasible, acceptable, and effective tool for uncontrolled hypertension management. [ABSTRACT FROM AUTHOR]

Wheat bran is one of the most abundant by-products from grain milling, which can be used as substrate for solid-state fermentation (SSF) to obtain enzymes able to convert this agro-industrial waste into glucose syrup, which in turn can be applied for the production of different food products. The present study aimed to determine centesimal composition of wheat bran, obtain enzymatic extract that converts wheat bran into wheat glucose syrup (WGS), produce rice flakes cereal bars (RFCB), and evaluate their nutritional composition and the presence of functional compounds, as well as their antioxidant potential. Determination of centesimal composition of wheat bran demonstrated its nutritional potential. Enzymatic extract was obtained and it converted wheat bran into WGS, which were applied to rice flakes producing RFCB. These cereal bars proved to be a source of dietary fiber (1.8 g) and soluble protein (7.2 g) while RCFB produced with corn glucose syrup did not present these nutritional components. In addition, RFCB produced with WGS showed polyphenolic compounds, among them flavonoids, which exhibited antioxidant activity by DPPH and ABTS radical scavenging (47.46% and 711.89 μM Trolox Equivalent/g, respectively), and iron ion reduction (71.70 μM Trolox equivalent/g). Final product showed a decrease in caloric value and sodium content. Therefore, the present study showed that the bioprocess of SSF yields a nutritional, ecological, and functional food product, which might be of great interest for food industry, adding nutritional and functional value to a well-stablished product., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The high disease burden of type 2 diabetes seriously affects the quality of life of patients, and with the deep integration of the Internet and healthcare, the application of electronic tools and information technology to has become a trend for disease management. The aim of this study was to evaluate the effectiveness of different forms and durations of E-health interventions in achieving glycemic control in type 2 diabetes patients. PubMed, Embase, Cochrane, and Clinical Trials.gov were searched for randomized controlled trials reporting different forms of E-health intervention for glycemic control in type 2 diabetes patients, including comprehensive measures (CM), smartphone applications (SA), phone calls (PC), short message service (SMS), websites (W), wearable devices (WD), and usual care. The inclusion criteria were as follows: (1) adults (age≥18) with type 2 diabetes mellitus; (2) intervention period ≥1 month; (3) outcome HbA1c (%); and (4) randomized control of E-health based approaches. Cochrane tools were used to assess the risk of bias. R 4.1.2 was used to conduct the Bayesian network meta-analysis. A total of 88 studies with 13,972 type 2 diabetes patients were included. Compared to the usual care group, the SMS-based intervention was superior in reducing HbA1c levels (mean difference (MD)-0.56, 95% confidence interval (CI): -0.82 to -0.31), followed by SA (MD-0.45, 95% CI: -0.61 to -0.30), CM (MD-0.41, 95% CI: -0.57 to -0.25), W (MD-0.39, 95% CI: -0.60 to -0.18) and PC (MD-0.32, 95% CI: -0.50 to -0.14) (p < 0.05). Subgroup analysis revealed that intervention durations of ≤6 months were most effective. All type of E-health based approaches can improve glycemic control in patients with type 2 diabetes. SMS is a high-frequency, low-barrier technology that achieves the best effect in lowering HbA1c, with ≤6 months being the optimal intervention duration. [ABSTRACT FROM AUTHOR]

Background: Lifestyle factors such as physical fitness, dietary habits, mental stress, and sleep quality, are strong predictors of the occurrence, clinical course, and overall treatment outcomes of common cardiovascular diseases. However, these lifestyle factors are rarely monitored, nor used in daily clinical practice and personalized cardiac care. Moreover, non-adherence to long-term self-reporting of these lifestyle factors is common. In the present study, we evaluate adherence to a continuous unobtrusive and patient-friendly lifestyle monitoring system using evidence-based assessment tools. Methods: In a prospective observational trial (N = 100), the project investigates usability of and adherence to a monitoring system for multiple lifestyle factors relevant to cardiovascular disease, i.e., daily physical activity levels, dietary habits, mental stress, smoking, and sleep quality. Patients with coronary artery disease, valvular disease and arrhythmias undergoing an elective intervention are asked to participate. The monitoring system consists of a secured online platform with a custom-built conversational interface—a chatbot—and a wrist-worn wearable medical device. The wrist-worn device collects continuous objective data on physical activity and the chatbot is used to collect self-report data. Participants collect self-reported lifestyle data via the chatbot for a maximum of 4 days every other week; in the same week physiological data are collected for 7 days for 24 h. Data collection starts one week before the intervention and continues until 1-year after discharge. Via a dashboard, patients can observe their lifestyle measures and adherence to self-reporting, set and track personal goals, and share their lifestyle data with practitioners and relatives. The primary outcome of the trial is adherence to using the integrated platform for self-tracking data. The secondary outcomes include system usability, determinants of adherence and the relation between baseline lifestyle behaviour and long-term patient-relevant outcomes. Discussion: Systematic monitoring during daily life is essential to gain insights into patients' lifestyle behaviour. In this context, adherence to monitoring systems is critical for cardiologists and other care providers to monitor recovery after a cardiac intervention and to detect clinical deterioration. With this project, we will evaluate patients' adherence to lifestyle monitoring technology. This work contributes to the understanding of patient-centered data collection and interpretation, to enable personalized care after cardiac interventions in order to ultimately improve patient-relevant outcomes and reduce health care costs. Trial registration: Netherlands Trial Registry (NTR) NL9861. Registered 6th of November 2021. [ABSTRACT FROM AUTHOR]

Sugarcane is a notable crop grown in the tropical region of the world. It is an abundant waste material of the sugar industry which is a low cost and low combustion fuel thus the bagasse can be exploited to manufacture adsorbents for water treatment. Because the presence of contaminants in polluted water is not uniform, pollutant species compete for active sites during the adsorption process. Investigation of the competitive adsorption of Zn(II), Cu(II), Pb(II), and Fe(II) in a quaternary solution using hybrid biochar developed from sugarcane bagasse (SCB) mixed Low-Density Polyethylene (LDPE) and pure SCB biochar is the main aim of this study. The biochar was developed using the retort carbonisation process and characterised via SEM (Scanning Electron Microscopy), BET (Branueur Emmett Teller) analysis, and FTIR (Fourier Transform Infrared Spectroscopy). Both biochar species mixture possessed some orbicular properties with mesoporous heterogeneous superficial morphology. The biomass biochar and hybrid biochar specific surface area are 533.6 m2/g and 510.5 m2/g respectively. For the two used adsorbents, >99% removal efficiency was recorded over the sphere for dosage investigation. Thus, this implies they are capable of removing heavy metals from the aqueous solution simulated. The Langmuir isotherm fitted best in each domain however there was an exception for Pb(II) ions in biomass biochar with the experimental adsorption capacity of ∼ 22 mg/g for the HMs. Based on the correlation coefficient (R2); the experimental data fitted the pseudo-first-order kinetic model well having a correlation coefficient value of greater than 0.9. The mechanism of adsorption for the HMs was chemisorption. This study has a three-pronged benefit of water treatment, resource conservation, and solid waste utilisation. [ABSTRACT FROM AUTHOR]

Background: Diversified diet is the key to combat micronutrient deficiency in India. Kitchen garden is a sustainable approach to provide diversified diet in rural area. Aims and Objectives: The objectives of this study were to assess the utilization and perception of kitchen garden use among the households in rural area. Materials and Methods: A community-based cross-sectional study carried out among women in the age group 18-65 years in Nagamangala was asked about the details on awareness and utilization of kitchen garden. Results: One-third of the study subjects were in the age group 30-40 years. About 18.2% of them were involved in some form of agriculture related work. Around 64% of the households had space available for kitchen garden. About 54% households had kitchen garden and 95% of the subjects used their kitchen garden products for self-use. Conclusion: Having kitchen garden contributes to household food security by providing direct access to food that can be easily harvested, prepared, and consumed. [ABSTRACT FROM AUTHOR]

We developed a Research Readiness Survey (RRS) to identify students' information literacy needs prior to instruction by a team of faculty members and librarians in our doctor of chiropractic program clinical research literacy courses. In addition to describing students' responses to our RRS, we explored associations between (1) students' overall performance on the RRS and their prior earned degrees and (2) their self-reported ability and performance on questions pertaining to evaluating information quality (standard 3 of the Association of College and Research Libraries [ACRL] Information Literacy Competency Standards for Higher Education). The RRS is composed of 50 questions, of which 22 pertain to information literacy knowledge assessment per ACRL standards. We calculated means and standard deviations for summary scores on 4 ACRL standards and for a total RRS score. We used analysis of variance to assess whether standard 3 scores differed by students' self-reported ability to judge health information quality and whether there was an association between total RRS scores and students' previously earned degrees. In 2017–2018, 245 students (70% of matriculates) completed the RRS. Students performed best on standard 3 (average score 67%) and worst on standard 2, the ability to access information (average score = 59%). Students who reported an average ability to judge information quality had higher standard 3 scores than students who reported poor ability (p =.003). Students with bachelor's degrees had higher total RRS scores than students with associate's degrees (p =.004). Matriculating students had the most difficulty with accessing information, supporting the need to include librarians on the teaching team. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Family Practice / Türkiye Aile Hekimligi Dergisi is the property of Deomed Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There has been increasing interest among national organizations for medical schools to provide students experiential training in the social determinants of health (SDH) through community partnerships. Despite this interest, there is limited data about how these experiential activities can be designed most effectively, and community organizations' views of partnering with medical schools on these curricula is unknown. The authors' objective was to determine community organizations' and clinical clerkship directors' perceptions of the benefits and challenges of utilizing academic-community partnerships to improve medical students' understanding of the SDH. The authors conducted a qualitative study consisting of open-ended, semi-structured interviews (between 2018 and 2021). All community organizations and clinical clerkship directors who partnered with a health equity curriculum were eligible to participate. Semi-structured interviews elicited participants' perceptions of the academic-community partnership; experience with the curriculum and the students; and recommendations for improving the curriculum. All interviews were audio recorded and transcribed. The authors used a directed content analysis approach to code the interviews inductively and identified emerging themes through an iterative process. Of the fifteen participants interviewed, ten were from community organizations and five from clinical clerkships. Three primary themes emerged: (1) community organizations felt educating students about the SDH aligned with the organization's mission and they benefited from consistent access to volunteers; (2) students benefited through greater exposure to the SDH; (3) participants suggested standardizing students' experiences, ensuring the students and organizations are clear about the goals and expectations, and working with organizations that have experience with or the capacity for a large volume of volunteers as ways to improve the experiential activity. This study found that community organizations were very willing to partner with a medical school to provide students experiential learning about the SDH, and this partnership was beneficial for both the students and the organizations. [ABSTRACT FROM AUTHOR]

Background: Even after a physician recommendation, many people remain unscreened for colorectal cancer (CRC). The proliferation of electronic health records (EHRs) and tethered online portals may afford new opportunities to embed patient-facing interventions within clinic workflows and engage patients following a physician recommendation for care. We evaluated the effectiveness of a patient-facing intervention designed to complement physician office-based recommendations for CRC screening. Design: Using a 2-arm pragmatic, randomized clinical trial, we evaluated the intervention's effect on CRC screening use as documented in the EHR (primary outcome) and the extent to which the intervention reached the target population. Trial participants were insured, aged 50 to 75 y, with a physician recommendation for CRC screening. Typical EHR functionalities, including patient registries, health maintenance flags, best practice alerts, and secure messaging, were used to support research-related activities and deliver the intervention to enrolled patients. Results: A total of 1,825 adults consented to trial participation, of whom 78% completed a baseline survey and were exposed to the intervention. Most trial participants (>80%) indicated an intent to be screened on the baseline survey, and 65% were screened at follow-up, with no significant differences by study arm. One-third of eligible patients were sent a secure message. Among those, more than three-quarters accessed study material. Conclusions: By leveraging common EHR functionalities, we integrated a patient-facing intervention within clinic workflows. Despite practice integration, the intervention did not improve screening use, likely in part due to portal-based interventions not reaching those for whom the intervention may be most effective. Implications: Embedding patient-facing interventions within the EHR enabled practice integration but may minimize program effectiveness by missing important segments of the patient population. Highlights: Electronic health record tools can be used to facilitate practice-embedded pragmatic trial and patient-facing intervention processes, including patient identification, study arm allocation, and intervention delivery. The online portal-embedded intervention did not improve colorectal cancer (CRC) screening uptake following a physician recommendation, likely in part because portal users tend to be already highly engaged with healthcare. Relying on patient portals alone for CRC screening interventions may not alter screening use and could exacerbate well-known care disparities. [ABSTRACT FROM AUTHOR]

Introduction: Despite digital health tools being popular for supporting self‐management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self‐management after stroke. The 4‐week trial incorporated facilitated person‐centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial. Methods: Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open‐text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth. Results: Overall, 27/54 trial participants completed the survey (13 intervention: 52%; 14 control: 48%); and 5/8 invited participants in the intervention group attended the focus group. Goal setting: The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person‐centred goals. Electronic messages (intervention): Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey; 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the benefits of receiving messages as a 'reminder' to act. Overall trial satisfaction: Messages were acceptable for educating about stroke (77%). Having options for short message services or email to receive messages was considered important. Feedback on the length of the intervention related to specific goals, and benefits of receiving the programme earlier after stroke was expressed. Conclusion: The participant experience has indicated acceptance and utility of iVERVE. Feedback from this evaluation is invaluable to inform refinements to future Phase II and III trials, and wider research in the field. Patient or Public Contribution: Two consumer representatives sourced from the Stroke Foundation (Australia) actively contributed to the design of the iVERVE programme. In this study, participant experiences directly contributed to the further development of the iVERVE intervention and future trial design. [ABSTRACT FROM AUTHOR]

Multiple aspects of the physiological and nutritional mechanisms involved with silicon (Si) absorption by quinoa plants remain poorly investigated, as well as the best way of supplying this element to crops. Thus, this study aimed at evaluating whether the application of Si increases its uptake by quinoa plants and consequently the use efficiency of N and P, as well as the levels of phenolic compounds in the leaves, crop productivity and the biofortification of grains. For this purpose, the concentration of 3 mmol L−1 of Si was tested, according to the following procedures: foliar application (F), root application in the nutrient solution (R), combined Si application via nutrient solution and foliar spraying (F + R), and no Si application (0). The provision of Si through the leaves and roots promoted the highest uptake of the element by the plant, which resulted in an increased use efficiency of N and P. Consequently, such a higher uptake favored the productivity of grains. The optimal adoption of the application of Si through leaves and roots promoted the highest Si concentration and ascorbic acid content in quinoa grains. [ABSTRACT FROM AUTHOR]

Background: Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. Methods: Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines. Results: A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers. Conclusion: The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives. [ABSTRACT FROM AUTHOR]

Objective: There are many systematic reviews of weight management interventions delivered by healthcare professionals (HCP), but it is not clear under what circumstances interventions are effective due to differences in review methodology. This review of systematic reviews synthesises the evidence about: (a) the effectiveness of HCP-delivered weight management interventions and (b) intervention and sample characteristics related to their effectiveness.Design: The review of reviews involved searching six databases (inception - October 2020). Reviews were included if they were (a) systematic, (b) weight management interventions delivered, at least partially, by HCP, (c) of randomised controlled trials and (d) written in English. Data regarding weight management outcomes (e.g. weight) and moderating factors were extracted. Secondary analyses were conducted using study-level data reported in each of the reviews.Setting: The review included studies that were delivered by HCP in any clinical or non-clinical setting.Participants: Not applicable.Results: Six systematic reviews were included (forty-six unique studies). First-level synthesis showed that weight management interventions delivered by HCP are effective. The second-level synthesis found that interventions are only successful for up to 6 months, are most effective for women, non-Caucasians and adults and are most effective if they have at least six sessions.Conclusions: As interventions are only successful for up to 6 months, they are not sufficient for achieving and maintaining a healthy weight. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is an increasingly common chronic health condition for which integrated care that is multidisciplinary and patient-centric is recommended yet challenging to implement. Objective: The aim of Coordinating Health Care With Artificial Intelligence-Supported Technology in AF is to evaluate the feasibility and potential efficacy of a digital intervention (AF-Support) comprising preprogrammed automated telephone calls (artificial intelligence conversational technology), SMS text messages, and emails, as well as an educational website, to support patients with AF in self-managing their condition and coordinate primary and secondary care follow-up. Methods: Coordinating Health Care With Artificial Intelligence-Supported Technology in AF is a 6-month randomized controlled trial of adult patients with AF (n=385), who will be allocated in a ratio of 4:1 to AF-Support or usual care, with postintervention semistructured interviews. The primary outcome is AF-related quality of life, and the secondary outcomes include cardiovascular risk factors, outcomes, and health care use. The 4:1 allocation design enables a detailed examination of the feasibility, uptake, and process of the implementation of AF-Support. Participants with new or ongoing AF will be recruited from hospitals and specialist-led clinics in Sydney, New South Wales, Australia. AF-Support has been co-designed with clinicians, researchers, information technologists, and patients. Automated telephone calls will occur 7 times, with the first call triggered to commence 24 to 48 hours after enrollment. Calls follow a standard flow but are customized to vary depending on patients' responses. Calls assess AF symptoms, and participants' responses will trigger different system responses based on prespecified protocols, including the identification of red flags requiring escalation. Randomization will be performed electronically, and allocation concealment will be ensured. Because of the nature of this trial, only outcome assessors and data analysts will be blinded. For the primary outcome, groups will be compared using an analysis of covariance adjusted for corresponding baseline values. Randomized trial data analysis will be performed according to the intention-to-treat principle, and qualitative data will be thematically analyzed. Results: Ethics approval was granted by the Western Sydney Local Health District Human Ethics Research Committee, and recruitment started in December 2020. As of December 2021, a total of 103 patients had been recruited. Conclusions: This study will address the gap in knowledge with respect to the role of postdischarge digital care models for supporting patients with AF. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000174886; https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12621000174886 International Registered Report Identifier (IRRID): DERR1-10.2196/34470 [ABSTRACT FROM AUTHOR]

This article reflects on current trends and proposes new considerations for the future of mobile technologies for health (mHealth). Our focus is predominantly on the value of and concerns with regard to the application of digital health within low- and middle-income countries (LMICs). It is in LMICs and marginalized communities that mHealth (within the wider scope of digital health) could be most useful and valuable. Peer-reviewed literature on mHealth in LMICs provides reassurance of this potential, often reflecting on the ubiquity of mobile phones and ever-increasing connectivity globally, reaching remote or otherwise disengaged populations. Efforts to adapt successful programs for LMIC contexts and populations are only just starting to reap rewards. Private-sector investment in mHealth offers value through enhanced capacity and advances in technology as well as the ability to meet increasing consumer demand for real-time, accessible, convenient, and choice-driven health care options. We examine some of the potential considerations associated with a private-sector investment, questioning whether a core of transparency, local ownership, equity, and safety is likely to be upheld in the current environment of health entrepreneurship. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic restricting clinical practice and exacerbating the lack of medical staff. There is currently a lack of young residents who are deciding on further training in gynecology and obstetrics.Design: review and prospective, cross-sectional study.Setting: the aim of this study was to investigate if structured mentoring programs can counteract this deficiency.Population: medical students took part from Germany in the clinical phase.Methods: An anonymous questionnaire was developed and distributed to students from January to October 2020. Epidemiological data, questions about mentoring experiences, necessity and their expected influence on career planning were collected and statistically evaluated.Main Outcome Measures: structured mentoring-programs can influence the choice of subject. In particular, men are still underrepresented. Research on the topic of mentoring during in the field of gynaecology and obstetrics is completely lacking.Results: A representative number of 927 medical students took part in the survey. 22% (170/906) of the students had already participated in a mentoring program with a significantly higher proportion of men (69%; 117/170; p < 0.001). Of these, 94% (453/170) said this was helpful. 6% (55/906) wanted to pursue a career in gynecology and obstetrics. When asked about their appreciation for structured mentoring programs in gynecology and obstetrics, 95% (880/906) would participate and 94% agreed (871/906) that this could have an impact on their choice of specialist and career planning.Conclusions: An active provision of mentoring programs and more content can be a way of counteracting the shortage of residents in gynecology and obstetrics. [ABSTRACT FROM AUTHOR]

Cost-related medication non-adherence (CRN) can negatively impact health outcomes in older adults with asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO) by reducing access and adherence to essential medications. The objective of this study is to examine the association of ACO to any CRN and specific forms of CRN among a nationally representative sample of older (age ≥ 65 years) adults. We adopted a cross-sectional study design using data from pooled cross-sectional Medicare Current Beneficiary Surveys (MCBS) (2006–2013) and linked fee-for-service Medicare claims. Unadjusted and adjusted logistic regressions that accounted for the complex survey design examined the association of ACO to any CRN and specific forms of CRN. Among older adults with ACO, 16% reported any CRN. The most common form of CRN was "failing to get prescription". As compared to older adults with no asthma and no COPD, those with ACO were more likely to report any CRN (adjusted odds ratios [AOR] = 1.50, 95%CI = [1.14, 1.96]) and all forms of CRN. However, when the number of unique medications was added to the model, there were no statistically significant differences in CRN between the two groups. Older adults with ACO represent a vulnerable population with increased risk for CRN. Multiple factors can contribute to CRN including: a higher number of prescribed medications, multiple co-morbidities, and cost of therapies. Medication comprehensive review interventions have the potential of reducing the risk of CRN among the older Medicare beneficiaries with ACO. [ABSTRACT FROM AUTHOR]