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Background: Rabies is a preventable yet deadly public health threat. Despite the availability of effective vaccines for both humans and animals, the persistence of rabies-related fatalities underscores the need for enhanced public education strategies. This study aimed to develop and validate a Rabies Health Education Module delivered via a Massive Open Online Course, targeting adult dog owners in Kelantan, Malaysia. Methods: The development of RaHEM followed the ADDIE framework. A comprehensive analysis was conducted through literature reviews, cross-sectional surveys, and stakeholder interviews. The module's content was designed and developed based on the Modified Health Belief Model and Mayer's Cognitive Theory of Multimedia Learning. Validation was performed by a panel of six experts and ten dog owners through content and face validity indices, respectively. Results: The module was organized into five core topics, each addressing specific aspects of rabies prevention. Content validity indices for all topics exceeded the acceptable threshold of 0.83, with an overall module CVI of 0.91 for relevance and 0.88 for clarity. Face validity indices also surpassed the 0.83 threshold, with overall module FVI scores of 1.00 for understandability and 0.99 for clarity. Conclusion: The RaHEM MOOC was successfully developed and thoroughly validated, ensuring it met its intended objectives and was suitable for the target audience. This educational module offers a promising approach to enhancing rabies prevention through accessible and engaging online education, potentially contributing to reduced rabies transmission and fatalities. Further studies are recommended to evaluate the module's effectiveness in improving rabies knowledge and attitudes. [ABSTRACT FROM AUTHOR]

In order to improve the attractiveness of social robot serving health interventions in public workspace, we propose a product design method with the combination of Style-generative adversarial network (StyleGAN) model and particle swarm optimisation-support vector regression (PSO-SVR). This paper aims to explore the modelling generation method of social robots for health intervention based on artificial intelligence generated content (AIGC) and a mapping model between the shape characteristics and users' visual perception based on Kansei Engineering (KE). Firstly, to address the defects of typical KE over-reliance on existing samples, we introduce the StyleGAN model in AIGC to learn and train existing robots' shape samples and generate new robots' shape sample images. Secondly, the morphological deconstruction method is used to deconstruct the shape features of the new robot sample. Factor analysis (FA) is also used to reduce dimension and cluster emotional words and establish a Likert scale between the shape features of robots and users' emotional vocabulary. Finally, particle swarm optimisation-support vector regression (PSO-SVR) is used to establish a mapping model between the shape features of social robots and the emotional images of users, thus obtaining the most attractive shape combination scheme. The research results showed that the StyleGAN model in AIGC can be used to assist industrial designers in creative expression and provide rich sample sources for KE; and the PSO-SVR of machine learning can be used to build a mapping model among users' visual feelings, emotional images and shape features. In the end, we designed an attractive social robot for public health intervention. [ABSTRACT FROM AUTHOR]

Background/Objectives: This paper examines hunger over time to analyze how food insecurity is impacted by reduced income, including household funding from the government. Federal policies and community-based programs have the ability to prevent increases in food insecurity, particularly for populations that have risk factors, such as households with children; single-parent households; low-income households, especially those in rural areas; Black and Hispanic households; and, households experiencing economic hardships. Methods: This study is bas ed on a cross-sectional survey that was administered in 2018 and 2019 to food pantry clients, an already food insecure population accessing resources, in Eastern Massachusetts. Baseline surveys were matched with a 3-month follow-up survey (n = 308) and multinomial logistic mixed effect models were used to analyze the association between change in household hunger and change in household income. Results: This study found that participants who experienced decreased income compared to no income change from baseline to follow-up had 2.16 times the odds (95% CI: 1.05, 4.46) of experiencing increased household hunger compared to no change in hunger from baseline to follow-up, after adjusting for all other covariates. Conclusions: Food insecurity in the United States remained stable during the beginning of COVID-19, despite prevalence of reduced household income. The expanded government benefits that were implemented early in the pandemic contributed to total household income, which prevented increased food insecurity. Increased food insecurity after the removal of benefits starting in 2022 indicates the importance of continuing support established during times when consistent income is compromised to prevent a delayed rise in food insecurity. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is a public health concern in Riyadh, Saudi Arabia, where cultural and social factors shape parental perceptions. This study explores how Riyadh-based parents view childhood obesity. Methods: A hybrid approach to thematic analysis was employed, combining deductive and inductive coding to allow for emergent themes directly from the data. Semistructured interviews were conducted with twelve parents in Riyadh, Saudi Arabia, whose children were identified as overweight or obese. The data were analysed to identify key themes related to parental perceptions and childhood obesity management. Results: Four themes emerged from the data: (1) perceptions towards childhood obesity; (2) perceived barriers to weight management; (3) perceived benefits to weight management; and (4) perceived motivators to addressing obesity. Conclusion: Parents in Riyadh often view childhood obesity as a sign of health due to deep-rooted cultural norms. However, as they witness health and social challenges in their children, such as bullying or physical difficulties, their perceptions begin to shift. This study highlights the role of cultural beliefs, lifestyle constraints, and limited institutional support as barriers to managing childhood obesity. Addressing these factors through awareness initiatives and community support could empower parents to more effectively promote healthier behaviours for their children, ultimately contributing to improved health outcomes. [ABSTRACT FROM AUTHOR]

Background: Between 2020 and 2022, countries used a range of different public health and social measures (PHSMs) to reduce the transmission of SARS‐CoV‐2. The impact of these PHSMs varied as the pandemic progressed, variants of concern (VOCs) emerged, vaccines rolled out and acceptance/uptake rates evolved. In this study, we assessed the impact of PHSMs in the World Health Organization (WHO) European Region during VOC phases. Methods: We relied on time series data on genome sequencing, PHSMs, health outcomes and physical contacts. Panel regression models were used to assess the association between PHSMs and SARS‐CoV‐2 transmission (approximated using time‐varying reproduction numbers). The interpretation of these regression models was assisted by hierarchical clustering, which was used to detect the temporal co‐occurrence of PHSMs. Generalised linear models were used to check if PHSMs are associated with physical contacts. Results: We identified four phases based on the dominating VOC in the WHO European Region: wild type (before early 2021), Alpha (early to mid‐2021), Delta (mid‐to‐late 2021) and Omicron (after late 2021). 'School closure', 'stay‐at‐home requirement' and 'testing policy' were consistently associated with lower transmission across VOC phases. The impact of most PHSMs varied by VOC phases without clear increasing or decreasing trends as the pandemic progressed. Several PHSMs associated with lower transmission were not associated with fewer physical contacts. Conclusions: The impact of PHSMs evolved as the pandemic progressed—although without clear trends. The specific mechanisms by which some PHSMs reduce SARS‐CoV‐2 transmission require further research. [ABSTRACT FROM AUTHOR]

Abstract Background In most countries engaged on the last mile towards malaria elimination, residual transmission mainly persists among vulnerable populations represented by isolated and mobile (often cross-border) communities. These populations are sometimes involved in informal or even illegal activities. In regions with Plasmodium vivax transmission, the specific biology of this parasite poses additional difficulties related to the need for a radical treatment against hypnozoites to prevent relapses. Among hard-to-reach communities, case management, a pillar of elimination strategy, is deficient: acute malaria attacks often occur in remote areas, where there is limited access to care, and drugs acquired outside formal healthcare are often inadequately used for treatment, which typically does not include radical treatment against P. vivax. For these reasons, P. vivax circulation among these communities represents one of the main challenges for malaria elimination in many non-African countries. The objective of this article is to describe the protocol of the CUREMA study, which aims to meet the challenge of targeting malaria in hard-to-reach populations with a focus on P. vivax. Results CUREMA is a multi-centre, international public health intervention research project. The study population is represented by persons involved in artisanal and small-scale gold mining who are active and mobile in the Guiana Shield, deep inside the Amazon Forest. The CUREMA project includes a complex intervention composed of a package of actions: (1) health education activities; (2) targeted administration of treatment against P. vivax after screening against G6PD deficiency to asymptomatic persons considered at risk of silently carrying the parasite; (3) distribution of a self-testing and self-treatment kit (malakit) associated with user training for self-management of malaria symptoms occurring while in extreme isolation. These actions are offered by community health workers at settlements and neighbourhoods (often cross-border) that represent transit and logistic bases of gold miners. The study relies on hybrid design, aiming to evaluate both the effectiveness of the intervention on malaria transmission with a pre/post quasi-experimental design, and its implementation with a mixed methods approach. Conclusions The purpose of this study is to experiment an intervention that addresses both Plasmodium falciparum and P. vivax malaria elimination in a mobile and isolated population and to produce results that can be transferred to many contexts facing the same challenges around the world.

China’s rapid growth has led to environmental, health, and economic challenges due to the widespread use of solid fuels such as coal and biomass. This issue is particularly prevalent in rural areas and affects 2.4 billion people globally. The harmful compounds released from burning these fuels are linked to various health issues. This review aims to summarize the health implications of solid fuel use in China and provide recommendations for cleaner cooking fuels. The study investigates the link between solid cooking fuel use and noncommunicable diseases (NCDs) in China. It includes data from 2000 to 2022, with a focus on indoor air pollution and NCD development. The research adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines for systematic reviews and meta-analyses. The search yielded 16 studies examining the link between solid cooking fuel use and NCDs in China. These studies covered a range of NCDs and indoor pollutants across 26 provinces, offering a comprehensive exploration of the relationship between indoor air pollution and NCDs. The findings revealed a significant prevalence of chronic obstructive pulmonary disease and lung cancer attributable to indoor air pollution exposure. The study underscores the need for public health intervention to reduce the burden of NCDs and promote the adoption of clean fuel. The evidence provided could motivate policies to encourage cleaner fuel usage.

Background: In most countries engaged on the last mile towards malaria elimination, residual transmission mainly persists among vulnerable populations represented by isolated and mobile (often cross-border) communities. These populations are sometimes involved in informal or even illegal activities. In regions with Plasmodium vivax transmission, the specific biology of this parasite poses additional difficulties related to the need for a radical treatment against hypnozoites to prevent relapses. Among hard-to-reach communities, case management, a pillar of elimination strategy, is deficient: acute malaria attacks often occur in remote areas, where there is limited access to care, and drugs acquired outside formal healthcare are often inadequately used for treatment, which typically does not include radical treatment against P. vivax. For these reasons, P. vivax circulation among these communities represents one of the main challenges for malaria elimination in many non-African countries. The objective of this article is to describe the protocol of the CUREMA study, which aims to meet the challenge of targeting malaria in hard-to-reach populations with a focus on P. vivax. Results: CUREMA is a multi-centre, international public health intervention research project. The study population is represented by persons involved in artisanal and small-scale gold mining who are active and mobile in the Guiana Shield, deep inside the Amazon Forest. The CUREMA project includes a complex intervention composed of a package of actions: (1) health education activities; (2) targeted administration of treatment against P. vivax after screening against G6PD deficiency to asymptomatic persons considered at risk of silently carrying the parasite; (3) distribution of a self-testing and self-treatment kit (malakit) associated with user training for self-management of malaria symptoms occurring while in extreme isolation. These actions are offered by community health workers at settlements and neighbourhoods (often cross-border) that represent transit and logistic bases of gold miners. The study relies on hybrid design, aiming to evaluate both the effectiveness of the intervention on malaria transmission with a pre/post quasi-experimental design, and its implementation with a mixed methods approach. Conclusions: The purpose of this study is to experiment an intervention that addresses both Plasmodium falciparum and P. vivax malaria elimination in a mobile and isolated population and to produce results that can be transferred to many contexts facing the same challenges around the world. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the level of awareness of university students regarding auricular hematoma in the Aseer region, Saudi Arabia. Methods: A survey was conducted among 310 randomly chosen university students in the Aseer region. A validated questionnaire was used to evaluate demographic data on the students' perception, knowledge, awareness, and attitude toward first aid and preventive measures of auricular hematoma. Results: The results revealed significant gaps in knowledge about auricular hematoma among university students. Only 65% of participants reported some exposure to information about the condition, with just 30% correctly identifying its causes. However, most participants exhibited a positive attitude toward protective measures and expressed a willingness to adopt them if provided with appropriate information about sporting facilities. Conclusion: The study highlighted the need for educational methods to increase awareness and knowledge regarding auricular hematoma among students. [ABSTRACT FROM AUTHOR]

IntroductionAutism Spectrum Disorder (ASD) presents significant challenges in social communication and interaction, critically impacting the lives of children with ASD. Traditional interventions, such as Applied Behavior Analysis (ABA) and Social Skills Training (SST), have been widely used to address social skill deficits in these children. While these methods are effective, they often require substantial resources, long-term engagement, and specialized expertise, which limit their accessibility and adaptability to diverse social contexts. Recent advancements in artificial intelligence (Al), particularly Transformer-based models, offer a novel opportunity to enhance and personalize social skills training.MethodsThis study introduces a Public Health-Driven Transformer (PHDT) model specifically designed to improve social skills in children with ASD. By integrating public health principles with state-of-the-art Al methodologies, the PHDT model creates interventions that are adaptable, accessible, and sensitive to individual needs. Leveraging multi-modal data inputs-such as text, audio, and facialcues-PHDT provides real-time social context interpretation and adaptive feedback, enabling a more naturalistic and engaging learning experience.Results and discussionExperimental results reveal that PHDT significantly outperforms traditional methods in fostering engagement, retention, and social skill acquisition. These findings highlight PHDT's potential to improve social competencies in children with ASD and to revolutionize access to specialized support within public health frameworks. This work underscores the transformative impact of Al-driven, public health-oriented interventions in promoting equitable access to essential developmental resources and enhancing the quality of life for children with ASD.

Abstract Background Breast cancer is the most diagnosed cancer in the world, with a worse prognosis documented in low- and middle-income countries. Inequalities pertaining to breast cancer outcomes are observed at within-country level, with demographics and socioeconomic status as major drivers. Aim This review aims to aggregate all available evidence from low- and middle-income countries on public health interventions that can be utilized to reduce breast cancer inequalities within the breast cancer continuum. Methods The study was a systematic review and narrative synthesis of available literature, with the literature search conducted between September and October 2021. The search was re-run in September 2022 to update the review. PubMed, Scopus, Embase, African Index Medicus and LILACS were searched, based on predetermined criteria. Randomized controlled trials, cohort studies and quasi-experimental studies were included for review, while studies without an intervention and comparator group were excluded. The Joanna Briggs Institute family of checklists was used for quality assessment of the included studies. Data pertaining to study design, quality control and intervention effectiveness was extracted. Results A total of 915 studies were identified for screening and 21 studies met the selection criteria. Only one study specifically evaluated the impact of an intervention on breast cancer inequalities. Diverse, multi-level interventions that can be utilized to address breast cancer inequalities through targeted application to disadvantaged subpopulations were identified. Educational interventions were found to be effective in improving screening rates, downstaging through early presentation as well as improving time to diagnosis. Interventions aimed at subsidizing or eliminating screening payments resulted in improved screening rates. Patient navigation was highlighted to be effective in improving outcomes throughout the breast cancer continuum. Conclusion Findings from the systematic review underline the importance of early detection in breast cancer management for low- and middle-income countries. This can be achieved through a variety of interventions, including population education, and addressing access barriers to public health services such as screening, particularly among under-served populations. This study provides a comprehensive database of public health interventions relevant to low- and middle-income countries that can be utilized for planning and decision-making purposes. Findings from the review highlight an important research gap in primary studies on interventions aimed at reducing breast cancer inequalities in low- and middle-income countries. Systematic review registration PROSPERO registration number: CRD42021289643.

Background: Breast cancer is the most diagnosed cancer in the world, with a worse prognosis documented in low- and middle-income countries. Inequalities pertaining to breast cancer outcomes are observed at within-country level, with demographics and socioeconomic status as major drivers. Aim: This review aims to aggregate all available evidence from low- and middle-income countries on public health interventions that can be utilized to reduce breast cancer inequalities within the breast cancer continuum. Methods: The study was a systematic review and narrative synthesis of available literature, with the literature search conducted between September and October 2021. The search was re-run in September 2022 to update the review. PubMed, Scopus, Embase, African Index Medicus and LILACS were searched, based on predetermined criteria. Randomized controlled trials, cohort studies and quasi-experimental studies were included for review, while studies without an intervention and comparator group were excluded. The Joanna Briggs Institute family of checklists was used for quality assessment of the included studies. Data pertaining to study design, quality control and intervention effectiveness was extracted. Results: A total of 915 studies were identified for screening and 21 studies met the selection criteria. Only one study specifically evaluated the impact of an intervention on breast cancer inequalities. Diverse, multi-level interventions that can be utilized to address breast cancer inequalities through targeted application to disadvantaged subpopulations were identified. Educational interventions were found to be effective in improving screening rates, downstaging through early presentation as well as improving time to diagnosis. Interventions aimed at subsidizing or eliminating screening payments resulted in improved screening rates. Patient navigation was highlighted to be effective in improving outcomes throughout the breast cancer continuum. Conclusion: Findings from the systematic review underline the importance of early detection in breast cancer management for low- and middle-income countries. This can be achieved through a variety of interventions, including population education, and addressing access barriers to public health services such as screening, particularly among under-served populations. This study provides a comprehensive database of public health interventions relevant to low- and middle-income countries that can be utilized for planning and decision-making purposes. Findings from the review highlight an important research gap in primary studies on interventions aimed at reducing breast cancer inequalities in low- and middle-income countries. Systematic review registration: PROSPERO registration number: CRD42021289643. [ABSTRACT FROM AUTHOR]

As resolution for opioid-related claims and litigation against pharmaceutical manufacturers and other stakeholders, state and local governments are newly eligible for millions of dollars of settlement funding to address the overdose crisis in the United States. To inform effective use of opioid settlement funds, we propose a simple framework that highlights the principal determinants of overdose mortality: the number of people at risk of overdose each year, the average annual number of overdoses per person at risk, and the average probability of death per overdose event. We assert that the annual number of overdose deaths is a function of these three determinants, all of which can be modified through public health intervention. Our proposed heuristic depicts how each of these drivers of drug-related mortality – and the corresponding interventions designed to address each term – operate both in isolation and in conjunction. We intend for this framework to be used by policymakers as a tool for identifying and evaluating public health interventions and funding priorities that will most effectively address the structural forces shaping the overdose crisis and reduce overdose deaths. [ABSTRACT FROM AUTHOR]

IntroductionThe COVID-19 pandemic has profoundly impacted global health systems, requiring the monitoring of infection waves and strategies to control transmission. Estimating the time-varying reproduction number is crucial for understanding the epidemic and guiding interventions.MethodsProbability distributions of serial interval are estimated for Pre-Delta and Delta periods. We conducted a comparative analysis of time-varying reproduction numbers, taking into account population immunity and variant differences. We incorporated the regional heterogeneity and age distribution of the population, as well as the evolving variants and vaccination rates over time. COVID-19 transmission dynamics were analyzed with variants and vaccination.ResultsThe reproduction number is computed with and without considering variant-based immunity. In addition, values of reproduction number significantly differed by variants, emphasizing immunity’s importance. Enhanced vaccination efforts and stringent control measures were effective in reducing the transmission of the Delta variant. Conversely, Pre-Delta variant appeared less influenced by immunity levels, due to lower vaccination rates. Furthermore, during the Pre-Delta period, there was a significant difference between the region-specific and the non-region-specific reproduction numbers, with particularly distinct pattern differences observed in Gangwon, Gyeongbuk, and Jeju in Korea.DiscussionThis research elucidates the dynamics of COVID-19 transmission concerning the dominance of the Delta variant, the efficacy of vaccinations, and the influence of immunity levels. It highlights the necessity for targeted interventions and extensive vaccination coverage. This study makes a significant contribution to the understanding of disease transmission mechanisms and informs public health strategies.

IntroductionMobilizing existing creative, cultural and community assets is seen as a crucial pathway to improving public health. Schools have been identified as key institutional community assets and arts-in-nature practice has been shown to promote children’s mental health. The ‘Branching Out’ research investigated how an established arts-in-nature practice called ‘Artscaping’ could be scaled up through the mobilization of community assets including school staff and local volunteers to reach more children in primary schools.MethodsThe Branching Out model was piloted in six primary schools across Cambridgeshire with ‘Community Artscapers’ delivering 1.5-h Artscaping sessions with children outdoors for 8 weeks. Interviews were conducted with 11 Community Artscapers (six school staff and five volunteers) and four school leaders reflecting on their experiences of the Branching Out model and the data was subject to a reflexive thematic analysis.ResultsThe findings presented here discuss themes relating to mobilizing community assets, including framing the opportunity, recruiting and sustaining volunteers, training and supporting Community Artscapers, and tensions in roles and responsibilities. They also cover impacts for the children, including mental health provision, freedom in creativity and being outside, personal development, emotional impacts, and social connection, as well as impacts for the Community Artscapers, including making a difference, emotional wellbeing, personal and professional development, and connection and community.DiscussionThese findings are considered in terms of their alignment with public health policy drivers and the potential for the Branching Out model to become replicable and self-sustaining across schools to promote children’s mental health as a public health intervention.

Introduction: Our goal in this study was to identify stimulant abuser patients who are at specifically high risk of suicide attempt (SAT), in order to prioritize them in preventive and risk mitigation programs.Methods: We used the California State Emergency Department Database (SEDD) to obtain discharge information for 2011. The SEDD contains discharge information on all outpatient ED encounters, including uninsured patients and those covered by Medicare, Medicaid, and private insurance. We identified SAT and stimulant abuse by using the relevant International Classification of Diseases, Ninth Revision, codes.Results: The study included 10,124,598 outpatient ED visits. Stimulant abuse was observed in 0.97% of ED visits. Stimulant abuse was more common among young and middle-aged males and people with low median household income. Moreover, it was more common among Native American (1.8%) and Black (1.8%), followed by non-Hispanic White (1.1%) patients. The prevalence of SAT was 2.0% (N = 2000) for ED visits by patients with a history of stimulant abuse, and 0.3% (N = 28,606) for ED visits without a history of stimulant abuse (odds ratio 7.29, 95% confidence interval, 6.97-7.64). The SATs were directly associated with stimulant abuse, younger age (age groups >10), and non-Hispanic White and Native American race. Association of SAT with stimulant abuse was stronger in female patients.Conclusion: Stimulant abuse was the only modifiable risk factor for suicide attempt in our study. Reaching out to populations with higher prevalence of stimulant abuse (young and middle-aged individuals who are Native American or Black, with lower household income) to control the stimulant abuse problem, may reduce the risk of SAT. In this regard, people who are at higher risk of SAT due to non-modifiable risk factors (younger age, and Native American or White race) should be prioritized. Moreover, controlling stimulant abuse among women may be specifically effective in SAT prevention.

Summary: Background: In a cluster randomized trial (clinicaltrials.gov: NCT02810678) a flexible but comprehensive health system intervention significantly increased the number of household contacts (HHC) identified and started on tuberculosis preventive treatment (TPT). A follow-up study was conducted one year later to test the hypotheses that these effects were sustained, and were reproducible with a simplified intervention. Methods: We conducted a follow-up study from May 1, 2018 until April 30, 2019, as part of a multinational cluster randomized trial. Eight sites in 4 countries that had received the intervention in the original trial received no further intervention; eight other sites in the same countries that had not received the intervention (control sites in the original trial) now received a simplified version of the intervention. This consisted of repeated local evaluation of the Cascade of care for TB infection, and stakeholder decision making. The number of HHC identified and starting TPT were repeatedly measured at all 16 sites and expressed as rates per 100 newly diagnosed index TB patients. The sustained effect of the original intervention was estimated by comparing these rates after the intervention in the original trial with the last 6 months of the follow-up study. The reproducibility was estimated by comparing the pre-post intervention changes in rates at sites receiving the original intervention with the pre-post changes in rates at sites receiving the later, simplified intervention. Findings: With regard to the sustained impact of the original intervention, compared to the original post-intervention period, the number of HHC identified and treated per 100 newly diagnosed TB patients was 10 more (95% confidence interval: 84 fewer to 105 more), and 1 fewer (95% CI: 22 fewer to 20 more) respectively up to 14 months after the end of the original intervention. With regard to the reproducibility of the simplified intervention, at sites that had initially served as control sites, the number of HHC identified and treated per 100 TB patients increased by 33 (95% CI: −32, 97), and 16 (−69, 100) from 3 months before, to up to 6 months after receiving a streamlined intervention, although differences were larger, and significant if the post-intervention results were compared to all pre-intervention periods. Interpretation: Up to one year after it ended, a health system intervention resulted in sustained increases in the number of HHC identified and starting TPT. A simplified version of the intervention was associated with non-significant increases in the identification and treatment of HHC. Inferences are limited by potential bias due to other temporal effects, and the small number of study sites. Funding: Funded by the Canadian Institutes of Health Research (Grant number 143350).

AbstractThis research article presents a comprehensive analysis aimed at enhancing the stochastic modeling of COVID-19 dynamics by incorporating vaccination classes through a higher-order spectral scheme. The ongoing COVID-19 pandemic has underscored the critical need for accurate and adaptable modeling techniques to inform public health interventions. In this study, we introduce a novel approach that integrates various vaccination classes into a stochastic model to provide a more nuanced understanding of disease transmission dynamics. We employ a higher-order spectral scheme to capture complex interactions between different population groups, vaccination statuses, and disease parameters. Our analysis not only enhances the predictive accuracy of COVID-19 modeling but also facilitates the exploration of various vaccination strategies and their impact on disease control. The findings of this study hold significant implications for optimizing vaccination campaigns and guiding policy decisions in the ongoing battle against the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Tobacco use results in over 6 million deaths throughout the world annually. It is anticipated that by 2020, 13.3% of deaths in India will be directly related to tobacco usage, up from 1.4% in 1990. Massive initiatives that could help people quit smoking have been implemented over time. Materials and Methods: A total of 60 current tobacco users participated in the study. The Fagerstorm Nicotine Dependence scale was used to assess the extent of addiction to smoking and smokeless tobacco, and a carbon monoxide (CO) breath analyzer was used to detect carbon monoxide levels in smokers. The extent of addiction was evaluated at the beginning and at 10th, 30th, 3 months and 6 months of follow-up. Results: Participant’s average addiction level on the Fagerstrom scale was 3.7 (CI = (2.6 to 4.7) for smokers at baseline, which was reduced to 2.2, CI = (1.3 to 3.1) at the end of treatment (p < .0001) and 5.4 CI = (4.5 to 6.2) for participants using smokeless tobacco at baseline, which was reduced to 2.4, CI = (1.8 to 3.1) at the end of treatment (p < .0001). Based on behavioural modification therapy (BMT) there was a significant reduction in addiction and CO levels from the baseline to 6 months of follow-up. Discussion: By using BMT and well planned follow-up, people in both groups were able to minimize their tobacco use, and the majority of participants had a favorable attitude towards the tobacco cessation program. [ABSTRACT FROM AUTHOR]

Crutchfield (Crutchfield in Bioethics 33:112–121, [4]) has argued that if moral bioenhancement (MBE) ought to be compulsory, then it ought to be covert. More precisely, they argue that MBE is a public health intervention, and for this reason should be governed by public health ethics. Taking from various public health frameworks, Crutchfield provides an array of values to consider, such as: utility, liberty, equality, transparency, social trust, and autonomy. Subsequently, they argue that a covert MBE programme does better than an overt one, in preserving or promoting said values, and hence, that a covert MBE is preferable. In this paper, I will provide novel reasons to doubt that the relevant values are in fact better promoted or preserved by a covert MBE programme. Additionally, I will provide a novel autonomy-based consideration which counts in favour of the MBE programme being overt, rather than covert. Given that as things currently stand it is unclear which kind of MBE programme is preferable, the upshot of my criticism of Crutchfield will be to provide some recommendations as to how we might proceed in establishing whether a covert or overt MBE programme fares better. [ABSTRACT FROM AUTHOR]

Abstract Background To maximise their potential benefits to communities, effective health behaviour interventions need to be implemented, ideally ‘at scale’, and are often adapted as part of this. To inform future implementation and scale-up efforts, this study broadly sought to understand (i) how often health behaviour interventions are implemented in communities, (ii) the adaptations that occur; (iii) how frequency it occurred ‘at scale’; and (iv) factors associated with ‘scale-up’. Methods A cross-sectional survey was conducted of corresponding authors of trials (randomised or non-randomised) assessing the effects of preventive health behaviour interventions. Included studies of relevant Cochrane reviews served as a sampling frame. Participants were asked to report on the implementation and scale-up (defined as investment in large scale delivery by a (non)government organisation) of their intervention in the community following trial completion, adaptations made, and any research dissemination strategies employed. Information was extracted from published reports of the trial including assessments of effectiveness and risk of bias. Results Authors of 104 trials completed the survey. Almost half of the interventions were implemented following trial completion (taking on average 19 months), and 54% of those were adapted prior to doing so. The most common adaptations were adding intervention components, and adapting the intervention to fit within the local service setting. Scale-up occurred in 33% of all interventions. There were no significant associations between research trial characteristics such as intervention effectiveness, risk of bias, setting, involvement of end-user, and incidence of scale-up. However the number of research dissemination strategies was positively associated to the odds of an intervention being scaled-up (OR = 1.50; 95% CI: 1.19, 1.88; p

Objectives: To evaluate the impact of early implementation of public health and social measures (PHSMs) on contact rates over time and explore contact behavior of asymptomatic versus symptomatic cases. Methods: We used the largest contact tracing data in China thus far to estimate the mean contacts over time by age groups and contact settings. We used bootstrap with replacement to quantify the uncertainty of contact matrixes. The Pearson correlation was performed to demonstrate the number of contacts over time in relation to the evolution of restrictions. In addition, we analyzed the index cases with a high number of contacts and index cases that produced a high number of secondary cases. Results: Rapidly adapted PHSMs can reduce the mean contact rates in public places while increasing the mean contact rates within households. The mean contact rates were 11.81 (95% confidence interval, 11.61-12.01) for asymptomatic (at the time of investigation) cases and 6.70 (95% confidence interval, 6.54-6.87) for symptomatic cases. The percentage of asymptomatic cases (at the time of investigation) meeting >50 close contacts make up more than 65% of the overall cases. The percentage of asymptomatic cases producing >10 secondary cases account for more than 80% of the overall cases. Conclusion: PHSMs may increase the contacts within the household, necessitating the need for pertinent prevention strategies at home. Asymptomatic cases can contribute significantly to Omicron transmission. By making asymptomatic people aware that they are already contagious, hence limiting their social contacts, it is possible to lower the transmission risk.

The article "Letter: Timely Follow-Up in Cirrhosis - A Key Public Health Intervention" published in the journal Alimentary Pharmacology & Therapeutics discusses the correlation between timely outpatient follow-up and reduced 1-year mortality in cirrhosis patients. The study spans nearly 19 years and suggests that advancements in treatment strategies and technology may have influenced the results. The authors recommend considering additional variables like smoking, physical activity, and dietary habits to enhance the interpretability of the study results and suggest personalized interventions, community-level support, and policy changes to improve health outcomes for cirrhosis patients. [Extracted from the article]

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ObjectivesThis research aims to assess the effectiveness and cost-effectiveness of pre-pregnancy deafness screening policies.MethodsMarried couples from Shanghai, Beijing, and Suzhou in China were enrolled. We conducted high-throughput, pre-pregnancy genetic screenings for deafness in women and their partners. We compared the cost-effectiveness of deafness genetic screening with the status quo. The two-step screening (wife then partner) and following treatments and interventions were included in the decision tree model. We conducted a cost-effectiveness analysis based on the decrease in deaf newborns, healthy newborn births, and cost-utility analysis of pre-pregnancy deafness genetic screening separately. Cost, utility, and probability data used in the three models were collected from a survey combined with literature and expert consultants. A 5% discount rate and a series of one-way sensitivity analyses along with a Monte Carlo simulation were used to test the reliability of this research.ResultsBetween Jan 1, 2019, and Dec 31, 2021, we recruited 6,200 females and 540 male spouses from community health service centers in Shanghai, Beijing, and Suzhou. The incremental cost-effectiveness ratio (ICER) for reducing deaf newborn births was USD 32,656 per case and USD 1,203,926 per case for increasing one healthy newborn birth. This gap exists because of the overall decrease of newborn births. From the perspective of the whole society, deafness genetic screening is not cost-effective for reducing the overall quality-adjusted life years (QALY) in the population.DiscussionPre-pregnancy genetic testing is effective in decreasing the occurrence of congenital deafness. It is a cost-saving measure when compared with the costs of future medical expenditure and income loss for the affected families. However, such screening and preventive avoidance of pregnancy will decrease the population size and QALY. Only post-screening ART with PGT was shown to increase the birth of healthy newborns. Focusing on key groups such as premature births or consanguineous couples may improve the societal effects of screening.

Landmark studies demonstrating a reduction in onward HIV transmission and improved survival have informed a shift in global antiretroviral therapy policy to a ‘treat all’ approach. Global HIV stakeholders have called on countries to urgently scale up their HIV programs, involving responsibilities for various health system actors for accelerating HIV epidemic control. In this article we explore how community members in South Africa who were part of a large-scale ‘Universal Testing and Treatment’ trial made decisions around taking up home-based HIV testing, a major component of the trial's intervention and the entry point to a comprehensive continuum of HIV prevention and care. Drawing on data collected with a qualitative cohort of purposively selected households in the study intervention communities between 2016 and 2018 we describe how the goal of achieving HIV epidemic control was internalized, enacted, and potentially transformed in the interactions between community members and health workers in high HIV burden community settings. Further, we consider the implications for how community members related to their individual health and a collective responsibility to a broader public health good (in this case HIV epidemic control). Our findings suggest that in contexts of precarity – where there is low social cohesion – a community-wide health intervention can create an avenue for people to perform being good, moral citizens. Our findings reveal how complex community and social dynamics inform decisions to take up health interventions, rather than purely ‘rational’ understandings of individual and collective health benefit.

ABSTRACTConspiracies regarding vaccines are widely prevalent, with negative consequences on health-seeking behaviors. The current study aimed to investigate the possible association between the embrace of vaccine conspiracies and the attitude to booster COVID-19, seasonal influenza, and monkeypox (mpox) vaccinations as well as the perceived side effects following COVID-19 vaccination. The target population involved academic staff and university students in health colleges in the Kingdom of Saudi Arabia. A self-administered questionnaire was distributed in January 2023 to collect data on participants’ demographics, self-reported side effects following each dose, willingness to get booster COVID-19, seasonal influenza, and mpox vaccinations, as well as an evaluation of vaccine conspiracies and attitude to mandatory vaccination. Among the 273 participants, the willingness to receive yearly booster COVID-19 vaccination was observed among 26.0% of the participants, while it was 46.9% and 34.1% for seasonal influenza and mpox vaccinations, respectively. Multinomial logistic regression analyses demonstrated a significant correlation between endorsing vaccine conspiracies and higher frequency of self-reported side effects following uptake of the second and third doses of COVID-19 vaccines. Vaccine conspiracies were also correlated with attitude toward booster COVID-19, influenza, mpox, and mandatory vaccination. The findings of this pilot study highlighted the potential adverse impact of the preexisting notions and negative attitudes toward vaccines, which could have contributed to heightened perceived side effects following COVID-19 vaccination. The study also highlighted the ongoing divisions concerning mandatory vaccination policies, emphasizing the need for cautious implementation of this strategy as a last resort for public health benefit.

To estimate the proportion of patients visiting urgent care centers or emergency departments or being hospitalized who were not up to date with recommended mammography screening to assess the potential impact of non-primary care–based cancer screening interventions. Adult participants from the 2019 National Health Interview Survey were included. Among participants not up to date with breast cancer screening guidelines based on ACR recommendations, the proportion of patients reporting an urgent care, emergency department visit, or hospitalization within the last year was estimated accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and mammography screening adherence. The study included 9,139 women between the ages of 40 and 74 years without history of breast cancer. Of these respondents, 44.9% did not report mammography screening within the last year. Among participants who did not report mammography screening, 29.2% reported visiting an urgent care center, 21.8% reported visiting an emergency room, and 9.6% reported being hospitalized within the last year. The majority of patients receiving non-primary care–based services, who were not up to date with mammography screening, were from historically underserved groups including Black and Hispanic patients. Nearly 10% to 30% of participants who have not obtained recommended breast cancer screening have visited non-primary care–based services including urgent care centers or emergency rooms or have been hospitalized within the last year. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract 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.

Background: Recent global reports highlighted the significance of improving the quality of healthcare delivery in all settings, including rural and Hard-to-reach communities, as a central strategy for attaining sustainable development goals. Objectives: This study aimed at assessing and document relevant data associated with delivering qualitative Maternal and Child health (MCH) services in the hard-to-reach (HTR) communities using carefully selected indicators. Methods: The study used a mixed-design approach of quantitative and qualitative methods. Results: This study report high performance on the first antenatal visit (ANC 1), use of modern contraceptives (CPR), Penta 3, measles vaccination coverage, and, Low dropout rate also noticed in Penta 3, thus signifying a generally good performance in all the local government areas (LGAs). Furthermore, Yola South, Fufore, Toungo, Ganye and Michika LGA were found to be the best performing LGAs on the selected maternal and Child indicators, namely: (ANC1), ANC4, ANC8, Institutional delivery rate, and Contraceptive Prevalence Rate (CPR), while Gombi, Guyuk and Madagali LGAs were the poorest performing LGAs. The poor performance of these LGAswere associated with human and environmental interferences: ongoing insecurity, high HTR communities due to mountains and riverine, high illiteracy, inadequate outreach services, poverty, lack of adequate emergency transport system, inadequate human resource for health (HRH), inadequate and poor infrastructure, many communities lacking primary healthcare center. Conclusion: The assessment highlights the coverage of LGAs with low utilization of MCH services in HTR communities of Adamawa State, the reasons for the low coverage, and the possible strategies for increased utilization of these services. These findings suggest an urgent need for designing efficient outreaches for the delivery of maternal newborn and child’s intervention in HTR communities.

Background: To maximise their potential benefits to communities, effective health behaviour interventions need to be implemented, ideally 'at scale', and are often adapted as part of this. To inform future implementation and scale-up efforts, this study broadly sought to understand (i) how often health behaviour interventions are implemented in communities, (ii) the adaptations that occur; (iii) how frequency it occurred 'at scale'; and (iv) factors associated with 'scale-up'. Methods: A cross-sectional survey was conducted of corresponding authors of trials (randomised or non-randomised) assessing the effects of preventive health behaviour interventions. Included studies of relevant Cochrane reviews served as a sampling frame. Participants were asked to report on the implementation and scale-up (defined as investment in large scale delivery by a (non)government organisation) of their intervention in the community following trial completion, adaptations made, and any research dissemination strategies employed. Information was extracted from published reports of the trial including assessments of effectiveness and risk of bias. Results: Authors of 104 trials completed the survey. Almost half of the interventions were implemented following trial completion (taking on average 19 months), and 54% of those were adapted prior to doing so. The most common adaptations were adding intervention components, and adapting the intervention to fit within the local service setting. Scale-up occurred in 33% of all interventions. There were no significant associations between research trial characteristics such as intervention effectiveness, risk of bias, setting, involvement of end-user, and incidence of scale-up. However the number of research dissemination strategies was positively associated to the odds of an intervention being scaled-up (OR = 1.50; 95% CI: 1.19, 1.88; p < 0.001). Conclusions: Adaptation of implemented trials is often undertaken. Most health behaviour interventions are not implemented or scaled-up following trial completion. The use of a greater number of dissemination strategies may increase the likelihood of scaled up. [ABSTRACT FROM AUTHOR]

Background: Food allergy affects up to 10% of Australian infants. It was hypothesized that if parents follow the Australasian Society of Clinical Immunology and Allergy guidelines, Australian food allergy rates may stabilize or decline. Objective: This project aimed to determine whether SmartStartAllergy influenced parental introduction of peanut by age 12 months, including in high-risk infants. Methods: SmartStartAllergy integrates with general practice management software to send text messages to parents via participating general practices. The intervention group participants were sent text messages when their child was aged 6, 9, and 12 months; the control group participants were parents of 12-month-old infants. When their child was aged 12 months, all participants completed a questionnaire regarding eczema and family history of atopy. Infants with severe eczema and/or a family history of atopy were considered high-risk. Results: Between 21 September 2018 and 26 April 2022, a total of 29,092 parents were enrolled in SmartStartAllergy as intervention (n = 18,090) and control (n = 11,002) group members The intervention group was more likely to introduce peanut by 12 months (crude odds ratio = 5.18; P < .0001; 95% CI = 4.35-6.16). After adjustment for the infants’ level of risk and family history of atopy and food allergy, the intervention group was more likely to introduce peanut by 12 months of age (adjusted odds ratio = 5.34; P < .01; 95% CI = 4.48-6.37). Conclusion: SmartStartAllergy appears to be an effective tool for encouraging parental introduction of peanut. The ability to provide parents with credible allergy prevention information, along with the capacity to collect simple responses via text along with additional information via an online questionnaire, make this a useful public health tool.

Introduction: A social determinants of health index score or Vaccine Equity Metric was used to prioritize resources and address geographic disparities in California's vaccination coverage. We calculated the improvement index or percentage of the vaccination disparity gap closed to evaluate the impacts of this vaccination strategy in the San Francisco Bay Area during the SARS-CoV-2 Delta variant surge. Methods: We conducted a cross-sectional study on San Francisco Bay Area ZIP codes during the Delta surge (July 6–October 5, 2021). Data came from the California Immunization Registry and the 2019 5-year American Community Survey. We used Spearman correlations to examine the relationships between Vaccine Equity Metric category and vaccine coverage and Kruskal–Wallis tests to compare vaccination improvement index across Vaccine Equity Metric categories. Results: We studied 248 ZIP codes in the San Francisco Bay Area. Those with the lowest resources (Vaccine Equity Metric Level 1) had the highest absolute increase in vaccination coverage (14.3 vs 5.4 percentage points in Vaccine Equity Metric Level 4), although a contribution was higher starting vaccination rates in Level 4 ZIP codes with the greatest resources. The ratio of vaccination coverage between the lowest- and highest-resourced ZIP codes increased from 0.79 to 0.9, suggesting reduced disparity. However, it is difficult to interpret given wide differences in n (Level 1 n=8 vs Level 4 n=151). In contrast, the vaccination improvement index accounts for each Vaccine Equity Metric category's baseline vaccination; all were statistically similar (grand mean=41.5%, p=0.367), implying comparable improvement across all ZIP codes. Conclusions: Using a Vaccine Equity Metric to identify and prioritize resources to vulnerable communities contributed to equitable vaccine allocation in the San Francisco Bay Area. Our study shows an example of the improvement index's advantages over conventional health equity metrics, such as absolute differences and relative effect measures, which can overestimate an intervention's impact.

Objectives: Preference information is increasingly being elicited to support decision-making. Although discrete choice experiments (DCEs) are commonly used, little is known about how respondents' relative experience of a health issue, and its treatment, might impact the results of preference studies. The aim of this study was to explore how preferences differ between groups of individuals with varying levels of experience of a health issue and its treatment, using a weight loss maintenance (WLM) programme as a case study. Methods: An online DCE survey was provided to four groups, each differing in their level of experience with weight loss and WLM programmes. One group was recruited from a randomised controlled trial of a WLM programme (ISRCTN14657176) and the other three from an online panel. Choice data were analysed using mixed logit models. Relative attribute importance scores and willingness-to-pay (WTP) estimates were estimated to enable comparisons between groups. Results: Preferences differed between the groups across different attributes. The largest differences related to the outcome (weight re-gain) and cost attributes, resulting in WTP estimates that were statistically significantly different. The most experienced group was willing to pay £0.35 (95% CI: £0.28, £0.42) to avoid a percentage point increase in weight re-gain, compared with £0.12 (95% CI: £0.08, £0.16) for the least experienced group. Conclusion: This study provides evidence in a public health setting to suggest that preferences differ based on respondent experience of the health issue and its treatment. Health preference researchers should therefore carefully consider the appropriate composition of their study samples. [ABSTRACT FROM AUTHOR]

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]

Abstract Background Future prevalence of colonization with extended-spectrum betalactamase (ESBL-) producing K. pneumoniae in humans and the potential of public health interventions against the spread of these resistant bacteria remain uncertain. Methods Based on antimicrobial consumption and susceptibility data recorded during > 13 years in a Swiss region, we developed a mathematical model to assess the comparative effect of different interventions on the prevalence of colonization. Results Simulated prevalence stabilized in the near future when rates of antimicrobial consumption and in-hospital transmission were assumed to remain stable (2025 prevalence: 6.8% (95CI%:5.4–8.8%) in hospitals, 3.5% (2.5–5.0%) in the community versus 6.1% (5.0–7.5%) and 3.2% (2.3–4.2%) in 2019, respectively). When overall antimicrobial consumption was set to decrease by 50%, 2025 prevalence declined by 75% in hospitals and by 64% in the community. A 50% decline in in-hospital transmission rate led to a reduction in 2025 prevalence of 31% in hospitals and no reduction in the community. The best model fit estimated that 49% (6–100%) of observed colonizations could be attributable to sources other than human-to-human transmission within the geographical setting. Conclusions Projections suggests that overall antimicrobial consumption will be, by far, the most powerful driver of prevalence and that a large fraction of colonizations could be attributed to non-local transmissions.

Introduction: Alcohol‐related brain damage (ARBD) is an umbrella term referring to the neurocognitive impairments caused by excessive and prolonged alcohol use and the associated nutritional deficiencies. This study evaluated the outcomes of an online research‐informed training program for ARBD which aimed to improve client outcomes by promoting support staff's awareness and confidence in working with clients who may have (or who are at risk of developing) the condition. Methods: Staff working within a large non‐governmental non‐profit housing organisation (n = 883) enrolled in the training program. Questionnaires were used pre‐ and post‐training to collect self‐reported awareness of ARBD and confidence in supporting individuals with the condition. Semi‐structured interviews were conducted with 27 staff members approximately 10 weeks post‐completion of the program. Interviews were audio‐recorded, transcribed verbatim and analysed by employing qualitative content analysis. Results: Findings from the questionnaires indicated a significant increase in all measures after completing the training program. Three main themes were developed based on the interview data: changes to awareness and understanding; professional practice; and training‐specific characteristics. Participants reported changes in their ability to identify potential service users with ARBD and confidence in doing so. Discussion and Conclusion: Our findings demonstrate that online training programs can be effective in improving support staff's ability to identify ARBD, potentially leading an increase in signposting service users to relevant services. The research‐informed nature of the training demonstrates that translating research findings directly to frontline workers can have a substantial impact and may improve outcomes for this client group. [ABSTRACT FROM AUTHOR]

Background/objectives: This paper examines hunger over time to analyze how food insecurity is impacted by reduced income, including household funding from the government. Federal policies and community-based programs have the ability to prevent increases in food insecurity, particularly for populations that have risk factors, such as households with children; single-parent households; low-income households, especially those in rural areas; Black and Hispanic households; and, households experiencing economic hardships., Methods: This study is bas ed on a cross-sectional survey that was administered in 2018 and 2019 to food pantry clients, an already food insecure population accessing resources, in Eastern Massachusetts. Baseline surveys were matched with a 3-month follow-up survey ( n = 308) and multinomial logistic mixed effect models were used to analyze the association between change in household hunger and change in household income., Results: This study found that participants who experienced decreased income compared to no income change from baseline to follow-up had 2.16 times the odds (95% CI: 1.05, 4.46) of experiencing increased household hunger compared to no change in hunger from baseline to follow-up, after adjusting for all other covariates., Conclusions: Food insecurity in the United States remained stable during the beginning of COVID-19, despite prevalence of reduced household income. The expanded government benefits that were implemented early in the pandemic contributed to total household income, which prevented increased food insecurity. Increased food insecurity after the removal of benefits starting in 2022 indicates the importance of continuing support established during times when consistent income is compromised to prevent a delayed rise in food insecurity.

Agriculture is one of the most dangerous U.S. occupations with high rates of injuries and fatalities, and especially more dangerous for children, having more young worker deaths than any other industry. Thus, safety education is essential in promoting safe and healthy working habits in agriculture. Augmented reality (AR) technology has great potential to enhance the effectiveness of safety education due to its high levels of system-user interactivity and media enjoyment. This study aims to: (1) develop Augmented Reality Intervention for Safety Education (ARISE), an AR 3D simulator that presents farm accident situations with immersive media technology, (2) examine the feasibility of ARISE, and (3) evaluate the potential of ARISE as an effective agricultural safety education program for farm parents and children. To test the feasibility of ARISE, we conducted semi-structured in-depth interviews with ten parent-child dyads at an extension office located in Maryland. Participants were farmers who owned and operated a family farm(s) with their child or children ages 5–13. The interviews included asking participants questions about their perceptions of farm risks, sources of risk education, and protection methods. In the next step, participants used ARISE with researcher guidance. After using the application, participants were asked questions about their experience using ARISE and suggestions for improvement. The interviews were then transcribed and analyzed following the conventional content analysis method. Three main themes emerged—demand (e.g., perceived risk and need for education; lack of farm safety education from school), acceptability (e.g., attitude toward AR technology; perceived realism; perceived ease of use; perceived usefulness), and implementation. These findings help us understand how an immersive experience can play an impactful role in enhancing agricultural safety. The feasibility of ARISE sheds light on the potential of AR technology for an innovative safety education program.

Background: There is a marked increase in unscheduled care visits in school-aged children with asthma after returning to school in September. This is potentially associated with children not taking their asthma preventer medication during the school summer holidays. A cluster randomised controlled trial (PLEASANT) was undertaken with 1279 school-age children in 141 general practices (71 on intervention and 70 on control) in England and Wales. It found that a simple letter sent from the family doctor during the school holidays to a parent with a child with asthma, informing them of the importance of taking asthma preventer medication during the summer relatively increased prescriptions by 30% in August and reduced medical contacts in the period September to December. Also, it is estimated there was a cost-saving of £36.07 per patient over the year. We aim to conduct a randomised trial to assess if informing GP practices of an evidence-based intervention improves the implementation of that intervention.Methods/design: The TRAINS study-TRial to Assess Implementation of New research in a primary care Setting-is a pragmatic cluster randomised implementation trial using routine data. A total of 1389 general practitioner (GP) practices in England will be included into the trial; 694 GP practices will be randomised to the intervention group and 695 control group of usual care. The Clinical Practice Research Datalink (CPRD) will send the intervention and obtain all data for the study, including prescription and primary care contacts data. The intervention will be sent in June 2021 by postal and email to the asthma lead and/or practice manager. The intervention is a letter to GPs informing them of the PLEASANT study findings with recommendations. It will come with an information leaflet about PLEASANT and a suggested reminder letter and SMS text template.Discussion: The trial will assess if informing GP practices of the PLEASANT trial results will increase prescription uptake before the start of the school year. The hope is that the intervention will increase the implementation of PLEASANT work and then increase prescription uptake during the summer holiday prior to the start of school.Trial Registration: ClinicalTrials.gov ID: NCT05226091. [ABSTRACT FROM AUTHOR]

Background: Providing freely accessible exercise facilities may increase physical activity at a population level. An increasingly popular strategy is outdoor fitness equipment in urban parks. Few studies have evaluated the effectiveness of this intervention in smaller cities. This study examined fitness equipment use, perceived effectiveness, and ways to increase use in a city of 100,000 people in 2015. Methods: Two parks with fitness equipment and 4 without were directly observed. Interviews with 139 adults in active parks or living nearby were also conducted. Results: Only 2.7% of adult park users used the fitness equipment over 100 hours of observation across 3 seasons. In contrast, 22.3% of adults interviewed reported monthly or more use of the equipment, highlighting the limitations of self-report methods. Adults interviewed perceived the equipment as potentially beneficial and suggested strategies to increase public use, including increased advertising, the introduction of programming to teach and encourage use, improved equipment quality, and improved maintenance of the equipment and surrounding area. Conclusions: In a low density city, park fitness equipment may not be an effective public health practice without additional efforts to market, introduce programming, and maintain these sites. [ABSTRACT FROM AUTHOR]