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BMC Public Health Jul 2023State-based Guidelines were issued for Early Childhood Education and Care (ECEC) services (caring for children 0-6 years) recommending greater time outdoors and... (Randomized Controlled Trial)
Randomized Controlled Trial
The impact of an e-newsletter or animated video to disseminate outdoor free-play information in relation to COVID-19 guidelines in New South Wales early childhood education and care services: a randomised controlled trial.
BACKGROUND
State-based Guidelines were issued for Early Childhood Education and Care (ECEC) services (caring for children 0-6 years) recommending greater time outdoors and inclusion of indoor-outdoor programs to facilitate social distancing to reduce spread of COVID-19. The aim of this 3-arm randomised controlled trial (RCT) was to examine the impact of different dissemination strategies on increasing ECEC service intentions to adopt recommendations from the Guidelines.
METHODS
This was a post-intervention only RCT. A sample of eligible ECEC services in New South Wales (n = 1026) were randomly allocated to one of three groups; (i) e-newsletter resource; (ii) animated video resource; or (iii) control (standard email). The intervention was designed to address key determinants of guideline adoption including awareness and knowledge. Following delivery of the intervention in September 2021, services were invited to participate in an online or telephone survey from October-December 2021. The primary trial outcome was the proportion of services intending to adopt the Guidelines, defined as intention to; (i) offer an indoor-outdoor program for the full day; or (ii) offer more outdoor play time. Secondary outcomes included awareness, reach, knowledge and implementation of the Guidelines. Barriers to Guideline implementation, cost of the dissemination strategies and analytic data to measure fidelity of intervention delivery were also captured.
RESULTS
Of the 154 services that provided post-intervention data, 58 received the e-newsletter (37.7%), 50 received the animated video (32.5%), and 46 received the control (29.9%). Services who received the animated video had nearly five times the odds (OR: 4.91 [1.03, 23.34] p = 0.046) than those in the control group, to report having intentions to adopt the Guidelines. There were no statistically significant differences in awareness or knowledge of the Guidelines between either intervention or control services. Development costs were greatest for the animated video. The extent to which the dissemination strategy was viewed in full, were similar for both the e-newsletter and animated video.
CONCLUSION
This study found potential for the inclusion of interactive strategies to disseminate policy and guideline information within the ECEC setting, in the context of the need for rapid communication. Further research should explore the added benefits of embedding such strategies within a multi-strategy intervention.
TRIAL REGISTRATION
Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on the 23/02/2023 (ACTRN 12,623,000,198,628).
Topics: Child; Child, Preschool; Humans; New South Wales; COVID-19; Australia; Communication; Communications Media
PubMed: 37420179
DOI: 10.1186/s12889-023-16177-7 -
Indian Journal of Dermatology 2024We retrospectively analyzed the clinical data of 1 case of disseminate and recurrent infundibular folliculitis (DRIF) in our hospital and 31 cases of DRIF reported in...
We retrospectively analyzed the clinical data of 1 case of disseminate and recurrent infundibular folliculitis (DRIF) in our hospital and 31 cases of DRIF reported in previous domestic and international studies. There were 32 cases, including 22 males and 10 females, with a mean age of onset of 24.72 ± 13.68 years. Skin lesions were more likely to occur on the trunk and proximal extremities and may involve the face, neck, and genitals. Typical histopathology revealed mild thickening and spongy edema of the spinous layer, different degrees of pigmentation increase in the basal layer, and mild to moderate spongy edema and inflammatory cell infiltration (predominantly lymphocytes and neutrophils) in the infundibulum and around the hair follicle. DRIF is a chronic disease more prevalent in young men of African descent and individuals with Fitzpatrick skin types 4-6. This disease is diagnosed based on clinical features and histopathology and is preferentially treated with retinoids.
PubMed: 38572033
DOI: 10.4103/ijd.ijd_695_23 -
Medical Humanities Dec 2023Arthur Conan Doyle's medical and writing careers intertwined and his work has a history of being read in the light of his medical expertise. He wrote at a time when the...
Arthur Conan Doyle's medical and writing careers intertwined and his work has a history of being read in the light of his medical expertise. He wrote at a time when the professionalisation and specialisation of medicine had resulted in an increasing distance between the profession and the public, yet general practitioners relied financially on maintaining good relationships with their patients and popular medical journalism proliferated. A variety of contrasting voices often disseminated narratives of medical science. These conflicting developments raised questions of authority and expertise in relation to the construction of medicine in the popular imagination: how is knowledge constructed? Who should disseminate it? How and by whom is authority conferred? How can the general population judge experts in medical science? These are questions explored more widely in Conan Doyle's writing as he examines the relationship between expertise and authority. In the early 1890s, Conan Doyle wrote for the popular, mass-market periodical His contributions to it address these questions of authority and expertise for a lay audience. First establishing the medical context of doctor/patient relationships in which these questions arose, this article undertakes a close reading of these mostly rarely studied single-issue stories and articles as a means of ascertaining how Conan Doyle and his illustrators identified the relationship between competing narratives, expertise and authority. It argues that rather than maintaining a distance between public and professional, Conan Doyle's illustrated work demonstrates to his readers that there are ways to successfully navigate the appearance of authority and recognise expertise as they confront entangled representations of advances in medical science.
Topics: Male; Humans; Literature, Modern; Medicine; Medicine in Literature; Knowledge; Physician-Patient Relations
PubMed: 37142410
DOI: 10.1136/medhum-2022-012491 -
Human Vaccines & Immunotherapeutics Dec 2024Dengvaxia is the first dengue vaccine recommended in the United States (U.S.). It is recommended for children aged 9-16 y with laboratory-confirmed previous dengue...
Dengvaxia is the first dengue vaccine recommended in the United States (U.S.). It is recommended for children aged 9-16 y with laboratory-confirmed previous dengue infection and living in areas where dengue is endemic. We conducted focus groups with parents and in-depth interviews with key informants (i.e. practicing pediatricians, physicians from immunization clinics, university researchers, and school officials) in Puerto Rico (P.R.) to examine acceptability, barriers, and motivators to vaccinate with Dengvaxia. We also carried out informal meetings and semi-structured interviews to evaluate key messages and educational materials with pediatricians and parents. Barriers to vaccination included lack of information, distrust toward new vaccines, vaccine side effects and risks, and high cost of/lack of insurance coverage for laboratory tests and vaccines. Motivators included clear information about the vaccine, a desire to prevent future dengue infections, the experience of a previous dengue infection or awareness of dengue fatality, vaccine and laboratory tests covered by health insurance, availability of rapid test results and vaccine appointments. School officials and parents agreed parents would pay a deductible of $5-20 for Dengvaxia. For vaccine information dissemination, parents preferred an educational campaign through traditional media and social media, and one-on-one counseling of parents by healthcare providers. Education about this vaccine to healthcare providers will help them answer parents' questions. Dengvaxia acceptability in P.R. will increase by addressing motivators and barriers to vaccination and by disseminating vaccine information in plain language through spokespersons from health institutions in P.R.
Topics: Child; Humans; Dengue; Dengue Vaccines; Parents; Puerto Rico; United States; Vaccination; Vaccines; Adolescent
PubMed: 38599678
DOI: 10.1080/21645515.2024.2323264 -
Nature Communications Aug 2023Infections caused by metallo-beta-lactamase-producing organisms (MBLs) are a global health threat. Our understanding of transmission dynamics and how MBLs establish...
Infections caused by metallo-beta-lactamase-producing organisms (MBLs) are a global health threat. Our understanding of transmission dynamics and how MBLs establish endemicity remains limited. We analysed two decades of bla evolution in a hospital using sequence data from 270 clinical and environmental isolates (including 169 completed genomes) and identified the bla gene across 7 Gram-negative genera, 68 bacterial strains and 7 distinct plasmid types. We showed how an initial multi-species outbreak of conserved IncC plasmids (95 genomes across 37 strains) allowed endemicity to be established through the ability of bla to disseminate in successful strain-genetic setting pairs we termed propagators, in particular Serratia marcescens and Enterobacter hormaechei. From this reservoir, bla persisted through diversification of genetic settings that resulted from transfer of bla plasmids between bacterial hosts and of the integron carrying bla between plasmids. Our findings provide a framework for understanding endemicity and spread of MBLs and may have broader applicability to other carbapenemase-producing organisms.
Topics: Integrons; beta-Lactamases; Bacterial Proteins; Plasmids; Serratia marcescens; Carbapenems; Genomics; Microbial Sensitivity Tests; Anti-Bacterial Agents
PubMed: 37553339
DOI: 10.1038/s41467-023-39915-2 -
Cancer Letters Jun 2024Tumor cells disseminate in various distant organs at early stages of cancer progression. These disseminated tumor cells (DTCs) can stay dormant/quiescent without causing... (Review)
Review
Tumor cells disseminate in various distant organs at early stages of cancer progression. These disseminated tumor cells (DTCs) can stay dormant/quiescent without causing patient symptoms for years or decades. These dormant tumor cells survive despite curative treatments by entering growth arrest, escaping immune surveillance, and/or developing drug resistance. However, these dormant cells can reactivate to proliferate, causing metastatic progression and/or relapse, posing a threat to patients' survival. It's unclear how cancer cells maintain dormancy and what triggers their reactivation. What are better approaches to prevent metastatic progression and relapse through harnessing cancer dormancy? To answer these remaining questions, we reviewed the studies of tumor dormancy and reactivation in various types of cancer using different model systems, including the brief history of dormancy studies, the intrinsic characteristics of dormant cells, and the external cues at the cellular and molecular levels. Furthermore, we discussed future directions in the field and the strategies for manipulating dormancy to prevent metastatic progression and recurrence.
Topics: Humans; Neoplasms; Animals; Neoplasm Metastasis; Tumor Microenvironment; Disease Progression; Signal Transduction; Neoplasm Recurrence, Local; Cell Proliferation
PubMed: 38649107
DOI: 10.1016/j.canlet.2024.216899 -
The Journal of Mental Health Policy and... Dec 2023In the US, much of the research into new intervention and delivery models for behavioral health care is funded by research institutes and foundations, typically through... (Review)
Review
BACKGROUND
In the US, much of the research into new intervention and delivery models for behavioral health care is funded by research institutes and foundations, typically through grants to develop and test the new interventions. The original grant funding is typically time-limited. This implies that eventually communities, clinicians, and others must find resources to replace the grant funding -otherwise the innovation will not be adopted. Diffusion is challenged by the continued dominance in the US of fee-for-service reimbursement, especially for behavioral health care.
AIMS
To understand the financial challenges to disseminating innovative behavioral health delivery models posed by fee-for-service reimbursement, and to explore alternative payment models that promise to accelerate adoption by better addressing need for flexibility and sustainability.
METHODS
We review US experience with three specific novel delivery models that emerged in recent years. The models are: collaborative care model for depression (CoCM), outpatient based opioid treatment (OBOT), and the certified community behavioral health clinic (CCBHC) model. These examples were selected as illustrating some common themes and some different issues affecting diffusion. For each model, we discuss its core components; evidence on its effectiveness and cost-effectiveness; how its dissemination was funded; how providers are paid; and what has been the uptake so far.
RESULTS
The collaborative care model has existed for longest, but has been slow to disseminate, due in part to a lack of billing codes for key components until recently. The OBOT model faced that problem, and also (until recently) a regulatory requirement requiring physicians to obtain federal waivers in order to prescribe buprenorphine. Similarly, the CCBHC model includes previously nonbillable services, but it appears to be diffusing more successfully than some other innovations, due in part to the approach taken by funders.
DISCUSSION
A common challenge for all three models has been their inclusion of services that were not (initially) reimbursable in a fee-for-service system. However, even establishing new procedure codes may not be enough to give providers the flexibility needed to implement these models, unless payers also implement alternative payment models.
IMPLICATIONS FOR HEALTH CARE PROVISION AND USE
For providers who receive time-limited grant funding to implement these novel delivery models, one key lesson is the need to start early on planning how services will be sustained after the grant ends.
IMPLICATIONS FOR HEALTH POLICY
For research funders (e.g., federal agencies), it is clearly important to speed up the process of obtaining coverage for each novel delivery model, including the development of new billable service codes, and to plan for this as early as possible. Funders also need to collaborate with providers early in the grant period on sustainability planning for the post-grant environment. For payers, a key lesson is the need to fold novel models into stable existing funding streams such as Medicaid and commercial insurance coverage, rather than leaving them at the mercy of revolving time-limited grants, and to provide pathways for contracting for innovations under new payment models.
IMPLICATIONS FOR FURTHER RESEARCH
For researchers, a key recommendation would be to pay greater attention to the payment environment when designing new delivery models and interventions.
Topics: United States; Humans; Fee-for-Service Plans; Medicaid; Ambulatory Care Facilities
PubMed: 38113385
DOI: No ID Found -
Journal of Bone Oncology Feb 2024Epigenetic alterations, including DNA methylation and post translational modifications to histones, drive tumorigenesis and metastatic progression. In the context of...
Epigenetic alterations, including DNA methylation and post translational modifications to histones, drive tumorigenesis and metastatic progression. In the context of bone metastasis, epigenetic modifications in tumor cells can modulate dissemination of cancer cells to the bone, tumor progression in the bone marrow, and may be associated with patient survival rates. Bone disseminated tumor cells may enter a dormant state or stimulate osteolysis through the "vicious cycle" of bone metastasis where bone disseminated tumor cells disrupt the bone microenvironment, which fuels tumor progression. Epigenetic alterations may either exacerbate or abrogate the vicious cycle by regulating tumor suppressors and oncogenes, which alter proliferation of bone-metastatic cancer cells. This review focuses on the specific epigenetic alterations that regulate bone metastasis, including DNA methylation, histone methylation, and histone acetylation. Here, we summarize key findings from researchers identifying epigenetic changes that drive tumor progression in the bone, along with pre-clinical and clinical studies investigating the utility of targeting aberrant epigenetic alterations to treat bone metastatic cancer.
PubMed: 38304486
DOI: 10.1016/j.jbo.2024.100524 -
BMJ Open Dec 2023Four years after the devastating Ebola outbreak, governments in West Africa were quick to implement non-pharmaceutical interventions (NPIs) in response to the rapid...
INTRODUCTION
Four years after the devastating Ebola outbreak, governments in West Africa were quick to implement non-pharmaceutical interventions (NPIs) in response to the rapid spread of SARS-CoV-2. The NPIs implemented included physical distancing, closure of schools and businesses, restrictions on public gatherings and mandating the use of face masks among others. In the absence of widely available vaccinations, NPIs were the only known means to try to slow the spread of COVID-19. While numerous studies have assessed the effectiveness of these NPIs in high-income countries, less is known about the processes that lead to the adoption of policies and the factors that influence their implementation and adherence in low-income and middle-income countries. The objective of this scoping review is to understand the extent and type of evidence in relation to the policy formulation, decision-making and implementation stages of NPIs in West Africa.
METHODS AND ANALYSIS
A scoping review will be undertaken following the guidance developed by Arskey and O'Malley, the Joanna Briggs Institute (JBI) methodology for scoping reviews and the PRISMA guidelines for Scoping Reviews. Both peer-reviewed and grey literature will be searched using Web of Science, Embase, Scopus, APA PsycInfo, WHO Institutional Repository for Information Sharing, JSTOR and Google Advanced Search, and by searching the websites of the WHO, and the West African Health Organisation. Screening will be conducted by two reviewers based on inclusion and exclusion criteria, and data will be extracted, coded and narratively synthesised.
ETHICS AND DISSEMINATION
We started this scoping review in May 2023, and anticipate finishing by April 2024. Ethics approval is not required since we are not collecting primary data. This protocol was registered at Open Science Framework (https://osf.io/gvek2/). We plan to disseminate this research through publications, conference presentations and upcoming West African policy dialogues on pandemic preparedness and response.
Topics: Humans; COVID-19; SARS-CoV-2; Pandemics; Academies and Institutes; Africa, Western; Research Design; Systematic Reviews as Topic; Review Literature as Topic
PubMed: 38072480
DOI: 10.1136/bmjopen-2023-079810 -
JMIR MHealth and UHealth Jan 2024Among the millions of mobile apps in existence, thousands fall under the category of mobile health (mHealth). Although the utility of mHealth apps has been demonstrated...
BACKGROUND
Among the millions of mobile apps in existence, thousands fall under the category of mobile health (mHealth). Although the utility of mHealth apps has been demonstrated for disease diagnosis, treatment data management, and health promotion strategies, to be effective they must reach and be used by their target audience. An appropriate marketing strategy can ensure that apps reach potential users and potentially convert them to actual users. Such a strategy requires definitions of target end users, communication channels, and advertising content, as well as a timeline for effectively reaching and motivating end users to adopt and maintain engagement with the mHealth app.
OBJECTIVE
The aim of this study was to identify strategies and elements that ensure that end users adopt and remain engaged with mHealth apps.
METHODS
A systematic search of the PubMed, PsycINFO, Scopus, and CINAHL databases was conducted for suitable studies published between January 1, 2018, and September 30, 2022. Two researchers independently screened studies for inclusion, extracted data, and assessed the risk of bias. The main outcome was dissemination strategies for mHealth apps.
RESULTS
Of the 648 papers retrieved from the selected databases, only 10 (1.5%) met the inclusion criteria. The marketing strategies used in these studies to inform potential users of the existence of mHealth apps and motivate download included both paid and unpaid strategies and used various channels, including social media, emails, printed posters, and face-to-face communication. Most of the studies reported a combination of marketing concepts used to advertise their mHealth apps. Advertising messages included instructions on where and how to download and install the apps. In most of the studies (6/10, 60%), instructions were oriented toward how to use the apps and maintain engagement with a health intervention. The most frequently used paid marketing platform was Facebook Ads Manager (2/10, 20%). Advertising performance was influenced by many factors, including but not limited to advertising content. In 1 (10%) of the 10 studies, animated graphics generated the greatest number of clicks compared with other image types. The metrics used to assess marketing strategy effectiveness were number of downloads; nonuse rate; dropout rate; adherence rate; duration of app use; and app usability over days, weeks, or months. Additional indicators such as cost per click, cost per install, and clickthrough rate were mainly used to assess the cost-effectiveness of paid marketing campaigns.
CONCLUSIONS
mHealth apps can be disseminated via paid and unpaid marketing strategies using various communication channels. The effects of these strategies are reflected in download numbers and user engagement with mHealth apps. Further research could provide guidance on a framework for disseminating mHealth apps and encouraging their routine use.
Topics: Humans; Advertising; Benchmarking; Communication; Databases, Factual; Mobile Applications; Telemedicine
PubMed: 38180796
DOI: 10.2196/50293