Evaluation of pilot implementation of seasonal malaria chemoprevention on morbidity in young children in Northern Sahelian Ghana

Background In Sahelian Africa, the risk of malaria increases with the arrival of the rains, particularly in young children. Following successful trials, the World Health Organization (WHO) recommended the use of seasonal malaria chemoprevention (SMC) in areas with seasonal peak in malaria cases. This study evaluated the pilot implementation of SMC in Northern Ghana. Methods Fourteen communities each serving as clusters were selected randomly from Lawra District of Upper West Region as intervention area and West Mamprusi District in the Northern Region as the non-intervention area. The intervention was undertaken by the National Malaria Control Programme in collaboration with regional health directorates using sulfadoxine-pyrimethamine plus amodiaquine and standard WHO protocols. Before and after surveys for malaria parasitaemia and haemoglobin levels as well as monitoring for malaria morbidity and mortality were undertaken. Results At the end of the intervention, participant retention was 92.9% (697/731) and 89.5% (634/708) in the intervention and the non-intervention areas, respectively. The proportion of children with asexual parasites reduced by 19% (p = 0.000) in the intervention and increased by 12% (p = 0.000) in the non-intervention area. Incidence rates of severe malaria were 10 and 20 per 1000 person-years follow up in the intervention and comparison areas, respectively with P.E of 45% (p = 0.62). For mild malaria, it was 220 and 170 per 1000 person-years in intervention and comparison area, respectively with PE of - 25% (p = 0.31). The proportion of children with anaemia defined as Hb< 11.0 g/dl reduced from 14.2% (52.8–38.6%) in the intervention area as compared to an increase of 8.1% (54.5% to 62.6) the non-intervention arm, Mean Hb reduced by 0. 24 g/dl (p = 0.000) in the non-intervention area and increased of 0.39 g/dl (p = 000) in the intervention area. Conclusions The feasibility and effectiveness of SMC introduction in Northern Ghana was demonstrated as evidenced by high study retention, reduction in malaria parasitaemia and anaemia during the wet season.

Digital Technologies for Mental Health Improvements in the COVID-19 Pandemic: Systematic Review (Preprint)

BACKGROUND Digital technologies have been used to support mental health services for two decades, but the COVID-19 pandemic creates a unique opportunity for greater utilization and more data-driven assessment of these digital technologies. OBJECTIVE This research aims to provide a systematic review of the characteristics and effectiveness of digital inventions that were employed to improve mental health in the real context of COVID-19 pandemic. METHODS A combination of search terms was applied for automatic search of publications in the relevant databases. The key features of included studies were extracted, including the intervention, participant, and study details. RESULTS A total of 14 eligible studies were included in the final review, which were conducted across different geographic regions and among diverse cultural groups. Ten studies mainly examined the impact of digital technologies on healthy individuals, while only one study developed specific interventions for the isolated COVID-19 depressed patients in hospitals. Digital technologies identified in this study mainly include web-based interventions, smartphone or social media applications such as SMS messages, mobile games, and even video conferencing app. But only five of them were aligned with theoretical approaches from standardized psychological treatments. Most of the studies have reported positive effects of digital technologies, either on improving general mental and emotional well-being or addressing specific conditions (e.g., depression, loneliness). CONCLUSIONS This systematic review suggests that digital technologies hold promise in bridging the mental health-care gap during and after the COVID-19 pandemic, and calls for more rigorous studies to identify pertinent features that are likely to achieve more effective mental health outcomes.

Effect of Xylitol Chewing Gum on Presence of Streptococcus mutans in Saliva

BACKGROUND: Oral disease ranks third among the most serious diseases in the world, after cancer and cardiovascular disease. Vietnamese population has suffered from various dental and oral diseases, of which the most common have been identified to be cavities and inflammation around the teeth. AIM: The aim of the study was to evaluate the effectiveness of using xylitol gum on the status of Strepptococus mutans bacteria in saliva. METHODS: The study design was an uncontrolled clinical study conducted at the Hanvinco Texture Factory (Hanoi). Two hundred and fifty-four subjects between the ages of 18 and 63 were included in the clinical trial. These subjects brushed their teeth for 2 weeks before providing a saliva sample for S. mutans. The 80 subjects with the highest number of salivary S. mutans were recruited for the further analysis (at least 104 CFU/ml). After each clinical intervention, participant chewed Lotte xylitol gum after each meal, two capsules each time and 1 time in the evening (total 4 times/day), continuously for 4 weeks. Saliva samples were quantified for S. mutans by real-time PCR method. RESULTS: Quantitative analysis of S. mutans bacteria in saliva of 254 subjects showed that 19.7% had S. mutans detected within 105 CFU/ml of saliva. These result shows that nearly 20% of the subjects examined have a high risk of tooth decay. After continuous use of xylitol chewing gum 4 times a day for 4 weeks by 80 subjects, it showed a decrease in the number of S. mutans in the saliva of participants, and the difference was statistically significant. CONCLUSIONS: The use of xylitol chewing gum taken 4 times/day is effective in reducing the number of S. mutans bacteria in saliva when combined with brushing your teeth.

Using a Critical Safety Behavior Scoring Tool for Just-in-Time Training for N95 Respirator Use

Background Historically, health care workers (HCWs) have exhibited marginal adherence to proper N95 respirator use. During the COVID-19 pandemic, HCWs with little to no prior training on N95 respirator use are relying on N95s as their primary respiratory protection. There is a need for simple, effective, and easily implementable just-in-time training (JITT) interventions to improve N95 respirator-related safety behavior. This study investigated two JITT interventions. Methods A pilot experimental pretest posttest study design was used to evaluate two training interventions for N95 respirator donning/doffing performance at a Midwestern hospital system. HCW participants were randomly assigned to an intervention: one used a 4-minute instructional video alone, while the other used the same video but added a video reflection intervention (participant watched and scored a video of their own performance). All performances were scored using a 10-point Critical Safety Behavior Scoring Tool (CSBST). Findings Sixty-two HCWs participated (32 video alone, 30 video reflection). The two groups’ CSBST scores were not significantly different at pretest. Averaged participant scores on the CSBST improved immediately following both interventions. Scores were significantly higher on the posttest for the reflective practice intervention ( p<.05). Years of experience and frequency of N95 respirator use did not predict pre or post scores. Conclusions/Applications to Practice We provide evidence to support the use of a time-efficient JITT intervention to improve HCW N95 respirator donning/doffing practices during the COVID-19 pandemic and beyond. Hospital safety professionals should consider this type of training for HCWs required to wear respiratory protection.

Benefits of Mindfulness Professional Development for Elementary Teachers

Using an embedded quasi-experimental mixed-method approach, this exploratory study aimed to understand the benefits of mindfulness training for elementary school teachers and leaders in one rural school district. After the delivery of two 90-minute mindfulness professional developments with on-the-job practice of strategies over 2 weeks, quantitative statistical comparisons of the intervention and inactive control groups were made using survey results from the Mindfulness in Teaching Scale (Frank et al., 2016). Qualitative analyses used intervention participant journal entry responses along with one-on-one interviews. After analyses, the results suggest mindfulness training can benefit teachers, specifically in the use of intrapersonal mindfulness practices, reshaping daily interactions with students, and reducing stress.

A short-term evaluation of a prototype disposable Oscillating Positive Expiratory Pressure (OPEP) device in a cohort of children with cystic fibrosis

Background Oscillating Positive Expiratory Pressure (OPEP) devices are important adjuncts to airway clearance therapy in patients with cystic fibrosis (CF). Current devices are typically reusable and require daily, or often more frequent, cleaning to prevent risk of infection by acting as reservoirs of potentially pathogenic organisms. In response, a daily disposable OPEP device, the UL-OPEP, was developed to mitigate the risk of contamination and eliminate the burdensome need for cleaning devices. Methods A convenience sample of 36 participants, all current OPEP device users, was recruited from a paediatric CF service. For one month, participants replaced their current OPEP device with a novel daily disposable device. Assessment included pre- and post-intervention lung function by spirometry, as well as Lung Clearance Index. Quality of life was assessed using the Cystic Fibrosis Questionnaire – Revised, while user experience was evaluated with a post-study survey. Results 31 participants completed the study: 18 males; median age 10 years, range 4–16 years. Lung function (mean difference ± SD, %FEV1 = 1.69 ± 11.93; %FVC = 0.58 ± 10.04; FEV1: FVC = 0.01 ± 0.09), LCI (mean difference ± SD, 0.08 ± 1.13), six-minute walk test, and CFQ-R were unchanged post-intervention. Participant-reported experiences of the device were predominantly positive. Conclusions The disposable OPEP device maintained patients’ lung function during short term use (≤ 1 month), and was the subject of positive feedback regarding functionality while reducing the risk of airway contamination associated with ineffective cleaning. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).

The effectiveness of a formal curriculum in teaching mass casualty management

Objective: To improve knowledge, skills, and confidence in mass casualty management through design and implementation of a formal educational curriculum.Design: Observational study using a mixed-methods formal educational training curriculum. Setting: Rural Emergency Medical Services (EMS) system in Pennsylvania. Subjects/participants: Convenience sample of 141 licensed EMS providers.Interventions: Formal educational curriculum using a computerized mass casualty scenario, lectures, hands-on skill stations, post-intervention participant satisfaction survey, knowledge retention at three- and six-month post curriculum.Results: The formal curriculum resulted in an improvement in scene size-up, incident command system (ICS) set-up, and medical management of 12 percent, 27 percent, and 26 percent, respectively. Average scores on the written component evaluating mass casualty incident (MCI) management and knowledge of test patient triage were 84 percent and 74 percent, respectively. Knowledge recall at three- and six-month post-training was highly retained as test scores were generally unchanged from the time of the educational session. Course and instructor evaluations by participants reflected a high degree of satisfaction (scoring five on a five-point Likert scale).Conclusions: The formal curriculum was effective in improving the knowledge, skills, and confidence of mass casualty management. Although traditional educational methods tend to show decreases in long-term knowledge retention, the mixed active learning strategies used in this curriculum resulted in high level retention since short and long-term test scores were similar and unchanged over time. Additionally, this curriculum was perceived by participants as highly satisfactory toward their knowledge and skill development.

Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis

Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0–8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.

Canadian after-school care providers’ perceived role promoting healthy lifestyles: A focused ethnography

BACKGROUND: After-school care (ASC) programs have garnered interest in recent years as the hours of 3:00–6:00p.m. are an opportune time for children to engage in healthy behaviours, specifically healthy eating (HE) and physical activity (PA). Care providers are major influencers within the ASC setting, impacting HE and PA opportunities for children. However, little is known regarding the role care providers play in health promotion interventions in the ASC setting, specifically those using comprehensive approaches. The purpose of this research was to explore care providers’ perceptions and experiences implementing the ASC health promotion intervention School’s Out…Let’s Move (SOLMo). SOLMo was guided by the evidence-based comprehensive school health (CSH) framework, and included a focus on HE and PA. METHODS: This research was guided by the qualitative method focused ethnography. Semi-structured interviews with care providers (n=13) taking part in SOLMo were conducted to explore their perceptions of the intervention. Participant observation was included as part of data generation to further understand care providers’ roles. RESULTS: Through latent content analysis, five themes emerged: 1) enhanced awareness; 2) improved programming; 3) strong relationships; 4) collaborative approach; and 5) role tension. CONCLUSIONS: As major influencers, care providers’ play a crucial role, and these results will contribute to implementation strategies used to promote healthy lifestyle behaviours for children.

Attitude of Gratitude: Evaluation of a Wellness Program to Improve Dispositional Gratitude Among Medical Students

Introduction: Medical students face significant mental health challenges as they matriculate through medical training. Research has emphasized the need for more interventions that promote physician trainee well-being and resilience during the early stages of training. Recent interventions have shown to be effective in promoting mental health and well-being; however, no interventions have examined the impact that daily gratitude practice, which is linked to increased well-being, may have on dispositional gratitude levels among medical students. Methods: In Spring 2019, medical students at the University of South Florida were invited to participate in a gratitude program. Participants logged three good things that happened to them each day, for a period of 30 days. Their dispositional gratitude levels were assessed using the short-form Gratitude Resentment and Application Test (GRAT) before and after the 30-day intervention. Participant demographics and changes in GRAT scores from baseline to follow-up were examined. Results: Forty-six medical students volunteered to participate in a short-term, gratitude-focused wellness program. Overall levels of dispositional gratitude increased significantly among medical students (p<.001). While a significant increase in GRAT score was found among the thirty-five female participants (p<.001), no significant change was found among the eleven male participants (p=.154). GRAT scores increased significantly among both first- and second-year medical students (p=.001). However, no significant increases were reported among third- and fourth-year students (p=.109). GRAT scores increased significantly regardless of whether students used a tool to practice gratitude at baseline. Conclusion: Our results demonstrate that a 30-day gratitude practice program can improve dispositional gratitude among medical students, particularly among female students and pre-clinical students in years one and two.