The effect of an Empowerment-Based Human Centered Educational Program on early weaning

Aim: To determine the effects of an Empowerment-Based Human Centered Educational Program on early weaning. Background: Exclusive breastfeeding (EBF) means that the infant receives only breast milk during the first six months of life. It is essential for the healthy growth of the infants and is supported by the main health organizations all around the world. Intervention studies performed within the antenatal period suggest that the education extends the duration of breastfeeding and increases the frequency of EBF. Methods: This is a semi-randomized control study. An interactive training module including role-plays which contain traditional patterns, short films, short presentations, and group practice with models was prepared. The participants were recruited in the study based on the voluntary participation of pregnant women followed up for antenatal care in a total of four family health centers in Pendik, a district of Istanbul. The pregnant women of one center formed the control group while others constituted the intervention group. All of them were certified as “Baby Friendly” institution. A pretest and a posttest have been performed to measure breastfeeding knowledge in the intervention group. The mothers of the intervention group have been randomized into two subgroups: one group for reminder call and the other for routine follow-up. All the participants including control group were called at the end of the postpartum sixth month to determine the rates of EBF. Results: Statistically significant increase in the rates of EBF at the end of six months showed the effectiveness of the education module (42.9 versus 22.2%, P = 0.001). Supplementary food taking time was earlier in the control group (18.5 ± 8 versus 15 ± 9.5 week, P = 0.03). The main reason of early weaning reported by the mothers was “the insufficiency of the mother’s milk.” Conclusion: The group training and postnatal reminders were found to be more effective than the individual training provided at the baby-friendly health institutions in terms of the effectiveness on increasing the frequency of EBF.

Pragmatic randomized trial of a pre-visit intervention to improve the quality of telemedicine visits for vulnerable patients living with HIV

Introduction The COVID-19 pandemic has required a shift of many routine primary care visits to telemedicine, potentially widening disparities in care access among vulnerable populations. In a publicly-funded HIV clinic, we aimed to evaluate a pre-visit phone-based planning intervention to address anticipated barriers to telemedicine. Methods We conducted a pragmatic randomized controlled trial of patients scheduled for a phone-based HIV primary care visit at the Ward 86 HIV clinic in San Francisco from 15 April to 15 May 2020. Once reached by phone, patients were randomized to either have a structured pre-visit planning intervention to address barriers to an upcoming telemedicine visit versus a standard reminder call. The primary outcome was telemedicine visit attendance. Results Of 476 scheduled telemedicine visits, 280 patients were reached by a pre-visit call to offer enrollment. Patients were less likely to be reached if virally unsuppressed (odds ratio (OR) 0.11, 95% confidence intervals (CI) 0.03–0.48), CD4 < 200 (OR 0.24, 95% CI 0.07–0.85), or were homeless (OR 0.24, 95% CI 0.07–0.87). There was no difference between intervention and control in scheduled visit attendance (83% v. 78%, OR 1.38, 95% CI 0.67–2.81). Conclusions A structured phone-based planning call to address barriers to telemedicine in a public HIV clinic was less likely to reach patients with poorly-controlled HIV and patients experiencing homelessness, suggesting additional interventions may be needed in this population to ensure access to telemedicine-based care. Among patients reachable by phone, telemedicine visit attendance was high and not improved with a structured pre-visit intervention, suggesting that standard reminders may be adequate in this population.

When Does Increasing Mobilization Effort Increase Turnout? Evidence from a Field Experiment on Reminder Calls

When does increasing mobilization effort increase turnout? Recent experiments find second calls containing a reminder to vote increase turnout beyond an initial contact. We argue existing studies cannot explain why reminder calls are effective because they test bundled treatments including a late mobilization attempt, a late mobilization attempt given earlier contact, and potentially activating reciprocity established in earlier contact. We report results from a two-round voter mobilization field experiment that allows us to isolate these different mechanisms. We find that reminder calls increase turnout by 1.2% points among subjects contacted in an earlier attempt, but that enhancing reciprocity by providing a reminder call offer during an early call does not increase turnout beyond a second call. Additionally, we fail to find heterogeneous effects of reminder calls by stated preference for a reminder or by stated vote intention, suggesting certain mechanisms do not explain the effects of reminder calls.

Knowledge, Attitude and Practice of Oral Biopsy Procedures among Dental Surgeons Registered with Nepal Dental Association

Background: Oral biopsy procedures are rarely practiced by dental surgeons around the world though they should be able to perform the biopsies for the diagnosis of oral lesions. Our objective was to access the knowledge, attitude and practice of oral biopsy procedures among the dental surgeons who are members of Nepal Dental Association.Methods: A cross sectional study was conducted from December 2018 to March 2019, among the dental surgeons who were registered in Nepal Dental Association till September 2018. A standard pretested questionnaire was prepared using Google forms, was emailed to 374 dental surgeons. Two reminder emails were sent at an interval of 1 month. The non-responding dental surgeons who were reachable through mobile number (N=274) were contacted after the third 3rd email. Out of 274, 10 dental surgeons had completed postgraduation, so 264 of them were included in the study. A reminder call was made after one week. The data was entered in SPSS version 20 software and analyzed using descriptive statistics.Results: There were 160 responses to the emails after the conversation through mobile phone. The response rate was 60.6% with the predominance of female responders (66.9%). Though the majority of dental surgeons (96.2%) had encountered one or the other lesions requiring biopsy, only few of them (7.5%) had performed the biopsy which was mainly due to lack experience and skill (75.6%).Conclusions: Most of the dental surgeon are not comfortable performing biopsy with majority seem to lack expereice and skill. There is need to organize training to Dental Surgeons to enhance their practical skills. Keywords: Dental surgeon; lesion; oral biopsy

Performance Measures Based on How Adults With Cancer Feel and Function: Stakeholder Recommendations and Feasibility Testing in Six Cancer Centers

PURPOSE: Patient-reported outcome measures (PROMs) that assess how patients feel and function have potential for evaluating quality of care. Stakeholder recommendations for PRO-based performance measures (PMs) were elicited, and feasibility testing was conducted at six cancer centers. METHODS: Interviews were conducted with 124 stakeholders to determine priority symptoms and risk adjustment variables for PRO-PMs and perceived acceptability. Stakeholders included patients and advocates, caregivers, clinicians, administrators, and thought leaders. Feasibility testing was conducted in six cancer centers. Patients completed PROMs at home 5-15 days into a chemotherapy cycle. Feasibility was operationalized as ≥ 75% completed PROMs and ≥ 75% patient acceptability. RESULTS: Stakeholder priority PRO-PMs for systemic therapy were GI symptoms (diarrhea, constipation, nausea, vomiting), depression/anxiety, pain, insomnia, fatigue, dyspnea, physical function, and neuropathy. Recommended risk adjusters included demographics, insurance type, cancer type, comorbidities, emetic risk, and difficulty paying bills. In feasibility testing, 653 patients enrolled (approximately 110 per site), and 607 (93%) completed PROMs, which indicated high feasibility for home collection. The majority of patients (470 of 607; 77%) completed PROMs without a reminder call, and 137 (23%) of 607 completed them after a reminder call. Most patients (72%) completed PROMs through web, 17% paper, or 2% interactive voice response (automated call that verbally asked patient questions). For acceptability, > 95% of patients found PROM items to be easy to understand and complete. CONCLUSION: Clinicians, patients, and other stakeholders agree that PMs that are based on how patients feel and function would be an important addition to quality measurement. This study also shows that PRO-PMs can be feasibly captured at home during systemic therapy and are acceptable to patients. PRO-PMs may add value to the portfolio of PMs as oncology transitions from fee-for-service payment models to performance-based care that emphasizes outcome measures.

Comparing Telephone Counseling With Reminding to Promote On-Time Repeated Mammography: A Randomized Trial in a Cohort With 4 Years Follow-Up

Background. Long-term continuous adherence to biennial screening mammograms as guidelines recommend remains low. Limited evidence suggests that reminder calls may increase short-term adherence as much as telephone counseling, but research is needed comparing the long-term effects of these two approaches. Purpose. To compare the impacts of two telephone outreach interventions and mailed reminders on 4-year continuous mammography adherence. Method. A cohort of 3,215 women, age 50 to 81 years, was selected from 30,160 women from a 4-year randomized trial of three interventions to promote biennial mammography: reminder letter only (LO), letter plus reminder call (RC), and two letters plus educational material and a counseling call (CC). Women selected remained eligible for the trial all 4 years and received annual interventions as needed. The proportion with a mammogram in the last 24 months was determined at baseline and four annual time points. Results. Continuous adherence at all four time points was higher in the RC (78.8%) and CC arms (78.8%) than in the LO arm (75.1%; p < .001). Multivariable analysis confirmed this finding: CC (odds ratio = 1.27; 95% confidence interval = [1.01, 1.61]) and RC (odds ratio = 1.23; 95% confidence interval = [0.98, 1.56]). Only 27.8% of women eligible for an initial counseling call actually received counseling. Conclusions. Compared with letters alone, outreach calls can modestly increase continuous mammography adherence among insured women with consistent primary care. Telephone counseling was no more effective than a reminder call, possibly due to limited acceptance of counseling calls by women who may find them unwelcome or unnecessary.

Testimony at court: a randomised controlled trial investigating the art and science of persuading witnesses and victims to attend trial

The presence of civilian witnesses and victims in court is central to the effective operation of the criminal justice system. However, there is evidence of significant non-attendance which can result in ineffective and cracked trials. To address this, West Midlands Police Witness Care Unit and the Behavioural Insights Team designed an intervention using behavioural insight principles consisting of (1) a new conversation guide for Witness Care Officers (WCOs); (2) a redesigned ‘Warning Letter’ confirming details of the proceedings; and (3) a new reminder call and SMS. The impact of the new approach was evaluated through a randomised controlled trial in which 36 WCOs were randomly assigned to either “business as usual” (control) or treatment. The evaluation used an intention-to-treat design with implementation guided and encouraged at several points. Subgroup analysis was undertaken to explore whether differential effects were seen for domestic violence cases or between those that were victims and witnesses. Results indicated that the treatment approach was directionally positive in all cases, but that the increase in attendance was not statistically significant. This is in line with findings of other similar research in this area.

ALTERNATIVE SOLUTION ON THE EXECUTION OF COURT’S VERDICT WITHIN EMPLOYMENT TERMINATION DISPUTE

This paper aims to analyze the juridical barriers of execution of verdict in case of dismissal dispute as well as offering a solution to the execution of such verdict to be carried out so that workers obtain their rights. Through the statute and case approaches, it is concluded that the juridical barriers are: 1) in a reminder implementation, the existing regulation does not authorize the bailiff to force the defendant to attend the reminder call if the defendant refuses to attend the call voluntarily; and 2) in the execution seizure, the goods to be confiscated shall belong to the defendant, whereas the plaintiff can not prove it because all the evidence is in the hands of the employer. While alternative solutions in order the verdict may be executed well are: 1) involving authorized third parties who may assist the worker as a plaintiff to prove the ownership of the items for which the request is for confiscation; and 2) implementing the body's forced effort to an employer with a bad faith in accordance with Supreme Court Regulation No. 1 Year 2000, but by reducing the minimum limit of debt that is not as much as one billion rupiah due to cases of dismssal dispute are less possibility of paying for the workers’ rights who reached that amount.

A 4-year randomized trial comparing three outreach interventions to promote screening mammograms

As population health has become a focus of health care payers and providers, interest has grown in mail, phone, and other forms of outreach for improving population rates of cancer screening. Translational research is needed to compare the effectiveness and cost of low- and high-intensity behavioral outreach interventions for promoting cancer screening. The purpose of the article is to compare the effectiveness in promoting biannual mammograms of three interventions delivered over 4 years to a primary care population with a high baseline mammography adherence of 83.3%. We randomized women aged 40–84 to reminder letter only (LO arm), letter + reminder call (RC arm), and two letters + counseling call (CC arm) involving tailored education and motivational interviewing. Mammography adherence (≥1 mammogram in the previous 24 months) at four time points was determined from insurance claims records. Over 4 years, 30,162 women were randomized. At the end of 4 years, adherence was highest in the RC arm (83.0%) compared with CC (80.8%) and LO (80.8%) arms (p = .03). Only 23.5% of women in the CC arm were reached and accepted full counseling. The incremental cost per additional mammogram for RC arm women was $30.45 over the LO arm cost. A simple reminder call can increase screening mammogram adherence even when baseline adherence is high. Some more complex behavioral interventions delivered by mail and phone as in this study may be less effective, due to limited participation of patients, a focus on ambivalence, lack of follow-up, and other factors.