Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-30 (of 523 Records) |
Query Trace: Peer K [original query] |
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Informing digital programs for lupus self-management education: A systematic scoping review
Carpenter K , Gilman S , French M , Shakur Y , Dunlop-Thomas C , Cullerton L , Drenkard C , Barbour KE , Lim SS . Arthritis Care Res (Hoboken) 2024 OBJECTIVE: We describe the characteristics, content, and effectiveness of digital self-management (SM) education programs for lupus and other chronic conditions to identify gaps and inform the improvement of future programs in lupus. METHODS: Three bibliographic databases were searched for articles published between May 2012 and April 2022. The search was cast to capture the breadth of digital SM education programs in the following conditions: lupus, epilepsy, fibromyalgia, multiple sclerosis, sickle cell anemia, Sjogren's syndrome, psoriatic arthritis, and rheumatoid arthritis. Title and abstract screening, as well as full-text review, was conducted by two independent reviewers. Data extraction was first completed by one author charting all studies and then, a second time, by four members of the research team charting collaboratively. RESULTS: Of the 1,969 articles identified through the search, 14 met inclusion criteria. Two additional articles were included following bibliography review. The 16 articles represented 12 unique digital SM education programs. Programs covered five conditions: epilepsy (n=3), fibromyalgia (n=2), multiple sclerosis (n=4), lupus (n=1), and rheumatoid arthritis (n=2). Most programs were asynchronous and internet-based (n=9) with a prescribed sequence of content (n=8). Peer, technical, or specialist support was offered in seven programs. Most programs demonstrated statistically significant improvement of symptoms in the intervention group (n=8). CONCLUSION: This scoping review summarizes the current landscape for digital SM education programs in lupus and similar conditions. In lupus, further investigation will fill in the gaps around digital SM education needs, user experience and evaluation of outcomes. |
Identifying best practices for increasing HIV pre-exposure prophylaxis (PrEP) use and persistence in the United States: A systematic review
Kamitani E , Higa DH , Crepaz N , Wichser M , Mullins MM . AIDS Behav 2024 A qualitative systematic review was conducted to evaluate pre-exposure prophylaxis (PrEP) interventions, describe characteristics of best practices for increasing PrEP use and persistence, and explore research gaps based on current PrEP interventions. We searched CDC's Prevention Research Synthesis (PRS) Project's cumulative HIV database (includes CINAHL, EMBASE, Global Health, MEDLINE, PsycInfo, and Sociological Abstracts) to identify PrEP intervention studies conducted in the U.S., published between 2000 and 2022 (last searched January 2023). Eligibility criteria include studies that evaluated PrEP interventions for persons testing negative for HIV infection, or for healthcare providers who prescribed PrEP; included comparisons between groups or pre/post; and reported at least one relevant PrEP outcome. Each eligible intervention was evaluated on the quality of study design, implementation, analysis, and strength of evidence (PROSPERO registration number: CRD42021256460). Of the 26 eligible interventions, the majority were focused on men who have sex with men (n = 18) and reported PrEP adherence outcomes (n = 12). Nine interventions met the criteria for Best Practices (i.e., evidence-based interventions, evidence-informed interventions). Five were digital health interventions while two implemented individual counseling, one offered motivational interviewing, and one provided integrated medical care with a PrEP peer navigator. Longer intervention periods may provide more time for intervention exposure to facilitate behavioral change, and engaging the community when developing, designing and implementing interventions may be key for effectiveness. For digital health interventions, two-way messaging may help participants feel supported. Research gaps included a lack of Best Practices for several populations (e.g., Black persons, Hispanic/Latino persons, persons who inject drugs, and women of color) and evidence for various intervention strategies (e.g., interventions for promoting provider's PrEP prescription behavior, peer support). These findings call for more collaborative work with communities to develop interventions that work and implement and disseminate Best Practices for increasing PrEP use and persistence in communities. |
The OCCHLTH mnemonic-construction and content of a tool for increasing awareness of occupational illness and injury
Pandalai SP . J Occup Environ Med 2024 66 (5) 403-420 INTRODUCTION: Unidentified or nonmitigated occupational illnesses and injuries can complicate disease management. The "occupational health" (OCCHLTH) mnemonic aims to raise awareness of work-related exposures and associated illnesses and injuries. METHODS: Occupational safety and health history-taking elements were combined with peer-reviewed information [from the PubMed database (first review January 1, 2000, to February 8, 2016; updated to February 8, 2021)] about workplace exposure-outcome associations to create the mnemonic. RESULTS: Seven components constitute the OCCHLTH mnemonic. Literature results support its categories and subcategories. Three components represent symptom onset and health conditions. Four represent occupational exposures. Evaluating published occupational illness cases explored mnemonic applicability. CONCLUSIONS: Awareness of occupational risk factors can affect clinical decision-making. The OCCHLTH mnemonic encourages consideration of occupational causes of illness and injury to optimize patient care. Further evaluation of the utility of the OCCHLTH mnemonic is needed. |
Beyond misinformation: developing a public health prevention framework for managing information ecosystems
Ishizumi A , Kolis J , Abad N , Prybylski D , Brookmeyer KA , Voegeli C , Wardle C , Chiou H . Lancet Public Health 2024 The COVID-19 pandemic has highlighted how infodemics (defined as an overabundance of information, including misinformation and disinformation) pose a threat to public health and could hinder individuals from making informed health decisions. Although public health authorities and other stakeholders have implemented measures for managing infodemics, existing frameworks for infodemic management have been primarily focused on responding to acute health emergencies rather than integrated in routine service delivery. We review the evidence and propose a framework for infodemic management that encompasses upstream strategies and provides guidance on identifying different interventions, informed by the four levels of prevention in public health: primary, secondary, tertiary, and primordial prevention. On the basis of a narrative review of 54 documents (peer-reviewed and grey literature published from 1961 to 2023), we present examples of interventions that belong to each level of prevention. Adopting this framework requires proactive prevention and response through managing information ecosystems, beyond reacting to misinformation or disinformation. |
Weight loss in short-term interventions for physical activity and nutrition among adults with overweight or obesity: A systematic review and meta-analysis
Rotunda W , Rains C , Jacobs SR , Ng V , Lee R , Rutledge S , Jackson MC , Myers K . Prev Chronic Dis 2024 21 E21 INTRODUCTION: Reaching, enrolling, and retaining participants in lengthy lifestyle change interventions for weight loss is a major challenge. The objective of our meta-analysis was to investigate whether lifestyle interventions addressing nutrition and physical activity lasting 6 months or less are effective for weight loss. METHODS: We searched for peer-reviewed studies on lifestyle change interventions of 6 months or less published from 2012 through 2023. Studies were screened based on inclusion criteria, including randomized controlled trials (RCTs) for adults with overweight or obesity. We used a random-effects model to pool the mean difference in weight loss between intervention and control groups. We also performed subgroup analyses by intervention length and control type. RESULTS: Fourteen RCTs were identified and included in our review. Half had interventions lasting less than 13 weeks, and half lasted from 13 to 26 weeks. Seven were delivered remotely, 4 were delivered in person, and 3 used combined methods. The pooled mean difference in weight change was -2.59 kg (95% CI, -3.47 to -1.72). The pooled mean difference measured at the end of the intervention was -2.70 kg (95% CI, -3.69 to -1.71) among interventions lasting less than 13 weeks and -2.40 kg (95% CI, -4.44 to -0.37) among interventions of 13 to 26 weeks. CONCLUSION: Short-term multicomponent interventions involving physical activity and nutrition can achieve weight loss for adults with overweight or obesity. Offering short-term interventions as alternatives to long-term ones may reach people who otherwise would be unwilling or unable to enroll in or complete longer programs. |
Evaluation of a peer-support, 'mentor mother' program in Gaza, Mozambique; a qualitative study
Katirayi L , Ndima S , Farah A , Ludwig W , Mabote A , Chiposse I , Muteerwa A , Cowan JG , Meque I . BMC Health Serv Res 2024 24 (1) 382 BACKGROUND: Retention in prevention of mother-to-child transmission of HIV programs is critical to reduce vertical transmission. To addresses challenges with retention, Mozambique launched a peer-support program in 2018, in which HIV-positive mothers provide adherence support as mentor mothers (MMs) for HIV-positive pregnant and lactating women and HIV-exposed and infected children. METHODS: A descriptive qualitative evaluation was conducted across nine facilities in Gaza Province to assess the acceptability and barriers to implementation of the mentor mother program (MMP) among those receiving services and providing services. In-depth interviews and focus group discussions were conducted with MMs, MM supervisors, health care workers (HCWs), HIV-positive mothers enrolled in the MMP, HIV-positive mothers who declined MMP enrollment, and key informants involved in the implementation of the program. Thematic analysis identified emerging recurrent themes and patterns across the participants' responses. Data were collected between November-December 2020. RESULTS: There were initial challenges with acceptability of the MMP, especially regarding confidentiality concerns and MM roles. Sharing additional information about MMs and making small changes during the beginning of the MMP resulted in generally high acceptance of the MMP. HIV-positive mothers reported that counseling from MMs improved their understanding of the importance of anti-retroviral treatment (ART) and how to take and administer ART. HIV-positive mothers reported having reduced guilt and shame about their HIV-status, feeling less alone, and having more control over their health. MMs shared that their work made them feel valued and decreased their self-stigmatization. However, MMs also reported feeling that they had inadequate resources to perform optimal job functions; they listed inadequate transportation, insufficient stipends, and false addresses of clients among their constraints. Overall, HCWs felt that their workload was significantly reduced with MM support and wanted more MMs in the community and health facility. CONCLUSIONS: This study found that the MMP was considered a substantive and highly valued support to HIV-positive mothers, resulting in increased ART literacy among patients, improved self-reported well-being and sense of community and reduced feelings of isolation. Recommendations include strengthening MM training, increasing financial and materiel resources, additional information provided to newly enrolled mothers and support for the male partners. |
Implementing a needs assessment to advance health equity in overdose prevention and surveillance initiatives
Winston TR , Reed M , Roberts M , Panjwani A , Farfalla J , Pless V , Miles A , Rooks-Peck C , Underwood NL . Public Health Rep 2024 333549241239905 OBJECTIVES: State, local, and federal agencies have expanded efforts to address the root causes of overdoses, including health inequity and related social determinants of health. As an Overdose Data to Action (OD2A) technical assistance provider, the Association of State and Territorial Health Officials (ASTHO) conducted the first national needs assessment to understand capacity and technical assistance needs of OD2A jurisdictions in advancing health equity. METHODS: ASTHO designed and disseminated the OD2A Recipient Health Equity Needs Assessment (RHENA) to 66 OD2A-funded jurisdictions from February to March 2022. OD2A principal investigators and staff were contacted via email and asked to complete the needs assessment within 6 weeks. One coder manually coded open-ended responses, conducted a thematic analysis on the qualitative data, and performed a simple frequency analysis on the quantitative data. RESULTS: Fifty-two jurisdictions (78.8%) responded, including 36 states, 12 cities/counties, and 2 territories. Most jurisdictions (n = 46; 88.5%) reported having a formal or informal health equity lead in place. Common barriers included a lack of access to data sources (n = 37; 71.2%), lack of partnerships (n = 20; 38.5%), and lack of funding (n = 14; 26.9%). Respondents reported needing more information sharing among jurisdictions and partner organizations, coaching on best practices, and routine discussions such as peer-to-peer learning sessions. CONCLUSION: Findings suggest that gaps remain in programmatic policies and principles to address inequities in overdose prevention. Results are being used to identify additional technical assistance opportunities, jurisdictional capacity, and approaches to advance health equity. |
An Update on Pediatric Environmental Health Specialty Units: Activities and impacts, 2015-2019
Woolf AD , Jackson JE , Corcoran P , Fritz MK , Kim SS , Maslak TM , Shah M , Hansen L . Acad Pediatr 2024 INTRODUCTION: Pediatric Environmental Health Specialty Units (PEHSUs) address health concerns impacting children and their families related to environmental hazards by providing consultation and education to families, communities, and healthcare professionals. This analysis evaluated productivity of the national PEHSU program. METHODS: PEHSUs reported data on services provided to U.S. communities between October 1, 2014 and September 30, 2019. Descriptive statistics and qualitative analysis are presented. RESULTS: During this period, 6,102 consultations and 4,644 educational outreach activities were recorded. PEHSU faculty and staff published 462 articles, reviews, book chapters, fact sheets, commentaries, short informational pieces, and other materials between 2014-2019. These included 190 articles in scientific peer-reviewed journals and 29 textbook chapters to increase professional capacity in pediatric and reproductive environmental health. Lead, other metals, substances of abuse, pesticides, mold, and air pollution were frequently reported as agents of concern and educational topics. Requests for an overview of pediatric environmental health and outdoor pollutants were other frequently reported topics. DISCUSSION: PEHSUs work to decrease harmful exposures and improve children's health. They serve as expert resources for families, healthcare professionals, and communities on health effects related to environmental exposures. Data show the breadth and depth of concerns addressed and demonstrate the productivity and impact of this national program. WHATS-NEW: In 2015-2019, Pediatric Environmental Health Specialty Units (PEHSUs) doubled their average annual productivity as measured by numbers of consultations and training activities, compared with the previous ten years. PEHSUs continue to be a critical resource for healthcare professonals and communities. |
Correction: A peer-to-peer collaborative learning approach for the implementation of evidence-informed interventions to improve HIV-related health outcomes
Keuroghlian AS , Marc L , Goldhammer H , Massaquoi M , Downes A , Stango J , Bryant H , Cahill S , Yen J , Perez AC , Head JM , Mayer KH , Myers J , Rebchook GM , Bourdeau B , Psihopaidas D , Chavis NS , Cohen SM . AIDS Behav 2024 |
Autoimmune hepatitis: Brighton Collaboration case definition and guidelines for data collection, analysis, and presentation of immunisation safety data
Kochhar S , Assis DN , Mack C , Izurieta HS , Muratori L , Munoz A , Nordenberg D , Gidudu JF , Blau EF , Vierling JM . Vaccine 2024 This report introduces a Brighton Collaboration (BC) case definition for autoimmune hepatitis (AIH), which has been classified as a priority adverse event of special interest (AESI), as there were possible cases seen following COVID-19 vaccination. The case definition was developed by a group of subject matter and BC process experts to facilitate safety data comparability across pre- and post-licensure clinical trials, as well as pharmacovigilance activities in multiple settings with diverse resources and healthcare access. The usual BC case definition development process was followed in an expedited manner, and took two months to complete, including finalising the manuscript for publication, instead of the usual 1 year development time. It includes a systematic review of the literature and an expert consensus to define levels of diagnostic certainty for AIH, and provides specific guidelines for data collection and analysis. Histology, serological and biochemical tests and exclusion of alternate diagnosis were considered necessary to define the levels of certainty (definitive, probable and possible). AEFI reports of suspected AIH were independently classified by the WG members to test its useability and these classifications were used to finalise the case definition. The document underwent peer review by external AIH experts and a Reference Group of vaccine safety stakeholders in high-, low- and middle-income countries to ensure case definition useability, applicability, and scientific integrity. The expedited process can be replicated for development of other standardised case definitions for priority AESIs for endemics and epidemics. While applicable to cases reported following immunisation, the case definition is independent of lapsed time following vaccination and, as such, can also be used to determine background incidence for vaccinated and unvaccinated control groups in studies of causal association. While use of this case definition is also appropriate for the study of safety of other products including drugs, it is not meant to guide clinical case management. |
Experience and findings from surveillance peer review in Nigeria, August 2017-May 2019
Hamisu AW , Etapelong SG , Ayodeji I , Richard B , Fiona B , Gidado S , Abbott SL , Edukugho AA , Bolu O , Adeyelu A , Mawashi KY , Adamu US , Nsubuga P , Shuaib F . Pan Afr Med J 2023 45 9 INTRODUCTION: acute flaccid paralysis (AFP) surveillance is the gold standard of the Global Polio Eradication Initiative (GPEI) for detecting cases of poliomyelitis and tracking poliovirus transmission. Nigeria's AFP surveillance performance indicators are among the highest in countries of the World Health Organization (WHO) African Region. The primary AFP surveillance performance indicators are the rate of non-polio AFP among children and the proportion of timely, adequate specimen collection. The surveillance working group of the National Emergency Operations Centre assessed the quality of AFP surveillance data in some reportedly high-performing states. METHODS: we conducted a retrospective review of AFP surveillance performance indicators in Nigeria for 2010-2019. We also reviewed data in reports from four groups of surveillance peer reviews and validation visits (conducted by in-country GPEI partners) during August 2017-May 2019 in 16 states with high primary AFP surveillance indicators; the validation visits reviewed clinical information and the dates of specimen collection and onset of paralysis with caretakers. RESULTS: there were consistently increasing AFP surveillance primary performance indicators during 2010-2016, followed by declines during 2017-2019. From the data for 16 states with peer reviews conducted from August 2017-May 2019, overall concordance of reported and "true" (validated) AFP indicator data in peer review investigations was highly variable. True AFP concordance ranged from 58%-100%, and stool timeliness concordance ranged from 56%-95%. The most common clinical causes of reported AFP cases that were not true AFP were spastic paralysis, malaria, sickle cell disease, and malnutrition. All the states that participated in peer reviews developed surveillance improvement plans based on the gaps identified. CONCLUSION: Nigeria has highly sensitive AFP surveillance according to reported primary AFP performance indicators. The findings of peer reviews indicate that the AFP surveillance system needs to be strengthened and well-supervised to enhance data quality. |
A Community Guide Systematic Review: Digital HIV pre-exposure prophylaxis interventions
Kamitani E , Peng Y , Hopkins D , Higa DH , Mullins MM . Am J Prev Med 2024 INTRODUCTION: HIV preexposure prophylaxis (PrEP) is highly effective when taken as prescribed. Digital health adherence interventions have been identified as effective for improving antiretroviral therapy adherence among people with HIV, but limited evidence exists for PrEP adherence interventions among people without HIV. The purpose of this Community Guide systematic review was to present the characteristics and effectiveness of digital PrEP adherence interventions. METHODS: The author searched the CDC HIV Prevention Research Synthesis cumulative database for digital health interventions with PrEP adherence outcomes published in peer-reviewed journals from 2000-2022. Studies with comparison arms or pre-post data evaluating interventions in high-income countries were included. Two reviewers independently screened citations, extracted data, conducted risk of bias assessment, and resolved discrepancies through discussion. Summary effect estimates were calculated using median and interquartile interval. RESULTS: Nine studies were included and all focused on gay, bisexual, and other men who have sex with men. Eight studies were U.S.-based while the other was conducted in the Netherlands. Five were randomized control trials and four were pre-/post studies. All studies showed improved adherence in the intervention arms compared with comparison groups or pre-intervention data. One study also reported improvement in PrEP care retention. DISCUSSION: Digital health adherence interventions with different strategies to improve PrEP and HIV-related outcomes were identified. The small number of studies identified is a limitation. Findings from this review served as the basis for the Community Preventive Services Task Force recommendation to use these interventions to increase PrEP adherence to prevent HIV infection. |
A peer-to-peer collaborative learning approach for the implementation of evidence-informed interventions to improve HIV-related health outcomes
Keuroghlian AS , Marc L , Goldhammer H , Massaquoi M , Downes A , Stango J , Bryant H , Cahill S , Yen J , Perez AC , Head JM , Mayer KH , Myers J , Rebchook GM , Bourdeau B , Psihopaidas D , Chavis NS , Cohen SM . AIDS Behav 2024 The nationwide scale-up of evidence-based and evidence-informed interventions has been widely recognized as a crucial step in ending the HIV epidemic. Although the successful delivery of interventions may involve intensive expert training, technical assistance (TA), and dedicated funding, most organizations attempt to replicate interventions without access to focused expert guidance. Thus, there is a grave need for initiatives that meaningfully address HIV health disparities while addressing these inherent limitations. Here, the Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) initiative Using Evidence-Informed Interventions to Improve HIV Health Outcomes among People Living with HIV (E2i) piloted an alternative approach to implementation that de-emphasized expert training to naturalistically simulate the experience of future HIV service organizations with limited access to TA. The E2i approach combined the HAB-adapted Institute for Healthcare Improvement's Breakthrough Series Collaborative Learning Model with HRSA HAB's Implementation Science Framework, to create an innovative multi-tiered system of peer-to-peer learning that was piloted across 11 evidence-informed interventions at 25 Ryan White HIV/AIDS Program sites. Four key types of peer-to-peer learning exchanges (i.e., intervention, site, staff role, and organization specific) took place at biannual peer learning sessions, while quarterly intervention cohort calls and E2i monthly calls with site staff occurred during the action periods between learning sessions. Peer-to-peer learning fostered both experiential learning and community building and allowed site staff to formulate robust site-specific action plans for rapid cycle testing between learning sessions. Strategies that increase the effectiveness of interventions while decreasing TA could provide a blueprint for the rapid uptake and integration of HIV interventions nationwide. |
Lessons learned from early implementation of the Growing Expertise in E-health Knowledge and Skills (GEEKS) program in Nigeria, 2019 - 2021
Rachlin A , Adegoke OJ , Sikare E , Adeoye OB , Dagoe E , Adeyelu A , Tolentino H , MacGregor J , Obasi S , Adah G , Garba AB , Abah AU , Friday J , Oyiri F , Porter AM , Olajide L , Wilson I , Usman R , Usifoh N , Fasogbon O , Franka R , Ghiselli M , Nguku P , Waziri N , Lam E , Bolu O . Pan Afr Med J 2023 46 81 INTRODUCTION: the Growing Expertise in E-health Knowledge and Skills (GEEKS) program is an applied apprenticeship program that aims to improve informatics capacity at various levels of the national health system and create a sustainable informatics workforce. Nigeria adapted the GEEKS model in 2019 as a mechanism to strengthen data quality and use of routine immunization (RI) and vaccine-preventable disease (VPD) surveillance data among Expanded Programme on Immunization (EPI) staff. Since the start of the GEEKS-EPI program, there has not been a formal assessment conducted to measure the extent to which GEEKS-EPI has been able to build local informatics workforce capacity and strengthen RI and VPD surveillance (VPDS) data quality and use in Nigeria. METHODS: we conducted a qualitative assessment to inform the extent to which GEEKS-EPI has been able to build informatics skillsets to enhance local workforce capacity, foster collaboration across government agencies, and create a sustainable informatics workforce in Nigeria. In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs) were held with GEEKS-EPI supervisors, mentors, and mentees from previous GEEKS-EPI cohorts. RESULTS: while there were challenges reported during early implementation of the GEEKS-EPI program in Nigeria, particularly early on in the COVID-19 pandemic, participants and supervisors reported that the fellowship provided a framework for building a sustainable RI and VPDS informatics workforce through regular mentorship, peer-to-peer exchanges and Subject Matter Expert (SME)-led trainings. CONCLUSION: lessons learned from early implementation of GEEKS-EPI in Nigeria will help to inform its implementation in other countries, where strengthened national RI and VPDS informatics capacity is the primary objective. |
Identifying leadership practices to support the uptake of reusable elastomeric half mask respirators in health delivery settings
Haas EJ , Furek A , Greenawald LA . Healthc Manage Forum 2024 8404704241226698 An increase in reusable elastomeric half mask respirators among healthcare personnel has been documented during pandemic emergencies; however, research has not detailed leadership practices to support their use. Forty-three organizations implemented EHMRs received from the United States federal government which prompted interviews with 73 individuals who managed respirator distribution and fit testing between October 2021 and November 2022. Interview data was qualitatively analyzed. Themes around organizational culture and leadership practices emerged when discussing how elastomeric half mask respirators were integrated into health delivery settings including communication and outreach methods to aid worker support. Example included on-line and hands-on training, peer support, leadership support, and a culture that supports respirator use. To support a shift to reusable respiratory protection being procured and implemented, organizational- and individual-level perspectives are needed. Employee engagement, respirator champions, and updated verbal and written communication mechanisms are important takeaways for leaders to consider during any routine or emergency scenario. |
Systematic review of microplastics and nanoplastics in indoor and outdoor air: identifying a framework and data needs for quantifying human inhalation exposures
Eberhard T , Casillas G , Zarus GM , Barr DB . J Expo Sci Environ Epidemiol 2024 BACKGROUND: Humans are likely exposed to microplastics (MPs) in a variety of places including indoor and outdoor air. Research to better understand how exposure to MPs correlates to health is growing. To fully understand the possible impacts of MPs on human health, it is necessary to quantify MP exposure and identify what critical data gaps exist. OBJECTIVES: The current paper provides a human exposure assessment of microplastics in the air using systematically reviewed literature that provided concentration of MPs in air as well as doses used in toxicology studies to calculate inhalation exposure dose. METHODS: All published peer-reviewed journal articles, non-published papers, and grey literature that focused on micro- or nano-plastics in indoor and outdoor air were systematically searched using PRISMA guidelines. Literature that defined specific concentrations and size of MPs in air or exposed to human lung cells, animals, or humans with measurable health impacts were included in data extraction. Inhalational exposures were calculated for different age groups using published MP concentrations from the included literature using exposure dose equations and values from U.S. ATSDR and EPA. RESULTS: Calculated mean indoor inhalational exposures from passive sampling methods were higher than those calculated from active sampling methods. When comparing indoor and outdoor sampling, calculated inhalation exposures from indoor samples were greater than those from outdoor samples. Inhalation exposures of MPs differed between age groups with infants having the highest calculated dose values for all locations followed by preschool age children, middle-school aged children, pregnant women, adolescents, and non-pregnant adults. MP doses used in toxicology studies produced higher calculated mean inhalational exposures than those from environmental samples. IMPACT: This study is the first known systematic review of inhalational MP exposure from indoor and outdoor air. It also provides inhalational exposures calculated from previously published environmental samples of MPs as well as from toxicology studies. |
Costs and cost-effectiveness of influenza illness and vaccination in low- and middle-income countries: A systematic review from 2012 to 2022
Gharpure R , Chard AN , Cabrera Escobar M , Zhou W , Valleau MM , Yau TS , Bresee JS , Azziz-Baumgartner E , Pallas SW , Lafond KE . PLoS Med 2024 21 (1) e1004333 BACKGROUND: Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. METHODS AND FINDINGS: We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: "influenza" AND "cost" OR "economic." The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. CONCLUSIONS: The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs. |
Understanding psychosocial determinants of malaria behaviours in low-transmission settings: a scoping review
Casella A , Monroe A , Toso M , Hunter G , Underwood C , Pillai R , Hughes J , Van Lith LM , Cash S , Hwang J , Babalola S . Malar J 2024 23 (1) 15 BACKGROUND: Recent estimates show progress toward malaria elimination is slowing in many settings, underscoring the need for tailored approaches to fight the disease. In addition to essential structural changes, human behaviour plays an important role in elimination. Engagement in malaria behaviours depends in part on psychosocial determinants such as knowledge, perceived risk, and community norms. Understanding the state of research on psychosocial determinants in low malaria transmission settings is important to augment social and behaviour change practice. This review synthesizes research on psychosocial factors and malaria behaviours in low-transmission settings. METHODS: A systematic search of peer-reviewed literature and supplemental manual search of grey literature was conducted using key terms and eligibility criteria defined a priori. Publications from 2000-2020 in the English language were identified, screened, and analysed using inductive methods to determine the relationship between the measured psychosocial factors and malaria behaviours. RESULTS: Screening of 961 publications yielded 96 for inclusion. Nineteen articles collected data among subpopulations that are at increased risk of malaria exposure in low-transmission settings. Purposive and cluster randomized sampling were common sampling approaches. Quantitative, qualitative, and mixed-methods study designs were used. Knowledge, attitudes, and perceived risk were commonly measured psychosocial factors. Perceived response-efficacy, perceived self-efficacy, and community norms were rarely measured. Results indicate positive associations between malaria knowledge and attitudes, and preventive and care-seeking behaviour. Studies generally report high rates of correct knowledge, although it is comparatively lower among studies of high-risk groups. There does not appear to be sufficient extant evidence to determine the relationship between other psychosocial variables and behaviour. CONCLUSIONS: The review highlights the need to deploy more consistent, comprehensive measures of psychosocial factors and the importance of reaching subpopulations at higher risk of transmission in low transmission contexts. Malaria-related knowledge is generally high, even in settings of low transmission. Programmes and research should work to better understand the psychosocial factors that have been positively associated with prevention and care-seeking behaviours, such as norms, perceived response efficacy, perceived self-efficacy, and interpersonal communication. These factors are not necessarily distinct from that which research has shown are important in settings of high malaria transmission. However, the importance of each factor and application to malaria behaviour change programming in low-transmission settings is an area in need of further research. Existing instruments and approaches are available to support more systematic collection of psychosocial determinants and improved sampling approaches and should be applied more widely. Finally, while human behaviour is critical, health systems strengthening, and structural interventions are essential to achieve malaria elimination goals. |
Vaccine value profile for Neisseria gonorrhoeae
Lyu Y , Choong A , Chow EPF , Seib KL , Marshall HS , Unemo M , de Voux A , Wang B , Miranda AE , Gottlieb SL , Mello MB , Wi T , Baggaley R , Marshall C , Abu-Raddad LJ , Abara WE , Chen XS , Ong JJ . Vaccine 2023 Neisseria gonorrhoeae infection (gonorrhoea) is a global public health challenge, causing substantial sexual and reproductive health consequences, such as infertility, pregnancy complications and increased acquisition or transmission of HIV. There is an urgency to controlling gonorrhoea because of increasing antimicrobial resistance to ceftriaxone, the last remaining treatment option, and the potential for gonorrhoea to become untreatable. No licensed gonococcal vaccine is available. Mounting observational evidence suggests that N. meningitidis serogroup B outer membrane vesicle-based vaccines may induce cross-protection against N. gonorrhoeae (estimated 30%-40% effectiveness using the 4CMenB vaccine). Clinical trials to determine the efficacy of the 4CMenB vaccine against N. gonorrhoeae are underway, as are Phase 1/2 studies of a new gonococcal-specific vaccine candidate. Ultimately, a gonococcal vaccine must be accessible, affordable and equitably dispensed, given that those most affected by gonorrhoea are also those who may be most disadvantaged in our societies, and most cases are in less-resourced settings. This vaccine value profile (VVP) provides a high level, holistic assessment of the current data to inform the potential public health, economic and societal value of pipeline vaccines. This was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations. All contributors have extensive expertise on various elements of the N. gonorrhoeae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using published data obtained from peer-reviewed journals or reports. |
Laboratory-acquired infections and pathogen escapes worldwide between 2000 and 2021: a scoping review
Blacksell SD , Dhawan S , Kusumoto M , Le KK , Summermatter K , O'Keefe J , Kozlovac JP , Almuhairi SS , Sendow I , Scheel CM , Ahumibe A , Masuku ZM , Bennett AM , Kojima K , Harper DR , Hamilton K . Lancet Microbe 2023 Laboratory-acquired infections (LAIs) and accidental pathogen escape from laboratory settings (APELS) are major concerns for the community. A risk-based approach for pathogen research management within a standard biosafety management framework is recommended but is challenging due to reasons such as inconsistency in risk tolerance and perception. Here, we performed a scoping review using publicly available, peer-reviewed journal and media reports of LAIs and instances of APELS between 2000 and 2021. We identified LAIs in 309 individuals in 94 reports for 51 pathogens. Eight fatalities (2·6% of all LAIs) were caused by infection with Neisseria meningitidis (n=3, 37·5%), Yersinia pestis (n=2, 25%), Salmonella enterica serotype Typhimurium (S Typhimurium; n=1, 12·5%), or Ebola virus (n=1, 12·5%) or were due to bovine spongiform encephalopathy (n=1, 12·5%). The top five LAI pathogens were S Typhimurium (n=154, 49·8%), Salmonella enteritidis (n=21, 6·8%), vaccinia virus (n=13, 4·2%), Brucella spp (n=12, 3·9%), and Brucella melitensis (n=11, 3·6%). 16 APELS were reported, including those for Bacillus anthracis, SARS-CoV, and poliovirus (n=3 each, 18·8%); Brucella spp and foot and mouth disease virus (n=2 each, 12·5%); and variola virus, Burkholderia pseudomallei, and influenza virus H5N1 (n=1 each, 6·3%). Continual improvement in LAI and APELS management via their root cause analysis and thorough investigation of such incidents is essential to prevent future occurrences. The results are biased due to the reliance on publicly available information, which emphasises the need for formalised global LAIs and APELS reporting to better understand the frequency of and circumstances surrounding these incidents. |
Modeling the impacts of antiviral prophylaxis strategies in mitigating seasonal influenza outbreaks in nursing homes
Morris SE , Zipfel CM , Peer K , Madewell ZJ , Brenner S , Garg S , Paul P , Slayton RB , Biggerstaff M . Clin Infect Dis 2023 BACKGROUND: Antiviral chemoprophylaxis is recommended for use during influenza outbreaks in nursing homes to prevent transmission and severe disease among non-ill residents. Centers for Disease Control and Prevention (CDC) guidance recommends prophylaxis be initiated for all non-ill residents once an influenza outbreak is detected and be continued for at least 14 days and until seven days after the last laboratory-confirmed influenza case is identified. However, not all facilities strictly adhere to this guidance and the impact of such partial adherence is not fully understood. METHODS: We developed a stochastic compartmental framework to model influenza transmission within an average-sized U.S. nursing home. We compared the number of symptomatic illnesses and hospitalizations under varying prophylaxis implementation strategies, in addition to different levels of prophylaxis uptake and adherence by residents and healthcare personnel (HCP). RESULTS: Prophylaxis implemented according to current guidance reduced total symptomatic illnesses and hospitalizations among residents by an average of 12% and 36%, respectively, compared with no prophylaxis. We did not find evidence that alternative implementations of prophylaxis were more effective: compared to full adoption of current guidance, partial adoption resulted in increased symptomatic illnesses and/or hospitalizations, and longer or earlier adoption offered no additional improvements. In addition, increasing uptake and adherence among nursing home residents was effective in reducing resident illnesses and hospitalizations, but increasing HCP uptake had minimal indirect impacts for residents. CONCLUSIONS: The greatest benefits of influenza prophylaxis during nursing home outbreaks will likely be achieved through increasing uptake and adherence among residents and following current CDC guidance. |
Another Year of Successes for PCD: Impact Factor, Collections, New Student Committee, Dr Lynne Wilcox Paper of the Year, and 2024 Calls for Papers
Jack L Jr . Prev Chronic Dis 2023 20 E106 Preventing Chronic Disease (PCD) brings 2023 to a close having achieved impressive accomplishments. This final Editor in Chief’s Column of the year provides updates on the journal’s increased impact factor; commitment to student development; publication of collections; formation of the Student Scientific Writing and Review Training Committee; upcoming 20th anniversary; and 2024 calls for papers. PCD has been positioned for success because of tremendous support from its editorial board, associate editors, Statistics Review Committee, and its pool of peer reviewers. PCD celebrates the hundreds of authors who submit articles annually to the journal for consideration. In addition, a major source of support to the journal has come from senior leadership in the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). |
Accuracy-based proficiency testing for estradiol measurements
Tim Cao Z , Rej R , Vesper H , Rex Astles J . Clin Biochem 2023 110700 OBJECTIVES: Accuracy of estradiol measurements is important but conventional proficiency testing (PT) cannot assess accuracy when possibly non-commutable samples are used and method peer-group means are the targets. Accuracy-based assessment of estradiol measurements is needed. Design and Methods Five serum samples were prepared from single donors, frozen, and distributed overnight to 76 New York State Department of Health (NYSDOH)-certified laboratories. Participants analyzed samples for estradiol. The biases of group means were assessed against the Centers for Disease Control and Prevention (CDC)-defined targets, evaluated using the Hormones Standardization Program (HoSt) E2 performance criterion of ±12.5%. Each laboratory's performance was evaluated using total allowable error (acceptance limits) of target ±25% or ±15 pg/mL (55.1 pmol/L) (whichever was greater, NYSDOH), target ±30% (Clinical Laboratory Improvement Amendments [CLIA]), and target ±26% (minimal limit based on biological variation [BV]). RESULTS: The biases (range) were 34% (-17% to 175%), 40% (-33% to 386%), 16% (-45% to 193%), 5% (-27% to 117%), and -4% (-31% to 21%), for samples at estradiol of 24.1, 28.4, 61.7, 94.1 and 127 pg/mL, or 88.5, 104.3, 226.5, 245.4 and 466.2 pmol/L, respectively. Large positive method/analytical systematic biases were revealed for 9 commonly used method/analytical systems in the United States at low estradiol concentrations. Of the 9 analytical systems, 0, 0, 3, 7 and 6 met the HoSt criterion for the samples with estradiol at the five respective concentrations. PT evaluation showed that 59%, 69% and 87% of laboratories would receive a PT event pass score when the CDC-defined target and a criterion of NYSDOH, CLIA or BV was used, respectively. However, >95% laboratories would obtain PT pass score if method peer-group means were used as targets regardless of the criterion used. CONCLUSIONS: Improvement in accuracy of estradiol measurements is needed, particularly at low estradiol concentrations. Accuracy-based PT provides unambiguous information about the accuracy of methods/analytical systems. |
A new partnership: Bringing novel aspects of CDC data to diabetes care
Kahn SE , Anderson CAM , Benoit SR , Bullard KM , Buse JB , Holliday CS , Imperatore G , Selvin E . Diabetes Care 2023 46 (12) 2091 The epidemic of diabetes continues to exert great burden and cost on affected people, their families, and society. Current estimates of the burden of prediabetes and diabetes in youth and adults for the U.S. are made available through the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/diabetes/data/statistics-report/index.html and https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html) and for regions of the world by the International Diabetes Federation (https://diabetesatlas.org/2022-reports/). These data are typically updated every year or two. | | CDC’s estimates for the prevalence of both diagnosed and undiagnosed diabetes, prevalence of prediabetes among adults, incidence of newly diagnosed diabetes, risk factors for diabetes-related complications, and burden of coexisting conditions and complications provide valuable information, but many questions are not addressed in these national data. Therefore, commencing with this month’s issue, Diabetes Care and CDC begin a partnership to enhance knowledge among the journal’s readership by highlighting important aspects of the national burden of diabetes that expand upon the data and information provided on the CDC’s website. Through this collaboration, we will at least twice a year publish in Diabetes Care in-depth explorations of timely and clinically significant topics authored by members of CDC. As with all original manuscripts submitted to Diabetes Care, they will undergo peer review to ensure they are scientifically rigorous and informative. |
Approaches for measuring cumulative childhood adversity: A study of youth from 5 sub-Saharan African countries
Gilbert LK , Matthews S , Dube SR , Annor FB . Child Abuse Negl 2023 106542 BACKGROUND: Adverse childhood experiences (ACEs) include forms of abuse, neglect, and household stressors that are potentially early life traumatic experiences. A summed integer count of ACEs is often used to examine cumulative childhood adversity (CCA) but has limitations. OBJECTIVES: The current study tests two additional methods for measuring CCA using large samples of youth in low- and middle-income countries. PARTICIPANTS AND SETTING: Pooled data were analyzed from a multi-country, nationally representative sample of youth aged 18-24 years (N = 11,498) who completed the Violence Against Children and Youth Surveys (VACS) in Lesotho, Cote d'Ivoire, Kenya, Namibia, and Mozambique. METHODS: ACE exposures included: physical, sexual, and emotional violence; witnessing interparental violence; witnessing community violence; orphanhood. CCA was operationalized using an ACE score, ACE impact (standardized regression coefficients from outcome severity), and ACE exposure context (household; intimate partner; peer; community). Associations between CCA with mental distress (MD) were examined by sex using p ≤ 0.05 as the significance level. RESULTS: Exposure to ≥3 ACEs was associated with MD (p < 0.05) for both sexes. Among females, all contexts contributed to MD except peer ACEs (p < 0.05). Among males, household and community ACEs contributed to MD. High-impact ACEs were associated with MD both sexes. ACE context was the best-fitting model for these data. CONCLUSIONS: The challenges operationalizing CCA warrant continued research to ensure adversity type, severity, and context lead to validly assessing ACEs impact on child wellbeing. |
The impact of injury control research centers: Advancing the field of injury and violence prevention
Baker W , Skillman M , Rocha L , Bayne A , Whitehouse S , Murphy E , Papanikolaou M , Caples M , Choudhary E . J Saf Res 2023 Introduction: The Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control (NCIPC) funds Injury Control Research Centers (ICRCs). These centers study injury and violence prevention through three core areas: (1) Research conducts cutting-edge, multidisciplinary research in the injury and violence prevention field; (2) Outreach translates injury and violence prevention research into action; and (3) Training educates and trains the next generation of injury and violence prevention professionals. We examined ICRC work from 2012 to 2019 to determine whether they fulfilled their goal of furthering injury and violence prevention research and practice. Methods: We created a database of core area accomplishments reported through annual and interim progress reports. These reports track core area accomplishments by injury and violence prevention topic area, publications, partnerships, and trainings. Results: From 2012 to 2019, ten ICRCs from two funding cycles received approximately $49 million. ICRCs reported 703 research, 1,432 outreach, and 660 training accomplishments. There were also 342 accomplishments contributing to a special tool or resource. These accomplishments focused on preventing traumatic brain injury, suicide, adverse childhood experiences, and transportation safety. ICRCs produced over 3,500 peer-reviewed publications. ICRCs reported over 3,600 accomplishments partnered with academic institutions, public health agencies, healthcare, and non-profit organizations. ICRCs created resources for audiences such as students, law enforcement, and policy makers. ICRCs trained 3,131 students and faculty. Practical Applications: ICRCs are the hubs of modern research and practice in the injury and violence prevention field. They successfully bring together stakeholders from disparate disciplines, perspectives, and agencies to join forces and tackle critical public health problems. Conclusion: ICRCs are an integral component of NCIPC's, CDC's and the Department of Health and Human Service's missions to protect and enhance the health of Americans. Research covered NCIPC research priorities over the funding period, furthering injury and violence prevention research and working as a foundation to practice and policy. Outreach and partnerships with an array of organizations put research into action. Trainings educated the new generation of injury and violence prevention professionals. © 2023 National Safety Council and Elsevier Ltd |
Increasing access to contraception: Examining barriers and facilitators of long-acting reversible contraception
Kroelinger CD , Pagano HP , DeSisto CL , Estrich C , Romero L , Pliska E , Akbarali S , Velonis A , Cox S . J Womens Health (Larchmt) 2023 33 (1) 52-61 Objective(s): To identify barriers and facilitators related to reimbursement processes, device acquisition costs, stocking, and supply of long-acting reversible contraception (LARC) from 27 jurisdictions (26 states/1 territory) participating in the Increasing Access to Contraception Learning Community from 2016 to 2018. Materials and Methods: A descriptive study using qualitative data collected through 27 semistructured key informant interviews was conducted during the final year of the learning community among all jurisdictional teams. Excerpts were extracted and coded by theme, then summarized as barriers or facilitators using implementation science methods. Results: Most jurisdictions (89%) identified barriers to reimbursement processes, device acquisition, stocking, and supply of LARC devices, and 85% of jurisdictions identified facilitators for these domains. Payment methodology challenges and lack of billing and coding processes were identified as the most common barriers to reimbursement processes. Device acquisition cost challenges and lack of delivery facility protocols for billing were the most common barriers to device acquisition, stocking, and supply of LARC. The most common facilitator of reimbursement processes was expanded payment methodology options, whereas supplemental funding for acquisition costs and protocol development were identified as the most common facilitators of device acquisition, stocking, and supply. Conclusion: Revised payment methodologies and broader health systems changes including additional funding sources and protocols for billing, stocking, and supply were used by learning community jurisdictions to address identified barriers. The learning community framework offers a forum for information exchange, peer-to-peer learning, and sharing of best practices to support jurisdictions in addressing identified barriers and facilitators affecting contraception access. |
A comparison of total cost estimates between exclusive breastfeeding and breast milk substitute usage in humanitarian contexts
Mowl Z , Lefevre A , Ververs M . Public Health Nutr 2023 26 (12) 1-26 OBJECTIVE: Using a model-based analysis, we calculated the total costs associated with the exclusive breastfeeding (EBF) and breast milk substitute (BMS) usage for one infant for six months within select humanitarian contexts to (a) determine if there is a notable difference in costs and (b) use these results to inform future creation of data-informed humanitarian response standard operating procedures (SOPs). DESIGN: The inputs and costing data were drawn from a mixture of local e-commerce vendors, peer-reviewed literature, and personal communications with field-based humanitarian responders. To account for cost fluctuations, each input's costs along with low and high parameters are presented. All costs are presented in 2021 United States Dollars (USD). SETTING: Humanitarian responses within Indonesia and Jordan. PARTICIPANTS: Not applicable. RESULTS: There was a notable difference in the total cost of care in both selected locations across the study arms (Indonesia: $542; Jordan: $892). CONCLUSIONS: Given the reality of limited funding for comprehensive humanitarian response around the world and the necessity of prioritizing certain interventions, humanitarian response organizations should consider the notable cost difference between EBF and BMS usage (along with the proven health benefits of EBF). This difference should play a role in informing the future creation of SOPs while also ensuring that all infants within a humanitarian crisis receive appropriate feeding. |
Rabies importation in dogs and reduction of waiting period - The fear for scientifically justified changes
Müller T , Wallace RM , Freuling CM . Vaccine 2023 The re-introduction of rabies into susceptible animal populations can have dire human and animal health impacts, in addition to substantial financial implications for re-elimination [1], [2]. In the late 1970s and early 1980s the canine rabies virus variant was reintroduced into the southern United States, resulting in 2 human and over 500 animal deaths and over $40m USD to re-eliminate the disease over the following 20 years [3], [4]. In 2015, canine rabies was introduced into Sarawak, Malaysia [5], where it has resulted in over 30 human deaths and control efforts are still ongoing to control the outbreak. Clearly, the introduction of canine rabies is no trivial matter, and global standards, such as those from the World Organization for Animal Health’s (WOAH) Terrestrial Animal Health Code [6], have been developed to support countries to prevent such occurrences. Current-day importation of rabies-infected dogs into North America and Europe are driven entirely be the illegal movement of dogs; that is, dogs that did not comply with national and international requirements for movement [7], [8], [9]. | | WOAH’s current standards for dog movement from countries endemic with rabies virus include criteria that the dog is healthy at the time of travel, is up-to-date on rabies vaccination, is permanently identified (e.g. microchip), has an adequate rabies virus neutralizing antibody (RVNA) titer (defined as >0.5 IU/ml), and has served a waiting period of at least 90 days (and not more than 365 days) after the date of which the adequate serum sample was collected – referred to as the “waiting period” [6]. Given the fact that nearly all modern-day rabies importation events have been associated with intentional or unintentional non-compliance with the WOAH waiting period, several peer-reviewed scientific publications have re-examined the rationale for the 90-day waiting period (Table 1), with particular interest in compromising between the scientific evidence and alleviating long-waiting periods that may be encouraging dog owners and importers to undermine the waiting period requirement [9], [10], [11]. This against the background that people are increasingly unsatisfied with the 90 day waiting period based on our experience and furthermore, that fraudulent documents can run rampant in the current system [12], [13]. |
A literature review of digital behavioral parent training programs for parents of adolescents
Morgan MHC , Huber-Krum S , Willis LA , Shortt JW . Prev Sci 2023 Parents of adolescents are faced with a variety of challenges related to their children's behavior and development. Behavioral parent training (BPT) programs may be effective strategies to mitigate adverse childhood experiences (ACEs) and other common behavioral problems in the adolescent period. Adolescence is the period following the onset of puberty and describes the transition from childhood to adulthood. Digital BPTs, including those delivered via the internet, downloaded digital content, text message, tablet, and video call, may present a unique opportunity to reach a broad audience of parents of adolescents by removing barriers to program accessibility (e.g., cost and transportation). We conducted a literature review to synthesize the existing evidence on digital BPTs for parents of adolescents. We described the digital BPTs, study designs, and evaluation and feasibility outcomes. A structured literature search identified studies meeting the following criteria for inclusion: (a) published between January 2000 and October 2022, (b) peer-reviewed, (c) available in English language, (d) study included a description of a digital BPT methodological approach, (e) study had to identify at least one parent or child behavioral outcome (e.g., parent-reported communication with their child) or feasibility outcome associated with the digital BPT, and (f) study included parents of adolescents aged 10-18 years. We extracted data on the characteristics of the study and demographic characteristics of participants, digital BPT, and evaluation and feasibility outcomes. Twenty-eight studies met inclusion criteria. Twenty-two unique digital BPTs were evaluated across the published studies. Thirteen digital BPTs (59.1%) were developed from or grounded by an identified theory. Six digital BPTs were freely accessible by the public, while the remaining 16 were available through study participation or purchase. One digital BPT was specifically tailored to parents of adolescents of a racial/ethnic minority group. Of the 16 studies that reported either parent or adolescent race/ethnicity, 10 consisted of more than 50% White parent or adolescent participants. Twenty-four (88.9%) studies provided evaluation data for the digital BPT. Fourteen studies (63.6%) employed a randomized control trial study design, and the remaining study designs included quasi-experimental (n = 2), mixed methods (n = 1), open trial (n = 3), case study (n = 1), pretest-posttest design (n = 1), and feasibility and acceptability trial (n = 2). All studies reported improvements in at least one parent-reported or adolescent-reported behavioral outcome or feasibility outcomes, with effect sizes (Cohen's d) ranging from small (e.g., 0.20-0.49) to very large (e.g., > 1.20). The findings of this review illustrate that technology may be a valuable way to deliver BPTs to parents of adolescents. However, few digital BPTs were developed for parents of adolescents from racial/ethnic minority groups, and many digital BPTs were not available without cost or participation in a research study. Considerations for future research are discussed. |
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