The Participation of Pediatric Dentists in Oral Health Promotion and Education in Serbia

Objectives

To identify the involvement of Serbian paediatric dentists in oral health promotion and education, and to propose further actions for the improvement of these activities.

Methods

This is an analysis of data collected by a cross-sectional, questionnaire-based survey of 445 dentists involved in the provision of dental health services to children at the primary healthcare level. We explored dentists' involvement in oral health education and promotion and the cooperation with other health professionals at the healthcare centre and the community level as well as their attitudes towards the importance of some factors influencing their work.

Results

Dentists estimate their cooperation with different services with ratings higher than 3 on the scale of 1 to 5. They reported the highest satisfaction in cooperation with paediatric services for preschool and schoolchildren (4.0±1.0). At the community level, they reported excellent cooperation with kindergartens (4.4±0.8), while collaboration with Roma health mediators (3.14±1.34) and nongovernmental organizations (2.5±1.4) received lower ratings. According to the average rating (4.7±0.7), dentists perceive the motivation of patients and/or their guardians for keeping good oral health as the factor with the highest importance for the quality of interventions they provide.

Conclusions

Dentists involved in the provision of dental healthcare for children and adolescents in primary healthcare centres in Serbia participate in different oral healthcare education and promotion activities in the community, and highlight the importance of strengthening cooperation with healthcare and other professionals and services aimed at vulnerable population groups, both within the health sector and nongovernmental organizations.

Barriers to and facilitators of physical activity in adults living with and beyond cancer, with special emphasis on head and neck cancer: a systematic review of qualitative and mixed methods studies

PURPOSE

Physical activity can improve health outcomes for cancer patients; however, only 30% of patients are physically active. This review explored barriers to and facilitators of physical activity promotion and participation in patients living with and beyond cancer. Secondary aims were to (1) explore similarities and differences in barriers and facilitators experienced in head and neck cancer versus other cancers, and (2) identify how many studies considered the influence of socioeconomic characteristics on physical activity behaviour.

METHODS

CINAHL Plus, MEDLINE, PsycINFO, Scopus and Cochrane (CDSR) were searched for qualitative and mixed methods evidence. Quality assessment was conducted using the Mixed Methods Appraisal Tool and a Critical Appraisal Skills Programme Tool. Thematic synthesis and frequency of reporting were conducted, and results were structured using the Capability-Opportunity-Motivation-Behaviour model and Theoretical Domains Framework.

RESULTS

Thirty qualitative and six mixed methods studies were included. Socioeconomic characteristics were not frequently assessed across the included studies. Barriers included side effects and comorbidities (physical capability; skills) and lack of knowledge (psychological capability; knowledge). Having a dry mouth or throat and choking concerns were reported in head and neck cancer, but not across other cancers. Facilitators included improving education (psychological capability; knowledge) on the benefits and safety of physical activity.

CONCLUSION

Educating patients and healthcare professionals on the benefits and safety of physical activity may facilitate promotion, uptakeand adherence. Head and neck cancer patients experienced barriers not cited across other cancers, and research exploring physical activity promotion in this patient group is required to improve physical activity engagement.

The impact of price promotions on confectionery and snacks on the energy content of shopping baskets: A randomised controlled trial in an experimental online supermarket

Overconsumption of foods high in fat, sugars, and salt (HFSS) poses a significant risk to health. The government in England has passed legislation that would limit some price promotions of HFSS foods within supermarkets, but evidence regarding likely impacts of these policies, especially in online settings, is limited. This study aimed to determine whether there were any differences in the energy and nutrient content of shopping baskets after removing promotions on HFSS foods in an online experimental supermarket. UK adults (n = 511) were asked to select food from four categories with a £10 budget in an online experimental supermarket: confectionery; biscuits and crackers; crisps, nuts and snacking fruit; cakes and tarts. They were randomly allocated to one of two trial arms: (1) promotions present (matched to promotion frequency seen in a major UK retailer) (n = 257), or (2) all promotions removed from all products within the target food categories (n = 254). The primary outcome analysis used linear regression to compare total energy (kcal) of items placed in shopping baskets when promotions were present vs. absent, while secondary analyses investigated differences in nutrients and energy purchased from individual food categories. Mean energy in food selected without promotions was 5156 kcal per basket (SD 1620), compared to 5536 kcal (SD 1819) with promotions, a difference of -552kcal (95%CIs: -866, -238), equivalent to 10%. There were no significant differences in energy purchased for any individual category between groups. No evidence was found of other changes in nutritional composition of baskets or of significant interactions between the impact of promotions and participant characteristics (gender, age, ethnicity) on energy purchased. Removing promotions on HFSS foods resulted in significantly less total energy selected in an online experimental supermarket study.

Nursing students' attitudes, behaviour, and knowledge toward smoking cessation: Results from a descriptive survey at a regional university

BACKGROUND

Smoking is the largest single cause of lifestyle-related preventable morbidity and mortality. Nurses form the largest cohort of health professionals and are strategically placed to implement smoking cessation interventions. However their capacity is underutilised, particularly in rural and remote areas in countries such as Australia where the incidence of smoking in is higher than average and access to healthcare is limited. One strategy to address the underutilisation of nurses in smoking cessation interventions is to include training in the university/college nursing curriculum. To effectively implement this training, it is vital to have an in-depth knowledge of student nurses' attitudes towards smoking including the role of healthcare professionals in smoking cessation, their smoking behaviour and that of their peers, and knowledge regarding smoking cessation techniques and resources.

OBJECTIVES

Investigate nursing students' attitudes, behaviour, and knowledge towards smoking cessation, determine the impact of demographics and educational experienced on these, and develop recommendations for future research and educational practice.

DESIGN

Descriptive survey.

PARTICIPANTS

Non-probability sample of undergraduate nursing students (n = 247) from a regional Australian university.

RESULTS

Significantly more participants had tried smoking cigarettes than had not (p = 0.026). There were no significant relationships between gender and smoking (p = 0.169) or e-cigarette use (p = 0.200), but a significant relationship was found between age and smoking status where older participants (48-57 years) were more likely to smoke (p < 0.001). Most participants (70 %) were supportive of public health measures to reduce cigarette smoking but felt that they lacked specific knowledge to assist their patients to cease smoking.

CONCLUSIONS

Within education there needs to be an emphasis on the central role that nurses play in smoking cessation with a greater focus on training nursing students about smoking cessation strategies and resources. There is also a need to ensure that students know it falls within their duty of care to address smoking cessation with patients.

Innovation and Entrepreneurship in Promotion and Tenure in Biomedical Engineering: Communication from the Biomedical Engineering Society Long Range Planning Committee

Promotion and tenure (P&T) remain the central tenets of academia. The criteria for P&T both create and reflect the mission of an institution. The discipline of biomedical engineering is built upon the invention and translation of tools to address unmet clinical needs. 'Broadening the bar' for P&T to include efforts in innovation, entrepreneurship, and technology-based transfer (I/E/T) will require establishing the criteria and communication of methodology for their evaluation. We surveyed the department chairs across the fields of biomedical and bioengineering to understand the state-of-the-art in incorporation, evaluation, and definition of I/E/T as applied to the P&T process. The survey results reflected a commitment to increasing and respecting I/E/T activities as part of the P&T criteria. This was balanced by an equally strong desire for improving the education and policy for evaluating I/E/T internally as well as externally. The potential for 'broadening the bar' for P&T to include I/E/T activities in biomedical engineering may serve as an example for other fields in engineering and applied sciences, and a template for potential inclusion of additional efforts such as diversity, equity, and inclusion (DEI) into the pillars of scholarship, education, and service.

The tick saliva peptide HIDfsin2 promotes the tick-borne virus SFTSV replication in vitro by enhancing p38 signal pathway

Pathogens co-evolved with ticks to facilitate blood collection and pathogen transmission. Although tick saliva was recently found to be rich in bioactive peptides, it is still elusive which saliva peptide promotes virus transmission and which pathways are invovled. Here, we used a saliva peptide HIDfsin2 and a severe fever with thrombocytopenia syndrome virus (SFTSV) both carried by the tick Haemaphysalis longicornis to elucidate the relationship between tick saliva components and tick-borne viruses. HIDfsin2 was found to promote the replication of SFTSV in a dose-dependent manner in vitro. HIDfsin2 was further revealed to MKK3/6-dependently magnify the activation of p38 MAPK. The overexpression, knockdown and phosphorylation site mutation of p38α indicated that p38 MAPK activation facilitated SFTSV infection in A549 cells. Moreover, the blockade of p38 MAPK activation significantly suppressed SFTSV replication. Differently, HIDfsin2 or pharmacological inhibition of p38 MAPK activation had no effect on a mosquito-borne Zika virus (ZIKV). All these results showed that HIDfsin2 specifically promoted SFTSV replication through the MKK3/6-dependent enhancement of p38 MAPK activation. Our study provides a new perspective on the transmission of tick-borne viruses under natural conditions, and supports that the blockade of p38 MAPK activation can be a promising strategy against the mortal tick-borne virus SFTSV.

Prevent2Protect Project: Regulatory Focus Differences in Sexual Health Knowledge and Practices

The way people perceive risks and make decisions about their health is regulated by two motivational systems-prevention of harm or promotion of pleasure. People more focused on prevention strive to avoid negative outcomes and enact more health-protective behaviors. In contrast, people more focused on promotion strive to attain positive outcomes and take more risks with their health. Building upon recent evidence extending this framework to sexual behaviors and health, we conducted a pre-registered online survey ( OSF ) with Portuguese and Spanish adults (N = 742; M_age = 31.42, SD = 9.16) to examine whether self-reported STI knowledge and sexual health practices differ based on predominant regulatory focus. This study was part of the Prevent2Protect project ( OSF ). Results showed that prevention-focused participants had heard about more STIs and retrieved more of their knowledge from scientific sources but had been tested for fewer STIs in the past. In contrast, promotion-focused participants indicated they had specific knowledge about more STIs, retrieved more of their knowledge from medical and peer sources, and had been tested for more STIs in the past. They also reported more frequent STI testing, using free testing facilities or asking their family practice doctor to get tested, more routine sexual health check-ups, and more use of other contraceptive methods, such as birth control pills. These results remained unchanged after controlling for demographic differences. Overall, our findings showed that different motives in sexuality shape sexual health knowledge and sexual health practices.

Roles of cancer stem cells in gastrointestinal cancers

Cancer stem cells (CSCs) are the main cause of tumor growth, invasion, metastasis and recurrence. Recently, CSCs have been extensively studied to identify CSC-specific surface markers as well as signaling pathways that play key roles in CSCs self-renewal. The involvement of CSCs in the pathogenesis of gastrointestinal (GI) cancers also highlights these cells as a priority target for therapy. The diagnosis, prognosis and treatment of GI cancer have always been a focus of attention. Therefore, the potential application of CSCs in GI cancers is receiving increasing attention. This review summarizes the role of CSCs in GI cancers, focusing on esophageal cancer, gastric cancer, liver cancer, colorectal cancer, and pancreatic cancer. In addition, we propose CSCs as potential targets and therapeutic strategies for the effective treatment of GI cancers, which may provide better guidance for clinical treatment of GI cancers.

Vibratome technique revealed initial carcinogenic changes that induce GST-P+ single hepatocytes and minifoci in rat liver

The drastic initial carcinogenic changes that induce single hepatocytes and minifoci positive for GST-P (a specific biomarker of foci and nodules) identified previously in rat livers (K. Satoh, Life Sci. 2018) require elucidation. Notably, after animals were administered benzyl isothiocyanate (BITC, anti-cancer phytochemical, 0.5% by wt) in their basal diet, immunocytochemical staining of vibratome-prepared liver specimens for GST-P revealed that the canalicular networks and bile ducts of the animal livers were heavily and finely stained for GST-P even though the biomarker is a cytosolic enzyme. In addition, the mean diameter of the canaliculi was greatly enlarged. The results thus indicate that GST-P was rapidly synthesized in all hepatocytes but rapidly excreted into bile. Similar results were obtained with animals administered dietary AAF carcinogen (0.04%). The biliary excretion of GST-P was detectable not only in all hepatocytes but also within minifoci, foci and nodules. A new initiation model was therefore proposed assuming that GST-P⁺ single hepatocytes are formed after injury to canaliculi by carcinogens to decrease the excretion of GST-P from hepatocytes. The key findings from this study and the biomarker analysis using a vibratome technique might help elucidate the 'unknowable' mechanism of cancer initiation in rat chemical carcinogenesis.

Oral health providers' views of oral health promotion in Jazan, Saudi Arabia: a qualitative study

BACKGROUND

Oral health promotion (OHP) is a crucial aspect of dental care, as it aims to improve and protect oral health of individuals. This study aimed to qualitatively explore views of oral health providers in Jazan, Saudi Arabia, on their perceptions of their responsibilities for OHP, as well as the barriers and potential opportunities for implementing health promotion in dental practice.

METHODS

A convenience sample of 11 oral health providers from Ministry of Health (MOH) facilities were recruited and participated in virtual one-on-one semi-structured interviews, which were transcribed and analyzed using inductive thematic analysis with N-Vivo software.

RESULTS

The results showed that the providers recognized the significant role and responsibility of OHP in improving oral health. However, several barriers hindered their OHP efforts, including a lack of training, funding, time, and a lack of interest in OHP. Potential opportunities for improvement included increasing recruitment of new oral health providers and educators, developing more training programs for providers and the community, and expanding support in terms of finances and logistics.

CONCLUSION

The findings of the study suggest that oral health providers are aware of OHP, but that both patients and organizations will need to shift their behaviours and perspectives for OHP to be successfully implemented. Further research on OHP in the Kingdom of Saudi Arabia (KSA) is needed to validate these findings.

A scoping review of empirical research on prescription drug promotion

BACKGROUND

Pharmaceutical spending on prescription drug promotion is considerable, and exposure to advertising can influence demand and behavior. The U.S. Food and Drug Administration (FDA) provides industry guidance to help ensure that communications to consumers and health care providers about prescription drug promotion are truthful, balanced, and accurately communicated. As empirical research has accelerated on this topic in the past decade, an understanding of the current landscape of the science will help inform future research.

OBJECTIVES

Using systematic methods, this rigorous scoping review of the literature over the past decade (2012-2021) (1) examined the extent to which prescription drug promotion has been empirically investigated with consumers, patients, and health care providers; (2) examined the extent to which content and features of prescription drug promotion have been empirically investigated; and (3) identified themes across the literature to better understand the current landscape of prescription drug promotion.

METHODS

Databases searched include PubMed, Web of Science, CINAHL, APA PsycInfo, Business Source Corporate, Communication Source, Cochrane Library, and ClinicalTrials.gov for original research published in English from January 1, 2012, through November 10, 2021, using terms related to direct-to-consumer advertising, prescription drugs, and outcomes of interest (e.g., attitudes, perceptions, intentions, behaviors).

RESULTS

Of 804 screened references, 151 studies addressed the first research question, and 40 studies addressed the second. The most common theme across the body of evidence focused on testing of features and content in prescription drug promotional materials (84), followed by studies examining attitudes, perceptions, and behaviors toward prescription drug promotion more generally (43). Some (27) studies focused on targeted populations, such as patients, the elderly, non-English speaking people or individuals of a non-white race/ethnicity. Twenty-four studies assessed influence of exposure to prescription drug promotion on actual clinical outcomes, while 11 studies examined emerging technologies around prescription drug promotion. Seven studies evaluated the extent to which prescription drug promotion complied with existing guidelines and requirements.

CONCLUSIONS

Findings from this scoping review suggest there has been an increase in the number of empirical studies conducted on prescription drug promotion over the past decade. Potential areas that warrant further study include examination of emerging technologies, an expanded focus on targeted populations, and construct measurement.

[How important is an academic career in medicine today? A survey of medical students in Germany: results of study arm XIII of the KARiMED study]

OBJECTIVE

Academic careers still play a significant role in medicine. Although the doctorate remains interesting for many students, there are no data available from medical students, for example, with regard to the interest of a habilitation. In parallel, a good work-life/family balance is a key career element for young medical professionals. The aim was to obtain an up-to-date opinion on the academic career of medical students.

METHODOLOGY

Using an online survey, medical students of all semesters in Germany were questioned on the topics of academic career, mentoring, and work-life balance from October 2017 to December 2018. For this purpose, the medical students were invited by e-mail to participate and answer an anonymized online questionnaire.

RESULTS

A total of 1,775 participants from all 38 German medical faculties (68.3% female; age 23.3 ± 4.0 years) were included. Almost half of the participants could envision working in a branch office after graduation. While a professional career appeared important to a clear majority (70.8%), leisure time was rated as even more important (84.3%), and work-life balance clearly prioritized personal life (41.2%) over career (9.6%). Acquiring a title was rated as important to one's career by 53.6%. However, while the acquisition of a doctorate was still an option for 88.0% of the respondents, the situation is significantly different for academic titles following a successful habilitation. Although the significance of a habilitation is rated as high to very high (66.1%), the titles of assistant professor ("yes": 13.0%), associate professor (6.0%) or university professor (7.0%) are much less likely to be considered by medical students and are therefore rated as "maybe" and "no". Nevertheless, almost 60% wished for better information and advice in their future field of work.

CONCLUSION

Careers in medicine are undergoing a transformation where better compatibility of leisure/family and work is no longer the sole focus. On the contrary, work-life blending is sought, as a connection between work and life. Changes are therefore necessary for professional and especially academic careers in order to make working in science and research attractive again.

Effects of polystyrene nanoplastics on the physiological and biochemical characteristics of microalga Scenedesmusquadricauda

The contamination of the aquatic environment with microplastics has become a global environmental concern. Microplastic particles can be shredded to form smaller nanoplastics, and knowledge on their impacts on phytoplankton, especially freshwater microalgae, is still limited. To investigate this issue, the microalga Scenedesmus quadricauda was exposed to polystyrene nanoplastics (PS-NPs) of five concentrations (10, 25, 50, 100, and 200 mg/L). The growth; the contents of antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and peroxidase (POD); the chlorophyll content; and concentrations of soluble protein and soluble polysaccharide were accordingly measured. The results showed that the microalgal density increased with the increase of the polystyrene nanoplastic concentrations, and the physiological features of alga were enhanced after the stimulation of nanoplastics. Furthermore, a high concentration (200 mg/L) of nanoplastics increased the contents of chlorophyll, soluble protein, and polysaccharide (P < 0.05). The antioxidant enzyme activities of Scenedesmus quadricauda were significantly activated by nanoplastics. Lastly, we propose three possible algal recovery mechanisms in response to nanoplastics in which Scenedesmus quadricauda was tolerant with PS-NPs by cell wall thickening, internalization, and aggregation. The results of this study contribute to understanding of the ecological risks of nanoplastics on freshwater microalgae.

PMo12 as a redox mediator for bio-reduction of Cr(VI): Promotor or inhibitor?

Slow reduction rate and low reduction ability were the main limitations of bio-reduction of Cr(VI). As an efficient redox mediator, how phosphomolybdic acid (PMo₁₂) affected bio-reduction of Cr(VI) was worthy of exploration. In this study, short-term and long-term effects of PMo₁₂ on Cr(VI) reduction were investigated to reveal the relevant mechanism. After evaluating the short-term effect of PMo₁₂ concentration from 0.05 to 1.00 mM on Cr(VI) bio-reduction, 0.50 mM was found to be optimum by improving Cr(VI) reduction rate by 16.3 % and microbial electron transport system activity (ETSA) by 43.0 % with Cr(VI) reduction efficiency of 100 % in short-term (22 h) batch experiments. By contrast, in long-term (28 days) continuous flow experiments, 0.50 mM PMo₁₂ exhibited serious inhibition on Cr(VI) bio-reduction. The cumulative toxicity of Mo, strong oxidative stress (reactive oxygen species increased by 16.5 %), the inhibition of extracellular polymeric substances production and the reduction of microbial activity were proved to be the main inhibition mechanism. In terms of microbial electron transport system, the main electron carriers including flavin mononucleotide (FMN), nitrate reductase (NAR), nitrite reductase (NIR) were seriously inhibited. BugBase analysis confirmed that the relative abundance of biofilm forming bacteria decreased after PMo₁₂ addition, and the relative abundance of oxidative stress tolerance bacteria continued to increase.

Telehealth interventions for physical activity and exercise participation in postpartum women: A quantitative systematic review

Postpartum women are one of the least physically active vulnerable populations globally and telehealth has been proposed as a potential method of delivering effective exercise interventions for this population. However, clinical practice guidelines are based upon the recommendations for the general population and therefore, the most efficacious exercise dose and the delivery method for this population is unclear. This quantitative systematic review will examine the implementation and outcomes of telehealth exercise interventions in the postpartum population to synthesise the degree to which these outcomes have been assessed and evaluated. Five databases were searched from January 2001 to March 2022. Studies implementing synchronous telehealth exercise interventions for postpartum women were included. Interventions were examined against the Template for Intervention Description and Replication (TIDieR) checklist that assesses intervention reporting completeness and replicability. Of the 1036 records identified, 16 studies progressed to data extraction. Six interventions provided individualised exercise prescription, and only four were delivered by university-level exercise practitioners. Physical activity participation was well reported, however health-related outcomes (i.e., muscular strength and aerobic capacity) were very minimally assessed. Only one intervention utilised modern video conferencing as the primary telehealth communication method. With the minimal assessment of health-related outcomes, there is limited scope to assess the effectiveness of these interventions for postpartum women. Future research interventions need to be reported according to a validated trial reporting system and focus on relevant health related outcomes including postpartum depressive symptoms, quality of life, cardiovascular fitness, muscular strength and body composition.

Enhancement and mechanisms of iron-assisted anammox process

Anaerobic ammonium oxidation (anammox) is a sustainable biological nitrogen removal technology that has limited large-scale applications owing to the low cell yield and high sensitivity of anammox bacteria (AnAOB). Fortunately, iron-assisted anammox, being a highly practical method could be an effective solution. This review focused on the iron-assisted anammox process, especially on its performance and mechanisms. In this review, the effects of iron in three different forms (ionic iron, zero-valent iron and iron-containing minerals) on the performance of the anammox process were systematically reviewed and summarized, and the strengthening effects of Fe (II) seem to be more prominent. Moreover, the detailed mechanisms of iron-assisted anammox in previous researches were discussed from macro to micro perspectives. Additionally, applicable iron-assisted methods and unified strengthening mechanisms for improving the stability of nitrogen removal and shortening the start-up time of the system in anammox processes were suggested to explore in future studies. This review was intended to provide helpful information for scientific research and engineering applications of iron-assisted anammox.

Knowledge, perception and acceptability of breastfeeding and bottle feeding among Saudi population

Despite the enormous benefits of breastfeeding (BF), its prevalence is suboptimal, with exclusive BF ranging between 7.3 % and 51% in the Saudi community. The aim of this study was to assess the Saudi community's knowledge regarding BF, exposure to BF promotional messages and formula milk advertisements and acceptability of BF in public places. It was a cross-sectional study that included Saudis aged 20-55 years old between December 2019 and June 2020. It utilised a self-administered questionnaire, which asked about background information, knowledge of BF, exposure to BF-promoting messages and exposure to formula milk advertisements and acceptability of BF versus bottle feeding in public. Data were analysed using the Statistical Package for the Social Sciences (SPSS v. 22). For the analysis, a p-value <0.05 was considered significant. The sample included for analysis was 914. The mean age of participants was 33.8 ± 9 years. The majority of participants were female 823 (90%); males 87 (10%). The vast majority (94%) agreed that breast milk is more beneficial than formula milk. Nearly two-thirds (61%) were continuously exposed to messages advertising formula feeding, compared to only 35% who were exposed to messages promoting BF. The study found that 67.2% accept BF in public places. Among male participants, only 49% accepted BF in public places compared to 79% of female participants who accepted it; p-value <0.001. Acceptability of BF in public places was significantly higher among participants who had family members who breastfed (68%), compared to those who did not (50%), (p-value 0.01).

Physical activity promotion to persons with spinal cord injury by health and exercise professionals: A scoping review

OBJECTIVES

Health and exercise professionals (HEPs) are ideal promoters and valued messengers of physical activity (PA) information among persons with spinal cord injury (SCI). However, little is known about what strategies used by HEPs increase PA behavior in persons with SCI, or what factors influence HEPs when promoting PA to persons with SCI. The purposes of this scoping review were to (1) ascertain the extent, range and nature of the literature, (2) identify strategies used by HEPs that are associated with an increase in PA behavior for persons with SCI, and (3) identify the facilitators and barriers to PA promotion by the HEPs.

METHODS

A comprehensive search was undertaken. Search terms were expanded surrounding three key terms: PA, promotion, and SCI.

RESULTS

Twenty-four articles representing 18 unique studies were identified. HEPs predominantly consisted of physiotherapists, occupational therapists, and leisure trainers/therapists. Most interventions were delivered by HEPs to persons with SCI in in-patient rehabilitation centres and community-based settings. Tailored exercise programs and on-going counseling support were considered essential for increasing PA behavior. HEPs' common barriers to PA promotion were perceived lack of time, education, and training.

CONCLUSION

A need to improve and sustain SCI-specific PA knowledge and education was identified if PA promotion is to become a structured and integral component of practice. This study provides valuable information for interventions to increase PA behavior among persons with SCI by improving PA promotion by HEPs.

Exploring women's exposure to marketing of commercial formula products: a qualitative marketing study from two sites in South Africa

Background

Regulating the marketing of commercial formula products is a long-term commitment required to protect breastfeeding. Marketing strategies of formula manufacturers, retailers and distributors evolve at a rapid rate.

Objective

The aim of this research was to describe exposure of pregnant women and mothers of young children in South Africa to marketing of commercial formula products, compared to international recommendations and national legislation.

Methods

Using mobile phone marketing diaries twenty participants in Cape Town and Johannesburg documented the formula marketing they were exposed to for one week. Ten mothers were interviewed to explore their perceptions towards marketing exposure in more depth.

Results

Women reported limited infant formula advertising, but an abundance of strategies used to market growing-up formula and powdered drinks for children over 36 months. Strategies included product packaging, in-store displays, online distribution channels and educational material about product ranges. Online strategies were reported, namely social media marketing (sponsored adverts and support groups), websites and mobile phone applications providing infant and young child feeding information and price discounts, print and TV advertisements, and competitions. Products for children over 36 months are cross-promoted with products prohibited to be advertised by national legislation.

Conclusions

South African women are being exposed to covert marketing of infant, follow-up, and growing-up formula. Explicit marketing of products for children over 36 months of age allows formula companies to provide messages about branding and use of commercial formula products to mothers. National legislation should be updated and effectively implemented to address changing marketing strategies.

The effectiveness of a "EspaiJove.net"- a school-based intervention programme in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population: a cluster randomised controlled trial

BACKGROUND

The aim of this study is to evaluate the short- and long-term effects of the universal mental health literacy intervention "EspaiJove.net" in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population. We also examine whether these effects depend on the intervention intensity.  METHODS: A clustered school-based randomised controlled trial (cRCT) design.

SUBJECTS

1,298 secondary pupils aged 13 and 14 were recruited from 18 schools in Barcelona (Spain) between September 2016 and January 2018.

INTERVENTION

Three programmes were assessed: 1) Sensitivity Programme (SP; 1 h); 2) Mental Health Literacy (MHL; 6 h); 3) MHL plus a first-person Stigma Reduction Programme (MHL + SR; 7 h); 4) Control group (CG): waiting list.

OUTCOME MEASURES

1) MHL: EspaiJove.net EMHL Test (First part and Second Part); 2) Stigma: RIBS and CAMI; 3) Help-seeking and use of treatment: GHSQ.

ANALYSIS

The data was collected at baseline, post-intervention and 6 and 12 months later. An intention-to-treat analysis and imputation method was used to analyse the missing data. Intervention effects were analysed using multilevel modelling.

RESULTS

One thousand thirty-two students were included (SP = 225; MHL = 261; MHL + SR = 295 and CG = 251). The MHL and MHL + SR interventions showed short- and long-term an increase in knowledge compared to SP and CG, but no significant change post-intervention or over time (First part p = 0.52 and Second part p = 0.62) between intervention groups and CG. No significant changes were found in stigma scores post-intervention or over time (CAMI p = 0.61 and RIBS p = 0.98) or in help-seeking scores (parent p = 0.69; teacher p = 0.23 and healthcare professional p = 0.75). The MHL + SR intervention was the best valued and recommended (p < 0.005).

CONCLUSIONS

The three interventions of the EspaiJove.net programme (SP, MHL and MHL + SR) seem not to be effective in terms MHL, Stigma and help-seeking behaviours. The contact with a person who has experimented mental illness first-hand did not reduce stigma attitudes. Further research should deal with the heterogeneity of MHL interventions (concept, duration and measures) and identify which components of stigma interventions are effective.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03215654 (registration date 12 July 2017).

Physical activity promotion in chiropractic: a systematic review of clinician-based surveys

BACKGROUND

Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients.

METHODS

Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the 'Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices' tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors' views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported.

RESULTS

From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.).

CONCLUSION

A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors' own PA participation.

Pharmaceutical brochures in Lebanon: do they meet WHO recommendations?

BACKGROUND

Drug promoting brochures can influence physicians prescription patterns. The validity of the info presented in these brochures is of major importance. World Health Organization (WHO) issued criteria to guarantee validity, equity and ethical presentation of data in medical brochures. This study aims to evaluate the quality and the validity of information presented in the pharmaceutical brochures distributed among family physicians in Lebanon.

METHODS

Pharmaceutical brochures were randomly collected at the family medicine center in Hôtel Dieu de France hospital in Beirut - Lebanon. These brochures were evaluated in reference to the WHO ethical criteria for medicinal drug promotion and on guidelines for quality assurance of the graphs, references, texts and illustrations.

RESULTS

Among the 60 brochures collected, only 4 fulfilled all the WHO ethical criteria, and 24 presented less than half the required criteria. Information concerning the drug safety are the least mentioned. Only 11.8% of the presented graphs are based on studies of high methodological level. Half of the brochures presented necessary information to identify studies references which are not always retrievable. Texts present mainly brand names instead of generic names and emphasize on information reflecting the drug efficacy.

CONCLUSION

The pharmaceutical brochures in this study presented incomplete or invalid information. Prescribing physicians should be aware of the claims found in the brochures distributed by pharmaceutical companies and should be familiar with the principles of the evidence-based medicine to be able to critically appraise the validity of the reference studies and avoid the pitfalls in graphs reading.