healthcare system

PURPOSE

This study explored employee health behavior changes and healthcare utilization following workplace genetic testing (wGT). Wellness program-associated wGT seeks to improve employee health, but related health implications are unknown.

METHODS

Employees of a large U.S. healthcare system offering wGT (cancer, heart disease, and pharmacogenomics - PGx) were sent electronic surveys. Self-reported data from those who received test results were analyzed. Descriptive statistics characterized responses, while logistic regression analyses explored correlates of responses to wGT.

RESULTS

53.9% (n=418/776) of respondents (88.3% female, mean age = 44 years) reported receiving wGT results. 12.0% (n=48/399) received results indicating increased risk (IR) of cancer, 9.5% (n=38/398) had IR of heart disease, and 31.4% (n=125/398) received informative PGx results. IR results for cancer and/or heart disease (n=67) were associated with health behavior changes (aOR 3.23; 95% CI 1.75, 6.13; p<0.001) and healthcare utilization (aOR 8.60; 95% CI 4.43, 17.5; p<0.001). Informative PGx results (n=125) were associated with medication changes (PGx - informative: 15.2%; PGx - uninformative: 4.8%; p=0.002).

CONCLUSION

This study explored employee responses to wGT, contributing to the understanding of the ethical and social implications of wGT. Receiving IR results from wGT may promote health behavior changes and healthcare utilization in employees.

Developing an infection prevention and control intervention to reduce hospital-acquired infections in Cambodia and Lao People's Democratic Republic: the HAI-PC study protocol

Background

Hospital-acquired infections (HAIs) are significant public health issues, especially in low-and middle-income countries (LMICs). Hand hygiene and low-level disinfection of equipment practices among healthcare workers are some of the essential measures to reduce HAIs. Various infection prevention and control (IPC) interventions to reduce HAI incidence have been developed. However, effective interventions have not been well developed in the LMICs context. Therefore, this protocol aims to develop, pilot, and assess the feasibility and acceptability of an IPC intervention in Cambodia and the Lao People's Democratic Republic.

Methods

This study will consist of four phases guided by the Medical Research Council (MRC) Framework. Three hospitals will be purposely selected - each from the district, provincial, and national levels - in each country. The gap analysis will be conducted in Phase 1 to explore IPC practices among healthcare workers at each hospital through desk reviews, direct observation of hand hygiene and low-level disinfection of equipment practices, in-depth interviews with healthcare workers, and key informant interviews with stakeholders. In Phase 2, an IPC intervention will be developed based on the results of Phase 1 and interventions selected from a systematic literature review of IPC interventions in LMICs. In Phase 3, the developed intervention will be piloted in the hospitals chosen in Phase 1. In Phase 4, the feasibility and acceptability of the developed intervention will be assessed among healthcare workers and representatives at the selected hospitals. National consultative workshops in both countries will be conducted to validate the developed intervention with the national technical working groups.

Discussion

The MRC Framework will be employed to develop and evaluate an intervention to reduce HAIs in two LMICs. This theoretical framework will be used to explore the factors influencing hand hygiene compliance among healthcare workers. The gap analysis results will allow us to develop a comprehensive IPC intervention to reduce HAI incidence in Cambodia and Lao People's Democratic Republic. Findings from this protocol will feed into promising IPC interventions to reduce HAI incidence in other resource-limited settings.

Clinical trial registration

ClinicalTrial.Gov, identifier NCT05547373.

Adaptation of ACTivate Your Wellbeing, a Digital Health and Well-being Program for Young Persons: Co-design Approach

BACKGROUND

ACTivate your wellbeing is a digital health and well-being program designed to support and encourage positive lifestyle behavior change. The website includes 5 lifestyle behavior change modules and a 12-week well-being intervention based on acceptance and commitment therapy. It was timely to adapt the resource for a new audience in the wake of the COVID-19 pandemic. Young persons' mental health needs have increased substantially, and lifestyle behaviors play a critical role in both mental and physical health statuses.

OBJECTIVE

This study aimed to adapt an existing health and well-being website for use by young persons aged 16 to 24 years.

METHODS

A 3-staged participatory, co-design approach was adopted. The participants reviewed the existing program and provided feedback (stage 1) before cocreating new content (stage 2). Finally, the updated program underwent formative evaluation (stage 3). Two groups were created: one had access for 3 weeks and the other could self-select their study duration. The options were 3 weeks, 60 days, or 90 days. Outcome measures were the Warwick and Edinburgh Mental Well-being Scale, 4-item Patient Health Questionnaire, and Acceptance and Action Questionnaire version 2.

RESULTS

Stage 1 identified that the website was appealing to the new audience (19/24, 79%), and the 3 web-based focus group discussions explored data from the written review in more depth to identify and clarify the main areas for update and adaptation. Overall, 3 themes were developed, and the data informed the creation of 6 tasks for use in 5 web-based co-design workshops. Stage 2 led to the cocreation of 36 outputs, including a new name, new content, scenarios, images, and a new user dashboard, which included streaks and an updated color scheme. After the website update program was completed, 40 participants registered to use the website for formative evaluation (stage 3). Data analysis revealed differences in engagement, completion, and mean well-being after intervention between the 2 groups. The completion rate was 68% in the 3-week duration group, and well-being scores improved after intervention.

CONCLUSIONS

Young persons engaged actively with the participatory design process. The participants discussed the updates they desired during the web-based discussions, which worked well via Zoom (Zoom Video Communications Inc) when small groups were used. The participants easily cocreated new content during the web-based co-design workshops. The web-based format enabled a range of participants to take part, share their ideas, search for images, and design digital content creatively together. The Zoom software enabled screen sharing and collaborative whiteboard use, which helped the cocreation process. The formative evaluation suggested that younger users who engage more with the website for a shorter duration may benefit more.

Violence Prevention Programs Are Effective When Initiated During the Initial Workup of Patients in an Urban Level I Trauma Center

This study represents the first attempt at evaluating the ability of the CureViolence Hospital-Response Intervention Program (previously CeaseFire) to disrupt the pattern of violent reinjury. The clinical data points of 300 African American men who presented to our trauma center with a gunshot wound and received intervention at the bedside between 2005 and 2007 (with a 48-month follow-up) were collected. This cohort was matched with a post hoc historical control group using hospital records from 2003 to 2005. The mean age for both groups was 23.9 years. Odds ratios and 95% confidence intervals were obtained. Using a binary logistical regression model, we assessed the performance of three variables of interest: age at the time of the initial injury, treatment group, and initial disposition group to predict recidivism. We utilized the Nagelkerke R square method, which described the proportion of the variance of the reinjury rate and validated our findings using the Hosmer-Lemeshow test (for goodness-of-fit). Six percent (n = 18) of subjects in the treatment group and 11% (n = 33) in the control group returned with a new injury, yielding a total reinjury rate of 8.5%. Most patients returned only once with another violent injury. Individuals who did not receive CureViolence services were nearly twice as likely (odds ratio = 1.94; 95% confidence interval = 1.065, 3.522) to return with a violent reinjury. This finding suggests that Hospital-Response Intervention Programs (HRIP) have a protective effect in violently injured patients. We therefore conclude our HRIP positively affected at-risk patients and prevented violent reinjury.

Raising Ecological Awareness and Digital Literacy in Primary School Children through Gamification

Environmental education, at least in northwest Spain, is often overlooked in the education system from infant schooling onwards and interventions are needed to raise the profile of this subject. The aim of this study was to examine the impact of a learning program designed for primary school students to broaden their ecological awareness and improve digital literacy using gamification tools. The research was developed using a qualitative approach, with data obtained from 156 subjects, including teachers, students and families. The results show that the children assimilated new habits on the better usage of water and electricity and recycling paper and plastic. Moreover, they acquired more efficient strategies for finding information online, by using apps and developing content with digital tools. Gaming dynamics and resources were the key to students’ learning, with the tablet proving an essential tool for boosting motivation, interaction and problem solving.

Activity-Integrated Hidden Markov Model to Predict Calving Time

Simple Summary

Dairy cows are known to become more active during the time calving approaches. Dairy farms provide individual calving pens to monitor the behavior of pregnant cows. Frequent posture changes such as alternating between lying and standing are good indicators that calving is imminent. In this paper, we aimed to determine how using these behavior changes or activities could help predict calving time. The activity monitoring video cameras in this study were located at a top corner of the calving pens so that the whole pens are visible. By processing the collected video sequences, the activities of pregnant cows three days before the calving were modeled in a Hidden Markov Model to predict the time when the calving event occurs. The experimental results show that the proposed method has promise.

Abstract

Accurately predicting when calving will occur can provide great value in managing a dairy farm since it provides personnel with the ability to determine whether assistance is necessary. Not providing such assistance when necessary could prolong the calving process, negatively affecting the health of both mother cow and calf. Such prolongation could lead to multiple illnesses. Calving is one of the most critical situations for cows during the production cycle. A precise video-monitoring system for cows can provide early detection of difficulties or health problems, and facilitates timely and appropriate human intervention. In this paper, we propose an integrated approach for predicting when calving will occur by combining behavioral activities extracted from recorded video sequences with a Hidden Markov Model. Specifically, two sub-systems comprise our proposed system: (i) Behaviors extraction such as lying, standing, number of changing positions between lying down and standing up, and other significant activities, such as holding up the tail, and turning the head to the side; and, (ii) using an integrated Hidden Markov Model to predict when calving will occur. The experiments using our proposed system were conducted at a large dairy farm in Oita Prefecture in Japan. Experimental results show that the proposed method has promise in practical applications. In particular, we found that the high frequency of posture changes has played a central role in accurately predicting the time of calving.

Awareness Development and Usage of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Randomized Controlled Trial

Background

Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management.

Objective

The study aimed to develop awareness and knowledge in order to enhance lifestyle behavior changes among individuals with HTN in a rural community of Bangladesh by using health education and mobile health (mHealth) technology (SMS text messaging).

Methods

A prospective randomized 5-month intervention, open-label (1:1), parallel-group trial was implemented among the individuals with HTN aged 35 years or older. Both men and women were included. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visits by community health workers. After block randomization, they were assigned to either the intervention group (received SMS text messaging and health education; n=209) or the control group (received only health education; n=211). The primary outcome was the evaluation of self-reported behavior changes (salt intake, fruits and vegetables intake, physical activity, and blood pressure [BP], and body weight monitoring behaviors). The secondary outcomes were measurements of actual salt intake and dietary salt excretion, blood glucose level, BP values, and quality of life (QOL).

Results

During the study period, a total of 8 participants were dropped, and the completion rate was 98.0% (412/420). The adherence rates were significantly higher (9%) among the control group regarding salt intake (P=.04) and physical activity behaviors (P<.03), and little differences were observed in other behaviors. In primary outcome, the focused behavior, salt intake less than 6 g/day, showed significant chronological improvement in both groups (P<.001). The fruits intake behavior steadily improved in both groups (P<.001). Participants in both groups had a custom of vegetables intake everyday/week. Physical activity suddenly increased and continued until the study end (P<.001 in both groups). Both BP and body weight monitoring status increased from baseline to 1 month but decreased afterward (P<.001). In case of secondary outcomes, significant chronological changes were observed in food salt concentration and urinary salinity between the groups (P=.01). The mean systolic BP and diastolic BP significantly chronologically decreased in both groups (systolic BP, P=.04; diastolic BP, P=.02.P<.05). All of these supported self-reported behavior changes. For the QOL, both groups showed significant improvement over the study periods (P<.001).

Conclusions

Based on these results, we suggest that face-to-face health education requires integration of home health care provision and more relevant and timely interactive SMS text messages to increase the effectiveness of the intervention. Besides, community awareness can be created to encourage “low-salt culture” and educate family members.

Trial Registration

Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104; https://clinicaltrials.gov/ct2/show/NCT03614104 and UMIN-CTR R000033736; https://tinyurl.com/y48yfcoo

International Registered Report Identifier (IRRID)

RR2-10.2196/15523

The Association between Living Status Transitions, Behavior Changes and Family Relationship Improvement among Methadone Maintenance Treatment Participants in Guangdong, China

The quality of family relationships is important for individual and family well-being. Improving family relationships is also an important goal in methadone maintenance treatment (MMT). Little is known about factors associated with the improvement of family relationships among MMT clients. This study aimed to identify factors associated with family relationship improvement in MMT. We retrospectively analyzed existing data from 2006 to 2014 at 15 MMT clinics in Guangdong, China, including 2171 subjects with 4691 follow-ups. Generalized estimating equations were used to investigate the association between living status transitions, behavior changes and family relationship improvement, with covariates controlled for. Family relationship improvement was found in 23.1% of all follow-up intervals. Participants who began living with family, living on a regular wage, and gained employment were more likely to have improved family relationships. The quality of family relationships also improved among participants who ceased contact with drug-addicted fellows, ceased drug use, and those who were sexually active. These results suggest that improvement in living status, positive changes in drug use, and sexual activity are associated with family relationship improvement and corresponding interventions may be developed to facilitate clients’ recovery.

Frontotemporal dementia in eight Chinese individuals

Frontotemporal dementia (FTD) has rarely been reported in Chinese populations. There are many potential reasons for this, including possible hesitancy on the part of patients or families to bring FTD-related symptoms to medical attention. Here, we present data on eight Chinese individuals, all of whom met criteria for the behavioral variant of FTD or the semantic variant of primary progressive aphasia. These patients presented for neurological evaluation at a relatively advanced stage. The mean MMSE score at initial presentation was 15. Behavioral symptoms were common and usually elicited during the medical history only after direct questioning. Delay in presentation was attributed to a variety of issues, including family disagreements about whether the symptoms represented a disease and lack of medical insurance. These cases illustrate that the symptoms of FTD in Chinese-Americans are similar to those in Caucasians but various factors, some potentially culturally relevant, may influence the likelihood and timing of clinical presentation for FTD, as well as other dementias. Additional study of FTD in diverse ethnic groups needs to address barriers to clinical presentation, including factors that may be culturally specific.