NEARER SCAN (LENO BESIK) evaluation of a task-sharing echocardiographic active case finding programme for rheumatic heart disease in Australia and Timor-Leste: protocol for a hybrid type II effectiveness-implementation study
NEARER SCAN (LENO BESIK) evaluation of a task-sharing echocardiographic active case finding programme for rheumatic heart disease in Australia and Timor-Leste: protocol for a hybrid type II effectiveness-implementation study
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Introduction
Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste.
Methods and analysis
Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the ‘Single Parasternal Long Axis view with a Sweep of the Heart’ (SPLASH) technique and interpreted by experts remote from the site of acquisition. Approximately 1500 children and pregnant women will be screened across high-risk communities in Australia and Timor-Leste over an 18-month period. The study will use a type II effectiveness-implementation hybrid design. A tailored package of implementation strategies will be co-designed with communities and health services and mapped onto a Theory of Change framework. The clinical effectiveness will be assessed as the change in the proportion of the target population that are prescribed secondary prophylaxis for RHD by the end of the study compared with baseline. The implementation will be assessed as the adoption, penetration, sustainability, fidelity and cost of the programme with a mixed-methods theory-based and economic evaluation. Data will include numbers of normal, abnormal and uninterpretable SPLASH echocardiograms obtained, numbers of participants progressing through the cascade of care, interviews with staff and programme costs.
Ethics and dissemination
Ethical approval has been obtained from the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, Darwin (HREC-2022-4479), the Western Australian Aboriginal Health Ethics Committee (HREC-1237) and the Instituto Nasional Saude Publika Timor-Leste Ethics and Technical Committee (03-UEPD/INSP-TL/V/2023). Informed consent is required to be enrolled. Study findings will be disseminated in the communities involved and submitted for publication.
Trial registration number
Introduction
Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste.
Methods and analysis
Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the ‘Single Parasternal Long Axis view with a Sweep of the Heart’ (SPLASH) technique and interpreted by experts remote from the site of acquisition. Approximately 1500 children and pregnant women will be screened across high-risk communities in Australia and Timor-Leste over an 18-month period. The study will use a type II effectiveness-implementation hybrid design. A tailored package of implementation strategies will be co-designed with communities and health services and mapped onto a Theory of Change framework. The clinical effectiveness will be assessed as the change in the proportion of the target population that are prescribed secondary prophylaxis for RHD by the end of the study compared with baseline. The implementation will be assessed as the adoption, penetration, sustainability, fidelity and cost of the programme with a mixed-methods theory-based and economic evaluation. Data will include numbers of normal, abnormal and uninterpretable SPLASH echocardiograms obtained, numbers of participants progressing through the cascade of care, interviews with staff and programme costs.
Ethics and dissemination
Ethical approval has been obtained from the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, Darwin (HREC-2022-4479), the Western Australian Aboriginal Health Ethics Committee (HREC-1237) and the Instituto Nasional Saude Publika Timor-Leste Ethics and Technical Committee (03-UEPD/INSP-TL/V/2023). Informed consent is required to be enrolled. Study findings will be disseminated in the communities involved and submitted for publication.
Trial registration number
NCT06002243.
Ward manager denies favouring Letby but admits failings
Ward manager denies favouring Letby but admits failings
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The manager of the unit in which former nurse Lucy Letby murdered seven children has denied giving her preferential treatment – but admitted she should have acted sooner.
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Evaluating the importance of rural internships to subsequent medical workforce distribution outcomes: an Australian cohort study
Evaluating the importance of rural internships to subsequent medical workforce distribution outcomes: an Australian cohort study
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Objective
To evaluate the importance of rural internships to observed medical workforce distribution outcomes up to 8 years post-medical school.
Design and setting
Cohort study of medical graduates of The University of Queensland (UQ), Australia.
Participants
UQ graduates who were medical interns in Queensland’s public health system between 2014 and 2021 and observed working in Australia in 2022. Internship location was defined as being metropolitan or rural, along with other key rural exposures of whether they are of rural origin (childhood) and whether at least 1 year of clinical training at medical school was in a rural location.
Primary outcome measure
Current work location was collected from the Australian Health Practitioner Regulation Agency (AHPRA) in 2022, classified as either rural or metropolitan and measured in association with their internship location.
Results
From 1930 eligible graduates, 21.5% took up a rural internship, which was associated with rural origin (OR 1.5, 95% CI 1.2 to 2.0) and medical school rural immersions of either 1 year (OR 2.8, 95% CI 2.1 to 3.7) or 2 years (OR 5.8, 95% CI 4.4 to 7.7). Completing a rural internship was associated with currently working rural (47% vs 14%, OR 4.6, 95% CI 3.5 to 5.9), which weakened the observed (adjusted) effect of rural origin (OR 1.5, 95% CI 1.2 to 2.0) or medical school rural immersions (1 year: OR 1.4, 95% CI 1.0 to 1.9; 2 years: OR 1.7, 95% CI 1.2 to 2.3). All combinations of the key rural exposures that included rural internship had the highest proportions currently working rurally (range 32–69%) compared with the combinations with a metropolitan internship (range 12–22%).
Conclusions
Internship location appears to be a critical factor in shaping medical workforce distribution decisions. This evidence supports the need for strengthened and expanded rural training pathways after medical school. In particular, clearer pathways into specialty programmes via rural internships are likely to support increased numbers choosing (with confidence) to preference rural internship first and subsequently more working in rural areas long term.
Objective
To evaluate the importance of rural internships to observed medical workforce distribution outcomes up to 8 years post-medical school.
Design and setting
Cohort study of medical graduates of The University of Queensland (UQ), Australia.
Participants
UQ graduates who were medical interns in Queensland’s public health system between 2014 and 2021 and observed working in Australia in 2022. Internship location was defined as being metropolitan or rural, along with other key rural exposures of whether they are of rural origin (childhood) and whether at least 1 year of clinical training at medical school was in a rural location.
Primary outcome measure
Current work location was collected from the Australian Health Practitioner Regulation Agency (AHPRA) in 2022, classified as either rural or metropolitan and measured in association with their internship location.
Results
From 1930 eligible graduates, 21.5% took up a rural internship, which was associated with rural origin (OR 1.5, 95% CI 1.2 to 2.0) and medical school rural immersions of either 1 year (OR 2.8, 95% CI 2.1 to 3.7) or 2 years (OR 5.8, 95% CI 4.4 to 7.7). Completing a rural internship was associated with currently working rural (47% vs 14%, OR 4.6, 95% CI 3.5 to 5.9), which weakened the observed (adjusted) effect of rural origin (OR 1.5, 95% CI 1.2 to 2.0) or medical school rural immersions (1 year: OR 1.4, 95% CI 1.0 to 1.9; 2 years: OR 1.7, 95% CI 1.2 to 2.3). All combinations of the key rural exposures that included rural internship had the highest proportions currently working rurally (range 32–69%) compared with the combinations with a metropolitan internship (range 12–22%).
Conclusions
Internship location appears to be a critical factor in shaping medical workforce distribution decisions. This evidence supports the need for strengthened and expanded rural training pathways after medical school. In particular, clearer pathways into specialty programmes via rural internships are likely to support increased numbers choosing (with confidence) to preference rural internship first and subsequently more working in rural areas long term.
Association between physicians maldistribution and core clinical competency of resident physicians: a nationwide cross-sectional study
Association between physicians maldistribution and core clinical competency of resident physicians: a nationwide cross-sectional study
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Objectives
With physician maldistribution recognised as a global issue, Japan implemented the physician uneven distribution (PUD) index as a strategic measure. Currently, there is a lack of objective assessment of core clinical competencies in regions influenced by varying levels of physician distribution. In this study, we objectively assess the core clinical competencies in regions affected by physician maldistribution and explore the relationship between the PUD index and the clinical competencies of resident physicians.
Design, setting and participants
In this cross-sectional study, we gathered data from the January 2023 General Medicine In-Training Examination (GM-ITE) survey. Participants included postgraduate year 1 and 2 resident physicians in Japanese hospitals mandating the GM-ITE or those who voluntarily took it. The GM-ITE scores of the resident physicians were assessed. The PUD index, a Japanese policy indicator, reflects regional physician disparities. A low PUD index signals a medical supply shortage compared with local demand. The trial registration number is 23-7.
Results
The high and low PUD index groups included 2143 and 1580 participants, respectively. After adjusting for relevant confounders, multivariate linear regression analyses revealed that the low PUD index group had significantly higher GM-ITE scores than the high PUD index group (adjusted coefficient: 1.14; 95% CI 0.62 to 1.65; p<0.001).
Conclusions
The study revealed no clinically differences in GM-ITE scores between residents in regions with disparate physician distributions, suggesting that factors beyond PUD may influence clinical competency. This finding prompts a re-evaluation of whether current assessment methodologies or educational frameworks fully support learning across varied community settings.
Objectives
With physician maldistribution recognised as a global issue, Japan implemented the physician uneven distribution (PUD) index as a strategic measure. Currently, there is a lack of objective assessment of core clinical competencies in regions influenced by varying levels of physician distribution. In this study, we objectively assess the core clinical competencies in regions affected by physician maldistribution and explore the relationship between the PUD index and the clinical competencies of resident physicians.
Design, setting and participants
In this cross-sectional study, we gathered data from the January 2023 General Medicine In-Training Examination (GM-ITE) survey. Participants included postgraduate year 1 and 2 resident physicians in Japanese hospitals mandating the GM-ITE or those who voluntarily took it. The GM-ITE scores of the resident physicians were assessed. The PUD index, a Japanese policy indicator, reflects regional physician disparities. A low PUD index signals a medical supply shortage compared with local demand. The trial registration number is 23-7.
Results
The high and low PUD index groups included 2143 and 1580 participants, respectively. After adjusting for relevant confounders, multivariate linear regression analyses revealed that the low PUD index group had significantly higher GM-ITE scores than the high PUD index group (adjusted coefficient: 1.14; 95% CI 0.62 to 1.65; p<0.001).
Conclusions
The study revealed no clinically differences in GM-ITE scores between residents in regions with disparate physician distributions, suggesting that factors beyond PUD may influence clinical competency. This finding prompts a re-evaluation of whether current assessment methodologies or educational frameworks fully support learning across varied community settings.
Association between prophylactic closure of mucosal defect and delayed adverse events after endoscopic resection: a systematic review and meta-analysis
Association between prophylactic closure of mucosal defect and delayed adverse events after endoscopic resection: a systematic review and meta-analysis
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Objective
To investigate the potential of prophylactic closure of mucosal defects to prevent adverse events following endoscopic resection of superficial layers of the gastrointestinal (GI) wall.
Design
Systematic review and meta-analysis.
Data sources
We searched PubMed, Embase, Web of Science and the Cochrane Library for studies eligible for inclusion in our meta-analysis from inception to February 2022.
Data extraction and synthesis
We compared the effects of closure versus non-closure of mucosal defects with respect to adverse events including delayed bleeding, delayed perforation and postpolypectomy coagulation syndrome (PPCS). We used a random-effects model for all analyses. Subgroup analyses were performed based on gastrointestinal sites, surgical procedures and study designs.
Results
In total, this study includes 11 383 patients from 28 studies. For delayed bleeding, closure group was associated with a lower incidence (Risk Ratio [RR]: 0.40, 95% Confidence interval [CI]: 0.30 to 0.53, p<0.001; I2=25%) and consistent results were observed in the subgroups. Also, for delayed perforation, a combined analysis of all sites and surgical methods showed a protective effect of prophylactic closure of mucosal defects (RR: 0.42, 95% CI: 0.22 to 0.82, p=0.01; I2=0%). Similar results were observed in the subgroup analyses, despite the wide CIs. Regarding the PPCS, neither the pooled RRs nor the subgroup analyses showed significant differences.
Conclusion
Prophylactic closure of mucosal defects is beneficial in reducing the incidence of delayed bleeding and delayed perforation after endoscopic resection, but there is no significant difference in reducing the incidence of PPCS.
Objective
To investigate the potential of prophylactic closure of mucosal defects to prevent adverse events following endoscopic resection of superficial layers of the gastrointestinal (GI) wall.
Design
Systematic review and meta-analysis.
Data sources
We searched PubMed, Embase, Web of Science and the Cochrane Library for studies eligible for inclusion in our meta-analysis from inception to February 2022.
Data extraction and synthesis
We compared the effects of closure versus non-closure of mucosal defects with respect to adverse events including delayed bleeding, delayed perforation and postpolypectomy coagulation syndrome (PPCS). We used a random-effects model for all analyses. Subgroup analyses were performed based on gastrointestinal sites, surgical procedures and study designs.
Results
In total, this study includes 11 383 patients from 28 studies. For delayed bleeding, closure group was associated with a lower incidence (Risk Ratio [RR]: 0.40, 95% Confidence interval [CI]: 0.30 to 0.53, p<0.001; I2=25%) and consistent results were observed in the subgroups. Also, for delayed perforation, a combined analysis of all sites and surgical methods showed a protective effect of prophylactic closure of mucosal defects (RR: 0.42, 95% CI: 0.22 to 0.82, p=0.01; I2=0%). Similar results were observed in the subgroup analyses, despite the wide CIs. Regarding the PPCS, neither the pooled RRs nor the subgroup analyses showed significant differences.
Conclusion
Prophylactic closure of mucosal defects is beneficial in reducing the incidence of delayed bleeding and delayed perforation after endoscopic resection, but there is no significant difference in reducing the incidence of PPCS.
Correction: Impact of workplace smoke-free policy on secondhand smoke exposure from cigarettes and exposure to secondhand heated tobacco product aerosol during COVID-19 pandemic in Japan: the JACSIS 2020 study
Correction: Impact of workplace smoke-free policy on secondhand smoke exposure from cigarettes and exposure to secondhand heated tobacco product aerosol during COVID-19 pandemic in Japan: the JACSIS 2020 study
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Takenobu K, Yoshida S, Katanoda K, et al. Impact of workplace smoke-free policy on secondhand smoke exposure from cigarettes and exposure to secondhand heated tobacco product aerosol during COVID-19 pandemic in Japan: the JACSIS 2020 study. BMJ Open 2022;12:e056891. doi: 10.1136/bmjopen-2021-056891
This article was previously published with an error.
The authors have informed the journal that two of the authors have received payment from the tobacco industry on projects unrelated to the one described in the article. This was not in breach of the journal’s policy at the time of publication, which stated that we will not ‘consider for publication any study that is partly or wholly funded by the tobacco industry’.1 However, to make these personal funds transparent, we have corrected the competing interests statement of the article.
Takenobu K, Yoshida S, Katanoda K, et al. Impact of workplace smoke-free policy on secondhand smoke exposure from cigarettes and exposure to secondhand heated tobacco product aerosol during COVID-19 pandemic in Japan: the JACSIS 2020 study. BMJ Open 2022;12:e056891. doi: 10.1136/bmjopen-2021-056891
This article was previously published with an error.
The authors have informed the journal that two of the authors have received payment from the tobacco industry on projects unrelated to the one described in the article. This was not in breach of the journal’s policy at the time of publication, which stated that we will not ‘consider for publication any study that is partly or wholly funded by the tobacco industry’.1 However, to make these personal funds transparent, we have corrected the competing interests statement of the article.
Rationale and design of Dapagliflozin vErsus SacubiTrIl-valsartaN therapY in Heart Failure with reduced ejection fraction (DESTINY-HF): a pragmatic randomised controlled trial protocol
Rationale and design of Dapagliflozin vErsus SacubiTrIl-valsartaN therapY in Heart Failure with reduced ejection fraction (DESTINY-HF): a pragmatic randomised controlled trial protocol
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Background
Heart failure affects almost 64 million people, with more than half of it constituting heart failure with reduced ejection fraction (HFrEF). Angiotensin receptor-neprilysin inhibitors (ARNI) and sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are in the first line for HFrEF, but no head-to-head trials are available. Moreover, growth differentiation factor-15 (GDF-15) has been demonstrated as a promising prognostic marker, specifically for HFrEF, but has not been explored much.
Methods
This pragmatic randomised controlled trial recruits 100 patients with HFrEF (ejection fraction <40%) of New York Heart Association (NYHA) II–III and allocates them in a 1:1 ratio to the dapagliflozin and sacubitril/valsartan groups. The primary objective is to assess the difference in N-terminal pro-brain natriuretic peptide serum levels at the end of 16 weeks. The secondary efficacy objectives are to assess GDF-15, Kansas City Cardiomyopathy Questionnaire-overall summary score and estimated glomerular filtration rate. Patients will be assessed at baseline, fourth week and 16th week after randomisation. As health technology assessment practices widely differ in countries, cost assessment is a vital factor to consider. The cost needed to treat one cardiovascular event is also compared between both groups. The occurrence of safety events will also be evaluated at each follow-up point.
Conclusion
This pragmatic study aims to compare the efficacy, safety and cost-effectiveness of dapagliflozin versus sacubitril/valsartan in patients with HFrEF in real-world settings. The study aims to provide clinicians with data to make informed decisions regarding the preferred drug class. Additionally, examining the impact of ARNI and SGLT2i on GDF-15 levels could offer better insights into prognosis among patients with HFrEF.
Ethics and dissemination
This study involves human participants and was approved by Institutional Ethics Committee at AlIMS Jodhpur with reference number AIIMS/IEC/2023/5842 approved this study. Participants gave informed consent to participate in the study before taking part. The research findings will be disseminated via closed group discussions at the site of study, scientific conferences, peer-reviewed published manuscripts, and social media.
Trial registration number
CTRI/2023/12/060772.
Background
Heart failure affects almost 64 million people, with more than half of it constituting heart failure with reduced ejection fraction (HFrEF). Angiotensin receptor-neprilysin inhibitors (ARNI) and sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are in the first line for HFrEF, but no head-to-head trials are available. Moreover, growth differentiation factor-15 (GDF-15) has been demonstrated as a promising prognostic marker, specifically for HFrEF, but has not been explored much.
Methods
This pragmatic randomised controlled trial recruits 100 patients with HFrEF (ejection fraction <40%) of New York Heart Association (NYHA) II–III and allocates them in a 1:1 ratio to the dapagliflozin and sacubitril/valsartan groups. The primary objective is to assess the difference in N-terminal pro-brain natriuretic peptide serum levels at the end of 16 weeks. The secondary efficacy objectives are to assess GDF-15, Kansas City Cardiomyopathy Questionnaire-overall summary score and estimated glomerular filtration rate. Patients will be assessed at baseline, fourth week and 16th week after randomisation. As health technology assessment practices widely differ in countries, cost assessment is a vital factor to consider. The cost needed to treat one cardiovascular event is also compared between both groups. The occurrence of safety events will also be evaluated at each follow-up point.
Conclusion
This pragmatic study aims to compare the efficacy, safety and cost-effectiveness of dapagliflozin versus sacubitril/valsartan in patients with HFrEF in real-world settings. The study aims to provide clinicians with data to make informed decisions regarding the preferred drug class. Additionally, examining the impact of ARNI and SGLT2i on GDF-15 levels could offer better insights into prognosis among patients with HFrEF.
Ethics and dissemination
This study involves human participants and was approved by Institutional Ethics Committee at AlIMS Jodhpur with reference number AIIMS/IEC/2023/5842 approved this study. Participants gave informed consent to participate in the study before taking part. The research findings will be disseminated via closed group discussions at the site of study, scientific conferences, peer-reviewed published manuscripts, and social media.
Trial registration number
CTRI/2023/12/060772.
Emerging lessons from experiences at transitions in care among hospitalised patients with cancer with postdischarge frequent emergency department use: a qualitative study using linked clinical and patient-reported interview data from Quebec, Canada
Emerging lessons from experiences at transitions in care among hospitalised patients with cancer with postdischarge frequent emergency department use: a qualitative study using linked clinical and patient-reported interview data from Quebec, Canada
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Background
While teamwork is essential to providing high-quality patient-centred care, challenges in interprofessional collaboration and decision-making in hospital settings are common, especially for patients with cancer. The purpose of this qualitative study was to identify emerging themes and potential challenges related to hospital discharge experiences among patients hospitalised for cancer who became frequent emergency department (ED) users postdischarge.
Methods
A cohort of patients with cancer discharged from an academic health centre in Montreal (Canada) between October 2014 and November 2016 was assembled. Using health administrative claims from the provincial universal healthcare programme, frequent ED (FED) users were identified as patients who had a ≥4 ED visits in the year following hospital discharge. Qualitative analysis of transcripts from semistructured telephone interviews conducted with patients 25–30 days’ postdischarge was used for in-depth exploratory analyses to characterise hospital discharge experiences and transition process from the hospital to the community.
Results
Overall, 182 (14.5%) of 1253 patients with cancer who became FED users were included in this study. The mean age was 69.1 (SD=11.5), 59.9% (n=109) were male, and the most frequent cancers were 80 (43.9%) respiratory and 52 (28.6%) upper digestive cancer. Content analyses revealed six emerging themes from the FED patient interviews. Overall, these included (1) incomplete communication of information, (2) hospital discharge planning, (3) coordinating care among team members, (4) follow-up with outpatient providers, (5) monitoring and managing symptoms after discharge and (6) enlisting help of social and community supports.
Conclusions
Using integrated data from clinical, administrative claims and patient interviews, this study provided insights into the challenges related to hospital discharge experiences and transition into community among hospitalised patients with cancer with FED use. Application of our findings could assist in hospital discharge preparation and improvement in healthcare delivery and health outcomes.
Trial registration number
Background
While teamwork is essential to providing high-quality patient-centred care, challenges in interprofessional collaboration and decision-making in hospital settings are common, especially for patients with cancer. The purpose of this qualitative study was to identify emerging themes and potential challenges related to hospital discharge experiences among patients hospitalised for cancer who became frequent emergency department (ED) users postdischarge.
Methods
A cohort of patients with cancer discharged from an academic health centre in Montreal (Canada) between October 2014 and November 2016 was assembled. Using health administrative claims from the provincial universal healthcare programme, frequent ED (FED) users were identified as patients who had a ≥4 ED visits in the year following hospital discharge. Qualitative analysis of transcripts from semistructured telephone interviews conducted with patients 25–30 days’ postdischarge was used for in-depth exploratory analyses to characterise hospital discharge experiences and transition process from the hospital to the community.
Results
Overall, 182 (14.5%) of 1253 patients with cancer who became FED users were included in this study. The mean age was 69.1 (SD=11.5), 59.9% (n=109) were male, and the most frequent cancers were 80 (43.9%) respiratory and 52 (28.6%) upper digestive cancer. Content analyses revealed six emerging themes from the FED patient interviews. Overall, these included (1) incomplete communication of information, (2) hospital discharge planning, (3) coordinating care among team members, (4) follow-up with outpatient providers, (5) monitoring and managing symptoms after discharge and (6) enlisting help of social and community supports.
Conclusions
Using integrated data from clinical, administrative claims and patient interviews, this study provided insights into the challenges related to hospital discharge experiences and transition into community among hospitalised patients with cancer with FED use. Application of our findings could assist in hospital discharge preparation and improvement in healthcare delivery and health outcomes.
Trial registration number
NCT01179867.
Feasibility of a culturally adapted technology-delivered, family-based childhood obesity intervention for Latino/Hispanic families in rural Nebraska: the Hispanic Family Connections study protocol
Feasibility of a culturally adapted technology-delivered, family-based childhood obesity intervention for Latino/Hispanic families in rural Nebraska: the Hispanic Family Connections study protocol
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Introduction
Addressing childhood obesity risk factors like home environment, parental roles, excess weight, physical activity and healthy eating among Latino/Hispanic (L/H) families living in rural communities is an important priority. However, evidence supporting these interventions among L/H families living in rural communities is missing. Our trial will use cultural adaptation and implementation science frameworks to evaluate the feasibility of delivering a culturally appropriate family-based childhood obesity (FBCO) programme via an automated telephone system (interactive voice response) to L/H families in rural Nebraska.
Methods and analysis
A mixed-methods feasibility trial for L/H families with overweight or obese children. Aim 1 will focus on collaboratively adapting and evaluating all intervention materials to fit the rural L/H community profile better, including translation of materials to Spanish, culturally relevant content and images, and use of health communication strategies to address different levels of health literacy. In aim 2, a 6-month feasibility trial with contextual evaluation will randomise 48 dyads (parent and child) to either Family Connections (FC; n=29) or a waitlist standard-care group (n=29) to determine overall study reach, preliminary effectiveness in reducing child body mass index (BMI) z-scores, potential for programme adoption, implementation and sustainability through local health departments (RE-AIM outcomes). We will also evaluate health department perceptions of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs (innovation, context, recipient characteristics) and FC participants’ view of the intervention (ie, relative advantage, observability, trialability, complexity, compatibility). The study will answer three critical questions: (1) is a telephone-delivered FBCO programme in rural Nebraska culturally relevant, usable and acceptable by L/H families?; (2) is a telephone-delivered FBCO programme effective at reducing BMI z-scores in L/H children living in rural Nebraska? and (3) what real-world institutional and contextual factors influence the impact of the intervention and might affect its potential ability to sustainably engage a meaningful population of L/H families who stand to benefit?
Ethics and dissemination
This protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB#:0745-20-EP). Dissemination of findings will occur through ClinicalTrials.gov, in scientific forums and to the local rural communities, pilot data to inform the design of a larger clinical trial.
Trial registration number
Introduction
Addressing childhood obesity risk factors like home environment, parental roles, excess weight, physical activity and healthy eating among Latino/Hispanic (L/H) families living in rural communities is an important priority. However, evidence supporting these interventions among L/H families living in rural communities is missing. Our trial will use cultural adaptation and implementation science frameworks to evaluate the feasibility of delivering a culturally appropriate family-based childhood obesity (FBCO) programme via an automated telephone system (interactive voice response) to L/H families in rural Nebraska.
Methods and analysis
A mixed-methods feasibility trial for L/H families with overweight or obese children. Aim 1 will focus on collaboratively adapting and evaluating all intervention materials to fit the rural L/H community profile better, including translation of materials to Spanish, culturally relevant content and images, and use of health communication strategies to address different levels of health literacy. In aim 2, a 6-month feasibility trial with contextual evaluation will randomise 48 dyads (parent and child) to either Family Connections (FC; n=29) or a waitlist standard-care group (n=29) to determine overall study reach, preliminary effectiveness in reducing child body mass index (BMI) z-scores, potential for programme adoption, implementation and sustainability through local health departments (RE-AIM outcomes). We will also evaluate health department perceptions of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs (innovation, context, recipient characteristics) and FC participants’ view of the intervention (ie, relative advantage, observability, trialability, complexity, compatibility). The study will answer three critical questions: (1) is a telephone-delivered FBCO programme in rural Nebraska culturally relevant, usable and acceptable by L/H families?; (2) is a telephone-delivered FBCO programme effective at reducing BMI z-scores in L/H children living in rural Nebraska? and (3) what real-world institutional and contextual factors influence the impact of the intervention and might affect its potential ability to sustainably engage a meaningful population of L/H families who stand to benefit?
Ethics and dissemination
This protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB#:0745-20-EP). Dissemination of findings will occur through ClinicalTrials.gov, in scientific forums and to the local rural communities, pilot data to inform the design of a larger clinical trial.
Trial registration number
NCT04731506.
Validity and reliability of chemical-based disinfectant use questionnaire in a sample of the Lebanese public community
Validity and reliability of chemical-based disinfectant use questionnaire in a sample of the Lebanese public community
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Introduction
Worldwide, people heavily use chemical-based disinfectants to prevent the spread of COVID-19 with limited or no safety instructions. Awareness about the safe use of chemical-based disinfectants is highly recommended to limit the spread of COVID-19 and to avoid any health risks when misused, especially in developing countries where a poor healthcare system is prominent. Awareness in this context refers to the understanding and knowledge of proper usage, safety protocols and potential health risks associated with chemical disinfectants. Practices refer to the actual behaviours and actions taken when using disinfectants, including frequency of use, methods of application and adherence to safety guidelines.
Objective
The purpose of this paper is to develop a valid and reliable questionnaire to assess the community level of awareness and practice concerning chemical-based disinfectant use during COVID-19 in Lebanon.
Design
The questionnaire was adapted and modified from a previous study held in Iran, in which the questions were generated and developed with content validity ratio and index (CVR and CVI). The study design was divided into the qualitative phase/development of the Disinfectants Use Questionnaire (DUQ) and the quantitative phase/psychometric properties of the DUQ. The questionnaire was subjected to face and content validity tests through expert reviews. Data validation, for 130 participants (80.8% females, 85.5% bachelor’s degree and above, 80.8% students and 70.8% aged within 30 years), was examined through psychometric properties at the final stage of the validation. CVI for items (I-CVI), scale-level CVI (S-CVI), universal agreement calculation (S-CVI/UA), S-CVI and the average calculation method (S-CVI/Ave), based on I-CVI and based on proportion relevance, were calculated to determine the content validity.
Results
23 items of the 28-item scale had an I-CVI of 1, and the I-CVI of the remaining five ranged between 0.75 and 0.88. The S-CVI/UA was 0.82 and the S-CVI/Ave was 0.96, which meant that the items were good for the underlying construct. For the psychometric measures, principal axis factoring was performed and the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy, Bartlett’s test, eigenvalues and total variances were quite accepted and satisfactory.
Conclusion
This study showed that DUQ is a valid and reliable tool for evaluating the community level of awareness and practice concerning chemical-based disinfectant use during COVID-19.
Introduction
Worldwide, people heavily use chemical-based disinfectants to prevent the spread of COVID-19 with limited or no safety instructions. Awareness about the safe use of chemical-based disinfectants is highly recommended to limit the spread of COVID-19 and to avoid any health risks when misused, especially in developing countries where a poor healthcare system is prominent. Awareness in this context refers to the understanding and knowledge of proper usage, safety protocols and potential health risks associated with chemical disinfectants. Practices refer to the actual behaviours and actions taken when using disinfectants, including frequency of use, methods of application and adherence to safety guidelines.
Objective
The purpose of this paper is to develop a valid and reliable questionnaire to assess the community level of awareness and practice concerning chemical-based disinfectant use during COVID-19 in Lebanon.
Design
The questionnaire was adapted and modified from a previous study held in Iran, in which the questions were generated and developed with content validity ratio and index (CVR and CVI). The study design was divided into the qualitative phase/development of the Disinfectants Use Questionnaire (DUQ) and the quantitative phase/psychometric properties of the DUQ. The questionnaire was subjected to face and content validity tests through expert reviews. Data validation, for 130 participants (80.8% females, 85.5% bachelor’s degree and above, 80.8% students and 70.8% aged within 30 years), was examined through psychometric properties at the final stage of the validation. CVI for items (I-CVI), scale-level CVI (S-CVI), universal agreement calculation (S-CVI/UA), S-CVI and the average calculation method (S-CVI/Ave), based on I-CVI and based on proportion relevance, were calculated to determine the content validity.
Results
23 items of the 28-item scale had an I-CVI of 1, and the I-CVI of the remaining five ranged between 0.75 and 0.88. The S-CVI/UA was 0.82 and the S-CVI/Ave was 0.96, which meant that the items were good for the underlying construct. For the psychometric measures, principal axis factoring was performed and the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy, Bartlett’s test, eigenvalues and total variances were quite accepted and satisfactory.
Conclusion
This study showed that DUQ is a valid and reliable tool for evaluating the community level of awareness and practice concerning chemical-based disinfectant use during COVID-19.