How to reach every newborn: three key messages.

Work-related asthma (WRA) is a relevant problem in several countries, is cause of disability and socioeconomic consequences for both the patient and the society and is probably still underdiagnosed. A correct diagnosis is extremely important to reduce or limit the consequences of the disease. This consensus document was prepared by a EAACI Task Force consisting of an expert panel of allergologists, pneumologists and occupational physicians from different European countries. This document is not intended to address in detail the full diagnostic work-up of WRA, nor to be a formal evidence-based guideline. It is written to provide an operative protocol to allergologists and physicians dealing with asthma useful for identifying the subjects suspected of having WRA to address them to in-depth investigations in a specialized centre. No evidence-based system could be used because of the low grade of evidence of published studies in this area, and instead, 'key messages' or 'suggestions' are provided based on consensus of the expert panel members.

The historic, cultural separation of primary care and behavioral health has caused the spread of integrated care to lag behind other practice transformation efforts. The Advancing Care Together study was a 3-year evaluation of how practices implemented integrated care in their local contexts; at its culmination, practice leaders ("innovators") identified lessons learned to pass on to others. Individual feedback from innovators, key messages created by workgroups of innovators and the study team, and a synthesis of key messages from a facilitated discussion were analyzed for themes via immersion/crystallization. Five key themes were captured: (1) frame integrated care as a necessary paradigm shift to patient-centered, whole-person health care; (2) initialize: define relationships and protocols up-front, understanding they will evolve; (3) build inclusive, empowered teams to provide the foundation for integration; (4) develop a change management strategy of continuous evaluation and course-correction; and (5) use targeted data collection pertinent to integrated care to drive improvement and impart accountability. Innovators integrating primary care and behavioral health discerned key messages from their practical experience that they felt were worth sharing with others. Their messages present insight into the challenges unique to integrating care beyond other practice transformation efforts.

IntroductionThe Brazilian health system has not been able to enforce the constitutional Right to Health for the entire population, leaving litigation as the last alternative for the fulfillment of the right. In order to harmonize and underpin the decision making of federal judges, an Academic Detailing (AD) program with concepts of evidence-based medicine and health policies for federal judges will be conducted nationwide in Brazil. AD is a strategy to provide information, combining an interactive outreach approach with the best evidence. This study reports the method used to define key messages to be used during visits.MethodsGovernment, federal judges and academy representatives were invited to a workshop on health litigation in Brazil. They were divided into six groups to discuss five hypothetical scenarios. In each scenario, groups listed two possible key messages to disseminate during AD, addressing the legal, scientific, economic or ethical dimensions. After the definition, a vote was taken, according to the importance that each participant attributed to them (1 to 10), and then a score was generated.ResultsOf the thirty-one participants, five were from the judiciary, three prosecutors, one health insurance representative, nine managers and thirteen from the academy. From the case study presented, fifty-five key messages were suggested. After removing duplicates, twenty-five were selected to assign importance values by each participant. The key messages were sorted from highest to lowest score, the most important being “Explain what evidence-based medicine means and what scientific evidence means”.ConclusionsKnowledge of theoretical concepts of evidence-based medicine, health policies and the technology incorporation process seem to be of fundamental importance to federal judges. This information will serve as a basis for decision making regarding litigious proceedings involving the constitutional Right to Health in Brazil. From the selected key messages, bulletins to the academic detailing program to federal judges shall be produced.

Our ‘Key messages from research’ papers bring together the most up-to-date research into a succinct and accessible overview for frontline practitioners and commissioners of services. This paper focuses on Our ‘Key messages from research’ papers bring together the most up-to-date research into a succinct and accessible overview for frontline practitioners and commissioners of services. This paper is intended for child sexual exploitation coordinators/lead professionals from any agency, and for those planning multi-agency approaches. It focus on the importance of an integrated approach, including through the sharing of intelligence to disrupt exploiters.

BackgroundThe 1000 days, between a woman’s pregnancy and her child’s second birthday, offer a unique window of opportunity to build healthier and more prosperous societies. The right nutrition during this time can have a profound impact on a child’s ability to grow, learn, and rise out of poverty. An essential nutrition action is one of the most effective preventive actions for reducing nutrition-related morbidity and mortality among young children. Nonetheless, there is limited evidence regarding the practice of essential nutrition action and its associated factors.ObjectiveThe main aim of this study was to assess the practice of key essential nutrition action messages and associated factors among mothers of children from birth up to 2 years old in Wereilu Wereda, South Wollo Zone, Northeast Ethiopia.MethodsA community-based cross-sectional study was conducted on 563 mothers of children from birth up to 2 years old in Wereilu Wereda from April 1–30, 2018. A multi-stage sampling technique was employed. A structured, adapted and pre-tested questionnaire was used to collect the data. The data was collected through the interviews. The data were entered in EPI-data Version 4.2 and exported to SPSS version 24.0 for analysis. Bivariate and multivariable logistic regression was carried out to asses’ associations between the outcome and independent variables. A p-value of < 0.05 was considered statistically significant in this study.ResultsThe prevalence of good practice was 256 (46.5%). Educational status of the mother and the father, monthly income, parity, place of birth, postnatal care follow-up, level of knowledge and level of attitude were predictors of good practice.ConclusionThe practices of key essential nutrition action messages in the study area were found to be low. So, it is better to improve access to information to the community on key essential nutrition action messages through trained health workers coupled with media.

BackgroundEssential nutrition action(ENA) is a framework for managing advocacy, establishing a foundation, and implementing a comprehensive package of preventive nutritional activities. Essential Nutrition Actions study studies provide current information on each nutrition action, allowing health systems to focus more on nutrition, which is critical in tackling the "double burden" of malnutrition: underweight and overweight. Hence, this study aimed at assessing the level of ENA practice and its predictors among mothers of children aged 6 to 24 months in southern Ethiopia.MethodsA community-based cross-sectional study was conducted from May 1 to 30, 2021 among randomly selected 633 mothers of children aged 6–24 months. A multi-stage sampling technique was used to access study participants. Data were collected by using a pretested, structured interviewer-administered questionnaire. To identify predictors of ENA practice, bivariable and multivariable logistic regression were used. The strength of the association was measured using an adjusted odds ratio with 95 percent confidence intervals. The statistical significance was declared at a p-value less than 0.05.ResultsA total of 624 participants took part in the study, with a response rate of 98.6%. The uptake of key ENA messages among mothers was measured using 27 items, and it was found to be 47.4% (95% CI: 43.8, 51.4). Complementary feeding was the commonest ENA message practiced by 66.7% of respondents, while prevention of iodine deficiency disorder was practiced by only 33.7% of respondents. Variables namely, mother’s education level of college and above [AOR: 3.90, 95% CI: 1.79, 8.51], institutional delivery [AOR: 2.75, 95% CI: 1.17,6.49], having PNC service [AOR: 2.95, 95% CI: 1.91, 4.57], being knowledgeable on ENA message [AOR: 2.37, 95% CI: 1.81, 3.26] and being a model household [AOR: 3.83,95% CI: 2.58, 5.69] were positively associated with a good uptake of key ENA messages. On the other hand, primiparity [AOR: 0.32, 95% CI: 0.21,0.56] was identified as a negative predictor.ConclusionThe overall practice of key Essential nutrition action messages in the study area was low as compared to studies. Stakeholders must step up their efforts to improve and hasten the utilization of maternal and child health services, especially institutional delivery and Postnatal care by focusing on uneducated women to promote compliance to key ENA messages. Furthermore, health workers need to focus on awareness-raising and model household creation.

Background of studyBipolar disorder is a disease affecting the mood or emotional state of the patients. These patients have endomorphic physical personality, prone to develop abnormal metabolic parameters. These new types of atypical antipsychotics have propensity to cause disturbance in various metabolic parameters.Methodology-A total of 60 patients will be selected. Diagnosis of the drug naive patients of bipolar disorder as per ICD 10 will be done . Metabolic parameters , both biochemical and clinical , like BP, fasting blood glucose , lipid profile , ECG , weight and waist circumference will be taken before the start of the treatment to see any changes.60 Patients divided into 30 groups each, will be started on the antipsychotic treatment with RISPERIDONE and OLANZAPINE along with the standard treatment. Analysis of the same parameters of the patients will be done after 6 months.Comparison of the effects of two drugs (RISPERIDONE AND OLANZAPINE) on the metabolic profile of patients will be done.Results-Will be discussed at the time of presentation.Conclusion-Will be discussed at the time of presentation.Three key messages- Bipolar disorder, metabolic syndrome, antipsychotics.

Objective A nationwide survey of teachers investigated the teaching of food hygiene in UK secondary schools. Previous studies have focused on effective strategies in consumer food hygiene training but there is little research focusing on school-based education. Design The questionnaire was developed based on the results of in-depth interviews with school teachers and included topics such as where teachers gained up-to-date food hygiene knowledge and how key food hygiene messages were reinforced. Setting Postal questionnaires were completed by those responsible for teaching food hygiene in secondary schools. Method Postal questionnaires were distributed to 1989 secondary schools throughout the UK (response rate 38 per cent). Results Overall, the results indicate that teachers use a combination of methods to teach food hygiene and to reinforce food safety messages. Respondents rated demonstrations of good practice and practical activities involving young people preparing food as most effective. Teachers cited their most preferred resources for teaching food hygiene, influences on the choice of these resources, and limitations on use. Conclusion In the UK, teachers cover food hygiene in D&amp;T and home economics (or equivalents in Scotland and Northern Ireland). Topics such as cooking food properly, cleanliness, storing and chilling food safely, and cross-contamination are covered, reflecting the key FSA food hygiene messages. Steps to support the teaching of food hygiene in secondary schools such as guidelines on food hygiene legislation, key topics, resources, and ideas for practical activities could help to improve young people's knowledge of food hygiene and encourage young people to spread key messages to adults.

ContextTonsillectomy is one of the most common procedures that need to be accomplished in the early stages of a trainee’s career. The key message from the National Prospective Tonsillectomy Audit...

Background: In the last 15 years, the care provided for individuals born with differences of sex development (DSD) has evolved, with a strong emphasis on interdisciplinary approaches. However, these developments have not convinced some stakeholders to embrace the current model of care. This care model has also paid insufficient attention to socio-cultural differences and global inequalities. Summary: This article is an opinion statement, resulting from in-depth discussions and reflection among clinicians, patients, and family support organizations based in the USA and Europe, where we seek areas of common ground and try to identify opportunities to further develop resources. The product of these conversations is summarized in 10 panels. The corresponding sections provide additional discussion on some of the panel items. Key Messages: Participants identified areas of agreement, gained a deeper understanding of the reasons behind disagreements on certain matters, and identified the necessary steps to foster future consensus. We offer preliminary recommendations for guiding clinical management and resource allocation. By promoting a broader consensus, we aim to enhance the quality of care and well-being for individuals of all ages who have a DSD. Background: In the last 15 years, the care provided for individuals born with differences of sex development (DSD) has evolved, with a strong emphasis on interdisciplinary approaches. However, these developments have not convinced some stakeholders to embrace the current model of care. This care model has also paid insufficient attention to socio-cultural differences and global inequalities. Summary: This article is an opinion statement, resulting from in-depth discussions and reflection among clinicians, patients, and family support organizations based in the USA and Europe, where we seek areas of common ground and try to identify opportunities to further develop resources. The product of these conversations is summarized in 10 panels. The corresponding sections provide additional discussion on some of the panel items. Key Messages: Participants identified areas of agreement, gained a deeper understanding of the reasons behind disagreements on certain matters, and identified the necessary steps to foster future consensus. We offer preliminary recommendations for guiding clinical management and resource allocation. By promoting a broader consensus, we aim to enhance the quality of care and well-being for individuals of all ages who have a DSD.

BackgroundEngland’s Time to Change programme to reduce mental health-related stigma and discrimination included a social marketing campaign using traditional and social media, and targeted middle-income groups aged 25–45 between 2009 and 2016. From 2017, the same age group on low to middle incomes were targeted, and the content focused on men’s mental health, by changing the advertising and adapting the ‘key messages’. This study investigates changes in stigma-related public knowledge, attitudes and desire for social distance in England since Time to Change began in 2008–19 and for 2017–19.MethodsUsing data from a face-to-face survey of a nationally representative quota sample of adults for England, we evaluated longitudinal trends in outcomes with regression analyses and made assumptions based on a simple random sample. The pre-existing survey used a measure of attitudes; measures of knowledge and desire for social distance were added in 2009.ResultsReported in standard deviation units (95% CI), the improvement for knowledge for 2009–19 was 0.25 (0.19, 0.32); for attitudes, 2008–19, 0.32 (0.26, 0.39) and for desire for social distance, 2009–19 0.29 (0.23, 0.36). Significant interactions between year and both region and age suggest greater improvements in London, where stigma is higher, and narrowing of age differences. There were significant improvements between 2017 and 2019 in knowledge [0.09 (0.02, 0.16)] and attitudes [0.08 (0.02, 0.14)] but not social distance.ConclusionThe positive changes support the effectiveness of Time to Change but cannot be definitively attributed to it. Inequalities in stigma by demographic characteristics present targets for research and intervention.

Our ‘Key messages from research’ papers bring together the most up-to-date published research into a succinct and accessible overview, supporting confident provision of the best possible responses to child sexual abuse. Aimed at commissioners of children’s social care and related children’s services, this paper outlines the characteristics of child sexual exploitation before looking at safeguarding models and the commissioning of different types of service.

To assess whether immediate post-operative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective. Randomised trial of immediate post-operative enteral feeding through a nasojejunal tube v conventional postoperative intravenous fluids until the reintroduction of normal diet. Teaching hospitals in London. 30 patients under the care of the participating consultant surgeon who were undergoing elective laparotomies with a view to gastrointestinal resection for quiescent, chronic gastrointestinal disease. Two patients did not proceed to resection. Nutritional state, nutritional intake and nitrogen balance, gut mucosal permeability measured by lactulose-mannitol differential sugar absorption test, complications, and outcome. Successful immediate enteral feeding was established in all 14 patients with a mean (SD) daily intake of 6.78 (1.57)MJ (1622 (375) kcal before reintroduction of oral diet compared with 1.58 (0.14) MJ (377 (34) kcal) for those on intravenous fluids (P < 0.0001). Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fluids but positive in all 14 enterally fed patients (mean (SD) - 13.2 (11.6) g v 5.3 (2.7) g; P < 0.005). There was no difference by day 5. There was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the operation in those on intravenous fluids (0.11(0.06) v 0.15 (0.12); P < 0.005). There were also fewer postoperative complications in the enterally fed group (P < 0.005). Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe, prevents an increase in gut mucosal permeability, and produces a positive nitrogen balance.

Pesan Utama - Untuk mencegah penyebaran wabah, banyak wilayah di Indonesia memberlakukan Pembatasan Sosial Berskala Besar (PSBB) dengan berbagai tingkat pembatasan pergerakan orang dan barang. - Minimnya kejelasan pembatasan di ranah industri dan transportasi di masa PSBB berisiko menciptakan gangguan pasok dan keterlambatan distribusi yang dapat berakhir pada kelangkaan dan kenaikan harga-harga. Kondisi tersebut kemudian juga diperumit dengan adanya pemberlakukan upaya-upaya lainnya oleh pemerintah daerah ketika mengumumkan PSBB di wilayah mereka. - Pihak berwenang harus memastikan bahwa seluruh rantai pasok pangan tetap aktif dan tidak terganggu. Kementerian Perindustrian (Kemenperin) sebaiknya mengeluarkan izin kepada semua sektor yang terlibat dalam rantai pasok pangan dan Kementerian Perhubungan (Kemenhub) sebaiknya memperbolehkan izin-izin tersebut untuk diverifikasi dengan cepat pada titik-titik pemeriksaan. Kementerian Badan Usaha Milik Negara (Kementerian BUMN) sebaiknya mengarahkan perusahaan surveyornya untuk meningkatkan kapasitas survey di pelabuhan-pelabuhan. - Kemenperin, Kemenhub, dan pemerintah daerah harus memastikan protokol kesehatan ditaati oleh semua industri dan penyedia jasa transportasi dengan menjabarkan sanksi dan melakukan pemeriksaan secara acak. - Pemerintah daerah harus mencegah penyebaran wabah dengan memastikan gangguan paling minimum terhadap pasok pangan.

Human resources are one of the pillars of healthcare provision, and their effective management is essential to meet the challenges of modern healthcare systems and promote the integration of care. In this sense, skill mix, task shifting and task sharing are fundamental strategies for redistributing tasks between different professionals, optimizing the use of skills and enabling more fluid collaboration between multidisciplinary teams. These practices not only increase the efficiency and quality of care, but also facilitate the coordination and continuity of services, ensuring that patients receive an integrated approach centered on their needs. This workshop is important because, as well as exploring the application of these strategies, it also offers a space for discussion on the relevance of this approach, encouraging critical reflection on its impact and benefits in the context of integrated care. Who is it for? This workshop is aimed at everyone who is interested in the themes of care integration and who is interested in discussing the challenges of human resources in this context. Approach: This workshop will be based on the discussion of a case study on the need to have a skill mix strategy in a context of a lack of human resources and disintegration in the provision of care. Through this case, it is intended that participants will be able to discuss and reflect openly on the need to identify the essential skills for integrated care and how tasks can be shared and distributed. The discussion will be open, allowing each participant to contribute their perspective on which roles and professions are best suited to take on certain tasks, in order to improve both the efficiency and quality of the care provided. Throughout the workshop, participants will be able to analyze the gaps in the scenario presented and suggest strategies for redistributing responsibilities, promoting an exchange of ideas that encourages collaborative solutions to the current challenges of integration and optimal use of available human resources. Session Plan Introduction - 15 mins. - Presentation of the workshop objectives and presentation of the concepts of skill mix, task shifting and task sharing, contextualizing their importance in the area of integrated care. Case Presentation - 10min. - Presentation of the case to the participants. Case Discussion - 25 mins. - Once the case has been contextualized and read by the participants, the facilitator will start the discussion by introducing some questions that should stimulate the participation of those present. These questions include: What competencies and functions were redistributed? What barriers were faced and how were they resolved? How did the skill-mix contribute to the integration of care? What lessons can we learn? During this discussion, the main ideas will be put into a summary table that will serve as a basis for presenting the main messages at the end of the workshop. Conclusion - 10 minutes - Key messages. Presentation of the main messages identified by the participants in the workshop on a summary board to be filled in during the workshop.