Tailoring a Physical Activity Promotion Program for a Rural Area

Background/Purpose: VERBTM Summer Scorecard (VSS) has used social marketing to successfully promote physical activity for urban and suburban youth. The purpose of this study was to adapt the program to meet the needs of a minority, rural population. Method: Qualitative marketing research methods including focus groups were used to gather data from parents (N = 12) and their children (N =12) in April 2012. A structured, open-ended focus group guide was developed specific to parents and youth and based on the social marketing framework. Marketing topics covered included Product, Price, Place and Promotion. Attention was given to testing two previously used version of the Scorecard that is the central component of the program. All focus groups were conducted by a skilled moderator and were audio-recorded and transcribed. Focus group transcripts were read by the entire team, coded based on social marketing constructs, and summaries with illustrative quotes were created. All materials (i.e. recruitment flyers, focus group guides, and consent forms) and methods were approved by the university Institutional Review Board. Analysis/Results: Coded transcripts were reviewed for emerging themes. Content analysis was conducted within parent groups and youth groups and across groups for comparison purposes. Results suggested the previously used Scorecards would not work with African-American youth and families in rural Georgia. Conclusions: What works for one community, may not work for another. Qualitative market research enabled the investigators to culturally tailor physical activity interventions prior to implementation, thereby, increasing adoption and odds of success with the target audience

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Tailoring a Physical Activity Promotion Program for a Rural Area

Background/Purpose: VERBTM Summer Scorecard (VSS) has used social marketing to successfully promote physical activity for urban and suburban youth. The purpose of this study was to adapt the program to meet the needs of a minority, rural population. Method: Qualitative marketing research methods including focus groups were used to gather data from parents (N = 12) and their children (N =12) in April 2012. A structured, open-ended focus group guide was developed specific to parents and youth and based on the social marketing framework. Marketing topics covered included Product, Price, Place and Promotion. Attention was given to testing two previously used version of the Scorecard that is the central component of the program. All focus groups were conducted by a skilled moderator and were audio-recorded and transcribed. Focus group transcripts were read by the entire team, coded based on social marketing constructs, and summaries with illustrative quotes were created. All materials (i.e. recruitment flyers, focus group guides, and consent forms) and methods were approved by the university Institutional Review Board. Analysis/Results: Coded transcripts were reviewed for emerging themes. Content analysis was conducted within parent groups and youth groups and across groups for comparison purposes. Results suggested the previously used Scorecards would not work with African-American youth and families in rural Georgia. Conclusions: What works for one community, may not work for another. Qualitative market research enabled the investigators to culturally tailor physical activity interventions prior to implementation, thereby, increasing adoption and odds of success with the target audience

Treating an opiate-dependent inpatient population: a one-year follow-up study of treatment completers and noncompleters

Introduction: The aim of this study was to compare the characteristics of patients who completed (completers) inpatient treatment of drug dependence with those who failed to complete this programme (noncompleters). Method: Participants were assessed at admission using the Substance Abuse Assessment Questionnaire (SAAQ) to obtain information about the sociodemographic background, history of drug and alcohol use, physical health, mental health, offending behaviour, and interpersonal relationships. Follow-up interviews were carried out 3, 6, 9, and 12 months after discharge using the SAAQ-Follow-up. To form the three comparison groups, participants were divided on the basis of completion of detoxification and receipt of aftercare. Results and conclusions: Significantly better treatment outcome was observed amongst those who completed detoxification and went on to spend at least 6 weeks in a recovery and/or residential rehabilitation unit. In contrast, there were no significant differences between noncompleters and completers who had no aftercare on the majority of measures of drug use during follow-up. D 2002 Elsevier Science Ltd. All rights reserved

The effects of a leaflet-based intervention, ‘Hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services: A Non-Randomised Stepped Wedge Study.

Aims: We aimed to investigate the effect of an intervention in which ambulance personnel provided advice supported by a booklet - ‘Hypos can strike twice’- issued following a hypoglycaemic event to prevent future attendances. Methods: We used a non-randomised stepped wedge-controlled design. The intervention was introduced at different times (steps) in different areas (clusters) of operation within East Midlands Ambulance Service NHS Trust (EMAS). During the first step (T0) no clusters were exposed to the intervention and during the last step (T3) all clusters were exposed. Data were analysed using a general linear mixed model (GLMM) and an interrupted-time series analysis (ITSA). Results: The study included 4825 patients (mean age 65.42 years, SD 19.42; 2166 females) experiencing hypoglycaemic events attended by EMAS. GLMM indicated a reduction in the number of unsuccessful attendances (i.e. attendance followed by a repeat attendance) in the final step of the intervention when compared to the first (odds ratio OR: 0.50, 95%CI: 0.33-0.76, p=0.001). ITSA indicated a significant decrease in repeat ambulance attendances for hypoglycaemia - relative to the pre-intervention trend (p=0.008). Furthermore, the hypoglycaemia care bundle was delivered in 66% of attendances during the intervention period, demonstrating a significant level of practice change (p<0.001). Conclusion: The ‘Hypos can strike twice’ intervention had a positive effect on reducing numbers of repeat attendances for hypoglycaemia and in achieving the care bundle. The study supports the use of informative booklets by ambulance clinicians to prevent future attendances for recurrent hypoglycaemic events

Model-based economic evaluation of the effectiveness of “‘Hypos’ can strike twice”:A leaflet-based ambulance clinician referral intervention to prevent recurrent hypoglycaemia

“‘Hypos’ can strike twice” (HS2) is a pragmatic, leaflet-based referral intervention designed for administration by clinicians of the emergency medical services (EMS) to people they have attended and successfully treated for hypoglycaemia. Its main purpose is to encourage the recipient to engage with their general practitioner or diabetic nurse in order that improvements in medical management of their diabetes may be made, thereby reducing their risk of recurrent hypoglycaemia. Herein we build a de novo economic model for purposes of incremental analyses to compare, in 2018–19 prices, HS2 against standard care for recurrenthypoglycaemia in the fortnight following the initial attack from the perspective of the UK National Health Service (NHS). We found that per patient NHS costs incurred by people receiving the HS2 intervention over the fortnight following an initial hypoglycaemiavaverage £49.79, and under standard care costs average £40.50. Target patient benefit assessed over that same period finds the probability of no recurrence of hypoglycaemia averaging 42.4% under HS2 and 39.4% under standard care, a 7.6% reduction in relative risk. We find that implementing HS2 will cost the NHS an additional £309.36 per episode of recurrent hypoglycaemia avoided. Contrary to the favourable support offered in Botan et al., we conclude that in its current form the HS2 intervention is not a cost-effective use of NHS resources when compared to standard NHS care in reducing the risk of hypoglycaemia recurring within a fortnight of an initial attack that was resolved at-scene by EMS ambulance clinicians

Model-based economic evaluation of the effectiveness of “‘Hypos’ can strike twice”, a leaflet-based ambulance clinician referral intervention to prevent recurrent hypoglycaemia

“‘Hypos’ can strike twice” (HS2) is a pragmatic, leaflet-based referral intervention designed for administration by clinicians of the emergency medical services (EMS) to people they have attended and successfully treated for hypoglycaemia. Its main purpose is to encourage the recipient to engage with their general practitioner or diabetic nurse in order that improvements in medical management of their diabetes may be made, thereby reducing their risk of recurrent hypoglycaemia. Herein we build a de novo economic model for purposes of incremental analyses to compare, in 2018–19 prices, HS2 against standard care for recurrent hypoglycaemia in the fortnight following the initial attack from the perspective of the UK National Health Service (NHS). We found that per patient NHS costs incurred by people receiving the HS2 intervention over the fortnight following an initial hypoglycaemia average £49.79, and under standard care costs average £40.50. Target patient benefit assessed over that same period finds the probability of no recurrence of hypoglycaemia averaging 42.4% under HS2 and 39.4% under standard care, a 7.6% reduction in relative risk. We find that implementing HS2 will cost the NHS an additional £309.36 per episode of recurrent hypoglycaemia avoided. Contrary to the favourable support offered in Botan et al., we conclude that in its current form the HS2 intervention is not a cost-effective use of NHS resources when compared to standard NHS care in reducing the risk of hypoglycaemia recurring within a fortnight of an initial attack that was resolved at-scene by EMS ambulance clinicians