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Patient education is recommended as an integral part of disease management in ankylosing spondylitis (AS), a chronic rheumatic disease that predominantly affects young males and requires long-term disease management. Convenient and cost-effective approaches to deliver patient education are required to these patients. This study aimed to examine the effects of a theory-based educational intervention delivered through a social networking app, WeChat, on disease knowledge, self-efficacy, exercise adherence, and health outcomes in Chinese AS patients. This study was a single-blind randomized controlled trial conducted in a tertiary hospital in Chengdu, China. Eligible participants were randomly allocated to the intervention or control group. Participants in the control group received standard care. The intervention group received the health belief model (HBM)-based educational intervention, consisting of 4 individual educational sessions and educational information sharing through WeChat, the predominant social networking app in China. The primary outcomes were disease knowledge, self-efficacy, and exercise adherence. The secondary outcomes were disease activity and physical function. Data were collected at baseline and at the end of the intervention (12th week). Chi-square test, t test, Mann-Whitney U tests were used to examine the effects of educational intervention. This study included 118 patients with AS. The majority of participants were male (93/118, 78.8%). Around half of them were married (56/118, 47.5%), never smoked (70/118, 59.3%), and had college educational level or above (62/118, 52.5%). At posttest, participants in the intervention group had higher disease knowledge (all P<.001) and self-efficacy (P<.001), and a larger proportion of participants in the intervention group adhered to regular exercise routines than those in the control group (P=.003). The within-group analyses for the intervention group showed increases in all scores of disease knowledge (all P<.001) and self-efficacy score (P<.001), but only correct answer score (P=.04) and general knowledge score (P=.002) of disease knowledge in the control group improved. The within-group analysis for the control group found a decline of physical function (P=.002) but no significant change in disease activity (P>.05). The within-group analysis for the intervention group showed no significant change in disease activity or physical function (P>.05). At posttest, no statistically significant difference was found on disease activity or physical function between the intervention and control groups (P>.05). The HBM-based educational intervention through WeChat can effectively improve patient disease knowledge, self-efficacy, and exercise adherence. WeChat is feasible and effective to deliver patient education for patients with chronic diseases such as AS. This mHealth intervention can be integrated into routine rheumatology care.

Childhood obesity is a global public health issue, which has prompted governments to invest in prevention programmes. We aimed to investigate the effectiveness of parent-focused early childhood obesity prevention interventions globally. We did a systematic review and individual participant data meta-analysis. We searched databases and trial registries (MEDLINE, Embase, CENTRAL, CINAHL, PsycInfo, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform) from inception until Sept 30, 2024, for randomised controlled trials commencing before 12 months of age examining parent-focused behavioural interventions to prevent obesity in children, compared with usual care, no intervention, or attention control. Individual participant data were checked, harmonised, and assessed for integrity and risk of bias. We excluded trials that were quasi-randomised, investigated pregnancy-only interventions, or did not collect any child weight-related outcomes. The primary outcome was BMI Z score at age 24 months (±6 months). We did an intention-to-treat, two-stage, random effects meta-analysis to examine effects overall and for prespecified subgroups. We assessed certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation. This study is registered with PROSPERO, CRD42020177408. Of 19 990 identified records, 47 (0·24%) trials were completed and eligible. Of these, 18 (38%) assessed our primary outcome, BMI Z score. We obtained individual participant data for 17 (94%; n=9128) of these 18 trials (n=9383), representing 97% of eligible participants. Of these 9128 participants, 4549 (50%) were boys, 4415 (48%) were girls, and 164 (2%) had unknown sex. We found no evidence of an effect of interventions on BMI Z score at age 24 months (±6 months; mean difference –0·01 [95% CI –0·08 to 0·05]; high certainty evidence, τ2=0·01; n=6505; 2623 missing). Findings were robust to prespecified sensitivity analyses (eg, different analysis methods and missing data), and we found no evidence of differential intervention effects for prespecified subgroups including priority populations and trial-level factors. These findings indicate that examined parent-focused behavioural interventions are insufficient to prevent obesity at age 24 months (±6 months). This evidence highlights a need to re-think childhood obesity prevention approaches. Australian National Health and Medical Research Council.

This paper examines empathetic behavior in the United States, a strongly individualistic country, as contrasted with Hungary and Ethiopia, which are moderately individualistic and strongly collectivistic respectively. It suggests that empathy may have a wider than originally perceived application in diverse settings to combat factors of ethnic bias and discrimination that adversely impact health. Models that distinctly focus on the development of healthcare provider empathic care are needed to enable the needs of resource scarce regions of the world to be met, including pockets of the U.S. More investigation is warranted on how empathic behavior can positively impact health outcomes and disparities.

Background Overweight, obesity, and associated comorbidities are a pressing global issue among children of all ages, particularly among low-income populations. Rapid weight gain (RWG) in the first 6 months of infancy contributes to childhood obesity. Suboptimal sleep-wake patterns and gut microbiota (GM) have also been associated with childhood obesity, but little is known about their influences on early infant RWG. Sleep may alter the GM and infant metabolism, and ultimately impact obesity; however, data on the interaction between sleep-wake patterns and GM development on infant growth are scarce. In this study, we aim to investigate associations of infant sleep-wake patterns and GM development with RWG at 6 months and weight gain at 12 months. We also aim to evaluate whether temporal interactions exist between infant sleep-wake patterns and GM, and if these relations influence RWG. Methods The Snuggle Bug/ Acurrucadito study is an observational, longitudinal study investigating whether 24-h, actigraphy-assessed, sleep-wake patterns and GM development are associated with RWG among infants in their first year. Based on the Ecological Model of Growth, we propose a novel conceptual framework to incorporate sleep-wake patterns and the GM as metabolic contributors for RWG in the context of maternal-infant interactions, and familial and socio-physical environments. In total, 192 mother-infant pairs will be recruited, and sleep-wake patterns and GM development assessed at 3 and 8 weeks, and 3, 6, 9, and 12 months postpartum. Covariates including maternal and child characteristics, family and environmental factors, feeding practices and dietary intake of infants and mothers, and stool-derived metabolome and exfoliome data will be assessed. The study will apply machine learning techniques combined with logistic time-varying effect models to capture infant growth and aid in elucidating the dynamic associations between study variables and RWG. Discussion Repeated, valid, and objective assessment at clinically and developmentally meaningful intervals will provide robust measures of longitudinal sleep, GM, and growth. Project findings will provide evidence for future interventions to prevent RWG in infancy and subsequent obesity. The work also may spur the development of evidence-based guidelines to address modifiable factors that influence sleep-wake and GM development and prevent childhood obesity.

This study examines how feeding, sleep, and growth during infancy impact the gut microbiome (GM) in toddlers. The research was conducted on toddlers (n = 36), born to Latina women of low-income with obesity. Their mothers completed retrospective feeding and sleeping questionnaires at 1, 6, and 12 months; at 36 months, fecal samples were collected. Sequencing of the 16S rRNA gene (V4 region) revealed that breastfeeding for at least 1 month and the introduction of solids before 6 months differentiated the GM in toddlerhood (Bray–Curtis, pseudo-F = 1.805, p = 0.018, and pseudo-F = 1.651, p = 0.044, respectively). Sleep had an effect across time; at 1 and 6 months of age, a lower proportion of nighttime sleep (relative to 24 h total sleep) was associated with a richer GM at three years of age (Shannon H = 4.395, p = 0.036 and OTU H = 5.559, p = 0.018, respectively). Toddlers experiencing rapid weight gain from birth to 6 months had lower phylogenetic diversity (Faith PD H = 3.633, p = 0.057). These findings suggest that early life nutrition, sleeping patterns, and growth rate in infancy may influence the GM composition. Further verification of these results with objective sleep data and a larger sample is needed.

Introduction While vaccines are crucial for disease prevention, disparities in vaccination coverage persist among youths aged 10 to 29 years, including within the United States. Serious games are emerging as a new strategy to address vaccine hesitancy. This systematic review aimed to aggregate and assess the current evidence on game-based interventions to improve youth vaccination rates, evaluating their impact and identifying factors influencing their effectiveness. Methods This systematic review was conducted through a meticulous search and evaluation of literature from databases including PubMed, Cumulative Index to Nursing and Allied Health Literature database, ProQuest platform, Cochrane Library, and Google Scholar. Studies were included if they (a) were designed with the purpose of improving youth vaccination rates; (b) were published in English; (c) were published between January 2011 and June 2023; and (d) evaluated the effect of game-based interventions. Search terms included Medical Subject Headings terms and keywords of the eligible articles. Results Out of 269 studies, 11 were included in the final analysis of this review. The earliest study dated back to 2013, with 5 being randomized controlled trial and 6 studies incorporating theoretical models in their design or outcome measures. The findings indicated a generally positive effect of game-based interventions on vaccine-related knowledge. However, the impact on actual vaccine uptake was limited. In-game avatar customization and collaboration games were found as effective tools for player engagement. Conclusion The review findings indicated that serious games boost vaccine knowledge but lack strong evidence for influencing youth vaccine uptake. More rigorous research and tailored game designs are needed to determine the effectiveness of game-based interventions and effectively address the diverse needs of youth in vaccine decision-making.

Much attention has been given to the use of the emergency department (ED) by the uninsured patient, whereas the insured patient actually uses ED more frequently. The focus of this article is how to reduce costs for the geriatric insured chronically ill patient using nurse practitioners in a home-based program. Patients in this category are enrolled and offered scheduled and urgent visits. Patients are asked to contact the home-based company when considering an ED visit. Assuming the patient’s needs can be served at home, nurse practitioners are dispatched to diagnose infections; administer breathing treatments: order medications: and administer oral, intramuscular, and intravenous medications. Home-based companies achieve revenue through a value-based system in which actual costs for each engaged patient is compared with unenrolled patients of the same acuity and with similar conditions. The company demonstrates the savings and receives a portion of the savings for each enrolled patient. Patients incur no costs except for the health plan premiums they are already paying. Patients wait for urgent care in the home, rather than risking exposure to other contagions in an ED waiting room. Many high-risk high-need patients have difficulty attending regular clinic appointments, so scheduled, home-based visits can identify changes in a patient’s condition that patients and caregivers are unable to recognize. Mild illnesses in such patients may escalate to more serious problems in high-risk high-need patients, and the home-based concept offers a new career opportunity to nurse practitioners while decreasing health care costs among the sickest 5% of the population on whom more than 50% of health care costs are incurred annually. •The home-based medical model, using nurse practitioners, offers a new practice improvement model by offering scheduled and urgent visits in the home for high-need/high-risk (HNHR) insured geriatric patients with certain contracted health plans.•Each patient is seen regularly, usually every 3–4 months based on acuity. Additionally, patients are offered urgent care service in the home with nurse practitioners on call from 7 am to 11 pm as an alternative to emergency department (ED) care.•The urgent care service reduces the cost of uncomplicated ED visits by HNHR patients for whom attending routine clinic appointments is difficult. Within the HNHR population, cost savings have resulted in a considerable return on investment for participating health plans.•Upon admission to the home-based program, patients and caregivers are instructed to call the home-based company triage number. Calls are evaluated to determine whether the patient’s needs are appropriate for a home-based visit. On call staff are dispatched if an urgent in-home visit is appropriate to serve the patient’s needs.•Urgent visits provide the opportunity for the patient to wait in their home setting, rather than in the ED or urgent care facility waiting area.•Home-based care is a new and rewarding career opportunity for nurse practitioners.

Introduction Infant sleep is influenced by biopsychosocial interactions. However, the influence of an interactive home environment is underexplored. The aim was to examine whether early positive parent-child interactions and an enriched home environment were associated with better infant sleep later. Methods Pregnant, obese, and low-income Latina women were recruited for a RCT delivering a 12-month intervention for infants to prevent overweight (n=129). At 1, 6, and 12 months, mothers reported breastfeeding duration, completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R, range: 0-100), and underwent the Home Observation for Measurement of the Environment (HOME, range: 0-45) Inventory including subscales of Responsivity, Acceptance, Organization, Learning Materials, Involvement, and Variety. Pearson correlations between HOME and BISQ-R at each visit were conducted. Significant associations (α<0.05) were entered into stepwise multivariable linear regressions adjusting for infant sex, mother’s education, breastfeeding, and 1-month BISQ-R to determine which HOME subscales were associated with 6- and 12-month total BISQ-R if the total HOME was significant. Results The mean 1-, 6- and 12-month BISQ-R were 84(SD=6.1), 76.4(SD=8.3), and 78.5(SD=8.0), respectively. The 1-month HOME total score (M=21.8[SD=4.4]) significantly correlated with the 6- and 12-month BISQ-R. The regression of 1-month HOME with 6-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.3, p=0.001), greater HOME total scores (β=0.2, p=0.037), and 1-month BISQ-R scores(β=0.2, p=0.038), which explained 13.1% of the variance (F[3,106]=6.5, p<0.001). The regression of 1-month HOME subscales with 6-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.31, p=0.001), greater Responsivity scores (β=0.21, p=0.022), and 1-month BISQ-R scores (β=0.2, p=0.027), which explained 13.9% of the variance (F[3,106]=6.86, p<0.001). The regression of 1-month HOME with 12-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.24, p=0.013) and greater HOME total scores (β=0.24, p=0.016), which explained 7.9% of the variance (F[2,100]=5.4, p=0.006). The regression of 1-month HOME subscales with 12-month BISQ-R indicated greater BISQ-R scores were associated with greater Variety scores (β=0.29, p=0.003), shorter breastfeeding (β=-0.24, p=0.011), and 1-month BISQ-R scores(β=0.18, p=0.049), which explained 13.5% of the variance (F[3,99]=6.29, p=0.001). Conclusion Better infant sleep was associated with an early interactive home environment, especially parent’s responsiveness and people/events providing organized variety. Support (if any):