“I had to change my attitude”: narratives of most significant change explore the experience of universal home visits to pregnant women and their spouses in Bauchi State, Nigeria

Background Universal home visits to pregnant women and their spouses in Bauchi State, northern Nigeria, discussed local evidence about maternal and child health risks actionable by households. The expected results chain for improved health behaviours resulting from the visits was based on the CASCADA model, which includes Conscious knowledge, Attitudes, Subjective norms, intention to Change, Agency to change, Discussion of options, and Action to change. Previous quantitative analysis confirmed the impact of the visits on maternal and child outcomes. To explore the mechanisms of the quantitative improvements, we analysed participants’ narratives of changes in their lives they attributed to the visits. Methods Local researchers collected stories of change from 23 women and 21 men in households who had received home visits, from eight male and eight female home visitors, and from four government officers attached to the home visits program. We used a deductive thematic analysis based on the CASCADA results chain to analyze stories from women and men in households, and an inductive thematic approach to analyze stories from home visitors and government officials. Results The stories from the visited women and men illustrated all steps in the CASCADA results chain. Almost all stories described increases in knowledge. Stories also described marked changes in attitudes and positive deviations from harmful subjective norms. Most stories recounted a change in behaviour attributed to the home visits, and many went on to mention a beneficial outcome of the behaviour change. Men, as well as women, described significant changes. The home visitors’ stories described increases in knowledge, increased self-confidence and status in the community, and, among women, financial empowerment. Conclusions The narratives of change gave insights into likely mechanisms of impact of the home visits, at least in the Bauchi setting. The compatibility of our findings with the CASCADA results chain supports the use of this model in designing and analysing similar interventions in other settings. The indication that the home visits changed male engagement has broader relevance and contributes to the ongoing debate about how to increase male involvement in reproductive health.

Sedimentary architecture and landforms of the late Saalian (MIS 6) ice sheet margin offshore of the Netherlands

Reconstructing the growth and decay of palaeo-ice sheets is critical to understanding the relationships between global climate and sea-level change and to testing numerical ice sheet models. In this study, we integrate recently acquired high-resolution 2D seismic reflection and borehole datasets from two wind-farm sites offshore of the Netherlands to investigate the sedimentary, geomorphological, and glaciotectonic records left by the Saalian Drenthe substage glaciation, when Scandinavian land ice reached its southernmost extent in the southern North Sea (ca. 160 ka, Marine Isotope Stage 6). A complex assemblage of glaciogenic sediments and glaciotectonic structures is buried in the shallow subsurface. The northern wind-farm site revealed a set of NE–SW-oriented subglacial meltwater channels filled with till and glaciofluvial sediments and an E–W-trending composite ridge with local evidence of intense glaciotectonic deformation that denotes the maximum limit reached by the ice. Based on the identified glacial geomorphology, we refine the mapping of the maximum ice sheet extent offshore, revealing that the ice margin morphology is more complex than previously envisaged and displaying a lobate shape. Ice retreat left an unusual paraglacial landscape characterised by the progressive infilling of topographic depressions carved by ice-driven erosion and a diffuse drainage network of outwash channels. The net direction of outwash was to the west and southwest into a nearby glacial basin. We demonstrate the utility of offshore wind-farm data as records of process–form relationships preserved in buried landscapes, which can be utilised in refining palaeo-ice sheet margins and informing longer-term drivers of change in low-relief settings.

The political economy of non-communicable diseases

Non-communicable diseases are the major cause of death and disability globally, but are largely preventable. The five major modifiable risk factors are tobacco use, alcohol use, unhealthy diets, physical inactivity, and air pollution—all of which have a strong environmental component. Implementation of policy to address non-communicable diseases (NCDs), however, has focused on individual responsibility rather than creating supportive environments for health promotion and NCD prevention, in part because of industry influence. A political economy perspective is helpful in considering how economic interests intersect with political decisions to shape the environments in which individuals live. When ‘environments of risk’ are considered from a political economy perspective, it enables us to critically assess sociopolitical factors that generate product environments characterized by health-harming products, built environments that condition physical inactivity over physical activity, and marginalization of pollution reduction. The enormous size and reach of these ‘industries of risk’ translates into significant political power. Industry actively exerts power in formal decision-making forums (‘decision-making power’), shapes the agenda in political debates (‘non-decision-making power’), and exercises ideological power in ways that are contrary to NCD prevention. Despite the power wielded by industry interests in the policy process, there has been innovation and meaningful policy change for NCD prevention. Key strategies include: assembling strong, local evidence to underpin policy; developing strong coalitions of actors with public health interests; preparing for push-back from industry; and developing specific proposals for healthier economic policy.

Infections Deaths in the PLATO Trial

Background Cardiovascular benefits of aggressive dual antiplatelet therapy may be associated with extra risks including bleeding, cancer, and infections discovered first for prasugrel in the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel (TRITON) trial. Ticagrelor in PLATO also caused slightly more infections but surprisingly less sepsis-related deaths (SRD) than clopidogrel. However, verified infection fatalities in PLATO were lacking from the public domain. We obtained the complete Food and Drug Administration (FDA)-issued primary causes death list, matched it with the few local site records dataset and analyzed the patterns of infections and deaths reported in PLATO. Methods Among infections, the FDA spreadsheet contains only two primary death codes for pneumonia (12–2) and SRD (12–8). We obtained local evidence for two pneumonia and two SRD and matched those with the FDA records. We assessed how SRD patterns were reported among nonvascular death's dataset. Results The FDA PLATO records indicate that clopidogrel caused numerically less (n = 8) primary pneumonia deaths than ticagrelor (n = 10) but over three times more SRD (n = 23/7). Among matched verifiable outcomes, both pneumonia deaths were correct, but two clopidogrel SRD were incorrect. Of the remaining 21 clopidogrel SRD, 6 were reported as two separate closed paired entries in Brazil (lines 76 and 78 and 86 and 88) and India (lines 436 and 440), suggesting last minute addition of potentially incorrect SRD reports. Four ticagrelor SRD (lines 24,193,467 and 650) were “compensated” with close or next in line clopidogrel SRD entries (lines 22,195,468 and 651). Conclusion The FDA-issued evidence suggests no benefit of ticagrelor in preventing deaths from infections with slightly more pneumonia deaths, with possible misreporting of SRD in PLATO. These findings require an in-depth precise review of sepsis deaths in this trial.

863Alcohol and cancer in an Australian cohort of 226,162 participants aged 45 years and over

Background Australia has a relatively high level of alcohol consumption. Although alcohol consumption is known to increase the risk of several cancer types internationally, local evidence for Australia is limited. Methods Cox proportional hazards regressions were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk in relation to weekly alcohol consumption among 226,162 participants aged ≥45 years (2006-2009) in the 45 and Up Study, an Australian prospective cohort study. Incident cancer cases were ascertained by linkage to the New South Wales Cancer Registry to December 2013 by the Centre for Health Record Linkage. Results Over a median 5.4 years, 17,332 cancers were diagnosed. Increasing levels of alcohol intake were associated with increased risk of any cancer (HR per seven drink increase in weekly consumption: 1.02; 95% CI: 1.00-1.04), and cancers of the upper aerodigestive tract (1.19;1.10-1.29), mouth/pharynx (1.18;1.08-1.29), oesophagus (1.22;1.04-1.43), colorectum (1.09;1.04-1.15), colon (1.13;1.06-1.20), liver (1.22;1.04-1.44), breast (1.09;1.00-1.18), and melanoma (1.05;1.00-1.10); whereas an inverse association was observed for thyroid cancer (0.80;0.64-1.00). We estimated that by age 85 years, Australian men and women who consume >14 drinks/week increase their absolute risk of alcohol-attributable cancer by 4.4% and 5.4%, respectively, compared to non-drinkers. Conclusions We report relative risks of cancer incidence in relation to alcohol consumption that match the international evidence. In Australia, a nation with relatively high alcohol consumption, these risks may translate into a significant public health burden. Key messages We have generated estimates for the relationship between alcohol consumption and cancer risk in Australia.

Fidelity, Rigor, and Relevance: How SEAs are Approaching the ESSA Evidence Requirements

The Every Student Succeeds Act’s evidence requirements mandate the use of research in the selection of school improvement interventions, with the aim of ensuring that schools and districts invest their efforts and funding more wisely. This study of eight states presents three different approaches to the evidence requirements: using lists of pre-sanctioned evidence-based interventions, training schools and districts to evaluate the research supporting potential interventions, and building local evidence of effectiveness. Through interviews with state administrators, I show how each approach relied on different understandings and prioritizations of research rigor and local relevance.

Sedimentary architecture and landforms of the Late Saalian (MIS 6) ice sheet margin, offshore the Netherlands

Reconstructing the growth and decay of palaeo-ice sheets is critical to understanding the relationships between global climate and sea-level change, and to testing numerical ice sheet models. In this study, we integrate recently acquired high-resolution 2D-seismic reflection and borehole datasets from two windfarm sites offshore the Netherlands to investigate the sedimentary, geomorphological and glaciotectonic records left by the Saalian Drenthe substage glaciation, when Scandinavian land ice reached its southernmost extent in the southern North Sea (ca. 160 ka, Marine Isotope Stage 6). A complex assemblage of glaciogenic sediments and glaciotectonic structures are buried in the shallow subsurface. The northern windfarm site revealed a set of NE-SW oriented subglacial meltwater channels filled with till and glaciofluvial sediments and an E-W trending composite ridge with local evidence of intense glaciotectonic deformation that denotes the maximum limit reached by the ice. Based on the identified glacial geomorphology, we refine the mapping of the maximum ice-sheet extent offshore the Netherlands, revealing that the ice margin morphology is more complex than previously envisaged, displaying a lobate shape. Ice retreat left an unusual paraglacial landscape characterised by the progressive infilling of topographic depressions carved during the ice advance and a diffuse drainage network of outwash channels. The net direction of outwash was to the west and southwest into a nearby glacial basin. Antecedent topography influenced subglacial bed conditions, and their impact on ice dynamics during the glaciation and deglaciation stages. We demonstrate the utility of offshore windfarm data in refining palaeo ice margin limits, and the record of processes interactions preserved in buried landscapes to help inform longer-term drivers of change at low relief ice margins.

Barriers and Challenges of Implementing Telerehabilitation: A Systematic Review

Objectives: Telerehabilitation (TR) is an alternative approach for providing rehabilitation services in some situations, like Coronavirus Disease 2019 (COVID-19) pandemic. There exist some obstacles, especially during the pre-implementation phase of TR, necessitating an investigation of existing local evidence. This research aimed to investigate the challenges of TR. Methods: Five electronic databases (Scopus, PubMed, Google Scholar, SID, & Magiran) were searched for studies published in English and Persian language from 2011 to February 2021. Search results in all databases provided a total of 598 articles. After reviewing the titles of the articles, we excluded 574 articles as they were duplicated and/or irrelevant. Finally, based on the inclusion and exclusion criteria, 11 articles have remained. Results: Most extracted articles were published in 2020 (n=4). The remaining articles disturbed between 2013 until 2021. These articles were mostly reviews, case reports/series, or qualitative studies and surveys. Geographically, 27% of the final selected papers belonged to the USA, 46% to Asia, and 27% to Europe. Outcomes in studies mostly included TR advantages and disadvantages, facilitators, challenges, and barriers. Discussion: Studies specified numerous challenges for TR implementation. The main challenges in the technologies used in TR were the awareness and culture of individuals and the TR infrastructure. Despite these barriers, TR could be a better treatment selection in some patients. Therefore, it is necessary for health policymakers, and especially rehabilitation managers, technology developers, scientists, and clinicians to cooperatively make serious efforts to remove these barriers.