Using behavioural science in public health settings during the COVID-19 pandemic: The experience of public health practitioners and behavioural scientists.

INTRODUCTION: The emergence of COVID-19 and the importance of behaviour change to limit its spread created an urgent need to apply behavioural science to public health. Knowledge mobilisation, the processes whereby research leads to useful findings that are implemented to affect positive outcomes, is a goal for researchers, policy makers and practitioners alike. This study aimed to explores the experience of using behavioural science in public health during COVID-19, to discover barriers and facilitators and whether the rapidly changing context of COVID-19 influenced knowledge mobilisation. METHODS: We conducted a semi-structured interview study, with ten behavioural scientists and seven public health professionals in England, Scotland, Wales, The Netherlands and Canada. We conducted an inductive thematic analysis. RESULTS: We report three key themes and 10 sub-themes: 1.Challenges and facilitators of translation of behavioural science into public health (Methods and frameworks supported translation, Lack of supportive infrastructure, Conviction and sourcing of evidence and Embracing behavioural science) 2. The unique context of translation (Rapid change in context, the multi-disciplinary team and the emotional toll). 3. Recommendations to support future behavioural science translation (Embedding experts into teams, Importance of a collaborative network and showcasing the role of behavioural science). DISCUSSION: Barriers and facilitators included factors related to relationships between people, such as networks and teams; the expertise of individual people; and those related to materials, such as the use of frameworks and an overwhelming amount of evidence and literature. CONCLUSION: People and frameworks were seen as important in facilitating behavioural science in practice. Future research could explore how different frameworks are used. We recommend a stepped competency framework for behavioural science in public health and more focus on nurturing networks to facilitate knowledge mobilisation in future emergencies.

Effects of Cold Stimulation Induced Pain on Cardiopulmonary Parameters: A Gender Based Study.

Background Cold pressor induced pain elicits sympathetic responses which can be monitored by measuring blood pressure, heart rate and respiratory rate after exposure to the cold stress. Objective This study was done to evaluate gender difference in acute pain induced by cold pressor test on blood pressure, heart rate and respiratory rate of healthy individuals. Method Our study was cross sectional study with the sample size of 40 including 20 male and 20 female undergraduates. Acute pain was induced by immersion of hand in cold water at 4o C. Changes in blood pressure, heart rate and respiratory rate were recorded by the digital sphygmomanometer and AD Instruments (Model: ML856, Serial: T26-4025) and analysis was done by Lab Chart 7 Pro v 7.3.3 respectively. Acute pain parameter like pain threshold was also recorded. Statistical analysis was done by using Paired "t" test and non-parametric test. Result The present study enrolled 40 participants, aged between 18 - 24 years, and body mass index from 15.78 - 36.06 kg/m2 . The respiratory rate was increased in both males (17.30±3.19 to 19.0±3.21, P=0.01) and females (18.60±1.98 to 19.90±2.82, P= 0.01) however significant increase in heart rate was only found in females (77.80±8.07 to 80.70±7.80, P=0.03) after cold pressor test. The systolic as well as diastolic blood pressure did not increase significantly after cold pressor test. The pain thresholds ranged from 25.2 to 105.8 seconds (61.60±23.26, male Vs. 52.69±18.49, female, p = 0.188). Conclusion Our findings point towards autonomic adjustments suggesting more of sympathetic over activity immediately after cold pressor test.

Directions for surgical capacity developments in Nepal: a population-based assessment.

OBJECTIVES: Lack of access to safe surgery is seen as a major issue that needs to be addressed. The aim of this study was to understand which combinations of factors relate to high occurrences of unmet needs and disability in Nepal, and consequently, how to focus future work to maximise impact in this country. METHODS: A large population-based survey was conducted in Nepal in 2014 to evaluate the unmet surgical needs that result in disability. Recorded factors included diseased anatomical areas, disease specifics, disease locations, injury types, reasons for having an unmet need and the types of disability. RESULTS: Included in the study were 2695 individuals. The anatomical areas facing the highest disabling unmet surgical need were Head (3.9% of population), Groin/Genitalia (2.2% of population) and Extremities (3.6% of population). Four focus areas could be defined. Increase affordability, availability and acceptability of surgical care to non-traumatic disabling conditions of (i) the eye, and (ii) extremities, and (iii) to traumatic disabling conditions of extremities and finally (iv) increase acceptability of having surgical care for non-traumatic conditions in the groin and genital area. For the latter, fear/no trust was the main reason for receiving no surgical care despite the resulting shame. CONCLUSIONS: This study defined four focus areas that showed the largest unmet needs that resulted in a perceived disability. For those areas, affordability, availability and acceptability of surgical need to be addressed through technical developments, capacity building and raising awareness.

OBJECTIFS: L'absence d'accès à une chirurgie sûre est considérée comme un problème majeur à résoudre. Le but de cette étude était de comprendre quelles combinaisons de facteurs étaient liées aux besoins non satisfaits et aux incapacités au Népal, et par conséquent, comment cibler les travaux futurs pour maximiser l'impact dans ce pays. MÉTHODES: Une vaste enquête de population a été menée au Népal en 2014 pour évaluer les besoins chirurgicaux non satisfaits qui entraînent une incapacité. Les facteurs enregistrés comprenaient les zones anatomiques, les spécificités, les localisations de la maladie, les types de blessures, les raisons pour lesquelles les besoins n'étaient pas satisfaits et les types d'incapacité. RÉSULTATS: 2695 personnes ont été incluses dans l'étude. Les zones anatomiques impliquées dans des besoins chirurgicaux les plus invalidants étaient les suivantes: tête (3,9% de la population), aine/organes génitaux (2,2% de la population) et extrémités (3,6% de la population). Quatre domaines cibles d'intervention pourraient être définis. Premièrement, augmenter l'accessibilité financière, la disponibilité et l'acceptabilité des soins chirurgicaux aux affections invalidantes non traumatiques de 1) l'œil, 2) des extrémités et 3) aux affections traumatisantes des extrémités, et enfin 4) augmenter l'acceptabilité des soins chirurgicaux pour les affections non traumatiques dans l'aine et les parties génitales. Pour ces derniers, la crainte/l'absence de confiance était la principale raison de ne pas recevoir de soins chirurgicaux malgré la honte qui en résultait. CONCLUSIONS: Cette étude a défini quatre domaines cibles d'intervention qui ont montré les besoins non satisfaits les plus importants ayant entraîné une incapacité perçue. Pour ces domaines, il convient de prendre en compte le caractère abordable, la disponibilité et l'acceptabilité des interventions chirurgicales par le biais de développements techniques, d'un renforcement des capacités et la sensibilisation.

Sudden versus gradual pressure wean from Nasal CPAP in preterm infants: a randomized controlled trial.

OBJECTIVE: In preterm infants, nasal continuous positive airway pressure (NCPAP) is widely used for treatment of respiratory distress syndrome. However, the strategies for successfully weaning infants off NCPAP are still not well defined and there remains considerable variation between the methods. The objective of this study is to determine whether gradual weaning of NCPAP pressure is more successful than sudden weaning off NCPAP to room air. STUDY DESIGN: A randomized controlled trial was conducted in a level 3 neonatal intensive care unit on 70 preterm neonates who were born between 26 and 32 weeks gestation and required NCPAP for at least 48 h. When infants were stable on NCPAP at 0.21 FiO2 and 5 cm H2O positive end expiratory pressure, neonates were randomized to the gradual wean group (reduction in pressure by 1 cm every 8 h until 3 cm H20 was reached) or to sudden wean group (one time NCPAP removal to room air). The primary outcome was a success at the first trial to wean to room air. Secondary outcomes were a number of trials, and weight and postmenstrual age (PMA) at the time of successful wean. Total number of days on NCPAP and length of stay (LOS) in the hospital were also compared between the groups. RESULTS: Of the 70 infants included in the study, 35 were randomized to sudden group and 33 infants to gradual group (2 excluded for protocol deviation). In sudden and gradual groups, 14 and 22 infants, respectively, were weaned successfully in the first attempt (P=0.03). The infants were successfully weaned at 32.7±1.7 weeks versus 33.1±2.4 weeks (P=0.39) PMA and at a weight of 1651±290 g versus 1589±398 g (P=0.46) in the sudden and gradual groups, respectively. The total number of days on NCPAP was 27±19 days versus 32±24 days (P=0.38) and LOS was 63±25 days versus 63±22 days (P=0.99) in the sudden and gradual groups, respectively. CONCLUSIONS: Gradual weaning method was more successful as compared to sudden weaning method in the initial trial off NCPAP. There was no difference in the PMA, weight at the time of successful wean, total days on NCPAP and LOS between the two groups.

Cold Pressor Test in Borderline Hypertensive University Students.

Background Hyperactive sympathetic reaction is an important factor for development of hypertension in young individuals. The stress induced increase in blood pressure recovers within very short period of time and those with exaggerated stress induced cardiovascular response at young age have a high risk of blood pressure elevation in future. Objective To determine the cardiovascular reactivity in response to cold and to correlate its relation with factors such as smoking, family history and physical activity. Method Study was conducted in the Department of Pharmacy, Kathmandu University from July to November, 2015. Resting blood pressure was recorded using sphygmomanometer in sitting position after 5 minutes of rest. Out of 130 volunteers, 34 were found to be prehypertensive and equal number of normotensive were recruited randomly to perform the test. The subjects were directed to immerse his/her right hand up to the wrist in cold water of 10˚C for 1 minute. The blood pressure was recorded just before the hand was taken out of the water and then 1.5 minutes and 4 minutes after the withdrawal. Data was analyzed by Student's t test using Microsoft Excel 2007. Result Systolic and diastolic blood pressure increased significantly after cold pressor test in both normal (systolic blood pressure from 110±6.46 to 119±9.45 mmHg and diastolic blood pressure from 71±4.63 to 78±6.15 mmHg) and prehypertensive group (systolic blood pressure from 122±6.75 to 126±8.05 mmHg and diastolic blood pressure from 79±6.78 to 85±7.76 mmHg). Maximum recovery in both systolic and diastolic blood pressure was observed in 2.5 minutes of removal of hand from cold water. Though sharp drop was observed in blood pressure at the end of 2.5 minute in both groups of individuals, the recovery in case of prehypertensive individual was not sharper. In the present study, significant rise in diastolic blood pressure was observed in prehypertensive smoking males. Also the difference was significant (p<0.02) in recovery of diastolic blood pressure between smoker and non smoker prehypertensive group. Conclusion This study suggests that prolonged elevation in blood pressure in response to stress in young individual can be used as marker of development of hypertension in future. Adopting a healthier lifestyle can help to delay the development of hypertension in later life.

An experimental system to study responses of Medicago truncatula roots to chitin oligomers of high degree of polymerization and other microbial elicitors.

KEY MESSAGE: A fully acetylated, soluble CO preparation of mean DP of ca. 7 was perceived with high sensitivity by M. truncatula in a newly designed versatile root elicitation assay. The root system of legume plants interacts with a large variety of microorganisms, either pathogenic or symbiotic. Understanding how legumes recognize and respond specifically to pathogen-associated or symbiotic signals requires the development of standardized bioassays using well-defined preparations of the corresponding signals. Here we describe the preparation of chitin oligosaccharide (CO) fractions from commercial chitin and their characterization by a combination of liquid-state and solid-state nuclear magnetic resonance spectroscopy. We show that the CO fraction with highest degree of polymerization (DP) became essentially insoluble after lyophilization. However, a fully soluble, fully acetylated fraction with a mean DP of ca. 7 was recovered and validated by showing its CERK1-dependent activity in Arabidopsis thaliana. In parallel, we developed a versatile root elicitation bioassay in the model legume Medicago truncatula, using a hydroponic culture system and the Phytophthora ß-glucan elicitor as a control elicitor. We then showed that M. truncatula responded with high sensitivity to the CO elicitor, which caused the production of extracellular reactive oxygen species and the transient induction of a variety of defense-associated genes. In addition, the bioassay allowed detection of elicitor activity in culture filtrates of the oomycete Aphanomyces euteiches, opening the way to the analysis of recognition of this important legume root pathogen by M. truncatula.

Intrauterine condom tamponade in management of post partum haemorrhage.

BACKGROUND: Uterine tamponade is often used to control post partum hemorrhage. Among various methods, condom Foley's catheter tamponade is simple, easy to use and is believed to be effective. The study evaluates outcome of condom Foley's catheter tamponade. METHODS: In this prespective observational study, condom tamponade was applied to fourteen cases with varying degrees of PPH, not controlled with pharmacologic measures. The efficacy on control of bleeding was assessed along with the total amount of blood loss and any complications. RESULTS: The condom tamponade stopped bleeding in all the cases. Average amount of blood loss was 1221 ml. No complications were noted. CONCLUSIONS: Thus, condom tamponade is an effective method to control intractable PPH. It's simple and does not require expertise to use, so, it can have a wide application even in resource poor settings.

Interpleural catheter technique for perioperative pain management.

Management of pain in surgical patient is very crucial. It is more so in thoracic and upper abdominal surgery. Lots of technique and drugs have been used to control postoperative pain including thoracic epidural analgesia. We describe a case in whom Intraoperative and Postoperative pain was managed by injecting 0.5% bupivacaine 20 ml in the interpleural space through the catheter, followed by continuous infusion of 0.1% bupivacaine 10 ml/ hour for 24 hours. The whole perioperative and postoperative period was uneventful. The first series of patients in whom this technique was used was described by Murphy in 1983, (1) who used it in patients with multiple fractured ribs and in postoperative patients after gallbladder and kidney surgery. One year later, Reiestad and Kvalheim published their results of continuous intercostal nerve block for postoperative pain relief and presented their modification of the technique, which is now termed interpleural analgesia.

Chlamydia trachomatis in pelvic inflammatory disease.

C. trachomatis seems to be an important causative organism of pelvic inflammatory disease (PID) as C. trachomatis antigen and/or antibody was found in 234 (69.85%) of 335 patients clinically diagnosed to have PID. Antigen was detected in the lower genital tract of 118 (35.22%) patients whereas IgG antibody was present in 188 (56.11%), of whom 89 (47.34%) had a high titre. Repeat testing of sera of 37 patients showed a rise in antibody titre in 18 (40%). As the success rate of therapy for PID with doxycycline was found to be 80 per cent, early diagnosis and treatment may be recommended to prevent further complications of PID.