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Switzerland, with an adolescent HPV vaccination coverage at 59%, remains far from reaching the crucial swiss national goal of 80% coverage. Our objective was to implement a new information brochure in schools to increase HPV vaccination uptake. We designed a public health quality project. A new information brochure was produced and was distributed to a test group of 9th grade students from the Canton of Vaud, in Switzerland during the 2019-2020 school year. Vaccine uptake of the test group was compared to those of all other students in 2019-2020 and of students in the same schools in 2017-2018. 12,143 electronic records were analyzed. 713 students were enrolled in 6 schools where the new brochure was distributed. Median age was 13 years (IQR 12-13), and 6,031 (49.7%) were female. Vaccine uptake was 52% (6,299/12,143). The new brochure did not result in increased uptake. Age ≥ 13 years (aOR 1.39, 95% CI 1.22-1.58) was significantly associated with uptake. Uptake increased between 2017-2018 (51%, 3,216/6,307) and 2019-2020 (52.8%, 3,083/5,836, p=0.04) due to increased acceptance among boys. The only determinant of uptake in 2019-2020 was uptake in the same schools in 2017-2018. The introduction of a new information brochure was insufficient to increase HPV vaccination coverage. More innovative strategies are needed.

Purpose: The purpose of this study was to examine the ease of reading cochlear implant (CI) brochures provided to parents and caregivers who are making informed decisions about the management of their child's hearing loss. Method: CI brochures from three Food and Drug Administration–approved CI manufacturers were examined: Advanced Bionics, Cochlear Americas, and MED-EL. Reading grade levels and ease of reading were analyzed using a commercially available computer software program, applying six readability formulas commonly used to examine hearing-related patient education materials (PEMs). Results: The readability of the CI brochures exceeds the fifth- to sixth-grade reading-level guidelines. The CI brochures may be difficult for the average English-speaking adult to read with ease and requires at least a 10th-grade comparable reading level. Conclusions: Despite health literacy initiatives, audiology-focused PEMs continue to be created without full consideration of the burden for the reader. Authors of PEMs should consider the average reading level of the reader as a variable potentially influencing the decision-making process. Likewise, clinicians should consider the average reading level needed to understand PEMs when presenting information and resources to parents and caregivers for informed and shared decision making.

RESUMO O artigo analisa diversos panfletos produzidos no contexto do movimento vintista luso-brasileiro, que tinham como tema central a rede de polêmicas formada em torno da denominada praga periodiqueira. A expressão aludia à notável proliferação de publicações políticas observada em meio ao processo de Independência. A abordagem enfatiza as diferentes visões referentes a questões como liberdade e limites da imprensa, função pública dos redatores, protocolos de escrita e mobilização política; em particular, os significados acerca da emergência de um conjunto de fórmulas discursivas que se tornaram referências de escrita pública e de debate político, no Brasil e em Portugal, ao longo do século XIX. ABSTRACT The paper analyzes several pamphlets produced in the context of the Luso-Brazilian constitutionalist movement, whose main theme was the network of controversies formed around the so-called praga periodiqueira (periodical plague). The expression referred to the remarkable proliferation of political publications that took place during the Independence process. The approach emphasizes the different views regarding issues such as freedom and limits of the press, public role of editors, writing protocols and political mobilization. It highlights the meanings about the emergence of a set of discursive formulas that became references of public writing and of political debate throughout the XIX century in Brazil and Portugal. RESUMEN El artículo analiza varios panfletos producidos en el contexto del movimiento vintista luso-brasileño, cuyo tema central fue la red de polémicas formada en torno a la llamada peste periódica. La expresión aludía a la notable proliferación de publicaciones políticas observada en pleno proceso de Independencia. El enfoque enfatiza las diferentes miradas en torno a temas como la libertad y los límites de la prensa, el papel público de los escritores, los protocolos de escritura y la movilización política; en particular, los significados sobre el surgimiento de un conjunto de fórmulas discursivas que se convirtieron en referencias de la escritura pública y del debate político, en Brasil y Portugal, a lo largo del siglo XIX.

Peer-to-peer recruitment efforts are important in generating interest and participation of patients as partners in research but difficult to sustain when face-to-face interactions are limited. The Retinoblastoma Research and You! booklet, co-developed by patients, researchers and health professionals, serves as a guide for patient engagement in research while retaining an element of personalization. The Retinoblastoma Research and You! booklet was developed through two virtual workshops to iterate and finalize the booklet design and content. The booklet outlines how individual patients' lived experiences and skills can influence retinoblastoma research and highlights real-world examples of patient-partnered research activities at different stages of the research process.

This manuscript aimed to produce an illustrated booklet of Brazilian sign language (LIBRAS) booklet to facilitate the communication between dentists (and academics) and deaf patients during dental treatment and other healthcare promotion activities.A literature review was conducted to select signs, symptoms, and diseases related to dentistry expressed in LIBRAS; in addition, photographs were taken to illustrate and produce the booklet. The booklet (in PDF format) was made available on an open-access website and printed copies were freely distributed at the dental clinics of the Federal University of Pará.Learning of specific LIBRAS is extremely important to guarantee social inclusion and improve dental treatment of deaf patients.

Medication product package labels (MPPLs) and patient information leaflets (PILs) are sometimes the last source of information for patients before they take their medications. They provide a setting in which patients can immediately inform themselves about the medication they are taking or reread any content provided by physicians or pharmacists, as needed. Despite the growing number of people who are at risk of vision impairement, some pharmaceutical companies print MPPLs and PILs in fonts that patients cannot read. Problems arising from MPPLs and PILs have been identified as remarkable sources of medication errors and fatalities. As a result, the purpose of this article is to emphasize the need for patient-centered MPPLs and PILs to protect public health.

Recent research indicates that parents of children with craniosynostosis may be at risk of emotional distress. Yet, parents may not be accessing the support they need to cope with common challenges. The aim of this project was to develop a research-informed booklet to promote psychological health in new families, and to assess acceptability of the booklet within the craniosynostosis community. The first draft was designed in close collaboration with leading UK charity Headlines Craniofacial Support 5 parent representatives, and 3 specialist clinical psychologists via online focus groups. The draft booklet, attached to an online acceptability survey, was distributed to a broader group of parents and multidisciplinary specialists working in craniofacial teams in England for feedback. A total of 44 complete responses to the online acceptability survey were received. Acceptability (measured by the number of respondents who would recommend the booklet) was 100%. All respondents reported they "agreed" or "strongly agreed" with the UK-wide distribution of the booklet. Evidence for psychological intervention in the craniofacial field remains scarce, and specialist teams may be under-resourced to effectively screen and support parents. It is hoped this booklet will begin to address the gap in psychological support for new families affected by craniosynostosis.

With an ageing population and an increase in the prevalence of dementia, stoma care nurses (SCNs) are experiencing greater challenges in their role supporting this group of patients with their stoma care. Following concerns raised in our department by relatives about the care and teaching provided in this area, with patients occasionally denying having even seen an SCN, the need for a visual tool to enable timely interventions and increase knowledge for family, carers and ward staff became apparent. There is a comprehensive list of local and national guidelines underlining the need to provide more support and an increased comprehensive teaching plan specially tailored to dementia patients’ needs. The development of a patient progress diary, with a traffic light system showing each stage that the patient has reached, has provided a visual, up-to-date guide to the patient’s stoma management and highlights the need for further input to enable the patient to be discharged home safely and in a timely manner. The diary was formulated by the SCNs and printed by Coloplast, culminating in an easy-to-read booklet with a pictorial step-by-step guide to be inserted into patients’ washbags. The diary was reviewed by Great Western Hospitals Patient Advice and Liaison Service (PALS) and the Carers Committee, who provided positive feedback and subsequently supported the development of this patient-focused tool. Since introducing the diary, our team has decided to implement it with all patients, with positive feedback from patients, relatives, carers and ward staff. This has assisted in safe, timely and effective discharge planning.

Background Job loss after a cancer diagnosis can lead to long-term financial toxicity and its attendant adverse clinical consequences, including decreased treatment adherence. Among women undergoing (neo)adjuvant chemotherapy for breast cancer, access to work accommodations (e.g., sick leave) is associated with higher job retention after treatment completion. However, low-income and/or minority women are less likely to have access to work accommodations and, therefore, are at higher risk of job loss. Given the time and transportation barriers that low-income working patients commonly face, it is crucial to develop an intervention that is convenient and easy to use. Methods We designed an intervention to promote job retention during and after (neo)adjuvant chemotherapy for breast cancer by improving access to relevant accommodations. Talking to Employers And Medical staff about Work (TEAMWork) is an English/Spanish mobile application (app) that provides (1) suggestions for work accommodations tailored to specific job demands, (2) coaching/strategies for negotiating with an employer, (3) advice for symptom self-management, and (4) tools to improve communication with the medical oncology team. This study is a randomized controlled trial to evaluate the app as a job-retention tool compared to a control condition that provides the app content in an informational paper booklet. The primary outcome of the study is work status after treatment completion. Secondary outcomes include work status 1 and 2 years later, participant self-efficacy to ask an employer for accommodations, receipt of workplace accommodations during and following adjuvant therapy, patient self-efficacy to communicate with the oncology provider, self-reported symptom burden during and following adjuvant therapy, and cancer treatment adherence. Discussion This study will assess the use of mobile technology to improve vulnerable breast cancer patients’ ability to communicate with their employers and oncology providers, work during treatment and retain their jobs in the long term, thereby diminishing the potential consequences of job loss, including decreased treatment adherence, debt, and bankruptcy. Trial registration ClincalTrials.gov NCT03572374. Registered on 08 June 2018.

BACKGROUND AND AIMS Alcohol consumption is increasing among older adults. Rethink My Drink is a brief internet-delivered intervention to reduce alcohol consumption and related harms, adapted specifically for older adults. This protocol for a large-scale randomised controlled trial will evaluate whether Rethink My Drink is effective in reducing alcohol consumption and cognitive decline in a sample of older risky drinkers, compared with an active control. DESIGN 1:1 parallel group, randomised controlled trial. SETTING Online trial in Australia. PARTICIPANTS Hazardous or harmful drinkers (defined as those scoring ≥5 on the Alcohol Use Disorders Identification Test [AUDIT]) age 60 to 75 years old (n = 842). Participants will be recruited from August 2021 to August 2022 through online social media advertisements and community networks. INTERVENTION AND COMPARATOR Participants will be randomly allocated to receive access to Rethink My Drink (intervention) or Alcohol: The Facts (comparator), an online patient information booklet provided by New South Wales (NSW) Health. MEASUREMENTS Primary outcomes include (i) average weekly standard drinks and (ii) rate of cognitive decline. Secondary outcomes include (i) typical quantity of drinks per drinking day; (ii) heavy episodic drinking; (iii) age-specific risky drinking; (iv) alcohol-related harms; (v) subjective cognitive complaints; and (vi) quality of life. All primary and secondary outcomes will be assessed at baseline, post-intervention (4 weeks) and 12 months. Effectiveness will be evaluated using multilevel linear regression, adjusting for baseline demographic differences. Bonferroni adjustments will be used to control for multiple comparisons. Multiple imputation, regression weighting and sensitivity analyses will assess the effect of attrition. COMMENTS This will be the first large-scale trial, internationally, to examine whether a brief internet-delivered intervention is effective in reducing alcohol consumption and cognitive decline among older adults. If successful, the intervention will provide an accessible and highly scalable treatment to reduce risky alcohol consumption in older adulthood.

The double royal wedding that took place in 1615 between the Crowns of France and the Hispanic Monarchy was an extremely relevant event. Every alliance between those two states was significant, but the political context made the occasion even more compelling. The Hispanic government took advantage of that importance to develop a great campaign of propaganda. The sources of this paper will be the pamphlets, widely distributed at the Modern Age, with the aim of analyzing the messages that the monarchy tried to send. Las dobles bodas celebradas entre las Coronas de Francia y la Monarquía Hispánica fueron un evento tremendamente relevante. Si una unión entre los estados más poderosos del momento siempre lo era, lo que supuso en el contexto de acercamiento entre ambos reinos la hizo aún más destacable. La necesidad política y económica hizo necesaria una campaña de propaganda entre dos potencias enemigas para silenciar las oposiciones internas. Uno de los elementos de esa propaganda más difundidos fueron las relaciones de sucesos, que serán el objeto de estudio de este trabajo, con la finalidad de analizar qué mensajes trató de difundir la monarquía a través de ellas. El presente trabajo forma parte del proyecto de tesis doctoral financiado con un contrato de Formación del Profesorado Universitario (FPU18/01356), del Ministerio de Ciencia, Innovación y Universidades.

Background Initiating hemodialysis via an arteriovenous (AV) access is considered best practice for most patients. Despite the well-recognized advantages of AV access, 80% of US patients start hemodialysis with a catheter. Limited patient knowledge about vascular access, among other factors, may play a role in this high rate. We used iterative stakeholder input to develop novel, mixed media vascular access education materials and evaluated their preliminary acceptability. Methods We conducted preliminary focus groups and interviews with key stakeholders to assess patient vascular access understanding and elicit perspectives on existing education materials. We then used stakeholder input to inform initial development and iterative updates to the content and design of an animated video and complementary brochure. Video development (scripting, storyboarding, animation) was guided by an evidence-based framework and two health behavior change models. We assessed acceptability of the completed materials with patients and medical providers/personnel via interviews. Results Overall, 105 stakeholders participated in education materials development and review (80 patients/care partners, 25 medical providers/personnel). Preliminary qualitative work included 52 patients/care partners and 16 providers/personnel; video development included 28 patients/care partners and nine providers/personnel. The video script, storyboards, and animation underwent 14, four, and nine stakeholder-guided iterations, respectively. Responsive changes included aesthetic modifications, technical updates, and content additions (e.g., HD circuit, access self-monitoring, enhanced patient testimonials). The final 18-minute video and complementary brochure define vascular access types, describe care processes, outline potential complications, and address common patient concerns. Interviews with 28 patients/care partners and nine providers/personnel from diverse geographic regions revealed preliminary acceptability of, and enthusiasm for, the materials by patients and providers. Conclusions In collaboration with key stakeholders, we developed mixed media vascular access education materials that were well-received by patients and providers. Preliminary findings suggest that the materials are promising to improve vascular access understanding among patients.

Research ethics committees (RECs) and regulatory agencies assess whether the benefits of a proposed early-stage clinical trial outweigh the risks based on preclinical studies reported in investigator’s brochures (IBs). Recent studies have indicated that preclinical evidence presented in IBs is reported in a way that does not enable proper risk-benefit assessment. We interviewed different stakeholders (regulators, REC members, industry representatives, preclinical and clinical researchers, ethicists, and metaresearchers) about their views on measures to increase the completeness and robustness of preclinical evidence reporting in IBs.This study was preregistered (https://osf.io/nvzwy/). We used purposive sampling and invited stakeholders to participate in an online semistructured interview between March and June 2021. The themes were derived using inductive content analysis. We used a strengths, weaknesses, opportunities, and threats (SWOT) matrix to categorize our findings.Twenty-seven international stakeholders participated. The interviewees pointed to several strengths and opportunities to improve completeness and robustness, mainly more transparent and systematic justifications of the inclusion of studies. However, weaknesses and threats were mentioned that could undermine efforts to enable more thorough assessment: The interviewees stressed that current review practices are sufficient to ensure the safe conduct of first-in-human trials. They feared that changes to the IB structure or review process could overburden stakeholders and slow drug development.In principle, having more robust decision-making processes in place aligns with the interests of all stakeholders and with many current initiatives to increase the translatability of preclinical research and limit uninformative or ill-justified trials early in the development process. Further research should investigate measures that could be implemented to benefit all stakeholders.

Off-label use of gabapentinoids is common among patients admitted to hospital medical wards, who are at risk of adverse drug events. In this study, we will assess if educational brochures can increase rates of gabapentinoid deprescription among medical inpatients, compared with usual care.We describe the protocol for a prospective before-and-after trial that will take place on 5 medical wards of 2 tertiary care hospitals in Montréal, Canada. The study intervention will include distribution of educational brochures to users of gabapentinoids during hospital admission, as well as short educational sessions for medical staff on safe gabapentinoid prescribing practices. We will include patients with a gabapentinoid prescription before admission who are aged 60 years or older. Exclusion criteria are known seizure disorder, severe cognitive impairment, expected prognosis less than 3 months and inability to read English or French. The primary outcome is the rate of gabapentinoid deprescription at 8 weeks postdischarge. We aim to recruit 160 participants, with a 1:1 distribution between intervention and control groups.If successful, the use of educational brochures and staff education represents a scalable intervention to reduce gabapentinoid overuse by encouraging deprescription conversations between patients and their health care providers. Results of the study will be disseminated through publication in peer-reviewed journals and presentations at conferences.ClinicalTrials.gov, no. NCT04855578.

To assess the effect of a patient decision aid on the quality of decision-making for patients with age-related cataracts.773 patients with cataracts aged 50-80 years were randomly assigned to receive either the intervention decision aid (including standard information, quantitative information on the possible outcomes of cataract surgery and a value clarification exercise) or the control booklet (including standard information). The primary outcome was informed choice (defined as adequate knowledge and congruency between attitudes and surgical intentions), which was assessed at 2 weeks after intervention via a telephone interview.The decision aid increased the proportion of participants making an informed choice, from 5.68 % in the control group to 27.7 % in the intervention group (P0.001). Compared with controls, more participants in the intervention group had adequate overall knowledge about cataract surgery (36.8 % vs. 8.79 % in controls; P0.001), and fewer participants intended to undergo surgery (22.5 % vs. 34.1 % in controls; P0.001).Use of the patient decision aid may increase the proportion of patients making informed choices. Importantly, it might also reduce the acceptance of operations.Patient decision aids represent a simple and low-cost tool to facilitate informed choice among patients with cataracts.

Background: Fear of blood donation is implicated in vasovagal reactions, donor recruitment, and retention. This study examined the extent to which fear among donors is associated with various donor outcomes in an Australian sample, and whether fear can be addressed on-site to reduce adverse reactions and improve the donation experience. Study design and methods: Six hundred and sixty-four donors (age M = 33.4, SD = 12.7; 55% female) participated in a two-center, pragmatic, parallel group, individually randomized controlled trial. Following donor registration and consent, whole-blood (n = 539) and plasma (n = 125) donors were assigned to one of four Conditions: control; fear assessment; fear assessment + brochure; fear assessment + brochure + tailored conversation focused on any self-reported fear and coping strategies. Post-donation questionnaires assessed the donors' experience including positive support, donor self-efficacy, anxiety, fear, venipuncture pain, and vasovagal reactions. Results: Fear among donors predicted higher venipuncture pain, post-donation anxiety, and vasovagal reactions and remained significant after controlling for other established predictors (i.e., total estimated blood volume, age, sex, and donation experience). Mediational analyses showed that exposure to brochures (with or without the tailored conversation) was associated with less pain, with this effect mediated by donor perceptions of more positive support. Venipuncture pain was also associated with vasovagal reactions, reduced likelihood of return within 6 months, and less satisfaction with the donation experience. Conclusion: The current results underline the importance of interventions to address fear among both whole-blood and plasma donors to secure the safety and well-being of donors and the blood supply.

BACKGROUND: We compared results from household data sources to medical record sources by using data from a vaccination coverage survey. METHODS: Vaccination coverage (VC) was calculated based on parental recall, household vaccination booklet, and Zhejiang provincial immunization information system (ZJIIS). We evaluated the accuracy of VC based on household sources (vaccination booklet and recall) assuming the medical record was accurate. Concordance, sensitivity, specificity, positive predictive value, and negative predictive value were estimated as well as the Kappa statistic was also used to evaluate the agreement between data sources. RESULTS: Among the 1,800 children identified in the household survey, all were registered in ZJIIS. VC estimated using the vaccination booklet alone was substantially lower than that based on medical records (net bias 3.4–16.7% in different age groups). VC based on parental recall ranged from 2.5% below (among children aged 1 year) to 16.7% points above (among children aged 6 years) than those based on medical records. Concordance was lowest for card estimates (32.5–45.5%). Sensitivity was 75%, while negative predictive value was

BackgroundResearch investigating predictors of side-effect expectations is disparate and largely based on hypothetical vignettes.PurposeTo carry out a secondary analysis of a randomized controlled trial and investigate the predictors of side-effect expectations for side-effects that were, or were not, warned about.MethodsTwo hundred and three healthy adults completed measures concerning demographics, psychological factors, baseline symptoms, and medication-related beliefs before reading one of two types of patient information leaflet (PIL) (standard or positively framed PIL) for a sham medication and asking them about their side-effect expectations. Associations between these measures and side-effect expectations whilst controlling for the PIL received were assessed using regression analyses.Results82.8% of participants expected side-effects that were warned about in the PIL, and 29.1% expected side-effects that were not warned about. Participants who were younger, from White backgrounds, less optimistic, experienced increased anxiety and received the standard PIL were more likely to expect side-effects that were warned about. Those with higher beliefs about medicine overuse and lower trust in medicine development were more likely to expect side-effects that were not warned about. Higher somatization, baseline symptoms, modern health worries scores, and lower trust in pharmaceutical companies were associated with increased expectations for all side-effects. The results suggest we can not only rely on altering side-effect risk communication to reduce side-effect expectations and therefore nocebo effects. We must also consider patients’ beliefs about trust in medicines. More work is needed to investigate this in a patientsample in which the medication is known to them.

Immigrant and refugee patients may have limited English proficiency. Effective use of professional interpreter services reduces clinically significant errors and increases the quality of care. A multitude of professional interpreter services are available, and clinicians should carefully select the preferred modality of interpretation based on the type of encounter. Ad hoc interpreters, such as family members, are least preferred because of concerns of privacy and evidence of poorer outcomes. Children less than 18 years of age should only be used as interpreters in emergency situations. Professional telephonic, video, or in-person interpreters each have distinct advantages in specific clinical situations.

To evaluate patients' knowledge, risk perception, and anxiety about future health risks after an episode of hypertensive disorder of pregnancy (HDP), as well as their satisfaction with an educational pamphlet.From January 2016 to June 2017, participants were randomly assigned to one of 2 groups and asked to complete questionnaire #1 (demographics, knowledge, risk perception, anxiety, and satisfaction) after receiving medical counselling at the HDP postpartum clinic. Participants in the intervention group then received the educational pamphlet. One month later, both groups completed the questionnaire again (questionnaire #2). The primary outcome of this study was improvement in the global knowledge score at 1 month, reflecting improved understanding of the health risks of HDP. Secondary outcomes included retention of information, risk perception, satisfaction, and anxiety level.Of 137 eligible women, 57 were randomly assigned to the intervention group and 56, to the control group. Participants in both groups had similar baseline characteristics. Thirteen percent of participants did not complete questionnaire #2. The knowledge score was higher in the intervention group than the control group at 1 month, (88.2%; 95% confidence interval [CI] 26.37-28.32 and 71.3%; 95% CI 20.78-23.45, respectively [P0.0001]). No difference was seen in anxiety level between the groups (4.0 ± 1.00 vs. 3.8 ± 0.92; P = 0.6746). The intervention group was highly satisfied with the medical counselling they received (5.5 ± 0.84 out 6) and with the pamphlet (5.6 ± 0.66 out 6).The educational pamphlet increased women's knowledge about future health risks of HDP without increasing anxiety and it may be helpful in promoting lifestyle changes necessary to modify these risks.

Objectives International regulations require Investigator's Brochures (IBs) to compile all available evidence that inform the risk-benefit assessment for the newly planned clinical trial. This study examined the adherence of IBs to the basic principles of evidence synthesis when compiling prior clinical studies. Study Design and Setting For 97 IBs for phase I/II trials reviewed at one German research ethics committee we assessed the reporting on search, appraisal, and synthesis procedures for prior clinical studies. For a random subsample of 30 IBs, we evaluated the quality of reporting of the compiled 247 prior clinical studies. Results Only 2% of all 97 IBs reported a comprehensive search strategy, provided a critical appraisal of the compiled prior clinical studies or presented respective study results in a structured manner. For the 247 prior clinical studies compiled in 30 IBs, the information required to appraise their risk of bias (eg, sample size calculation or baseline characteristics) was rarely reported. Conclusion When compiling all available evidence supporting the rationale for the proposed clinical study IBs do not acknowledge the broadly established principles for reviewing and reporting evidence. This may impact negatively on the trustworthiness and efficiency of risk-benefit assessment.

Objectives 1) To evaluate and improve the suitability and readability of an educational booklet designed for use in an intervention aimed at promoting healthy lifestyles as a way to manage cardiometabolic risk factors in adults with low levels of physical activity and 2) to check its acceptability to real end users. Methods A 7-phase methodology was used. The evaluation committee (9 experts, 6 potential end users) scored the booklet using the Suitability Assessment of Materials (SAM) and health education material (HEM) questionnaires on two occasions (original and revised version). Acceptability was also assessed by 75 real end users after a lifestyle intervention. Results The SAM and HEM scores of the revised booklet were respectively 10% (SD = 9%) and 10% (SD = 7%) higher than the original booklet scores. The revised version attained “superior” scoring in all questionnaires: SAM, 87% (SD = 8%); HEM, 3.5 (SD = 0.4) out of 4; Acceptability, 3.7 (SD = 0.4) out of 4. Conclusions The suitability and readability of an educational booklet—to promote a healthy lifestyle—were improved following a systematic peer-review evaluation prior to its use in an intervention. Practice implications Improving the suitability and readability of educational resources can have a positive impact on patient knowledge and awareness, and hence on intervention effectiveness.

During the decolonisation of southern Africa (1960s-1990s), several national liberation movements benefited from support from the Nordic countries, where they established foreign missions and mobilized international aid. As a result, a considerable amount of African primary source material has been amassed over the years. This material is now accessible through the Pamphlet Collection of the Nordic Africa Institute (NAI). The Pamphlet Collection contains over 700 boxes with (primary) source material from the entire African continent, including unique material from national liberation movements that is difficult to find elsewhere. Scholars of the Cold War can use this fascinating collection to study African agency during an era that – often wrongly - seemed to be dominated by Great Power competition. This Research Note explores contents of the Pamphlet Collection, with a particular focus on material from southern Africa.

Background\udMany countries are introducing low-dose computed tomography screening programmes for people at high risk of lung cancer. Effective communication strategies that convey risks and benefits, including unfamiliar concepts and outcome probabilities based on population risk are critical to achieving informed choice and mitigating inequalities in uptake.\ud\udMethods\udThis study investigated the acceptability of an aspect of NHS England's communication strategy in the form of a leaflet that was used to invite and inform eligible adults about the Targeted Lung Health Check (TLHC) programme. Acceptability was assessed in terms of how individuals engaged with, comprehended, and responded to the leaflet. Semi-structured, ‘think aloud’ interviews were conducted remotely with 40 UK screening-naïve current and former smokers (aged 55-73). The verbatim transcripts were analysed thematically using a coding framework based on the Dual Process Theory of cognition.\ud\udResults\udThe leaflet helped participants understand the principles and procedures of screening and fostered cautiously favourable intentions. Three themes captured the main results of the data analysis: (1) Response – participants experienced anxiety about screening results and further investigations, but the involvement of specialist healthcare professionals was reassuring; (2) Engagement – participants were rapidly drawn to information about lung cancer prevalence, and benefits of screening, but deliberated slowly about early diagnosis, risks of screening and less familiar symptoms of lung cancer; (3) Comprehension – participants understood the main principles of the TLHC programme, but some were confused by its rationale and eligibility criteria. Radiation risks, abnormal screening results and numerical probabilities of screening outcomes were hard to understand.\ud\udConclusion\udThe TLHC information leaflet appeared to be acceptable to the target population. There is scope to improve aspects of comprehension and engagement in ways that would support informed choice as a distributed process in lung cancer screening.\ud\udPatient or public contribution\udThe insight and perspectives of patient representatives directly informed and improved the design and conduct of this study.

Electroconvulsive therapy (ECT) is considered an effective, yet underused and stigmatized form of psychiatric treatment. Public misconception can impact informed decision making, and therefore, it is important to educate the community with accurate and realistic representations of modern ECT. The aim of this study was to determine whether exposure to brief information packages developed in Australia leads to changes in attitudes and knowledge about ECT.A sample of 100 undergraduate psychology students and 88 volunteers from the general public were randomly allocated to view 1 of 3 resource packages (each containing an information pamphlet and videos totaling ~15 minutes): Concord Centre for Mental Health-Revised, Concord Centre for Mental Health-Original, and a generic information package on depression. Participants' attitudes and knowledge of ECT were assessed before and after psychoeducation using the Questionnaire on Attitudes and Knowledge of ECT (QuAKE).Participants in the student and general population exposed to either ECT resource package showed significantly improved attitudes and knowledge of ECT compared with participants exposed to generic information about depression and its treatment. A fine-grained analysis of the QuAKE revealed that, although many aspects of knowledge and attitudes improved after exposure to ECT information packages, some remained unchanged.Brief education through information resources in video and written format can markedly improve attitudes and knowledge toward ECT. Further research is recommended to determine whether the resources contribute to informed decision making of consumers with mental illness, especially those who are candidates for ECT.

Summary Natural environments can be used to promote health through facilitating recreational walking. However, efforts to encourage this often neglect messages identified in psychological research that are effective at influencing intentions to walk. This is despite the National Institute for Health and Care Excellence stating that promotional efforts should utilize theoretical frameworks of behaviour change and be targeted towards less active adults. As an illustrative example, this experiment compared a prototypical recreational walking brochure with an “enhanced” version including such persuasive messages on people’s intentions to walk for recreation in natural environments. The enhanced brochure heightened intentions for inexperienced recreational walkers through our hypothesized mechanisms, but appeared to dissuade already-experienced walkers. Optimal messaging strategies in recreational walking brochures require tailoring to more and less active readerships. Guidelines are provided for authors of recreational walking brochures, though the principles and techniques could easily be extended to other means of outdoor walking promotion.

Purpose Incorporating a Decision Aid (DA) about nutrition support into the general pediatric healthcare setting may improve parent and patient understanding about the risks and benefits of nutrition support options. We aimed to evaluate the acceptability and usability of our newly developed DA for parents of children in the general pediatric healthcare setting who require nutrition support. Design and methods Participants were 18 parents with a child who had received nutrition support; and 12 Healthcare Professionals (HCPs) involved in pediatric nutrition support discussions. Parents' and HCPs' ratings of acceptability and feasibility of the booklet, and parents' perceived knowledge acquisition after reading the booklet were assessed. Results Parents were satisfied with the DA, reporting that it was an appropriate length and unbiased. Most parents felt the DA was relevant to their decision-making, improved understanding, and would recommend it to other parents. HCPs felt that the booklet clearly described the essential information for nutrition support options, but less certain of the booklets' impact on parent decision-making. Regardless, most HCPs would recommend the booklet to other clinicians. Conclusion Our decision aid appears to be acceptable and useful for parents deciding on nutrition support for their child in the general pediatric hospital setting. Practice implications A DA may facilitate shared decision-making through improved understanding of the risks and benefits of different nutrition support options in the pediatric setting. Further evaluation is required with specific pediatric conditions, to determine the effectiveness for parents actively deciding on their child's nutrition support.

Background We evaluated the effectiveness of a simple, low-cost educational brochure in improving disposal rates of unused opioids after outpatient upper extremity surgery. Methods This cross-sectional study enrolled eligible adult patients from a peripheral nerve clinic between November 2017 and September 2018. Patients either received or did not receive the educational brochure, which outlined a simple method to dispose of unused opioids and completed a survey at 2 weeks after surgery. We compared the proportion of patients who disposed of unused opioids after surgery between the group that had received the brochure and the group that had not. Categorical data were analyzed with χ2 test, proportions data with binomial tests, and numerical data with Mann-Whitney U test, all with a significance level of P < .05. Results There were 339 survey respondents. Nineteen patients who did not meet inclusion criteria were excluded. Of the 320 remaining patients, 139 received the brochure and 181 did not. An additional 55 patients were excluded due to preoperative opioid use. Overall, 35.3% of recipients and 38.3% of those who did not receive the brochure used all of their prescribed opioid medication ( P = .625; confidence interval = −14.6%-8.8%). Among patients with unused opioid medication, a significantly higher proportion of brochure recipients disposed of the medicine compared with those who did not receive the brochure (46.7% vs 19.6%, P < .001). Conclusions Distribution of an educational brochure significantly improved disposal of unused opioids after surgery. This easily implemented intervention can improve disposal of unused opioids and ultimately decrease excess opioids available for diverted use in the community.

Purpose The aim of this study was to determine the effect of precolonoscopy information with the guidance of an education booklet on anxiety and bowel preparation adequacy in patients undergoing colonoscopy. Design A randomized controlled study. Methods The education group was informed face to face by the researcher with the guidance of the colonoscopy education booklet and provided the education booklet. The control group received usual care. Findings The mean state and trait anxiety scores of the patients in the education group were found to be significantly lower than the control group. In the education group, the bowel preparation adequacy was determined to be higher compared with the control group. Conclusions Informing patients with the guidance of the education booklet before the colonoscopy decreased patients' state and trait anxiety levels and increased their bowel preparation adequacy.

Objective To compare patient booklets with clinical guidelines and care pathways to assess: gaps in content and depth of information delivered, opportunities for patients participation and to review the trajectory of care to inform recovery. Methods A systematic review of the grey literature was conducted using Google search engine and a variety of terms related to cardiac surgery, patient outcomes and recovery pathways. Patient books and care pathways were obtained from major hospitals in Melbourne. Resources were included if they were published between January 2013-August 2018 and written in English. Results A total of 31 resources were included in the review, (n = 14 patient booklets, n = 17 clinician guides). Twenty-one topics of recovery were identified. Patient booklets provided information on more topics of recovery than clinician guides (50 % and 24 % respectively). Clinician guides provided more depth on information on topics of recovery than patient booklets (85 % and 73 % respectively). The majority of patient booklets outlined patient participation was in five topics of recovery. Conclusions Gaps in the type and depth of information exist between patient and clinician guidelines. Clearer guidelines on how patients can participate in care are needed. Practice implications Nurses are key drivers in facilitating patient participation in postoperative recovery.

OBJECTIVE Despite its high prevalence, cancer-related insomnia typically remains untreated because of a lack of access to cognitive-behavioral therapy for insomnia (CBT-I), the treatment of choice for this condition. While face-to-face CBT-I appears to be optimal in terms of efficacy, self-administered formats may be more cost-effective. The goal of this secondary analysis of a randomized clinical trial was to compare the cost-effectiveness of a professionally-based CBT-I (PCBT-I) to that of a video-based CBT-I (VCBT-I). METHODS A total of 161 women with breast cancer received six weekly, individual CBT-I sessions (PCBT-I; n = 81) or a 60-minutes animated video +6 short booklets (VCBT-I; n = 80). Participants completed the Insomnia Severity Index (ISI) and provided information to calculate treatment costs. RESULTS Total per patient treatment costs were 5.5 times greater for PCBT-I ($1298.90) than VCBT-I ($234.36; P

Background Nationally, Hispanics experience health disparities manifested as a higher prevalence of chronic diseases in comparison to non-Hispanic Whites. Factors that influence health disparities in this population include inadequate dissemination of culturally and linguistically appropriate health information. Method Our qualitative analysis is based on data obtained from three focus groups with Spanish-speaking Hispanic adults conducted at a clinic in Nebraska. Participants were asked about their perceptions of health information in the form of videos, brochures, and websites. We followed the consolidated criteria for reporting qualitative research and used the theoretical framework of content analysis. Results For videos, attributes associated with higher levels of trust included a friendly health professional, the logo or name of a health care institute, and a reference specifying “se habla Español.” For brochures, attributes associated with trust included use of visual aids, use of numerous colors and big font sizes, the year of printing, and a health care agency logo. For websites, characteristics associated with trust were inclusion of plain language, use of pictures and videos, and date of last update. In all focus groups, participants perceived the use of mixed English/Spanish language in health information from pamphlets and websites as unprofessional. The use of unknown governmental logos in health promotional videos and websites was perceived as untrustworthy information. Conclusions Spanish-speaking Hispanics prefer health information supported by a health care agency or delivered by a health care professional. Health communication strategies should avoid the use of mixed English/Spanish language in sensitive information especially when combined with governmental logos.

Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment that remains largely underutilized. Patient psychoeducation about ECT may improve uptake of this treatment.This randomized controlled trial compared two forms of psychoeducation about ECT: video psychoeducation and an informational brochure. In 2019, a national sample of 556 U.S. adults who screened positive for depression were recruited and randomly assigned to receive one of these educational interventions online. Participant perceptions, knowledge, and willingness to receive ECT were assessed before and after psychoeducation.Both the video psychoeducation and brochure groups showed significantly more positive perceptions and knowledge about ECT following the intervention, with no significant differences between groups. The proportion of participants who reported being willing to receive ECT increased significantly after receipt of psychoeducation (from 31% to 63% in the video psychoeducation group and from 29% to 56% in the brochure group). Female gender, severity of depression, and comorbid mental and substance use disorders were associated with positive changes in ECT perceptions and increased willingness to receive ECT.These findings suggest brief psychoeducation for ECT is needed and may improve acceptance of this robust treatment.

Background Although novel oral anticoagulants have been applied into clinical practice, warfarin remains the only approved oral anticoagulant for heart valve replacement. Currently, an increasing number of Chinese clinical pharmacists provide patients with warfarin education. However, little research to date has been carried out to evaluate the relationship between warfarin knowledge level and anticoagulation control among patients with heart valve replacement. Objective To evaluate knowledge of warfarin and the relationship between knowledge level and anticoagulation control among patients with heart valve replacement. Setting Fujian Medical University Union Hospital, China. Method A prospective and cross-sectional study was designed to evaluate the warfarin education of inpatients new to warfarin therapy using a validated Anticoagulation Knowledge Assessment questionnaire. Included patients were followed up for at least 3 months. Data were retrieved from hospital databases and telephone follow up. Main outcome measure Spearman’s rho correlation analysis was used to assess the relationships between time in therapeutic range and warfarin knowledge level. Results 383 patients were included. The mean age of patients was 50.3 ± 7.9 years. The mean knowledge questionnaire score was 62.3 ± 8.8%. The majority of incorrect answers related to drug–warfarin interaction. Five of the frequently incorrect questions covered drugs, herbs and diet that affect warfarin therapy. There were significant correlations between total questionnaire score and time in therapeutic range (rho = 0.539, P

Background: Interventions to help parents quit smoking may yield important benefits for children with asthma. Children’s exposure to environmental tobacco smoke can be measured by reporting of an adult in the household and testing the child’s biomarker, e.g., cotinine. Objective: The aim of the study was to assess the effectiveness of “face-to-face” intervention carried out since 2016 in families with children diagnosed with asthma 3 years after beginning the anti-tobacco intervention. Methods: This study was a follow-up to an interventional study that assessed the effectiveness of direct patient education versus educational leaflets alone about parental tobacco smoking. The patients with asthma (ages 4‐17 years) enrolled in our original intervention study conducted in 2016 were under the care of the allergy outpatient clinic. The active group was individually educated about the harmful effects of environmental tobacco smoke on their children. The control group included patients and parents, among whom only leaflets were distributed. After 3 years of ongoing intervention, in patients from both groups, exposure to tobacco smoking was evaluated with a questionnaire addressed to parents and/or caregivers and measurement of cotinine in children’s urine. The forced expiratory volume in the first second of expiration and fractional exhaled nitric oxide levels were measured. Results: Seventy participants completed the study: 37 in the active group and 33 in the control group. In the active group, 27% of the parents quit smoking entirely compared with 9.4% of parents in the control group. In the group of active intervention, a significant decrease in the cotinine level (p < 0 .001) and the number of cigarettes smoked daily were observed (p Conclusion: “Face-to-face” intervention among families with smokers were effective and lowered cotinine levels in children with asthma and the number of cigarettes smoked assessed 3 years after the intervention.

Objective: The purpose of this study was to evaluate the effects of a Web-based Multimedia Intervention (WBMI) for breast cancer-related lymphedema (BCRL) patients on symptom burden, function, psychological well-being, costs, and arm volume. Methods: Women with BCRL were randomized to intervention (n = 80) or control (n = 80) groups. The WBMI offered 12 modules, each of which took about 30 minutes to complete. The Pamphlet took about 2 hours to read. Data on symptom burden, psychological well-being, function, and costs were collected preintervention; and 1, 3, 6, and 12 months postintervention. A subgroup of 45 regional patients had arm extracellular fluid measured by bioimpedance at baseline and at 3, 6, and 12 months postintervention. Intervention perceived value was also captured. Results: A statistically significant difference (p = 0.011) was observed for rates of intervention completion, WBMI (58%), and Pamphlet (77%). With the exception of the number of biobehavioral symptoms (mood), no statistically significant differences between groups in symptom reduction were apparent between baseline and 1 or 12 months (effect sizes = 0.05–0.28, p > 0.05) based on the Lymphedema Symptom Intensity and Distress Scale–Arm (LSIDS-A). No statistically significant differences between the groups were observed for changes in other variables. The WBMI was perceived as providing better self-care information than the Pamphlet (p = 0.001). Conclusions: WBMI participants experienced improved biobehavioral symptoms and higher perceived quality of information. The lack of significant differences on other variables may be due to the high percentage of participants who did not complete the WBMI.

Lesbian, Gay, Bisexual, and Transgender (LGBT) patients face significant dermatologic health disparities. LGBT patients are often discriminated against, refused healthcare, or otherwise have negative healthcare experiences that may deter future utilization of professional care. While a number of factors may mitigate these negative experiences, the present article focuses on improving organizational and institutional drivers specific to individual dermatology clinics. Clinic workflow and operations, emerging technologies and EHRs, clinic culture, clinic environment and resource availability, and provider and staff education are all characteristics of healthcare clinics that can be improved to better facilitate high-quality dermatologic care for LGBT patients.

IntroductionType 2 diabetes and cardiovascular disease are highly prevalent conditions, for which health education represents a significant component of management. A wide variety of health education formats are available and preferences of people with diabetes or cardiovascular disease for certain formats may vary between sociodemographic groups.MethodsA questionnaire was deployed to collect information about the influence of six sociodemographic factors of interest on the preference for health education format in type 2 diabetes and/or cardiovascular disease. Chi-squared tests were used to examine the distribution of preferences between groups. The characteristics of the population preferring the online format were then examined in more detail using logistic regression.ResultsResponses were received from 1559 participants. Overall the preferred modality was one to one learning from a doctor or nurse (67%). Age, gender, diagnosis and educational level all affected the preferences expressed. The characteristics showing most consistent and significant influence were age and educational level. Overall, 29% ranked the online modality highly (1 or 2). This group were more likely to be aged under 65 (p

The purposes of this study were to develop a caregiver-education booklet and to elicit intervention strategies for a self-management support program for caregivers of relatives with dementia in Shanghai. Two focus groups with 32 eligible caregivers were conducted to clarify the knowledge and information about the scope and main points of, as well as the barriers to and support for caregiver self-management. Content analysis revealed that the main challenges caregivers faced were a lack of reliable and accessible information about dementia care, frustrations related to communication with the care recipient, disturbances in daily routines, and unfamiliarity with and/or difficulty in balancing the caregiver's own health needs. Access to individualized and reliable instruction and/or group support were the major types of support the participants expected for their self-management. Based on the findings and relevant literature, an illustrated caregiver-education booklet was developed and the intervention strategies were also discussed for the program.

Objective: To determine whether an antepartum educational leaflet distributed to parents before infant delivery affected the rate of infant car-seat (ICS) use 1 month after delivery, because to the...

Background In Japan, a recent opinion poll in 2017 showed that 41.9% of the respondents wished to donate their organs, but only 12.7% declared their intention to donate or not do so. Therefore, it is important to explore measures to prompt more individuals to register their intention about organ donation. Methods A field experimental questionnaire survey was conducted to confirm the effect of a prompt message for registering intentions for organ donation, which was communicated at a driver's license center. The study employed a prospective randomized control design. Seven thousand six hundred fifteen individuals visited the Tokyo Fuchu License Examination Center to update their driver's license and received leaflets including a message prompting organ donation registration and the questionnaire. Of the participants who received leaflets, 3224 respondents provided complete responses to the questionnaire (valid response rate: 42.3%). Subsequently, a questionnaire survey was conducted to assess the participants' willingness to register for organ donation. A control condition and the following types of messages were used: peer-framed, gain-framed, loss-framed, reciprocity-framed, and peer + reciprocity-framed. Results The reciprocity message emerged as a significant predictor of increase in immediate decision response. The loss-framed message was a significant predictor of decrease in no intention to register. Conclusions This study found that reciprocity and loss-framed messages promoted the readiness to register for organ donation among individuals from a Japanese urban area. Mandatory distribution of prompt messages at every driver's license centers in Japan would be recommended.

Objectives The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents. Methods A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants’ knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention. Results After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of Conclusions An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents. Practice implications In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age.

Background Patient information leaflets are an important source of medicine information for patients. In Thailand, there is a lack of studies exploring activities of healthcare professionals and their attitudes towards provision of patient information leaflets. Objectives This study aimed to survey healthcare professionals' practices on provision of medicine information, expectations of, attitudes towards provision of patient information leaflets and factors influencing these. Setting Two university hospitals in Thailand. Methods A self-completion questionnaire was distributed to chiefs of departments for further distribution to staff. A stratified sample of physicians and nurses was invited, while all pharmacists were invited to ensure sufficient numbers for comparison. Main outcome measure Healthcare professionals' practices on provision of medicine information, expectations of, attitudes towards provision of patient information leaflets. Results Of the total 981 healthcare professionals invited, 493 responded (50.3% response rate). The number of respondents aware of patient information leaflets was 270 (57.6%). Of these, only 44.4% had ever given patient information leaflets to patients. Pharmacists provided patient information leaflets more frequently than other healthcare professionals. The expectation for patient information leaflets to be available was high; mean score 7.9 ± 2.31 of possible 10. Most respondents had positive attitudes towards providing patient information leaflets to patients (58.2%). Respondents who were aware of patient information leaflets availability were more likely to have a positive attitude (OR 0.543, p = 0.002). Level of education, time spent in direct care and being aware of patient information leaflets were factors associated with healthcare professionals' attitudes. Conclusion Limited number of healthcare professionals had provided patient information leaflets to patients but most had positive attitudes regarding the usefulness of patient information leaflets for patients. Increased availability and use of patient information leaflets should be promoted.

Goals/background Patients who "no-show" for colonoscopy or present with poor bowel preparation waste endoscopic resources and do not receive adequate examinations for colorectal cancer (CRC) screening. Using the Health Belief Model, we modified an existing patient education pamphlet and evaluated its effect on nonattendance rates and bowel preparation quality. Study We implemented a color patient education pamphlet to target individual perceptions about CRC and changed bowel preparation instructions to include a low-residue diet instead of the previous clear liquid diet. We compared the nonattendance rate over a 2-month period before and after the introduction of the pamphlet, allowing for a washout period during which pamphlet use was inconsistent. We compared the Boston Bowel Preparation Scale (BBPS) in 100 consecutive patients who underwent colonoscopy during each of the 2 periods. Results Baseline characteristics between the 2 groups were similar, although patients who received the pamphlet were younger (P=0.03). The nonattendance rate was significantly lower in patients who received the pamphlet (13% vs. 21%, P=0.01). The percentage of patients with adequate bowel preparation increased from 82% to 86% after introduction of the pamphlet, although this was not statistically significant (P=0.44). The proportion of patients with a BBPS score of 9 was significantly higher in the pamphlet group (41% vs. 27%, P=0.03). There was no difference in adenoma and sessile serrated adenoma detection rates before and after pamphlet implementation. Conclusions After implementing a theory-based patient education intervention with a low-residue diet, our absolute rate for colonoscopy nonattendance decreased by 8% and the proportion of patients with a BBPS score of 9 increased by 14%. The Health Belief Model appears to be a useful construct for CRC screening interventions.

Culturally-tailored interventions increase rates of colorectal cancer (CRC) screening in diverse populations. South Asian Americans have very low rates of CRC screening. Targeted interventions may improve community awareness and likelihood of undergoing screening. We identified and recruited multiple South Asian-serving community and religious centers to conduct South Asian physician-led presentations about CRC screening. A post-presentation survey tool was used to evaluate CRC screening history, intent to screen, and acceptance of a tailored brochure. In a convenience sample of 103 surveys, many participants had not undergone screening in the past (48%), and intent to screen after the presentation was high in those previously not screened (87%). Those who took a culturally-tailored brochure said they would share materials with family and friends (95% and 39% respectively). Our results support earlier findings of success in culturally-tailored interventions and indicate acceptance of culturally-tailored CRC screening outreach in community sites.

Diarrhea still causes high morbidity and mortality in children under five, requiring constant interventions. Thus, the study aims to evaluate the effects of educational technologies on maternal self-efficacy to prevent childhood diarrhea.Randomized clinical trial carried out in Fortaleza, Ceará, Brazil, with four randomized groups of mothers of children under 5 years of age, as follows: control group (n = 61), group A (booklet, n = 60), group B (video, n = 60), and group AB (booklet and video, n = 60). From June to October 2015, data collection was carried out in three moments (the first in person and the others by telephone monitoring).All groups improved their self-efficacy after the intervention, with higher scores in the group AB (booklet and video). A statistically significant association was found between the occurrence of diarrhea and maternal self-efficacy in groups A (booklet) (p = 0.023) and AB (booklet and video) (p = 0.042) at the second moment of data collection. From the second moment to the third moment, the risk of diarrhea decreased in group A, from 12.8 to 1.3, and in group AB, from 8.5 to 1.1.The technologies used, isolated or combined, were effective in improving maternal self-efficacy and decreasing the occurrence of childhood diarrhea; therefore, they can be used by nurses as health education tools.

"Allegations" charts how accused female characters across a number of early modern texts convene and organize relations among the English legal system, the emerging realm of popular print, and the proto-public sphere. Because these systems in their existing state largely fail to serve the women accused, the women instead refashion these established channels and summon their own assemblies in hopes of vindicating themselves. This assembled court of public opinion thus has the opportunity to override and modify the initial judgements that the existing channels of power hand down. The printed realm and the popular engagement it facilitates come to offer a counterweight to traditional arrangements, and the accused who reimagine the legal sphere through print lead the way towards more participatory elements in literature.