Onno C. P. van Schayck

Introduction: Tobacco-related morbidity and mortality are increasingly shifting toward low- and middle-income countries (LMICs), with most smokers beginning during adolescence. In Kyrgyzstan, adolescent-specific cessation services are not yet systematically integrated into primary care. This...

Background: Type 2 diabetes mellitus, a public health challenge, disproportionately impacts low- and middle-income countries (LMICs), accounting for 73% of global cases. Due to resource constraints, these nations have adopted task-shifting strategies using community health workers (CHWs). However, evidence on the effectiveness of training CHWs in diabetes management is limited and, at most, indirect due to the limited studies, variable training methods, and complex interventions that make it difficult to isolate training effects. Objective: A systematic review was conducted to answer the question: Does training CHWs in type 2 diabetes improve the efficacy of diabetes screening and management at the community level in LMICs? Methods: A total of 2 reviewers, supervised by 2 supervisors, conducted the review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. They searched databases, including PubMed, MEDLINE Ovid, Scopus, EBMR, and CINAHL, for studies published between January 2000 and April 2024, including randomized and nonrandomized controlled trials and observational studies assessing CHW training in diabetes management in LMICs. The primary outcome was the mean change in glycated hemoglobin (HbA _1c ) percentage levels. Data were narratively synthesized for training characteristics and study outcomes, and quality was assessed using the Risk of Bias 2 and ROBINS-I tools. Results: A total of 3387 studies were screened; 69 were eligible for full-text review, and 4 studies (3 randomized controlled trials [RCTs] and 1 observational stepped-wedge study, ~1000 patients) were included for narrative analysis. One of the 3 RCTs reported a statistically significant mean HbA _1c reduction of −0.24% ( P =.001), but HbA _1c was not the primary outcome, and most patients were normoglycemic, prediabetic, or had diabetes. Other studies reported nonsignificant HbA _1c reductions. The risk of bias among RCTs was moderate (some concerns, 1 trial at high risk), and the observational study had a serious risk of bias. No meta-analysis was performed due to the limited number of RCTs. Conclusions: Training CHWs in type 2 diabetes management has shown limited and, at most, indirect effects in improving glycemic control in LMIC settings. These findings are constrained by the small number of eligible studies, heterogeneity in training methodologies, and the multicomponent nature of the included interventions, with 1 trial demonstrating a statistically significant yet small reduction in HbA _1c (−0.24%). Our review included only 4 eligible studies with a small representation of CHWs and multicomponent interventions. Considering the limited number of eligible studies, the heterogeneity in training methodologies and study designs, and the multicomponent nature of the included interventions, the existing evidence remains inadequate to definitively conclude whether CHW training significantly improves diabetes management across LMICs. Therefore, strengthening and standardizing CHW training might be an effective strategy to enhance diabetes care in underserved settings. Future larger trials and implementation research can help maximize the impact of CHWs against the growing diabetes burden.

Aim: This study aims to assess the perspectives of patients with chronic conditions on the use of the Assessment of Burden of Chronic Conditions (ABCC) tool during consultations with their healthcare providers in primary care. Background: The increasing prevalence of chronic conditions, including multimorbidity, poses major challenges to healthcare systems today, particularly in primary care where most chronic care takes place. Effective management strategies are crucial for improving quality of life (QoL). The ABCC tool offers a unique approach to chronic disease management by facilitating shared decision-making and self-management. Methods: This qualitative phenomenological study involved semi-structured interviews. Fourteen patients with chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes mellitus (T2DM) and/or chronic heart failure (CHF) were recruited from a previously conducted quasi-experimental study on the effectiveness of the ABCC tool. Findings: Participants generally expressed satisfaction with the comprehensive questionnaire, user-friendly design and clear visualisation. They appreciated the opportunity to facilitate discussions with healthcare providers and help with monitoring. However, some confusion around the grey balloons in the tool highlighted the need for clearer explanations. Participants had limited awareness of advanced treatment recommendation functions. Conclusions: This study provides valuable insights into patients’ experiences with the ABCC tool. Despite challenges such as recall bias and limited awareness of certain features, participants generally expressed satisfaction with using the tool. Based on these findings, the tool can be further improved and its use should be further supported. However, the ABCC tool shows promise as a valuable instrument for improving consultations in clinical practice.

Background: Childhood obesity and mental health problems are major public health concerns worldwide. Early-life exposure to green spaces has been shown to promote physical activity, reduce obesity risk, and improve cognitive and emotional development. Schoolyards offer a unique opportunity to promote health, as children spend a large proportion of their time at school. Methods: This quasi-experimental protocol study investigates the effects of transforming gray schoolyards into biodiverse green spaces on children’s health and well-being. Four primary schools in Limburg (Belgium and The Netherlands) were recruited: two intervention schools and two control schools. Children aged 7–12 years were enrolled, with baseline data collected in November 2021 and follow-up measurements scheduled every six months until November 2023. Outcomes include body mass index (BMI) z-score (primary outcome), waist circumference, diet, cognitive performance, psychological well-being, biodiversity knowledge, and physical activity. Data will be analyzed using linear mixed models, and cost-effectiveness analyses will be performed. Expected Results: Improvements in BMI z-scores, cognitive functioning, dietary behavior, and psychological well-being are expected among children in green schoolyards compared to those in control schools. Increased biodiversity awareness and reduced exposure to black carbon are also anticipated. Conclusions: This study is designed to provide evidence on the health impacts of greener schoolyards and contribute to strategies for promoting child development through environmental interventions.

Introduction: Workplace smoking cessation programs are effective in reducing smoking prevalence among employees with a lower socioeconomic position (SEP). However, effective participation of these employees remains challenging. This study evaluates a communication training program designed to...