Liver transplantation for hepatocellular carcinoma in Ireland:Pre-operative alpha-fetoprotein predicts tumour recurrence in a 14-year single-centre national experience

AIM: To examine the results of orthotopic liver transplantation(OLT) for hepatocellular carcinoma(HCC) in Ireland over a 14-year period.METHODS: Cases of HCC receiving OLT between January 1995 and September 2009 in the Irish Liver Transplant Unit were reviewed from a prospectively maintained database. Outcome measures included overall and recurrence free survival, alpha-fetoprotein(AFP) and tumour pathological features. RESULTS: On explant pathology, 57 patients had HCC. The median follow-up time was 42.7 mo. The overall 1, 3 and 5 years survival was 87.7%, 72.1% and 72.4%. There was no difference in survival when comparedto patients undergoing OLT without malignancy. The tumour recurrence rate was 14%. The Milan criteria were exceeded in 32% of cases but this did not predict overall survival or recurrence. On multivariate analysis pre-operative AFP > 100 ng/m L was an independent risk factor for recurrence(RR = 5.2, CI: 1.1-24.3, P = 0.036).CONCLUSION: Patients undergoing OLT for HCC had excellent survival even when conventional listing criteria were exceeded. Pre-operative AFP predicts recurrence independent of tumour size and its role in selection criteria should be investigated in larger studies.

Postnatal PMTCT: Women’s Perception Barriers at a Johannesburg Health Centre, South Africa

Background: Maximising women’s participation and ensuring optimal outcomes will require that the women’s perception barriers to postnatal prevention of Mother-to-Child Transmission (PMTCT) programme of HIV be addressed. However, little is known about women’s perception barriers to postnatal PMTCT programme of HIV and how these barriers affect the women’s health seeking behavior and uptake. Objective: This study sought to explore the women’s perception barriers to postnatal PMTCT programme at a Johannesburg Community Health Centre during April-May, 2016. Methods: A qualitative study on 30 women (aged 20 - 39 years) was conducted at a Johannesburg community health (CHC), South Africa, during May-June 2016, after obtaining their consent. The data was analysed thematically to understand women’s perception barriers to postnatal PMTCT programme. Results: The study found that inadequate counselling was perceived to be the single key health service barrier to PMTCT programme. At the individual level, adherence to ART was considered the leading women’s barriers to the postnatal PMTCT. Exclusive breastfeeding was, however, perceived as important women’s barriers to the postnatal PMTCT. Inadequate emotional support from families and community was a noteworthy women’s perception barrier to the programme. Conclusion: The study makes two recommendations: firstly, the staff, programme managers and health policy makers need to be aware of the women’s perception barriers to the postnatal PMTCT programme. Secondly, the programme should be strengthened by addressing perception barriers to the programme to enhance women participation to ensure optimal outcomes for women and their infants.

Predictive Ability of Hypertriglyceridemic Waist,Hypertriglyceridemic Waist-to-Height Ratio,and Waist-to-Hip Ratio for Cardiometabolic Risk Factors Clustering Screening among Chinese Children and Adolescents

Objective Hypertriglyceridemic waist(HW),hypertriglyceridemic waist-to-height ratio(HWHtR),and waist-to-hip ratio(WHR)have been shown to be indicators of cardiometabolic risk factors.However,it is not clear which indicator is more suitable for children and adolescents.We aimed to investigate the relationship between HW,HWHtR,WHR,and cardiovascular risk factors clustering to determine the best screening tools for cardiometabolic risk in children and adolescents.Methods This was a national cross-sectional study.Anthropometric and biochemical variables were assessed in approximately 70,000 participants aged 6–18 years from seven provinces in China.Demographics,physical activity,dietary intake,and family history of chronic diseases were obtained through questionnaires.ANOVA,χ2 and logistic regression analysis was conducted.Results A significant sex difference was observed for HWHtR and WHR,but not for HW phenotype.The risk of cardiometabolic health risk factor clustering with HW phenotype or the HWHtR phenotype was significantly higher than that with the non-HW or non-HWHtR phenotypes among children and adolescents(HW:OR=12.22,95%CI:9.54-15.67;HWHtR:OR=9.70,95%CI:6.93-13.58).Compared with the HW and HWHtR phenotypes,the association between risk of cardiometabolic health risk factors(CHRF)clustering and high WHR was much weaker and not significant(WHR:OR=1.14,95%CI:0.97-1.34).Conclusion Compared with HWHtR and WHR,the HW phenotype is a more convenient indicator with higher applicability to screen children and adolescents for cardiovascular risk factors.

Cost effectiveness analysis of population-based serology screening and ^(13)C-Urea breath test for Helicobacter pylori to prevent gastric cancer:A markov model

AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy. METHODS:A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses. RESULTS:Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost- effectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION:The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.

Assessment of serum angiogenic factors as a diagnostic aid for small bowel angiodysplasia in patients with obscure gastrointestinal bleeding and anaemia

To assess the use of serum levels of angiopoietin-1 (Ang1), Ang2 and tumor necrosis factor-α (TNFα) as predictive factors for small bowel angiodysplasia (SBA). METHODSSerum samples were collected from patients undergoing capsule endoscopy for any cause of obscure gastrointestinal bleeding (OGIB) or anaemia. Based on small bowel findings patients were divided into 3 groups: (1) SBA; (2) other bleeding causes; and (3) normal, according to diagnosis. Using ELISA technique we measured serum levels of Ang1, Ang2 and TNFα and compared mean and median levels between the groups based on small bowel diagnosis. Using receiver operator curve analysis we determined whether any of the factors were predictive of SBA. RESULTSSerum samples were collected from a total of 120 patients undergoing capsule endoscopy for OGIB or anaemia: 40 with SBA, 40 with other causes of small bowel bleeding, and 40 with normal small bowel findings. Mean and median serum levels were measured and compared between groups; patients with SBA had significantly higher median serum levels of Ang2 (3759 pg/mL) compared to both other groups, with no significant differences in levels of Ang1 or TNFα based on diagnosis. There were no differences in Ang2 levels between the other bleeding causes (2261 pg/mL) and normal (2620 pg/mL) groups. Using Receiver Operator Curve analysis, an Ang2 level of > 2600 pg/mL was found to be predictive of SBA, with an area under the curve of 0.7. Neither Ang1 or TNFα were useful as predictive markers. CONCLUSIONElevations in serum Ang2 are specific for SBA and not driven by other causes of bleeding and anaemia. Further work will determine whether Ang2 is useful as a diagnostic or prognostic marker for SBA.

Risk factors for sudden cardiac death to determine high risk patients in specific patient populations that may benefit from a wearable defibrillator

BACKGROUND There is a high risk for sudden cardiac death(SCD) in certain patient groups that would not meet criteria for implantable cardioverter defibrillator(ICD) therapy.In conditions such as hypertrophic cardiomyopathy(HCM) there are clear risk scores that help define patients who are high risk for SCD and would benefit from ICD therapy. There are however many areas of uncertainty such as certain patients post myocardial infarction(MI). These patients are high risk for SCD but there is no clear tool for risk stratifying such patients.AIM To assess risk factors for sudden cardiac death in major cardiac disorders and to help select patients who might benefit from Wearable cardiac defibrillators(WCD).METHODS A literature search was performed looking for risk factors for SCD in patients post-MI, patients with left ventricular systolic dysfunction(LVSD), HCM, long QT syndrome(LQTS). There were 41 studies included and risk factors and the relative risks for SCD were compiled in table form.RESULTS We extracted data on relative risk for SCD of specific variables such as age,gender, ejection fraction. The greatest risk factors for SCD in post MI patients was the presence of diabetes [Hazard ratio(HR) 1.90-3.80], in patient with LVSD was ventricular tachycardia(Relative risk 3.50), in LQTS was a prolonged QTc(HR36.53) and in patients with HCM was LVH greater than 20 mm(HR 3.10). A proportion of patients currently not suitable for ICD might benefit from a WCDCONCLUSION There is a very high risk of SCD post MI, in patients with LVSD, HCM and LQTS even in those who do not meet criteria for ICD implantation. These patients may be candidates for a WCD. The development of more sensitive risk calculators to predict SCD is necessary in these patients to help guide treatment.

Chronic care model in the diabetes pay-for-performance program in Taiwan:Benefits,challenges and future directions

In this review,we discuss the chronic care model(CCM)in relation to the diabetes pay-for-performance(P4P)program in Taiwan.We first introduce the 6 components of the CCM and provide a detailed description of each of the activities in the P4P program implemented in Taiwan,mapping them onto the 6 components of the CCM.For each CCM component,the following three topics are described:the definition of the CCM component,the general activities implemented related to this component,and practical and empirical practices based on hospital or local government cases.We then conclude by describing the possible successful features of this P4P program and its challenges and future directions.We conclude that the successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives(i.e.,shared care network),physician-led P4P and the implementation of activities based on the CCM components.However,due to the low rate of P4P program coverage,approximately 50%of patients with diabetes cannot enjoy the benefits of CCMrelated activities or receive necessary examinations.In addition,most of these CCM-related activities are not allotted an adequate amount of incentives,and these activities are mainly implemented in hospitals,which compared with primary care providers,are unable to execute these activities flexibly.All of these issues,as well as insufficient implementation of the e-CCM model,could hinder the advanced improvement of diabetes care in Taiwan.

Factors associated with patient absenteeism for scheduled endoscopy

AIM: To identify risk factors to help predict which patients are likely to fail to appear for an endoscopic procedure. METHODS: This was a retrospective, chart review, cohort study in a Canadian, tertiary care, academic, hospital-based endoscopy clinic. Patients included were: those undergoing esophagogastroduodenoscopy, colonoscopy or flexible sigmoidoscopy and patients who failed to appear were compared to a control group. The main outcome measure was a multivariate analysis of factors associated with truancy from scheduled endoscopic procedures. Factors analyzed included gender, age, waiting time, type of procedure, referring physician, distance to hospital, first or subsequent endoscopic procedure or encounter with gastroenterologist, and urgency of the procedure. RESULTS: Two hundred and thirty-four patients did not show up for their scheduled appointment. Compared to a control group, factors statistically significantly associated with truancy in the multivariate analysis were: non-urgent vs urgent procedure (OR 1.62, 95% CI 1.06, 2.450), referred by a specialist vs a family doctor (OR 2.76, 95% CI 1.31, 5.52) and office-based consult prior to endoscopy vs consult and endoscopic procedure during the same appointment (OR 2.24, 95% CI 1.33, 3.78). CONCLUSION: Identifying patients who are not scheduled for same-day consult and endoscopy, those referred by a specialist, and those with non-urgent referrals may help reduce patient truancy.

Screw placement is everything: Risk factors for loss of reduction with volar locking distal radius plates

AIM To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.METHODS A total of 250 patients with a distal radius fracture stabilised with volar locking plates between January 2010 and December 2014 were included in a multicentre retrospective cohort study. We measured the distance of the distal locking screws to the joint line immediately postoperatively and then measured radial shortening after six to eight weeks using the change in ulnar variance.RESULTS Multivariate linear regression analysis showed that there was a significant linear association between the distance of the screws from the joint line and radial shortening. No other patient, injury, or treatment-related characteristic significantly influenced radial shortening in multivariate analysis.CONCLUSION Distal locking screws should be placed as close as possible to the subchondral joint line to prevent postoperative loss of reduction.

Experimental Design and Its Posterior Efficiency for the Calibration of Wearable Sensors

This paper investigates experimental design (DoE) for the calibration of the triaxial accelerometers embedded in a wearable micro Inertial Measurement Unit (μ-IMU). Firstly, a new linearization strategy is proposed for the accelerometer model associated with the so-called autocalibration scheme. Then, an effective Icosahedron design is developed, which can achieve both D-optimality and G-optimality for linearized accelerometer model in ideal experimental settings. However, due to various technical limitations, it is often infeasible for the users of wearable sensors to fully implement the proposed experimental scheme. To assess the efficiency of each individual experiment, an index is given in terms of desired experimental characteristic. The proposed experimental scheme has been applied for the autocalibration of a newly developed μ-IMU.

Intensive care performance: How should we monitor performance in the future?

Intensive care faces economic challenges. Therefore, evidence proving both effectiveness and efficiency, i.e., cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care and how accurate and representative is this measurement? In the following report, several topics which are used for the evaluation of intensive care unit(ICU) performance are discussed:(1) The use of general outcome prediction models to determine the risk of patients who are admitted to ICUs in an increasing variety of case mix for the different intensive care units, together with three major limitations;(2) As critical care outcomes research becomes a more established entity, mortality is now only one of many endpoints that are relevant. Mortality is a limited outcome when assessing critical care performance, while patient interest in quality of life outcomes is relevant; and(3) The Quality Indicators Committee of the Society of Critical Care Medicine recommended that short-term readmission is a major performance indicator of the quality of intensive care medicine.

Antioxidant Property of a Dietary Supplement of Moringa oleifera Leaves and Pleurotus ostreatus in Wistar Rats Subjected to Forced Swimming Endurance Test

The antioxidant property of Moringa oleifera leaves and Pleurotus ostreatus on swimming performance and related biochemical parameters were investigated in thirty adult male and female wistar rats. Purpose: The aim of the present study was to evaluate the antioxidant property of M. oleifera and P. ostreatus mixture in specific proportions in wistar rats. Material and Methods: The mushroom species and M. oleifera leaves were cultivated at the biotechnology laboratory of the University Cheikh Anta Diop de Dakar, Senegal. Oxidative stress in rats was induced by swimming. The dietary supplement was composed of a mixture of powders of Moringa oleifera and Pleurotus ostreatus in 2:1 ratio. Three groups received different doses of dietary supplements 500 mg/kg, 1000 mg/kg, and 1500 mg/kg, with one group being the stressed and the other the control group. Parameters in serum such as serum glutamyl oxaloacetate transaminase, serum glutamyl pyruvate transaminase, albumin, Testosterone, creatinine, and, oxidative stress parameters (catalase, reduced glutathione, and malondialdehyde) were measured. Results: Results showed that the dietary supplement has an effect on oxidative stress because it increases the activity of catalase and the level of cellular glutathione in rats. The 500 mg/kg dose would be the most appropriate dose for stressful conditions. The 1000 mg/kg dose would be the most appropriate dose for liver damage. Conclusion: This study shows that the antioxidant properties of M. oleifera leaves and Pleurotus ostreatus are demonstrated by their ability to improve body energy stores and tissue antioxidant capacity. The dietary supplement of M. oleifera leaves and P. ostreatus powders mixture could be good in stressful conditions.

Paroxetine vs pregabalin for the management of neuropathic pain in multiple sclerosis

AIM: To compare the effectiveness and tolerability of paroxetine vs pregabalin for the management of multiple sclerosis(MS)-induced neuropathic pain(NPP).METHODS: A randomized, flexible-dose open-label 8-wk study involving 21 relapsing-remitting MS patients with MS-induced NPP was conducted to evaluate the effectiveness and tolerability of pregabalin versus paroxetine for pain management. The trial included a 3-wk dose titration phase followed by a 5-wk stable dose phase. Primary outcome measures included daily patient-reported pain intensity as measured using a 100 mm visual analogue scale(VAS pain) and daily impact of pain on daily activities(VAS impact). Hierarchical regression modeling was conducted on each outcome to determine if within person VAS trajectory for pain and impact differed across study groups, during 56 d follow-up. RESULTS: Attrition rates were significantly greater(P < 0.001) in the paroxetine versus pregabalin study group(70% vs 18.2%, respectively). Average study duration between study groups also significantly differed(P < 0.001). Paroxetine participants completed an average of 27.3 d of treatment vs 49.5 d in the pregabalin group, with the majority of patients withdrawing due to adverse events. Due to the high attrition rates in the paroxetine study arm, the investigators stopped the study prior to achieving complete recruitment. As such, no significant differences between pregabalin and paroxetine study arms were noted for the primary outcome measures(VAS pain, VAS impact). Comparative assessment of baseline patient characteristics also revealed no significant differences between the study arms. CONCLUSION: High attrition rates associated with paroxetine use suggest that it be used with caution for MS-induced NPP. Efficacy outcomes could not be assessed due to attrition.

Development of An ICR Mouse Bioassay for Toxicity Evaluation in Neurotoxic Poisoning Toxins-Contaminated Shellfish

Objective To develop an ICR （female） mouse bioassay （MBA） for toxicity confirmation and evaluation of neurotoxins （brevetoxins）-contaminated shellfish. Methods Brevetoxins （BTX-B） as a causative agent of neurotoxic shellfish poisoning （NSP） under different shellfish matrices were intraperitoneally injected at different doses into mice to study their toxic effects and to differentiate the range of lethal and sublethal dosages. Their sensitivity and specificity were analyzed with 2 competitive ELISA kits for quantitative determination of standard BTX-B and dihydroBTX-B under different shellfish matrix-diluent combinations. Detection rates of MBA and two antibody-based assays for BTX-B from field NSP-positive shellfish samples were compared. Results BTX-B could be detected in shellfish tissues at concentration of 50-400 μg/100 g under shellfish matrix-Tween-saline media, which were appropriate to identify toxic shellfish at or above the regulatory limit （80 μg/100 g shellfish tissues）. The LD 50 identified was 455 g/kg for BTX-B under general shellfish matrices （excluding oyster matrices） dissolved in Tween-saline. The presence of shellfish matrices, of oyster matrices in particular, retarded the occurrence of death and toxicity presentation in mice. Two antibody-based assays, even in the presence of different shellfish matrix-diluent combinations, showed acceptable results in quantifying BTX-B and dihydroBTX-B well below the regulatory limit. Conclusion The two ELISA analyses agree favorably （correlation coefficient, r 0.96; Student＇s t-tests, P〉0.05） with the developed bioassay.

Pandemic influenza: A global challenge for social marketing marketing

Recent years have seen increased attention and concern regarding the potential for pandemic influenza, following large-scale outbreaks of swine flu and bird flu. Governments and health agencies have time to develop social marketing strategies and specific messages that have the potential to minimize fear, refute or inoculate against misinformation that the public may encounter, and enhance the likelihood of the public taking the recommended preventive and remedial actions should these become necessary. This paper presents an overview of how social marketing can be used to tackle the global challenge of pandemic influenza. The potential pandemic influenza poses a major challenge for social marketers (along with governments, health services, and businesses). There are a number of critical factors about a potential pandemic influenza that make it fundamentally different to the majority of issues to which social marketing has previously been applied. The underlying principles of social marketing are equally applicable to a global infectious disease outbreak (such as pandemic influenza). Even if the current strains do not become pandemic, social marketers should use this impetus to develop the skills and resources to address future communicable disease outbreaks. This paper applies the concepts of social marketing to a unique health issue which has the potential to become one of the largest global public health crises in history, but which can be tackled with effective global social marketing.

Estrogen rapid effects:a window of opportunity for the aging brain?

Estrogen produces several beneficial effects in healthy neurological tissues and exhibits cardioprotective effects.Hormone therapy has been widely used to treat menopausal estrogen deficiency for more than 80 years.Despite high initial expectations of cardioprotective effects,there has been substantial distrust following important randomized clinical trials,such as the Women’s Health Initiative.Subsequently,the timing of treatment in relation to the onset of menopause came under consideration and led to the proposal of the timing hypothesis,that early initial treatment is important,and benefits are lost as the timing since menopause becomes prolonged.Subsequent analyses of the Women’s Health Initiative data,together with more recent data from randomized and observational trials,consistently show reductions in coronary heart disease and mortality in younger menopausal women.Regarding cognitive function,the timing hypothesis is consistent with observations from basic and animal studies.There is some clinical evidence to support the benefits of hormonal therapy in this context,though skepticism remains due to the paucity of clinical trials of substantial length in younger menopausal women.It is likely that the effects of estrogens on cognitive performance are due to rapid mechanisms,including mechanisms that influence Ca2+homeostasis dynamics,provide protection in a hostile environment and reduce inflammatory signals from neural tissues.In the future,inflammatory profiles accounting for early signs of pathological inflammation might help identify the‘window of opportunity’to use estrogen therapy for successful cognitive protection.

Systematic review of evidence for different treatment settings in anorexia nervosa

AIM: To compare outcomes in anorexia nervosa(AN) in different treatment settings: inpatient, partial hospitalization and outpatient. METHODS: Completed and published in the English language, randomized controlled trials comparing treatment in two or more settings or comparing different lengths of inpatient stay, were identified by database searches using terms "anorexia nervosa" and "treatment" dated to July 2014. Trials were assessed for risk of bias and quality according to the Cochrane handbook by two authors(Madden S and Hay P) Data were extracted on trial quality, participant features and setting, main outcomes and attrition. RESULTS: Five studies were identified, two comparing inpatient treatment to outpatient treatment, one study comparing different lengths of inpatient treatment, one comparing inpatient treatment to day patient treatment and one comparing day patient treatment with outpatient treatment. There was no difference in treatment outcomes between the different treatment settings and different lengths of inpatient treatment. Both outpatient treatment and day patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was also cheaper than prolonged inpatient care for weight normalization also followed by evidence based outpatient care. CONCLUSION: There is preliminary support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting for anorexia nervosa.

Mothers’ and health workers’ perceptions of participation in a child-friendly health initiative in rural South Africa

Background: Primary health care clinics promote health in addition to treating illness, but are often perceived as unfriendly and frightening places for children. This research aimed to improve child-friendliness in primary health care settings in a rural, high HIV prevalence area in South Africa. Methods: As part of a larger intervention (“Amagugu” Intervention) health staff in nine primary health care clinics were trained in a child-friendliness approach. 281 enrolled mothers were invited to attend clinic with their primary school-aged children and assessed childfriendliness via structured questionnaires administered by independent assessors;a sub-group also participated in in-depth interviews. Post intervention, focus groups were conducted with 87 primary health staff to determine their experiences of providing child-friendly services. Results: Mothers rated 65% of clerks and 70% of nurses as “very friendly”. Qualitative data showed that heavy clinical loads, limited human resources and inadequate infrastructure were perceived as barriers to child-friendliness, while good clinic leadership and appropriate resources facilitated child-friendliness. Post intervention most health workers reported that child-friendly health promotion activities were rewarding. Conclusions: Providing child-friendliness training and support to primary health care facilities in low-resource settings is feasible, acceptable and yielded encouraging results.

Development of a Systematic Review of Public Health Interventions to Prevent Children Drowning

Drowning is the leading cause of death from unintended injury in children globally. Drowning is preventable, and mechanisms exist which can reduce its impact, however the peer-reviewed literature to guide public health interventions is lacking. This paper describes a protocol for a review of drowning prevention interventions for children. Electronic searching will identify relevant peer-reviewed literature describing interventions to prevent child drowning worldwide. Outcome measures will include: drowning rates, water safety behaviour change, knowledge and/or attitude change, water safety policy and legislation, changes to environment and water safety skills. Quality appraisal and data extraction will be independently completed by two researchers using standardised forms recording descriptive and outcome data for each included article. Data analysis and presentation of results will occur after data have been extracted. This review will map the types of interventions being implemented to prevent drowning amongst children and identify gaps within the literature.

Physical activity and nutrition intervention for mothers of young children: Process evaluation

Introduction: Process evaluation of community based projects is integral to understanding the success or failure of health promotion interventions. Process evaluation was used to assess the intervention strategies and resources in a playgroup setting aimed at mothers of young children. Methods: Process evaluation data were collected from participants (n = 249) and staff (n = 25) involved in the intervention. Data included staff perspectives on use of the playgroup as a setting, participants’ views on the feasibility and acceptability of the program strategies and resources, and program reach. Results: Responding participants reported that the intervention was useful (98%) and relevant for their age group (92%), encouraged them to think about making changes to their physical activity (95%) and dietary (98%) behaviors, and helped them to make changes to their physical activity (66%) and dietary (79%) behaviors. Participants reported that the most useful intervention strategies included the program booklet (85%), workshops (86%), newsletters (73%) and SMS (57%). Conclusion: This research provides valuable information on participants’ perspectives of the program strategies, content and overall implementation. It provides insight into the feasibility and acceptability of the intervention and identifies areas for improvement when conducting programs in playgroup settings. The process evaluation indicated that playgroups are a suitable setting for health promotion targeting mothers of young children.