bluuebunny/crossref_metadata_2025 huggingface dataset:
High‐intensity interval exercise is more efficient than medium intensity exercise at inducing neurogenesis
Authors: Lambertus Marvin , Geiseler Samuel , Morland Cecilie
Published: November 2024

The neurogenic potential of the brain decreases during ageing, whereas the risk of neurodegenerative diseases and stroke rises. This creates a mismatch between the rate of neuron loss and the brain's capacity for replacement. Adult neurogenesis primarily occurs in the subgranular zone (SGZ) and the ventricular‐subventricular zone (V‐SVZ). Exercise enhances SGZ neurogenesis, and we previously showed that V‐SVZ neurogenesis is induced by exercise via activation of the lactate receptor HCA1. Here, we investigated how high‐intensity interval training (HIIT) and medium‐intensity interval training (MIIT) affect neurogenesis in these niches. Wild‐type (WT) and HCA1 knockout (KO) mice were randomized to sedentary, HIIT or MIIT (n = 5–8 per group) for 3 weeks. In the SGZ, HIIT increased the density of doublecortin (DCX)‐positive cells in WT mice by 85% (5.77±1.76 vs. 3.12±1.54 cells/100 µm, P = 0.013) and KO mice (67% increase; 7.91±2.92 vs. 4.73±1.63 cells/100 µm, P = 0.004). MIIT did not alter the density of DCX‐positive cells in either genotype. HIIT increased the density of Ki‐67‐positive cells only in KO mice (P = 0.038), whereas no differences in nestin‐positive cells were observed. In the V‐SVZ, HIIT increased the density of DCX‐positive cells in WT mice by 155% (117.79±39.72 vs. 46.25±19.96 cells/100 µm, P < 0.001) and MIIT increased the density of DCX‐positive cells by 80% (83.26±39.48 vs. 46.25±19.96 cells/100µm, P = 0.027). No exercise‐induced changes were observed in KO mice. Similar patterns were noted for Ki‐67 positive and DCX/Ki‐67 double‐positive cells in the V‐SVZ. These findings suggest that HIIT enhances neurogenesis more robustly than MIIT in both niches, with HCA1 playing a crucial role in V‐SVZ neurogenesis.

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Key points

The neurogenic potential of the brain decreases with age, whereas the risk of neurodegenerative diseases and stroke increases, highlighting a mismatch between neuronal loss and replacement capacity.

Exercise enhances neurogenesis in both the subgranular zone and the ventricular‐subventricular zone.

High‐intensity interval exercise is more effective than medium‐intensity interval exercise at promoting neurogenesis in both the subgranular zone and the ventricular‐subventricular zone of wild‐type mice.

The enhancement of neurogenesis in the ventricular‐subventricular zone is dependent on the activation of the HCA1 receptor, as evidenced by the ability of medium‐ and high‐intensity interval exercise to induce neurogenesis in wild‐type mice and the lack of this effect in HCA1 knockout mice.

By contrast, neurogenesis in the subgranular zone is independent on the activation of the HCA1 receptor, highlighting that neurogenesis in the two major neurogenic niches are regulated differently.
Spontaneous tumour lysis syndrome in chronic lymphocytic leukaemia: an unanticipated complication of an undiagnosed disease
Authors: Verma Saluja Komal , Arya Yajesh , Sukheeja Deepti , Suman Chetan Prakash
Published: November 2024

Spontaneous tumour lysis syndrome (STLS) is a rare oncological emergency characterised by the spontaneous destruction of tumour cells in the absence of chemotherapy, with the release of large amounts of intracellular ions and metabolic products leading to organ damage and at times death. In chronic lymphocytic leukaemia (CLL), historically, tumour lysis syndrome has been rarely observed owing to low rate of proliferation and slow response to chemotherapy. We report a rare case of STLS in underlying undiagnosed CLL. A man in his 60s presented with vomiting, diarrhoea, breathlessness on exertion and oliguria. Laboratory evaluation revealed a typical constellation of metabolic abnormalities; hyperuricaemia, hyperkalaemia, hyperphosphataemia and hypocalcaemia with acute kidney injury. Peripheral blood examination showed lymphocytosis with smudge cells. Flow cytometry revealed atypical B lymphoid cells positive for CD5, CD19, CD23, CD45 and CD200. Bone marrow studies and lymph node biopsy supported the diagnosis of underlying CLL which was further confirmed by fluorescent in situ hybridisation. With prompt diagnosis, intervention and intensive monitoring, the end-organ damage was successfully prevented. This case report highlights the importance of keeping high index of suspicion for STLS even without a background history of malignancy as this life-threatening condition is potentially salvageable.
Paradoxical cerebral embolism caused by patent foramen ovale in a patient with multiple endocrine neoplasia type 1 and severe primary hyperparathyroidism
Authors: Matsuda Takaaki , Osaki Yoshinori , Sekiya Motohiro , Shimano Hitoshi
Published: November 2024

A man in his late 30s with gait difficulty, dysarthria, impaired consciousness and polyuria was diagnosed with left thalamic infarction. Hypercalcaemia (3.52 mmol/L (2.15–2.52)), high intact-parathyroid hormone (i-PTH) levels (88.8 pmol/L (1.1–6.9)) and high D-dimer levels (14.7 mg/L (<1.0)) were identified, followed by a positive microbubble test on transesophageal echocardiogram, suggesting high-risk patent foramen ovale (PFO) for ischaemic stroke. Paradoxical cerebral embolism via PFO, complicated by a hypercoagulable state and hypercalcemic dehydration, was considered. Polyglandular parathyroid hyperplasia, plus radiolucent mandibular tumours, suggested multiple endocrine neoplasia type 1 (MEN1) or hyperparathyroidism-jaw tumour syndrome. Genetic testing confirmed MEN1. Treatment was 24 mg of oral evocalcet and total parathyroidectomy with forearm autotransplantation, resulting in improved serum calcium and i-PTH levels. Finally, he underwent transcatheter PFO closure. We emphasise careful, etiological pursuit in young-onset stroke and the usefulness of genetic testing in differentiating hyperparathyroidism associated with mandibular tumours.
Metabolomic signature of retinal ageing, polygenetic susceptibility, and major health outcomes
Authors: Liu Riqian , Yang Shaopeng , Zhong Xiaoying , Zhu Ziyu , Huang Wenyong , Wang Wei
Published: November 2024

Background/aims

To identify the metabolic underpinnings of retinal aging and examine how it is related to mortality and morbidity of common diseases.

Methods

The retinal age gap has been established as essential aging indicator for mortality and systemic health. We applied neural network to train the retinal age gap among the participants in UK Biobank and used nuclear magnetic resonance (NMR) to profile plasma metabolites. The metabolomic signature of retinal ageing (MSRA) was identified using an elastic network model. Multivariable Cox regressions were used to assess associations between the signature with 12 serious health conditions. The participants in Guangzhou Diabetic Eye Study (GDES) cohort were analyzed for validation.

Results

This study included 110 722 participants (mean age 56.5±8.1 years at baseline, 53.8% female), and 28 plasma metabolites associated with retinal ageing were identified. The MSRA revealed significant correlations with each 12 serious health conditions beyond traditional risk factors and genetic predispositions. Each SD increase in MSRA was linked to a 24%–76% higher risk of mortality, cardiovascular diseases, dementia and diabetes mellitus. MSRA showed dose–response relationships with risks of these diseases, with seven showing non-linear and five showing linear increases. Validation in the GDES further established the relation between retinal ageing-related metabolites and increased risks of cardiovascular and chronic kidney diseases (all p<0.05).

Conclusions

The metabolic connections between ocular and systemic health offer a novel tool for identifying individuals at high risk of premature ageing, promoting a more holistic view of human health.
Seasonal variations in peptic ulcer disease incidence in Taiwan, a country spanning both tropical and subtropical regions: a real-world database analysis
Authors: Lai Yi-Chen , Chen Yu-Han , Chen Chien-An , Ho Chung-Han , Wu Yu-Cih , Wang Jhi-Joung , Weng Shih-Feng , Kao Yuan
Published: November 2024

Objective

Previous studies have shown that the incidence of peptic ulcer disease (PUD) exhibits seasonal variations. This study aimed to investigate the seasonal variation in PUD incidence in Taiwan, which spans both tropical and subtropical regions, using a nationwide database.

Methods

A cross-sectional study was conducted using real-world claims data from Taiwan, which includes a representative sample of 2 million individuals. Patients hospitalised with a primary diagnosis of PUD between 2001 and 2019 were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for gastric ulcers (GUs), duodenal ulcers (DUs) and unspecified peptic ulcers. Descriptive statistics were used to present the seasonal variations in PUD incidence. Patients’ gender, age, PUD type, geographical region and non-steroidal anti-inflammatory drugs (NSAIDs) usage across the four seasons (spring, summer, fall, winter) were compared using Pearson’s χ2test.

Results

Among the 13 022 patients, new-onset PUD cases varied annually, peaking at 771 cases in 2004 and reaching a low of 614 cases in 2018. PUD incidence was higher in males than in females, and more common in elderly individuals aged ≥65 (59.5%). GU had the highest prevalence (56.1%), followed by DU (36.3%) and unspecified ulcers (7.7%). PUD incidence peaked in winter (26.8%), followed by spring (25.1%), fall (24.2%) and summer (23.9%). This seasonal trend was consistent across gender and age groups, with no significant impact on latitude, NSAID usage or PUD type.

Conclusion

Across the tropical and subtropical regions of Taiwan, seasonal variation in PUD incidence is observed with the highest rates occurring in winter, regardless of age or sex. However, NSAID usage tends to obscure this trend. The seasonal variation in DU incidence showed no significant differences between north and south Taiwan, suggesting that factors other than temperature may affect DU incidence compared with their effect on GU incidence.
Changes in tobacco and alcohol consumption during the COVID-19 pandemic in India: a propensity score matching approach
Authors: Summan Amit , Laxminarayan Ramanan
Published: November 2024

Objectives

The COVID-19 pandemic may have influenced alcohol and tobacco consumption in low-income and middle-income countries, yet the effects are relatively unknown. In this study, we estimated the medium-term effects of the pandemic on tobacco and alcohol consumption in India.

Methods

We used data from the fifth round of the National Family Health Survey 2019–2021, a nationally representative survey conducted between June 2019 and April 2021. We employed propensity score matching to evaluate the change in tobacco and alcohol consumption patterns by exploiting the gap in survey activities due to the pandemic lockdown—no data collection took place from April to October 2020. Individuals surveyed after the lockdown were considered COVID-19-affected, while those surveyed before were considered as unaffected.

Results

The tobacco use rate was 1.4% lower and alcohol consumption was 0.3% lower for COVID-19-affected individuals relative to non-affected individuals. By tobacco product, there was a 0.9%, 0.6% and 0.4% decrease in the use of smokeless tobacco, cigarettes and bidi, respectively. Recent initiation decreased by 2.3%, 1.6% and 1.4%, for cigarettes, smokeless tobacco and alcohol, respectively. Tobacco use declined to a greater extent in low-wealth and rural populations, and in male and older subsamples. Alcohol use decreased in urban households, and among male and young subsamples, relative to their counterparts. Secondhand smoke exposure decreased by 4.6%.

Conclusion

Tobacco and alcohol consumption, including recent initiation, decreased during the pandemic in India. Varying effects by subgroups suggest the need for targeted future control policies that support cessation and limit consumption.
Reducing family and school-based violence at scale: a large-scale pre–post study of a parenting programme delivered to families with adolescent girls in Tanzania
Authors: Lachman Jamie , Wamoyi Joyce , Martin Mackenzie , Han Qing , Calderón Alfaro Francisco Antonio , Mgunga Samwel , Nydetabura Esther , Manjengenja Nyasha , Wambura Mwita , Shenderovich Yulia
Published: November 2024

Background

Parenting programmes, including those delivered in the Global South, are effective strategies to reduce violence against children (VAC). However, there is limited evidence of their impact when implemented at scale within routine delivery systems. This study aimed to address this gap by evaluating the real-world delivery of Parenting for Lifelong Health for Teens in Tanzania.

Methods

Participating parents/caregivers and their adolescent girls were recruited by local implementing partners in 2020–2021 as part of a community-based HIV prevention initiative focused on addressing drivers of female adolescent HIV-vulnerability such as VAC, caregiver–adolescent relationships and sexual reproductive health communication. The 14-session, group-based parenting programme was delivered by trained teachers and community facilitators. Quantitative surveys administered by providers measured a variety of outcomes including child maltreatment (primary outcome) and multiple secondary outcomes linked to increased risk of VAC. Multilevel models examined pre–post effects as well as variation by attendance and baseline demographic variables.

Results

Pre–post data from 27 319 parent/caregiver–child dyads were analysed, of which 34.4% of parents/caregivers were male. Analyses showed large reductions in child maltreatment (parents/caregivers: IRR=0.55, (95% CI 0.54, 0.56); adolescents: IRR=0.57, (95% CI 0.56, 0.58)), reduced intimate partner violence experience, reduced school-based violence, increased communication about sexual health, reduced poor supervision, reduced financial insecurity, reduced parenting stress, reduced parent and adolescent depression, and reduced adolescent conduct problems. In contrast to these positive outcomes, parents/caregivers and adolescents also reported reduced parental positive involvement and support of education, with those experiencing greater adversity reporting less change than those with less adversity.

Conclusions

This study is the first to examine the large-scale implementation of an evidence-based parenting programme in the Global South. Although additional research is necessary to examine potential negative effects on positive parenting and parent support of education, findings suggest that Furaha Teens can sustain its impact on key outcomes associated with VAC when delivered at scale.
Assessing alcohol industry penetration and government safeguards: the International Alcohol Control Study
Authors: Leung June Yue Yan , Casswell Sally , Randerson Steve , Athauda Lathika , Banavaram Arvind , Callinan Sarah , Campbell Orfhlaith , Chaiyasong Surasak , Dearak Song , Dumbili Emeka W , Romero-García Laura , Gururaj Gopalkrishna , Kalapat Romtawan , Karki Khem , Karlsson Thomas , Kong Mom , Liu Shiwei , Maldonado Vargas Norman Danilo , Gonzalez-Mejía Juan Felipe , Naimi Timothy , Nthomang Keitseope , Oladunni Opeyemi , Owino Kwame , Herrera Palacio Juan Camilo , Phatchana Phasith , Pradhan Pranil Man Singh , Rossow Ingeborg , Shorter Gillian , Sibounheuang Vanlounny , Štelemėkas Mindaugas , Son Dao The , Vallance Kate , van Dalen Wim , Wettlaufer Ashley , Zamora Arianne , Jankhotkaew Jintana
Published: November 2024

Background

The alcohol industry uses many of the tobacco industry’s strategies to influence policy-making, yet unlike the Framework Convention on Tobacco Control, there is no intergovernmental guidance on protecting policies from alcohol industry influence. Systematic assessment of alcohol industry penetration and government safeguards is also lacking. Here, we aimed to identify the nature and extent of industry penetration in a cross-section of jurisdictions. Using these data, we suggested ways to protect alcohol policies and policy-makers from undue industry influence.

Methods

As part of the International Alcohol Control Study, researchers from 24 jurisdictions documented whether 22 indicators of alcohol industry penetration and government safeguards were present or absent in their location. Several sources of publicly available information were used, such as government or alcohol industry reports, websites, media releases, news articles and research articles. We summarised the responses quantitatively by indicator and jurisdiction. We also extracted examples provided of industry penetration and government safeguards.

Results

There were high levels of alcohol industry penetration overall. Notably, all jurisdictions reported the presence of transnational alcohol corporations, and most (63%) reported government officials or politicians having held industry roles. There were multiple examples of government partnerships or agreements with the alcohol industry as corporate social responsibility activities, and government incentives for the industry in the early COVID-19 pandemic. In contrast, government safeguards against alcohol industry influence were limited, with only the Philippines reporting a policy to restrict government interactions with the alcohol industry. It was challenging to obtain publicly available information on multiple indicators of alcohol industry penetration.

Conclusion

Governments need to put in place stronger measures to protect policies from alcohol industry influence, including restricting interactions and partnerships with the alcohol industry, limiting political contributions and enhancing transparency. Data collection can be improved by measuring these government safeguards in future studies.
Factors influencing the implementation of food fortification regulation among small and medium-scale corn millers in Dar es Salaam Tanzania: a qualitative study
Authors: Lema Dorice C , Mahiti Gladys Reuben , Sunguya Bruno F
Published: November 2024

Objective

The study aimed to explore factors influencing the implementation of food fortification regulation among corn millers in Dar es Salaam Tanzania.

Methods

This phenomenological qualitative study was conducted in Dar es Salaam, Tanzania among purposely interviewed corn millers. In-depth interviews conducted with nine corn millers were analysed using thematic analysis with the aid of N-Vivo software version 12.

Results

The implementation of food fortification regulation among corn millers is influenced by access to knowledge and the right information, lack of consumers’ awareness, zero costs for the fortification of corn flour, and lack of punitive measures for non-compliance to the regulation.

Conclusion and recommendations

Laxity in implementing food fortification as an important population-wide approach in addressing micronutrient deficiency is evident in Tanzania. This is triggered by non-punitive measures for non-compliance of the regulation among micro, small and medium-scale corn millers. Strengthening efforts to identify and implement measures against non-compliers, demand creation for fortified products through educational and advocacy interventions, and supportive supervision can help reach more than 90% of the population with fortified corn flour in Tanzania.
Effects of smartphone-based chatbot intervention to increase influenza and COVID-19 vaccine uptake among South Asian ethnic minorities in Hong Kong: protocol for a randomised waitlist-controlled trial
Authors: Wong Cho Lee , So Winnie Kwok Wei , Chan Carmen Wing Han , Choi Kai Chow , Li Huiyuan
Published: November 2024

Introduction

Protecting non-native ethnic minority groups against cocirculation of influenza and COVID-19 is crucial, and vaccination could be a viable option. Smartphone-based chatbots offer promising opportunities for improving vaccine knowledge and addressing barriers encountered by ethnic minorities. This trial aims to evaluate the effects of smartphone-based chatbot intervention on influenza and COVID-19 vaccine uptake, intention to receive vaccination and vaccine hesitancy among South Asian ethnic minorities in Hong Kong.

Method and analysis

An assessor-blinded, cluster-randomised, waitlist-controlled trial will be conducted. This study consists of two phases. In phase I, a smartphone-based chatbot intervention will be developed, including designing a simple chatbot called ‘Ali’ to deliver prewritten educational text messages and vaccination reminders as well as respond to users’ questions, and on-demand option for communication with research assistants. An expert panel will be invited to review the designed chatbot, and pilot testing will be performed. In phase II, a total of 612 South Asians will be recruited from each of the six participating non-governmental community centres or ethnic minority associations. They will be randomly allocated to intervention (n=306) or waitlist control group (n=306). The intervention group will receive in-app notifications related to the education text messages and vaccination reminders via the smartphone-based chatbot twice a week for two weeks. The waitlist control group will receive usual care only. Evaluation will include vaccination uptake, intention to receive vaccination and vaccine hesitancy. Assessments will take place at baseline (T0), immediately postintervention (T1) and 3-month postintervention (T2).

Ethics and dissemination

This study has been approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No.: 2021.688). The findings will be disseminated in peer-reviewed journals and through local or interventional conference presentations.

Trial registration number

ChiCTR2200061503.
Impact of the active job openings-to-applicants ratio on the number of ambulance dispatches in Japan, 2003-2021: a longitudinal ecological study
Authors: Kamikawa Yohei
Published: November 2024

Objective

To examine the contribution of the active job openings-to-applicants ratio, a macroeconomic indicator, to the number of ambulance dispatches.

Design

Longitudinal ecological study.

Setting

Japan, between January 2003 and December 2021.

Participants

All ambulance dispatches.

Primary and secondary outcome measures

The contribution of the active job openings-to-applicants ratio in a month, adjusted by the number of older people, mean temperature and total population, to the number of ambulance dispatches in that specific month was examined and the primary model was compared to the conventional model considering only the older population, mean temperature, and total population.

Results

There were 108 724 969 ambulance dispatches during this period. The active job openings-to-applicants ratio was significantly associated with the number of ambulance dispatches (the increase rate of monthly ambulance dispatches for 1% rise in the active job openings-to-applicants ratio, 1.00082; 95% CI 1.00052 to 1.00112). Additionally, the primary model effectively demonstrated better fitness to the actual trend than the conventional model (the quasi-likelihood under the independence model criteria were −2 626 817 720 and −2 626 775 185, respectively).

Conclusions

The number of ambulance dispatches was correlated with the active job openings-to-applicants ratio. Macroeconomic perspectives may be needed to address the issue of increasing ambulance dispatches.
Evaluating the effectiveness of the Smart About Meds (SAM) mobile application among patients discharged from hospital: protocol of a randomised controlled trial
Authors: Tamblyn Robyn , Habib Bettina , Buckeridge David L , Weir Daniala L , Frolova Elizaveta , Alattar Rolan , Rogozinsky Jessica , Beauchamp Caroline , Pupo Rosalba , Bartlett Susan J , McDonald Emily
Published: November 2024

Introduction

Almost half of patients discharged from hospital are readmitted or return to the emergency department (ED) within 90 days. Non-adherence to medication changes made during hospitalisation and the use of potentially inappropriate medications (PIMs) both contribute to postdischarge adverse events. We developed Smart About Meds (SAM), a patient-centred mobile application that targets medication non-adherence and PIMs use. This protocol describes a randomised controlled trial (RCT) to evaluate SAM.

Methods and analysis

A pragmatic, stratified RCT will evaluate SAM among 3250 adult patients discharged from hospital. At discharge, consenting participants will be randomised 1:1 to usual care or SAM. SAM integrates novel patient-centred features with pharmacist monitoring to manage non-adherence to new medication regimens. SAM also notifies patients of PIMs in their regimen, with advice to discuss with their physician.

Following discharge, patients will be followed for 90 days to measure the primary composite outcome of ED visits, hospital readmissions and death. Secondary outcomes will include primary adherence to medication changes, secondary adherence to disease-modifying medications, patient empowerment and health-related quality of life.

The primary outcome will be analysed according to intention-to-treat. Multivariable logistic regression will estimate differences between treatment groups in the proportion of patients experiencing the primary outcome and will assess modification of intervention effects by hospital, unit, age, sex and comorbidity burden. With a sample size of 3250, the study will have 80% power to detect a 5% absolute reduction in the primary outcome. Binary and continuous secondary outcomes will be assessed using multivariable logistic and linear regression, respectively.

Ethics and dissemination

The Research Ethics Board of the McGill University Health Centre in Montréal, Canada has approved this study. Results will be submitted for publication in a peer-reviewed journal and presented at scientific conferences. If effective, SAM will be made available in app stores.

Trial registration number

NCT05371548.
Qualitative exploration of awareness about risk factors and transformative behaviours among Pakistani patients with coronary artery disease
Authors: Barolia Rubina , Yaqoob Adnan , Ladak Laila , Khan Aamir Hameed , Pannu Furqan Yaqub
Published: November 2024

Objectives

To explore patients’ awareness of risk factors for coronary artery disease (CAD) and experiences of the behavioural modifications, they made during their recovery through in-depth semistructured interviews.

Design

Qualitative exploration was undertaken as part of a larger project to answer the study questions.

Setting

Participants were recruited from a public-sector tertiary care hospital in Lahore Pakistan.

Participants

A total of 20 participants, men and women, who had more than 6 months of experience living with CAD, were recruited using a purposive sampling technique.

Results

The data were organised and analysed using NVIVO software. An inductive coding approach was used to generate codes, categories and themes. Three themes emerged from participants’ data: lifestyle choices and behavioural factors, reflective awareness and lifestyle changes, holistic perspectives and health management.

Conclusions

The present study’s findings align with recent literature, emphasising the complex nature of risk factors contributing to heart disease. The participants’ understanding and behavioural changes show the importance of health awareness and preventive measures in reducing cardiovascular risks.
Qualitative study exploring reintegration of clinical trial participants with HIV to public health services in Johannesburg, South Africa
Authors: Nxumalo Sibongiseni Thandazani , Harris Bernice , Napoles Lizeka , Oladimeji Kelechi Elizabeth , Lalla-Edward Samanta Tresha
Published: November 2024

Objective

People living with HIV (PLHIV) are often recruited from primary healthcare clinics (PHC) into clinical trials. On trial completion, they are transferred back to the facility for continued care and support in managing their condition, potentially leading to better health outcomes. Because transferring PLHIV back to PHCs post-clinical trials may result in decreased access to specialised care or resources that were available during the trial, this study explored insights into challenges faced during reintegration from clinical trial settings into PHCs and antiretroviral therapy (ART) adherence post-clinical trials.

Design

This cross-sectional study was conducted using a qualitative research approach. Participants were recruited using purposive sampling.

Setting

The study was conducted at the Ezintsha Research Centre in Johannesburg, South Africa, between November 2022 and February 2023.

Participants

The study population consisted of PLHIV who had participated in two clinical trials (DORA and ADVANCE) at the Ezintsha Research Centre in Johannesburg, South Africa.

Methods

Using a semistructured guide, 12 in-depth interviews were conducted with PLHIV until data saturation was reached. Data were then transcribed verbatim and analysed thematically with MAXQDA software.

Results

The majority (n=8, 67%) of participants were female, and the average age of all participants was 40 (SD 7.2) years. Two main themes emerged: reintegration from clinical trials to public healthcare and barriers to ART adherence. These themes were further separated into seven subthemes, namely, negative attitude of healthcare workers, poor healthcare service delivery, poor communication to patients, waiting time at healthcare facilities, lack of privacy and confidentiality, mistakes in ART dispensing and bad reception at facilities post-clinical trials.

Conclusion

Clinical trial sites should cultivate better stakeholder engagement with PHCs to facilitate a smoother transition of research participants, especially PLHIV, back into public healthcare for continued care.
Perspectives from clinicians from different levels of care in Maputo, Mozambique: qualitative study of the barriers to and facilitators of paediatric injury care in resource-poor hospital settings
Authors: Amado Vanda , Zandamela Americo , Couto Maria Tereza , Wallis Lee A , Laflamme Lucie
Published: November 2024

Objectives

Providing care for injured children is challenging in resource-poor settings. While checklists can assess local capacities and guide the setting of priorities for improvement, key insights can be gained from consultation with locally practising clinicians. This study aimed to highlight barriers to and facilitators of the delivery of paediatric injury care experienced by clinicians from hospitals at different levels of care in Maputo, Mozambique.

Design

We conducted semistructured individual qualitative interviews with clinical staff at four hospitals. Data were analysed using inductive content analysis.

Setting

The study was conducted in four hospitals, each representing a specific level of care in Maputo, Mozambique.

Participants

We recruited clinicians (doctors, nurses and technicians) involved in paediatric injury care to be interviewed on-site (we target around 10 clinicians per hospital).

Results

From the 40 interviews conducted, four categories of barriers emerged: (1) prehospital care constraints, (2) shortage of child-appropriate resources, (3) inappropriate infrastructure for paediatric emergency care and (4) limited qualified staff available. By contrast, one category of facilitators stood out, namely that of cross-boundaries support and mentorship, between professionals and institutions.

Conclusion

From clinicians’ perspective, barriers to paediatric injury care are often similar across hospitals and professional groups, and they include the prehospital setting. Resource and infrastructure challenges were emphasized, as expected, and clinicians expressed a clear desire for knowledge and competence sharing.
Lived Experiences of Conscious Intubated Patients in the Intensive Care Units: A Qualitative Phenomenological Study in Iran
Authors: Nasiri Elhameh , Dashti Seemin , Karimollahi Mansoureh , Alefbaei Akram , Aghamohamamadi Delshad , Shahmari Mehraban
Published: November 2024

Objective

Mechanically ventilated patients experience significant suffering in intensive care units (ICUs). Recognising and understanding these patients’ distressing experiences can greatly improve the quality of care provided. This study aims to explore the lived experiences of conscious intubated patients in ICUs in Iran.

Design

A qualitative study was conducted using an interpretative phenomenological approach. In-depth interviews served as the primary means of data collection. Subsequently, the collected data was analysed using the method of Diekelmannet al(1989).

Setting

The study was conducted in the ICU.

Participants

A purposive method was employed to select 13 patients who underwent conscious intubation for over 24 hours.

Results

Three main themes and seven subthemes emerged from the data analysis of the lived experience: (1) interpersonal discourse complexity (semantic misalignment and others’ impressionability), (2) sensory disquietude (pharyngeal discomfort, thirst beyond the quench and disgust with oral hygiene) and (3) resilient adaptation (emotional responses and coping strategies).

Conclusions

The findings of the lived experiences reveal a nuanced understanding of the intricate interplay between communication barriers, sensory discomfort and the adaptive capacities of conscious intubated patients in the ICU. This comprehensive analysis contributes to a deeper appreciation of their multifaceted experiences.
Evaluating the feasibility and attitudes towards SARS-CoV-2 self-testing in a rural population in Zimbabwe: a cross-sectional survey
Authors: Pfavayi Lorraine Tsitsi , Choto Emilia , Tagwireyi Paradzayi , Mduluza Takafira , Mutapi Francisca
Published: November 2024

Objectives

The widespread adoption of self-testing for SARS-CoV-2 has proven effective in curbing the virus’ spread, particularly in Western countries. However, significant knowledge gaps persist regarding the feasibility, acceptance and factors influencing the uptake of self-testing in low-resource areas, notably rural Africa. Our aim was to assess the willingness and capability of rural Zimbabwean participants to self-diagnose COVID-19 using rapid lateral flow tests (LFTs) and adhere to post-positive test guidelines. Additionally, we aimed to identify barriers to self-testing uptake and reasons for non-compliance with follow-up actions.

Design and setting

We conducted a cross-sectional survey in Shamva District, Zimbabwe.

Participants

A total of 120 villagers aged 18 years and above participated. We employed a questionnaire to gather data on participants' attitudes towards self-testing for SARS-CoV-2 using LFTs, along with their knowledge, attitudes and practices regarding COVID-19.Primary outcomesincluded the likelihood of self-testing, the ability and accuracy of self-testing, adherence to post-test guidelines and socio-demographic factors influencing these responses.

Results

Among the 120 participants, 108 (90%) expressed willingness to use LFTs for self-testing. The subset unwilling to self-test belonged to a religious sect historically opposed to Western medicine. All self-tests yielded valid results, as confirmed by the appearance of control lines on the LFT. Participants demonstrated the ability to interpret their results accurately without assistance and expressed willingness to adhere to post-test guidelines. Questionnaire responses indicated a preference for self-testing due to its ease, lack of pain, convenience and confidentiality. Moreover, participants exhibited a high level of knowledge about COVID-19.

Conclusion

This study underscores the acceptability and feasibility of SARS-CoV-2 LFT self-testing in rural settings, suggesting its potential as an additional public health measure for epidemics and pandemics in low-resource areas.
Does intermittent nutrition enterally normalise hormonal and metabolic responses to feeding in critically ill adults? A protocol for the DINE-Normal proof-of-concept randomised parallel-group study
Authors: Beattie Clodagh Emer , Thomas Matt , Borislavova Borislava , Smith Harry A , Ambler Michael , White Paul , Hayes Kati , Milne Danielle , Ramesh Aravind V , Gonzalez Javier T , Betts James A , Pickering Anthony E
Published: November 2024

Introduction

Over half of patients who spend >48 hours in the intensive care unit (ICU) are fed via a nasogastric (NG) tube. Current guidance recommends continuous delivery of feed throughout the day and night. Emerging evidence from healthy human studies shows that NG feeding in an intermittent pattern (rather than continuous) promotes phasic hormonal, digestive and metabolic responses that are important for effective nutrition. It is not yet known whether this will translate to the critically ill population. Here, we present the protocol for a proof-of-concept study comparing diurnal intermittent vs continuous feeding on hormonal and metabolic outcomes for patients in the ICU.

Methods and analysis

The study is a single-centre, prospective, randomised, open-label trial comparing intermittent enteral nutrition with the current standard practice of continuous enteral feeding. It aims to recruit participants (n=30) needing enteral nutrition via an NG tube for >24 hours who will be randomised to a diurnal intermittent or a continuous feeding regimen with equivalent nutritional value. The primary outcome is peak plasma insulin/c-peptide within 3 hours of delivering the morning intermittent feed on the second study day, compared with that seen in the continuous feed delivery group at the same time point. Secondary outcomes include feasibility, tolerability, efficacy and metabolic/hormonal profiles.

Ethics and dissemination

We obtained ethical approval from the Wales Research Ethics Committee 3 prior to data collection (reference 23/WA/0297). We will publish the results of this study in an open-access peer-reviewed journal.

Trial registration number

NCT06115044.
OPTI-HEP-D: a protocol for an intervention study comprising screening and linkage to care of people living with hepatitis D in Catalonia
Authors: Palom Adriana , Rando-Segura Ariadna , Fernandez Gema , Calatayud Laura , Sellés-Sánchez Alicia , Pérez del Campo Dúnia , Mormeneo Bayo Saray , Perez Moreno Maria Mar Olga , Tabernero David , Ayats Josefina , Llopis Maria Antonia , Quer Juan Carlos , Buti Maria
Published: November 2024

Introduction

Hepatitis B virus (HBV) affects 296 million people globally, causing 780 000 annual deaths. It has been estimated that 12–43 million individuals are co-infected with hepatitis D virus (HDV). In Spain, the prevalence of HBsAg in adults is 0.22%, with an anti-HDV prevalence of 7.7%, although not extensively documented since many HBsAg-positive cases are not tested for anti-HDV. The primary objective of this project is to optimise hepatitis D care by implementing a screening programme for anti-HDV in all HBsAg-positive individuals over a 1 year period in Catalonia. Secondary objectives include evaluating hepatitis D prevalence, establishing a digital registry for all anti-HDV positive cases, testing them for HDV-RNA in a centralised laboratory and offering linkage to care.

Methods and analysis

This prospective study will be performed in seven hospital centres in Catalonia, which attend to more than 95% of the adult population. Approximately, 9290 HBsAg-positive individuals are expected to be screened for anti-HDV in 1 year. All anti-HDV positive samples will be sent to a centralised laboratory for HDV-RNA quantification. All individuals testing positive for anti-HDV will be registered on an electronic platform and linked to care. The registry will collect data on demographics, infection stage, risk factors, disease awareness and previous diagnoses. No additional interventions will be conducted for those with adequate follow-up.

Ethics and dissemination

The Vall d’Hebron Hospital Ethics Committee (PR(AG)628/2023) and the Spanish Agency of Medicines and Medical Devices approved this study. These findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration study

Grant number: IN-ES-980–7058.
Development of the Ontario Hereditary Cancer Research Network, a unified registry as a resource for individuals with inherited cancer syndromes: an observational registry creation protocol
Authors: Farncombe Kirsten M , Hughes Lauren K , Tuzlali Elif , Akbari Mohammad Reza , Andrulis Irene L , Aronson Melyssa , Bell Kathleen , Brazas Michelle D , Cable-Cibula Melissa , Chan Brandon , Courtot Melanie , Feilotter Harriet , Harland Jamie , Lark Katie , Lerner-Ellis Jordan , MacDougall Ellen , Malkin David , Narod Steven A , Panabaker Karen , Radvanyi Laszlo , Rusnak Alison , Stein Lincoln , Kim Raymond H
Published: November 2024

Introduction

In Canada, care for individuals with hereditary cancer is fragmented across the provinces and territories, with carriers of pathogenic variants in cancer-susceptibility genes seeing multiple doctors and often advocating for their own management plans. The need for a national registry of carriers has been well established. While other cancer consortia exist, barriers in clinical and genomic data sharing limit the utility of the information gathered.

Methods and analysis

Within the province of Ontario, the Ontario Hereditary Cancer Research Network (OHCRN), funded by and located at the Ontario Institute for Cancer Research, is being developed to fill this gap. The registry will hold clinical, genomic and self-reported data from consented carriers and will make this data available to qualified researchers in anonymised and aggregated form. Individuals must agree to certain components to participate in OHCRN; there are also optional consents participants can agree to without impacting their involvement in OHCRN. We plan to open the registry for participant enrolment in mid-2025.

Ethics and dissemination

Ethics approval for registry creation was obtained from the Ontario Cancer Research Ethics Board, a centralised body that streamlines reviews for cancer research studies in Ontario. Registry data will be disseminated to participants and researchers as aggregate data through the OHCRN website and presented at scientific conferences, made available to Ontario Health (Cancer Care Ontario) to inform policy and evidence-based practice, as well as be available to the scientific community for further analysis and answering relevant questions.
Exploring the influence of nurses’ demographics and hospital work environment on medical error reporting practices in Jordan: a cross-sectional study
Authors: Dalky Ala’a , Oweidat Islam Ali , Abuzaid Sajeda Ramadan , Khalifeh Anas Husam , AlBashtawy Mohammed
Published: November 2024

Objective

Nurses have a significant role in maintaining patient and healthcare safety. Thus, healthcare administrators should focus on nurse performance and create a friendly hospital work environment to ensure patient safety and healthcare quality. Limited studies have investigated the impact of nurses’ demographics on nurses’ error reporting practices and nurses’ perceptions of the hospital work environment, especially in Jordan. This study aims to investigate the factors influencing nurses’ medical error reporting practices in Jordan, specifically focusing on the role of nurses’ demographics and the hospital work environment.

Design:This is a descriptive cross-sectional study.

Setting

Data collection was done in three hospitals (public, university-affiliated and private) in Jordan, using surveys that included demographics, the incident reporting practice scale and the Practice Environment Scale-Nursing Work Index from 11 June 2023 to 13 August 2023.

Participants

350 nurses with a diploma, associate degree, bachelor’s degree or postgraduate degree had worked at the targeted hospitals for at least 6 months and were responsible for direct inpatient care.

Primary outcome measure

The level of medical error reporting practices and the nursing work environment. Also, differences were assessed among demographic characteristics and investigated the factors for medical error reporting practices.

Results

Jordanian nurses had low medical error reporting practices (M=2.34; SD=0.57) and nursing work environment (M=2.4; SD=0.56). Nurses who were single and in private hospitals had higher medical error reporting practices (p<0.05). Medical error reporting practices positively correlated with the nursing work environment (r=0.807, p<0.01) and negatively correlated with the average number of patients per shift (r=−0.109, p<0.05). The nursing work environment was a significant predictor, with an 81.0% variance in medical error reporting practices.

Conclusions

The study found that Jordanian nurses have low perceptions of their work environment and medical error reporting practices, which are influenced by marital status and hospital type. Enhancing the nurse work environment and providing ongoing standards training are critical for improving safety behaviours, patient outcomes and care quality. Future research should investigate the long-term consequences of interventions on reporting practices and patient outcomes.
Impact of suspected preterm labour in foetal cardiovascular and metabolic programming: a prospective cohort study protocol
Authors: Abadía-Cuchí Natalia , Clavero-Adell Marcos , González Jesús , Medel-Martinez Ana , Fabre Marta , Ayerza-Casas Ariadna , Youssef Lina , Lerma-Irureta Juan , Maestro-Quibus Pilar , Rodriguez-Calvo Jesús , Ruiz-Martinez Sara , Lerma Diego , Schoorlemmer Jon , Oros Daniel , Paules Cristina
Published: November 2024

Introduction

Suspected preterm labour (SPL) is an obstetric complication that occurs in 9% of all pregnancies and is the leading cause of antenatal hospital admissions. More than half of women with SPL deliver a premature baby which is a known risk factor for developing cardiovascular and metabolic disorders in childhood and later in adult life. On the other hand, the other half of these women will deliver at term, labelled as ‘false preterm labour’. Although this has been thought to be a benign condition, accumulating evidence reported in recent years showed long-term effects for the foetus, neonate and infant even when birth occurs at term. However, the impact of SPL on cardiovascular and metabolic programming has not been studied yet. The aim of this prospective cohort study is to evaluate the impact of SPL on cardiac remodelling and function and on cardiovascular and metabolic profiles independently of gestational age at birth.

Methods and analysis

Prospective cohort study of subjects exposed and not exposed to an episode of SPL. Women with singleton pregnancies who are admitted at a tertiary hospital due to SPL and matched controls will be recruited. Evaluation of cardiovascular remodelling by foetal echocardiography will be performed during admission. Cord blood will be collected at birth in order to analyse different metabolomic footprints and several cardiovascular and metabolic risk biomarkers. Moreover, children will undergo an echocardiography 6 months after birth. The relationship between SPL and cardiovascular and metabolic programming will be modelled considering different covariates such as socioeconomic factors, perinatal characteristics, lifestyle, diet and exercise.

Ethics and dissemination

Ethical approval was granted in April 2020 from CEIC Aragón (CEICA) (C.P.-C.I. PI20/136). Study outcomes will be disseminated at international conferences and published in peer-reviewed scientific journals.

Trial registration number

NCT05670665.