bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity assessment of the POLARS score tool in the prediction of post rectal cancer surgery LARS score in a population-based Swedish cohort
Authors: Rethy Boglarka , Nordenvall Caroline , Pieniowski Emil , Jansson-Palmer Gabriella , Johar Asif , Lagergren Pernilla , Abraham-Nordling Mirna
Published: January 2024

Objective

Low anterior resection syndrome (LARS) is one of the most common functional impairments after rectal cancer surgery with a high impact on quality of life. The Pre-Operative LARS score (POLARS) nomogram and its online tool has been developed to predict the degree of postoperative LARS. The aim of this study was to analyse how accurately the POLARS score could predict LARS scores when compared with actual patient-reported LARS (PR-LARS) scores in a population-based Swedish cohort.

Design

This retrospective cohort study included patients who underwent curative rectal cancer surgery between 2007 and 2013 in Stockholm County and were identified using the Swedish Colorectal Cancer Registry (SCRCR). Information regarding preoperative risk factors, patient and treatment characteristics, and presence of LARS postoperatively were collected from patient charts, SCRCR and patient questionnaires. The POLARS model formula was used to predict LARS scores, which then were compared with the actual PR-LARS scores. Individual LARS score differences between the two estimates were shown with a modified Bland-Altman plot of difference.

Results

The cohort included 477 patients, of whom 359 (75%) of patients were categorised as having no/minor LARS based on the POLARS score. The correctly identified patients by the POLARS score were 80/255 (31%) in the major LARS group and 184/222 (83%) no/minor LARS group. The sensitivity was 31% for major LARS and the positive predictive value was 68%.

Conclusion

The POLARS score has a low sensitivity for major LARS in this Swedish cohort. Other methods to predict the risk of LARS need to be developed.
Convergence of HIV and non-communicable disease epidemics: geospatial mapping of the unmet health needs in an HIV hyperendemic community in South Africa
Authors: Cuadros Diego F , Devi Chayanika , Singh Urisha , Olivier Stephen , Castle Alison C , Moosa Yumna , Edwards Johnathan A , Kim Hae-Young , Siedner Mark J , Wong Emily B , Tanser Frank
Published: January 2024

Introduction

As people living with HIV (PLHIV) are experiencing longer survival, the co-occurrence of HIV and non-communicable diseases has become a public health priority. In response to this emerging challenge, we aimed to characterise the spatial structure of convergence of chronic health conditions in an HIV hyperendemic community in KwaZulu-Natal, South Africa.

Methods

In this cross-sectional study, we used data from a comprehensive population-based disease survey conducted in KwaZulu-Natal, South Africa, which collected data on HIV, diabetes and hypertension. We implemented a novel health needs scale to categorise participants as: diagnosed and well-controlled (Needs Score 1), diagnosed and suboptimally controlled (Score 2), diagnosed but not engaged in care (Score 3) or undiagnosed and uncontrolled (Score 4). Scores 2–4 were indicative of unmet health needs. We explored the geospatial structure of unmet health needs using different spatial clustering methods.

Results

The analytical sample comprised 18 041 individuals. We observed a similar spatial structure for HIV among those with combined needs Score 2–3 (diagnosed but uncontrolled) and Score 4 (undiagnosed and uncontrolled), with most PLHIV with unmet needs clustered in the southern urban and peri-urban areas. Conversely, a high prevalence of need Scores 2 and 3 for diabetes and hypertension was mostly distributed in the more rural central and northern part of the surveillance area. A high prevalence of need Score 4 for diabetes and hypertension was mostly distributed in the rural southern part of the surveillance area. Multivariate clustering analysis revealed a significant overlap of all three diseases in individuals with undiagnosed and uncontrolled diseases (unmet needs Score 4) in the southern part of the catchment area.

Conclusions

In an HIV hyperendemic community in South Africa, areas with the highest needs for PLHIV with undiagnosed and uncontrolled disease are also areas with the highest burden of unmet needs for other chronic health conditions, such as diabetes and hypertension. Our study has revealed remarkable differences in the distribution of health needs across the rural to urban continuum even within this relatively small study site. The identification and prioritisation of geographically clustered vulnerable communities with unmet health needs for both HIV and non-communicable diseases provide a basis for policy and implementation strategies to target communities with the highest health needs.
Establishing cost-effectiveness threshold in China: a community survey of willingness to pay for a healthy life year
Authors: Xu Lizheng , Chen Mingsheng , Angell Blake , Jiang Yawen , Howard Kirsten , Jan Stephen , Si Lei
Published: January 2024

Introduction

The willingness to pay per quality-adjusted life year gained (WTP/Q) is commonly used to determine whether an intervention is cost-effective in health technology assessment. This study aimed to evaluate the WTP/Q for different disease scenarios in a Chinese population.

Methods

The study employed a quadruple-bounded dichotomous choice contingent valuation method to estimate the WTP/Q in the general public. The estimation was conducted across chronic, terminal and rare disease scenarios. Face-to-face interviews were conducted in a Chinese general population recruited from Jiangsu province using a convenience sampling method. Interval regression analysis was performed to determine the relationship between respondents’ demographic and socioeconomic conditions and WTP/Q. Sensitivity analyses of removing protest responses and open question analyses were conducted.

Results

A total of 896 individuals participated in the study. The WTP/Q thresholds were 128 000 Chinese renminbi (RMB) ($36 364) for chronic diseases, 149 500 RMB ($42 472) for rare diseases and 140 800 RMB ($40 000) for terminal diseases, equivalent to 1.76, 2.06 and 1.94 times the gross domestic product per capita in China, respectively. The starting bid value had a positive influence on participants’ WTP/Q. Additionally, residing in an urban area (p<0.01), and higher household expenditure (p<0.01), educational attainment (p<0.02) and quality of life (p<0.02) were significantly associated with higher WTP/Q. Sensitivity analyses demonstrated the robustness of the results.

Conclusion

This study implies that tailored or varied rather than a single cost-effectiveness threshold could better reflect community preferences for the value of a healthy year. Our estimates hold significance in informing reimbursement decision-making in health technology assessment in China.
A hybrid effectiveness-implementation trial of application-based tiered care (Mom’s Good Mood) in treating perinatal anxiety within a primary health care system in China
Authors: Zhu Beibei , Hou Yanyan , Yu Xiayan , Jiang Minmin , Lu Mengjuan , Shang Mengqing , Zhen Hualong , Gu Yue , Li Haiyan , Tao Fangbiao
Published: January 2024

Introduction

Perinatal anxiety (PNA) is a major public health concern.

Methods

A hybrid effectiveness-implementation trial was conducted in two antenatal clinics in Hefei, China, to assess the effectiveness and cost-effectiveness of application-based tiered care (Mom’s Good Mood, MGM) in treating PNA and to understand how well it fits into routine practices. Pregnant women who scored at least 5 points on the 7-Item Generalised Anxiety Disorder Scale (GAD-7) scale were successively assigned to the control group or the intervention group, which were given the usual care and MGM on usual care, respectively. At 6 months post partum, anxiety, depression and life satisfaction were assessed. Intention-to-treat analysis and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework were adopted.

Results

A total of 214 women were assigned to the control group and 341 to the intervention group. The mean changes in GAD-7 scores (Least-squares means, LSM, −1.42, 95% CI −2.18 to −0.66) and the risk of anxiety (adjusted odds ratio, aOR 0.30, 95% CI 0.18 to 0.51) were decreased, and the anxiety remission rate (aOR 2.72, 95% CI 1.69 to 4.40) were improved in the intervention group. Similar findings were observed regarding the change in Edinburgh Postnatal Depression Scale scores (LS −1.92, 95% CI −2.85 to −0.99), depression remission rate (aOR 2.24, 95% CI 1.39 to 3.63) and the risk of depression (aOR 0.57, 95% CI 0.33 to 0.98). MGM only costs ¥1.88 (US$0.27) per pregnant woman to boost the postpartum anxiety remission rate by 1% and was revealed to have a high reach rate of 78.3%, an adoption rate of 51.3%–80.8%.

Conclusion

MGM is a cost-effective and accessible tool in coping with PNA.

Trial registration number

ChiCTR2100053419.
Institutional leadership afterDobbs: a mixed methods analysis of US medical schools' public statements regarding abortion
Authors: McNeilly Sarah M , Kim Vivian E , Conroy Carmen , Danvers Antoinette
Published: January 2024

Introduction

Medical schools, as significant and influential organisations within their communities, have the potential and the capacity to impact abortion policy. Organisations often engage in advocacy by issuing public statements that clarify their stance on specific policies. This study analyses the quantity and quality of publicly discoverable statements that US medical schools issued regardingDobbs v Jackson Women’s Health Organization.

Methods

We conducted a mixed methods study using an explanatory sequential design. Using qualitative analysis, an inductive thematic approach was used to identify themes from public statements made within 6 months of 2 May 2022,Dobbsleak. Descriptive statistics and logistic regression analysis were used to assess the association between themes and institutional characteristics.

Results

Most institutions (n=124/188, 65.96%) did not issue public statements regardingDobbs. Among all 188 US medical schools, allopathic institutions (OR=12.19, 95% CI (2.83 to 52.57), p=0.001), schools in protective states (OR=3.35, 95% CI (1.78 to 6.29), p<0.0001) and those with family planning divisions (OR=4.60, 95% CI (2.33 to 9.08), p<0.0001) were at increased odds of issuing statements. Of the 64 medical schools with statements, 64.06% (n=41/64) espoused pro-choice views, 34.37% (n=22) were neutral/non-committal and 1.56% (n=1) expressed antiabortion views. Those in protective states were at 3.35 times increased odds of issuing pro-choice statements (95% CI (1.16 to 9.72), p=0.03) compared with restrictive counterparts.

Conclusion

Medical schools largely did not take a public stance onDobbs. By refraining from actively engaging in this critical discourse, medical schools are foregoing a leadership opportunity to affect meaningful sociopolitical change, particularly in states with restrictive abortion laws.
Colonisation and its aftermath: reimagining global surgery
Authors: Qin Rennie , Alayande Barnabas , Okolo Isioma , Khanyola Judy , Jumbam Desmond Tanko , Koea Jonathan , Boatin Adeline A , Lugobe Henry Mark , Bump Jesse
Published: January 2024

Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession (‘non-specialists’, non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.
Mentorship as an overlooked dimension of research capacity strengthening: how to embed value-driven practices in global health
Authors: Bonaconsa Candice , Nampoothiri Vrinda , Mbamalu Oluchi , Dlamini Sipho , Surendran Surya , Singh Sanjeev K , Ahmad Raheelah , Holmes Alison , Rasheed Muneera A , Mendelson Marc , Charani Esmita
Published: January 2024

Mentorship in global health remains an overlooked dimension of research partnerships. Commitment to effective mentorship models requires value-driven approaches. This includes having an understanding of (1) what mentorship means across different cultural and hierarchical boundaries in the health research environment, and (2) addressing entrenched power asymmetries across different aspects including funding, leadership, data and outputs, and capacity strengthening. Existing guidance towards equity and sustainability fails to inform how to navigate complex relationships which hinder effective mentorship models. We focus this perspective piece on human capacity strengthening in research partnerships through mentorship. Using a case study of a research partnership, we describe the lessons learnt and the challenges faced in the mentor mentee relationship while maintaining an effective and sustainable partnership. Human capacity strengthening must research projects and collaborations, and recognise local leadership and ownership. To be transformative and effective, practices need to be driven by common values across research teams.
What is the impact of healthcare innovation on measurable outcomes of healthcare organisation performance? A systematic review
Authors: Madden Caoimhe , O'Malley Róisín , O'Dowd Emily , O'Connor Paul , Lydon Sinéad , Gormly Jared , Byrne Dara
Published: January 2024

Objective

The lack of quantitative evidence of effectiveness has been cited as a notable shortcoming of initiation and diffusion of innovations in healthcare. Therefore, this review aimed to synthesise research assessing the impact of healthcare innovations on measurable outcomes of healthcare organisation performance.

Design

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources

Systematic searches were conducted across three electronic databases, namely MEDLINE, CINAHL and PsycINFO.

Eligibility criteria for selecting studies

Articles were required to: (a) be published in an English-language, peer-reviewed journal since 2000; (b) describe the application of a specific innovation within a secondary healthcare setting; (c) report data on the summative evaluation of the impact of the innovation on healthcare outcomes, using an outcome measure in line with Level Four of Kirkpatrick’s Evaluation Hierarchy (ie, a measure of organisation performance) and (d) consist of a research design that allowed for evaluation of innovation impact on outcome measures by means of a comparator.

Results

Innovations targeting organisational change were most commonly implemented. Innovations generally had a positive impact, evident in almost two-thirds of the outcome measures assessed across the included articles. Innovation impact was predominantly measured via health utilisation metrics and medical-clinical indicators, with safety outcomes and patient/family perceptions less frequently assessed.

Conclusion

There is evidence to show that innovations result in discernible change in organisational importance, including on important metrics such as finance and healthcare utilisation. Bundling outcome measures are recommended to provide a more complete picture of the true impact of innovation on healthcare organisation performance.
Exploratory study to assess the functional capacity, safety and ability to isolate novel COVID-19 of a novel self-administrative nasopharyngeal wash specimen collecting device
Authors: Mohanasundari S K , Thanigainathan Sivam , Gadapalli R , Rawat Pankaj , Vandana S , Deepak K , Gupta N
Published: January 2024

Introduction

Although nasopharyngeal/oropharyngeal swabs are considered the gold standard for SARS-CoV-2 diagnosis, these procedures are distressing, require trained personnel and may pose a risk of transmission.

Aim

This study aims to assess the functional capacity, safety, ability to isolate the novel COVID-19 and end-users’ acceptance of a novel self-collection device for obtaining nasopharyngeal wash samples.

Methods

Initially, the novel device’s functional capacity (amount of nasopharyngeal wash specimen collected by participants themselves using the novel device) and safety (procedure-related complications such as bleeding, aspiration or syncope) were assessed in 15 healthy volunteers. Then, its ability to isolate the novel COVID-19 in symptomatic patients, procedure-related discomfort and end-users’ acceptance were compared with the conventional nasopharyngeal/oropharyngeal swab technique.

Results

All 15 volunteers obtained more than 1 mL of nasopharyngeal wash sample using the novel device, with no reported medical complications. Out of 14 COVID-19-suspected patients, 9 tested positive using the novel method compared with 8 with the conventional method (p=0.09). The novel method demonstrated significantly less discomfort (median score 1 vs 5, p<0.001) and significantly higher acceptability (median score 9 vs 2, p<0.001) compared with the conventional method.

Conclusion

The novel self-administrative nasopharyngeal wash specimen-collecting device allowed patients to collect samples safely. The procedure could isolate the novel COVID-19 from the nasopharynx, similar to the conventional nasopharyngeal swab technique. The novel method was less discomforting and more acceptable for end-users compared with the conventional method and is suitable for mass screening.
A chatbot to improve adherence to internet-based cognitive–behavioural therapy among workers with subthreshold depression: a randomised controlled trial
Authors: Yasukawa Sakiko , Tanaka Taku , Yamane Kenji , Kano Ritsuko , Sakata Masatsugu , Noma Hisashi , Furukawa Toshi A , Kishimoto Takuya
Published: January 2024

Background

Internet-based cognitive–behavioural therapy (iCBT) is effective for subthreshold depression. However, iCBT has problems with adherence, especially when unaccompanied by human guidance. Knowledge on how to enhance adherence to iCBT without human involvement can contribute to improving the effectiveness of iCBT.

Objective

This is an implementation study to examine the effect of an automated chatbot to improve the adherence rate of iCBT.

Methods

We developed a chatbot to increase adherence to an existing iCBT programme, and a randomised controlled trial was conducted with two groups: one group using iCBT plus chatbot (iCBT+chatbot group) and one group not using the chatbot (iCBT group). Participants were full-time employees with subthreshold depression working in Japan (n=149, age mean=41.4 (SD=11.1)). The primary endpoint was the completion rate of the iCBT programme at 8 weeks.

Findings

We analysed data from 142 participants for the primary outcome. The completion rate of the iCBT+chatbot group was 34.8% (24/69, 95% CI 23.5 to 46.0), that of the iCBT group was 19.2% (14/73, 95% CI 10.2 to 28.2), and the risk ratio was 1.81 (95% CI 1.02 to 3.21).

Conclusions

Combining iCBT with a chatbot increased participants’ iCBT completion rate.

Clinical implications

Encouraging messages from the chatbot could improve participation in an iCBT programme. Further studies are needed to investigate whether chatbots can improve adherence to the programme in the long term and to assess their impact on depression, anxiety and well-being.

Trial registration number

UMIN000047621.
Relationship between emotion recognition and cognition in multiple sclerosis: a meta-analysis protocol
Authors: Degraeve Béatrice , Henry Audrey , Lenne Bruno
Published: January 2024

Introduction

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system characterised by a broad and unpredictable range of symptoms, including cognitive and socio-cognitive dysfunction. Alongside the well-known deficits in information processing speed (IPS), executive functioning and episodic memory, recent evidence also highlighted socio-cognitive impairments in MS, such as emotion-recognition deficits. Recently, several studies investigated the association between emotion-recognition and cognitive impairment to assess whether social cognition is parallel to (or even dependent on) general cognitive dysfunction. Yet, there have been inconsistent findings, raising the need for a meta-analysis of the literature.

Objectives

The aim of the present paper is to outline the protocol for an upcoming meta-analysis we designed to clarify these conclusions.

Methods and analysis

We plan to estimate combined effect sizes for the association between emotion-recognition and cognitive impairment in MS across three cognitive domains (IPS, executive functions and episodic memory) and 7 emotion scores of interests (total and by 6-basic emotions subscores). Further, we plan to investigate whether identified variables are the cause for heterogeneity in any combined association. To that end, we will conduct additional meta-regression analyses to explore whether overall correlations differ according to clinical characteristics of MS patients (ie, disease duration, MS-phenotype, severity of depression and disability). Ultimately, this study will provide support either for an association of these disorders (in which emotion-recognition deficits might result from more fundamental cognitive dysfunction), or for two distinct sets of symptoms which may occur independently, for targeted patient profiles.
Twelve-month efficacy of CGRP monoclonal antibodies and predictive value of short-term response: results of an Australian multicentre study
Authors: Ray Jason Charles , Dalic Linda , Baker Josephine , Cheng Shuli , Hutton Elspeth Jane , Matharu Manjit
Published: January 2024

Introduction

Clinical trials show that calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are effective preventative treatments for chronic migraine. Their efficacy over longer time periods and in cohorts originally excluded from trials remains uncertain. This study aims to explore the impact of CGRP mAbs in an Australian real-life setting.

Methods

A multicentre cohort study was performed in the tertiary headache clinics of the Alfred and Austin Hospitals, Melbourne, Australia. Patients were commenced on a CGRP mAb for chronic migraine and asked to keep a headache diary, recorded at 3 monthly appointments for 12 months. Primary outcome was a ≥50% reduction in monthly headache days (MHD).

Results

From a population of 105 patients, 90 patients commenced galcanezumab and 15 commenced fremanezumab. The ≥50% responder rate of the cohort was 52.4% after 3 months. Over 12 months follow-up, 25.7% of the cohort ceased due to a lack of efficacy and 16.2% ceased due to an adverse event. There was no difference in response or cessation between medications. There was poor agreement in 3-month and 12-month response rates (Cohen’s κ=0.130; p=0.171). On subgroup analysis, continuous headache at baseline and number of trialled preventative treatments were the only factors associated with efficacy.

Conclusion

CGRP mAbs were associated with sustained reductions in MHD over 12-month follow-up in patients with resistant migraine in Australia. Further studies are required to determine treatment options for patients with continuous headache. Poor agreement between outcomes at 3 and 12 months highlights the need to assess some patients at later timepoints.
Detecting signatures of consciousness in acute brain injury after stimulation with apomorphine and methylphenidate: protocol for a placebo-controlled, randomized, cross-over study
Authors: Othman Marwan H , Møller Kirsten , Kjaergaard Jesper , Kondziella Daniel
Published: January 2024

Introduction

Acute brain injury can lead to states of decreased consciousness, that is, disorder of consciousness (DoC). Detecting signs of consciousness early is vital for DoC management in the intensive care unit (ICU), neurorehabilitation and long-term prognosis. Our primary objective is to investigate the potential of pharmacological stimulant therapies in eliciting signs of consciousness among unresponsive or low-responsive acute DoC patients.

Methods

In a placebo-controlled, randomised, cross-over setting, we evaluate the effect of methylphenidate and apomorphine in 50 DoC patients with acute traumatic or non-traumatic brain injury admitted to the ICU. Patients are examined before and after administration of the trial drugs using (1) neurobehavioural scales to determine the clinical level of consciousness, (2) automated pupillometry to record pupillary responses as a signature for awareness and (3) near-infrared spectroscopy combined with electroencephalography to record neurovascular coupling as a measure for cortical activity. Primary outcomes include pupillary dilations and increase in cortical activity during passive and active paradigms.

Ethics

The study has been approved by the ethics committee (Journal-nr: H-21022096) and follows the principles of the Declaration of Helsinki. It is deemed to pose minimal risks and to hold a significant potential to improve treatment options for DoC patients. If the stimulants are shown to enhance cortical modulation of pupillary function and neurovascular coupling, this would warrant a large multicentre trial to evaluate their clinical impact.

Dissemination

Results will be available on EudraCT, clinicaltrialsregister.eu and published in an international peer-reviewed journal.

Trial registration number

EudraCT Number: 2021-001453-31.
Are children with disabilities more likely to be malnourished than children without disabilities? Evidence from the Multiple Indicator Cluster Surveys in 30 countries
Authors: Rotenberg Sara , Chen Shanquan , Hunt Xanthe , Smythe Tracey , Kuper Hannah
Published: January 2024

Introduction

A key Sustainable Development Goal target is to eliminate all forms of malnutrition. Existing evidence suggests children with disabilities are at greater risks of malnutrition, exclusion from nutrition programmes and mortality from severe acute malnutrition than children without disabilities. However, there is limited evidence on the nutritional outcomes of children with disabilities in large-scale global health surveys.

Methods

We analysed Multiple Indicator Cluster Survey data from 30 low and middle-income countries to compare nutritional outcomes for children aged 2–4 years with and without disabilities. We estimated the adjusted prevalence ratios for stunting, wasting and underweight comparing children with and without disabilities by country and sex, using quasi-Poisson models with robust SEs. We accounted for the complex survey design, wealth quintile, location and age in the analyses. We meta-analysed these results to create an overall estimate for each of these outcomes.

Results

Our analyses included 229 621 children aged 2–4 across 30 countries, including 15 071 children with disabilities (6.6%). Overall, children with disabilities were more likely to be stunted (adjusted risk ratio (aRR) 1.16, 95% CI 1.11 to 1.20), wasted (aRR 1.28, 95% CI 1.18 to 1.39) and underweight (aRR 1.33, 95% CI 1.17, 1.51) than children without disabilities. These patterns were observed in both girls and boys with disabilities, compared with those without.

Conclusion

Children with disabilities are significantly more likely to experience all forms of malnutrition, making it critical to accelerate efforts to improve disability inclusion within nutrition programmes. Ending all forms of malnutrition will not be achievable without a focus on disability.
Impact of a peer-support programme to improve loneliness and social isolation due to COVID-19: does adding a secure, user friendly video-conference solution work better than telephone support alone? Protocol for a three-arm randomised clinical trial
Authors: Lee Jacques Simon , Rose Louise , Borgundvaag Bjug , McLeod Shelley L , Melady Donald , Mohindra Rohit , Sinha Samir K , Wesson Virginia , Wiesenfeld Lesley , Kolker Sabrina , Kiss Alex , Lowthian Judy
Published: January 2024

Introduction

The COVID-19 pandemic has forced the implementation of physical distancing and self-isolation strategies worldwide. However, these measures have significant potential to increase social isolation and loneliness. Among older people, loneliness has increased from 40% to 70% during COVID-19. Previous research indicates loneliness is strongly associated with increased mortality. Thus, strategies to mitigate the unintended consequences of social isolation and loneliness are urgently needed. Following the Obesity-Related Behavioural Intervention Trials model for complex behavioural interventions, we describe a protocol for a three-arm randomised clinical trial to reduce social isolation and loneliness.

Methods and analysis

A multicentre, outcome assessor blinded, three-arm randomised controlled trial comparing 12 weeks of: (1) the HOspitals WoRking in Unity (‘HOW R U?’) weekly volunteer-peer support telephone intervention; (2) ‘HOW R U?’ deliver using a video-conferencing solution and (3) a standard care group. The study will follow Consolidated Standard of Reporting Trials guidelines.

We will recruit 24–26 volunteers who will receive a previously tested half day lay-training session that emphasises a strength-based approach and safety procedures. We will recruit 141 participants ≥70 years of age discharged from two participating emergency departments or referred from hospital family medicine, geriatric or geriatric psychiatry clinics. Eligible participants will have probable baseline loneliness (score ≥2 on the de Jong six-item loneliness scale). We will measure change in loneliness, social isolation (Lubben social network scale), mood (Geriatric Depression Score) and quality of life (EQ-5D-5L) at 12–14 weeks postintervention initiation and again at 24–26 weeks.

Ethics and dissemination

Approval has been granted by the participating research ethics boards. Participants randomised to standard care will be offered their choice of telephone or video-conferencing interventions after 12 weeks. Results will be disseminated through journal publications, conference presentations, social media and through the International Federation of Emergency Medicine.

Trial registration number

NCT05228782.
Validation of oxygen saturations measured in the community by emergency medical services as a marker of clinical deterioration in patients with confirmed COVID-19: a retrospective cohort study
Authors: Inada-Kim Matthew , Chmiel Francis P , Boniface Michael , Burns Daniel , Pocock Helen , Black John , Deakin Charles
Published: January 2024

Objectives

To evaluate oxygen saturation and vital signs measured in the community by emergency medical services (EMS) as clinical markers of COVID-19-positive patient deterioration.

Design

A retrospective data analysis.

Setting

Patients were conveyed by EMS to two hospitals in Hampshire, UK, between 1 March 2020 and 31 July 2020.

Participants

A total of 1080 patients aged ≥18 years with a COVID-19 diagnosis were conveyed by EMS to the hospital.

Primary and secondary outcome measures

The primary study outcome was admission to the intensive care unit (ICU) within 30 days of conveyance, with a secondary outcome representing mortality within 30 days of conveyance. Receiver operating characteristic (ROC) analysis was performed to evaluate, in a retrospective fashion, the efficacy of different variables in predicting patient outcomes.

Results

Vital signs measured by EMS staff at the first point of contact in the community correlated with patient 30-day ICU admission and mortality. Oxygen saturation was comparably predictive of 30-day ICU admission (area under ROC (AUROC) 0.753; 95% CI 0.668 to 0.826) to the National Early Warning Score 2 (AUROC 0.731; 95% CI 0.655 to 0.800), followed by temperature (AUROC 0.720; 95% CI 0.640 to 0.793) and respiration rate (AUROC 0.672; 95% CI 0.586 to 0.756).

Conclusions

Initial oxygen saturation measurements (on air) for confirmed COVID-19 patients conveyed by EMS correlated with short-term patient outcomes, demonstrating an AUROC of 0.753 (95% CI 0.668 to 0.826) in predicting 30-day ICU admission. We found that the threshold of 93% oxygen saturation is prognostic of adverse events and of value for clinician decision-making with sensitivity (74.2% CI 0.642 to 0.840) and specificity (70.6% CI 0.678 to 0.734).
Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial
Authors: Kjeld Simone G , Thygesen Lau C , Danielsen Dina , Jensen Marie P , Krølner Rikke F , Pisinger Charlotta , Andersen Susan
Published: January 2024

Objectives

Public health interventions are designed to improve specific health-related outcomes; however, they may also produce negative side effects, such as substitution use, psychological or social harms. Knowledge about the unintended effects of school-based smoking preventive interventions is sparse. Hence, this study examined these potential unintended effects of the smoking-reducing intervention, Focus, among students in the vocational education and training setting.

Design

Cluster randomised controlled trial stratified by school type with 5 months follow-up.

Setting and participants

Across Denmark, eight schools were randomised to the intervention group (n=844 students, response proportion 76%) and six schools to the control group (n=815 students, response proportion 75%). This study focused solely on students who smoked at baseline (N=491).

Interventions

The intervention was developed systematically based on theory and a thoroughly mixed-methods needs assessment. Intervention components included a comprehensive school tobacco policy (smoke-free school hours) supported by a 3-day course for school staff and launched by an edutainment session for students; class-based lessons and a quit-and-win competition; and individual telephone smoking cessation support.

Outcomes

Alternative tobacco and nicotine products (regular use of smokeless tobacco, hookah and e-cigarettes), regular cannabis use, boredom and loneliness at school, stress and perceived stigmatisation among smokers.

Results

We found no statistically significant unintended effects of the intervention. Nonetheless, insignificant findings indicated that students in the intervention group were less likely to be bored during school hours (OR 0.59, 95% CI 0.32 to 1.10) and experience stress (OR 0.62, 95% CI 0.35 to 1.10), but more likely to report feeling stigmatised compared with the control group (OR 1.55, 95% CI 0.71 to 3.40).

Conclusions

Overall, findings suggested no unintended effects of the Focus trial with respect to substitution use, psychological, nor group or social harms. Future research is encouraged to report potential harmful outcomes of smoking preventive interventions, and interventions should be aware of the possible stigmatisation of smokers.

Trial registration number

ISRCTN16455577.
Seroprevalence of anti-SARS-CoV-2 antibodies and risk of viral exposure among healthcare workers in the South Kivu province, eastern Democratic Republic of the Congo: a cross-sectional study
Authors: Chasinga Tshass B , Cikwanine Jean-Paul Buhendwa , Kribi Sarah , Yoyu Jonathan Tunangoya , Hofmann Natalie , Grossegesse Marica , Nitsche Andreas , Tomczyk Sara , Vietor Ann C , Leendertz Fabian H , Eckmanns Tim , Kusinza Aline B , Munguakonkwa Eric , Kalk Andreas , Raha Maroyi , Kambale Nelson S , Ayagirwe Rodrigue B , Schubert Grit , Mukwege Denis
Published: January 2024

Objectives

Healthcare workers (HCWs) are on the frontline of combating COVID-19, hence are at elevated risk of contracting an infection with SARS-CoV-2. The present study aims to measure the impact of SARS-CoV-2 on HCWs in central sub-Saharan Africa.

Setting

A cross-sectional serological study was conducted at six urban and five rural hospitals during the first pandemic wave in the South Kivu province, Democratic Republic of the Congo (DRC).

Participants

Serum specimens from 1029 HCWs employed during the first pandemic wave were collected between August and October 2020, and data on demographics and work-related factors were recorded during structured interviews.

Primary and secondary outcome measures

The presence of IgG antibodies against SARS-CoV-2 was examined by ELISA. Positive specimens were further tested using a micro-neutralisation assay. Factors driving SARS-CoV-2 seropositivity were assessed by multivariable analysis.

Results

Overall SARS-CoV-2 seroprevalence was high among HCWs (33.1%), and significantly higher in urban (41.5%) compared with rural (19.8%) hospitals. Having had presented with COVID-19-like symptoms before was a strong predictor of seropositivity (31.5%). Personal protective equipment (PPE, 88.1% and 11.9%) and alcohol-based hand sanitizer (71.1% and 28.9%) were more often available, and hand hygiene was more often reported after patient contact (63.0% and 37.0%) in urban compared with rural hospitals, respectively. This may suggest that higher exposure during non-work times in high incidence urban areas counteracts higher work protection levels of HCWs.

Conclusions

High SARS-CoV-2 seropositivity indicates widespread transmission of the virus in this region of DRC. Given the absence of publicly reported cases during the same time period at the rural sites, serological studies are very relevant in revealing infection dynamics especially in regions with low diagnostic capacities. This, and discrepancies in the application of PPE between urban and rural sites, should be considered in future pandemic response programmes.
Language Access Systems Improvement initiative: impact on professional interpreter utilisation, a natural experiment
Authors: Karliner Leah S , Gregorich Steven E , Mutha Sunita , Kaplan Celia , Livaudais-Toman Jennifer , Pathak Sarita , Garcia Maria E , Diamond Lisa
Published: January 2024

Objectives

This study aims to evaluate the Language Access Systems Improvement (LASI) initiative’s impact on professional interpreter utilisation in primary care and to explore patient and clinician perspectives on professional interpreter use.

Design

Multi methods: Quantitative natural experiment pre-LASI and post-LASI, qualitative semistructured interviews with clinicians and focus groups with patients post-LASI.

Setting

Large, academic primary care practice.

Participants

Cantonese, Mandarin, Spanish, English-speaking adult patients and their clinicians.

Intervention

LASI initiative: Implementation of a clinician language proficiency test and simultaneous provision of on-demand access to professional interpreters via video medical interpretation.

Main outcome measures

Quantitative: Proportion of language discordant primary care visits which were professionally interpreted. Qualitative: Salient themes related to professional interpreter use and non-use.

Results

The researchers categorised language concordance for 1475 visits with 152 unique clinicians; 698 were not fully language concordant (202 pre-LASI and 496 post-LASI). Professional interpreter utilisation increased (pre-LASI 57% vs post-LASI 66%; p=0.01); the visits with the lowest percentage of profssional interpreter use post-LASI were those in which clinicians and patients had partial language concordance. In inverse probability weighted analysis, restricting to 499 visits with strict estimated propensity score overlap (100% common support), post-LASI visits had higher odds of using a professional interpreter compared with pre-LASI visits (OR 2.39; 95% CI 1.04 to 5.48). Qualitative results demonstrate video interpretation was convenient and well liked by both clinicians and patients. Some partially bilingual clinicians reported frustration with patient refusal of interpreter services; others reported using the video interpreters as a backup during visits. Views of the care-partner role differed for clinicians and patients. Clinicians reported sometimes having family interpret out of convenience or habit, whereas patients reported wanting family members present for support and advocacy, not interpretation.

Conclusions

LASI increased utilisation of professional interpreters; however, this was least prominent for partially language concordant visits. Health systems wishing to implement LASI or similar interventions will need to support clinicians and patients with partial bilingual skills in their efforts to use professional interpreters.

Trial registration number

HSRP20153367.
Perceptions of senior nursing students on how the COVID-19 pandemic influenced their clinical practice in the Northwest Province, South Africa: a qualitative study
Authors: Apolinario Sofia Fatima Filomena , Bam Edith Nokwanda , Moagi Miriam
Published: January 2024

Objective

To explore and describe senior nursing students’ perspectives on clinical practice during COVID-19 and provide the most up-to-date information on the quality of clinical experience for nursing students in relation to nursing practice, nursing education, and nursing research.

Design

The research design that was employed is a qualitative, explorative, descriptive in order to explore and describe nursing students’ perceptions of clinical, training during the COVID-19 pandemic.

Setting

The study took place in a local university located in the Northwest province, South Africa.

Participants

The population consisted of 16 senior nursing students who had been exposed to clinical practice during the COVID-19 pandemic. There were 14 women and 2 men. Study included full-time, registered undergraduate nursing students who enrolled in 2019. All nursing students who did not engage in clinical practice before or during COVID-19 were exempt.

Interventions

There were no direct interventions in this study; however, few recommendations were made for each of the themes that emerged in this study.

Primary and secondary outcome measures

The researchers’ aim with the study was to find out the nursing students’ perspective on clinical training during a global pandemic, through interviews and focus group discussions. The researcher did in fact receive such feedback from the participants.

Results

Four major themes emerged: (1) the lack of preceptors to facilitate clinical teaching; (2) not allowed to work in COVID-19 wards; (3) difficulties with online classes and tests and (4) poor communication.

Conclusion

The COVID-19 pandemic influenced how students viewed and experienced clinical training, which in turn had an impact on their learning experiences. These effects also had some impact on their experiences and decisions to continue working as professional nurses.
Risk factors for cognitive impairment in middle-aged type 2 diabetic patients: a cross-sectional study
Authors: Li Yao-Shuang , Li Jing-Bo , Wang Jun-Jia , Wang Xiao-He , Jiang Wei-Ran , Qiu Hui-Na , Xia Long-Fei , Wu Fan , Lin Chen-Ying , Liu Yan-Lan , Lin Jing-Na
Published: January 2024

Objective

The aim of this study was to investigate risk factors for cognitive impairment (CI) and explore the relationship between obesity and cognition in hospitalised middle-aged patients with type 2 diabetes (T2DM).

Methods

Subjects were divided into normal cognitive function (NCF) (n=320) and CI (n=204) groups based on the results of the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). The risk factors for CI were determined by logistic regression analysis and generalised linear modelling. The associations between obesity parameters (body mass index (BMI) and waist circumference (WC)) and cognitive ability were studied with the use of linear regression analysis, piecewise regression modelling and interaction analysis. The receiver operating characteristic curve analysis was used to examine the diagnostic value of influencing factors for cc

Results

The prevalence of CI was 38.9% in hospitalised middle-aged T2DM patients (median age, 58 years). Age, WC, hypoglycaemic episode within past 3 months and cerebrovascular disease (CVD) were identified as independent risk factors for CI, while the independent protective factors were education, diabetic dietary pattern, overweight and obesity. BMI was a protective factor for the MoCA score within a certain range, whereas WC was a risk factor for the MMSE and MoCA scores. The area under the curve for the combination of BMI and WC was 0.754 (p<0.001).

Conclusion

Age, education, diabetic dietary pattern, WC, overweight, obesity, hypoglycaemic episode in 3 months and CVD may be potential influencing factors for the occurrence of CI in hospitalised middle-aged population with T2DM. The combination of BMI and WC may represent a good predictor for early screening of CI in this population. Nevertheless, more relevant prospective studies are still needed.
Methods and measures to evaluate the impact of participatory model building on public policymakers: a scoping review protocol
Authors: Henson Rosie Mae , Purtle Jonathan , Headen Irene , Stankov Ivana , Langellier Brent A
Published: January 2024

Introduction

Public policymakers are increasingly engaged in participatory model building processes, such as group model building. Understanding the impacts of policymaker participation in these processes on policymakers is important given that their decisions often have significant influence on the dynamics of complex systems that affect health. Little is known about the extent to which the impacts of participatory model building on public policymakers have been evaluated or the methods and measures used to evaluate these impacts.

Methods and analysis

A scoping review protocol was developed with the objectives of: (1) scoping studies that have evaluated the impacts of facilitated participatory model building processes on public policymakers who participated in these processes; and (2) describing methods and measures used to evaluate impacts and the main findings of these evaluations. The Joanna Briggs Institute’s Population, Concept, Context framework was used to formulate the article identification process. Seven electronic databases—MEDLINE (Ovid), ProQuest Health and Medical, Scopus, Web of Science, Embase (Ovid), CINAHL Complete and PsycInfo—will be searched. Identified articles will be screened according to inclusion and exclusion criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist for scoping reviews will be used and reported. A data extraction tool will collect information across three domains: study characteristics, methods and measures, and findings. The review will be conducted using Covidence, a systematic review data management platform.

Ethics and dissemination

The scoping review produced will generate an overview of how public policymaker engagement in participatory model building processes has been evaluated. Findings will be disseminated through peer-reviewed publications and to communities of practice that convene policymakers in participatory model building processes. This review will not require ethics approval because it is not human subject research.