bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers and facilitators to interdisciplinary communication during consultations: a qualitative study
Authors: Liu Pingyang , Lyndon Audrey , Holl Jane L , Johnson Julie , Bilimoria Karl Y , Stey Anne M
Published: February 2022

Objective

Communication failures between clinicians lead to poor patient outcomes. Critically injured patients have multiple injured organ systems and require complex multidisciplinary care from a wide range of healthcare professionals and communication failures are abundantly common. This study sought to determine barriers and facilitators to interdisciplinary communication between the consulting trauma, intensive care unit (ICU) team and specialty consultants for critically injured patients at an urban, safety-net, level 1 trauma centre.

Design

An observational qualitative study of barriers and facilitators to interdisciplinary communication.

Setting

We conducted observations of daily rounds in two trauma surgical ICUs and recorded the most frequently consulted teams.

Participants

Key informant interviews after presenting clinical vignettes as discussion prompts were conducted with a broad range of clinicians from the ICUs and physicians and nurse practitioners from the consultant teams who were identified during the observations. Interviews were recorded and transcribed verbatim. Data of these 10 interviews were combined with primary transcript data from prior study (25 interviews) and analysed together because of the same setting with same themes. Independent coding of the transcripts, with iterative reconciliation, was performed by two coders.

Outcomes measures

Facilitators and barriers of interdisciplinary communication were identified.

Results

A total of 35 interview transcripts were analysed. Cardiology and interventional radiology were the most frequently consulted teams. Consulting and consultant clinicians reported that perceived accessibility from the team seeking a consultation and the consultant team impacted interdisciplinary communication. Accessibility had a physical dimension as well as a psychological dimension. Accessibility was demonstrated by responsiveness between clinicians of different disciplines and in turn facilitated interdisciplinary communication. Social norms, cognitive biases, hierarchy and relationships were reported as both facilitators and barriers to accessibility, and therefore, interdisciplinary communication.

Conclusion

Accessibility impacted interdisciplinary communication between the consulting and the consultant team.

Article summary

Elucidates barriers and facilitators to interdisciplinary communication between consulting and consultant teams.
Prelacteal feeding practice and its determinant factors among mothers
having children less than 6 months of age in Bure district, Northwest
Ethiopia: a community-based cross-sectional study
Authors: Mose Ayenew , Abebe Haimanot
Published: February 2022

Objective

The main aim of this study was to assess prelacteal feeding practice
and its determinant factors among mothers having children less than 6
months of age in Bure district, Northwest Ethiopia.

Design

Community-based cross-sectional study design.

Setting

Northern Ethiopia.

Participants

The present study was conducted among 621 mothers who had children
less than 6 months of age in Bure district, Northwest Ethiopia, from 1
March 2019 to 30 March 2019.

Primary outcome

Mothers prelacteal feeding practice, modelled using multivariable
logistic regression.

Secondary outcome

Determinant factors of prelacteal feeding practice.

Results

This study found that the prevalence of prelacteal feeding practice
was 11.6% ((95% CI 9.0% to 14.2%)). Delayed initiation of breast feeding
(adjusted OR, AOR=5.4, 95% CI 2.2 to 13.5), mothers who did not get
counselling of breast feeding (AOR=2.9, 95% CI 1.2 to 7.2), home
delivery (AOR=6.9, 95% CI 2.2 to 21.5), primiparous mothers (AOR=4.1,
95% CI 1.4 to 12.2), a newborn with history of neonatal illness
(AOR=3.3, 95% CI 1.3 to 8.5) and lack of postnatal care visits (AOR=3.9,
95% CI 1.3 to 11.8) were determinant factors of prelacteal feeding
practice.

Conclusions

Delayed initiation of breast feeding, mothers who did not get
counselling of breast feeding, home delivery, primiparous mothers,
newborns with a history of neonatal illness and lack of postnatal care
visits were determinant factors of prelacteal feeding practice.
Therefore, healthcare workers should provide a home to home health
education for mothers on the merits of early initiation of breast
feeding, promote institutional delivery, enhance maternal health-seeking
behaviour and encourage mothers to have postnatal care visits is
recommended.
Systematic review on the use of patient-held health records in low-income and middle-income countries
Authors: Joseph Linju , Lavis Anna , Greenfield Sheila , Boban Dona , Humphries Claire , Jose Prinu , Jeemon Panniyammakal , Manaseki-Holland Semira
Published: February 2022

Objective

To review the available evidence on the benefit of patient-held health records (PHRs), other than maternal and child health records, for improving the availability of medical information for handover communication between healthcare providers (HCPs) and/or between HCPs and patients in low-income and middle-income countries (LMICs).

Methods

The literature searches were conducted in PubMed, EMBASE, CINAHL databases for manuscripts without any restrictions on dates/language. Additionally, articles were located through citation checking using previous systematic reviews and a grey literature search by contacting experts, searching of the WHO website and Google Scholar.

Results

Six observational studies in four LMICs met the inclusion criteria. However, no studies reported on health outcomes after using PHRs. Studies in the review reported patients’ experience of carrying the records to HCPs (n=3), quality of information available to HCPs (n=1) and the utility of these records to patients (n=6) and HCPs (n=4). Most patients carry PHRs to healthcare visits. One study assessed the completeness of clinical handover information and found that only 41% (161/395) of PHRs were complete with respect to key information on diagnosis, treatment and follow-up. No protocols or guidelines for HCPs were reported for use of PHRs. The HCPs perceived the use of PHRs improved medical information availability from other HCPs. From the patient perspective, PHRs functioned as documented source of information about their own condition.

Conclusion

Limited data on existing PHRs make their benefits for improving health outcomes in LMICs uncertain. This knowledge gap calls for research on understanding the dynamics and outcomes of PHR use by patients and HCPs and in health systems interventions.

PROSPERO registration number

CRD42019139365.
Effectiveness of low-dose amitriptyline and mirtazapine for insomnia disorder: study protocol of a randomised, double-blind, placebo-controlled trial in general practice (the DREAMING study)
Authors: Bakker Mette H , Hugtenburg Jacqueline G , van Straten Annemieke , van der Horst Henriëtte E , Slottje Pauline
Published: February 2022

Introduction

For over more than a decade, low-dose amitriptyline and mirtazapine are prescribed off-label for insomnia. However, placebo-controlled evidence on these antidepressants for insomnia is still lacking. Therefore, the present trial aims to assess the effectiveness of low-dose amitriptyline (10–20 mg/day) and mirtazapine (7.5–15 mg/day) in patients with insomnia disorder with difficulty maintaining sleep or early-morning awakening problems in general practice.

Methods and analysis

The Drug REdiscovery: low-dose Amitriptyline and Mirtazapine for INsomnia disorder in General practice (DREAMING) study is a randomised, double-blind, placebo-controlled trial in about 50 general practices. Adults (18–85 years) with insomnia disorder (Diagnostic and Statistical Manual of Mental Disorders-5) who ask their general practitioner (GP) for sleep medication when non-pharmacological treatment is deemed not effective, are eligible. Exclusion criteria: isolated sleep initiation problem, contraindications for or drug–drug interactions with either amitriptyline or mirtazapine. Participants (n=156) will be randomly assigned to three parallel treatment groups of 16-week treatment with either amitriptyline (one or two tablets of 10 mg/day) or mirtazapine (one or two tablets of 7.5 mg/day) or placebo (one or two tablets) alongside usual GP care. All participants start and end with single dose, but dose can be doubled following GP consultation in week 3. Questionnaire assessments will be conducted at baseline, week 6, 12, 20 and 52. The primary study outcome is self-reported insomnia severity at 6 weeks, measured with the Insomnia Severity Index (ISI) in an intention to treat analysis. Secondary outcomes include subjective sleep quality quantified by sleep indices, daytime functioning and symptoms, safety and treatment evaluation and other sleep care consumption.

Ethics and dissemination

The Medical Ethics Committee of the VU Medical Centre Amsterdam approved this trial. The results of this trial will be published in peer-reviewed scientific journals and presented at relevant academic conferences and to key stakeholders.

Trial registration number

NTR7449.
Use of Patient-Reported Outcomes Measurement Information System (PROMIS) measures to characterise health status for patients seeking care from an orthopaedic provider: a retrospective cohort study
Authors: Horn Maggie E , Reinke Emily K , Yan Xiaofang , Luo Sheng , Bolognesi Michael , Reeve Bryce B , George Steven Z
Published: February 2022

Objectives

Characterise the health status of patients newly consulting an orthopaedic specialist across eight clinical subspecialties.

Design

Retrospective cohort.

Setting

18 orthopaedic clinics, including 8 subspecialties (14 ambulatory and 4 hospital based) within an academic health system.

Participants

14 910 patients consulting an orthopaedic specialist for a new patient consultation who completed baseline Patient-Reported Outcomes Measurement Information System (PROMIS) measures associated with their appointment from 17 November 2017 to 13 May 2019. Patients were aged 55.72±5.8 years old, and 61.3% were female and 79.3% were Caucasian and 13.4% were black or African American. Patients who did not complete PROMIS measures or cancelled their appointment were excluded from the study.

Primary outcome

PROMIS domains of physical function, pain interference, pain intensity, depression, anxiety, fatigue, sleep disturbance and the ability to participate in social roles.

Results

Mean PROMIS scores for physical function were (38.1±9.2), pain interference (58.9±8.1), pain intensity (4.6±2.5), depression (47.9±8.9), anxiety (49.9±9.5), fatigue (50.5±10.3), sleep disturbance (51.1±9.8) and ability to participate in social roles (49.1±10.3) for the entire cohort. Across the clinical subspecialties, neurosurgery, spine and trauma patients were most profoundly affected across almost all domains and patients consulting with a hand specialist reported the least limitations or symptoms across domains. There was a moderate, negative correlation between pain interference and physical functioning (r=−0.59) and low correlations between pain interference with anxiety (r=0.36), depression (r=0.39) as well as physical function and anxiety (r=−0.32) and depression(r=−0.30) and sleep (r=−0.31).

Conclusions

We directly compared clinically meaningful PROMIS domains across eight orthopaedic subspecialties, which would not have been possible with legacy measures alone. These results support PROMIS’s utility as a common metric to assess and compare patient health status across multiple orthopaedic subspecialties.
Life or limb: an international qualitative study on decision making in sarcoma surgery during the COVID-19 pandemic
Authors: Bunzli Samantha , O'Brien Penny , Aston Will , Ayerza Miguel A , Chan Lester , Cherix Stephane , de las Heras Jorge , Donati Davide , Eyesan Uwale , Fabbri Nicola , Ghert Michelle , Hilton Thomas , Idowu Oluwaseyi Kayode , Imanishi Jungo , Puri Ajay , Rose Peter , Sabah Dundar , Turcotte Robert , Weber Kristy , Dowsey Michelle M , Choong Peter F M
Published: February 2022

Objectives

The COVID-19 pandemic is unprecedented as a global crisis over the last century. How do specialist surgeons make decisions about patient care in these unprecedent times?

Design

Between April and May 2020, we conducted an international qualitative study. Sarcoma surgeons from diverse global settings participated in 60 min interviews exploring surgical decision making during COVID-19. Interview data were analysed using an inductive thematic analysis approach.

Setting

Participants represented public and private hospitals in 14 countries, in different phases of the first wave of the pandemic: Australia, Argentina, Canada, India, Italy, Japan, Nigeria, Singapore, Spain, South Africa, Switzerland, Turkey, UK and USA.

Participants

From 22 invited sarcoma surgeons, 18 surgeons participated. Participants had an average of 19 years experience as a sarcoma surgeon.

Results

17/18 participants described a decision they had made about patient care since the start of the pandemic that was unique to them, that is, without precedence. Common to ‘unique’ decisions about patient care was uncertainty about what was going on and what would happen in the future (theme 1: the context of uncertainty), the impact of the pandemic on resources or threat of the pandemic to overwhelm resources (theme 2: limited resources), perceived increased risk to self (theme 3: duty of care) and least-worst decision making, in which none of the options were perceived as ideal and participants settled on the least-worst option at that point in time (theme 4: least-worst decision making).

Conclusions

In the context of rapidly changing standards of justice and beneficence in patient care, traditional decision-making frameworks may no longer apply. Based on the experiences of surgeons in this study, we describe a framework of least-worst decision making. This framework gives rise to actionable strategies that can support decision making in sarcoma and other specialised fields of surgery, both during the current crisis and beyond.
Effectiveness of rehabilitation interventions on the secondary consequences of surviving a cardiac arrest: a systematic review and meta-analysis
Authors: Joshi Vicky L , Christensen Jan , Lejsgaard Esben , Taylor Rod S , Zwisler Ann Dorthe , Tang Lars H
Published: February 2022

Aim

The aim of this systematic review was to assess the effectiveness of rehabilitation interventions on the secondary physical, neurological and psychological consequences of cardiac arrest (CA) for adult survivors.

Methods

A literature search of electronic databases (MEDLINE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Psychological Information Database, Web of Science and Cochrane Central Register of Controlled trials) was conducted for randomised controlled trials (RCTs) and observational studies up to 18 April 2021. The primary outcome was health-related quality of life (HRQoL) and main secondary outcome was neurological function with additional secondary outcomes being survival, rehospitalisation, safety (serious and non-serious adverse events), psychological well-being, fatigue, exercise capacity and physical capacity. Two authors independently screened studies for eligibility, extracted data and assessed risk of bias.

Results

Three RCTs and 11 observational studies were included (total 721 participants). Study duration ranged from 8 weeks to 2 years. Pooled data from two RCTs showed low-quality evidence for no effect on physical HRQoL (standardised mean difference (SMD) 0.19, (95% CI: −0.09 to 0.47)) and no effect on mental HRQoL (SMD 0.27 (95% CI: −0.01 to 0.55)).

Regarding secondary outcomes, very low-quality evidence was found for improvement in neurological function associated with inpatient rehabilitation for CA survivors with acquired brain injury (SMD 0.71, (95% CI: 0.45 to 0.96)) from five observational studies. Two small observational studies found exercise-based rehabilitation interventions to be safe for CA survivors, reporting no serious or non-serious events.

Conclusions

Given the overall low quality of evidence, this review cannot determine the effectiveness of rehabilitation interventions for CA survivors on HRQoL, neurological function or other included outcomes, and recommend further high-quality studies be conducted. In the interim, existing clinical guidelines on rehabilitation provision after CA should be followed to meet the high burden of secondary consequences suffered by CA survivors.

PROSPERO registration number

CRD42018110129.
Disparities in multiple sleep characteristics among non-Hispanic White and Hispanic/Latino adults by birthplace and language preference: cross-sectional results from the US National Health Interview Survey
Authors: Gaston Symielle A , Martinez-Miller Erline E , McGrath John , Jackson II W Braxton , Napoles Anna , Pérez-Stable Eliseo , Jackson Chandra L
Published: February 2022

Objective

To investigate whether sleep disparities vary by birthplace among non-Hispanic White (NHW) and Hispanic/Latino adults in the USA and to investigate language preference as an effect modifier.

Design

Cross-sectional.

Setting

USA.

Participants

254 699 men and women.

Methods

We used pooled 2004–2017 National Health Interview Survey data. Adjusting for sociodemographic and behavioural/clinical characteristics, survey-weighted Poisson regressions with robust variance estimated prevalence ratios (PRs) and 95% CIs of self-reported sleep characteristics (eg, sleep duration, trouble staying asleep) among (1) foreign-born NHW adults and Hispanic/Latino heritage groups versus US-born NHW adults and (2) Hispanic/Latino heritage groups versus foreign-born NHW adults. We further stratified by language preference in comparisons of Hispanic/Latino heritage groups with the US-born NHW group.

Results

Among 254 699 participants with a mean age±SE 47±0.9 years, 81% self-identified their race/ethnicity as NHW, 12% Mexican, 2% Puerto Rican, 1% Cuban, 1% Dominican and 3% Central/South American. Compared with US-born NHW adults, foreign-born NHW adults were more likely to report poor sleep quality (eg, PRtrouble staying asleep=1.27 (95% CI: 1.17 to 1.37)), and US-born Mexican adults were no more likely to report non-recommended sleep duration while foreign-born Mexican adults were less likely (eg, PR≤5-hours=0.52 (0.47 to 0.57)). Overall, Mexican adults had lower prevalence of poor sleep quality versus US-born NHW adults, and PRs were lowest for foreign-born Mexican adults. US-born Mexican adults were more likely than foreign-born NHW adults to report shorter sleep duration. Regardless of birthplace, Puerto Rican adults were more likely to report shorter sleep duration versus NHW adults. Generally, sleep duration and quality were better among Cuban and Dominican adults versus US-born NHW adults but were similar versus foreign-born NHW adults. Despite imprecision in certain estimates, Spanish language preference was generally associated with increasingly better sleep among Hispanic/Latino heritage groups compared with US-born NHW adults.

Conclusion

Sleep disparities varied by birthplace, Hispanic/Latino heritage and language preference, and each characteristic should be considered in sleep disparities research.
Examining LGBTI+ inclusive sexual health education from the perspective of both youth and facilitators: a systematic review
Authors: O'Farrell Muire , Corcoran Phil , Davoren Martin P
Published: February 2022

Objectives

To critically appraise and synthesise the evidence in relation to both the receipt and delivery of LGBTI+ (Lesbian, Gay, Bisexual, Transgender, Intersex) inclusive sexual health education.

Design

A systematic review and narrative synthesis.

Data sources

A systematic search of three online databases (EMBASE, PsychINFO and SocINDEX) from January 1990 to May 2021 was conducted.

Eligibility criteria

Studies included were (1) peer-reviewed; (2) English; (3) quantitative, qualitative and mixed methods; that evaluated (4) inclusive sexual health in an educational or online setting and (5) focused on training or educating. Studies were excluded if (1) the population was not LGBTI+ inclusive; (2) the studies did not focus on original data or (3) the study was not available in full text.

Data extraction and synthesis

The studies that met the inclusion criteria were assessed using the Critical Appraisal Skills Programme tool. A narrative synthesis was then completed employing content analysis focusing on the results section of each article.

Results

Of the 5656 records retrieved, 24 studies met the inclusion criteria. The majority of studies noted that both LGBTI+ youth and those who facilitate sexual health education are turning to online sources of information. Current sexual health education programmes operate mainly from a heterosexual perspective, creating a sense of exclusion for LGBTI+ youth. This is compounded by a lack of training, or provision of an inclusive curricula, resulting in facilitators feeling ill equipped or inhibited by their personal biases.

Conclusions

LGBTI+ youth are not experiencing inclusive and comprehensive sexual health education. In parallel, educators report poor access to information, training and resources remain the primary reasons. There is a need to standardise sexual health curricula, making them LGBTI+ inclusive and incorporate holistic aspects of health such as pleasure and healthy relationships. Online approaches should be considered in the future, as they represent equality of access for both sexual health education professionals and LGBTI+ youth alike.
Determinants of maternal knowledge of neonatal danger signs among
postpartum mothers in Southern Ethiopia: institutional-based cross-sectional
study
Authors: Mose Ayenew , Abebe Haimanot , Shitu Solomon , Shimels Habtamu
Published: February 2022

Objective

The main aim of this study was to assess knowledge of neonatal
danger signs and associated factors among postpartum mothers in Southern
Ethiopia.

Setting

Gurage zone, Southern Ethiopia.

Study participants

A total of 608 postpartum mothers were involved in this
study.

Methods

An institutional-based cross-sectional study design was conducted
among postpartum mothers attending Gurage zone public health facilities
of Southern Ethiopia from 1 January 2020 to 30 January 2020.

Results

Knowledge of neonatal danger signs among postpartum mothers was
48.2% (95% CI 44.4% to 52.3%). Mothers resided in an urban area
(adjusted OR, AOR=1.67, 95% CI 1.11 to 2.50), having antenatal follow-up
(AOR=1.49, 95% CI 1.02 to 2.18), mothers who had got breastfeeding
counselling (AOR=3.43, 95% CI 1.89 to 4.75), mothers who had got
postnatal care counselling (AOR=1.53, 95% CI 1.08 to 2.18), multiparous
mothers (AOR=1.37, 95% CI 1.24 to 2.19) and mothers who had good
practice of essential newborn care (AOR=1.53, 95% CI 1.06 to 2.21) were
factors significantly associated with maternal knowledge of neonatal
danger signs.

Conclusions

Knowledge of neonatal danger signs was low in the study area.
Mothers resided in an urban area, having antenatal follow-up, mothers
who had got breastfeeding counselling, mothers who had got postnatal
care counselling, multiparous mothers and good practice of essential
neonatal care were factors associated with maternal knowledge of
neonatal danger signs. Therefore, healthcare workers should encourage
mothers to have antenatal follow-up and provide postnatal care
counselling regarding key neonatal danger signs before discharge from
the health facilities.
Attaining a British consensus statement on managing idiopathic congenital talipes equinovarus (CTEV) through a Delphi process: a study protocol
Authors: Gelfer Yael , Blanco Jose , Trees Amanda , Davis Naomi , Buckingham Rachel , Peek Anna C , Wright Elizabeth , Rajan Rohan , Atherton William Guy , Watson Denise , Easton Vicky , Garg Neeraj , Mavrotas Jason , Tennant Sally , Theologis Tim
Published: February 2022

Introduction

Idiopathic congenital talipes equinovarus (CTEV) is the most common congenital limb deformity. Non-operative intervention using the Ponseti method has shown to be superior to soft tissue release and has become the gold standard for first-line treatment. However, numerous deviations from the Ponseti protocol are still reported following incomplete correction or deformity relapse. Significant variation in treatment protocols and management is evident in the literature. Reducing geographical treatment variation has been identified as one of The James Lind Alliance priorities in children’s orthopaedics. For this reason, the British Society of Children’s Orthopaedic Surgery (BSCOS) commissioned a consensus document to form a benchmark for practitioners and ensure consistent high quality care for children with CTEV.

Methods and analysis

The consensus will follow an established Delphi approach aiming at gaining an agreement on the items to be included in the consensus statement for the management of primary idiopathic CTEV up to walking age. The process will include the following steps: (1) establishing a steering group, (2) steering group meetings, (3) a two-round Delphi survey aimed at BSCOS members, (4) final consensus meeting and (5) dissemination of the consensus statement. Degree of agreement for each item will be predetermined. Descriptive statistics will be used for analysis of the Delphi survey results.

Ethics and dissemination

No patient involvement is required for this project. Informed consent will be assumed from participants taking part in the Delphi survey. Study findings will be published in an open access journal and presented at relevant national and international conferences. Charities and associations will be engaged to promote awareness of the consensus statement.
Analysing effects of financial support for regional suicide prevention programmes on methods of suicide completion in Japan between 2009 and 2018 using governmental statistical data
Authors: Hasegawa Toshiki , Matsumoto Ryusuke , Yamamoto Yoshimasa , Okada Motohiro
Published: February 2022

Objectives

To explore the mechanisms of reduction of suicide mortality in Japan (from 25.7 to 16.5 per 100 000 population) between 2009 and 2018, the present study determined the effects of execution amounts of regional suicide prevention programmes (Emergency Fund to Enhance Community-Based Suicide Countermeasure: EFECBSC) on gender-specific trends of suicide mortality by disaggregated methods.

Design and setting

Stepwise multiple regression analysis was used to determine the effects of execution amounts of 10 subdivisions of execution amounts of financial support for regional suicide prevention programmes (EFECBSC) on suicide methods and gender disaggregated suicide mortalities in Japan between 2009 and 2018 using the statistical data obtained from national governmental database.

Results

The suicide mortalities by the most common/frequent suicide methods, hanging, charcoal burning and jumping were significantly decreased between 2009 and 2018. Male hanging suicide was decreased by prefectural enlightenment, municipal development programmes, but female hanging suicide was decreased by municipal personal consultation programmes. Municipal development and enlightenment programmes decreased male and female charcoal-burning suicide mortalities, respectively. Jumping suicide was decreased by prefectural telephone consultation programmes but was unexpectedly increased by municipal personal consultation and enlightenment programmes.

Conclusions

This study revealed the contribution of ECEFBSC on reduction of suicide mortalities, especially hanging, charcoal-burning and jumping suicides, via enhancement of regional suicide prevention programmes in Japan; however, notably, the ‘means substitution’ from parts of hanging and charcoal burning to jumping is probably generated by EFECBSC. Therefore, these findings provide important aspects for planning evidence-based and cost-effective regional suicide prevention programmes.
Pragmatic cluster randomised control trial using Vaxcards as an age-appropriate tool to incentivise and educate school students about vaccination
Authors: Epstein Daniel , Enticott Joanne , Larson Heidi , Barton Christopher
Published: February 2022

Objective

This trial aimed to determine if return rates of consent forms for vaccination could be improved when Vaxcards were offered as an incentive to school children.

Setting

Nineteen schools in South East Melbourne participated.

Interventions

Students in the experimental arm received a pack of Vaxcards when they returned their government consent form.

Outcome measures

Return of ‘yes’ consent forms for vaccination as part of a local government council vaccine programme was the primary outcome of this trial. Return rates were compared between the intervention and control schools and with historical return rates.

Results

Secondary school students (N=3087) from 19 schools participated. Compared with historical returns, a small global reduction in ‘yes’ responses to consent forms of −4.21% in human papilloma virus consent ‘yes’ responses and −4.69% for diphtheria, tetanus and pertussis was observed across all schools. No difference between the experimental and control groups was observed.

Conclusions

Low ‘yes’ consent rates and reduction in consent rates between 2018 and 2019 for all groups are concerning. This finding highlights the need for behaviour change interventions across all groups to increase vaccine confidence. Lack of effect of incentivisation with Vaxcards in this study may have been due to the timing of receiving the cards (after the decision to vaccinate had been made, not before) and the limited intensity of the intervention. Optimising the timing and the intensity of exposure to Vaxcards could improve the outcome.

Trial registration number

ACTRN12618001753246.
Egocentric social network characteristics and cardiovascular risk among patients with hypertension or diabetes in western Kenya: a cross-sectional analysis from the BIGPIC trial
Authors: Ruchman Samuel G , Delong Allison K , Kamano Jemima H , Bloomfield Gerald S , Chrysanthopoulou Stavroula A , Fuster Valentin , Horowitz Carol R , Kiptoo Peninah , Matelong Winnie , Mugo Richard , Naanyu Violet , Orango Vitalis , Pastakia Sonak D , Valente Thomas W , Hogan Joseph W , Vedanthan Rajesh
Published: February 2022

Objectives

Management of cardiovascular disease (CVD) is an urgent challenge in low-income and middle-income countries, and interventions may require appraisal of patients’ social networks to guide implementation. The purpose of this study is to determine whether egocentric social network characteristics (SNCs) of patients with chronic disease in western Kenya are associated with overall CVD risk and individual CVD risk factors.

Design

Cross-sectional analysis of enrollment data (2017–2018) from the Bridging Income Generation with GrouP Integrated Care trial. Non-overlapping trust-only, health advice-only and multiplex (trust and health advice) egocentric social networks were elicited for each participant, and SNCs representing social cohesion were calculated.

Setting

24 communities across four counties in western Kenya.

Participants

Participants (n=2890) were ≥35 years old with diabetes (fasting glucose ≥7 mmol/L) or hypertension.

Primary and secondary outcomes

We hypothesised that SNCs would be associated with CVD risk status (QRISK3 score). Secondary outcomes were individual CVD risk factors.

Results

Among the 2890 participants, 2020 (70%) were women, and mean (SD) age was 60.7 (12.1) years. Forty-four per cent of participants had elevated QRISK3 score (≥10%). No relationship was observed between QRISK3 level and SNCs. In unadjusted comparisons, participants with any individuals in their trust network were more likely to report a good than a poor diet (41% vs 21%). SNCs for the trust and multiplex networks accounted for a substantial fraction of variation in measures of dietary quality and physical activity (statistically significant via likelihood ratio test, adjusted for false discovery rate).

Conclusion

SNCs indicative of social cohesion appear to be associated with individual behavioural CVD risk factors, although not with overall CVD risk score. Understanding how SNCs of patients with chronic diseases relate to modifiable CVD risk factors could help inform network-based interventions.

Trial registration number

ClinicalTrials.gov identifier:NCT02501746;https://clinicaltrials.gov/ct2/show/NCT02501746.
What supports and constrains the implementation of multifactorial falls risk assessment and tailored multifactorial falls prevention interventions in acute hospitals? Protocol for a realist review
Authors: Randell Rebecca , Wright Judy M , Alvarado Natasha , Healey Frances , Dowding Dawn , Smith Heather , Hardiker Nick , Gardner Peter , Ward Sue , Todd Chris , Zaman Hadar , McVey Lynn , Davey Christopher James , Woodcock David
Published: February 2022

Introduction

Falls are the most common type of safety incident reported by acute hospitals and can cause both physical (eg, hip fractures) and non-physical harm (eg, reduced confidence) to patients. It is recommended that, in order to prevent falls in hospital, patients should receive a multifactorial falls risk assessment and be provided with a multifactorial intervention, tailored to address the patient’s identified individual risk factors. It is estimated that such an approach could reduce the incidence of inpatient falls by 25%–30% and reduce the annual cost of falls by up to 25%. However, there is substantial unexplained variation between hospitals in the number and type of assessments undertaken and interventions implemented.

Methods and analysis

A realist review will be undertaken to construct and test programme theories regarding (1) what supports and constrains the implementation of multifactorial falls risk assessment and tailored multifactorial falls prevention interventions in acute hospitals; and (2) how, why, in what contexts and for whom tailored multifactorial falls prevention interventions lead to a reduction in patients’ falls risk. We will first identify stakeholders’ theories concerning these two topics, searching Medline (1946–present) and Medline In-Process & Other Non-Indexed Citations, Health Management Information Consortium (1983–present) and CINAHL (1981–present). We will then test these theories systematically, using primary studies to determine whether empirical evidence supports, refutes or suggests a revision or addition to the identified theories.

Ethics and dissemination

The study does not require ethical approval. The review will provide evidence for how to implement multifactorial falls risk assessment and prevention strategies in acute hospital settings. This will be disseminated to academic and clinical audiences and will provide the basis for a future multi-site study through which the theories will be further refined.

Systematic review registration

PROSPERO CRD42020184458.
‘Slash and clear’ vector control for onchocerciasis elimination and epilepsy prevention: a protocol of a cluster randomised trial in Cameroonian villages
Authors: Siewe Fodjo Joseph Nelson , Vieri Melissa Krizia , Ngarka Leonard , Njamnshi Wepnyu Y , Nfor Leonard N , Mengnjo Michel Karngong , Hendy Adam , Enyong Peter A , Palmer Dennis , Basanez Maria-Gloria , Colebunders Robert , Njamnshi Alfred K
Published: February 2022

Introduction

Onchocerciasis, caused by the filarial nematode Onchocerca volvulus, remains endemic in Cameroon despite decades of community-directed treatment with ivermectin (CDTI). CDTI is often hampered by coendemicity with loiasis (another filariasis caused by Loa loa) in some areas. Strong epidemiological evidence suggests that O. volvulus infection increases the risk for onchocerciasis-associated epilepsy (OAE) among Cameroonian children. This highlights the urgent need to strengthen onchocerciasis elimination programmes in mesoendemic/hyperendemic areas. Novel alternative strategies, such as the ‘slash and clear’ (S&C) vector control method, may be required to complement ongoing CDTI to accelerate elimination of transmission. The short-term impact of S&C on the biting rates of the blackfly vectors has been demonstrated in other settings. However, its long-term effectiveness and impact on parasitological and serological markers of onchocerciasis transmission as well as on OAE are still unknown.

Methods and analysis

We aim to assess the effectiveness of annual S&C interventions combined with CDTI in reducing onchocerciasis transmission and epilepsy incidence. Eight onchocerciasis-endemic villages located <5 km from the Mbam or Sanaga rivers will be randomised to two arms: four villages will receive yearly CDTI only for two consecutive years (Arm 1), while the other four villages will receive CDTI plus annual S&C for 2 years (Arm 2). Study outcomes (blackfly biting rates, infectivity rates and seroprevalence of onchocerciasis antibodies (Ov16 antibodies) in children, prevalence of microfilaridermia and epilepsy incidence) will be monitored prospectively and compared across study arms. We expect that S&C will have an added benefit over CDTI alone.

Ethics and dissemination

The protocol has received ethical approval from the institutional review board of the Cameroon Baptist Convention Health Board (reference number: IRB2021-03) and has been registered with the Pan African Clinical Trials Registry. Findings will be disseminated at national and international levels via meetings and peer-reviewed publications.

Trial registration number

PACTR202101751275357.
Association between chronic bladder catheterisation and bladder cancer incidence and mortality: a population-based retrospective cohort study in Ontario, Canada
Authors: Hird Amanda E , Saskin Refik , Liu Ying , Lee Yuna , Ajib Khaled , Matta Rano , Kodama Ronald , Carr Lesley , Kulkarni Girish S , Herschorn Sender , Narod Steven A , Nam Robert K
Published: February 2022

Objectives

To compare the risk of bladder cancer and bladder cancer mortality among patients with chronic bladder catheterisation (indwelling or intermittent) to patients from the general population.

Design

Retrospective cohort study.

Setting

Population-based study in Ontario, Canada between 2003 and 2018.

Participants

Adult patients 18–90 years of age with chronic bladder catheterisation were hard matched to patients from the general population without a history of bladder catheterisation.

Interventions

The presence of a chronic catheter was defined as a minimum of two physician encounters for bladder catheterisation, suprapubic tube insertion or home care for catheter care separated by at least 28 days. Urinary tract infection (UTI) rates were collected.

Main outcome measures

Bladder cancer and bladder cancer-specific mortality after a 1-year lag period were compared between groups.

Results

We identified 36 903 patients with chronic catheterisation matched to 110 709 patients without a history of catheterisation. Patients were followed for a median of 8.8 years (IQR: 5.2–11.9 years). The median age was 62 years (IQR: 50–71) and 52% were female. More patients in the catheter group developed bladder cancer (393 (1.1%) vs 304 (0.3%),p<0.001). There were 106 (0.3%) bladder cancer deaths in the catheter group and 59 (0.1%) in the comparison group (p<0.001). Chronic catheterisation (adjusted subdistribution HR (sdHR)=4.80, 95% CI: 4.26 to 5.42,p<0.001) and the number of UTIs (adjusted sdHR=1.04 per UTI, 95% CI: 1.04 to 1.05,p<0.001) were independent predictors of bladder cancer. The relative rate of bladder cancer-specific death was more than eightfold higher among patients with chronic catheterisation (adjusted sdHR=8.68, 95% CI: 6.97 to 10.81,p<0.001). Subgroup analysis among patients with neurogenic bladder and bladder calculi similarly revealed an increased risk of bladder cancer diagnosis and mortality. Bladder cancer risk was highest among patients in the two longest catheter duration quintiles (2.9–5.9 and 5.9–15.5 years).

Conclusions

This is the first study to quantify the increase in bladder cancer incidence and mortality in a large, diverse cohort of patients with chronic indwelling or intermittent bladder catheterisation. The risk was highest among patients with a chronic catheter beyond 2.9 years.
Patient participation in Delphi surveys to develop core outcome sets: systematic review
Authors: Barrington Heather , Young Bridget , Williamson Paula R
Published: February 2022

Objectives

To describe the design and conduct of core outcome set (COS) studies that have included patients as participants, exploring how study characteristics might impact their response rates.

Design

Systematic review of COS studies published between 2015 and 2019 that included more than one patient, carer or representative as participants (hereafter referred to as patients for brevity) in scoring outcomes in a Delphi.

Results

There were variations in the design and conduct of COS studies that included patients in the Delphi process, including differing: scoring and feedback systems, approaches to recruiting patients, length of time between rounds, use of reminders, incentives, patient and public involvement, and piloting. Minimal reporting of participant characteristics and a lack of translation of Delphi surveys into local languages were found. Additionally, there were indications that studies that recruited patients through treatment centres had higher round two response rates than studies recruiting through patient organisations.

Conclusions

Variability was striking in how COS Delphi surveys were designed and conducted to include patient participants and other stakeholders. Future research is needed to explore what motivates patients to take part in COS studies and what factors influence COS developer recruitment strategies. Improved reporting would increase knowledge of how methods affect patient participation in COS Delphi studies.
Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators
Authors: Spayne Jacqueline , Hesketh Therese
Published: February 2022

Background

Mortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies.

Objectives

The aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls.

Design

This study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated.

Results

Incidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs.

Conclusions

Countries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier.
Filtering Deep Convolutional Features for Image Retrieval
Authors: Zhang Bo-Jian , Liu Guang-Hai , Hu Jin-Kun
Published: February 2022

In image retrieval, highlighting target object and reducing the influence of background noise remains challenging. To address this problem, we propose a novel weighting method that aggregates deep convolutional features based on filtering, called filtering on spatial channel weighting (FSCW) factors, to represent image contents, and utilize it for image retrieval. There are three main contributions of this study. First, the designed filter can effectively remove the influence of background noise. Second, we propose a new channel selection and spatial weighting method, which can accurately distinguish target object from the background noise. Finally, we designed a new channel weighting strategy to suppress intra-image visual burstiness. Experimental results on benchmark datasets demonstrate that the proposed method effectively enhances discriminative power and outperforms some existing state-of-the-art methods in terms of the mAP metric. Furthermore, the proposed method is superior to some existing algorithms in distinguishing background noise and target object.
OPTIMAL CROSS-CURRENCY MORTGAGE DECISIONS
Authors: LÜTKEBOHMERT EVA , SCHMIDT THORSTEN , ZHU TIANJIAO
Published: February 2022

In this paper, we study optimal mortgage decisions in a cross-currency setting. In particular, we address the question on how a household should optimally split its mortgage portfolio in a fixed rate mortgage in the domestic currency and an adjustable rate mortgage denominated in a foreign currency subject to some risk constraints. We propose an affine factor model which allows to jointly investigate the impact of variations in interest rates as well as of exchange rate fluctuations on mortgage decisions. As a case study, we apply our model to real data on Swiss and German mortgage markets and we estimate parameters using a quasi-Kalman filter approach. We then study the impact of different income splits, risk attitudes, and mortgage specifications on the household’s portfolio choice in a mean–variance optimization approach.
Other Side of Voluntary Clawback Provisions in Executive Compensation Contracts: Evidence from the Investment Efficiency
Authors: Kim Sohyung , Lee Cheol , Mitra Santanu
Published: February 2022

This study examines how firm-initiated clawback provisions in executive compensation contracts affect firms’ investment efficiency. While existing the literature provides evidence on positive aspects of adopting clawback provisions, the potential impact of clawback adoption on firms’ long-term investment efficiency remains unexplored. Using three investment proxies (i.e., capital expenditure, new investment, and total investment), we find that clawback adopters tend to reduce their long-term investments after the clawback provisions are put in place, compared to nonadopters. In particular, we find evidence that the adoption of clawback policies decreases the investment efficiency in the post-adoption period, especially for the firms whose ex ante probability of underinvestment is high. Our additional analyses reveal that observed reduction in the investment efficiency for the firms that are likely to underinvest is more evident for the firms with financial constraints and the firms that adopt risk-taking and performance-based clawback triggers. In contrast, the clawback adopters that are likely to overinvest do not change their investment behavior in the post-adoption period. Overall, our findings suggest that the impleme ntation of clawback provisions may lead to unintended consequences for firms’ long-term investment practices, resulting in a decrease in the investment efficiency.