bluuebunny/crossref_metadata_2025 huggingface dataset:
Noninsulin antidiabetic prescription patterns in Colombia: a cross-sectional study
Authors: Machado-Alba Jorge Enrique , Gaviria-Mendoza Andrés , Machado-Duque Manuel Enrique , Valladales-Restrepo Luis Fernando , Alvarado-Segovia Andrés
Published: October 2024

Background:

The prevalence of type 2 diabetes mellitus (T2DM) continues to increase; the clinical practice guidelines continue to modify the recommendations for its treatment.

Objective:

The aim was to determine the prescription patterns of noninsulin antidiabetics in a group of patients from Colombia.

Design:

Cross-sectional study.

Methods:

The use of noninsulin antidiabetic drugs based on a population database of patients under treatment in 2022. Comorbidities were identified, including total numbers, proportions, and defined daily doses of each antidiabetic agent per 1000 inhabitants/day (DHD).

Results:

A total of 155,381 patients with T2DM were identified, with a mean age of 67.1 ± 12.0 years. The most widely used antidiabetics according to DHD were metformin (9.46 DHD), empagliflozin (5.3), sitagliptin (2.8), linagliptin (2.4), and dapagliflozin (2.3), mainly in combination therapy (55.5%), most often two (31.2% of patients) or three antidiabetics (22.4% of patients). The most frequent cardiovascular comorbidities were hypertension (67.6%), chronic kidney disease (6.3%), and coronary ischemic heart disease (2.5%), treated with angiotensin 2 receptor antagonists, followed by diuretics, calcium antagonists, and β-blockers.

Conclusion:

This group of patients with T2DM has been treated mainly with metformin alone or in combination with other antidiabetic drugs, but despite the changes in treatment in recent years, a significant number of patients with concomitant cardiovascular conditions are not receiving appropriate antidiabetic agents. Sodium-glucose type 2 cotransporter or glucagon-like peptide-1 receptor agonists may offer additional benefits with reduced cardiovascular risk.
Enhancing medication management of older adults in Qatar: healthcare professionals’ perspectives on challenges, barriers and enabling solutions
Authors: Alyazeedi Ameena , Stewart Carrie , Soiza Roy L. , Stewart Derek , Awaisu Ahmed , Ryan Cristin , Alhail Moza , Aldarwish Abdulaziz , Myint Phyo Kyaw
Published: October 2024

Background:

Polypharmacy and potentially inappropriate medications are significant challenges in older adults’ medication management. The Consolidated Framework for Implementation Research (CFIR) is a comprehensive approach used to explore barriers and enablers to the healthcare system in guiding the effective implementation of evidence-based practices.

Objectives:

This study examines the barriers and enablers to promote safe medication management among older adults in Qatar from healthcare professionals’ perspectives. This includes identifying critical factors within the healthcare system influencing medication management and suggesting practical solutions to improve it.

Design:

The study employs a qualitative design. Focus Groups (FGs) were conducted with healthcare professionals from the geriatric, mental health and medicine departments of Hamad Medical Corporation (HMC), the leading governmental sector in Qatar serving the older adult population.

Methods:

Utilising the CFIR, this study analysed feedback from healthcare professionals through FGs at HMC. A combined inductive and deductive thematic analysis was applied to transcripts from five FGs, focusing on identifying barriers and enablers to safe medication management among older adults. Two researchers transcribed the audio-recorded FG discussions verbatim, and two researchers analysed the data using a mixed inductive and deductive thematic analysis approach utilising CFIR constructs.

Results:

We engaged 53 healthcare professionals (31 physicians, 10 nurses and 12 clinical pharmacists) in FGs. The analysis identified current barriers and enabler themes under different CFIR constructs, including inner settings, outer settings, individual characteristics and intervention characteristics. We identified 44 themes, with 25 classifieds as barriers and 19 as enablers. The findings revealed that barriers and enablers within the inner settings were primarily related to structural characteristics, resources, policies, communication and culture. On the other hand, barriers and enablers from the outer settings included patients and caregivers, care coordination, policies and laws, and resources.

Conclusion:

This study identified several barriers and enablers to promote medication management for older adults using the CFIR constructs from the perspective of healthcare professionals. The multifaceted findings emphasise involving stakeholders like clinical leaders, policymakers and decision-makers to address medication safety factors. A robust action plan, continuously monitored under Qatar’s national strategy, is vital. Further research is needed to implement recommended interventions.
The Efficacy and Safety of Bisphosphonate Therapy for Osteopenia/Osteoporosis in Patients With Chronic Kidney Disease: A Systematic Review and Individual Patient-Level Meta-Analysis of Placebo-Controlled Randomized Trials
Authors: Whitlock Reid , MacDonald Kerry , Tangri Navdeep , Walsh Michael , Collister David
Published: October 2024

Background:

The efficacy and safety of bisphosphonate therapy for the treatment of osteoporosis and osteopenia in the setting of chronic kidney disease (CKD) is unclear.

Objective:

To determine the effect of bisphosphonate therapy on fractures, bone mineral density (BMD), and adverse events in adults across the spectrum of CKD and dialysis.

Design:

Systematic review and individual patient-level meta-analysis.

Setting:

Searches of Ageline, CINAHL, the Cochrane Library, EMBASE, and Medline from inception to August 25, 2016, supplemented with manual screening and clinicalstudydatarequest.com . Authors were contacted for individual patient-level data.

Patients:

Randomized, placebo-controlled trials with 100 or more participants that evaluated the treatment of primary osteoporosis/osteopenia in adult men and women with bisphosphonate therapy.

Measurements:

Study characteristics, quality, and data were assessed independently by 2 reviewers. Outcome measures were fractures, BMD, and adverse events including decline in estimated glomerular filtration rate (eGFR) and hypocalcemia (calcium <2.00 mmol/L).

Methods:

Single-stage individual patient-level meta-analysis.

Results:

Of 39 eligible studies, individual patient-level data was available for 7 studies, all of which were studies of ibandronate. Of 7428 participants (5010 ibandronate, 2418 placebo), 100% were female, 98.6% were white, the mean body mass index was 25.7 kg/m2 (SD 3.9), 18.9% were smokers and there were 740 fracture events. The mean eGFR was 69.1 mL/min/1.73 m2 (SD 15.9) including 14.5%, 54.9%, 27.5%, 3.0%, and 0.2% stages G1, G2, G3A, G3B, and G4 CKD. Ibandronate increased hip and lumbar spine BMD and decreased the risk of fracture in the overall population (hazard ratio (HR) 0.871, 95% confidence interval (CI) 0.746, 1.018) but in patients with stage G3B CKD, it increased the risk of fracture (HR 3.862, 95% CI 1.156, 12.903). Ibandronate did not impact eGFR over 12 months but increased the risk of hypocalcemia (HR 1.324, 95% CI 1.056, 1.660) with no evidence of any effect modification by CKD stage (all tests of interaction p > 0.05).

Limitations:

Clinically significant heterogeneity among studies, lack of long-term follow-up and bone biopsy results, limited representation of stage G4 and G5 CKD patients.

Conclusions:

Chronic kidney disease potentially modifies the efficacy but not the safety of bisphosphonate therapy in osteopenia and osteoporosis.

Registration:

PROSPERO CRD42020145613
Effects of smartphone-based music intervention on improving emotional and psychosomatic symptoms of patients with hematological malignancy: A study protocol for a non-inferiority randomized controlled trial
Authors: Zhang Weifen , Chen Lo-Ting , Xu Nengwen , Ke Feifei , Lan Liming , Li Linjie , Liu Wei’e , Chen Xijing
Published: October 2024

Objectives

Smartphone-based music intervention (S-MI) may increase the accessibility and feasibility for benefiting patients. This study aims to assess the effectiveness of S-MI in alleviating emotional and psychosomatic symptoms in patients with hematological malignancies, compared to the smartphone delivered Mindfulness-Based Stress Reduction Training (S-MBSR).

Methods

This study will be a non-inferiority randomized controlled trial design. A total of 120 eligible participants with hematological malignancies will be randomly assigned to either the experimental group (S-MI) ( n = 60) or the comparison group (S-MBSR) ( n = 60). Participants will use the Mind Habit app to participate in daily sessions of S-MI or S-MBSR, lasting 5–10 min each, for 2 weeks. The primary outcome, anxiety, and the secondary outcomes, depression, sleep quality, psychological perceived harmony, emotional regulation self-efficacy, as well as the exploratory outcome performance status, will be assessed four times (i.e., pre-test, mid-test, post-test, and follow-up) using validated instruments: the General Anxiety Disorder-7, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index Inventory, Balanced Index of Psychological Mindedness, Regulatory Emotional Self-Efficacy Scale and Zubrod/ECOG/WHO. In addition, participants will provide daily self-reports on their mood and psychosomatic symptoms both before and after each day's intervention. Physiological parameters will be collected at pre- and post-test. Compliance will be measured at pre-test and follow-up. Intent-to-Treat and Per Protocol Set analysis will be used for data analysis.

Results

The primary outcome will focus on evaluating the change of anxiety. Secondary outcomes will examine the changes in depression, sleep quality, psychological perceived harmony, and emotional regulation self-efficacy. The exploratory outcomes will encompass assessments of performance status, self-reported evaluations, physiological parameters, and compliance.

Conclusion

This study aims to provide empirical evidence supporting the efficacy of S-MI in mitigating emotional and psychosomatic symptoms in patients with hematological malignancies.

Trial Registration

The trial was registered and identified as ChiCTR2200065896.
Specialized nurses’ role in ensuring patient safety within the context of telehealth in home care: A scoping review
Authors: Vaismoradi Mojtaba , Rae John , Turunen Hannele , Logan Patricia A.
Published: October 2024

Objectives

Specialized nurses are uniquely positioned to implement innovative telehealth solutions to improve the quality and safety of home care, and this has become a focal point of contemporary healthcare research. This review aimed to identify the nature and scope of specialized nurses’ roles in ensuring patient safety within the context of telehealth in home care.

Methods

A scoping review of the international literature was carried out from January 1, 2013, to August 29, 2024. The review employed Levac et al.'s framework to delineate the research phenomenon and consolidate existing empirical research findings. Through a comparative analysis, the review integrated findings from selected studies, highlighting both similarities and differences related to this phenomenon, which led to the development of distinct categories.

Results

The search yielded 1127 articles, from which 23 studies met the inclusion criteria for research synthesis and subsequent reporting of results. These studies spanned specialized nurses’ roles in telehealth and various fields in which specialized nurses utilized telehealth to deliver high-quality and safe home care. The findings highlighted key outcomes linked to the improvement of patient safety in home care encompassing continuity of care, confidence in care, monitoring and early intervention, medication safety, engagement and adherence, and healthcare costs.

Conclusions

The review revealed the crucial role played by specialized nurses in harnessing telehealth in healthcare to meet the highest care standards, creating an environment that prioritizes the well-being and patient safety in home care.
Internet-delivered cognitive behaviour therapy for affective disorders, anxiety disorders and somatic conditions: An updated systematic umbrella review
Authors: Käll Anton , Biliunaite Ieva , Andersson Gerhard
Published: October 2024

Background

Internet-delivered cognitive behaviour therapy (ICBT), which can involve guidance from a clinician, continues to be a way to deliver psychological treatments. A previous umbrella review identified moderate-to-large effect sizes favouring ICBT compared to control conditions when treating major depression and anxiety disorders. Given the rapid developments in the field, an updated umbrella review of available meta-analyses can show other conditions and subpopulations for which ICBT is effective. The aim of the study was to provide an expanded overview of the efficacy of ICBT for a broader range of adult psychiatric and somatic conditions.

Methods

We conducted an updated search of the literature since the publication of the previous umbrella review back in 2019 and up until March 2024. Five different search engines were used (Medline (OVID), Scopus, Web of Science, Cochrane library and CINAHL). The search was expanded to include additional psychiatric conditions (e.g., suicidal ideation) and somatic conditions (e.g., tinnitus and chronic pain).

Results

Of the 6509 identified articles, 39 meta-analyses met the inclusion criteria. In these meta-analyses 19 unique outcomes were represented. The most common outcome was symptoms of major depressive disorder, followed by symptoms of anxiety. Effect sizes for the comparisons against control conditions ranged between small (e.g., SMD = 0.10 for stress in employees) to large (e.g., SMD = 1.20 for depressive symptoms among older adults).

Conclusions

ICBT can generally reduce symptoms of a wide range of conditions including both psychiatric and somatic conditions, as well as other mental health problems. This updated review of available meta-analyses also indicated that ICBT has been successful in treating symptoms in different subpopulations such as older adults and students. However, some knowledge gaps remain, including the use of ICBT for psychotic disorders, and the quality of the available meta-analyses’ points to a need for more stringent methodological procedures.
Multitask learning to predict successful weaning in critically ill ventilated patients: A retrospective analysis of the MIMIC-IV database
Authors: Lin Ming-Yen , Chi Hsin-You , Chao Wen-Cheng
Published: October 2024

Objective

Weaning is an essential issue in critical care. This study explores the efficacy of multitask learning models in predicting successful weaning in critically ill ventilated patients using the Medical Information Mart for Intensive Care (MIMIC) IV database.

Methods

We employed a multitask learning framework with a shared bottom network to facilitate common knowledge extraction across all tasks. We used the Shapley additive explanations (SHAP) plot and partial dependence plot (PDP) for model explainability. Furthermore, we conducted an error analysis to assess the strength and limitation of the model. Area under receiver operating characteristic curve (AUROC), calibration plot and decision curve analysis were used to determine the performance of the model.

Results

A total of 7758 critically ill patients were included in the analyses, and 78.5% of them were successfully weaned. Multitask learning combined with spontaneous breath trial achieved a higher performance to predict successful weaning compared with multitask learning combined with shock and mortality (area under receiver operating characteristic curve, AUROC, 0.820 ± 0.002 vs 0.817 ± 0.001, p < 0.001). We assessed the performance of the model using calibration and decision curve analyses and further interpreted the model through SHAP and PDP plots. The error analysis identified a relatively high error rate among those with low disease severities, including low mean airway pressure and high enteral feeding.

Conclusion

We demonstrated that multitask machine learning increased predictive accuracy for successful weaning through combining tasks with a high inter-task relationship. The model explainability and error analysis should enhance trust in the model.
Initial feasibility evaluation of the RISES system: An innovative and activity-based closed-loop framework for spinal cord injury rehabilitation and recovery
Authors: Madarshahian Shirin , Guerrero Tatiana , Aung Phyo Thuta , Gustafson Kristin , Harrop James S. , Johnson Dana R. , Khantan Mehdi , Lee Yunsoo , Matias Caio , McCurdy Michael , Grampurohit Namrata , Mulcahey MaryJane , Napoli Alessandro , Vaccaro Alexander , Serruya Mijail
Published: October 2024

Background

Electrical stimulation of the spinal cord may improve rewiring of the affected pathways. Immediate modulation of stimulation parameters, and its effects of it on kinematics and electromyographic variables is unclear.

Methods

This study piloted the safety and feasibility of the Reynolds Innovative Spinal Electrical Stimulation (RISES) technology with a focus on its novel closed-loop setting. This personalized, task-specific non-invasive stimulation system enables real-time stimulation parameter modulation and supports multi-data acquisition and storage. Four SCI participants underwent a clinical trial coupled with activity-based training. Primary safety outcome measures included adverse events (AEs) and skin integrity; secondary measures were vital signs, pain, and fatigue assessed at the pre, mid, and post-stimulation sessions. The trial included open-loop and closed-loop blocks of transcutaneous spinal cord stimulation (tSCS).

Results

Results showed no serious adverse events, with skin integrity unaffected. Vital signs and pain showed no significant differences across session timepoints. Fatigue levels differed significantly with post-session > mid-session > pre-session. Comparisons between open-loop and closed-loop blocks showed no significant differences in setup time, vital signs, pain, or fatigue. Average stimulation duration per task was significantly longer for open-loop (467.6 sec) than Closed-loop (410.8 sec).

Conclusions

RISES, demonstrated safety and feasibility. Further work will focus on clinical efficacy.
The Ethoses of (Dis)Connecting with Friends on Social Media: Digital Cocooning and Entrepreneurial Networking among People with Eating Disorders
Authors: Saukko Paula , Malson Helen , Brown Anna
Published: October 2024

Recent media studies conversations on disconnection or reducing mainly the quantity of engagement with social media so as to enhance well-being have suggested that these practices articulate a contemporary spirit focused on self-care and performance (productivity) that does not consider others or collective solutions. Drawing on and pushing forward disconnection research, we put forward a Foucauldian inspired concept of ethos that draws attention to qualitatively different principles and values characterizing social media socialities which users seek to foster and avoid. Interviews with people ( n = 31) with eating disorders (EDs) featured what we call digital cocooning; that is, interaction with trusted real-life friends and family afforded by messaging apps characterized by mutual responsiveness, acceptance, and belonging. However, what we term entrepreneurial networking with wider acquaintances mostly on traditional social media was experienced as evaluative and competitive and fuelled a sense of non-belonging, prompting unfriending. Disconnection research has highlighted how social media (dis)connections are often underpinned by contemporary possessive individualism, obscured by the dominant research on ostensibly universal psychological processes. The concept of ethos pushes this research beyond criticism toward also highlighting alternatives or how social relations in social media and society could be imagined otherwise.
Ratio of Tibial Tubercle–Trochlear Groove Distance to Patellar Width as a Predictor of Patellar Dislocation: Analysis of Individualized Tibial Tubercle Lateralization Parameters
Authors: Chen Yurou , Tian Wei , Yuan Mao , Yang Haitao , Lv Fajin , Lv Furong , Li Jia
Published: October 2024

Background:

Available conventional tibial tubercle lateralization (TTL) parameters fail to account for individual patient size or anatomy.

Purposes:

To evaluate the predictive ability of individualized TTL parameters and clarify the best predictor of patellar dislocation (PD) and to determine the relationship of the best predictor with other risk factors of PD with quadriceps isotonic contraction.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

A total of 15 patients with PD (28 knees) and 14 controls (28 knees) underwent 4-dimensional computed tomography, and the image with the knee fully extended and quadriceps isotonically contracted was selected for evaluation. The following TTL parameters were measured on the images: tibial tubercle–trochlear groove (TT-TG) distance, tibial tubercle–Roman arch distance, and tibial tubercle–posterior cruciate ligament distance, as well as their ratios to femoral condylar width and patellar width (PW). In addition, the following parameters were measured: Insall-Salvati ratio, Blackburne-Peel ratio, Caton-Deschamps ratio, modified Insall-Salvati ratio, bisect offset index, congruence angle, lateral patellar tilt, lateral trochlear inclination, sulcus depth, sulcus angle, trochlear groove medialization, patella–patellar tendon angle, patellofemoral axis angle (P-FAA), patellar articular facet–patellar tendon angle, patellar articular facet–femoral axis angle (PA-FAA), and patellar shape according to Wiberg type. The area under the receiver operating characteristic curve (AUC) was calculated to access the diagnostic accuracy of the TTL parameters for PD, and the TTL parameters with high diagnostic ability were evaluated for correlation with the remaining parameters.

Results:

The TT-TG/PW ratio had the best diagnostic ability for PD (AUC = 0.890). The TT-TG/PW ratio was positively correlated with bisect offset index, congruence angle, lateral patellar tilt, P-FAA and PA-FAA ( r = 0.610, 0.465, 0.635, 0.553 and 0.418, respectively; P≤ .027 for all), and TT-TG/PW ratio was greater in knees with type II versus type III patella ( P = .017).

Conclusion:

With the knee fully extended and quadriceps isotonically contracted, the TT-TG/PW ratio was found to be the best predictor of PD and reflected individualized TTL, which helps with clinical preoperative planning.
When Does Positive Communication Maximize Effective Information Flow?
Authors: Martin Daniel
Published: October 2024

Positive communication and its importance to organizations has become a popular topic of research among organizational scholars. However, there remains a paucity of work exploring nonlinearities in the role of positivity in communication effectiveness, with little research examining whether there can be too much of a good thing when it comes to communication positivity. To address these gaps in the literature on positive communication, I tested the hypothesis that work-related workplace communication will exhibit an inverted U-shaped curvilinear relationship with positive emotion. This relationship is hypothesized to result from a tradeoff between total workplace communication and the proportion of total workplace communication that is explicitly work-related as communication positivity increases. The results of this study generally support the hypothesized relationship and, save for some minor caveats, the hypothesized mechanisms underlying it. Enclosed are discussions on these caveats and the implications of this study’s findings for both organizational researchers and practitioners.
Experiences and Perspectives of Transgender Individuals Accessing Gender-Affirming Care in Manitoba, Canada
Authors: Bridgwater Ezra , Gill Gagan , Ducharme Jennifer , Hensel Jennifer
Published: October 2024

As the number of trans people seeking gender-affirming care (GAC) continues to increase globally, it is increasingly important to understand the experiences of this patient population to improve healthcare delivery and ensure identified needs are being met. This qualitative descriptive study describes the experiences and perspectives of trans people (age 18–34) accessing GAC in Manitoba, Canada based on data obtained from semi-structured focus groups and individual interviews ( N = 10). Three major themes were identified to capture key elements of seeking GAC: (1) the transition decision, (2) the transition process, and (3) barriers to receiving desired care. In each major theme, subthemes were described. In addition to providing insight into critical aspects of this journey, this study also highlights the importance of including a diverse variety of perspectives when considering the design of healthcare services for the trans community.
The light side of urban planning: Queer space in Beersheba between displacement and recognition
Authors: Mandelbaum Rani , Misgav Chen , Yiftachel Oren
Published: October 2024

How can the ‘dark side’ of urban policy and planning be transformed into a ‘light side?’ How can displaceability and exclusion of an urban minority be reversed? How can marginalized groups enter the mainstream and achieve recognition, security and a stake in urban resources? The critical literature on the ‘dark side’ of planning rarely deals with the transformation from oppression to justice for excluded groups. The story of queer (LGBTQ+) space in Beersheba, Israel, which illustrates such a process, is analyzed here through the struggle to organize a gay parade and be allocated municipal assets for community use. The paper traces the transformation of the relationships between the community, the mayor and the City Council. The analysis shows how urban citizenship became a site of struggle constructed “from below,” coupled with the ability to mobilize support from other cities and political pragmatism. In order to locate this struggle in a broader context, the LGBTQ+ struggle is compared to that of another minority, Beersheba’s Bedouin-Arab community. The latter’s plight shows that while the LGBTQ+ commrecognition and moving towards the ‘light side,’ the Arab community was experiencing the ‘dark side,’ with increasing urban oppression and displacement. The study thus shows how a liberal, gay struggle may also be used to “pinkwash” on-going displacement of other communities in the urban periphery.
The joys of fragile X: Understanding the strengths of fragile X and delivering a diagnosis in a helpful, holistic way
Authors: Herring Jonathan , Johnson Kirsten , Scerif Gaia , Weight Emilie , Richstein Jörg , Crawford Hayley , Robinson Heloise , Gawarammana Radhini , Ellis Katherine
Published: October 2024

The purpose of this article is to provide a positive framework for a doctor, geneticist, genetic counsellor or other professional to deliver a fragile X syndrome diagnosis and to offer support thereafter. Our aim is not to glamourise the condition nor downplay its impacts but rather to suggest that a more accurate and holistic definition of fragile X syndrome would cover all the aspects of the condition, including its variability and positive aspects. Fragile X syndrome is commonly described in terms of the ‘problems’ associated with it and stigmatic language is used. Instead, we believe that giving diagnosis and support in a holistic and family-centred way is imperative. In delivering a fragile X syndrome diagnosis, the strengths of those living with fragile X syndrome should be the starting point, encouraging development that builds on those strengths while supporting the areas of need. This article will set out these more positive aspects of fragile X syndrome to assist those providing a diagnosis of fragile X syndrome.

Lay abstract

The purpose of this article is to provide a positive framework for a doctor, geneticist, genetic counsellor or other professional to deliver a fragile X syndrome (FXS) diagnosis and offer support. Our aim is to give a more accurate and holistic definition of FXS. This would cover all the aspects of the condition, including its variability and positive aspects. FXS is commonly described in terms of the ‘problems’ associated with it and stigmatic language is used. Instead, we believe that giving diagnosis and support in a holistic and family-centred way is important. In delivering a FXS diagnosis, the strengths of those living with FXS should be the starting point. These strengths should be built on at the same time as supporting areas of need.
The British NHS at 75: Past, Contemporary, and Future Challenges
Authors: Williams Ben
Published: October 2024

This article assesses how and why the National Health Service (NHS) has remained at the forefront of British politics and society for 75 years amid significant economic pressures, organizational strain, shifting ideological trends, ongoing reforms, and an unprecedented public health emergency. The postwar “years of consensus” evolved into alleged decline and ostensible neglect during the 1980s, while New Labour sought to rejuvenate this core public service after 1997, featuring investment and often controversial reforms that challenged the party's social democratic values. Amid the New Labour era, NHS powers filtered down to devolved administrations, while from 2008 retrenchment and austerity ensued, fueled by global recession. Austerity eventually subsided, yet from early 2020 the NHS swiftly faced the extreme conditions of the globalized Covid-19 pandemic. The service continues to face challenges regarding its longer-term viability, and this article analyzes this scenario, within the context of the NHS's 75-year historical legacy, its contemporary status, comparative international trends, and likely future evolution.
The Health of Those Who Feed Us: An Assessment of Health Inequities Along the United States Food Chain
Authors: Vignola Emilia F. , Li Jia , Silver Sharon R. , Baron Sherry
Published: October 2024

While the health of all depends on the food chain, few studies have focused systematically on the health of food chain workers themselves (production, manufacturing, wholesale, retail, and commercial and institutional services). In this study we used 2018 and 2019 data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine health-related metrics of food chain workers, combined and by industry sector, compared to non-food chain workers, among 32 U.S. states. Logistic regression indicated U.S. food chain workers had higher prevalences of barriers to health care access, smoking, no physical exercise, and poor self-reported health than all other workers. Patterns were similar among food chain workers in all industry sectors except wholesale. Additionally, commercial food services workers had higher prevalence of poor mental health, while institutional food services workers had higher prevalences of obesity, diabetes, and hypertension than all other workers. We discuss implications of these results for interventions, with specific attention to improving employment conditions. Food chain worker health is critical for food system sustainability and population health equity.
What is the Role of Minimum Wages in Addressing Precarious Employment in the Informal and Formal Sectors? Findings from a Systematic Review
Authors: Håkansta Carin , Gunn Virginia , Kreshpaj Bertina , Matilla-Santander Nuria , Wegman David H. , Hogstedt Christer , Vignola Emilia F. , Muntaner Carles , Bodin Theo , O’Campo Patricia , Lewchuk Wayne
Published: October 2024

This article presents synthesized evidence from 16 studies examining initiatives with potential to mitigate workers’ exposure to precarious employment through the adoption of minimum wage policies. All studies were set in low-income countries and focused on both formal and informal workers. A systematic review of evaluated initiatives addressing precarious employment identified the evidence. We consider minimum wage policies as initiatives that could address precarious employment because of the central role of minimum wages in establishing employment terms for workers in precarious situations. We include initiatives aimed at formal and informal workers, given that precarious employment can exist in both sectors, that these workers share concerns regarding income and would benefit from minimum wage policies. The findings imply that minimum wage policies could increase precariously employed workers’ financial compensation, although with some differences and with little or no effect on employment security. It is not feasible to extend these conclusions beyond low-income economies due to differences with high-income economies in how the mechanisms through which minimum wage policies could impact worker compensation and employment security. However, they should serve as a reminder for high-income economies, many of which experience expanding informal sectors, about the need for related research and policy.
Association Between Patient-Level Factors and Positive Treatment Response Among Individuals With a Psychostimulant Use Disorder: A Cross-Sectional Study
Authors: Abulez Dana , Brown Clare C , Cucciare Michael A , Hayes Corey J
Published: October 2024

Objectives:

The purpose of this study was to provide insights into which patient-level characteristics are associated with a positive treatment response among patients whose primary drug of choice was a psychostimulant with a particular emphasis on understanding the impact of age at first use and co-occurring psychiatric comorbidities.

Methods:

We used a cross-sectional study design and the 2019 US Treatment Episode Data Set: Discharges (n = 167 802) to identify outpatient treatment episodes for which the primary drug of choice was a psychostimulant. We defined a positive treatment response as (1) a reduction in drug use between treatment admission and discharge or (2) no use at both admission and discharge. Multivariable logistic regression was conducted, overall and stratified by presence of psychiatric comorbidity, to identify demographic, clinical, and treatment-level factors associated with positive treatment response.

Results:

Treatment episodes among patients 11 years and under at the time of first use had a 22% higher odds of having a positive response to treatment as compared to those treatment episodes in which the person was 30 years or older at the time of first use. The presence of psychiatric comorbidity resulted in substantial differences in direction and magnitude of the relationships between treatment response and covariates. Positive response to treatment was less likely for episodes among Non-Hispanic Black/African American persons, in detoxification settings, for unemployed individuals, or for individuals living in the South, but a positive response was more likely for episodes occurring in rehabilitation/residential settings.

Conclusions:

Race/ethnicity, geographic region, treatment setting, and employment status were the strongest predictors of response to treatment. Treatment programs should maximize treatment of psychiatric conditions, intensify support for persons of color seeking treatment in detoxification settings, and increase efforts to find adequate employment for patients.
Is home environment associated with child fluid reasoning abilities in middle childhood in high-risk settings? findings from a cross-sectional study in Pakistan
Authors: Rasheed Muneera A. , Nilsen Sondre Aasen , Strand Tor A. , Shaheen Fariha , Kvestad Ingrid
Published: October 2024

Background

Evidence from low- and middle-income countries (LMIC) suggests that home environment is associated with early childhood development outcomes. However, studies from LMIC that have examined how the home environment during middle childhood is associated with intellectual abilities are scarce. The objective of the study was to explore the association between different aspects of the home environment at 7–8 years and fluid reasoning abilities in a rural, high-risk cohort in Pakistan.

Methods

We employed a cross-sectional research design to examine 1172 children between 7 and 8 years and their families, utilizing the Home Observation for Measurement of Environment for Middle Childhood (HOME-MC) to evaluate various aspects of the home environment and the Fluid Reasoning Index (FRI) of the Wechsler Intelligence for Children (WISC)-5th edition to assess the fluid reasoning abilities of the children. Multivariable regression analyses were used to examine the association between different components of HOME-MC (scored as indices) and FRI scores.

Findings

Learning materials and opportunities (β = 1.74, 95% CI = 1.15, 2.33) and Responsivity (β = 1.73, 95% CI = 1.07, 2.38) indices had the strongest association with FRI score followed by Family companionship index (β = 1.27, 95% CI = 0.63, 1.90). The eight different indices of the HOME-DC explained 22% of the total variation in FRI scores.

Conclusion

We conclude that concurrent learning opportunities, parental responsivity and family companionship at home are associated with fluid reasoning abilities during middle childhood which is comparable to what has been found in early childhood years.
Identifying and addressing health-related social needs: a Medicaid member perspective
Authors: Sabatino Meagan J. , Sullivan Kate , Alcusky Matthew J. , Nicholson Joanne
Published: October 2024

Background

Multiple state and national health care organizations have invested in activities to screen for and address the health-related social needs (HRSNs) of their patients. However, patient perspectives concerning HRSN screening discussions and facilitated referrals to supports are largely unexplored. The main objectives of this study were to explore the ways in which Massachusetts Medicaid (MassHealth) members engage with their health care clinicians to discuss HRSNs, to identify common needs discussed, and to describe whether members feel these needs are being addressed by health care clinicians and staff.

Methods

The study team performed a cross-sectional, qualitative research study that included in-depth, open-ended interviews with 44 adult MassHealth members. Interviews were conducted between June and October 2022. Interviews were recorded, transcribed, and systematically coded for analysis, and common themes were reported. The data collected for this study were part of a larger independent evaluation of MassHealth’s 2017-2022 Section 1115 Demonstration that granted authority from CMS to implement health care delivery system reforms in Massachusetts.

Results

In this qualitative study of Medicaid members, some reportedly felt comfortable freely discussing all of their clinical and social needs with their health care clinicians, while others noted feelings of apprehension. Several members recalled being asked about their HRSNs in various clinical or community settings, while others did not. The majority of members endorsed having an unmet HRSN, including housing, nutrition, financial, or transportation issues, and many barriers to addressing these HRSNs were discussed. Finally, many members cited a preference for discussing HRSNs with community-based care coordinators and social workers at the community partner organizations rather than with their health care clinicians. Community-based care coordinators were lauded as essential facilitators in making the connection to necessary resources to help address HRSNs.

Conclusions

Study results highlight an opportunity to increase the effectiveness of HRSN screening and referral practices within the health care setting through relationship building between Medicaid members and diverse interdisciplinary care teams that include staff such as community health workers. Continued investment in cross-sector partnerships, screening workflows, and patient-clinician relationships may contribute to establishing an environment in which members can comfortably discuss HRSNs and connect with needed services to improve their health.
Medical student perceptions of gender and pain: a systematic review of the literature
Authors: Patrick-Smith Maia , Bull Stephanie
Published: October 2024

Background

Gender bias exists in healthcare and affects how pain is assessed and managed. This bias affects patient outcomes and their trust in healthcare professionals. We also know that future clinicians develop their attitudes early in training. Medical school is therefore an opportunity to shape the values of future doctors and to combat systemic gender bias in healthcare. This systematic review aims to explore medical student perceptions of the relationship between patients’ gender and their pain, so that recommendations can be made for developing medical education.

Methods

Embase, MEDLINE, PsychINFO, LILACS, Global Index Medicus, PakMediNet and ERIC were searched for articles relating to medical student perceptions of gender and pain, with no geographical or language limitations. Quality was assessed using the Medical Education Research Study Quality Index and the Critical Appraisal Skills Programme checklist.

Results

Nine publications were identified, two qualitative and seven quantitative. All studies had methodological limitations. Many different study designs were used, although most involved simulated patients. All studies referred to gender as binary. Multiple studies found that women’s pain is more likely to be underestimated by medical students and that the patient’s gender drives different approaches during clinical history taking, examination and management in these simulated situations. Only one study found no effect of patients’ gender on students’ perception of their pain.

Conclusions

Whilst there is a paucity of high-quality studies in this area, patients’ gender was found to affect how their pain is perceived by medical students. No studies explored where students’ attitudes towards gender and pain arise from, and few involved ‘real life situations’. We propose that further work into medical student perceptions in ‘real situations’ is needed. This will help to inform how undergraduate medical education can be developed to tackle gender bias, and ultimately improve outcomes for patients.
Physical activity levels are positively related to progression-free survival and reduced adverse events in advanced ER+ breast cancer
Authors: Zimmer Philipp , Esser Tobias , Lueftner Diana , Schuetz Florian , Baumann Freerk T. , Rody Achim , Schneeweiss Andreas , Hartkopf Andreas D. , Decker Thomas , Uleer Christoph , Stoetzer Oliver J. , Foerster Frank , Schmidt Marcus , Mundhenke Christoph , Steindorf Karen , Tesch Hans , Jackisch Christian , Fischer Thomas , Hanson Sven , Kreuzeder Julia , Guderian Gernot , Fasching Peter A. , Bloch Wilhelm
Published: October 2024

Background

Increased levels of physical activity are associated with a reduction of breast cancer mortality, especially in postmenopausal women with positive hormone receptor status. So far, previous observational case–control and cohort studies have focused on associations between overall leisure time physical activity and survival of women with breast cancer in general.

Methods

In this multicenter prospective cohort study, conducted in Germany between 30th August 2012 to 29th December 2017, we investigated general physical activity in a homogenous sample of n = 1440 postmenopausal women with advanced (inoperable locally advanced or metastatic), hormone receptor-positive breast cancer receiving the same therapy (everolimus and exemestane). Self-reported physical activity was assessed using the Godin Leisure Time Exercise Questionnaire (GLTEQ) before and every 3 months during treatment. Participants were then classified into “active” and “insufficiently active” to screen their activity behavior the week prior to medical treatment. In addition, changes in physical activity patterns were assessed. Adjusted Cox regression analyses were performed for the activity categories to determine hazard ratios (HR). Besides progression-free survival (PFS), adverse events (AEs), QoL, and fatigue were assessed every 3 months until study termination.

Results

Compared to “insufficiently active” patients, “active” individuals indicated a significantly longer PFS (HR: 0.84 [0.74; 0.984], p = .0295). No significant differences were observed for changes of physical activity behavior. Patients who reported to be “active” at baseline revealed significantly fewer AEs compared to “insufficiently” active patients. In detail, both severe and non-severe AEs occurred less frequently in the “active” patients group. In line with that, QoL and fatigue were better in physical “active” patients compared to their insufficient active counterparts at the last post-baseline assessment. Participants who remained or become active indicated less AEs, a higher QoL, and reduced fatigue levels.

Conclusions

Physical activity behavior prior to medical treatment might have prognostic value in patients with advanced breast cancer in terms of extending the PFS. Moreover, physical activity before and during treatment may reduce treatment-related side effects and improve patients’ QoL and fatigue.

Trial registration

EUPAS9462. Registered 30th October 2012 “retrospectively registered.”
Deriving the PedsUtil health state classification system to measure health utilities for pediatric populations based on the PedsQL: a confirmatory factor analysis
Authors: Kim DeLuca Ellen , Dalziel Kim , Wittenberg Eve , Rose Angela M. , Prosser Lisa A.
Published: October 2024

Background

An important methodological challenge in conducting pediatric economic evaluations is estimating the preference-based health-related quality of life (HRQoL) of children. Current methods are highly variable and there is no single instrument available to value HRQoL consistently across multiple pediatric age groups. The Pediatric Quality of Life Inventory (PedsQL) is a non-preference-based generic HRQoL instrument validated for children 2–18 years, but it cannot be directly used in economic evaluations. The aim of this study was to establish the core dimension structure of the PedsUtil health state classification system using confirmatory factor analysis, which is the first step of deriving a preference-based measure of HRQoL based on the PedsQL.

Methods

Four competing dimension structures of the PedsUtil health state classification system were developed based on published literature and expert opinion. Using data from the Longitudinal Study of Australian Children (LSAC) (n = 45,207), the 4 dimension structures were evaluated using the robust weighted least squares estimation method. The analyses were stratified by 2-year age intervals (from 2 to 17 years) to reflect the study design of the LSAC, as well as special healthcare needs status of the child. Model fit was evaluated by examining standardized factor loadings and various fit indices including the comparative fit index (CFI), Tucker-Lewis Index (TLI), and the root mean square error of approximation (RMSEA). Modification indices and residual correlations were examined to re-specify the models to improve model fit when necessary.

Results

The findings supported a 7-dimension structure (i.e., Physical Functioning, Pain, Fatigue, Emotional Functioning, Social Functioning, School Functioning, and School Absence) of the PedsUtil health state classification system. The 7-dimension model exhibited adequate fit across subgroups with CFI values that ranged from 0.929 to 0.954, TLI values from 0.916 to 0.946, and RMSEA values from 0.058 to 0.102.

Conclusions

This study established the core dimension structure of the PedsUtil health state classification system using confirmatory factor analysis. The 7-dimension structure was found to be applicable across diverse pediatric populations. Research is currently ongoing to select the most representative item within each dimension of the PedsUtil health state classification system and valuation surveys will be fielded to estimate the PedsUtil scoring system.