bluuebunny/crossref_metadata_2025 huggingface dataset:
Qualitative genomic research with Indigenous peoples: a scoping review of participatory practice
Authors: Ehman Morgan , Caron Nadine R , Montour Laurie , Regier Dean A
Published: October 2024

Introduction

Indigenous peoples and perspectives are under-represented within genomic research. Qualitative methods can help redress this under-representation by informing the development of inclusive genomic resources aligned with Indigenous rights and interests. The difficult history of genomic research with Indigenous peoples requires that research be conducted responsibly and collaboratively. Research guidelines offer structuring principles, yet little guidance exists on how principles translate into practical, community-led methods. We identified the scope and nature of participatory practice described in published qualitative genomic research studies with Indigenous peoples.

Methods

We performed a search of PubMed, CINAHL, Embase, Scopus and the Bibliography of Indigenous Peoples in North America. Eligible studies reported qualitative methods investigating genomics-related topics with Indigenous populations in Canada, the USA, Australia or New Zealand. Abstracted participatory practices were defined through a literature review and mapped to a published ethical genomic research framework.

Results

We identified 17 articles. Published articles described a breadth of methods across a diversity of Indigenous peoples and settings. Reported practices frequently promoted Indigenous-partnered research regulation, community engagement and co-creation of research methods. The extent of participatory and community-led practice appeared to decrease as studies progressed.

Conclusion

Applying non-prescriptive Indigenous genomic research guidelines to qualitative inquiry can be achieved through varied methodological approaches. Our findings affirm the adaptive nature of this process in real-world settings and identify opportunities for participatory practice and improved reporting across the research lifecycle. These findings and the breadth of characterised applied research practices are instructive for researchers seeking to develop much-needed qualitative genomic research partnerships.
Development of a multifactorial prediction model for commute mode choice in 10 983 Finnish public sector employees: a cross-sectional study
Authors: Makkonen Anna , Gluschkoff Kia , Airaksinen Jaakko , Halonen Jaana I , Salo Paula , Ervasti Jenni
Published: October 2024

Objective

The objective of this study is to examine the feasibility of using survey data to identify factors that predict commute mode choice.

Design

The study design is cross-sectional.

Setting

Survey data from the Finnish Public Sector study (2020) were used.

Participants

42 574 public sector employees, of whom 10 983 were selected for the final sample. These included employees with 5 km or less commuting distances and those working full-time onsite or partly remotely. The mean age was 46 (SD 11) years, and 84% were women.

Primary outcomes

Commute by (1) bike or foot (an active mode) during summer and winter weather and (2) by car (a passive mode) during summer and winter weather.

Methods

Using logistic Lasso (least-absolute-shrinkage-and-selection-operator) regression, we developed and tested a prediction model for short commutes of 5 km or less to identify the characteristics of employees most likely to commute actively during summer and winter weather and passively during summer and winter weather.

Results

All models had a good predictive ability with a C-index of 0.82, 0.77, 0.72 and 0.71. Cycling and walking during summer weather were predicted by shorter commutes, higher physical activity, lower body mass index (BMI), female sex and higher team psychological safety. Predictors of cycling and walking during winter weather were shorter commute length, higher physical activity, lower BMI and higher age. Commuting by car during summer weather was predicted by longer journey length, higher BMI, lower physical activity, male sex and having children 7–18 years old living at home. Predictors of driving during winter weather were almost identical, but the male sex was replaced by having a spouse.

Conclusions

We identified the correlates of active and passive commute choice in different weather conditions with eight variables. This information can be used to develop and target interventions to promote sustainable and healthy commuting modes.
Association between exposure to proton pump inhibitors and delirium: a descriptive and disproportionality analysis of VigiBase
Authors: Decros Alexandre , Minoc Elise-Marie , Lelong-Boulouard Véronique , Chrétien Basile , Meurant Alexandre , Alexandre Joachim , Dolladille Charles , Villain Cédric
Published: October 2024

Objectives

Proton pump inhibitor (PPI) exposure can lead to hyponatraemia, which is a common cause of delirium. An association between PPI exposure and delirium without hyponatraemia has been suggested in the literature. We aimed to describe the association between reports of delirium and PPI exposure and to assess the association between PPI and delirium with and without hyponatraemia.

Design

A descriptive and disproportionality analysis of claims data.

Setting

World pharmacovigilance database VigiBase between 1 January 1991 and 9 February 2022.

Primary and secondary outcome measures

In the first part, we described reports of delirium for which involvement of a PPI or interactions of PPIs with other drugs were suspected. In the second part, delirium cases and non-cases were used to assess the disproportionality signal using the reporting OR (ROR) for the associations of PPI exposure with delirium or delirium/hyponatraemia co-events.

Results

We identified 2395 reports of delirium in which involvement of PPI exposure was suspected. Omeprazole, esomeprazole and pantoprazole were the most frequently reported PPIs. Hyponatraemia was present in 11% of the reports. The disproportionality analysis included 1 264 798 reports of adverse drug reactions in patients using PPIs, including 19 081 reports of delirium. We did not find a disproportionality signal for the association between PPI use and delirium (ROR 0.89, 95% CI 0.87 to 0.91). We detected an association of PPI use with delirium/hyponatraemia co-events (ROR 1.53, 95% CI 1.41 to 1.65).

Conclusions

Most reports of delirium in which the involvement of PPIs was suspected did not include concomitant hyponatraemia. However, no significant signal of disproportionate reporting of delirium was observed for PPIs compared with other drugs, except in cases of delirium associated with hyponatraemia. Hyponatraemia may be the main mechanism linking PPI exposure with delirium, and this possibility should be further explored in prospective studies.

Trial registration number

NCT05815550.
Effectiveness of meaning in life intervention programme in young and middle-aged cancer patients: study protocol for a randomised controlled trial
Authors: Wang Shuman , Xu Wenjie , Zhu Yu , Zheng Mimi , Wan Hongwei
Published: October 2024

Introduction

Diminished levels of meaning in life can have a range of detrimental effects on cancer patients, including heightened anxiety, depression, psychological distress, reduced quality of life and, in severe cases, even thoughts of suicide. Notably, young and middle-aged cancer patients often exhibit even lower levels of meaning in life compared with their counterparts in other age groups. The primary objective of this study is to formulate a meaning in life intervention programme and assess its efficacy in enhancing the meaning in life and other relevant indicators among young and middle-aged cancer patients.

Methods and analysis

A prospective, parallel-group randomised controlled trial will be conducted. Eighty-eight young and middle-aged cancer patients will be randomised into either the intervention or control group. The intervention group will receive 4 week, six-session, group-based meaning in life intervention programme, while the control group will receive treatment as usual. The primary outcome is meaning in life, and secondary outcomes are post-traumatic growth and psychological distress. These indicators will be assessed at baseline, on completion of the intervention and again 2 months following its conclusion.

Ethics and dissemination

The trial has received approval from the Institutional Review Board of Shanghai Proton and Heavy Ion Hospital (2202-53-04-2301A-2310B). The study results will be shared through peer-reviewed journals and conferences.

Trial registration number

Chinese Clinical Trial Registry, ChiCTR2200060672.
Impact of the COVID-19 pandemic on initiation of antihypertensive drugs in Sweden: an interrupted time series study
Authors: Tomas Ana , Wettermark Bjorn , Nyberg Fredrik , Hajiebrahimi Mohammadhossein
Published: October 2024

Objectives

Antihypertensives reduce the risk of myocardial infarction and stroke. Restrictions during the COVID-19 pandemic limited access to healthcare, which may have had a negative impact on drug prescribing. This study aimed to assess the effect of the COVID-19 pandemic on the initiation of antihypertensive drugs.

Design

Interrupted time series study using a segmented linear regression model.

Setting

Swedish population assessed through linked national healthcare registers.

Participants

720 300 new users of antihypertensives.

Intervention

March 2020, COVID-19 pandemic onset.

Main outcomes measures

The change in the initiation of antihypertensives expressed as monthly cumulative incidence, stratified by age and sex. Data on dispensed prescriptions of diuretics, beta-blockers, calcium channel blockers, ACE inhibitors (ACEi) and angiotensin receptor blockers were extracted from the Swedish Prescribed Drug Register, from March 2018 to November 2021. Initiation (new use) was defined as having no previous dispensations before March 2019. Monthly cumulative incidence in March 2019–November 2021 was calculated as the number of patients initiating each drug class in each month divided by the population.

Results

The start of the pandemic was associated with an immediate drop in the initiation of any antihypertensive, but no sustained effects were observed, as the incidence continued to increase in the postinterruption period by +0.02% each month in both sexes. The immediate drop was statistically significant for ACEi in both sexes and all antihypertensive classes except diuretics in patients >65 years. А significant postintervention trend change was observed for initiation of diuretics (+0.013% overall), driven mainly by a significant increase in patients >65 years. Similar findings were also observed for diuretics in females (+0.02%) and ACEi (+0.03%) in patients >65 years.

Conclusions

The pandemic had an immediate negative short-term effect, but we found no major long-term negative influence of the COVID-19 pandemic on initiation of any type of antihypertensive drugs.
Co-creation and implementation of a healthy lunch at Dutch primary schools in disadvantaged neighbourhoods: design of a cluster randomised cross-over effectiveness study
Authors: Wargers Annemieke , Polychronakis Katerina , Nieboer Daan , Raat Hein , Jansen Wilma
Published: October 2024

Introduction

The majority of children fails to have a healthy diet. Providing a healthy lunch at school is a way to target all children, regardless of ethnic and socioeconomic background. This study aims to investigate the effectivity and feasibility of a co-created healthy school lunch in disadvantaged neighbourhoods of the city of Rotterdam, the Netherlands.

Methods and analysis

This is a cluster randomised cross-over trial with five participating primary schools. Schools will be randomised to have an 18 week healthy school lunch the first or second half of the academic year. The other half of the academic year, children will bring their own lunch from home. A tailored lunch concept for each school will be co-created with school staff, parents, children and key-stakeholders.

Primary outcome is the dietary content of children’s lunches, assessed by observations for all children. Secondary outcomes include healthy lunch-related parameters, like general dietary behaviour, perceived health, taste preferences, concentration in class, and some feasibility outcomes, like satisfaction, implementation at school and affordability for parents. Secondary outcomes will be assessed by questionnaires for children (grades 5–8), parents and teachers. The observations and questionnaires for children and parents will be completed at baseline (September 2023), half way the academic year (January–February 2024) and at the end of the academic year (June–July 2024). Teachers will complete a monthly questionnaire starting in September 2023.

Ethics and dissemination

This study obtained ethical approval from the Institutional research Review Board Erasmus MC of Rotterdam, the Netherlands. Informed consent will be collected from all participants (parents, teachers and children 12 years or older) and/or their parents (for children under the age of 16). The findings will be disseminated by conference presentations and publications in scientific peer-reviewed journals.

Trial registration number

NCT06058325.
A Self-led Self-management Intervention Supporting Teens with IBD (ASSIST-IBD): protocol for a feasibility study of a novel digital treatment adherence intervention
Authors: Screti Cassandra , Atkinson Lou , Shaw Rachel , Muhammed Rafeeq , Heath Gemma
Published: October 2024

Introduction

Treatment non-adherence is common in young people with inflammatory bowel disease (IBD), yet support is lacking. A self-led self-management intervention supporting teens with IBD (ASSIST-IBD) is a new theory-based digital treatment adherence intervention, co-developed by young people living with IBD. ASSIST-IBD includes 10 short modules supporting adolescents to feel confident to follow their treatment plan, develop skills to overcome adherence obstacles, feel confident when talking to others about IBD and feel positive about the future. This research aims to determine the feasibility of implementing and measuring the effectiveness of ASSIST-IBD, using a single-arm mixed-methods feasibility trial.

Methods and analysis

24 young people (aged 13–17) with IBD identified as being ≤80% adherent, and their parents, will use ASSIST-IBD for 6–12 weeks. For the primary endpoint of progression to randomised controlled trial, qualitative and quantitative data will be collected on; number of eligible members of the target population; number of recruited participants; reasons for non-participation and ineligibility; retention and follow-up rates; reasons for early withdrawal; completeness and utility of outcome measures; as well as further data on intervention acceptability, user experiences and user engagement. Secondary outcomes of preliminary effectiveness will include pre-intervention and post-intervention measures of treatment adherence (MARS-5), quality-of-life (IMPACT-III) and well-being (WEMWBS), and self-reported behaviour change success. Quantitative data will be analysed using descriptive statistics; qualitative data will be analysed thematically. An active patient and public involvement and engagement group will advise on the research throughout, including the development of the protocol.

Ethics and dissemination

The study has been granted ethical approval by Aston University’s Health and Life Sciences Research Ethics Committee (ref:#HLS2112) and NHS Research Ethics Committee, Nottingham 1 Board (IRAS:#344918). Findings will be disseminated via peer-reviewed publications and lay summaries.

Registration details

This protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/KC649).
How professional development can be supported for health and care research methodologists: results of the PROfesSionnal develoPmEnt for Research methodologists (PROSPER) e-Delphi and consensus study
Authors: Iflaifel Mais , Williamson Paula R , Mitchell Eleanor J
Published: October 2024

Objective

Research methodologists play a pivotal role in health and care research, yet they face many challenges relating to their professional development. The PROfesSional develoPmEnt for Research methodologists study was designed to understand and prioritise the professional development and capacity-building needs of research methodologists in the UK.

Design, setting and participants

Three-round electronic Delphi (e-Delphi) survey, with input from stakeholders in the development of the candidate list of professional development aspects followed by a national consensus meeting of health and care research methodologists in the UK.

Main outcome measures

Rated importance of each professional development aspects on a 9-point scale.

Results

207 participants gave their consent to participate in the e-Delphi survey. 189 (91%) completed round 1 and 76% completed all three rounds. In round 1, 35 professional development aspects were rated by priority, with 21 additional aspects suggested by participants and included in subsequent rounds. Rounds 2 and 3 involved rating 56 aspects: 22 achieved ‘consensus in’, 20 were ‘consensus out’ and 14 had ‘no consensus’. The top ‘consensus in’ aspects were supportive line managers, clear career pathways and promotion criteria and time for training. A consensus meeting with 18 participants rerated the 14 ‘no consensus’ aspects, adding three more to the final list. The final list includes 25 priority areas for research methodologists’ professional development.

Conclusions

This study has established the priorities from a professional development perspective for research methodologists. These priorities particularly focus on the importance of support from others, training and development, the value and recognition of the role, employer/contractual agreements and methodological research funding. The list of priorities could help individuals, managers, employers and research funders to improve professional development opportunities and could form the start of the development of a ‘methodologists’ charter’.
Protocol for a scoping review of older informal carers and digital health service use
Authors: Sala Emanuela , Cretazzo Federica
Published: October 2024

Introduction

The ageing population and increasing demands for healthcare pose challenges for national health services, which are increasingly looking to digital health services (DHS) as a potential solution. However, older informal carers, who provide unpaid care, often lack the digital skills necessary to access and use DHS, placing them at risk of social exclusion. This scoping review aims to systematically map and explore the existing literature on this topic, with the goal of identifying and addressing gaps in the research.

Methods and analysis

This scoping review follows Arksey and O'Malley’s methodological framework. A systematic search will be conducted across seven databases: AgeLine, PubMed, ScienceDirect, Scopus, Social Sciences Abstracts, SocINDEX and Web of Science, focusing on studies published in English from 2010 onwards. The research team will collectively work on all stages of the review, ensuring consistency and collaboration throughout. Data extraction will capture key information on study topics, participant demographics, types of DHS and study design. The findings will be analysed using descriptive statistics.

Ethics and dissemination

Ethical approval is not required for this scoping review as it will rely solely on previously published data. The findings will be disseminated through peer-reviewed publications, conference presentations and engagements with non-academic stakeholders through seminars and workshops to maximise societal impact.
Rating of perceived exertion as a tool for managing exercise intensity during pregnancy: a scoping review
Authors: Gjestvang Christina , Olsen Malin Landro , Dalhaug Emilie Mass , Haakstad Lene A H
Published: October 2024

Objective

During pregnancy, international guidelines recommend ≥150 min of moderate-intensity aerobic physical activity per week, with an intensity perceived as fairly light to somewhat hard on the Borg Rating of Perceived Exertion (RPE) scale (ranging from 6 ‘no exertion’ to 20 ‘maximal exertion’, corresponding to 60% to 80% of maximum heart rate). However, the determination and monitoring of exercise intensity seem to be a particular source of confusion, and the most effective method to monitor exercise intensity remains uncertain. This study aimed to examine existing research on the correlation between the Borg RPE scale and maternal heart rate (MHR) for monitoring exercise intensity during pregnancy.

Design

Scoping review using the mixed methods appraisal tool (MMAT) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

Data sources

PubMed, Web of Science and SPORTDiscus were searched from 16–17 April 2023, with a subsequent search on 1 November 2023.

Eligibility criteria

We included studies investigating the correlation between perceived intensity on the Borg RPE scale (6–20) and MHR during exercise in pregnant individuals and written in English/Scandinavian language. There were no restrictions on publication year or study design.

Data extraction and synthesis

Two independent reviewers screened the articles based on title and abstract. Selected articles were read in full text and reference lists of screened articles were also checked. Out of 120 studies screened, six articles met the inclusion criteria after removing one duplicate. The results were qualitatively summarised to provide an overview of common themes and variations between studies. MMAT and GRADE assessed the risk of bias and the certainty of the evidence.

Results

The six studies involved a total of 260 healthy pregnant individuals (gestational week: from 16 to 38), with various exercise protocols (cycling, walking, running and resistance exercise) and intensities (from light to moderate). Three studies supported the Borg RPE scale to estimate exercise intensity during pregnancy, while three found no correlation between this scale and MHR. The certainty of the evidence was graded as low to moderate, with a potential risk of bias due to small sample sizes, incomplete outcome data and inconsistencies across studies.

Conclusion

The mixed results highlight the complexity of monitoring exercise intensity during pregnancy. Using both the Borg RPE scale and MHR might be better than using them separately for monitoring exercise intensity during pregnancy. Due to limited and inconsistent research, more extensive studies are needed.
What is the carbon footprint of academic clinical trials? A study of hotspots in 10 trials
Authors: Griffiths Jessica , Adshead Fiona , Al-Shahi Salman Rustam , Anderson Craig , Bedson Emma , Bliss Judith , Boshoff Ana , Chen Xiaoying , Cranley Denise , Doran Peter , Dunne Fidelma , Gamble Carrol , Gillies Katie , Hood Kerenza , Kavanagh Columb , Malone Julia , McGregor Naomi , McNamara Carolyn , Midha Elis , Moore Keith , Murphy Lucy , Newman Christine , O'Reilly Seamus , Perkins Alexis M , Pett Sarah , Sydes Matthew Robert , Whitty Laura , You Frank , Fox Lisa , Williamson Paula R
Published: October 2024

Background

Clinical trials are fundamental to healthcare, however, they also contribute to anthropogenic climate change. Following previous work to develop and test a method and guidance to calculate the carbon footprint of clinical trials, we have now applied the guidance to 10 further UK and international, academically sponsored clinical trials to continue the identification of hotspots and opportunities for lower carbon trial design.

Methods

10 collaborating clinical trial units (CTUs) self-identified and a trial was selected from their portfolio to represent a variety of designs, health areas and interventions. Trial activity data was collated by trial teams across 10 modules spanning trial setup through to closure, then multiplied by emission factors provided in the guidance to calculate the carbon footprint. Feedback was collected from trial teams on the process, experience and ease of use of the guidance.

Results

We footprinted 10 trials: 6 investigational medicinal product trials, 1 nutritional, 1 surgical, 1 health surveillance and one complex intervention trial. Six of these were completed and four ongoing (two in follow-up and two recruiting). The carbon footprint of the 10 trials ranged from 16 to 765 tonnes CO2e. Common hotspots were identified as CTU emissions, trial-specific patient assessments and trial team meetings and travel. Hotspots for specific trial designs were also identified. The time taken to collate activity data and complete carbon calculations ranged from 5 to 60 hours. The draft guidance was updated to include new activities identified from the 10 trials and in response to user feedback.

Discussion

There are opportunities to reduce the impact of trials across all modules, particularly trial-specific meetings and travel, patient assessments and laboratory practice. A trial’s carbon footprint should be considered at the design stage, but work is required to make this common place.
High-load strength training compared with standard care treatment in young adults with joint hypermobility and knee pain: study protocol for a randomised controlled trial (the HIPEr-Knee study)
Authors: Liaghat Behnam , Bojsen-Møller Jens , Juul-Kristensen Birgit , Henriksen Peter , Mohammadnejad Afsaneh , Heiberg Bibi Dige , Thorlund Jonas Bloch
Published: October 2024

Introduction

Patients with generalised joint hypermobility, including knee hypermobility (GJHk), often experience knee pain and are typically managed with low-intensity strength training and/or proprioceptive training as part of standard care. However, not all patients experience satisfactory outcomes. High-load strength training may offer additional benefits, such as increased muscle cross-sectional area, neural drive and tendon stiffness, which may reduce pain and improve active knee joint stability during movement tasks and daily activities. So far, no randomised controlled trials (RCTs) have compared high-load strength training with traditional treatment strategies (standard care) for this patient group.

Methods and analysis

In this RCT, we aim to recruit patients with GJHk and knee pain from primary care physiotherapy clinics in the Region of Southern Denmark and via social media. Patients with competing injuries or experience with high-load strength training will be excluded. Patients will be randomised (1:1 ratio) to either 2 weekly sessions of high-load strength training or standard care for 12 weeks. The primary outcome is self-reported knee pain during an activity nominated by the patient as the most aggravating for their present knee pain measured using the Visual Analogue Scale for Nominated Activity (VASNA, 0–100; 0=no pain and 100=worst imaginable pain). This will be collected at baseline, 6 weeks, 12 weeks and 12 months. Secondary outcomes include self-reported knee function and adverse events (collected at baseline, 12 weeks and 12 months), objective measurements including a 5-repetition maximum single-leg press, proprioception and single-leg-hop for distance (collected at baseline and 12 weeks), and a range of other outcome measures such as fear of movement, tendon stiffness and global perceived effect. We aim to recruit 90 patients in total to detect a 10 mm group difference in the primary outcome with 80% power.

Ethics and dissemination

This study was funded by Independent Research Fund Denmark (grant number 2034-00088B) on 14 June 2022; the Regional Committees on Health Research Ethics for Southern Denmark approved it (S-20230050) on 30 August 2023. The first recruitment site opened on 15 February 2024, and the final results will be submitted to a peer-reviewed journal to inform rehabilitation strategies for symptomatic GJHk.Protocol version 1, dated 4 July 2024.

Trial registration number

NCT06277401.
Cross-disciplinary working between gynaecologists and mental healthcare professionals: a mixed-methods systematic review protocol
Authors: Hartnett Yvonne , Conlan-Trant Rebecca , Duffy Richard , Doherty Anne M
Published: October 2024

Introduction

Reproductive hormone transitions (menstrual cycle, post partum and menopause) can trigger mental disorders in a subset of women. Gynaecological diseases, such as endometriosis and polycystic ovary syndrome, can also elevate the risk of mental illness. The link between psychiatrists and obstetricians is already well established in the peripartum period; however, the link between gynaecology and psychiatry is less so. This mixed-methods systematic review aims to synthesise the existing evidence for integrated mental healthcare for gynaecological illnesses or reproductive hormone transitions outside the perinatal period.

Methods and analysis

A systematic search of the MEDLINE, Embase, Scopus, PsycInfo, CINAHL and Web of Science databases will be conducted. All study types will be considered, both quantitative and qualitative. Opinion and expert consensus statements, as well as government and professional body documents, will also be included, but separately analysed and reported. Studies examining the unmet clinical needs and experiences of women experiencing mental disorders related to reproductive hormone transitions (menarche, menstrual, menopause, but not pregnancy or breast feeding) or gynaecological illness will be included. Studies related to the experience or training of professionals caring for them will be included, specifically on the concept of integrated or interdisciplinary work with colleagues outside their specialty. Abstracts of the identified papers will be screened independently by two reviewers. Full texts will be assessed by two reviewers, and data will be extracted using predetermined data extraction tools. Quantitative studies will be synthesised in narrative format. A thematic synthesis of qualitative studies will be conducted and an integrated narrative synthesis will be described.

Ethics and dissemination

Ethical approval is not required for this systematic review, as no primary data will be collected. The results will be disseminated via a peer-reviewed publication in a relevant scientific journal.

PROSPERO registration number

CRD42024523590.
Patient preferences for ocular hypertension monitoring: a discrete choice experiment
Authors: Wu Hangjian , Hernández Rodolfo , Crabb David P , Gazzard Gus , Harper Robert A , King Anthony , Morgan James E , Takwoingi Yemisi , Azuara-Blanco Augusto , Watson Verity
Published: October 2024

Background/aims

To elicit the preferences and calculate the willingness to pay (WTP) of patients with ocular hypertension (OHT) for eye monitoring services in the UK.

Methods

Patients with OHT aged at least 18 years recruited from four NHS ophthalmology departments were included in the study. Patients’ preferences and WTP for an OHT monitoring service in the National Health Service were elicited using a discrete choice experiment (DCE) within a postal survey based on six attributes: (1) how OHT monitoring is organised, (2) monitoring frequency, (3) travel time from home, (4) use of a risk calculator for conversion to glaucoma, (5) risk of developing glaucoma in the next 10 years and (6) cost of monitoring. We used a sequential mixed-methods approach to design the survey.

Results

360 patients diagnosed with OHT were recruited with a mean age of 69 years. In the DCE, reducing the risk of conversion to glaucoma was the most important factor influencing respondents’ choice of monitoring service. Respondents preferred hospital-based monitoring services to community optometrist monitoring, and annual monitoring compared with more frequent (every 6 months) and less frequent (every 18 or 24 months) monitoring. These results can be monetised using WTP. Results of heterogeneity analysis suggest that patients with prior experience in community optometrist monitoring preferred this to hospital-based monitoring.

Conclusions

Although hospital-based monitoring is generally preferred, patients with prior experience in community services have a different opinion, suggesting that patients who are unfamiliar with community optometry services may need additional support to accept monitoring in this setting.
Evaluating the effects, implementation experience and political economy of primary healthcare facility autonomy reforms within counties in Kenya: a mixed methods study protocol
Authors: Musiega Anita , Amboko Beatrice , Maritim Beryl , Nzinga Jacinta , Tsofa Benjamin , Mugo Peter Mwangi , Wong Ethan , Mazzilli Caitlin , Ng'ang'a Wangari , Hagedorn Brittany L , Turner Gillian , Musuva Anne , Murira Felix , Ravishankar Nirmala , Barasa Edwine
Published: October 2024

Introduction

There is a growing emphasis on improving primary healthcare (PHC) services and granting frontline service providers more decision-making autonomy. In October 2023, Kenya enacted legislation mandating nationwide facility autonomy. There is limited understanding of the effects of health facility autonomy on PHC facilities performance. It is recognised that stakeholder interests influence reforms, and gender plays a critical role in access to health and its outcomes. This protocol outlines the methods for a study that plans to evaluate the effects, implementation experience, political economy and gendered effects of health facility autonomy reforms in Kenya.

Methods and analysis

The research will use a before-and-after quasi-experimental study design to measure the effects of the reform on service readiness and service utilisation and a cross-sectional qualitative study to explore the implementation experience, political economy and gendered effects of these reforms. Data to measure the effects of autonomy will be collected from a sample of 80 health facilities and 1600 clients per study arm. Qualitative interviews will involve approximately 83 facility managers and policymakers at the county level, distributed across intervening (36) and planning to intervene (36) counties. Additionally, 11 interviews will be conducted at the national level with representatives from the Ministry of Health, the National Treasury, the Controller of Budget, the Council of Governors, the Auditor General and development partners. Given the uncertainty surrounding the implementation of the reforms, this study proposes two secondary designs in the event our primary design is not feasible—a cross-sectional study and a quasi-experimental interrupted time series design. The study will use a difference-in-difference analysis for the quantitative component to evaluate the effects of the reforms, while using thematic analysis for the qualitative component to evaluate the political economy and the implementation experience of the reforms.

Ethics and dissemination

This study was approved by the Kenya Medical Research Institute Scientific and Ethics Review Unit (KEMRI/SERU/CGMR-C/294/4708) and the National Commission for Science, Technology and Innovation (NACOSTI/P/23/28111). We plan to disseminate the findings through publications, policy briefs and dissemination workshops.
24-hour Movement Behaviour study—Lithuanian protocol: a comprehensive overview of behaviours and health outcomes in adolescents
Authors: Cavalheiro do Espirito Santo Rafaela , Melo Geiziane , Dubey Viney , Jankauskiene Rasa , Bacevičienė Miglė , Agostinis-Sobrinho Cesar
Published: October 2024

The 24-hour Movement Behaviour (24-h MovBeh) paradigm, encompassing physical activity (PA), sedentary behaviour (SB) and sleep patterns, is recognised as a holistic approach to adolescent health. It emphasises promoting PA, reducing SB and ensuring sufficient sleep, especially in school environments. Understanding the links between lifestyle factors and health outcomes is crucial for clinical and public health, informing interventions for lifestyle changes among adolescents. This study aims to assess adherence to 24-h MovBeh among Lithuanian adolescents, examining the patterns, inter-relationships and impacts on socio-demographic status, 24-h MovBeh, health-related fitness, blood pressure, body composition, dietary patterns, health-related quality of life, mental health, physical and exercise motivation, other lifestyles and health indicators, and academic performance. The 24-h MovBeh study is a prospective cohort study beginning in 2025 with baseline data collected in schools. It will recruit 500 primary and secondary school adolescents (11–14 years old) from Klaipeda and Kaunas, Lithuania. The study will evaluate 11 main categories: Socio-demographic status, 24-h MovBeh, health-related fitness, blood pressure, body composition, dietary patterns, health-related quality of life, mental health, physical and exercise motivation, other lifestyles and health indicators, and academic performance. Statistical analysis will estimate adherence to 24-h MovBeh and its inter-relationships with individual and environmental factors and health outcomes. The 24-h MovBeh study will be a crucial step towards establishing a monitoring system for health and lifestyle outcomes, benefiting researchers, policymakers, adolescents, and parents, while laying the groundwork for future intervention studies.
Prospective randomized evaluation of the sustained impact of assistive artificial intelligence on anesthetists’ ultrasound scanning for regional anesthesia
Authors: Kowa Chao-Ying , Morecroft Megan , Macfarlane Alan J R , Burckett-St Laurent David , Pawa Amit , West Simeon , Margetts Steve , Haslam Nat , Ashken Toby , Sebastian Maria Paz , Thottungal Athmaja , Womack Jono , Noble Julia Alison , Higham Helen , Bowness James S
Published: October 2024

Objectives

Ultrasound-guided regional anesthesia (UGRA) relies on acquiring and interpreting an appropriate view of sonoanatomy. Artificial intelligence (AI) has the potential to aid this by applying a color overlay to key sonoanatomical structures.

The primary aim was to determine whether an AI-generated color overlay was associated with a difference in participants’ ability to identify an appropriate block view over a 2-month period after a standardized teaching session (as judged by a blinded assessor). Secondary outcomes included the ability to identify an appropriate block view (unblinded assessor), global rating score and participant confidence scores.

Design

Randomized, partially blinded, prospective cross-over study.

Setting

Simulation scans on healthy volunteers. Initial assessments on 29 November 2022 and 30 November 2022, with follow-up on 25 January 2023 – 27 January 2023.

Participants

57 junior anesthetists undertook initial assessments and 51 (89.47%) returned at 2 months.

Intervention

Participants performed ultrasound scans for six peripheral nerve blocks, with AI assistance randomized to half of the blocks. Cross-over assignment was employed for 2 months.

Main outcome measures

Blinded experts assessed whether the block view acquired was acceptable (yes/no). Unblinded experts also assessed this parameter and provided a global performance rating (0–100). Participants reported scan confidence (0–100).

Results

AI assistance was associated with a higher rate of appropriate block view acquisition in both blinded and unblinded assessments (p=0.02 and <0.01, respectively). Participant confidence and expert rating scores were superior throughout (all p<0.01).

Conclusions

Assistive AI was associated with superior ultrasound scanning performance 2 months after formal teaching. It may aid application of sonoanatomical knowledge and skills gained in teaching, to support delivery of UGRA beyond the immediate post-teaching period.

Trial registration number

NCT05583032.
Circadian variation pattern of sudden cardiac arrest occurred in Chinese community
Authors: Yao Peng-Cheng , Li Mo-Han , Chen Mu , Che Qian-Ji , Fei Yu-Dong , Li Guan-Lin , Sun Jian , Wang Qun-Shan , Wu Yong-Bo , Yang Mei , Zhao Ming-Zhe , Yang Yu-Li , Cai Zhong-Xi , Luo Li , Wu Hong , Li Yi-Gang
Published: October 2024

Background

The circadian variation pattern of sudden cardiac arrest (SCA) occurred in Chinese community including both community healthcare centres and primary hospitals remains unknown. This study analysed the circadian variation of SCA in the Chinese community.

Methods

Data between 2018 and 2022 from the remote ECG diagnosis system of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine were analysed to examine the circadian rhythm of SCA, stratified by initial shockable (ventricular tachycardia or ventricular fibrillation) versus non-shockable (asystole or pulseless electrical activity) rhythm.

Results

Among 10 210 cases of SCA, major cases (8736, 85.6%) were non-shockable and 1474 (14.4%) cases were shockable. The circadian rhythm of SCA was as follows: peak time was from 08:00 to 11:59 (30.1%), while deep valley was from 00:00 to 03:59 (7.5%). The proportions of events by non-shockable and shockable events were similar and both reached their peak from 08:00 to 11:59, with a percentage of 29.0% and 36.4%, respectively. Multivariable analysis showed that the relative risk of shockable compared with non-shockable arrests was lower between 00:00 and 03:59 (adjusted OR (aOR): 0.72, 95% CI: 0.54 to 0.97, p=0.028) and 04:00 to 07:59 (aOR: 0.60, 95% CI: 0.46 to 0.79, p<0.001), but higher between 08:00 and 11:59 (aOR: 1.34, 95% CI: 1.09 to 1.64, p=0.005).

Conclusions

In Chinese community, there is a distinct circadian rhythm of SCA, regardless of initial rhythms. Our findings may be helpful in decision-making, in that more attention and manpower should be placed on the morning hours of first-aid and resuscitation management in Chinese community.
Prenatal diagnosis and risk stratification of congenital diaphragmatic hernia
Authors: Abbasi Nimrah , Backley Sami , Ryan Greg , Johnson Anthony
Published: October 2024

Congenital diaphragmatic hernia (CDH) is a rare heterogenous disorder with varying degrees of severity. Infant survival rates in high-income countries are approaching 80% in isolated CDH; however, over 50% will have long-term morbidities. Advanced antenatal imaging, including ultrasound and magnetic resonance imaging, has made it possible to prognosticate severity of CDH and to stratify risk when counseling expectant parents. Risk stratification can also better prepare healthcare teams to enable optimal neonatal management, and provide options for fetal intervention or, where legally permitted, pregnancy termination. Factors that may affect the immediate and long-term prognosis for CDH include prenatal diagnosis, gestational age at detection and delivery, side of the defect, presence of additional structural or genetic abnormalities, defect size, estimation of fetal lung volume, the extent of visceral herniation, and the delivery center’s experience in caring for neonates with CDH. Optimizing the outcome for families and infants begins with an early prenatal diagnosis followed by referral to a diverse and inclusive multidisciplinary center with CDH expertise. Prediction of disease severity is supported by accurate fetal imaging and comprehensive genetic testing, and allows the care team to provide realistic outcome expectations during the counseling of expectant parents of all racial and ethnic backgrounds.
Acute ketone monoester supplementation in young adults: modulating metabolic and neurocognitive functions across body weights
Authors: Yu Qian , Wong Ka Kit , Lei On Kei , Armada-da-Silva Paulo A.S. , Wu Zongze , Nie Jinlei , Shi Qingde , Kong Zhaowei
Published: October 2024

This study investigated the acute effects of ketone monoester on metabolic and neurocognitive indicators and underlying metabolism-brain-cognition interactions among young adults of healthy weight (HW) and those with overweight/obesity (OW). Forty participants were divided into two groups: HW ( n = 20, age 23.80 ± 3.96 years, body mass index (BMI) 21.49 ± 1.80 kg/m2) and OW ( n = 20, age 22.00 ± 2.13 years, BMI 28.23 ± 3.48 kg/m2). Each participant completed two trials (ketone monoester vs. placebo, 395 mg/kg dose) in a randomized order. Metabolic indicators (blood beta-hydroxybutyrate (BHB) and glucose) and neurocognitive function (causal density via functional near-infrared spectroscopy and cognitive interference via the Stroop task) were measured at baseline, 30 min, and 90 min post-supplementation. A chain mediation model was constructed to test the indirect effects of BHB level on cognitive interference through mediators like blood glucose and causal density. In the linear mixed models, significant effects were observed for trial ( β = −0.92, 0.20, −0.04, 25.53) and assessment time ( β = 0.50, −0.14, 0.09, −62.88) in BHB, glucose, causal density, and cognitive interference ( p < 0.05), but not for group factors. Compared to OW, the effects of ketone monoester on prefrontal connectomes were more enduring in the HW ( p < 0.05). Elevated BHB level improved cognitive function through decreasing glucose level and increasing causal density, with an estimate of −0.63. Acute ketone monoester supplementation elevated levels of blood BHB and prefrontal connectomes and decreased levels of glucose and cognitive interference, regardless of weight status. Elevated blood BHB enhanced cognitive function through multi-tiered neurometabolic pathways. Clinical trial registration: ClinicalTrials.gov (ID: NCT06368297).
Passing plastic: traces of plastic in the fecal samples of a high Arctic seabird in Tunu (East Greenland)
Authors: Ammendolia Justine , Covernton Garth A. , Skrepnyk Alexandra , Dower John F. , Jacobs Shoshanah
Published: October 2024

Arctic seabirds are key bio-indicators of marine plastic pollution due to their transient movement and large populations. Although many studies have quantified the ingestion of microplastic particles (<5 mm in size) through necropsy or regurgitation sampling methods, little is known about post-digestive particle excretion. Due to the logistical challenges of non-lethally sampling feces from Arctic seabirds, this pathway remains largely understudied. We non-lethally collected 110 fecal samples from little auks ( Alle alle) during the 2014 breeding season in Ukaleqarteq, Tunu (Kap Höegh, East Greenland). We identified 25 potential microplastic particles (>100 µm in size), 19 of which were analyzed for material composition using Fourier Transform Infrared Spectroscopy and Raman micro-spectroscopy. Of these, 13 particles were successfully matched to materials, with five as plastic. This produced an average concentration of 0.08 ± 0.28 microplastic particles per fecal sample, with no difference of occurrence between chicks and adults. Particle lengths ranged from 113 to 751 µm. The presence of microplastics larger than our lower limit of detectability of 100 µm suggests a need for analysis of smaller particles and microfibers in this species. We contribute to understanding how microplastics pass through little auks and characterize how this species interacts with the plastic pathways.