bluuebunny/crossref_metadata_2025 huggingface dataset:
209 THE ADVANCED NURSE PRACTITIONER CANDIDATE: PALLIATIVE CARE IN END-STAGE DEMENTIA UTILISING A CARE COORDINATED APPROACH IN THE COMMUNITY SETTING
Authors: Mills D
Published: October 2022

Background

Palliative care in the context of dementia is a relatively new concept. Over recent years, there has been an increased emphasis on extending palliative care for those with dementia worldwide, supported by the 2014 white paper from the European Association of Palliative Care (EAPC) defining optimal palliative care for people with dementia. Individualized care coordination for older adults in the community improves high quality care and sets the scene for this care-coordinated approach initiative led by the Advanced Nurse Practitioner candidate (ANPc)

Methods

Developing a robust pathway of care in partnership with community palliative care service will enhance the support given to achieve optimal and quality driven palliative and end of life care outcomes. The pathways achieved involve a three-step integrated pathway structure. Step one involves care intervention by the ANPc, step 2 a care coordinated approach with the ANPc and Community Palliative Care Team (CPCT) and step 3 CPCT with collaborative interactions with the ANPc. Inclusion criteria include patients with end stage dementia who have reached a FAST scale of seven or over. All patients accepted onto this pathway must reside within the healthcare area set out and experience at least one or more symptoms resulting from their dementia.

Results

Results to date have shown how this pathway has achieved significant care interventions meeting the need of people living with dementia at end stages of their journey in the community setting. Additionally, families have indicated the overall satisfaction of the service and with significant reductions in Carer stress.

Conclusion

Research indicates that individualized care coordination in the community is crucial to optimise quality care interventions, which this pathway achieves.
241 STOPPCASCADE: DEVELOPMENT OF A NOVEL EXPLICIT SCREENING TOOL FOR POTENTIALLY CLINICALLY RELEVANT PRESCRIBING CASCADES IN OLDER ADULTS
Authors: Randles M , Gallagher P , O'Mahony D
Published: October 2022

Background

Prescribing cascades represent an important, often underrecognized, element of problematic polypharmacy. Cascades occur when an Adverse Drug Event (ADE) is misinterpreted as a new medical condition, with the subsequent prescription of another, potentially inappropriate drug. Our objective was to develop and validate an explicit list of potentially clinically relevant prescribing cascades in older adults to facilitate the detection of more common and clinically important prescribing cascades and assist clinicians in medication review.

Methods

A structured literature search of PubMed, Cinahl and Google Scholar was undertaken. Search terms included Prescribing Cascades OR Cascades OR Cascade AND Older Adults OR Adults Over 65 OR Older People OR Gero* OR Geri*. We included adults aged ≥65 including studies in all settings i.e. community, hospital and residential care. We included all study designs including reviews, experimental and observational studies, case series and case reports. We also included published abstracts from scientific meetings in the literature search. Studies that didn’t include prescribing cascades in the abstract, studies with no access to full text article or English version of article and studies exclusively describing patients aged ≤65 were excluded. A physiological systems-based short-list was compiled with Anatomical Therapeutic Chemical codes identifying the initial prescribed drug (Drug A). Three assessment panellists (academic geriatricians) were asked to evaluate each individual published cascade and the accompanying evidence using a 5-point Likert scale to evaluate each cascade for inclusion/exclusion in the list. Potential cascades scored Likert 4 or 5 by 2 or 3 of the panellists were included in the final list.

Results

131 potential cascades were reviewed by the panel, 71 individual cascades were accepted, involving 41 drugs/drug classes.

Conclusion

The STOPPCascade list comprises 71 potentially important prescribing cascades in older adults. This novel explicit list is designed to identify potential prescribing cascades and to facilitate appropriate deprescribing.
243 “WHAT DO OUR PATIENTS THINK?” CREATING A GERIATRIC INPATIENT QUESTIONNAIRE TO IDENTIFY PATIENTS’ OPINION ON DELIVERY OF HOLISTIC CARE
Authors: Walsh J , Awadalla R , Kovalshyn V , Stankard A , Cosgrave N , NiBhuachalla B , Mulroy M
Published: October 2022

Background

Our aim is to assess our patients’ opinion on the delivery of key principles of Geriatric care in order to identify areas for improvement and change. The prevalence of delirium in frail older patients on inpatient wards is a major issue, the management of which includes a ward based multi-disciplinary approach. This holistic approach to patient care is our goal, however it is not clear whether the experience of our patients matches our aims.

Methods

We developed a patient questionnaire consisting of 22 questions based on the core principles of good geriatric care. The survey included 3 questions on environment and privacy, 2 on mealtime, functional ability and assistance, 3 on continence management, 2 on mobility and rehabilitation, 6 on respect and autonomy, 2 on psychological and social aspects of care, 3 on pain and sleep, and 2 on safety and Covid-19. These questions also had a large degree of overlap in terms of core principles. We distributed the questionnaire prior to discharge in 3 different Geriatric care settings: one ward managing acute stroke with a majority of single rooms, one ward managing acute medical presentations with a majority of multi-occupancy bays and one ward in a non-acute hospital managing medical Geriatric patients undergoing rehabilitation.

Results

Some key issues were identified by the survey: 60% identified issues with the ward environment and privacy, 100% did not wear a mask on the ward unless specifically asked to do so, 80% wore pyjamas or hospital gown for the majority of their stay, 40% reported issues in terms of respect and autonomy, 40% had issues with poor sleep due to external factors, 20% felt that they had insufficient time with rehabilitation.

Conclusion

The survey was designed to assess the subjective experience of older inpatients, collecting qualitative data to highlight key areas of improvement to achieve holistic inpatient care.
268 AUDIT: GENERIC PRESCRIBING COMPLIANCE IN AN ACUTE HOSPITAL
Authors: Byrne L , Hussain A , Buckley E
Published: October 2022

Background

Generic prescribing is cost-effective, and evidence suggests that clinical outcomes compared with brand name products are largely equivalent. Hospital guidelines recommend that medications should be prescribed using the approved generic name, not the brand name. There are some exceptions to this. Anecdotal evidence suggests that medication reconciliation for patients on admission to hospital are charted by brand name rather than the generic title. To investigate this we conducted a four-day audit of the prescribing of medications on patients admitted to medical wards in an acute hospital.

Methods

This audit took place over a four-day period. The Kardex of each patient admitted to the three medical wards was reviewed. Patients admitted under cardiology, haematology and oncology were excluded. All medications including whether they were prescribed using the generic or brand name were collected. Statistical analysis was carried out using Microsoft Excel.

Results

A total of 33 kardexes were collected. Two hundred and fifty-seven prescribed medications were reviewed. Ninety-five were charted as brand names and 63% (n=162) were prescribed using the generic name. One hundred and eighteen different categories of medications were prescribed. Enoxaparin was prescribed using the brand name ten times and the generic title three times. The antibiotic Piperacillin/tazobactam was prescribed three times using the brand name and one time using the generic title. Of the eight times atorvastatin was prescribed, it was charted using the generic name seven times (88%).

Conclusion

Almost two-thirds of medications for patients admitted to medical wards are prescribed using generic titles. However, there is room for improvement. Of note, commonly prescribed medications such as enoxaparin and certain antimicrobials were prescribed using the brand name. Opportunities e.g., induction, grand rounds and Non-Consultant Hospital Doctor (NCHD) teaching sessions should be utilised to provide education on the importance of generic prescribing to all NCHDs admitting patients.
344 LONG-TERM OUTCOMES FOR HIP FRACTURE PATIENTS WHO HAVE RECEIVED A PERIOD OF INPATIENT REHABILITATION
Authors: Curtin C , Cullen S , Walsh M , Keyes S
Published: October 2022

Background

Twenty-eight percent of the 3,666 hip fractures reported by the Irish Hip Fracture Database (IHFD) in 2020 received a period of rehabilitation in an off-site facility nationally. Longer term outcomes for hip fracture patients are not yet included in the IHFD. This study aimed to describe recovery after hip fracture in patients admitted to a single inpatient rehabilitation facility.

Methods

Patients who experienced hip fracture between January 2020 and July 2020 were followed up for one year after their fracture. Baseline data was collected in relation to age, pre-fracture residence and New Mobility Score (NMS) and clinical frailty score. Residence, NMS and quality of life (EQ-5D-5L) were collected by a clinical physiotherapist at 30 days, 120 days and 1 year after hip fracture. Data was inputted and analysed using Microsoft Excel.

Results

Of 122 hip fracture patients admitted to rehabilitation,103 were followed up. The average age of patients was 79, 66% were female. The mortality rate was 9% (n=9) at 1 year follow up. Pre-fracture, n= 98 lived at home. Of these patients, 67%, 82% and 83% had returned home by 30 days, 120 days and 1 year. Pre-fracture 53% had high mobility levels (NMS>6). Of these patient 4%, 27% and 34% had returned to this level by 30 days, 120 and 1 year. 70% of patients had a low mobility score (0-6 on NMS) and 30 % had a high mobility score (7-9) at 1 year follow-up. 56% and 4% of patients reported no pain and severe pain at 1 year post op, respectively. 45% of patients had no issues performing their usual activities and 4% had severe issues/an inability to perform their usual activities at 1 year.

Conclusion

Our results show that recovery after hip fracture is slow with many not achieving baseline mobility or return to pre-fracture function within the first year.
Compatibility of calcium chloride with milrinone, epinephrine, vasopressin, and heparin via in vitro testing and simulated Y-site administration
Authors: Kenneally Allison M , Agbana Preye , Gardner Brian , Bae Younsoo , Mitchell Trenika , Beckman Elizabeth J
Published: October 2022

Purpose

The purpose of this study is to evaluate calcium chloride (CaCl) compatibility with commercially available and extemporaneously compounded milrinone, vasopressin, epinephrine, and heparin. This report describes 2 clinical scenarios in which patients experienced intravenous catheter precipitation when receiving multiple continuous infusions, including CaCl, and the results of an in vitro simulation of those scenarios. The hypothesis was that one or a combination of the medications would precipitate with CaCl.

Methods

CaCl compatibility was tested in 3 stages to simulate clinical situations where line precipitation occurred. Multiple tests were conducted in each stage to determine if precipitation had occurred, including visual assessment, absorbance measurement at 650 nm, and pH measurement. First, milrinone, vasopressin, epinephrine, and heparin were mixed pairwise with CaCl in a test tube. Second, the medications were mixed in different combinations deemed likely to precipitate. Finally, 5 medications were infused via simulated Y-site administration. Incompatibility was defined as observed crystals, haziness, or turbidity upon visual inspection or absorbance of greater than 0.01 absorbance unit (AU). All solutions were tested at time 0 and at 20, 60, 240, and 1,440 minutes.

Results

Across all tests, only a commercially available formulation of heparin 2 units/mL in 0.9% sodium chloride injection precipitated with CaCl, alone or in combination with other medications. Upon further review, it was found that this specific formulation of heparin contained a monohydrate and dibasic sodium phosphate buffer.

Conclusion

CaCl only precipitated with a commercially available heparin formulation that contained a phosphate buffer. CaCl was deemed to be compatible with all other medications and formulations tested.
The Balance of the Constitution
Authors: Ekins Richard
Published: October 2022

The idea of balance in constitutional thought helps to illuminate what it is to be governed well. The article considers the idea of balance, beginning with John Finnis’s engagement with Gibbon’s Decline and Fall, and argues that the well-balanced constitution is stable rather than static, tempering public authority, which is to say disciplining and strengthening it. Anglo-American history confirms that the balance of a constitution is likely to change over time, not only because of unconstitutional action but also because of lawful exercise of power or changes in social and political conditions. In some cases, the balance may be lost, and may need now to be restored; in other cases, a new balance may have been struck. The article reflects on the institutional arrangements that characterize a well-balanced constitution, making clear the contribution that independent courts make (and the risks that misuse of judicial power may pose) and the importance of intelligently coordinating executive and legislative power. The people have a share in constitutional government, which requires a spirit of moderation and is put in doubt if the constitution is insulated from deliberate change.
Plant clonality in a soil-impoverished open ecosystem: insights from southwest Australian shrublands
Authors: Tsakalos James L , Ottaviani Gianluigi , Chelli Stefano , Rea Alethea , Elder Scott , Dobrowolski Mark P , Mucina Ladislav
Published: October 2022

Background and Aims

Clonality is a key life-history strategy promoting on-spot persistence, space occupancy, resprouting after disturbance, and resource storage, sharing and foraging. These functions provided by clonality can be advantageous under different environmental conditions, including resource-paucity and fire-proneness, which define most mediterranean-type open ecosystems, such as southwest Australian shrublands. Studying clonality–environment links in underexplored mediterranean shrublands could therefore deepen our understanding of the role played by this essential strategy in open ecosystems globally.

Methods

We created a new dataset including 463 species, six traits related to clonal growth organs (CGOs; lignotubers, herbaceous and woody rhizomes, stolons, tubers, stem fragments), and edaphic predictors of soil water availability, nitrogen (N) and phosphorus (P) from 138 plots. Within two shrubland communities, we explored multivariate clonal patterns and how the diversity of CGOs, and abundance-weighted and unweighted proportions .of clonality in plots changed along with the edaphic gradients.

Key Results

We found clonality in 65 % of species; the most frequent were those with lignotubers (28 %) and herbaceous rhizomes (26 %). In multivariate space, plots clustered into two groups, one distinguished by sandy plots and plants with CGOs, the other by clayey plots and non-clonal species. CGO diversity did not vary along the edaphic gradients (only marginally with water availability). The abundance-weighted proportion of clonal species increased with N and decreased with P and water availability, yet these results were CGO-specific. We revealed almost no relationships for unweighted clonality.

Conclusions

Clonality is more widespread in shrublands than previously thought, and distinct plant communities are distinguished by specific suites (or lack) of CGOs. We show that weighting belowground traits by aboveground abundance affects the results, with implications for trait-based ecologists using abundance-weighting. We suggest unweighted approaches for belowground organs in open ecosystems until belowground abundance is quantifiable.
Thailand’s debut in investment treaty arbitration: the curious case of Walter Bau and its lessons for participants in international investment law
Authors: Junngam Nartnirun
Published: October 2022

Thailand’s first experience with investment treaty arbitration has not been a pleasant one. Nevertheless, it offers important lessons to States, foreign investors, and arbitral tribunals regarding their respective participation in the process of decision-making. First, States must be meticulous in concluding investment treaties while bearing in mind that their subsequent practice affects the way those treaties are interpreted and applied. Second, foreign investors’ due diligence when making investments and their selection of a suitably qualified lawyer to represent them in arbitral proceedings will both affect the outcome of their case. Third, arbitral tribunals’ understanding of international law is critical for the credibility of investment treaty arbitration and will contribute to its legitimacy—or lack thereof. In fulfilling their role, arbitral tribunals should consider economic realities within the confines of an applicable investment treaty. Furthermore, to determine their jurisdiction ratione materiae and jurisdiction ratione personae for non-ICSID arbitration, they should adopt the single keyhole approach, following the definition of ‘investment’ and ‘investor’ given by the parties as lex specialis and acting in accordance with the principle of procedural economy.
AI4AVP: an antiviral peptides predictor in deep learning approach with generative adversarial network data augmentation
Authors: Lin Tzu-Tang , Sun Yih-Yun , Wang Ching-Tien , Cheng Wen-Chih , Lu I-Hsuan , Lin Chung-Yen , Chen Shu-Hwa
Published: October 2022

Motivation

Antiviral peptides (AVPs) from various sources suggest the possibility of developing peptide drugs for treating viral diseases. Because of the increasing number of identified AVPs and the advances in deep learning theory, it is reasonable to experiment with peptide drug design using in silico methods.

Results

We collected the most up-to-date AVPs and used deep learning to construct a sequence-based binary classifier. A generative adversarial network was employed to augment the number of AVPs in the positive training dataset and enable our deep learning convolutional neural network (CNN) model to learn from the negative dataset. Our classifier outperformed other state-of-the-art classifiers when using the testing dataset. We have placed the trained classifiers on a user-friendly web server, AI4AVP, for the research community.

Availability and implementation

AI4AVP is freely accessible at http://axp.iis.sinica.edu.tw/AI4AVP/; codes and datasets for the peptide GAN and the AVP predictor CNN are available at https://github.com/lsbnb/amp_gan and https://github.com/LinTzuTang/AI4AVP_predictor.

Supplementary information

Supplementary data are available at Bioinformatics Advances online.
Quality of reporting of robot-assisted cholecystectomy in relation to the IDEAL recommendations: systematic review
Authors: Kirkham Emily N , Jones Conor S , Higginbotham George , Biggs Sarah , Dewi Ffion , Dixon Lauren , Huttman Marc , Main Barry G , Ramirez Jozel , Robertson Harry , Scroggie Darren L , Zucker Benjamin , Blazeby Jane M , Blencowe Natalie S , Pathak Samir ,   RoboSurg Collaborative, Vallance A , Wilkinson A , Smith A , Torkington A , Jones A , Abbas A , Main B G , Zucker B , Turner B , Jones C S , Thomas C , Hoffmann C , Scroggie D L , Henshall D , Kirkham E N , Boden E , Gull E , Sewart E , Dewi F , Wood F , Loro F , Hollowood F , Fowler G , Higginbotham G , Sellers G , Robertson H , Richards H , Hughes I , Handa I , Blazeby J M , Olivier J , Ramirez J , Rees J , Chalmers K , Lee K Siang , Dixon L , Leandro L , Paynter L , Huppler L , Gourbault L , Huttman M , Wijeyaratne M , Dewhurst M , Shah M , Kiandee M , Dada M , Blencowe N S , Brewster O , Lok P , Winayak R , Ranat R , Macefield R , Purves R , Lawrence R , Millar R , Biggs S , Lawday S , Dalmia S , Cousins S , Pathak S , Rozwadowski S , Robinson T , Perra T , Leow T Wei , Brankin-Frisby T , Baker W , Hurst W , Young Y Embury
Published: October 2022

Introduction

Robotic cholecystectomy (RC) is a recent innovation in minimally invasive gallbladder surgery. The IDEAL (idea, development, exploration, assessment, long-term study) framework aims to provide a safe method for evaluating innovative procedures. This study aimed to understand how RC was introduced, in accordance with IDEAL guidelines.

Methods

Systematic searches were used to identify studies reporting RC. Eligible studies were classified according to IDEAL stage and data were collected on general study characteristics, patient selection, governance procedures, surgeon/centre expertise, and outcome reporting.

Results

Of 1425 abstracts screened, 90 studies were included (5 case reports, 38 case series, 44 non-randomized comparative studies, and 3 randomized clinical trials). Sixty-four were single-centre and 15 were prospective. No authors described their work in the context of IDEAL. One study was classified as IDEAL stage 1, 43 as IDEAL 2a, 43 as IDEAL 2b, and three as IDEAL 3. Sixty-four and 51 provided inclusion and exclusion criteria respectively. Ethical approval was reported in 51 and conflicts of interest in 34. Only 21 reported provision of training for surgeons in RC. A total of 864 outcomes were reported; 198 were used in only one study. Only 30 reported a follow-up interval which, in 13, was 1 month or less.

Conclusion

The IDEAL framework was not followed during the adoption of RC. Few studies were conducted within a research setting, many were retrospective, and outcomes were heterogeneous. There is a need to implement appropriate tools to facilitate the incremental evaluation and reporting of surgical innovation.
Thirty novel sequence variants impacting human intracranial volume
Authors: Nawaz Muhammad Sulaman , Einarsson Gudmundur , Bustamante Mariana , Gisladottir Rosa S , Walters G Bragi , Jonsdottir Gudrun A , Skuladottir Astros Th , Bjornsdottir Gyda , Magnusson Sigurdur H , Asbjornsdottir Bergrun , Unnsteinsdottir Unnur , Sigurdsson Engilbert , Jonsson Palmi V , Palmadottir Vala Kolbrun , Gudjonsson Sigurjon A , Halldorsson Gisli H , Ferkingstad Egil , Jonsdottir Ingileif , Thorleifsson Gudmar , Holm Hilma , Thorsteinsdottir Unnur , Sulem Patrick , Gudbjartsson Daniel F , Stefansson Hreinn , Thorgeirsson Thorgeir E , Ulfarsson Magnus O , Stefansson Kari
Published: October 2022

Intracranial volume, measured through magnetic resonance imaging and/or estimated from head circumference, is heritable and correlates with cognitive traits and several neurological disorders. We performed a genome-wide association study meta-analysis of intracranial volume (n = 79 174) and found 64 associating sequence variants explaining 5.0% of its variance. We used coding variation, transcript and protein levels, to uncover 12 genes likely mediating the effect of these variants, including GLI3 and CDK6 that affect cranial synostosis and microcephaly, respectively. Intracranial volume correlates genetically with volumes of cortical and sub-cortical regions, cognition, learning, neonatal and neurological traits. Parkinson’s disease cases have greater and attention deficit hyperactivity disorder cases smaller intracranial volume than controls. Our Mendelian randomization studies indicate that intracranial volume associated variants either increase the risk of Parkinson’s disease and decrease the risk of attention deficit hyperactivity disorder and neuroticism or correlate closely with a confounder.
Dual Antiviral Therapy for Persistent Coronavirus Disease 2019 and Associated Organizing Pneumonia in an Immunocompromised Host
Authors: Trottier Caitlin A , Wong Beverly , Kohli Rakhi , Boomsma Cassidy , Magro Francis , Kher Sucharita , Anderlind Christina , Golan Yoav
Published: October 2022

The management of patients with prolonged viral shedding and coronavirus disease 2019 symptoms remains unclear. Combining antivirals, as practiced in other infections, is theoretically advantageous. We present a case of persistent, symptomatic severe acute respiratory syndrome coronavirus 2 infection and associated organizing pneumonia that was successfully treated with an extended course of combination antiviral therapy.
FPGA-CPU Architecture Accelerated Regular Expression Matching With Fast Preprocessing
Authors: Zhong Jincheng , Chen Shuhui , Han Biao
Published: October 2022

Regular Expression Matching (REM) is the core of Deep Packet Inspection (DPI), which is important for various network security applications. The burgeoning Software Defined Network and Network Function Virtualization technologies make the network evolve more dynamic, which brings serious challenges for DPI engines to achieve high matching performance with fast rule-set update capability. To meet these challenges, this paper proposes a heterogeneous Field Programmable Gate Array (FPGA)-Central Processing Unit (CPU) architecture to accelerate Deterministic Finite Automaton (DFA)-based REM with high preprocessing performance. Firstly, a novel regex decomposition technique is proposed to solve the DFA state explosion problem, which splits each regex into one prefix and several postfixes. Secondly, heterogeneous architecture is presented to collaboratively handle regex matching, in which prefixes are matched in parallel in an FPGA and postfixes are matched in a CPU. To further improve the matching performance, several well-designed DFA compression techniques and regex decomposition optimizations are proposed. Our design has been implemented in a DPI prototype employing a medium-end FPGA. Extensive experiments are conducted to evaluate the performance. Results reveal that our proposed architecture achieves 6.33 Gbps matching throughput on the Snort rule-set (v3.0), which is close to state-of-the-art FPGA NFA-based schemes. However, the rule-set preprocessing time is significantly reduced to <7 minutes, compared with up to several hours of FPGA NFA-based countermeasures.
Disordering International Law
Authors: Kelsall Michelle Staggs
Published: October 2022

This article examines critical approaches to liberal internationalism in international law. It argues that, despite ongoing disavowals of the liberal international legal order, most critical international lawyers are yet to let go of liberal vocabularies in order to re-imagine how order might be constituted anew. The article proposes a disordering critique of international law. Disordering international law comprises a process of reflective discernment. Through this process, norms, conventions and principles are determined with reference to a multiplicity of spatial and temporal orders and reframe any understanding of how legal order is constituted internationally. Drawing from the concept of non-duality proposed by Ratna Kapur and the writings of Justice Cançado Trindade, it then conceptualizes a disordering sensibility. Scholars embarking on international legal disordering would ask: how do I understand the arrangement or disposition of people or things in relation to each other? How is ‘order’ determined as a result? What sequence, pattern or method am I imposing and how does that affect any characterization of ‘legal’ ordering? Whose knowledge is included, whose knowledge is excluded and why? The analysis, however, does not stop there. The further and final questions to ask are: how does this change any conception of legal ordering that remains central to the practice of international law? And how might we begin to conceptualize that order and practice differently? The return to practice provides a path towards change, which the article argues is urgently needed. I commence with some answers to these questions and hope to open a space for further disordering, premised on a turning away from dominant liberal frames.
Celestial music: astrology and instrumental affect in Der Natur Banquet (Wolfenbüttel, 1654)
Authors: Spracklan-Holl Hannah
Published: October 2022

On 10 April 1654, Duke August the Younger of Braunschweig-Lüneburg celebrated his 75th birthday. Three days later the occasion was celebrated at the Wolfenbüttel court with a masquerade entitled Der Natur Banquet, conceived and organized by August’s wife, Duchess Sophie Elisabeth of Braunschweig-Lüneburg. This article focuses on the opening of Der Natur Banquet, a procession of seven celestial bodies with accompanying music. Investigating the characteristics of these celestial bodies as described in contemporary astrological sources, I demonstrate that visual and aural rhetoric worked in tandem to display the political power and virtue of the duke and his dynasty. The article investigates the affective links between the astrological characteristics of each celestial body and the instruments used with it, and explores the possible influence of ‘Die Tugendsterne’ by Georg Philipp Harsdörffer and Sigmund Theophil Staden.
Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis
Authors: Peters Ruth , Xu Ying , Fitzgerald Oisin , Aung Htein Linn , Beckett Nigel , Bulpitt Christopher , Chalmers John , Forette Francoise , Gong Jessica , Harris Katie , Humburg Peter , Matthews Fiona E , Staessen Jan A , Thijs Lutgarde , Tzourio Christophe , Warwick Jane , Woodward Mark , Anderson Craig S ,   Dementia rIsk REduCTion (DIRECT) collaboration
Published: October 2022

Aims

Observational studies indicate U-shaped associations of blood pressure (BP) and incident dementia in older age, but randomized controlled trials of BP-lowering treatment show mixed results on this outcome in hypertensive patients. A pooled individual participant data analysis of five seminal randomized double-blind placebo-controlled trials was undertaken to better define the effects of BP-lowering treatment for the prevention of dementia.

Methods and results

Multilevel logistic regression was used to evaluate the treatment effect on incident dementia. Effect modification was assessed for key population characteristics including age, baseline systolic BP, sex, and presence of prior stroke. Mediation analysis was used to quantify the contribution of trial medication and changes in systolic and diastolic BP on risk of dementia. The total sample included 28 008 individuals recruited from 20 countries. After a median follow-up of 4.3 years, there were 861 cases of incident dementia. Multilevel logistic regression reported an adjusted odds ratio 0.87 (95% confidence interval: 0.75, 0.99) in favour of antihypertensive treatment reducing risk of incident dementia with a mean BP lowering of 10/4 mmHg. Further multinomial regression taking account of death as a competing risk found similar results. There was no effect modification by age or sex. Mediation analysis confirmed the greater fall in BP in the actively treated group was associated with a greater reduction in dementia risk.

Conclusion

The first single-stage individual patient data meta-analysis from randomized double-blind placebo-controlled clinical trials provides evidence to support benefits of antihypertensive treatment in late-mid and later life to lower the risk of dementia. Questions remain as to the potential for additional BP lowering in those with already well-controlled hypertension and of antihypertensive treatment commenced earlier in the life-course to reduce the long-term risk of dementia.

Classification of evidence

Class I evidence in favour of antihypertensive treatment reducing risk of incident dementia compared with placebo.
Incidence and predictors of frailty in Latin America and China: evidence from 10/66 cohort studies
Authors: Jiang M , Llibre Rodriguez JJ , Sosa AL , Acosta D , Jimenez-Velasquez IZ , Guerra M , Salas A , Huang YQ , Prince M , Albanese E
Published: October 2022

Introduction

Evidence on the incidence and risk factors of frailty in low- and middle-income countries is very limited. We aimed to compare the incidence of frailty and explore its determinants in rural and urban areas in six Latin American countries and China.

Methods

The 10/66 is a multi-site cohort study in older adults. We conducted baseline and follow-up surveys in 2003-2006, and 2007-2010. We assessed frailty using a modified Fried frailty phenotype criterion, and adjudicated frailty (yes/no) when two or more of the following indicators were present: exhaustion, low physical activity, slow gait speed, and weight loss. We excluded frail participants at baseline and calculated person-years as the time interval between baseline and follow-up for frailty-free people who were survived and reinterviewed or the midpoint of it for incident frailty cases. We used Poisson and Cox regressions to model the incidence of frailty and its risk factors.

Results

We included 9,747 participants (≥65 years) for the analysis of frailty risk factors. Of whom, 8,212 were reinterviewed with an average of 4.0 years of follow-up, the incidence of frailty was lowest in Venezuela (21.9 per 1000 person-years) and rural Peru (24.3 per 1000 person-years), highest in rural Mexico (110.5 per 1000 person-years) and urban Peru (84.0 per 1000 person-years). In the overall Cox regression, we found significant prospective associations of incident frailty with living in rural areas (HR: 1.97, 95% CI: 1.69, 2.29), dementia (HR: 1.76, 95% CI: 1.42, 2.18), depression (HR: 1.69, 95% CI: 1.49, 1.93), comorbidity, female gender, older age, disability, hearing, and vision problems. Higher arm circumference was associated with a lower frailty risk (HR: 0.97, 95% CI: 0.96, 0.98).

Conclusions

The incidence of frailty varied substantially in Latin America and China, and between urban and rural areas. The identified risk factors could be potential intervention targets to decrease the global burden of frailty.

Key messages

• In Latin America and China, the incidence of frailty varied from 21.9 to 110.5 cases per 1000 person-years.

• We identified 9 risk factors and 1 protective factor for developing frailty, and the most relevant risk factors were living in the rural area, dementia, and depression.
The Public Health Playbook: ideas for challenging the Corporate Playbook
Authors: Lacy-Nicols J , Marten R , Crosbie E , Moodie R
Published: October 2022

Background

Many commercial actors use a range of coordinated and sophisticated strategies to protect business interests at the expense of public health, for example: attacking and undermining legitimate science, intimidating and vilifying critics, and framing and reframing discussion and debate. These strategies can be thought of as a ‘Corporate Playbook’ that spans numerous health and planet-harming industries. To counter this Corporate Playbook and advance health and wellbeing, public health actors need to develop, refine, and modernize their own Public Health Playbook.

Methods

This paper seeks to consolidate thinking around how public health can counter and proactively minimize powerful commercial influences. It draws on previous attempts to develop approaches to counter commercial influence for public health, sustainability, human rights and democracy, and develops eight thematically grouped strategies.

Results

We propose an initial eight strategies: 1) Expand the public health workforce and coalitions; 2) Increase public sector resources; 3) Link with and learn from social movements to foster collective solidarity; 4) Protect public health advocates from industry threats; 5) Develop and implement rigorous conflict of interest safeguards; 6) Monitor and expose corporate activities; 7) Debunk corporate arguments; and 8) Leverage diverse commercial interests.

Conclusions

This set of strategies seeks to amplify inherent assets of the public health community and create opportunities to explicitly counter the Corporate Playbook. These strategies are not exhaustive, and our aim is to provoke further discussion and exploration on this topic. Moving forward, there is a need for further work to develop a rigorously researched and tested Public Health Playbook.
Structural stigma and 7-year improvement in life satisfaction: A repeated cross-sectional study of sexual minority individuals across 28 countries
Authors: Bränström R , Pachankis J
Published: October 2022

Background

Structural stigma toward sexual minority individuals varies widely across countries and is associated with psychosocial health outcomes. Yet, the association of changes in country-level structural stigma over time, as has recently characterized many European countries, with such outcomes is largely unknown. The current study examined the association between change in structural stigma from 2012 to 2019 across European Union countries and change in life satisfaction among sexual minority individuals during the same period. Secondary analyses examined whether changes in structural stigma differentially benefitted some subgroups of sexual minority individuals more than others.

Methods

The current study analyzed data from sexual minority respondents (2012: n = 82,668; 2019: n = 96,576) living in 28 European countries.

Results

Adjusted multilevel models showed that life satisfaction had improved among sexual minority individuals in all countries between 2012 and 2019 (β = 0.32, 95% CI: 0.29, 0.35), but the improvement was stronger among those living in higher stigma countries compared to those living in lower stigma countries. Changes also varied by relationship status; the strongest improvement in life satisfaction as a function of improvement in structural stigma was found among sexual minority individuals in a relationship.

Conclusions

Although life satisfaction has increased during the past decade among sexual minority individuals living in Europe, significant variation in this change exists across countries as a function of country-level structural stigma and individual sociodemographic characteristics. The findings support the relevance of structural stigma for sexual minority individuals’ life satisfaction and call for further research to understand the differential impact of structural stigma across sexual minority subgroups.
Tobacco Use Prevention and Cessation Programme For Pregnant Women Accessing Antenatal Care In Urban Public Health Facilities In Southern India
Authors: Thomas S , Lee H
Published: October 2022

Backgrounds and problem

By 2030, tobacco use is estimated to kill more than 8 million people worldwide annually, with LMICs accounting for over 80% of those deaths. In India, about 4.6% of women continue to use tobacco mainly (> 80%) in smokeless (SLT) form during pregnancy. This may lead to: higher risk of anemia (∼ 70%), hypertension, and postpartum hemorrhage; poor fetal development; and 2-3 times higher rate of low-birth and stillbirth babies.

Importance

Anti-tobacco initiatives often focus on smoking over SLT, which is commonly consumed by women. Drivers of SLT use among women include: cultural appropriateness, medicinal benefits, and poor social determinants of health. These factors must be taken into account while formulating effective anti-tobacco interventions for pregnant women, ensuring safe motherhood and neonatal health.

Solution

We propose integrating oral health interventions in mitigating tobacco use within the existing antenatal care (ANC) model. Women enrolled in public health facilities in an urban poor neighborhood in South India receive oral health education (OHE) integrated into ANC. The intervention promotes oral hygiene habits, dietary advices, improving dental healthcare utilization, and sensitization on the ill-effects of tobacco-use. Training for ANC providers focuses on delivering antenatal tobacco screening, cessation, and referral services. This includes expanding the medical history to record tobacco use, conduct oral examination and referrals to dentists and/or tobacco cessation centres. Final outcomes of OHE will be measured using pre and post KAP surveys informed by WHO Oral Health Surveys; and training programme using in-depth interviews among providers. Desired policy change is the inclusion of tobacco prevention and cessation programme in the Indian ANC guidelines.
Determinants of excess mortality during the COVID-19 pandemic in 18 countries of the CMOR consortium
Authors: Kneebone-Hopkins C , Artemiou A , Demetriou CA
Published: October 2022

Many countries suffered excess all-cause mortality during the COVID-19 pandemic. This study aims to identify factors associated with excess mortality rates (EMR) in partaking countries during 2020. Weekly all-cause death counts for 2015-2020 were extracted from national databases for Australia, Austria, Brazil, Cyprus, Denmark, Estonia, France, Georgia, Israel, Italy, Mauritius, Norway, Peru, Slovenia, Sweden, USA, Ukraine and UK. EMR per 100,000 population were gauged using a 5-year mean baseline. Separate OLS multiple linear regressions explored pre-pandemic country profiles including healthcare system, geographic, socio-economic and population factors. Feature selection methods detected the main factors contributing to 2020 EMR. The health system model showed that an extra nurse per 1,000 and a 1% increase in Healthcare Access and Quality Index reduces EMR by 41.7% (p = 0.019) and 0.48% (p = 0.034). The model was statistically significant (R^2=0.415,p=0.018). Although the geographical model suggested that a 1% increase in neighbouring countries increased EMR by 0.42% (p = 0.078), population density and the model itself were statistically insignificant (p > 0.05). The socio-economic and population model indicated a 1% increase in service employed (% of employed) and investment (% GDP) was linked with a 43.4% (p = 0.01) and 43.7% (p = 0.01) fall in EMR. The model was significant (R^2=0.488, p = 0.007). Death registration quality and population share over 70 years, improved model performance (R^2=0.632), but neither approached nominal significance. EMR during the COVID-19 pandemic benefited from higher ratios of nurses to population and able and prompt healthcare. The geographic traits were trivial in explaining EMR variation. Higher ratios of service employed, and investment (% of GDP) were linked to lower EMR. These results help to inform policies now and in future pandemics to strengthen resilience against EMR.

Key messages

• This study identified which pre-pandemic factors affected EMR in partaking countries, adding to a growing body of work on the COVID-19 pandemic.

• Higher ratios of nurses to population, able and prompt healthcare, higher % employed, and investment (% of GDP) were linked to lower EMR.
Prevalence of cardio-metabolic multi-morbidity and associated risk factors in a population-based sample of South Africans
Authors: Kandala N-B , Sewpaul R , Mbewu AD , Fagbamigbe AF , Reddy SP
Published: October 2022

Objectives

Cardio-metabolic multi-morbidity (CM), the co-existence of two or more cardio-metabolic disorders in the same person, is rapidly increasing. We examined the prevalence and risk factors associated with CM in a population-based sample of South African adults.

Study design

Data were analyzed on individuals aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES), a cross sectional population-based survey conducted in 2011-2012.

Methods

CM was defined as having ≥2 of hypertension, diabetes, stroke and angina. Multivariable logistic regression was used to investigate the sociodemographic and modifiable risk factors associated with CM.

Results

Of the 3832 individuals analyzed, the mean age was 40.8 years (S.D. 18.3), 64.5% were female and 18% were ≥60 years. The prevalence of CM was 10.5%. The most prevalent CM cluster was hypertension and diabetes (7.3%), followed by hypertension and angina (2.6%) and hypertension and stroke (1.9%). Of the individuals with diabetes, nearly three quarters had multi-morbidity from co-occurring hypertension, angina and/or stroke and of those with hypertension, 30% had co-occurring diabetes, angina and/or stroke. Age (30-44 years Adjusted Odds Ratio (AOR) = 2.68, 95% CI: 1.15-6.26), 45-59 years AOR = 16.32 (7.38-36.06), 60-74 years AOR = 40.14 (17.86-90.19), and ≥75 years AOR = 49.54 (19.25-127.50) compared with 15-29 years); Indian ethnicity (AOR = 2.58 (1.1-6.04) compared with black African ethnicity), overweight (AOR = 2.73 (1.84-4.07)) and obesity (AOR = 4.20 (2.75-6.40)) compared with normal or underweight) were associated with increased odds of CM.

Conclusions

A tenth of South Africans have two or more cardio-metabolic conditions. The findings call for immediate prioritization of prevention, screening and management of cardio-metabolic conditions and their risk factors to avert large scale health care costs and adverse health outcomes associated with multi-morbidity.
Metabolic syndrome as predictor of work exit type: A longitudinal study among 55,817 Dutch workers
Authors: Runge K , van Zon SKR , Henkens K , Bültmann U
Published: October 2022

Background

Chronic diseases like cardiovascular disease or type two diabetes mellitus are related to work exit types such as unemployment and work disability. It is unknown whether metabolic syndrome as a risk factor preceding these chronic diseases is related to work exit type. Metabolic syndrome is present when people have at least three out of the following five risk factors: hypertension, abdominal obesity, raised triglycerides, raised blood glucose, and reduced HDL-cholesterol. We examined the association of metabolic syndrome with work exit type while controlling for socio-demographic and occupational factors.

Methods

The sample included 55,817 Dutch workers aged 40-65 years from the Lifelines Cohort Study and Biobank. We used data from five measurement waves with a mean follow-up time of 4.1 years. Metabolic syndrome was measured at baseline and based on physical examinations, blood markers, and medication use. Follow-up work exit types were self-reported and included unemployment, work disability, early and regular retirement. Competing risk regression analysis was used.

Preliminary

Results

Metabolic syndrome increased the risk of work disability (adjusted SHR: 1.69, 95% CI: 1.42, 2.02) and unemployment (adjusted SHR: 1.11, 95% CI: 1.01, 1.22), and was not associated with early and regular retirement.

Conclusions

Metabolic syndrome increases the risk of work disability and unemployment. More awareness about and prevention of metabolic syndrome is needed among general practitioners and occupational physicians. Early detection of metabolic syndrome as a risk factor preceding chronic diseases might prevent premature work exit in middle- and late-career.

Key messages

• Metabolic syndrome increases the risk of work disability and unemployment among middle-aged and older workers.

• More metabolic syndrome awareness and prevention might help to extend healthy working years.