bluuebunny/crossref_metadata_2025 huggingface dataset:
Motivational factors influencing nurses’ participation in continuing education sessions: A hospital-based study
Authors: Ait Ali Driss , Fazaz Mohamed , Ounaceur Brahim , El Houate Brahim , El Koutbi Mohamed , El Khiat Abdelaati , Senhaji Fatima
Published: November 2022

In order to stay up-to-date in the nursing field, nurses must pursue continuous education. This study examined nurses’ motivations to take part in continuing education activities by conducting a survey amongst a sample of nurses employed in two hospitals in south-east Morocco. The survey was carried out using a two-part self-administered questionnaire. Out of 144 nurses who received the questionnaire, 118 (84%) replied. The results showed that the majority of nurses have never participated in a continuing education session in the last 3 years. Respondents’ motivation for continuing education was mainly intrinsic, with the emphasis on factors related to professional competence and knowledge seeking. The use of such results can therefore be of great use to both managers and practitioners in planning continuing education programmes. However, it is desirable that more studies take place to investigate further the issue of continuing education with the aim of promoting and developing professional nursing skills.
Review of the Evidence for Neurofeedback Training for Children and Adolescents Who Have Experienced Traumatic Events
Authors: Schutz Chantelle Alysse , Herbert James
Published: November 2022

Neurofeedback training is an established treatment for children with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder and is an increasingly accepted modality of treatment in the context of child trauma. This treatment is typically delivered as a complement to more traditional talk therapy such as trauma-focused-cognitive behavioral therapy (TF-CBT). This review examined the evidence for the effectiveness of this intervention for children with trauma through a systematic search of the literature. A targeted search across databases identified 10 eligible studies that focused on children/young people who had experienced traumatic events and/or demonstrated symptoms of trauma, and which conducted a repeated measures study at a minimum. While the included studies suggest some benefits from neurofeedback training, the available studies, including randomized trials, have to date been relatively small, involve dramatically different treatment length and intensity, and show inconsistent benefits relative to usual treatment conditions. To advance knowledge of this intervention further research is needed with a clear best practice protocol and with a clearer target group.
Building on Community Research Partnerships and Training Students in a Multi-Phase Community-Based Participatory Research Study With Young Women of Cambodian Heritage in Massachusetts
Authors: Nelson-Peterman Jerusha , Sibeko Lindiwe , Mouth Ronnie , Cordeiro Lorraine S.
Published: November 2022

Refugees bring significant economic and cultural benefits to communities and yet face elevated risk of chronic disease and barriers to good health in the U.S. Community-based participatory research (CBPR) can benefit refugee communities and provide training/mentoring opportunities for students. The Cambodian Women’s Health Study was a four-phase, multi-year CBPR university–community collaboration with the Massachusetts Cambodian community that focused on health, nutrition, pregnancy, and food security among primarily young women of Cambodian heritage ages 15–30 years old. Phase 1 was a focus group discussion (FGD, n = 4) and cross-sectional survey ( n = 56) with pregnant women. Phase 2 was a cross-sectional survey ( n = 107) with nonpregnant women. Phase 3 was a series of FGD (seven FGD, n = 38) with women. Phase 4 was a student-led translational nutrition intervention (three classes) with women ( n = 11) and men ( n = 10). The study design included compensation and support for the community partner and included structured mentoring of students (six graduates, eight undergraduates) in CBPR methods, adult learning, and cultural humility. Benefits to the community agency included enhanced research capacity, including supervising student research assistants, and robust compensation. Benefits to students included intensive mentoring and training. Successes included cost-effectiveness and strong recruitment and experiences with participants. Challenges included issues with student-led recruitment and organization that required additional mentoring and reflection. To work toward socially just and equitable research and interventions, CBPR collaborative efforts should include intentional meaningful compensation and community capacity-building as well as structured mentoring and training for student researchers and should build on existing work and relationships within communities.
Demographics, Tobacco Use, and Tobacco Control Measures of California Cities With Flavored Tobacco Sales Restrictions
Authors: Dove Melanie S. , Zheng Shichen , Pakdaman Sheila , Chen-Sankey Julia
Published: November 2022

In 2020, California passed a flavored tobacco sales restriction (FTSR), but the tobacco companies filed a referendum, and the ban will not be implemented unless approved by voters in November 2022. This study examined the percentage of the California population covered by a city FTSR and identified groups more likely to be covered. Mean demographics as well as tobacco use and control measures were compared for California cities with ( n = 93) and without ( n = 389) a FTSR, and t tests were used to examine the differences. We calculated adjusted odds ratios using logistic regression models. City FTSR policies covered 20.7% of the California population. Adjusted predictors of having a FTSR included the American Lung Association tobacco control score (odds ratio [OR] = 1.27, 95% confidence interval [CI]: [1.17, 1.38]), voting democratic (OR = 1.06, 95% CI: [1.02, 1.10]). and having a lower adult smoking prevalence (OR = 0.84, 95% CI: [0.72, 0.99]). A state-level policy would cover all populations in California.
An Alternative Airway Intervention to Preserve the Surgical Field in Oral and Maxillofacial Surgery
Authors: Dowsett Paul A. , Khan Saad A. , Khan Amina A. , D’Souza Rachael L. , Reebye Uday N.
Published: November 2022

Background/need. Office-based sedation has become increasingly commonplace in dental offices in recent years, allowing for practitioners to provide broader scope of care for their patients. Maintaining high standards of safety is of utmost importance when sedation is utilized in the office-based setting, especially for patients deemed at a higher-risk for intraoperative airway obstruction. This demographic includes but is not limited to individuals with a medical history significant for obstructive sleep apnea, chronic obstructive pulmonary disease, and morbid obesity. Presently, a wide variety of airway devices exist for use in the event of airway obstruction. However, in the context of oral and maxillofacial surgery, placement of these devices can encroach upon the surgical field, extending the perioperative period and putting the patient at greater long-term risk for maintaining adequate oxygenation. Methodology. The authors describe a preliminary technique trialed in our offices which utilizes a size 5.0 endotracheal tube (5OET) as an adjunct supraglottic airway to help mitigate the issue of oxygen saturation maintenance, as well as unimpeded access to the oral cavity. Implementation of the device requires identifying appropriate candidates during preoperative screening and placing the device through the nare and securing it above the glottis. Device Description. The ‘tube kit’ is comprised of a standard size straight 5.0 cuffed oral ETT, a 5-mL syringe for inflation of the cuff post insertion, lubricant, flex extension tubing, end tidal sampling line for capnography, tape for securement of the 5OET, and an anesthesia breathing circuit. Optional equipment pieces include an elbow connecter and a foam piece for comfort. Results/Current Status. Preliminary results have demonstrated oxygen saturations maintained above 98% when the 5OET is placed preoperatively. Continued use of the trial device will inform the development of a tube by our clinicians, and its efficacy will be studied in our offices. The next steps will be to start developing a pilot cuff that will be submitted for patent approval after its use in IRB-approved clinical studies.
Association of serum biochemical indexes and thyroid nodule with disease activity in patients with chronic spontaneous urticaria
Authors: Su Yuan-Ting , Cui Wei
Published: November 2022

Objectives: This study aimed to evaluate the correlation of serum biochemical indexes with disease activity and pruritus in patients with chronic spontaneous urticaria (CSU). Methods: Fifty CSU patients were enrolled and 50 health screen examinees were recruited as the control group. Peripheral blood samples were collected, and thyroid colour Doppler ultrasounds were recorded. Body mass index (BMI) was calculated for both groups. The urticaria activity score over 7 days (UAS-7) was used to evaluate the disease activity and degree of pruritus. Results: There was no significant difference in BMI between CSU patients and control ( p > .05). The serum WBC, NEU, CRP (all p = .000) and ALT levels ( p = .013) in the CSU patients were significantly higher than those in the healthy control group, and the UAS-7 score was positively correlated with WBC and NEU in the CSU patient group. The TG level of the CSU group was higher than healthy controls, albeit no statistical significance ( p = .522). The levels of T3 and TSH were significantly lower in the CSU group ( p = .000). The incidence rate of thyroid nodules in the CSU patients was significantly higher ( p = .045), and four CSU patients showed papillary carcinoma by pathology examination. The average UAS-7 score of patients with complications was significantly higher than that of patients without complications. Conclusion: Patients experiencing CSU generally exhibit abnormal serum biochemical indexes and thyroid function. Their incidence rates of thyroid nodule and thyroid papillary carcinoma are significantly higher than that of healthy subjects, which should be considered in clinical practice.
Assessing medical students’ perceived stress levels by comparing a chatbot-based approach to the Perceived Stress Questionnaire (PSQ20) in a mixed-methods study
Authors: Moldt Julia-Astrid , Festl-Wietek Teresa , Mamlouk Amir Madany , Herrmann-Werner Anne
Published: November 2022

Objective

Digital transformation in higher education has presented medical students with new challenges, which has increased the difficulty of organising their own studies. The main objective of this study is to evaluate the effectiveness of a chatbot in assessing the stress levels of medical students in everyday conversations and to identify the main condition for accepting a chatbot as a conversational partner based on validated stress instruments, such as the Perceived Stress Questionnaire (PSQ20).

Methods

In this mixed-methods research design, medical-student stress level was assessed using a quantitative (digital- and paper-based versions of PSQ20) and qualitative (chatbot conversation) study design. PSQ20 items were also shortened to investigate whether medical students’ stress levels can be measured in everyday conversations. Therefore, items were integrated into the chat between medical students and a chatbot named Melinda.

Results

PSQ20 revealed increased stress levels in 43.4% of medical students who participated ( N  =  136). The integrated PSQ20 items in the conversations with Melinda obtained similar subjective stress degree results in the statistical analysis of both PSQ20 versions. Qualitative analysis revealed that certain functional and technical requirements have a significant impact on the expected use and success of the chatbot.

Conclusion

The results suggest that chatbots are promising as personal digital assistants for medical students; they can detect students’ stress factors during the conversation. Increasing the chatbot's technical and social capabilities could have a positive impact on user acceptance.
Effect of ZnO-doped magnesium phosphate cements on osteogenic differentiation of mBMSCs in vitro
Authors: Wang Xiaomei , Shi Feng , Zhao Dechuan , Yan Yonggang
Published: November 2022

The insufficient osteogenesis of magnesium phosphate cements (MPCs) limits its further application. It is significant to develop a bioactive MPC with osteogenic properties. In this work, MPCs were reinforced by zinc oxide nanoparticles (ZnO-NPs). The composition, microstructure, setting time, compressive strength and degradation of ZnO-NPs/MPCs (ZNMPCs) were evaluated. The results showed that the setting times of MPCs were prolonged from 8.2 to 25.3 min (5.0ZNMPC). The exothermic temperatures were reduced from 45.8 ± 0.4℃ (MPCs) to 39.3 ± 0.5℃ (1.0ZNMPC). The compressive strength of ZNMPC composite cement with 1 wt. % ZnO-NPs (1.0ZNMPC) was the highest (42.9 MPa) among all the composite cements. Furthermore, the ZNMPCs were cultured with mouse bone marrow mesenchymal stem cells (mBMSCs). The results yielded that the ZNMPCs exhibited good cytocompatibility with enhanced differentiation, proliferation, and mineralization on mBMSCs, and it also pronouncedly elevated the expressions of genes and proteins involving osteogenesis. These findings suggested that ZNMPCs could drive the differentiation toward osteogenesis and mineralization of mBMSCs, providing a simple way to the MPC with enhanced osteogenesis for further orthopedic applications.
Developing Public Health Students’ Strategic Skills Through Authorship Training
Authors: August Ella , Zelner Sarah , Zelner Jon , Anderson Olivia S.
Published: November 2022

Collaborative writing skills are essential for public health professionals to carry out their work in a variety of settings, however, these strategic skills are not being taught comprehensively in public health schools and programs. In this paper, we argue that instructors should train public health students on a range of issues related to authorship, and we frame this training as a way of creating equitable opportunities for students to develop key professional skills. We conclude with specific recommendations and resources to support this training.
Impact of Obesity on Severity of Ankle Fracture
Authors: Wong Liam H. , Atwater Lara C. , Wyland Alden E.
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Ankle fractures are one of the most common types of foot and ankle trauma requiring surgery. Prior studies have investigated the association between obesity and ankle fracture on a general level, but not all studies have broken down the data by ankle fracture pattern subtypes. The aim of this study was to investigate the association between obesity and severity of ankle fractures, as classified by single malleolar (isolated fibular, posterior malleolar or medial malleolar), bimalleolar, trimalleolar and pilon subtypes.

Methods:

We retrospectively investigated the patient charts of 1,326 treated ankle fractures from 2011 to 2021 at a level 1 trauma center as identified by CPT codes. Collected data included age, diagnosis, BMI (obese > 30 kg/ m2), and vitamin D. For this study, we excluded patients who did not have a fracture of a malleoli or a pilon fracture (n=129). Severity of fracture was determined by number of malleoli fractured with the addition of pilon fracture as the most severe. Inferential statistics were performed using ANOVA and chi-squared tests.

Results:

Of 1,197 patients with an operatively managed ankle fracture (median age 28.7 years), 516 (43.2%) were obese. There were 434 (36.3%) unimalleolar fractures, 396 (33.1%) bimalleolar fractures, 294 (24.6%) trimalleolar fractures, and 73 (6.1%) pilon fractures. Obesity represented 39.4% (n=171) of unimalleolar fractures, 42.7% (n=169) of bimalleolar fractures, 50.0% (n=147) of trimalleolar fractures, and 39.7% (n=29) of pilon fractures (P<0.037). There were 273 (62.9%) lateral malleolar fractures, 127 (29.3%) medial malleolar fractures, and 34 (7.8%) posterior malleolar fractures. Obesity represented 45.4% (n=124) of lateral malleolar fractures, 29.1% (n=37) of medial malleolar fractures, and 29.4% (n=10) of posterior malleolar fractures (P<0.004). Obese patients had a higher probability of a trimalleolar fracture compared to a unimalleolar (OR 1.54; 95% CI, 1.14-2.07; P=0.005) as well as having a lateral malleolar fracture compared to a medial malleolar (OR 2.02; 95% CI, 1.29-3.18; P=0.002).

Conclusion:

This review of all operatively treated ankle fractures at a level 1, academic trauma center suggests that obesity is associated with increasing severity of ankle fracture patterns, with the exception of pilon fractures. Obese patients have a higher probability of having a trimalleolar fracture than a unimalleolar fracture. Obese patients are also more likely to have a lateral malleolar fracture compared to a medial malleolar fracture. Patients and clinicians should be aware of this higher risk of trimalleolar fractures as these fractures are commonly associated with worse outcomes and a higher probability of developing osteoarthritis.
Impact of Pain in Other Body Regions on the Foot-Specific Quality of Life in Patients with Hallux Valgus
Authors: Yamaguchi Satoshi , Kimura Seiji , Mikami Yukio
Published: November 2022

Category:

Bunion

Introduction/Purpose:

The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life (QOL) in patients with hallux valgus.

Methods:

Patients scheduled to undergo surgery for idiopathic hallux valgus (rheumatoid forefoot deformity not included) were recruited. Patients less than 20 years old, and those with a history of foot and ankle surgery were excluded. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific QOL was assessed using the Self- Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores were assessed using univariate and multivariate analyses.

Results:

Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS.

Conclusion:

More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific QOL and severer foot pain. Assessment of pain elsewhere is necessary to evaluate foot- specific QOL in HV patients.
Calcaneal Malunions Management and Types of Surgical Correction
Authors: Zeynalov Vadim , Arapova Irina
Published: November 2022

Category:

Hindfoot; Ankle

Introduction/Purpose:

Number of fractures of the calcaneus amounts to 1-5.7% of all fractures of skeleton bones according to various authors. Moreover, these figures correspond to 50% of all fractures of feet bones. Consequences of calcaneus malunion leads to early disability, arthrosis, pain syndrome, disorder of the entire low extremity axis of motion alongside cosmetic defects and shoe wearing discomfort. Purpose of the study: classification of calcaneal malunions based on a geometrically normal position and dimensions of hindfoot in order to develop optimal type of treatment for multicomponent calcaneal deformity.

Methods:

Twelve patients with post traumatic deformed hindfoot after malunited calcaneal fractures and as a result varus and valgus deformity, subtalar arthritis, pain syndrome, shoe wear discomfort at different stages after trauma (from 1 to 10 years) were examined, underwent surgical alignment of calcaneus and were followed up for 24 months. All cases were assessed clinically using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS); radiologically by measuring hindfoot varus/valgus, talus tilt, Meary's angle, and hight of calcaneal.

Results:

It was found a significant improvement in AOFAS (55.2 preoperatively to 78.8 after 24 months) and VAS (65 preoperatively to 30.1). Moreover, our study revealed a significant improvement in the radiographic measurements including hindfoot varus/valgus, the talar inclination, Meary's angle, and hight of calcaneus.

Conclusion:

The elimination of angular hindfoot varus or valgus deformation, exostectomy of the lateral wall and subtalar fusion, as well as the use of a tricortical autograft for distarction arthrodesis at III-V type Zwipp and Rammelt classification, resulted in reduced pain, improved function, cosmetic results and shoe wearing.
Reducing Isolation in an Online Teacher Preparation Program: Reflections From STRIDE Scholars
Authors: Bartz Jody Marie , Applequist Karen , Aruguete Joseph
Published: November 2022

The significant shortages of special educators across the United States, particularly in our rural communities, can negatively affect the delivery of high-quality services that enable young children and families to flourish (National Coalition on Personnel Shortages in Special Education and Related Services, 2019). We present our Project STRIDE (STrengthening Rural Inclusive Diverse Early Educators) program description along with longitudinal and reflective data collected from a cohort of graduate students working in rural communities in a southwestern U.S. state who were completing their degrees in Early Childhood Special Education (ECSE). Twenty STRIDE Scholars demonstrated significant growth in self-ratings from midpoint to end of program. Evaluative data obtained on program components revealed overall program satisfaction. We discuss how characteristics of learners potentially contribute to the self-reflection process and the value of purposeful embedding of self-reflection in distance teacher education programs.
How I use risk factors for success or failure of CD19 CAR T cells to guide management of children and AYA with B-cell ALL
Authors: Myers Regina M. , Shah Nirali N. , Pulsipher Michael A.
Published: November 2022

By overcoming chemotherapeutic resistance, chimeric antigen receptor (CAR) T cells facilitate deep, complete remissions and offer the potential for long-term cure in a substantial fraction of patients with chemotherapy refractory disease. However, that success is tempered with 10% to 30% of patients not achieving remission and over half of patients treated eventually experiencing relapse. With over a decade of experience using CAR T cells in children, adolescents, and young adults (AYA) to treat relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) and 5 years since the first US Food and Drug Administration approval, data defining the nuances of patient-specific risk factors are emerging. With the commercial availability of 2 unique CD19 CAR T-cell constructs for B-ALL, in this article, we review the current literature, outline our approach to patients, and discuss how individual factors inform strategies to optimize outcomes in children and AYA receiving CD19 CAR T cells. We include data from both prospective and recent large retrospective studies that offer insight into understanding when the risks of CAR T-cell therapy failure are high and offer perspectives suggesting when consolidative hematopoietic cell transplantation or experimental CAR T-cell and/or alternative immunotherapy should be considered. We also propose areas where prospective trials addressing the optimal use of CAR T-cell therapy are needed.
Electroacupuncture improves cognitive impairment in diabetic cognitive dysfunction rats by regulating the mitochondrial autophagy pathway
Authors: Ge Xia , Wang Ling , Cui Qianqian , Yan Hongli , Wang Zhongbao , Ye Shandong , Zhang Qingping , Fei Aihua
Published: November 2022

Background

Diabetes-associated cognitive dysfunction has become a major public health concern. However, the mechanisms driving this disease are elusive. Herein, we explored how electroacupuncture improves learning and memory function in diabetic rats.

Methods

The diabetic model was established by intraperitoneal injection of streptozotocin (STZ) in adult Sprague–Dawley rats. Rats were fed on high-fat and high-sugar diets. Learning and memory functions were assessed using behavioral tests. The hematoxylin and eosin (H&E) staining, Western blotting, real-time PCR, ELISA, immunohistochemistry, and transmission electronic microscopy (TEM) was performed to test related indicators.

Results

High-fat and high-sugar diets impaired learning and memory function in rats, while electroacupuncture treatment reversed these changes. The model group presented highly prolonged escape latency compared to the control group, indicating impaired learning and memory functions. The TEM examination showed that electroacupuncture enhanced Aβ clearance and mitochondrial autophagy in hippocampal neuronal cells by increasing DISC1 expression.

Conclusions

Electroacupuncture improves learning and memory function in diabetic rats by increasing DISC1 expression to promote mitophagy. This enhanced Aβ clearance, alleviating cytotoxicity in hippocampal neuronal cells.
Optimisation of the core subset for the APY approximation of genomic relationships
Authors: Pocrnic Ivan , Lindgren Finn , Tolhurst Daniel , Herring William O. , Gorjanc Gregor
Published: November 2022

Background

By entering the era of mega-scale genomics, we are facing many computational issues with standard genomic evaluation models due to their dense data structure and cubic computational complexity. Several scalable approaches have been proposed to address this challenge, such as the Algorithm for Proven and Young (APY). In APY, genotyped animals are partitioned into core and non-core subsets, which induces a sparser inverse of the genomic relationship matrix. This partitioning is often done at random. While APY is a good approximation of the full model, random partitioning can make results unstable, possibly affecting accuracy or even reranking animals. Here we present a stable optimisation of the core subset by choosing animals with the most informative genotype data.

Methods

We derived a novel algorithm for optimising the core subset based on a conditional genomic relationship matrix or a conditional single nucleotide polymorphism (SNP) genotype matrix. We compared the accuracy of genomic predictions with different core subsets for simulated and real pig data sets. The core subsets were constructed (1) at random, (2) based on the diagonal of the genomic relationship matrix, (3) at random with weights from (2), or (4) based on the novel conditional algorithm. To understand the different core subset constructions, we visualise the population structure of the genotyped animals with linear Principal Component Analysis and non-linear Uniform Manifold Approximation and Projection.

Results

All core subset constructions performed equally well when the number of core animals captured most of the variation in the genomic relationships, both in simulated and real data sets. When the number of core animals was not sufficiently large, there was substantial variability in the results with the random construction but no variability with the conditional construction. Visualisation of the population structure and chosen core animals showed that the conditional construction spreads core animals across the whole domain of genotyped animals in a repeatable manner.

Conclusions

Our results confirm that the size of the core subset in APY is critical. Furthermore, the results show that the core subset can be optimised with the conditional algorithm that achieves an optimal and repeatable spread of core animals across the domain of genotyped animals.
Factors influencing conveyance of older adults with minor head injury by paramedics to the emergency department: a multiple methods study
Authors: Nicholson Helen , Voss Sarah , Black Sarah , Taylor Hazel , Williams David , Benger Jonathan
Published: November 2022

Background

Head injury (HI) in older adults due to low-energy falls result in a substantial number of emergency department (ED) attendances. However, mortality associated with minor HI is very low. Reducing conveyance to hospital is important for older adults and is a priority for the National Health Service (NHS). Therefore, paramedics are required to make accurate decisions regarding conveyance to the ED. This study used routine data and semi-structured interviews to explore the factors that influence paramedic decision-making when considering whether to convey an adult aged 65 years and over with a minor HI to the ED.

Methods

Semi-structured telephone interviews were completed with ten UK paramedics from a single EMS (ambulance) provider organisation. Interviews explored the factors influencing the paramedics’ conveyance decision-making in adults aged 65 years and over with a minor HI. Data were initially analysed inductively to develop a thematic framework. A retrospective analysis of ambulance service data was also completed to determine the scope and scale of the issue in Southwest England. An in-depth audit of 100 conveyed patient records was used to determine the proportion of patients conveyed to the ED who met National Institute for Health and Care Excellence (NICE) and Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines.

Results

In 2019 South Western Ambulance Service NHS Foundation Trust (SWASFT) attended 15,650 emergency calls to patients aged 65 and over with minor HI, with 70.5% conveyed to ED. 81% of conveyed patients met NICE and JRCALC guideline criteria for conveyance, with the remainder conveyed due to wound care or other medical concerns. The framework developed from the interviews comprised four themes: resources; patient factors; consequences; paramedic factors. Important factors included: the patient’s social situation; guidelines; clinical support availability; the history and presentation of the patient; risk.

Conclusion

This study examined paramedic conveyance decisions for older people with minor HI. It identified multiple influencing factors, highlighting the complex nature of these decisions, and may serve as a basis for developing an intervention to safely decrease ED conveyance in this patient group.
Using information from network meta-analyses to optimize the power and sample allocation of a subsequent trial with a new treatment
Authors: Hu Dapeng , Wang Chong , Ye Fangshu , O’Connor Annette M.
Published: November 2022

Background

A critical step in trial design is determining the sample size and sample allocation to ensure the proposed study has sufficient power to test the hypothesis of interest: superiority, equivalence, or non-inferiority. When data are available from prior trials and leveraged with the new trial to answer the scientific questions, the value of society’s investment in prior research is increased. When prior information is available, the trial design including the sample size and allocation should be adapted accordingly, yet the current approach to trial design does not utilize such information. Ensuring we maximize the value of prior research is essential as there are always constraints on resources, either physical or financial, and designing a trial with adequate power can be a challenge.

Methods

We propose an approach to increasing the power of a new trial by incorporating evidence from a network meta-analysis into the new trial design and analysis. We illustrate the methodology through an example network meta-analysis, where the goal is to identify the optimal allocation ratio for the new three-arm trial, which involves the reference treatment, the new treatment, and the negative control. The primary goal of the new trial is to show that the new treatment is non-inferior to the reference treatment. It may also be of interest to know if the new treatment is superior to the negative control. We propose an optimal treatment allocation strategy which is derived from minimizing the standard error of the log odds ratio estimate of the comparison of interest. We conducted a simulation study to assess the proposed methods to design a new trial while borrowing information from the existing network meta-analysis and compare it to even allocation methods.

Results

Using mathematical derivation and simulations, we document that our proposed approach can borrow information from a network meta-analysis to modify the treatment allocation ratio and increase the power of the new trial given a fixed total sample size or to reduce the total sample size needed to reach a desired power.

Conclusions

When prior evidence about the hypotheses of interest is available, the traditional equal allocation strategy is not the most powerful approach anymore. Our proposed methodology can improve the power of trial design, reduce the cost of trials, and maximize the utility of prior investments in research.
Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study
Authors: Bel Haj Ali Khaoula , Sekma Adel , Messous Selma , Trabelsi Imen , Ben Youssef Jalel , Maghraoui Hamida , Razgallah Rabie , walha Adel , Grissa Mohamed Habib , Beltaief Kaouthar , Mezgar Zied , Coubantini Ahmed , Bouida Wahid , Msolli Mohamed Amine , Boukef Riadh , Boubaker Hamdi , Nouira Semir
Published: November 2022

Background

Little is known about the pattern and appropriateness of antibiotic prescriptions in patients with acute respiratory tract infections (ARTIs).

Objective

Describe the antibiotics used to treat ARTIs in Tunisian primary care offices and emergency departments (EDs), and assess the appropriateness of their use.

Methods

It was a prospective multicenter cross-sectional observational clinical study conducted at 63 primary care offices and 6 EDS during a period of 8 months. Appropriateness of antibiotic prescription was evaluated by trained physicians using the medication appropriateness index (MAI). The MAI ratings generated a weighted score of 0 to 18 with higher scores indicating low appropriateness. The study was conducted in accordance with the Declaration of Helsinki and national and institutional standards. The study was approved by the Ethics committee of Monastir Medical Faculty.

Results

From the 12,880 patients screened we included 9886 patients. The mean age was 47.4, and 55.4% were men. The most frequent diagnosis of ARTI was were acute bronchitis (45.3%), COPD exacerbation (16.3%), tonsillitis (14.6%), rhinopharyngitis (12.2%) and sinusitis (11.5%). The most prescribed classes of antibiotics were penicillins (58.3%), fluoroquinolones (17.6%), and macrolides (16.9%). Antibiotic therapy was inappropriate in 75.5% of patients of whom 65.2% had bronchitis. 65% of patients had one or more antibiotic prescribing inappropriateness criteria as assessed by the MAI. The most frequently rated criteria were with expensiveness (75.8%) and indication (40%). Amoxicillin-clavulanic acid and levofloxacin were the most inappropriately prescribed antibiotics. History of cardiac ischemia ([OR] 3.66; 95% [CI] 2.17–10.26; p < 0.001), asthma ([OR] 3.29, 95% [CI] 1.77–6.13; p < 0.001), diabetes ([OR] 2.09, 95% [CI] 1.54–2.97; p = 0.003), history of COPD ([OR] 1.75, 95% [CI] 1.43–2.15; p < 0.001) and age > 65 years (Odds Ratio [OR] 1.35, 95% confidence interval [CI] 1.16–1.58; p < 0.001) were associated with a higher likelihood of inappropriate prescribing.

Conclusion

Our findings indicate a high inappropriate use of antibiotics in ARTIs treated in in primary care and EDs. This was mostly related to antibiotic prescription in acute bronchitis and overuse of expensive broad spectrum antibiotics. Future interventions to improve antibiotic prescribing in primary care and EDs is needed.

Trial registration

the trial is registered at Clinicaltrials.gov registry (NCT04482231).
Neighbourhood socio-economic status and positive affectivity among older residents in Germany: a cross-sectional analysis with data from the Heinz Nixdorf Recall Study
Authors: Hartig Christina , Bolte Gabriele , Jöckel Karl-Heinz , Moebus Susanne , Riedel Natalie
Published: November 2022

Background

Physical and social neighbourhood characteristics can vary according to the neighbourhood socio-economic status (SES) and influence residents’ perceptions, behaviours and health outcomes both positively and negatively. Neighbourhood SES has been shown to be predictive of mental health, which is relevant for healthy ageing and prevention of dementia or depression. Positive affectivity (PA) is an established indicator of mental health and might indicate a positive emotional response to neighbourhood characteristics. In this study, we focussed on the association of neighbourhood SES with PA among older residents in Germany and considered social integration and environmental perceptions in this association.

Methods

We used questionnaire-based data of the ongoing population-based Heinz Nixdorf Recall Study for our cross-sectional analysis, complemented by secondary data on social welfare rates in the neighbourhood of residents’ address. PA was assessed using the Positive and Negative Affect Schedule (PANAS) in 2016. Linear regression models were performed to estimate the associations and adjusted for socio-demographic variables.

Results

Higher social welfare rates were associated with lower PA scores. The strongest negative association from the crude model (b = −1.916, 95%-CI [−2.997, −0.835]) was reduced after controlling for socio-demographic variables (b = −1.429, 95%-CI [−2.511, −0.346]). Social integration factors (b = −1.199, 95%-CI [−2.276, −0.121]) and perceived environmental factors (b = −0.875, 95%-CI [−1.971, 0.221]) additionally diminished the association of social welfare rates with PA in the full model (b = −0.945, 95%-CI [−2.037, 0.147]).

Conclusion

Our results suggest that neighbourhoods have an influence on the occurrence and the extent of PA. Public health interventions that address socio-economic disadvantage in the neighbourhood environment could be an effective and far-reaching way to reduce the risk of depression and depressive symptoms due to low PA in older residents.
Determination of skeletal muscle mass by aspartate aminotransferase / alanine aminotransferase ratio, insulin and FSH in Chinese women with sarcopenia
Authors: Yin Mengting , Zhang He , Liu Qianhui , Ding Fei , Hou Lisha , Deng Yiping , Cui Tao , Han Yixian , Chen Yijun , Huang Chen , Yue Jirong , He Yong
Published: November 2022

Background:

Sarcopenia is an age-related skeletal muscle disorder that involves a loss of muscle mass or strength and physiological function. Skeletal muscle deteriorates in both quantity and quality. The endocrine system is an important regulator of muscle metabolism. Therefore, we aimed to explore the relationship between biochemical markers and muscle mass in sarcopenia.

Methods:

We used the AWGS 2014 as the diagnostic criteria for sarcopenia, considering both the loss in muscle mass, muscle strength and physical performance. A total of 2837 elderly female participants over 50 years of age from the West China Health and Aging Trend (WCHAT) study were included. Insulin, glucose, 25(OH)VD, procalcitonin, alanine aminotransferase, aspartate aminotransferase, total protein, prealbumin, albumin, thyroid-stimulating hormone, free triiodothyronine, free tetraiodothyronine, triglycerides, cholesterol, high-density lipoprotein, very low-density lipoprotein, cortisol, and follicle-stimulating hormone were measured. Based on the findings of univariate analysis, multivariate regression and receiver operating characteristic (ROC) curves were established.

Results:

Participants with sarcopenia had significantly lower free triiodothyronine, insulin, total protein, albumin, prealbumin, albumin/prealbumin ratio (A/G), alanine aminotransferase, triglycerides, and very low-density lipoprotein concentrations (P < 0.05). Compared with those without sarcopenia, those with sarcopenia had significantly higher free tetraiodothyronine, cortisol, follicle-stimulating hormone (FSH), aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT), and high-density lipoprotein concentrations (P < 0.05). Insulin (OR = 0.854), FSH (OR = 1.016), and the AST/ALT ratio (OR = 1.819) were independent risk factors for low muscle mass (P < 0.001). The AUC of insulin was the highest, followed by the AST/ALT ratio and FSH (0.691, 0.671, and 0.634, respectively), and the AUC of the mixture of the above three reached 0.736.

Conclusion:

In this cross-sectional study of elderly Chinese females aged over 50 years from the WCHAT, FSH, insulin, and AST/ALT ratio were associated with sarcopenia and risk factors for low muscle mass.
Caring for older men and women: whose caregivers are more distressed? A population-based retrospective cohort study
Authors: Li Wenshan , Manuel Douglas G. , Isenberg Sarina R. , Tanuseputro Peter
Published: November 2022

Background

To our knowledge, no population-based studies have examined whether family or friend caregivers of men and women differ in their experience of distress over time. Thus, we aimed to describe, on a population-level and longitudinally, how older men and women care-receivers differed in their health and care needs, compare their caregivers’ distress trajectories, and identify factors that contribute to the observed differences.

Methods

This is a population-based, retrospective cohort study using routinely collected data. We examined longitudinally 485,407 community-dwelling Ontario residents, aged over 50 years, who have received at least one Residential Assessment Instrument-Home Care (RAI-HC) assessment between April 2008 and June 2015. Descriptive analyses were performed on the demographic characteristics, health profiles, and care needs of men and women. We also compared their caregivers’ baseline and one-year change in distress status. Logistic regressions were performed to examine if the effect of gender on caregiver distress is reduced after controlling for care-receiver’s health and functional status as well as their caregiver’s kinship and co-residence status.

Results

Men (39.5% of our cohort) were frailer, required more care, were mostly cared for by their spouses (52%), and mostly lived with their caregiver (66%). In contrast, women (60.5%) were more likely cared for by their child/child-in-law (60%), less likely to live with caregivers (47%), and received less care. Caregivers of men were more likely to be distressed at baseline (27.7% versus 20.4% of women caregivers) and remain distressed (74.6% versus 69.5%) or become distressed (19.3% versus 14.3%) throughout the year. In logistic regression modelling, the effect of care-receiver’s gender on caregiver distress is reduced from an unadjusted odds ratio of 1.49 (95% CI: 1.47–1.51) to 1.17 (95% CI: 1.15–1.19) when care-receiver’s health and caregiving factors are controlled for.

Conclusion

Older men and women differed in health and care needs. Caregivers, especially those caring for men, were often distressed and remained so through time. These results highlight the need for policies that account for the differential care needs and caregiver profiles of men and women in order to offer targetted and appropriate support.
Developing a shortened version of the dementia knowledge assessment scale (DKAS-TC) with a sample in Taiwan: an item response theory approach
Authors: Hung Su-Pin , Liao Yi-Han , Eccleston Claire , Ku Li-Jung Elizabeth
Published: November 2022

Background

The 25-item Dementia Knowledge Assessment Scale (DKAS2) is a widely used tool for measuring knowledge of dementia. To increase the applicability of the Chinese-language version of the tool (DKAS-TC) for the general public, this study aimed to develop a shortened version using the item response theory (IRT) approach.

Methods

A total of 401 participants voluntarily completed a Chinese-language version of the DKAS2 questionnaire (DKAS-TC) at the start of dementia awareness training courses in 2020 and 2021. The four Rasch family models were used to analyze the dimensionality of the shortened scale (the DKAS-s) and to confirm its accuracy in measuring dementia knowledge.

Results

The results justified supported the use of a dichotomous response scale for responding to the DKAS-s and demonstrated good fit of the data to a Rasch model with the four dimensions of “Causes and Characteristics”, “Communication and Engagement”, “Care Needs”, and “Risks and Health Promotion”. Moreover, we shortened the DKAS-TC by selecting items that had both above-average discriminative ability and above-average information. The DKAS-s retained 64.13% of the information contained in the DKAS-TC, resulting in a 16-item scale which retained four items in each of the original four dimensions. The DKAS-s also correlated highly (≥0.95) with the DKAS-TC and exhibited a sizeable range of difficulty of dementia knowledge.

Conclusions

The DKAS-s is expected to be more efficient in field settings while retaining an acceptable level of psychometric properties when used as a survey instrument to measure the general public’s knowledge of dementia.
Subjective well-being predicts Covid-19 risk in the elderly: a case–control study
Authors: Kashefi Fatemeh , Bakhtiari Afsaneh , Gholinia Hemmat , Bakouei Fatemeh , Faramarzi Mahbobeh
Published: November 2022

Background

Covid-19 is a serious public health concern. Previous studies have shown that although there are concerns about the subjective well-being (SWB) of older people in the Covid period, the link between SWB and the risk of Covid-19 is still unclear. This study aimed to investigate the predictive effect of SWB on the Covid-19 risk in the elderly as well as the determinants of SWB.

Methods

This case–control study was performed in the elderly over 60 years of age. The case group consisted of all hospitalized patients with COVID-19 and the control group from the same population with no history of COVID-19 matched by age, sex, and place of residence. Data collection tools included a demographic questionnaire and SWB scale of Keyes and Magyarmo to measure emotional, psychological and social well-being. All data were analyzed via SPSS and STATA software. Multiple binary logistic regression was run to predict the probability of Covid-19 risk on the values of total SWB and its three subscales and multiple linear regression to identify SWB determinants.

Results

The results showed that increasing one unit in total SWB reduces the risk of Covid-19 by 4% (OR = 0.969, CI = 0.947–0.991, p = 0.006). Emotional well-being with 0.823 had the highest odds ratio for predicting Covid-19 risk, followed by social well-being with an odds ratio of 0.981. Increasing age and education, better economic status, marriage against celibacy, lack of comorbidity, and a better understanding of own health were associated with greater SWB.

Discussion

This study provides evidence for the protective effect of SWB on Covid-19 risk. To promote SWB, we need to focus on the elderly with higher financial worries and comorbidities, as well as those with less education, health perception and SWB. Therefore, it will be important for the elderly to determine strategies to improve SWB during the epidemic.