bluuebunny/crossref_metadata_2025 huggingface dataset:
Change-of-Direction Ability of Para-Footballers With Cerebral Palsy Under a New Evidence-Based and Sport-Specific Classification System
Authors: Peña-González Iván , Roldan Alba , Toledo Carlos , Urbán Tomás , Reina Raúl
Published: November 2020

Purpose: This study aimed (1) to explore the validity and reliability of a new and specific change-of-direction (COD) test that requires dribbling skills to classify international footballers with cerebral palsy (CP) and compare it with another valid and reliable COD test without ball dribbling and (2) to probe whether both tests can discriminate between the new CP football classes (ie, FT1, FT2, and FT3) established worldwide in 2018. Methods: This study involved 180 international para-footballers with CP from 23 national teams at the 3 regional competitions held in 2018. They performed 2 COD tests, the modified agility test (no dribbling skills) and the dribbling speed test (DST). Results: Reliability was excellent for both the modified agility test (intraclass correlation coefficient [ICC]2,1 = .91, SEM = 5.75%) and the DST (ICC2,1 = .92, SEM = 4.66%). The modified agility test and DST results were highly to very highly correlated to one another for the whole group and considering the sport classes (r = .60–.80; P < .001). A 1-way analysis of variance showed significant differences between sport classes in both tests (P < .001). However, among classes, there were significant differences between FT1 and FT2 and FT3 (P < .01, effect size = large) and low to moderate effect sizes between FT2 and FT3 for either test. Conclusion: The DST appears to be valid and reliable to classify CP football players within the new classification system. Regression analysis revealed that 18.2% of the variance in the new sport classes could be explained by the 2 examined tests.
Countermovement Jump Height in National-Team Athletes of Various Sports: A Framework for Practitioners and Scientists
Authors: Haugen Thomas A. , Breitschädel Felix , Wiig Håvard , Seiler Stephen
Published: November 2020

Purpose: To quantify possible differences in countermovement jump height across sport disciplines and sex in national-team athletes. Methods: In this cross-sectional study, 588 women (23 [5] y, 66 [8] kg) and 989 men (23 [5] y, 82 [12] kg) from 44 different sport disciplines (including 299 medalists from European Championships, World Championships, and/or Olympic Games) tested a countermovement jump on a force platform at the Norwegian Olympic Training Center between 1995 and 2018. Results: Athletic sprinting showed the highest values among the men (62.7 [4.8] cm) and women (48.4 [6.0] cm), clearly ahead of the long jump/triple jump (mean difference ± 90% CL: 6.5 ± 5.0 and 4.3  ± 4.1; very likely and likely; moderate) and speed skating sprint (11.4 ± 3.1 and 7.5 ± 5.5 cm; most likely and very likely; very large and moderate). These horizontally oriented sports displayed superior results compared with more vertically oriented and powerful sports such as beach volleyball, weightlifting, and ski jumping, both in men (from 2.9 ± 4.7 to 15.6 ± 2.9 cm; small to very large; possibly to most likely) and women (5.9 ± 4.8 to 13.4 ± 3.4 cm; large to very large; very likely to most likely), while endurance sports and precision sports were at the other end of the scale. Overall, the men jumped 33% higher than the women (10.3, ±0.6 cm; most likely; large). Conclusions: This study provides practitioners and scientists with useful information regarding the variation in countermovement jump height among national-team athletes within and across sport disciplines.
Examining Associations Between Physical Activity and Academic Performance in a Large Sample of Ontario Students: The Role of Inattention and Hyperactivity
Authors: Ogrodnik Michelle , Halladay Jillian , Fenesi Barbara , Heisz Jennifer , Georgiades Katholiki
Published: November 2020

Background: Participation in physical activity (PA) is a modifiable factor that contributes to academic success, yet the optimal dose (ie, frequency) and mechanisms underlying the effect require further exploration. Methods: Using data from 19,886 elementary and 11,238 secondary school students across Ontario, Canada, this study examined associations between PA participation frequency, academic achievement, and inattention and hyperactivity. Results: Among elementary students, there was a positive association between PA frequency and academic achievement. Participating in 1 to 2 days per week of PA related to higher academic achievement compared with no days, whereas 7 days per week had the largest associations. For secondary students, a minimum of 3 to 4 days per week was associated with higher academic achievement with no significant benefit of additional days. Indirect effects of inattention and hyperactivity were found for both groups, suggesting that the benefits of PA on academic achievement may be partly explained by reductions in inattention and hyperactivity, especially for secondary school students. Conclusion: Students may experience academic benefits from PA even if they are not meeting the guidelines of exercising daily. These benefits may occur, in part, through reductions in inattention and hyperactivity. Further work is needed to determine the temporality and mechanism of these associations.
The Effects of a Soccer-Specific Fitness Test on Eccentric Knee Flexor Strength
Authors: Brogden Christopher Michael , Gough Lewis , Kelly Adam
Published: November 2020

Context: Physiological fitness testing, such as the Yo-Yo Intermittent Recovery Test (YYIR) is a key requirement of the Elite Player Performance Plan, introduced by the English Premier League. Eccentric hamstring strength has been identified as a risk factor for hamstring injuries in soccer players, with fatigue highlighted to further exasperate this issue. Objective: The aim of the current study was to examine the effect of the YYIR level 1 (YYIR1) on eccentric knee flexor strength assessed using the NordBord in youth soccer players. Design: Experimental design. Setting: Soccer club academy. Participants: A total of 67 male academy soccer players (age = 16.58 [0.57] y; height = 175.45 [5.85] cm; mass = 66.30 [8.21] kg) volunteered to participate in the current study during the English competitive soccer season. Main Outcome Measures: Participants conducted eccentric hamstring strength assessments using the NordBord prior to and immediately postcompletion of the YYIR1, with outcome measures of peak force and peak force relative to body mass recorded. Results: Paired t tests highlighted increased absolute eccentric knee flexor strength values (P < .001) immediately post-YYIR1 for both the dominant and nondominant limbs, with the same trend (P < .001) observed for eccentric strength relative to body mass. Conclusions: The results of this study indicate that the YYIR1 does not induce eccentric knee flexor fatigue and as such is not a valid assessment method to assess the effects of fatigue on hamstring function. However, results do suggest that the NordBord may be considered a viable and more accessible alternative to detect pre–post fitness test/fatigue protocol differences in eccentric knee flexor peak strength while working in the field.
Reinfections, still rare, provide clues on immunity
Authors: de Vrieze Jop
Published: November 2020

The growing group of people who get sick twice suggests protection can wane relatively quickly.
Tomorrow's catch
Authors: Stokstad Erik
Published: November 2020

Genomic technologies promise dramatic gains for aquaculture by accelerating the breeding of better strains.
Losing Australia's native gardeners
Authors: Decker Orsi
Published: November 2020

The loss of the country's digging mammals compromises the continent's arid soil health
Engineering near-infrared vision
Authors: Nelidova Dasha
Published: November 2020

An optogenetic technology inspired by snakes could aid those with incomplete blindness
Let's not overthink this
Authors: Thorp H. Holden
Published: November 2020

For some observers, the U.S. presidential election of 2020 appeared to be about science. Outgoing President Donald Trump consistently and dishonestly played down the threats from coronavirus disease 2019 (COVID-19) and climate change. President-elect Joe Biden said he would listen to scientists, a position that was mocked by Trump. Some might take Biden's victory—decisive but hardly a landslide—as feeble support for science. But was science actually on the ballot? Maybe it's best not to overthink this.
ClpX Is Essential and Activated by Single-Strand DNA Binding Protein in Mycobacteria
Authors: Kester Jemila C. , Kandror Olga , Akopian Tatos , Chase Michael R. , Zhu Junhao , Rubin Eric J. , Goldberg Alfred L. , Fortune Sarah M.
Published: November 2020

Tuberculosis, caused by
Mycobacterium tuberculosis
, imposes a major global health burden, surpassing HIV and malaria in annual deaths. The ClpP1P2 proteolytic complex and its cofactor ClpX are attractive drug targets, but their precise cellular functions are unclear.
From Hashtag to High School: How Viral Tweets Are Inspiring Young Scientists To Embrace STEM
Authors: Swift Jocelyn E. , Lovett Brian , Koltermann Christine E. , Beck Chelsey L. , Kasson Matt T.
Published: November 2020

Social media is an increasingly important professional tool for scientists. In particular, scientists use their social media profiles to communicate science and build communities with like-minded scientists and nonscientists. These networks include journalists who can amplify social media science communication, disseminating it to new audiences on- and offline. Our experience with an outreach project where Peeps marshmallows were inoculated with diverse fungi, which we called #FungalPeeps, has demonstrated that these networks can be an effective conduit between researchers and high school students. Following popular science journalism, #FungalPeeps, a project initiated at West Virginia University, inspired a mycology research project in Notre Dame High School in San Jose, California. Herein, we describe how this connection between academia, journalists, and the high school classroom happened, and how everyone involved benefited from this educational collaboration. We further suggest ways that modern social media networks could be leveraged to incorporate more such practical learning experiences into progressive science curricula to better cultivate young STEM scientists.
A Gammacoronavirus, Avian Infectious Bronchitis Virus, and an Alphacoronavirus, Porcine Epidemic Diarrhea Virus, Exploit a Cell Survival Strategy by Upregulating cFOS To Promote Virus Replication
Authors: Yuan Li Xia , Liang Jia Qi , Zhu Qing Chun , Dai Guo , Li Shumin , Fung To Sing , Liu Ding Xiang
Published: November 2020

The ongoing pandemic of coronavirus disease 2019 (COVID-19), caused by a newly emerged zoonotic coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), highlights the importance of coronaviruses as human and animal pathogens and our knowledge gaps in understanding the cellular mechanisms, especially the mechanisms shared among human and animal coronaviruses, exploited by coronaviruses for optimal replication and enhanced pathogenicity. This study reveals that the upregulation of cFOS, along with other AP-1 transcription factors, as a cell survival strategy is such a mechanism utilized by coronaviruses during their replication cycles.
Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria
Authors: van Herpt Thijs T W , Ligthart Symen , Leening Maarten J G , van Hoek Mandy , Lieverse Aloysius G , Ikram M Arfan , Sijbrands Eric J G , Dehghan Abbas , Kavousi Maryam
Published: November 2020

Introduction

Pre-diabetes, a status conferring high risk of overt diabetes, is defined differently by the American Diabetes Association (ADA) and the WHO. We investigated the impact of applying definitions of pre-diabetes on lifetime risk of diabetes in women and men from the general population.

Research design and methods

We used data from 8844 women without diabetes and men aged ≥45 years from the prospective population-based Rotterdam Study in the Netherlands. In both gender groups, we calculated pre-diabetes prevalence according to ADA and WHO criteria and estimated the 10-year and lifetime risk to progress to overt diabetes with adjustment for competing risk of death.

Results

Out of 8844 individuals, pre-diabetes was identified in 3492 individuals (prevalence 40%, 95% CI 38% to 41%) according to ADA and 1382 individuals (prevalence 16%, 95% CI 15% to 16%) according to WHO criteria. In both women and men and each age category, ADA prevalence estimates doubled WHO-defined pre-diabetes. For women and men aged 45 years having ADA-defined pre-diabetes, the 10-year risk of diabetes was 14.2% (95% CI 6.0% to 22.5%) and 9.2% (95% CI 3.4% to 15.0%) compared with 23.2% (95% CI 6.8% to 39.6%) and 24.6% (95% CI 8.4% to 40.8%) in women and men with WHO-defined pre-diabetes. At age 45 years, the remaining lifetime risk to progress to overt diabetes was 57.5% (95% CI 51.8% to 63.2%) vs 80.2% (95% CI 74.1% to 86.3%) in women and 46.1% (95% CI 40.8% to 51.4%) vs 68.4% (95% CI 58.3% to 78.5%) in men with pre-diabetes according to ADA and WHO definitions, respectively.

Conclusion

Prevalence of pre-diabetes differed considerably in both women and men when applying ADA and WHO pre-diabetes definitions. Women with pre-diabetes had higher lifetime risk to progress to diabetes. The lifetime risk of diabetes was lower in women and men with ADA-defined pre-diabetes as compared with WHO. Improvement of pre-diabetes definition considering appropriate sex-specific and age-specific glycemic thresholds may lead to better identification of individuals at high risk of diabetes.
Measuring wet bulb globe temperatures at point-of-exertion in worldwide UK military settings: a longitudinal observational study determining the accuracy of a portable WBGT monitor
Authors: Falconer Hall Patricia , Blackadder-Coward J , Pynn H
Published: November 2020

Introduction

Heat illness among the UK Armed Forces is usually exertional, and therefore preventable, yet the incidence has not reduced since 2011. JSP 539 explicitly states that wet bulb globe temperature (WBGT) should be measured ‘at the location of greatest heat risk’, not ‘that of most convenience’. A handheld WBGT tracker used at point-of-exertion could reduce this incidence if proven to be as accurate as the current in-service device.

Methods

Longitudinal observational comparison and equipment feasibility study of the Kestrel 5400 and QUESTemp 34 (QT-34) in worldwide firm base and deployed UK Armed Forces locations. The locations chosen were Kenya, South Sudan, Belize, Tidworth, Aldershot and Brecon. Paired data points of WBGT readings were collected from November 2017 to August 2018 in all weather conditions.

Results

WBGT readings were comparable between the QT-34 and Kestrel 5400 across the UK and overseas. In addition, there was no change in accuracy between readings taken from the Kestrel 5400 when tripod-mounted and handheld. The Kestrel was easy to set up and far less susceptible to resupply or power supply limitations, as it requires no user input for wet bulb temperature, and runs on AA batteries.

Conclusion

This equipment feasibility study has shown that the Kestrel 5400 gives an acceptable accuracy and is easier to use than the QT-34. The authors recommend that the Kestrel 5400 is introduced as an adjunct to the QT-34, and its use within the military setting monitored through ongoing comparative data collection in a large-scale proof-of-concept study.
Active living environments, physical activity and premature cardiometabolic mortality in Canada: a nationwide cohort study
Authors: Mah Sarah M , Sanmartin Claudia , Riva Mylène , Dasgupta Kaberi , Ross Nancy A
Published: November 2020

Objective

To evaluate sex-specific and age-specific associations of active living environments (ALEs) with premature cardiometabolic mortality.

Design

Population-based retrospective cohort study.

Setting

Residential neighbourhoods (1000-metre circular buffers from the centroids of dissemination areas) across Canada for which the Canadian ALE Measure was derived, based on intersection density, points of interest and dwelling density.

Participants

249 420 survey respondents from an individual-level record linkage between the Canadian Community Health Survey (2000–2010) and the Canadian Mortality Database until 2011, comprised of older women (65–85 years), older men (65–81 years), middle-aged women (45–64 years) and middle-aged men (45–64 years).

Primary outcome measures

Premature cardiometabolic mortality and average daily energy expenditure attributable to walking. Multivariable proportional hazards regression models were adjusted for age, educational attainment, dissemination area-level median income, smoking status, obesity, the presence of chronic conditions, season of survey response and survey cycle.

Results

Survey respondents contributed a total of 1 451 913 person-years. Greater walking was observed in more favourable ALEs. Walking was associated with lower cardiometabolic death in all groups except for middle-aged men. Favourable ALEs conferred a 22% reduction in death from cardiometabolic causes (HR 0.78, 95% CI 0.63 to 0.97) for older women.

Conclusions

On average, people walk more in favourable ALEs, regardless of sex and age. With the exception of middle-aged men, walking is associated with lower premature cardiometabolic death. Older women living in neighbourhoods that favour active living live longer.
Protocol for an economic analysis of the randomised controlled trial of Improving the Well-being of people with Opioid Treated CHronic pain: I-WOTCH Study
Authors: Manchira Krishnan Sheeja , Gc Vijay Singh , Sandhu Harbinder Kaur , Underwood Martin , Eldabe Sam , Manca Andrea , Iglesias Urrutia Cynthia P
Published: November 2020

Introduction

Over the last two decades, the use of opioids for the treatment of chronic pain in England has steadily increased despite lack of evidence of both long-term effectiveness in pain relief and significant, well-documented physical and mental adverse events. Guidelines recommend tapering when harms outweigh benefits, but the addictive nature of opioids hinders simple dose-reduction strategies. Improving the Well-being of people with Opioid Treated CHronic pain (I-WOTCH) trial tests a multicomponent self-management intervention aimed to help patients with chronic non-malignant pain taper opioid doses. This paper outlines the methods to be used for the economic analysis of the I-WOTCH intervention compared with the best usual care.

Methods and analysis

Economic evaluation alongside the I-WOTCH study, prospectively designed to identify, measure and value key healthcare resource use and outcomes arising from the treatment strategies being compared. A within-trial cost-consequences analysis and a model-based long-term cost-effectiveness analysis will be conducted from the National Health Service and Personal Social Service perspective in England. The former will quantify key parameters to populate a Markov model designed to estimate the long-term cost and quality-adjusted life years of the I-WOTCH intervention against best usual care. Regression equations will be used to estimate parameters such as transition probabilities, utilities, and costs associated with the model’s states and events. Probabilistic sensitivity analysis will be used to assess the impact of parameter uncertainty onto the predicted costs and health outcomes, and the resulting value for money assessment of the I-WOTCH intervention.

Ethics and dissemination

Full ethics approval was granted by Yorkshire & The Humber—South Yorkshire Research Ethics Committee on 13 September 2016 (16/YH/0325). Current protocol: V.1.7, date 31 July 2019. Findings will be disseminated in peer-reviewed journals, scientific conferences, newsletters and websites.

Trial registration number

International Standard Randomised Controlled Trial Number (49 470 934); Pre-result.
GlutenSpA trial: protocol for a randomised double-blind placebo-controlled trial of the impact of a gluten-free diet on quality of life in patients with axial spondyloarthritis
Authors: Couderc Marion , Pereira Bruno , Schaeverbeke Thierry , Thomas Thierry , Chapurlat Roland , Gaudin Philippe , Morel Jacques , Dougados Maxime , Soubrier Martin
Published: November 2020

Introduction

Subclinical intestinal inflammation and gut dysbiosis have been reported in patients with spondyloarthritis (SpA). In common practice, rheumatologists are increasingly confronted with patients with inflammatory rheumatism who are on gluten-free diets (GFDs), despite the lack of reliable data from controlled studies. This study aims to determine the impact of a GFD on the quality of life of patients with axial SpA.

Methods and analysis

The GlutenSpA study is a 24-week, randomised, double-blinded, placebo-controlled, multicentre trial. Patients with axial SpA (n=200) will follow a 16-week GFD and be randomly assigned (1:1) to an experimental or control arm. In the experimental arm with receive at least 6 gluten-free breads per day + 200 g of gluten-free penne pasta per week + 6 rice flavour capsules per day. The control arm will receive at least 6 gluten-containing breads per day + 200 g of gluten-containing penne pasta per week + 6 vital gluten-containing capsules per day. The primary end-point is the variation in Assessment of SpondyloArthritis International Society—Health Index (ASAS-HI) questionnaire between week 16 and baseline. A second open-label period of 8 weeks will follow the intervention period, during which the patient will be free to decide whether they will follow the GFD. The secondary outcomes comprise several patient-reported outcomes (SpA activity (Bath Ankylosing Spondylitis Disease Activity Index)), fatigue (Functional Assessment of Chronic Illness Therapy), depression (Hospital Anxiety and Depression Scale), functional disability index (Bath Ankylosing Spondylitis Functional Index)), variations in body mass index and Homeostasis Model Assessment Index and variations in the abundance and type of bacterial species found in the gut microbiota for a subgroup of patients (n=40). The data will be analysed using the intention-to-treat principle.

The regional ethics committee (CPP Nord-ouest IV) has approved the study (IDRCB 2018-A00309-46). The results of the trial will be submitted for publication in peer-reviewed journals. The authors have no relationship that may have influenced the submitted work.

Trial registration number

NCT04274374.
Clinical and biological determinants of P-wave duration: cross-sectional data from the population-based CoLaus|PsyCoLaus study
Authors: Bocchi Federica , Marques-Vidal Pedro , Pruvot Etienne , Waeber Gerard , Vollenweider Peter , Gachoud David
Published: November 2020

Objectives

P-wave duration (PWD) is associated with the development of atrial arrhythmias, cardiovascular and all-cause mortality. With this study, we aimed to assess the distribution and determinants of PWD in the general population.

Design

Cross-sectional study using data collected between 2014 and 2016.

Setting

In the population-based cohort CoLaus|PsyCoLaus, Lausanne, Switzerland, we used 12-lead ECGs to measure PWD. Potential demographic, clinical and biological determinants of PWD were collected by questionnaire, anthropometry, blood pressure measurement and biological assays.

Participants

Data from 3459 participants (55% women, 62±10 years, 93% Caucasian) were included. Participants were excluded if they presented with (1) no sinus rhythm or paced rhythm on the study ECG or Wolff-Parkinson-White ECG pattern; (2) missing or non-interpretable ECG; and (3) missing phenotypic data.

Primary outcome measure

Determine (1) the PWD distribution and (2) the demographic, clinical and biological determinants of PWD in a large population-based cohort.

Results

Median and IQR of PWD was 112 (102–120) ms . In the multivariable analyses, PWD was significantly associated with age (p<0.001) and height (p<0.001), with an adjusted regression coefficient (95% CI) of 0.29 ms/years (0.23 to 0.36) and 0.32 ms/cm (0.28 to 0.37), respectively. PWD, given thereafter in ms with adjusted mean±SE, was significantly (p<0.05) associated with (a) gender (woman 110.0±0.4; man 112.1±0.4), (b) body mass index (normal 110.1±0.4; overweight 110.9±0.4; obese 113.0±0.5), (c) abdominal obesity (no 110.5±0.3; yes 111.7±0.4) and (d) hypertension (no 110.4±0.3; yes 111.7±0.4).

Conclusion

PWD is positively associated with age, height, male gender, obesity markers and hypertension. Clinical interpretation of PWD should take these factors into consideration.
Specialised orthotic care to improve functioning in adults with neuromuscular disorders: protocol of a prospective randomised open-label blinded end-point study
Authors: van Duijnhoven Elza , Koopman Fieke Sophia , Tuijtelaars Jana Antonius Maria , Altmann Viola , Lagrand Rimke , van Dongen Johanna Maria , Nollet Frans , Brehm Merel-Anne
Published: November 2020

Introduction

People suffering from leg muscle weakness caused by neuromuscular disorders (NMDs) are often provided with leg orthoses to reduce walking problems such as increased walking effort, diminished walking speed, reduced balance and falls. However, evidence for the effectiveness of leg orthoses to improve walking in this patient group is limited and there is an absence of standardised practice in orthotic prescription. In 2012 a Dutch multidisciplinary guideline was developed aimed to standardise the orthotic treatment process in NMD. Although application of the guideline in expert centres (specialised orthotic care) seems beneficial regarding clinical effectiveness, larger studies are necessary to confirm results and investigate cost-effectiveness. Therefore, this study aims to examine the effectiveness and cost-effectiveness of specialised orthotic care compared with usual orthotic care in adults with slowly progressive NMD.

Methods and analysis

A prospective randomised open-label blinded end-point study will be performed, in which 70 adults with slowly progressive NMD are randomly assigned to specialised orthotic care (intervention) or usual orthotic care (control). Outcome measures are assessed at baseline and at 3 and 6 months follow-up. The primary endpoints are gross walking energy cost (J/kg/m) assessed during a 6 min walk test and achievement of personal goals, measured with the Goal Attainment Scale. Secondary endpoints include walking speed, gait biomechanics, stability, physical functioning, falls and fear of falling, perceived fatigue and satisfaction. For the economic evaluation, societal costs and health-related quality of life will be assessed using cost questionnaires and the 5-Level version of EuroQol 5 Dimension, retrospectively.

Ethics and dissemination

The study is registered in the Dutch trial register (NL 7511) and the protocol has been approved by the Medical Ethics Committee of the Academic Medical Center in Amsterdam. Results will be presented at national and international scientific conferences and disseminated through peer-reviewed journals and media aimed at a broad audience including patients.
Translation, adaptation and validation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) for use in Japan: a multicentre cross-sectional study
Authors: Aoki Takuya , Yamamoto Yosuke , Nakata Tomoaki
Published: November 2020

Objectives

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a well-established and internationally recognised scale for measuring patients’ experience with hospital inpatient care. This study aimed to develop a Japanese version of the HCAHPS and to examine its structural validity, criterion-related validity and internal consistency reliability.

Design

Multicentere cross-sectional study.

Setting

A total of 48 hospitals in Japan.

Participants

6522 patients aged ≥16 years who were discharged from the participating hospitals.

Results

Confirmatory factor analysis showed excellent goodness of fit of the same factor structure as that of the original HCAHPS, with the following composites: communication with nurses, communication with doctors, responsiveness of hospital staff, hospital environment, communication about medicines and discharge information. All hospital-level Pearson correlation coefficients between the Japanese HCAHPS composites and overall hospital rating exceeded the criteria. Results of inter-item correlations indicated adequate internal consistency reliability.

Conclusions

The Japanese HCAHPS has acceptable psychometric properties for assessing patients’ experience with hospital inpatient care. This scale could be used for quality improvement based on the assessment of patients’ experience with hospital care and for health services research in Japan.
Containment of Antibiotic REsistance—measures to improve antibiotic use in pregnancy, childbirth and young children (CAREChild): a protocol of a prospective, quasiexperimental interventional study in Lao PDR
Authors: Machowska Anna , Sihavong Amphoy , Eriksen Jaran , Vongsouvath Manivanh , Marrone Gaetano , Sychareun Vanphanom , Hanson Claudia , Keohavong Bounxou , Brauner Annelie , Mayxay Mayfong , Kounnavong Sengchanh , Lundborg Cecilia Stalsby
Published: November 2020

Introduction

Antibiotics are essential to treat infections during pregnancy and to reduce both maternal and infant mortality. Overall use, but especially non-indicated use, and misuse of antibiotics are drivers of antibiotic resistance (ABR). High non-indicated use of antibiotics for uncomplicated vaginal deliveries is widespread in many parts of the world. Similarly, irrational use of antibiotics is reported for children. There is scarcity of evidence regarding antibiotic use and ABR in Lao PDR (Laos). The overarching aim of this project is to fill those knowledge gaps and to evaluate a quality improvement intervention. The primary objective is to estimate the proportion of uncomplicated vaginal deliveries where antibiotics are used and to compare its trend before and after the intervention.

Methods and analysis

This 3-year, prospective, quasiexperimental study without comparison group includes a formative and interventional phase. Data on antibiotic use during delivery will be collected from medical records. Knowledge, attitudes and reported practices on antibiotic use in pregnancy, during delivery and for children, will be collected from women through questionnaires. Healthcare providers’ knowledge, attitudes and practices of antibiotics administration for pregnant women, during delivery and for children, will be collected via adapted questionnaires. Perceptions regarding antibiotics will be explored through focus group discussions with women and individual interviews with key stakeholders. Faecal samples for culturing of Escherichia coli and Klebsiella spp. and antibiotic susceptibility testing will be taken before, during and 6 months after delivery to determine colonisation of resistant strains. The planned intervention will comprise training workshops, educational materials and social media campaign and will be evaluated using interrupted time series analysis.

Ethics and dissemination

The project received ethical approval from the National Ethics Committee for Health Research, Ministry of Health, Laos. The results will be disseminated via scientific publications, conference presentations and communication with stakeholders.

Trail registration number

ISRCTN16217522; Pre-results.
Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals
Authors: van den Broek Steef , Heiwegen Nikki , Verhofstad Margot , Akkermans Reinier , van Westerop Liselore , Schoon Yvonne , Hesselink Gijs
Published: November 2020

Objective

Older adults are hospitalised from the emergency department (ED) without potentially needing hospital care. Knowledge about rates, associative factors and causes of these preventable emergency admissions (PEAs) is limited. This study aimed to determine the rates, associative factors and causes for PEAs of older adults.

Design

A mixed-method observational study.

Setting

The EDs of two Dutch hospitals.

Participants

492 patients aged >70 years and hospitalised from the ED.

Measurements

Quantitative data were retrospectively extracted from the electronical medical record over a 1-month period. Admissions were classified (non)preventable based on a standardised approach. Univariate and multivariate multilevel logistic regression analyses were performed to identify possible associations between PEAs and demographic, clinical and care process factors. Qualitative data were prospectively collected by email and telephone interviews and analysed thematically to explore hospital physician’s perceived causes for the identified PEAs.

Results

Of the 492 included cases, 86 (17.5%) were classified as PEA. Patients with a higher age (adjusted OR 1.04, 95% CI 1.01 to 1.08; p=0.04), a low urgency classification (adjusted OR 1.89, 95% CI 1.14 to 3.15; p=0.01), and attending the ED in the weekend (adjusted OR 2.02, 95% CI 1.22 to 3.37; p<0.01) were associated with an increased likelihood of a PEA. 49 physicians were interviewed by telephone and email. Perceived causes for PEAs were related to patient’s attitudes (eg, postponement of medical care at home), provider’s attitudes (eg, deciding for admission after family pressure), health system deficiencies (eg, limited access to community services during out-of-hours and delayed access to inpatient diagnostic resources) and poor communication between primary care and hospital professionals about patient treatment preferences.

Conclusions

Our findings contribute to existing evidence that many emergency admissions of older adults are preventable, thereby indicating a possible source of unnecessary expensive, and potentially harmful, hospital care.
Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN): protocol for a multicentre randomised controlled trial
Authors: Kearney Rebecca Samantha , Dhanjal Gurmit , Parsons Nicholas , Ellard David , Parsons Helen , Haque Aminul , Karasouli Eleni , Mason James , Nwankwo Henry , Brown Jaclyn , Liew ZiHeng , Drew Stephen , Modi Chetan , Bush Howard , Torgerson David , Underwood Martin
Published: November 2020

Introduction

First-time traumatic anterior shoulder dislocation (TASD) is predominantly managed non-operatively. People sustaining TASD have ongoing pain, disability and future risk of redislocation. There are no published randomised controlled trials (RCTs) comparing different non-operative rehabilitation strategies to ascertain the optimum clinically effective approach after TASD.

Methods and analysis

In this multicentre adaptive RCT, with internal pilot, adults with a radiologically confirmed first time TASD treated non-surgically will be screened at a minimum of 30 sites. People with neurovascular complications, bilateral dislocations or are unable to attend physiotherapy will be excluded.

Randomisation will be on a 1:1 treatment allocation, stratified by age, hand dominance and site. Participants will receive a single session of advice; or a single session of advice plus offer of further physiotherapy (maximum 4 months). The primary analysis will be the difference in Oxford Shoulder Instability Score at 6 months. A sample size of a minimum of 478 participants will allow us to show a four point difference with 90% power.

An embedded qualitative study will explore the participants’ experiences of the trial interventions.

Ethics, registration and dissemination

Funded by NIHR HTA (16/167/56), 1 June 2018; National Research Ethic Committee approved (18/WA/0236), 26 July 2018. First site opened 5 November 2018 and final results will be updated on trial registries and submitted to a peer-reviewed journal and will inform rehabilitation strategies after a TASD. Study Within A Trial (SWAT) funded by MRC (MR/R013748/1), 1 May 2019; registered on the MRC-HTMR All-Ireland Hub (reference number SWAT 121).

Trial registration number

ISRCTN63184243. (Trial stage: Pre-results)
Food insecurity and its predictors among lactating mothers in North Shoa Zone, Central Ethiopia: a community based cross-sectional study
Authors: Getacher Lemma , Egata Gudina , Aynalem Yared Asmare , Molla Abebaw , Tesfaye Adane , Abebe Haimanot , Bayih Wubet Alebachew , Habtegiorgis Samuel Derbie
Published: November 2020

Objective

To assess the prevalence of food insecurity (FI) and its predictors among lactating mothers in Ataye District, North Shoa Zone, Central Ethiopia.

Design

A community-based cross-sectional study design was used.

Setting

Two urban and four rural randomly selected kebeles of the Ataye District in Ethiopia.

Participants

Out of 635 participants, 612 lactating mothers aged 15–49 years participated from February to April 2018. Mothers who lived for at least 6 months and above in the district were included, and mothers who were not able to respond to an interview were excluded. A single lactating mother per household was included. Lactating mothers in the households were selected using a cluster sampling technique. The number of lactating mothers found in each kebele was taken from family folder documentation.

Primary outcome

The prevalence and predictors of food insecurity.

Results

The prevalence of FI among lactating mothers was 36.8%. No formal education (adjusted OR (AOR) =1.82, 95% CI 1.13 to 2.92), no income-generating activities (AOR=3.39, 95% CI 2.05 to 5.64), no home gardening practice (AOR=5.65, 95% CI 3.51 to 9.08), alcohol use by husbands (AOR=2.02, 95% CI 1.25 to 3.24), low minimum dietary diversity score (AOR=2.94, 95% CI 1.88 to 4.57), less than three frequencies of meals (AOR=3.97, 95% CI 1.65 to 9.54) and three meals only per day (AOR=1.86, 95% CI 1.08 to 3.17) were significant predictors of FI of mothers.

Conclusion

The prevalence of FI was high in the study area. No formal education, no income-generating activities, no home gardening practice, alcohol use by husbands, low minimum dietary diversity score, fewer than three frequencies of meals and three meals only per day were independent predictors of FI. Therefore, increasing home gardening, decreasing alcohol intake, increasing dietary diversity and performing income-generating activities are highly recommended to reduce FI.
Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review
Authors: von Philipsborn Peter , Biallas Renke , Burns Jacob , Drees Simon , Geffert Karin , Movsisyan Ani , Pfadenhauer Lisa Maria , Sell Kerstin , Strahwald Brigitte , Stratil Jan M , Rehfuess Eva
Published: November 2020

Objectives

To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival.

Design

Rapid systematic review.

Participants

Humans with viral respiratory infections, exposed to systemic NSAIDs.

Primary outcomes

Acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival.

Results

We screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution.

Conclusions

It is unclear whether the use of NSAIDs increases the risk of severe adverse outcomes in patients with viral respiratory infections. This absence of evidence should not be interpreted as evidence for the absence of such risk. This is a rapid review with a number of limitations.

PROSPERO registration number

CRD42020176056.
Assessing the impact of smoking on the health and productivity of the working-age Indonesian population using modelling
Authors: Satyana Regina P U , Uli Regina E , Magliano Dianna , Zomer Ella , Liew Danny , Ademi Zanfina
Published: November 2020

Objectives

To estimate the impact of smoking in the working-age Indonesian population in terms of costs, years of life, quality-adjusted life years (QALYs) and productivity-adjusted life years (PALYs) lost.

Methods

Life table modelling of Indonesian smokers aged 15–54 years, followed up until 55 years (retirement age). Contemporary data on demographics, all-cause mortality, population attributable fractions and prevalence of smoking were derived from the Institute for Health Metrics and Evaluation. The quality of life and reduction in productivity due to smoking were derived from published sources. The analysis was repeated but with the assumption that the cohorts were non-smokers. The differences in results represented the losses incurred due to smoking. Gross domestic product (GDP) per equivalent full-time worker (US$11 765) was used for estimation of the cost of each PALY, and an annual discount rate of 3.0% was applied to all costs and outcomes.

Results

The prevalences of smoking among Indonesian working-age men and women were 67.2% and 2.16%, respectively. This study estimated that smoking caused 846 123 excess deaths, 2.9 million years of life lost (0.40%), 41.6 million QALYs lost (5.9%) and 15.6 million PALYs lost (2.3%). The total cost of productivity loss due to smoking amounted to US$183.7 billion among the working-age population followed up until retirement. Healthcare cost was predicted to be US$1.8 trillion. Over a 1-year time horizon, US$10.2 billion was lost in GDP and 117 billion was lost in healthcare costs.

Conclusion

Smoking imposes significant health and economic burden in Indonesia. The findings stress the importance of developing effective tobacco control strategies at the macro and micro levels, which would benefit the country both in terms of health and wealth.
Long-term effects of an undergraduate palliative care course: a prospective cohort study in El Salvador
Authors: Fortin Magaña Miguel , Diaz Susana , Salazar-Colocho Pablo , Feng Ancu , López-Saca Mario
Published: November 2020

Background

International organisations recommend the inclusion of palliative care undergraduate education as a way to meet increasing demand; the long-term effects, however, are unknown. Since 2013 the Dr José Matías Delgado University has offered an undergraduate course for palliative care.

Aims

To assess whether a palliative care course results in improvement in self-perceived comfort among students and if it lasts up to 4 years later; and to examine students’ knowledge of palliative care and assess the relationship between comfort and knowledge.

Design

This is a prospective cohort study where students attending the course were requested to complete the Scale of Self-Perceived Comfort in palliative care pre and post course. Participants were contacted in 2018 and a group without palliative care education was established as a control group, matched one-to-one according to current academic level. They were asked to complete the Scale of Self-Perceived Comfort questionnaire together with the Palliative Care Knowledge Test.

Settings/participants

83 students who attended the course between the years 2014 and 2017 and 101 controls.

Results

In the postcourse test, participants had a 1.13-point increase (p≤0.001) in comfort, which persisted 4 years later and was superior to the control group by 0.6 points (p≤0.001). The control group showed no difference in the precourse test despite having more clinical experience (p=0.68). The students outscored the control group in the knowledge test by 4.2 points (p≤0.001). There appears to be no correlation between comfort and knowledge.

Conclusion

A palliative care undergraduate course results in improvement in student comfort and knowledge which persists up to 4 years later.
Prognostic significance of natriuretic peptide levels in atrial fibrillation without heart failure
Authors: Hamatani Yasuhiro , Iguchi Moritake , Ueno Kentaro , Aono Yuya , Esato Masahiro , Tsuji Hikari , Wada Hiromichi , Hasegawa Koji , Ogawa Hisashi , Abe Mitsuru , Morita Satoshi , Akao Masaharu
Published: November 2020

Objectives

Natriuretic peptides are an important prognostic marker in patients with heart failure (HF). However, little is known regarding their prognostic significance in patients with atrial fibrillation (AF) without HF and natriuretic peptides levels are underused in these patients in daily practice.

Methods

The Fushimi AF Registry is a community-based prospective survey of patients with AF in Fushimi-ku, Kyoto, Japan. We investigated patients with AF without HF (defined as prior HF hospitalisation, New York Heart Association functional class≥2 or left ventricular ejection fraction<40%) using the data of B-type natriuretic peptide (BNP, n=388) or N-terminal pro-B-type natriuretic peptide (NT-proBNP, n=771) at enrolment. BNPs were converted to NT-proBNP using a conversion formula. We divided the patients according to quartiles of NT-proBNP levels and compared the backgrounds and outcomes.

Results

Of 1159 patients (mean age: 72.1±10.2 years, median CHA2DS2-VASc score: 3 and oral anticoagulant (OAC) prescription: 671 (56%)), the median NT-proBNP level was 488 (IQR 169–1015) ng/L. Patients with high NT-proBNP levels were older, had higher CHA2DS2-VASc scores and had more OAC prescription (all p<0.001). Kaplan-Meier curves demonstrated that NT-proBNP levels were signiﬁcantly associated with higher incidences of stroke/systemic embolism, all-cause death and HF hospitalisation during a median follow-up period of 5.0 years (log rank, all p<0.001). Multivariable Cox regression analyses revealed that NT-proBNP levels were an independent predictor of adverse outcomes even after adjustment by various confounders.

Conclusion

NT-proBNP levels are a significant prognostic marker for adverse outcomes in patients with AF without HF and may have clinical value.

Trial registration number

UMIN000005834.