bluuebunny/crossref_metadata_2025 huggingface dataset:
Geographic variation in tobacco use in India: a population-based multilevel cross-sectional study
Authors: Singh Ankur , Arora Monika , Bentley Rebecca , Spittal Matthew J , Do Loc G , Grills Nathan , English Dallas R
Published: June 2020

Objective

This study aims to quantify the extent to which people’s use of tobacco products varies by local areas (city ward and village) across India and the variation in this clustering by tobacco products.

Design

Cross-sectional study.

Setting and participants

Data on 73 954 adults across 2547 city wards and villages were available for analysis from 30 states and 2 union territories in India.

Primary and secondary outcome measures

We included as primary outcomes self-reported any tobacco use, current cigarette smoking, current bidi smoking, current smokeless tobacco use and a derived variable for dual use describing respondents who engaged in both smoking and smokeless tobacco use.

Results

The median risk of an individual using tobacco was 1.64 times greater if a person hypothetically moved from an area of low to high risk of tobacco use (95% CI: 1.60 to 1.69). Area-level partitioning of variation differed by tobacco product used. Median ORs ranged from 1.77 for smokeless tobacco use to 2.53 for dual use.

Conclusions

Tobacco use is highly clustered geographically in India. To be effective in India, policy interventions should be directed to influence specific local contextual factors on adult tobacco use. Where people live in India influences their use of tobacco, and this association may be greater than has been observed in other settings. Tailoring tobacco control policies for local areas in India may, therefore, provide substantial public health benefits.
Exposure to endocrine-disrupting chemicals and anthropometric measures of obesity: a systematic review and meta-analysis
Authors: Ribeiro Carolina Martins , Beserra Bruna Teles Soares , Silva Nadyellem Graciano , Lima Caroline Lourenço , Rocha Priscilla Roberta Silva , Coelho Michella Soares , Neves Francisco de Assis Rocha , Amato Angélica Amorim
Published: June 2020

Objective

Endocrine-disrupting chemicals (EDCs) are viewed as a major potential link between the environment and obesity development. We did a systematic review and meta-analysis to examine the association between exposure to EDCs and obesity.

Data sources, design and eligibility criteria

PubMed, Scopus and Web of Science were searched from inception to 6 June 2018 for studies primarily addressing the association between exposure to EDCs after the age of 2 years and anthropometric measures of obesity or body fat. The Newcastle-Ottawa scale was used to assess the risk of bias.

Data extraction and synthesis

Two independent reviewers screened and conducted data extraction and synthesis. A third reviewer resolved disagreements.

Results

A total of 73 studies investigating bisphenol A (32 286 individuals), organochlorine compounds (34 567 individuals), phthalates (21 401 individuals), polybrominated biphenyls (2937 individuals), polycyclic aromatic hydrocarbons (5174 individuals), parabens (4097 individuals), benzoic acid (3671 individuals) and polyfluoroalkyl substances (349 individuals) met our inclusion criteria. Most had a cross-sectional design and low or medium risk of bias. In qualitative analysis, bisphenol A and phthalates were consistently associated with general and abdominal obesity, in children and adults, and some studies suggested this association was age-dependent and gender-dependent. Meta-analysis indicated a significant association between exposure to bisphenol A and overweight (OR 1.254, 95% CI 1.005 to 1.564), obesity (OR 1.503, 95% CI 1.273 to 1.774) and increased waist circumference (OR 1.503, 95% CI 1.267 to 1.783) in adults, and between exposure to 2,5-dichlorophenol and obesity in children (OR 1.8, 95% CI 1.1018 to 3.184).

Conclusion

Most observational studies supported a positive association between obesity and exposure to EDCs. Although causality cannot be determined from these data, they underscore the need to limit human exposure to EDCs in light of the evidence from animal and cell-based studies indicating the effects of these chemicals on adiposity.

PROSPERO registration number

CRD42018074548.
Cross-cultural adaptation and psychometric validation of the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P)
Authors: Ghanbari-Firoozabadi Mahdieh , Mirzaei Masoud , Vafaii Nasab Mohammadreza , Grace Sherry L , Okati-Aliabad Hassan , Madadizadeh Farzan , Dadras Hakimeh , Amrolahi Najmeh , Entezari Mohamadmehdi , Sadrbafghi Seyed Mahmood
Published: June 2020

Objectives

This study aimed to translate, cross-culturally adapt and psychometrically validate a Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P) and to identify the main barriers in an Iranian setting.

Setting

Afshar cardiac rehabilitation (CR) centre, affiliated with the Yazd University of Medical Sciences, in the centre of Iran.

Design

This was a multimethod study, culminating in a cross-sectional survey.

Participants

Inpatient CR graduates who did not attend their initial outpatient CR appointment.

Method

The 21-item CRBS was translated and cross-culturally adapted in accordance with best practices; an expert panel considered the items and previous non-attending patients were interviewed via phone to refine the scale. Next, structural validity was assessed; participants were invited to complete the CRBS on the phone between March 2017 and February 2018. Using exploratory factor analysis (EFA) with principal component analysis extraction and oblique rotation. Second, confirmatory factor analysis (CFA) was used to verify the results; several goodness-of-fit indices were considered. The internal consistency and 3-week test–retest reliability of the scale (5% subsample) were evaluated using Cronbach’s α and intraclass correlation (ICC), respectively.

Results

Face, content and cross-cultural validity were established by the experts and patients (n=50). One thousand and one hundred (40.7%) of the 2700 patients completed the CRBS-P. Structural validity was established by EFA (Bartlett’s test p<0.001; =0.759) and confirmed by the CFA; a four-factor solution with 18 items accounting for 61.256% of variance had the best fit (χ2/df=3.206, root mean square error of approximation=0.061 and Comparative Fit Index=0.959). The internal consistency and test–retest reliability (n=42) of the scale were acceptable (ICC=0.743 95% CI (0.502 to 0.868); overall α=0.797). The top barriers were not knowing about CR, cost and lack of encouragement from physicians.

Conclusion

The four-factor, 18-item CRBS-P had good psychometric properties, and hence can be reliably and validly used to measure CR barriers in Iran and other Persian-speaking populations.
Knowledge acquisition and retention after a high flow training programme in Peru: a quasi-experimental single group pre–post design
Authors: Ellington Laura E , Becerra Rosario , Mallma Gabriela , Tantaleán da Fieno José , Nair Deepthi , Onchiri Frankline , Nielsen Katie R
Published: June 2020

Objective

Respiratory infections remain the leading infectious cause of death in children under 5 and disproportionately affect children in resource-limited settings. Implementing non-invasive respiratory support can reduce respiratory-related mortality. However, maintaining competency after deployment can be difficult. Our objective was to evaluate the effectiveness of a comprehensive multidisciplinary high-flow training programme in a Peruvian paediatric intensive care unit (PICU).

Design

Quasi-experimental single group pre–post intervention study design.

Setting

Quaternary care PICU in a resource-constrained setting in Lima, Peru.

Participants

Attending physicians, fellows, paediatric residents, registered nurses, respiratory therapists and medical technicians working in the PICU were invited to participate.

Interventions

Concurrent with initial high-flow deployment, we implemented a training programme consisting of lectures, case-based discussion and demonstrations with baseline, 3-month and 12-month training sessions. Pre-training and post-training assessment surveys were distributed surrounding all training sessions.

Primary and secondary outcome measures

The primary outcome was achieving minimum competency (median score of 80%) on the high flow training assessment tool. Secondary outcomes included knowledge acquisition (differences in pre-baseline and post-baseline training assessments), short-term retention (differences in post-baseline and pre-3-month refresher training assessments) and long-term retention (differences in post-3-month refresher and pre-12-month refresher training assessments).

Results

Eighty participants (50% nurses, 15% ICU physicians and 34% other providers) completed the baseline assessment. Participants showed improvement in overall score and all subtopics except the clinical application of knowledge after baseline training (p<0.001). Participants failed to retain minimum competency at 3-month and 12-month follow-up assessments (70% (IQR: 57–74) and 70% (IQR: 65–74), respectively). After repeat training sessions, overall knowledge continued to improve, exceeding baseline performance (78% (IQR: 70–87), 83% (IQR: 74–87) and 87% (IQR: 83–91) at baseline, 3 and 12 months, respectively).

Conclusion

This study suggests the need for repeat training sessions to achieve and maintain competency after the implementation of new technology.
Nurture Early for Optimal Nutrition (NEON) programme: qualitative study of drivers of infant feeding and care practices in a British-Bangladeshi population
Authors: Lakhanpaul Monica , Benton Lorna , Lloyd-Houldey Oliver , Manikam Logan , Rosenthal Diana Margot , Allaham Shereen , Heys Michelle
Published: June 2020

Objectives

To explore optimal infant feeding and care practices and their drivers within the British-Bangladeshi population of East London, UK, as an exemplar to inform development of a tailored, coadapted participatory community intervention.

Design

Qualitative community-based participatory research.

Setting

Community and children’s centres and National Health Service settings within Tower Hamlets, London, UK.

Participants

141 participants completed the community study including: British-Bangladeshi mothers, fathers, grandmothers and grandfathers of infants and young children aged 6–23 months, key informants and lay community members from the British-Bangladeshi population of Tower Hamlets, and health professionals working in Tower Hamlets.

Results

141 participants from all settings and generations identified several infant feeding and care practices and wider socioecological factors that could be targeted to optimise nutritional outcomes. Our modifiable infant feeding and care practices were highlighted: untimely introduction of semi and solid foods, overfeeding, prolonged parent-led feeding and feeding to ‘fill the belly’. Wider socioecological determinants were highlighted, categorised here as: (1) society and culture (e.g. equating ‘chubby baby’ to healthy baby), (2) physical and local environment (e.g. fast food outlets, advertising) and (3) information and awareness (e.g. communication with healthcare professionals around cultural norms).

Conclusions

Parenting interventions should be codeveloped with communities and tailored to recognise and take account of social and cultural norms and influence from different generations that inform infant feeding and care practices and may be of particular importance for infants from ethnically diverse communities. In addition, UK infant feeding environment requires better regulation of marketing of foods for infants and young children if it is to optimise nutrition in the early years.
Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis—protocol
Authors: Vincent Britzer Paul , Randhawa Gurch , Cook Erica
Published: June 2020

Introduction

The need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a lower number of organ donors. Studies have been carried out among people of Indian origin living globally to understand the reasons for the low donation rate, but there has been no systematic review that has integrated all of these studies to synthesise the current literature. Therefore, the purpose of this review is to examine the barriers towards organ donor registration and consent among Indians living globally.

Methods and analysis

A systematic search will be conducted using the following relevant databases namely CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Grey literature. Studies from 1994 that satisfy our inclusion criteria will be included. Two reviewers will conduct the screening, data extraction and quality assessment of the studies; in event of any disagreement between the two reviewers at any stage, the third reviewer will reconcile any disagreements and consensus will be made.

Ethics and dissemination

As this study includes only secondary data, ethical approval for secondary data usage has been sought. This study will use Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to report and the study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various non-governmental organisations globally which are working with this particular community; following which further research can be developed based on this evidence and also helps in building a culturally competent strategy.

PROSPERO registration number

CRD42019155274.
Implementation of e-mental health interventions for informal caregivers of adults with chronic diseases: a protocol for a mixed-methods systematic review with a qualitative comparative analysis
Authors: Coumoundouros Chelsea , von Essen Louise , Sanderman Robbert , Woodford Joanne
Published: June 2020

Introduction

Informal caregivers provide the majority of care to individuals with chronic health conditions, benefiting the care recipient and reducing use of formal care services. However, providing informal care negatively impacts the mental health of many caregivers. E-mental health interventions have emerged as a way to provide accessible mental healthcare to caregivers. Much attention has been given to reviewing the effectiveness and efficacy of such interventions, however, factors related to implementation have received less consideration. Therefore, this mixed-methods systematic review will aim to examine factors associated with the effectiveness and implementation of e-mental health interventions for caregivers.

Methods and analysis

Eligible studies published since 1 January 2007 will be searched for in several electronic databases (CINAHL Plus with Full Text, the Cochrane Library, EMBASE, PsycINFO, PubMed and Web of Science), clinical trial registries and OpenGrey, with all screening steps conducted by two independent reviewers. Studies will be included if they focus on the implementation or effectiveness of e-mental health interventions designed for informal adult caregivers of adults with cancer, heart disease, stroke, diabetes, dementia or chronic obstructive pulmonary disease. Pragmatic randomised controlled trials quantitatively reporting on caregiver anxiety, depression, psychological distress or stress will be used for a qualitative comparative analysis to identify combinations of conditions that result in effective interventions. Qualitative and quantitative data on implementation of e-mental health interventions for caregivers will be integrated in a thematic synthesis to identify barriers and facilitators to implementation. These results will inform future development and implementation planning of e-mental health interventions for caregivers.

Ethics and dissemination

Ethical approval is not required for this study as no primary data will be collected. Results will be disseminated in the form of a scientific publication and presentations at academic conferences and plain language summaries for various stakeholders.

PROSPERO registration number

CRD42020155727.
Collaborative practice trends in US physician office visits: an analysis of the National Ambulatory Medical Care Survey (NAMCS), 2007–2016
Authors: Najmabadi Shahpar , Honda Trenton J , Hooker Roderick S
Published: June 2020

Objective

Practice arrangements in physician offices were characterised by examining the share of visits that involved physician assistants (PAs) and nurse practitioners (NPs). The hypothesis was that collaborative practice (ie, care delivered by a dyad of physician-PA and/or physician-NP) was increasing.

Design

Temporal ecological study.

Setting

Non-federal physician offices.

Participants

Patient visits to a physician, PA or NP, spanning years 2007–2016.

Methods

A stratified random sample of visits to office-based physicians was pooled through the National Ambulatory Medical Care Survey public use linkage ﬁle. Among 317 674 visits to physicians, PAs or NPs, solo and collaborative practices were described and compared over two timespans of 2007–2011 and 2012–2016. Weighted patient visits were aggregated in bivariate analyses to achieve nationally representative estimates. Survey statistics assessed patient demographic characteristics, reason for visit and visit specialty by provider type.

Results

Within years 2007–2011 and 2012–2016, there were 4.4 billion and 4.1 billion physician office visits (POVs), respectively. Comparing the two timespans, the rate of POVs with a solo PA (0.43% vs 0.21%) or NP (0.31% vs 0.17%) decreased. Rate of POVs with a collaborative physician-PA increased non-significantly. Rate of POVs with a collaborative physician-NP (0.49% vs 0.97%, p<0.01) increased. Overall, collaborative practice, in particular physician-NP, has increased in recent years (p<0.01), while visits handled by a solo PA or NP decreased (p<0.01). In models adjusted for patient age and chronic conditions, the odds of collaborative practice in years 2012–2016 compared with years 2007–2011 was 35% higher (95% CI 1.01 to 1.79). Furthermore, in 2012–2016, NPs provided more independent primary care, and PAs provided more independent care in a non-primary care medical specialty. Preventive visits declined among all providers.

Conclusions

In non-federal physician offices, collaborative care with a physician-PA or physician-NP appears to be a growing part of office-based healthcare delivery.
Study protocol for the safety and efficacy of probiotic therapy on days alive and out of hospital in adult ICU patients: the multicentre, randomised, placebo-controlled Restoration Of gut microflora in Critical Illness Trial (ROCIT)
Authors: Litton Edward , Anstey Matthew , Broadhurst David , Chapman Andy R , Currie Andrew , Ferrier Janet , Gummer Joel , Higgins Alisa , Lim Jolene , Manning Laurens , Myers Erina , Orr Katrina , Palermo Anne-Marie , Paparini Andrew , Pellicano Susan , Raby Edward , Rammohan Anu , Regli Adrian , Richter Bernhard , Salman Sam , Strunk Tobias , Waterson Sharon , Wibrow Brad , Wood Fiona M
Published: June 2020

Introduction

The effect of early and sustained administration of daily probiotic therapy on patients admitted to the intensive care unit (ICU) remains uncertain.

Methods and analysis

The Restoration Of gut microflora in Critical Illness Trial (ROCIT) study is a multicentre, randomised, placebo-controlled, parallel-group, two-sided superiority trial that will enrol 220 patients in five ICUs. Adult patients who are within 48 hours of admission to an ICU and are expected to require intensive care beyond the next calendar day will be randomised in a 1:1 ratio to receive early and sustained Lactobacillus plantarum 299v probiotic therapy in addition to usual care or placebo in addition to usual care. The primary endpoint is days alive and out of hospital to day 60.

Ethics and dissemination

ROCIT has been approved by the South Metropolitan Health Service Human Research Ethics Committee (ref: RGS00000004) and the St John of God Health Care Human Research Ethics Committee (ref: 1183). The trial results will be submitted for publication in a peer-reviewed journal.

Trial registration number

Australian and New Zealand Clinical Trials Registry (ANZCTR12617000783325); Pre-results.
Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure
Authors: Daw Paulina , van Beurden Samantha B , Greaves Colin , Veldhuijzen van Zanten Jet J C S , Harrison Alexander , Dalal Hasnain , McDonagh Sinead T J , Doherty Patrick J , Taylor Rod S
Published: June 2020

Introduction

Cardiac rehabilitation (CR) improves health-related quality of life and reduces hospital admissions. However, patients with heart failure (HF) often fail to attend centre-based CR programmes. Novel ways of delivering healthcare, such as home-based CR programmes, may improve uptake of CR. Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is a new, effective and cost-effective home-based CR programme for people with HF. The aim of this prospective mixed-method implementation evaluation study is to assess the implementation of the REACH-HF CR programme in the UK National Health Service (NHS). The specific objectives are to (1) explore NHS staff perceptions of the barriers and facilitators to the implementation of REACH-HF, (2) assess the quality of delivery of the programme in real-life clinical settings, (3) consider the nature of any adaptation(s) made and how they might impact on intervention effectiveness and (4) compare real-world patient outcomes to those seen in a prior clinical trial.

Methods and analysis

REACH-HF will be rolled out in four NHS CR centres across the UK. Three healthcare professionals from each site will be trained to deliver the 12-week programme. In-depth qualitative interviews and focus groups will be conducted with approximately 24 NHS professionals involved in delivering or commissioning the programme. Consultations for 48 patients (12 per site) will be audio recorded and scored using an intervention fidelity checklist. Outcomes routinely recorded in the National Audit of Cardiac Rehabilitation will be analysed and compared with outcomes from a recent randomised controlled trial: the Minnesota Living with HF Questionnaire and exercise capacity (Incremental Shuttle Walk Test). Qualitative research findings will be mapped onto the Normalisation Process Theory framework and presented in the form of a narrative synthesis. Results of the study will inform national roll-out of REACH-HF.

Ethics and dissemination

The study (IRAS 261723) has received ethics approval from the South Central (Hampshire B) Research Ethics Committee (19/SC/0304). Written informed consent will be obtained from all health professionals and patients participating in the study. The research team will ensure that the study is conducted in accordance with the Declaration of Helsinki, the Data Protection Act 2018, General Data Protection Regulations and in accordance with the Research Governance Framework for Health and Social Care (2005). Findings will be published in scientific peer-reviewed journals and presented at local, national and international meetings to publicise and explain the research methods and findings to key audiences to facilitate the further uptake of the REACH-HF intervention.
Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia
Authors: Feletto Eleonora , Lew Jie-Bin , Worthington Joachim , He Emily , Caruana Michael , Butler Katherine , Hui Harriet , Taylor Natalie , Banks Emily , Barclay Karen , Broun Kate , Butt Alison , Carter Rob , Cuff Jeff , Dessaix Anita , Ee Hooi , Emery Jon , Frayling Ian M , Grogan Paul , Holden Carol , Horn Christopher , Jenkins Mark A , Kench James G , Laaksonen Maarit A , Leggett Barbara , Mitchell Gillian , Morris Susan , Parkinson Bonny , St John D James , Taoube Linda , Tucker Katherine , Wakefield Melanie A , Ward Robyn L , Win Aung Ko , Worthley Daniel L , Armstrong Bruce K , Macrae Finlay A , Canfell Karen
Published: June 2020

Introduction

With almost 50% of cases preventable and the Australian National Bowel Cancer Screening Program in place, colorectal cancer (CRC) is a prime candidate for investment to reduce the cancer burden. The challenge is determining effective ways to reduce morbidity and mortality and their implementation through policy and practice. Pathways-Bowel is a multistage programme that aims to identify best-value investment in CRC control by integrating expert and end-user engagement; relevant evidence; modelled interventions to guide future investment; and policy-driven implementation of interventions using evidence-based methods.

Methods and analysis

Pathways-Bowel is an iterative work programme incorporating a calibrated and validated CRC natural history model for Australia (Policy1-Bowel) and assessing the health and cost outcomes and resource use of targeted interventions. Experts help identify and prioritise modelled evaluations of changing trends and interventions and critically assess results to advise on their real-world applicability. Where appropriate the results are used to support public policy change and make the case for optimal investment in specific CRC control interventions. Fourteen high-priority evaluations have been modelled or planned, including evaluations of CRC outcomes from the changing prevalence of modifiable exposures, including smoking and body fatness; potential benefits of daily aspirin intake as chemoprevention; increasing CRC incidence in people aged <50 years; increasing screening participation in the general and Aboriginal and Torres Strait Islander populations; alternative screening technologies and modalities; and changes to follow-up surveillance protocols. Pathways-Bowel is a unique, comprehensive approach to evaluating CRC control; no prior body of work has assessed the relative benefits of a variety of interventions across CRC development and progression to produce a list of best-value investments.

Ethics and dissemination

Ethics approval was not required as human participants were not involved. Findings are reported in a series of papers in peer-reviewed journals and presented at fora to engage the community and policymakers.
Waist-to-height ratio as a screening tool for cardiometabolic risk in children and adolescents: a nationwide cross-sectional study in China
Authors: Dou Yalan , Jiang Yuan , Yan Yinkun , Chen Hongyan , Zhang Yi , Chen Xiaotian , Wang Yin , Cheng Hong , Zhao Xiaoyuan , Hou Dongqing , Mi Jie , Yan Weili
Published: June 2020

Objectives

To demonstrate the accuracy and flexibility of using waist-to-height ratio (WHtR) as a screening tool for identifying children and adolescents with cardiometabolic risk (CMR) across a wide range of prevalence levels among general paediatric populations.

Design

A nationwide population-based cross-sectional study with all data collected at school settings in six cities of China.

Participants

A total of 8130 children and adolescents aged 7–18 years with complete anthropometric and CMR measurements based on blood tests were recruited.

Outcome measures

Elevated blood pressure, dyslipidaemia, elevated fasting blood glucose and central obesity were measured. The primary outcome, CMRs, was defined as meeting three or more of the above risk factors. The accuracy of WHtR for identifying CMRs was evaluated using areas under the curves (AUCs) with 95% CI of the receiver operating characteristic curve. The predictability of WHtR at given CMRs prevalence levels was estimated by positive predictive value (PPV) and negative predictive value.

Results

Overall, 6.1% of study participants were presented with CMRs. WHtR had high AUCs ranging from 0.84 (95% CI 0.81 to 0.88) to 0.88 (95% CI 0.86 to 0.90) in the total population and age-subgroup and gender-subgroup. The overall optimal WHtR cut-off value was 0.467, with boys having a higher cut-off than girls (0.481 vs 0.456). WHtR achieved an overall sensitivity of 0.89 and PPV of 18.8% at a specificity of 0.75. The screening performance of WHtR remained satisfactory across a wide range of given CMRs prevalence levels (5%, 10% and 20%).

Conclusion

WHtR as a screening tool could accurately and flexibly identify children affected with the clusters of three or more of CMR factors from the general paediatric population with various CMR prevalence levels. Our findings provide support for policy-making on early CMR identification and management in the high-risk group of children.
Association between vision impairment and mortality: protocol for a systematic review and meta-analysis
Authors: Ehrlich Joshua R , Ramke Jacqueline , Macleod David , Swenor Bonnielin K , Burn Helen , Lee Chan Ning , Waldock William J , Zhang Justine H , Gordon Iris , Congdon Nathan , Burton Matthew , Evans Jennifer R
Published: June 2020

Introduction

Due to growth and ageing of the world’s population, the number of individuals worldwide with vision impairment (VI) and blindness is projected to increase rapidly over the coming decades. VI and blindness are an important cause of years lived with disability. However, the association of VI and blindness with mortality, including the risk of bias in published studies and certainty of the evidence, has not been adequately studied in an up-to-date systematic review and meta-analysis.

Methods and analysis

The planned systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases, including MEDLINE Ovid, Embase Ovid and Global Health, will be searched for relevant studies. Two reviewers will then screen studies and review full texts to identify studies for inclusion. Data extraction will be performed, and for included studies, the risk of bias and certainty of the evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. The prognostic factor in this study is visual function, which must have been measured using a standard objective ophthalmic clinical or research instrument. We will use standard criteria from WHO to categorise VI and blindness. All-cause mortality may be assessed by any method one or more years after baseline assessment of vision. Results from included studies will be meta-analysed according to relevant sections of the Meta-analysis Of Observational Studies in Epidemiology checklist.

Ethics and dissemination

This review will only include published data; therefore, ethics approval will not be sought. The findings of this review and meta-analysis will be published in an open-access, peer-reviewed journal and will be included in the ongoing Lancet Global Health Commission on Global Eye Health.
INTREPID II: protocol for a multistudy programme of research on untreated psychosis in India, Nigeria and Trinidad
Authors: Roberts Tessa , Gureje Oye , Thara Rangaswamy , Hutchinson Gerard , Cohen Alex , Weiss Helen Anne , John Sujit , Lee Pow Joni , Donald Casswina , Olley Bola , Miguel Esponda Georgina , Murray Robin M , Morgan Craig
Published: June 2020

Introduction

There are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health.

Methods

INTREPID II is a programme of research incorporating incidence, case–control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological.

Ethics and dissemination

Informed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.
Paediatric ocular adnexal lymphoma: a population-based analysis
Authors: Moustafa Giannis A , Topham Allan K , Aronow Mary E , Vavvas Demetrios G
Published: June 2020

Objective

To investigate the incidence, clinicopathological characteristics and survival of ocular adnexal lymphoma (OAL) in the paediatric population.

Methods and analysis

In this retrospective case series, the Surveillance, Epidemiology and End Results database was accessed to identify individuals with OAL ≤18 years of age, diagnosed between 1973 and 2015. OAL located in the eyelid, conjunctiva, lacrimal apparatus and orbit were included. Main outcome measures were the age-adjusted incidence rates (IRs) per 1 000 000 population at risk (calculated for the period 2000–2015) and descriptive statistics of demographic and clinicopathological features.

Results

The IR of paediatric OAL was 0.12 (95% CI 0.08 to 0.16) per 1 000 000. Males (0.15; 95% CI 0.10 to 0.22) and blacks (0.24; 95% CI 0.13 to 0.42) had a higher tendency for OAL development. A total of 55 tumours in 54 children were identified. The majority were localised (78.4%), conjunctival (49.1%) lymphomas. Extranodal marginal zone lymphoma (EMZL, 45.5%, n=25) was the most frequent subtype, followed by diffuse large B-cell lymphoma (DLBCL, 9.1%, n=5), B lymphoblastic lymphoma (7.3%, n=4), follicular lymphoma (5.5%, n=3), Burkitt lymphoma (5.5%, n=3), anaplastic large cell lymphoma (ALCL, 3.6%, n=2), small lymphocytic lymphoma (1.8%, n=1), diffuse large B-cell lymphoma, immunoblastic (1.8%, n=1) and panniculitis-like T-cell lymphoma (1.8%, n=1). Localised, low-grade, conjunctival lymphomas were frequently treated with complete excision with or without radiation, while high-grade and distant tumours usually received chemotherapy. Only 29.1% of paediatric OAL cases were treated with radiation. Three out of five (60%) patients with DLBCL died of lymphoma at a median follow-up of 21 (range 10–86) months, and 1 out of 2 (50%) patients with ALCL died of lymphoma at 23 months from diagnosis.

Conclusion

OAL in the paediatric population is rare. The majority of OAL are EMZL and are characterised by excellent prognosis. The histological subtype was found to be the main predictor of outcome with cancer-specific deaths observed in patients with DLBCL and ALCL.
Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure
Authors: Marini Claudia , Fragasso Gabriele , Italia Leonardo , Sisakian Hamayak , Tufaro Vincenzo , Ingallina Giacomo , Stella Stefano , Ancona Francesco , Loiacono Ferdinando , Innelli Pasquale , Costantino Marco Fabio , Sahakyan Laura , Gabrielyan Sirvard , Avetisyan Mariam , Margonato Alberto , Agricola Eustachio
Published: June 2020

Objective

Pulmonary congestion is the main cause of hospital admission in patients with heart failure (HF). Lung ultrasound (LUS) is a useful tool to identify subclinical pulmonary congestion. We evaluated the usefulness of LUS in addition to physical examination (PE) in the management of outpatients with HF.

Methods

In this randomised multicentre unblinded study, patients with chronic HF and optimised medical therapy were randomised in two groups: ‘PE+LUS’ group undergoing PE and LUS and ‘PE only’ group. Diuretic therapy was modified according to LUS findings and PE, respectively. The primary endpoint was the reduction in hospitalisation rate for acute decompensated heart failure (ADHF) at 90-day follow-up. Secondary endpoints were reduction in NT-proBNP, quality-of-life test (QLT) and cardiac mortality at 90-day follow-up.

Results

A total of 244 patients with chronic HF and optimised medical therapy were enrolled and randomised in ‘PE+LUS’ group undergoing PE and LUS, and in ‘PE only’ group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in ‘PE+LUS’ group (9.4% vs 21.4% in ‘PE only’ group; relative risk=0.44; 95% CI 0.23 to 0.84; p=0.01), with a reduction of risk for hospitalisation for ADHF by 56% (p=0.01) and a number needed to treat of 8.4 patients (95% CI 4.8 to 34.3). At day 90, NT-proBNP and QLT score were significantly reduced in ‘PE+LUS’ group, whereas in ‘PE only’ group both were increased. There were no differences in mortality between the two groups.

Conclusions

LUS-guided management reduces hospitalisation for ADHF at mid-term follow-up in outpatients with chronic HF.
Pickering emulsions with ethiodized oil and nanoparticles for slow release of intratumoral anti-CTLA4 immune checkpoint antibodies
Authors: Tselikas Lambros , de Baere Thierry , Isoardo Thomas , Susini Sandrine , Ser-Le Roux Karine , Polrot Mélanie , Adam Julien , Rouanne Mathieu , Zitvogel Laurence , Moine Laurence , Deschamps Fréderic , Marabelle Aurélien
Published: June 2020

Background

Intratumorous immunotherapy for cancer is currently thriving. The aim of such local strategy is to improve the therapeutic index of these treatments, for higher on-target/on-tumor activity and less on-target/off-tumor adverse events. Strategies allowing for slow release of anti-CTLA4 in the tumor microenvironment could improve their clinical efficacy.

The purpose of the study was to develop a radiopaque delivery platform to improve the targeting and exposure of intratumorous anti-CTLA4 antibodies for cancer immunotherapy.

Methods

Pickering emulsions of anti-CTLA4 antibodies were formulated with radiopaque ethiodized oil and poly-lactic-co-glycolic acid (PLGA) nanoparticles. We characterized the microscopic aspect and stability of such emulsions using Turbiscan. We monitored the release of anti-CTLA4 over time from these emulsions and evaluated their structure using mass spectrometry. We then tested the functionality of the released antibodies by preforming ex vivo competitive binding assays. Finally, we assessed the in vivo efficacy of intratumorous anti-CTLA4 Pickering emulsions.

Results

Pickering emulsions of ethiodized oil and PLGA nanoparticles (PEEPs) resulted in a radiopaque water-in-oil emulsion with average internal phase droplet size of 42±5 µm at day 7. Confocal microscopy showed that anti-CTLA4 antibodies were effectively encapsulated by ethiodized oil with PLGA nanoparticles located at the interface between the aqueous and the oily phase. Turbiscan analysis showed that emulsions were stable with continuous and progressive release of anti-CTLA4 antibodies reaching 70% at 3 weeks. Structural and functional analysis of the released antibodies did not show significant differences with native anti-CTLA4 antibodies. Finally, intratumorous anti-CTLA4 PEEPs were able to eradicate tumors and cure mice in a syngeneic immunocompetent preclinical tumor model.

Conclusion

Pickering emulsions of ethiodized oil and PLGA is an innovative radiopaque delivery platform that does not alter the functionality of anti-CTLA4 immune checkpoint antibodies. Beyond local anti-CTLA4 applications, these emulsions might be used with other therapeutic molecules for optimal intratumorous or intra-arterial delivery of novel cancer immunotherapies.
Dual oxidase 1 limits the IFNγ-associated antitumor effect of macrophages
Authors: Meziani Lydia , Gerbé de Thoré Marine , Hamon Pauline , Bockel Sophie , Andrade Louzada Ruy , Clemenson Céline , Corre Raphaël , Liu Wincgygn , Dupuy Corinne , Mondini Michele , Deutsch Eric
Published: June 2020

Background

Macrophages play pivotal roles in tumor progression and the response to anticancer therapies, including radiotherapy (RT). Dual oxidase (DUOX) 1 is a transmembrane enzyme that plays a critical role in oxidant generation.

Methods

Since we found DUOX1 expression in macrophages from human lung samples exposed to ionizing radiation, we aimed to assess the involvement of DUOX1 in macrophage activation and the role of these macrophages in tumor development.

Results

UsingDuox1−/−mice, we demonstrated that the lack of DUOX1 in proinflammatory macrophages improved the antitumor effect of these cells. Furthermore, intratumoral injection ofDuox1−/−proinflammatory macrophages significantly enhanced the antitumor effect of RT. Mechanistically, DUOX1 deficiency increased the production of proinflammatory cytokines (IFNγ, CXCL9, CCL3 and TNFα) by activated macrophagesin vitroand the expression of major histocompatibility complex class II in the membranes of macrophages. We also demonstrated that DUOX1 was involved in the phagocytotic function of macrophagesin vitroandin vivo. The antitumor effect ofDuox1−/−macrophages was associated with a significant increase in IFNγ production by both lymphoid and myeloid immune cells.

Conclusions

Our data indicate that DUOX1 is a new target for macrophage reprogramming and suggest that DUOX1 inhibition in macrophages combined with RT is a new therapeutic strategy for the management of cancers.
Capital structure in the construction industry: theory and practice
Authors: Atakul Nur , Gundes Selin
Published: June 2020

Starting with the seminal work of Modigliani and Miller in 1958, various capital structure theories have been set forth by corporate finance researchers, such as the trade-off and financial hierarchy theories. The present research uses data from the survey questionnaire conducted with 158 Turkish construction companies to explain the financial decisions of contractors in terms of capital structure theories. Results reveal that firm age, size, and asset values appear to be positively correlated to debt–equity ratio and the volatility of earnings and cashflows are important determinants of leverage, confirming the trade-off theory. On the other hand, the construction sector clearly follows a financial order consistent with the financial hierarchy theory, but other propositions of the theory are not supported. Overall, it is concluded that capital structure decisions of construction firms cannot fully be explained by the existing models. Rather, firms appear to exploit “windows of opportunity” emerging from changes in macroeconomic indicators, such as interest rates, GDP, and resulting market conditions.
The role of the range of dispersal in a nonlocal Fisher-KPP equation: An asymptotic analysis
Authors: Brasseur Julien
Published: June 2020

In this paper, we study the asymptotic behavior as [Formula: see text] of solutions [Formula: see text] to the nonlocal stationary Fisher-KPP type equation [Formula: see text] where [Formula: see text] and [Formula: see text]. Under rather mild assumptions and using very little technology, we prove that there exists one and only one positive solution [Formula: see text] and that [Formula: see text] as [Formula: see text] where [Formula: see text]. This generalizes the previously known results and answers an open question raised by Berestycki et al. Our method of proof is also of independent interest as it shows how to reduce this nonlocal problem to a local one. The sharpness of our assumptions is also briefly discussed.
The buckling eigenvalue problem in the annulus
Authors: Buoso Davide , Parini Enea
Published: June 2020

We consider the buckling eigenvalue problem for a clamped plate in the annulus. We identify the first eigenvalue in dependence of the inner radius, and study the number of nodal domains of the corresponding eigenfunctions. Moreover, in order to investigate the asymptotic behavior of eigenvalues and eigenfunctions as the inner radius approaches the outer one, we provide an analytical study of the buckling problem in rectangles with mixed boundary conditions.
EVALUATING THE IMPACT OF INFORMAL SECTOR COMPETITORS ON THE PERFORMANCE OF FORMAL ENTERPRISES: EVIDENCE FROM BOSNIA AND HERZEGOVINA
Authors: WILLIAMS COLIN C. , KOSTA BRUNILDA
Published: June 2020

It is widely assumed that informal sector enterprises have a harmful impact on the performance of formal enterprises. This paper aims to provide an evidence-based evaluation of whether this is the case. To do so, it reports World Bank Enterprise Survey (WBES) data collected from 360 formal enterprises in Bosnia and Herzegovina in 2019. The finding is that formal enterprises viewing informal competition as a severe obstacle do not witness significantly lower sales growth, employment growth or productivity growth. Indeed, such enterprises witness significantly higher sales growth than those who do not view informal sector competitors as a severe obstacle. The theoretical and policy implications are discussed.
Mining User-generated Content of Mobile Patient Portal
Authors: Al-Ramahi Mohammad , Noteboom Cherie
Published: June 2020

Patient portals are positioned as a central component of patient engagement through the potential to change the physician-patient relationship and enable chronic disease self-management. The incorporation of patient portals provides the promise to deliver excellent quality, at optimized costs, while improving the health of the population. This study extends the existing literature by extracting dimensions related to the Mobile Patient Portal Use. We use a topic modeling approach to systematically analyze users’ feedback from the actual use of a common mobile patient portal, Epic's MyChart. Comparing results of Latent Dirichlet Allocation analysis with those of human analysis validated the extracted topics. Practically, the results provide insights into adopting mobile patient portals, revealing opportunities for improvement and to enhance the design of current basic portals. Theoretically, the findings inform the social-technical systems and Task-Technology Fit theories in the healthcare field and emphasize important healthcare structural and social aspects. Further, findings inform the humanization of healthcare framework, support the results of existing studies, and introduce new important design dimensions (i.e., aspects) that influence patient satisfaction and adherence to patient portal.