bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of the self-fatigue assessment in guiding early postoperative ambulation in gynaecological oncology patients: study protocol for a randomised controlled trial
Authors: Du Qian , Chen Bo , Xu Shaoyong , He Hong , Qin Xiaomin , Kang Tongting , Wang Xu , Huang Xiaojie
Published: June 2022

Introduction

Enhanced recovery after surgery (ERAS) guidelines strongly recommends that patients be in early postoperative ambulation within 24 hours. This study aims to assess the effectiveness and safety of the self-fatigue assessment method to guide patients’ early postoperative ambulation.

Methods and analysis

This is a single-centre, randomised, open, parallel-controlled trial. Five hundred and fifty-two patients who meet the inclusion criteria for gynaecological oncology surgery are randomly assigned in a 1:1 ratio to either a self-fatigue assessment group (study group) or a fixed activity distance assessment group (control group). The fixed activity distance group adopts a fixed early postoperative ambulation distance to guide the patient’s activity, while the self-fatigue assessment group uses the Borg Exercise Scale to assess the patient’s fatigue and stops activity when the fatigue level reaches 5–6. The primary outcome measure is the time to first postoperative flatus. Secondary outcome measures are the time to first bowel movement, the incidence of moderate to severe bloating, the incidence of bowel obstruction or venous thromboembolism, the incidence of adverse events (nausea, vomiting, dizziness), patient satisfaction, sleep quality scores, patient compliance with activities, hospital costs and days in hospital.

Ethics and dissemination

This study was approved by the Independent Ethics Committee of Xiangyang Central Hospital affiliated with Hubei University of Arts and Sciences and registered with the China Clinical Trials Registry in May 2021. The results of the trial will be disseminated through open access peer-reviewed journals and abstracts will be submitted to relevant national and international conferences.

Trial registration number

CTR2100046035.
Health systems analysis and evaluation of the barriers to availability, utilisation and readiness of sexual and reproductive health services in COVID-19-affected areas: a WHO mixed-methods study protocol
Authors: Kouanda Seni , Nahyuha Chomi Eunice , Kim Caron , Jen Sothornwit , Bahamondes Luis , Cecatti Jose Guilherme , Lumbiganon Pisake , Emefa Modey , Brizuela Vanessa , Kuganantham Hamsadvani , Seuc Armando Humberto , Ali Moazzam
Published: June 2022

Introduction

COVID-19 has led to an unprecedented increase in demand on health systems to care for people infected, necessitating the allocation of significant resources, especially medical resources, towards the response. This, compounded by the restrictions on movement instituted may have led to disruptions in the provision of essential services, including sexual and reproductive health (SRH) services. This study aims to assess the availability of contraception, comprehensive abortion care, sexually transmitted infection prevention and treatment and sexual and gender-based violence care and support services in local health facilities during COVID-19 pandemic. This is a standardised generic protocol designed for use across different global settings.

Methods and analysis

This study adopts both quantitative and qualitative methods to assess health facilities’ SRH service availability and readiness, and clients’ and providers’ perceptions of the availability and readiness of these services in COVID-19-affected areas. The study has two levels: (1) perceptions of clients (and the partners) and healthcare providers, using qualitative methods, and (2) assessment of infrastructure availability and readiness to provide SRH services through reviews, facility service statistics for clients and a qualitative survey for healthcare provider perspectives. The health system assessment will use a cross-sectional panel survey design with two data collection points to capture changes in SRH services availability as a result of the COVID-19 epidemic. Data will be collected using focus group discussions, in-depth interviews and a health facility assessment survey.

Ethics and dissemination

Ethical approval for this study was obtained from the WHO Scientific and Ethics Review Committee (protocol ID CERC.0103). Each study site is required to obtain the necessary ethical and regulatory approvals that are required in each specific country.
Effectiveness of a personal health coaching intervention (diabetescoach) in patients with type 2 diabetes: protocol for an open-label, pragmatic randomised controlled trial
Authors: Hohberg Vivien , Kreppke Jan-Niklas , Kohl Jan , Seelig Eleonora , Zahner Lukas , Streckmann Fiona , Gerber Markus , König Daniel , Faude Oliver
Published: June 2022

Introduction

The widespread prevalence of type 2 diabetes (T2D) not only influences patients’ daily lives but also has an economic impact on society. Increasing physical activity and a healthy diet can delay the progression of T2D. Although there are evidence-based recommendations on diet and physical activity, patients with T2D have difficulties implementing them. An appropriate lifestyle intervention can address this problem.

Methods and analysis

This study is based on the need to develop an intervention that helps patients to establish behavioural changes in order to achieve glycaemic control. The intervention will be evaluated in a monocentric, open-label, pragmatic, two-arm randomised controlled trial with a sample ratio of 1:1 and a parallel design. This superiority study will be conducted in Switzerland. All enrolled patients (n=90) will receive the standard medical treatment for T2D. The intervention group will receive personal health coaching by telephone and access to a smartphone and web application for 1 year. The control group will receive access to the application for 1 year and a one-time written diet and exercise recommendation. The primary outcomes are objectively measured physical activity and glycated haemoglobin. Secondary outcomes are self-reported physical activity, nutrition, cognitive mediators of changes in sport-related behaviour, blood values, medication and nutritional supplements, anthropometric data, quality of life, neuropathy and cost-effectiveness. All outcomes will be measured at baseline, at 27 weeks after inclusion and at 54 weeks after inclusion. The recruitment of participants and the measurements will be completed after 2 years. Linear mixed-effects models will be applied for each outcome variable to analyse the intervention effects.

Ethics and dissemination

This study was approved by the Ethics Committee North-western and Central Switzerland in February 2021 (ref: 2020-02755). All participants will be required to provide written informed consent. The results will be published in international peer-reviewed journals.

Trial registration number

ISRCTN79457541.
COVID-19 among staff and their family members of a healthcare research institution in Bangladesh between March 2020 and April 2021: a test-negative case–control study
Authors: Mahfuz Mustafa , Alam Md Ashraful , Fahim Shah Mohammad , Hasan S M Tafsir , Sarmin Monira , Das Subhasish , Mostafa Ishita , Parveen Shahana , Rahman Mustafizur , Arifeen Shams E , Clemens John D , Ahmed Tahmeed
Published: June 2022

Objective

To identify factors associated with COVID-19 positivity among staff and their family members of icddr,b, a health research institute located in Bangladesh.

Setting

Dhaka, Bangladesh.

Participants

A total of 4295 symptomatic people were tested for SARS-CoV-2 by reverse-transcription PCR between 19 March 2020 and 15 April 2021. Multivariable logistic regression was done to identify the factors associated with COVID-19 positivity by contrasting test positives with test negatives.

Result

Forty-three per cent of the participants were tested positive for SARS-CoV-2. The median age was high in positive cases (37 years vs 34 years). Among the positive cases, 97% were recovered, 2.1% had reinfections, 24 died and 41 were active cases as of 15 April 2021. Multivariable regression analysis showed that age more than 60 years (adjusted OR (aOR)=2.1, 95% CI 1.3 to 3.3; p<0.05), blood group AB (aOR=1.5, 95% CI 1.1 to 2; p<0.05), fever (aOR=3.1, 95% CI 2.6 to 3.7; p<0.05), cough (aOR=1.3, 95% CI 1.1 to 1.6; p<0.05) and anosmia (aOR=2.7, 95% CI 1.3 to 5.7; p<0.05) were significantly associated with higher odds of being COVID-19 positive when compared with participants who were tested negative.

Conclusions

The study findings suggest that older age, fever, cough and anosmia were associated with COVID-19 among the study participants.
Making space for patients’ preferences in precision medicine: a qualitative study exploring perspectives of patients with rheumatoid arthritis
Authors: Bywall Karin Schölin , Johansson Jennifer Viberg , Erlandsson Inger , Heidenvall Marie , Lason Marta , Appel Esbensen Bente
Published: June 2022

Objective

Precision medicine in rheumatoid arthritis (RA) creates new opportunities to involve patients in early identification of accurate indicators of health trajectories. The aim of this study was to explore patient perspectives on patient-centredness in precision medicine for RA treatment.

Design

Semistructured interviews were conducted to explore patients’ perspectives on a new personalised approach to RA treatment. The interview guide was developed together with patient research partners and health care professionals.

Setting

An invitation to the interviews was sent through a mobile application. The interviews were one-on-one, using an interview guide with open-ended questions. Interviews were conducted digitally (October 2020–February 2021) via Zoom or telephone, depending on each participant’s preferences.

Participants

Patients with RA (N=12) were purposively recruited. Patients were eligible if they had an RA diagnosis, were aged 18–80 years, and understood and expressed themselves in Swedish. Participants and researchers did not know each other prior to the interviews.

Results

Participants expressed desires and needs for patients to have an active role in precision medicine by making shared treatment decisions together with a healthcare professional. In order for that to work, patients need information on potential treatment options, an ability to express their preferences, an individual treatment plan and identification of personal treatment goals. Patients also identified two requirements of healthcare professional in precision medicine: a safe environment to express personal matters and two-way communication with healthcare professionals.

Conclusion

Communication between patients and healthcare professionals needs to be more focused on patients’ individual treatment preferences and expressed needs, in order to increase patient-centredness in treatment decisions, so shared decision-making can become a reality. More research is needed to design multifaceted implementation strategies to support patients and healthcare professionals to increase patient-centredness throughout treatment personalisation.
Application of the new ‘XU-line’ in the dynamic ultrasonographic evaluation of the spatial displacement of anterior cervical tissues for airway management: protocol for a prospective observational study
Authors: Wang Yujie , Mao Mingfeng , Zhou Yang , Shi Wanrui , Xu Mao
Published: June 2022

Introduction

Patients with cervical spondylosis have a high incidence of difficult airway, and unpredicted difficult intubation may be life-threatening. Traditional predictors and imaging data may suggest a difficult airway, but these data have limited predictive value, with low sensitivity and specificity. Ultrasonography is a non-irradiating, reproducible, inexpensive and simple tool that provides good imaging of the cervical soft tissue for airway assessment. This study will use the new ‘XU-line’ in the dynamic ultrasonographic airway evaluation of the spatial displacement of the anterior cervical tissues to determine whether preoperative ultrasonographic assessment of the neck anatomy can predict difficult airway.

Methods and analysis

This prospective, observational study will be conducted in a single centre. Four hundred and eleven patients scheduled for anterior cervical decompression and fusion under general anaesthesia will be recruited. The parallel trunk reference line through the mentum is defined as the XU-line, and the spatial displacement of the anterior cervical soft tissue relative to the XU-line at six anatomical levels in the transverse plane and two distances in the sagittal plane will be measured on ultrasonography with the patient in the supine position and the sniff position. The spatial displacement distances of soft tissue structures relative to the XU-line will be compared between the ‘easy intubation’ and ‘difficult intubation’ groups (in accordance with the Cormack-Lehane classification). Receiver operating characteristic curves will be used to determine the sensitivity and specificity of the ‘difficulty prediction capability’ of each ultrasonographic and physical measurement. Multiple logistic regression analysis will be performed to determine the independent predictors of difficult intubation.

Ethics and dissemination

Ethical approval for this study has been obtained from the Peking University Third Hospital Medical Science Research Ethics Committee. The results of this study will be disseminated via a peer-reviewed publication and national and international conferences and workshops.

Trial registration number

ChiCTR2000034446.
COVID-19 vaccine misinformation in English-language news media: retrospective cohort study
Authors: Lurie Peter , Adams Jordan , Lynas Mark , Stockert Karen , Carlyle Robyn Correll , Pisani Amy , Evanega Sarah Davidson
Published: June 2022

Objectives

To describe COVID-19 vaccine misinformation and track trends over time in traditional news media.

Design

Retrospective cohort study of a large database of online articles, July 2020–June 2021.

Setting

English-language articles from 100 news outlets with the greatest reach.

Main outcome measures

Numbers and percentages of articles containing COVID-19 vaccine misinformation over the study period. Further analysis by misinformation themes and whether articles included primary misinformation, fact-checking or simply referred to misinformation.

Results

41 718 (3.2% of all COVID-19 vaccine articles) contained at least one of the vaccine misinformation themes based on the Boolean string developed for this study. The volume of such articles increased beginning in November 2020, but their percentage of all articles remained essentially stable after October 2020. 56.2% contained at least one mention of a safety theme, followed by development, production, and distribution (26.6%), and conspiracies (15.1%). Of 500 articles through January 2021 randomly selected from those identified by the Boolean string, 223 were not relevant, and 277 included either fact-checking (175 articles), refers to misinformation (87 articles) or primary misinformation (15 articles). In eight study weeks, the reach of these 277 articles (defined as visitors to the sites containing the articles) exceeded 250 million people. Fact-checking accounted for 69.6% of all reach for these articles and the number of such articles increased after November 2020. Overall, approximately 0.1% (95% CI 0.05% to 0.16%) of all articles on COVID-19 vaccines in our sample contained primary misinformation.

Conclusions

COVID-19 vaccine misinformation in traditional news media is uncommon but has the capacity to reach large numbers of readers and affect the vaccine conversation. Recent increases in fact-checking may counteract some of the misinformation currently circulating.
Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015
Authors: Ha Thi Ninh , Kamarova Sviatlana , Youens David , Wright Cameron , McRobbie Donald , Doust Jenny , Slavotinek John , Bulsara Max K , Moorin Rachael
Published: June 2022

Objective

High use of CT scanning has raised concern due to the potential ionising radiation exposure. This study examined trends of CT during admission to tertiary hospitals and its associations with length of stay (LOS), readmission and mortality.

Design

Retrospective observational study from 2003 to 2015.

Setting

West Australian linked administrative records at individual level.

Participants

2 375 787 episodes of tertiary hospital admission in adults aged 18+ years.

Main outcome measures

LOS, 30-day readmissions and mortality stratified by CT use status (any, multiple (CTs to multiple areas during episode), and repeat (repeated CT to the same area)).

Methods

Multivariable regression models were used to calculate adjusted rate of CT use status. The significance of changes since 2003 in the outcomes (LOS, 30-day readmission and mortality) was compared among patients with specific CT imaging status relative to those without.

Results

Between 2003 and 2015, while the rate of CT increased 3.4% annually, the rate of repeat CTs significantly decreased −1.8% annually and multiple CT showed no change. Compared with 2003 while LOS had a greater decrease in those with any CT, 30-day readmissions had a greater increase among those with any CT, while the probability of mortality remained unchanged between the any CT/no CT groups. A similar result was observed in patients with multiple and repeat CT scanning, except for a significant increase in mortality in the recent years in the repeat CT group.

Conclusion

The observed pattern of increase in CT utilisation is likely to be activity-based funding policy-driven based on the discordance between LOS and readmissions. Meanwhile, the repeat CT reduction aligns with a more selective strategy of use based on clinical severity. Future research should incorporate in-hospital and out-of-hospital CT to better understand overall CT trends and potential shifts between settings over time.
Experience of Kenyan researchers and policy-makers with knowledge translation during COVID-19: a qualitative interview study
Authors: Guleid Fatuma Hassan , Njeru Alex , Kiptim Joy , Kamuya Dorcas Mwikali , Okiro Emelda , Tsofa Benjamin , English Mike , Molyneux Sassy , Kariuki David , Barasa Edwine
Published: June 2022

Objectives

Researchers at the KEMRI-Wellcome Trust Research Programme (KWTRP) carried out knowledge translation (KT) activities to support policy-makers as the Kenyan Government responded to the COVID-19 pandemic. We assessed the usefulness of these activities to identify the facilitators and barriers to KT and suggest actions that facilitate KT in similar settings.

Design

The study adopted a qualitative interview study design.

Setting and participants

Researchers at KWTRP in Kenya who were involved in KT activities during the COVID-19 pandemic (n=6) were selected to participate in key informant interviews to describe their experience. In addition, the policy-makers with whom these researchers engaged were invited to participate (n=11). Data were collected from March 2021 to August 2021.

Analysis

A thematic analysis approach was adopted using a predetermined framework to develop a coding structure consisting of the core thematic areas. Any other theme that emerged in the coding process was included.

Results

Both groups reported that the KT activities increased evidence availability and accessibility, enhanced policy-makers’ motivation to use evidence, improved capacity to use research evidence and strengthened relationships. Policy-makers shared that a key facilitator of this was the knowledge products shared and the regular interaction with researchers. Both groups mentioned that a key barrier was the timeliness of generating evidence, which was exacerbated by the pandemic. They felt it was important to institutionalise KT to improve readiness to respond to public health emergencies.

Conclusion

This study provides a real-world example of the use of KT during a public health crisis. It further highlights the need to institutionalise KT in research and policy institutions in African countries to respond readily to public health emergencies.
Hydroxychloroquine plus personal protective equipment versus personal protective equipment alone for the prevention of laboratory-confirmed COVID-19 infections among healthcare workers: a multicentre, parallel-group randomised controlled trial from India
Authors: Tirupakuzhi Vijayaraghavan Bharath Kumar , Jha Vivekanand , Rajbhandari Dorrilyn , Myatra Sheila Nainan , Ghosh Arpita , Bhattacharya Amritendu , Arfin Sumaiya , Bassi Abhinav , Donaldson Lachlan Hugh , Hammond Naomi E , John Oommen , Joshi Rohina , Kunigari Mallikarjuna , Amrutha Cynthia , Husaini Syed Haider Mehdi , Ghosh Subir , Nag Santosh Kumar , Selvaraj Hari Krishnan , Kantroo Viny , Shah Kamal D , Venkatesh Balasubramanian
Published: June 2022

Objectives

To determine whether hydroxychloroquine when used with personal protective equipment reduces the proportion of laboratory-confirmed COVID-19 among healthcare workers in comparison to the use of personal protective equipment alone.

Design

Multicentre, parallel-group, open-label randomised trial. Enrolment started on 29 June 2020 and stopped on 4 February 2021. Participants randomised in HydrOxychloroquine Prophylaxis Evaluation were followed for 6 months.

Setting

9 hospitals across India.

Participants

Healthcare workers in an environment with exposure to COVID-19 were randomised in a 1:1 ratio to hydroxychloroquine plus use of personal protective equipment or personal protective equipment alone. 886 participants were screened and 416 randomised (213 hydroxychloroquine arm and 203 personal protective equipment).

Intervention

Participants in intervention arm received 800 mg of hydroxychloroquine on day of randomisation and then 400 mg once a week for 12 weeks in addition to the use of personal protective equipment. In the control arm, participants continued to use personal protective equipment alone.

Main outcome

Proportion of laboratory-confirmed COVID-19 in the 6 months after randomisation.

Results

Participants were young (mean age 32.1 years, SD 9.1 years) with low-comorbid burden. 47.4% were female. In the 6 months after randomisation (primary analysis population=413), 11 participants assigned to the hydroxychloroquine group and 12 participants assigned to the standard practice group met the primary endpoint (5.2% vs 5.9%; OR 0.85, 95% CI 0.35 to 2.07, p=0.72). There was no heterogeneity of treatment effect in any prespecified subgroup. There were no significant differences in the secondary outcomes. The adverse event rates were 9.9% and 6.9% in the hydroxychloroquine and standard practice arms, respectively. There were no serious adverse events in either group.

Conclusions and relevance

Hydroxychloroquine along with personal protective equipment was not superior to personal protective equipment alone on the proportion of laboratory-confirmed COVID-19. Definitive conclusions are precluded as the trial stopped early for futility, and hence was underpowered.

Trial registration number

CTRI/2020/05/025067.
Lifestyle risk behaviours among adolescents: a two-year longitudinal study of the impact of the COVID-19 pandemic
Authors: Gardner Lauren Anne , Debenham Jennifer , Newton Nicola Clare , Chapman Cath , Wylie Fiona Elizabeth , Osman Bridie , Teesson Maree , Champion Katrina Elizabeth
Published: June 2022

Objective

To examine changes in the prevalence of six key chronic disease risk factors (the “Big 6”), from before (2019) to during (2021) the COVID-19 pandemic, among a large and geographically diverse sample of adolescents, and whether differences over time are associated with lockdown status and gender.

Design

Prospective cohort study.

Setting

Three Australian states (New South Wales, Queensland and Western Australia) spanning over 3000 km.

Participants

983 adolescents (baseline Mage=12.6, SD=0.5, 54.8% girl) drawn from the control group of the Health4Life Study.

Primary outcomes

The prevalence of physical inactivity, poor diet (insufficient fruit and vegetable intake, high sugar-sweetened beverage intake, high discretionary food intake), poor sleep, excessive recreational screen time, alcohol use and tobacco use.

Results

The prevalence of excessive recreational screen time (prevalence ratios (PR)=1.06, 95% CI=1.03 to 1.11), insufficient fruit intake (PR=1.50, 95% CI=1.26 to 1.79), and alcohol (PR=4.34, 95% CI=2.82 to 6.67) and tobacco use (PR=4.05 95% CI=1.86 to 8.84) increased over the 2-year period, with alcohol use increasing more among girls (PR=2.34, 95% CI=1.19 to 4.62). The prevalence of insufficient sleep declined across the full sample (PR=0.74, 95% CI=0.68 to 0.81); however, increased among girls (PR=1.24, 95% CI=1.10 to 1.41). The prevalence of high sugar-sweetened beverage (PR=0.61, 95% CI=0.64 to 0.83) and discretionary food consumption (PR=0.73, 95% CI=0.64 to 0.83) reduced among those subjected to stay-at-home orders, compared with those not in lockdown.

Conclusion

Lifestyle risk behaviours, particularly excessive recreational screen time, poor diet, physical inactivity and poor sleep, are prevalent among adolescents. Young people must be supported to find ways to improve or maintain their health, regardless of the course of the pandemic. Targeted approaches to support groups that may be disproportionately impacted, such as adolescent girls, are needed.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12619000431123)
Adverse events and overall health and well-being after COVID-19 vaccination: interim results from the VAC4COVID cohort safety study
Authors: Rogers Amy , Rooke Evelien , Morant Steve , Guthrie Greg , Doney Alex , Duncan Andrew , Mackenzie Isla , Barr Rebecca , Pigazzani Filippo , Zutis Krists , MacDonald Thomas M
Published: June 2022

Objectives

To describe the incidence of adverse events (AEs), reactogenicity symptoms, menstrual changes and overall self-rated improvement in health and well-being after COVID-19 vaccination.

Design

VAC4COVID is an ongoing prospective, active observational, post-authorisation cohort safety study (PASS) of UK-approved vaccines for COVID-19 disease.

Setting

The study is conducted through a secure website (www.vac4covid.com) by MEMO Research, University of Dundee, UK.

Participants

16 265 adult (18 years or older) UK residents with a valid email address and internet access.

Interventions

Any UK-authorised COVID-19 vaccination.

Main outcome measures

The outcomes reported in this interim analysis include AEs, reactogenicity-type AEs (headache, fatigue, muscle or joint pain, fever, nausea, dizziness or local vaccine reaction), menstrual changes and reported improvement in overall health and well-being.

Results

11 475 consented participants (mean age 54.8 years) provided follow-up data between 2 February and 5 October 2021 (mean follow-up duration 184 days), by which date 89.2% of participants had received two vaccine doses. 89.8% of 5222 participants who completed a follow-up questionnaire in the 7 days after any COVID-19 vaccination reported no AEs. The risk of experiencing any event (not necessarily vaccine-related) requiring hospitalisation was less than 0.2%. 43.7% of post-vaccination follow-up records reported improvement in health and well-being. Reactogenicity-type reactions were more common in the week after the first dose of ChAdOx1 than BNT162b2 (7.8% vs 1.6%), but this relationship was reversed after the second dose (1.3% vs 3.1%). 0.3% of women reported menstrual symptoms after vaccination; no differences between vaccine type or dose order were detected.

Conclusions

The study provides reassuring data on low rates of AEs after COVID-19 vaccination. Differences in reactogenicity-type AE profiles between ChAdOx1 and BNT162b2 and between first and second doses of these vaccines were observed.

Trial registration number

ISRCTN95881792; Pre-results.
Impact on staff of providing non-invasive advanced respiratory support during the COVID-19 pandemic: a qualitative study in an acute hospital
Authors: Wenzel David , Bleazard Lucy , Wilson Eleanor , Faull Christina
Published: June 2022

Objectives

To explore the experiences of healthcare workers providing non-invasive advanced respiratory support (NARS) to critically unwell patients with COVID-19.

Design

A qualitative study drawing on a social constructionist perspective using thematic analysis of semistructured interviews.

Setting

A single acute UK National Health Service Trust across two hospital sites.

Participants

Multidisciplinary team members in acute, respiratory and palliative medicine.

Results

21 nurses, doctors (juniors and consultants) and physiotherapists described the provision of NARS to critically unwell COVID-19 patients as extremely challenging. The main themes were of feeling ill prepared and unsupported, a need to balance complex moral actions and a sense of duty to patients and their families. The impact on staff was profound and findings are discussed via a lens of moral injury. Injurious events included staff feeling they had acted in a way that caused harm, failed to prevent harm or had been let down by seniors or the Trust. Participants identified factors that mitigated adverse impact.

Conclusions

Although many of the issues described by participants are likely immutable components of healthcare in a pandemic, there were several important protective factors that emerged from the data. Experience, debriefing and breaks from COVID-19 wards were valuable to participants and successfully achieving a peaceful death for the patient was often viewed as compensation for a difficult journey. These protective factors may provide modelling for future education and support services to help prevent moral injury or aide in its recovery.

Trial registration number

Registered on the Open Science Framework, DOI 10.17605/OSF.IO/TB5QJ
Cohort profile: maternal and child health and parenting practices during the COVID-19 pandemic in Ceará, Brazil: birth cohort study (Iracema-COVID)
Authors: Castro Marcia C , Farías-Antúnez Simone , Araújo David Augusto Batista Sá , Penna Ana Luiza , Oliveira Francisco Ariclene , de Aquino Camila Machado , Lima Neto Antônio Silva , de Sousa Geziel dos Santos , Tavares Machado Marcia Maria
Published: June 2022

Purpose

Maternal and child health and parenting practices during the COVID-19 pandemic in Ceará (Iracema-COVID) is a longitudinal, prospective population-based birth cohort designed to understand the effects of the pandemic and social withdrawal in maternal mental health, child development and parenting practices of mothers and families.

Participants

A sample of mothers who gave birth in July and August 2020 (n=351) was enrolled in the study in January 2021. Interviews were conducted by telephone. Data were collected through standardised questionnaires that, in addition to sociodemographic and economic data, collected information on breast feeding, mental health status and COVID-19.

Findings to date

Results from the first wave show that the majority of participants have 9–11 years of schooling (54.4%; 95% CI 61.0 to 70.9) and are of mixed race (71.5%; 95% CI 66.5 to 76.0). At the time of the survey, 27.9% of the participants were out of the labor force (95% CI 23.5 to 32.9) and 78.6% reported a decrease in family income after restrictions imposed due to the pandemic (95% CI 74.0 to 82.6). The prevalence of maternal common mental disorder symptoms was 32.5% (95% CI 27.8 to 37.6).

Future plans

Follow-up visits are planned to occur every 6 months for the next five years (2021–2025). Additional topics will be included in future waves (eg, food insecurity and parenting practices). Communication strategies for bonding, such as picture cards, pictures of mothers with their children and phone calls to the participants, will be used to minimise attrition. Results of this prospective cohort will generate novel knowledge on the impact of the COVID-19 pandemic on maternal and child health and parenting practices in a population of women and children living in fifth largest city of Brazil.
Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study
Authors: Sania Ayesha , Alam Ahmed Nawsher , Alamgir A S M , Andrecka Joanna , Brum Eric , Chadwick Fergus , Chowdhury Tasnuva , Hasan Zakiul , Hill Davina L , Khan Farzana , Kundegorski Mikolaj , Lee Seonjoo , Rahman Mahbubur , Rayport Yael K , Shirin Tahmina , Tasneem Motahara , Hampson Katie
Published: June 2022

Objective

To evaluate the diagnostic performance and feasibility of rapid antigen testing for SARS-CoV-2 detection in low-income communities.

Design

We conducted a cross-sectional community-based diagnostic accuracy study. Community health workers, who were trained and supervised by medical technicians, performed rapid antigen tests on symptomatic individuals, and up to two additional household members in their households and diagnostic results were calibrated against the gold standard RT-PCR.

Setting

Low-income communities in Dhaka, Bangladesh.

Participants

Between 19 May 2021 and 11 July 2021, 1240 nasal and saliva samples were collected from symptomatic individuals and 993 samples from additional household members (up to two from one household).

Results

The sensitivity of rapid antigen tests was 0.68 on nasal samples (95% CI 0.62 to 0.73) and 0.41 on saliva (95% CI 0.35 to 0.46), with specificity also higher on nasal samples (0.98, 95% CI 0.97 to 0.99) than saliva (0.87, 95% CI 0.85 to 0.90). Testing up to two additional household members increased sensitivity to 0.71 on nasal samples (95% CI 0.65 to 0.76), but reduced specificity (0.96, 95% CI 0.94 to 0.97). Sensitivity on saliva rose to 0.48 (95% CI 0.42 to 0.54) with two additional household members tested but remained lower than sensitivity on nasal samples. During the study period, testing in these low-income communities increased fourfold through the mobilisation of community health workers for sample collection.

Conclusions

Rapid antigen testing on nasal swabs can be effectively performed by community health workers yielding equivalent sensitivity and specificity to the literature. Household testing by community health workers in low-resource settings is an inexpensive approach that can increase testing capacity, accessibility and the effectiveness of control measures through immediately actionable results.
Nationwide observational study of incidence, management and outcome of spontaneous coronary artery dissection: a report from the Swedish Coronary Angiography and Angioplasty register
Authors: Wilander Henrik , Pagonis Christos , Venetsanos Dimitrios , Swahn Eva , Dworeck Christian , Johnston Nina , Jonasson Lena , Kellerth Thomas , Tornvall Per , Yndigegn Troels , Sederholm Lawesson Sofia
Published: June 2022

Objectives

The aim of this study was to conduct a nationwide all comer description of incidence, contemporary management and outcome in Swedish spontaneous coronary artery dissection (SCAD) patients. The incidence of SCAD as well as the management and outcome of these patients is not well described.

Design

A nationwide observational study.

Participants and setting

All patients with SCAD registered in the Swedish Coronary Angiography and Angioplasty Register from 2015 to 2017 were included. The index angiographies of patients with registered SCAD were re-evaluated at each centre to confirm the diagnosis. Patients with non-SCAD myocardial infarction (MI) (n=32 601) were used for comparison.

Outcome measures

Outcomes included all-cause mortality, reinfarction or acute coronary reangiography.

Results

This study found 147 SCAD patients, rendering an incidence of 0.74 per 100 000 per year and a prevalence of 0.43% of all MIs. The average age was 52.9 years, 75.5% were women and 47.6% presented with ST-segment elevation MI. Median follow-up time for major adverse cardiac event was 17.3 months. Percutaneous coronary intervention was attempted in 40.1% of SCAD patients and 30.6% received stent. The use of antithrombotic agents was similar between the groups and there was no difference regarding outcomes, 10.9% vs 13.4%, p=0.75. Mortality was lower in SCAD patients, 2.7% vs 8.0%, p=0.03, whereas SCAD patients more often underwent acute reangiography, 9.5% vs 4.6%, p<0.01.

Conclusion

In this nationwide, all comer Swedish study, the overall incidence of SCAD was low, including 25% men which is more and in contrast to previous studies. Compared with non-SCAD MI, SCAD patients were younger, with lower cardiovascular risk burden, yet suffered substantial mortality and morbidity and more frequently underwent acute coronary reangiography.
Canadian healthcare capacity gaps for disease-modifying treatment in Huntington’s disease: a survey of current practice and modelling of future needs
Authors: Bénard Angèle , Chouinard Sylvain , Leavitt Blair R , Budd Nathalie , Wu Jennifer W , Schoffer Kerrie
Published: June 2022

Objectives

Disease-modifying therapies in development for Huntington’s disease (HD) may require specialised administration and additional resource capacity. We sought to understand current and future capacity for HD management in Canada considering the possible introduction of an intrathecal (IT) disease-modifying treatment (DMT).

Design, setting and participants

Using a case study, mixed methods framework, online surveys followed by semistructured interviews were conducted in late 2020 and early 2021. Neurologists from Canadian HD (n=16) and community (n=11) centres and social workers (n=16) were invited to complete online surveys assessing current HD management and potential capacity to support administration of an IT DMT.

Outcome measures

Survey responses, anticipated demand and assumed resource requirements were modelled to reveal capacity to treat (ie, % of eligible patients) by centre. Resource bottlenecks and incremental support required (full-time equivalent, FTE) were also determined.

Results

Neurologists from 15/16 HD centres and 5/11 community centres, plus 16/16 social workers participated. HD centres manage 94% of patients with HD currently seeking care in Canada, however, only 20% of IT DMT-eligible patients are currently seen by neurologists. One-third of centres have no access to nursing support. The average national incremental nursing, room, neurologist and social worker support required to provide IT DMT to all eligible patients is 0.73, 0.36, 0.30 and 0.21 FTE per HD centre, respectively. At peak demand, current capacity would support the treatment of 6% of IT DMT-eligible patients. If frequency of administration is halved, capacity for IT-DMT administration only increases to 11%.

Conclusions

In Canada, there is little to no capacity to support the administration of an IT DMT for HD. Current inequitable and inadequate resourcing will require solutions that consider regional gaps and patient needs.
Living beyond expectations: a qualitative study into the experience of long-term survivors with pleural mesothelioma and their carers
Authors: Johnson Matthew , Allmark Peter , Tod Angela
Published: June 2022

Background

Malignant pleural mesothelioma (MPM) is characterised by poor prognosis and limited treatment options. However, a minority of patients can survive well beyond these bleak estimates. Little is known about the specific experiences and needs of long-term survivors and families.

Study purpose

The study aimed to gain in-depth understanding of the experiences of patients diagnosed with MPM 3 or more years, along with their main carer, and to determine the care and support needs of this group.

Participants and setting

People diagnosed with MPM 3 or more years were recruited via asbestos and mesothelioma social media and support groups. Potential participants were asked to identify someone who acted as their main carer.

Method

The study employed a cross-sectional qualitative interview design. A topic guide aided a conversational interview style, conducted remotely and recorded. Patient and carer pairs were interviewed jointly when possible, but were given an option for separate interviews if preferred. Fifteen patients, with 14 identifying a main carer, consented to participation.

Analysis

Recorded interviews were transcribed verbatim, and then anonymised by the interviewer. Framework analysis was used to analyse the data iteratively and to develop final themes.

Findings

Three themes were developed. Participants ‘Living beyond expectations’ remained acutely aware that MPM was incurable, but developed a range of coping strategies. Periods of disease stability were punctuated with crises of progression or treatment ending, straining coping. ‘Accessing treatment’ was important for patients and carers, despite the associated challenges. They were aware options were limited, and actively sought new treatments and clinical trials. ‘Support needs’ were met by healthcare professionals, voluntary groups and social media networks.

Conclusions

Managing patients via regional MPM multidisciplinary teams, facilitating equal access to treatment and trials, could reduce patient and carer burden. Greater awareness and support around crisis points for this group could improve care.
Cosmological dynamical systems in modified gravity
Authors: Böhmer Christian G. , Jensko Erik , Lazkoz Ruth
Published: June 2022

The field equations of modified gravity theories, when considering a homogeneous and isotropic cosmological model, always become autonomous differential equations. This relies on the fact that in such models all variables only depend on cosmological time, or another suitably chosen time parameter. Consequently, the field equations can always be cast into the form of a dynamical system, a successful approach to study such models. We propose a perspective that is applicable to many different modified gravity models and relies on the standard cosmological density parameters only, making our choice of variables model independent. The drawback of our approach is a more complicated constraint equation. We demonstrate our procedure studying various modified gravity models and show how much generic information can be extracted before a specific model is considered.
An ICDRI rumor propagation model based on the individual discrepancy theory in social networks
Authors: Qiao Donghang , Qiu Liqing , Sun Chengai
Published: June 2022

Rumors can bring about a seriously negative impact on all respects of society in this information era. More targeted control strategies can be acquired through the research of rumor propagation. When receiving rumors, individuals may keep imperturbable according to their rationality or bygone experience, and then choose not to propagate rumors provisionally. Oppositely, others may ask people around them about the realness of rumors due to bewilderment, which may further lead to the propagation of rumors. Therefore, an Ignorant–Conservative–Disseminator–Restorer–Ignorant (ICDRI) rumor dissemination model is proposed, which comprehensively considers users’ various probable actions under rumor and anti-rumor information. Furthermore, new links are added among nodes in accordance with the individual discrepancy theory and the influencing factors of rumor spreading including negation factor, authority factor, exhaustion factor, etc. According to the calculated basic regeneration number, simulation analysis and model comparison, the steady state and superiority of the ICDRI model is proved. Finally, strategies to control the spread of rumors are obtained through the sensitivity analysis of parameters. The simulation results demonstrate that the ICDRI model can more realistically reflect the dissemination of rumors, and the official rumor refutation or circular can efficaciously curb the spreading of rumors.
Dietary Supplements for Pain Relief in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Lim Kia Teng , Lim Kia Hui , Zhou Xuan , Yang Juan , Shin Kyung-Min , Mohabbat Arya B. , Baude Wyatt W. , Nanda Sanjeev , Bauer David , Theberath Monique , Theberath Nicole , Bauer Brent A. , Ganesh Ravindra
Published: June 2022

Pain is the most frequently encountered symptom by patients with fibromyalgia (FM). Dietary supplements (DSs) in particular have a proven impact as a possible adjunctive therapy for symptom management in FM. However, there is currently no conclusive review outlining the evidence for DSs in pain management in FM. This study aims to assess currently available studies evaluating the use of DSs for pain relief in FM. Randomized controlled trials regarding the use of DSs on adult FM patients were included for evidence synthesis. Study results indicated that DSs significantly relieved pain in FM (SMD 1.23; 95% CI 0.02–2.43, P = 0.046) but did not improve quality of life (QoL) (SMD 0.73; 95% CI −0.07–1.53, P = 0.075) in the data. Adverse events of DSs varied from mild to severe, with the most common being gastrointestinal symptoms and androgenic side effects in 5.7% and 3.9% of patients, respectively. More well-designed RCTs are required in the future. The protocol for this review has been published on PROSPERO (CRD42020149941).
Smilax china Polyphenols Stimulate Browning via β3-Adrenergic Receptor/AMP-Activated Protein Kinase α Signaling Pathway in 3T3-L1 Adipocytes
Authors: Kong Li , Xu Meng , Yang Licong , Liu Shanshan , Zheng Guodong
Published: June 2022

The aim of this study is to investigate the molecular mechanism of Smilax china L. polyphenols (SCLPs) in enhancing lipid metabolism and stimulating browning to reduce lipid accumulation in 3T3-L1 adipocytes. SCLP treatment obviously decreased lipid content in a dose-dependent manner (10–40 μg/mL) in adipocytes. SCLP treatment cooperated with noradrenalin to increase lipolysis. SCLPs reduced the gene expressions of C/EBP[Formula: see text] and Ap2 and enhanced the expressions of ACO, CPT, pHSL/HSL, ATGL, and PKA in adipocytes. Furthermore, SCLPs increased mRNA and protein expressions of brown adipocyte-specific factors (UCP-1, PRDM16, PGC-1α, and PPARγ) and mRNA expressions of beige adipocyte-specific markers (CD137, Tbx1, and Tmem26) in 3T3-L1 adipocytes, as well as mitochondrial biogenesis genes (Nrf1 and Tfam). In addition, according to the immunofluorescence staining, the mitochondria number was increased by SCLP. Moreover, β3-AR or AMPK agonist synergistic SCLPs enhanced the expressions of UCP-1, PRDM16, and PGC-1α. While β3-AR or AMPK antagonist significantly decreased the expressions of these brown adipocyte-specific factors, SCLP treatment inhibited the effect of antagonist to improve the expression of UCP-1, PRDM16, and PGC-1α. These results indicated that SCLPs may regulate lipid metabolism and stimulate browning via the β3-AR/AMPKα signaling pathway. Thus, SCLPs likely have potential therapeutic effects on obesity.
Genetic Algorithm with Local Search for the Multi-Target Scheduling in Flexible Manufacturing System
Authors: Wang Hao , Wang Yujue , Lv Xianwei , Yu Chen , Jin Hai
Published: June 2022

Traditional large-scale process manufacturing is gradually transformed into customized discrete manufacturing with the fierce global competition. Production planning has an important impact on improving manufacturing efficiency in the ever-changing from the view of engineering management. However, many nonprocessing-related factors in the flexible manufacturing system make it different between the formulation and implementation of the production plan. We established a multi-target optimization model based on the scheduling data of a discrete manufacturing company. In order to optimize the local effect of the scheduling model, we proposed an improved genetic algorithm with local search (GALS). The results of the experiments show that GALS is far superior to the current genetic algorithm scheduling in terms of the number and quality of scheduling solutions. Compared with the current scheduling strategy of the enterprise, the scheduling strategy given by GALS achieved an average improvement of 29.61% in minimizing completion time, achieved 44.8% in minimizing transportation time, and achieved 44.64% in machine load balancing.