bluuebunny/crossref_metadata_2025 huggingface dataset:
Scientific exploration of challenging planetary analog environments with a team of legged robots
Authors: Arm Philip , Waibel Gabriel , Preisig Jan , Tuna Turcan , Zhou Ruyi , Bickel Valentin , Ligeza Gabriela , Miki Takahiro , Kehl Florian , Kolvenbach Hendrik , Hutter Marco
Published: July 2023

The interest in exploring planetary bodies for scientific investigation and in situ resource utilization is ever-rising. Yet, many sites of interest are inaccessible to state-of-the-art planetary exploration robots because of the robots’ inability to traverse steep slopes, unstructured terrain, and loose soil. In addition, current single-robot approaches only allow a limited exploration speed and a single set of skills. Here, we present a team of legged robots with complementary skills for exploration missions in challenging planetary analog environments. We equipped the robots with an efficient locomotion controller, a mapping pipeline for online and postmission visualization, instance segmentation to highlight scientific targets, and scientific instruments for remote and in situ investigation. Furthermore, we integrated a robotic arm on one of the robots to enable high-precision measurements. Legged robots can swiftly navigate representative terrains, such as granular slopes beyond 25°, loose soil, and unstructured terrain, highlighting their advantages compared with wheeled rover systems. We successfully verified the approach in analog deployments at the Beyond Gravity ExoMars rover test bed, in a quarry in Switzerland, and at the Space Resources Challenge in Luxembourg. Our results show that a team of legged robots with advanced locomotion, perception, and measurement skills, as well as task-level autonomy, can conduct successful, effective missions in a short time. Our approach enables the scientific exploration of planetary target sites that are currently out of human and robotic reach.
Additive effects of booster mRNA vaccination and SARS-CoV-2 Omicron infection on T cell immunity across immunocompromised states
Authors: Müller Thomas R. , Sekine Takuya , Trubach Darya , Niessl Julia , Chen Puran , Bergman Peter , Blennow Ola , Hansson Lotta , Mielke Stephan , Nowak Piotr , Vesterbacka Jan , Akber Mira , Olofsson Anna , Amaya Hernandez Susana Patricia , Gao Yu , Cai Curtis , Söderdahl Gunnar , Smith C. I. Edvard , Österborg Anders , Loré Karin , Sällberg Chen Margaret , Ljungman Per , Ljunggren Hans-Gustaf , Karlsson Annika C. , Saini Sunil Kumar , Aleman Soo , Buggert Marcus
Published: July 2023

Suboptimal immunity to SARS-CoV-2 mRNA vaccination has frequently been observed in individuals with various immunodeficiencies. Given the increased antibody evasion properties of emerging SARS-CoV-2 subvariants, it is necessary to assess whether other components of adaptive immunity generate resilient and protective responses against infection. We assessed T cell responses in 279 individuals, covering five different immunodeficiencies and healthy controls, before and after booster mRNA vaccination, as well as after Omicron infection in a subset of patients. We observed robust and persistent Omicron-reactive T cell responses that increased markedly upon booster vaccination and correlated directly with antibody titers across all patient groups. Poor vaccination responsiveness in immunocompromised or elderly individuals was effectively counteracted by the administration of additional vaccine doses. Functionally, Omicron-reactive T cell responses exhibited a pronounced cytotoxic profile and signs of longevity, characterized by CD45RA
+
effector memory subpopulations with stem cell–like properties and increased proliferative capacity. Regardless of underlying immunodeficiency, booster-vaccinated and Omicron-infected individuals appeared protected against severe disease and exhibited enhanced and diversified T cell responses against conserved and Omicron-specific epitopes. Our findings indicate that T cells retain the ability to generate highly functional responses against newly emerging variants, even after repeated antigen exposure and a robust immunological imprint from ancestral SARS-CoV-2 mRNA vaccination.
Bidirectional interplay between SARS-CoV-2 and autophagy
Authors: Zhou Hao , Hu Zhiqiang , Castro-Gonzalez Sergio
Published: July 2023

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as the causative agent of the recent COVID-19 pandemic, continues representing one of the main health concerns worldwide. Autophagy, in addition to its role in cellular homeostasis and metabolism, plays an important part for the host antiviral immunity. However, viruses including SARS-CoV-2 have evolved diverse mechanisms to not only overcome autophagy’s antiviral pressure but also manipulate its machinery in order to enhance viral replication and propagation. Here, we discuss our current knowledge on the impact that autophagy exerts on SARS-CoV-2 replication, as well as the different counteracting measures that this virus has developed to manipulate autophagy’s complex machinery. Some of the elements regarding this interplay may become future therapeutic targets in the fight against SARS-CoV-2.
Extreme Diversity of Mycoviruses Present in Single Strains of Rhizoctonia cerealis, the Pathogen of Wheat Sharp Eyespot
Authors: Li Wei , Sun Haiyan , Cao Shulin , Zhang Aixiang , Zhang Haotian , Shu Yan , Chen Huaigu
Published: July 2023

Rhizoctonia cerealis
is a binucleate fungus that is widely distributed worldwide and can cause sharp eyespot disease in cereal crops. In this study, 131 virus-like sequences belonging to 117 viruses were obtained based on analysis of high-throughput RNA-Seq data from four strains of
R. cerealis
.
Microbiome Engineering Using Probiotic Yeast:
Saccharomyces boulardii
and the Secreted Human Lysozyme Lead to Changes in the Gut Microbiome and Metabolome of Mice
Authors: Kim Jungyeon , Atkinson Christine , Miller Michael J. , Kim Kyoung Heon , Jin Yong-Su
Published: July 2023

Our study identified changes in the microbiome by administering wild-type
S. boulardii
in mice to healthy mice based on long-read sequencing and demonstrated that a recombinant protein secreted by engineered
S. boulardii
in the intestine could change the microbiome. Our results provide valuable information for the development of therapeutics using engineered
S. boulardii
that changes the gut microbiome and host physiology.
Is telemedicine suitable for remotely supporting non-tertiary units in providing emergency care to unwell newborns?
Authors: Edwards Gemma , O'Shea Joyce E
Published: July 2023

Although the majority of term infants will breathe spontaneously at birth, the requirement for advanced resuscitation can be unpredictable, as can the precipitous delivery of an extremely preterm infant in a non-tertiary neonatal unit. Infants born in hospitals without a tertiary neonatal intensive care unit have a higher mortality which is a disparity that has been difficult to resolve.

Telemedicine, the use of videoconferencing software to connect those at the scene of a resuscitation to a remote clinician, can allow for real-time two-way communication between a local unit and a tertiary neonatal specialist. It has been present for some time in neonatology to provide secure video messaging with families and its use in neonatal acute care and resuscitation has been growing in recent years.

We sought to perform a review of the current evidence available on the use of telemedicine in neonatal resuscitation. Studies demonstrate improved quality of resuscitation, improved adherence to resuscitation guidelines and positive experiences reported by local and tertiary teams. Suitable technology needs to be available to establish a rapid and secure video connection, as does adequate availability of experienced neonatologists to provide remote guidance. Telemedicine is an exciting and emerging tool which is being developed as a standard of care in units which have piloted it.
Pyogenic flexor tenosynovitis due toKingella kingaein an infant
Authors: Garry Conor , Ernst Andrew , Langford Matthew , Adams Daniel J
Published: July 2023

Pyogenic flexor tenosynovitis is relatively common but is seldom reported in young children.Kingella kingaeis increasingly recognised as a causative agent. We report on an infant who presented with a palmar deep space infection and pyogenic flexor tenosynovitis caused byK. kingae.K. kingaeis a fastidious, often culture-negative, organism which has been increasingly recognised as a cause of paediatric orthopaedic infections, including flexor tenosynovitis. Clinical suspicion should be heightened, and antibiotic coverage broadened in the setting of a positive physical examination and negative blood cultures.
Association of a lifestyle score with cardiometabolic markers among individuals with diabetes: a cross-sectional study
Authors: Baechle Christina , Lang Alexander , Strassburger Klaus , Kuss Oliver , Burkart Volker , Szendroedi Julia , Müssig Karsten , Weber Katharina Susanne , Schrauwen-Hinderling Vera , Herder Christian , Roden Michael , Schlesinger Sabrina
Published: July 2023

Introduction

To investigate the associations of a lifestyle score with various cardiovascular risk markers, indicators for fatty liver disease as well as MRI-determined total, subcutaneous and visceral adipose tissue mass in adults with new-onset diabetes.

Research design and methods

This cross-sectional analysis included 196 individuals with type 1 (median age: 35 years; median body mass index (BMI): 24 kg/m²) and 272 with type 2 diabetes (median age: 53 years; median BMI: 31 kg/m²) from the German Diabetes Study. A healthy lifestyle score was generated based on healthy diet, moderate alcohol consumption, recreational activity, non-smoking and non-obese BMI. These factors were summed to form a score ranging from 0 to 5. Multivariable linear and non-linear regression models were used.

Results

In total, 8.1% of the individuals adhered to none or one, 17.7% to two, 29.7% to three, 26.7% to four, and 17.7% to all five favorable lifestyle factors. High compared with low adherence to the lifestyle score was associated with more favorable outcome measures, including triglycerides (β (95% CI) −49.1 mg/dL (−76.7; −21.4)), low-density lipoprotein (−16.7 mg/dL (−31.3; −2.0)), and high-density lipoprotein cholesterol (13.5 mg/dL (7.6; 19.4)), glycated hemoglobin (−0.5% (−0.8%; −0.1%)), high-sensitivity C reactive protein (−0.4 mg/dL (−0.6; −0.2)), as well as lower hepatic fat content (−8.3% (−11.9%; −4.7%)), and visceral adipose tissue mass (−1.8 dm³ (−2.9; −0.7)). The dose–response analyses showed that adherence to every additional healthy lifestyle factor was associated with more beneficial risk profiles.

Conclusions

Adherence to each additional healthy lifestyle factor was beneficially associated with cardiovascular risk markers, indicators of fatty liver disease and adipose tissue mass. Strongest associations were observed for adherence to all healthy lifestyle factors in combination.

Trial registration number

NCT01055093.
Exploring health literacy in patients with chronic diseases in Chongqing, China: a cross-sectional study
Authors: Liu Hongyan , Wen Yaqi , Wu Chengbin , Zhao Yu , Lai Weiyun , Zhao Yong , Yuan Jun , Liu Yaxin , Zhou Xiangxi , Sharma Manoj , Chen Yao , Zeng Huan
Published: July 2023

Objectives

Personal health literacy is the degree to which individuals have the ability to find, understand and use information and services to inform health-related decisions and actions for themselves and others. Health literacy levels remain low, despite the many measures that have been taken to improve it. In addition, the number of patients with chronic diseases is increasing. Our study aimed to explore the different aspects and factors influencing health literacy among patients with chronic diseases in Chongqing, China.

Design

Cross-sectional study.

Setting and patients

This study was conducted in Chongqing using the 2018 National Questionnaire on Health Literacy of Residents administered to 27 336 patients with chronic diseases.

Outcome measures

The prevalence and factors of health literacy in patients with chronic diseases.

Results

Among the patients who participated in the study (n=27 336), 51.3% were males. Only 21.6% of the patients with chronic diseases had adequate health literacy (questionnaire score was equal to or exceeded 80% of the total questionnaire score). Patients with chronic diseases aged 25–34 years (OR=1.18, 95% CI 1.02 to 1.36) and 35–44 years (OR=1.18, 95 % CI 1.03 to 1.35) had higher health literacy than patients aged 65–69 years. Patients from rural areas had higher health literacy levels than those from urban areas (OR=0.92, 95% CI 0.86 to 1.00). Furthermore, married patients had lower health literacy than unmarried patients (OR=0.88, 95% CI 0.80 to 0.97). Patients who were illiterate or slightly literate (OR=0.10, 95% CI 0.08 to 0.12) had lower health literacy than patients who were in junior college or had a bachelor’s degree or above. In addition, non-farmers had higher health literacy levels than farmers (OR=1.18, 95% CI 1.08 to 1.28). In terms of inadequate health literacy, patients who self-rated themselves as healthy had higher health literacy than those who self-rated as unhealthy (OR=1.80, 95% CI 1.33 to 2.43).

Conclusions

The health literacy of patients with chronic conditions remains at a low level and varies significantly with their demographic and social characteristics. These findings indicate that targeted interventions may be useful to improve health literacy in patients with chronic conditions in China.
Experience of respectful maternity care during childbirth and associated factors in public hospitals of the South West Region of Ethiopia: an institution-based, cross-sectional study
Authors: Birie Bamlaku , Niguse Wondwossen
Published: July 2023

Objective

To determine women’s level of experience of respectful maternity care during childbirth and associated factors in public hospitals in the South West Region of Ethiopia.

Design

Institution-based, cross-sectional study.

Setting

The study was conducted at secondary-level healthcare institutions in the South West Region of Ethiopia from 1 June to 30 July 2021.

Participants

384 postpartum women were sampled from four hospitals using a systematic random sampling technique, allocating a proportion to each health facility. Pretested structured questionnaires were used to collect data from the postnatal mothers through a face-to-face exit interview.

Outcome measures

The level of respectful maternity care was measured according to the Mothers on Respect Index. P values of <0.05 and 95% CIs were used to determine statistical significance.

Results

Of the 384 sampled women, 370 postnatal mothers participated in the study (response rate 96.3%). 11.6% (95% CI 8.4% to 15.1%), 39.7% (95% CI 34.3% to 44.6%), 20.8% (95% CI 17.3% to 25.1%), and 27.8% (95% CI 23.5% to 32.4%) of women experienced very low, low, moderate, and high levels of respectful maternal care during childbirth, respectively. Having no formal education was negatively associated with experience of respectful maternal care (adjusted OR (AOR)=0.51, 95% CI 0.294 to 0.899), while daytime delivery (AOR 8.53, 95% CI 5.032 to 14.47), giving birth through caesarean section (AOR 2.19, 95% CI 1.410 to 3.404) and future intention to give birth within the health facility (AOR 5.18, 95% CI 3.019 to 8.899) were positively associated with respectful maternal care.

Conclusion

In this study, only one-fourth of women experienced high-level respectful maternal care during childbirth. Responsible stakeholders must develop guidelines and strategies to monitor and harmonise respectful maternal care practices at all institutions.
Health economic impact of moderate-to-severe chronic pain associated with osteoarthritis in England: a retrospective analysis of linked primary and secondary care data
Authors: Coates Greg , Clewes Peter , Lohan Christoph , Stevenson Hannah , Wood Robert , Tritton Theo , Knaggs Roger , Dickson Alastair J , Walsh David
Published: July 2023

Objective

Despite the prevalence of osteoarthritis (OA) in England, few studies have examined the health economic impact of chronic pain associated with OA. The aim of this study was to compare outcomes in patients with moderate-to-severe chronic pain associated with OA and matched controls without known OA.

Design

Retrospective, longitudinal, observational cohort study.

Setting

Electronic records extracted from the Clinical Practice Research Datalink GOLD primary care database linked to Hospital Episode Statistics (HES) data set.

Participants

Patients (cases; n=5931) ≥18 years and with existing diagnosis of OA and moderate-to-severe pain associated with their OA, and controls matched on age, sex, comorbidity burden, general practitioner (GP) practice and availability of HES data.

Interventions

None.

Primary and secondary outcome measures

Total healthcare resource use (HCRU) and direct healthcare costs during 0–6, 0–12, 0–24 and 0–36 months of follow-up. Secondary outcomes measures included pharmacological management and time to total joint replacement.

Results

Patients with moderate-to-severe chronic pain associated with OA used significantly more healthcare services versus matched controls, reflected by higher HCRU and significantly higher direct costs. During the first 12 months’ follow-up, cases had significantly more GP consultations, outpatient attendances, emergency department visits and inpatient stays than matched controls (all p<0.0001). Total mean costs incurred by cases during 0–12 months’ follow-up were five times higher in cases versus controls (mean (SD): £4199 (£3966) vs £781 (£2073), respectively). Extensive cycling through pharmacological therapies was observed; among cases, 2040 (34.4%), 1340 (22.6%), 841 (14.2%), 459 (7.7%) and 706 (11.9%) received 1–5, 6–10, 11–15, 16–20 and >20 lines of therapy, respectively.

Conclusions

This wide-ranging, longitudinal, observational study of real-world primary and secondary care data demonstrates the impact of moderate-to-severe chronic pain associated with OA in patients compared with matched controls. Further studies are required to fully quantify the health economic burden of moderate-to-severe pain associated with OA.
Primary care family physicians’ experiences with clinical integration in qualitative and mixed reviews: a systematic review protocol
Authors: Tseng L Olivia , Newton Christie , Hall David , Lee Esther J , Chang Howard , Poureslami Iraj , Vasarhelyi Krisztina , Lacaille Diane , Mitton Craig
Published: July 2023

Introduction

Clinical (service) integration in primary care settings describes how comprehensive care is coordinated by family physicians (FPs) over time across healthcare contexts to meet patient care needs. To improve care integration and healthcare service planning, a systematic approach to understanding its numerous influencing factors is paramount. The objective of this study is to generate a comprehensive map of FP-perceived factors influencing clinical integration across diseases and patient demographics.

Methods and analysis

We developed the protocol with the guidance of the Joanna Briggs Institute systematic review methodology framework. An information specialist built search strategies for MEDLINE, EMBASE and CINAHL databases using keywords and MeSH terms iteratively collected from a multidisciplinary team. Two reviewers will work independently throughout the study process, from article selection to data analysis. The identified records will be screened by title and abstract and reviewed in the full text against the criteria: FP in primary care (population), clinical integration (concept) and qualitative and mixed reviews published in 2011–2021 (context). We will first describe the characteristics of the review studies. Then, we will extract qualitative, FP-perceived factors and group them by content similarities, such as patient factors. Lastly, we will describe the types of extracted factors using a custom framework.

Ethics and dissemination

Ethics approval is not required for a systematic review. The identified factors will help generate an item bank for a survey that will be developed in the Phase II study to ascertain high-impact factors for intervention(s), as well as evidence gaps to guide future research. We will share the study findings with various knowledge users to promote awareness of clinical integration issues through multiple channels: publications and conferences for researchers and care providers, an executive summary for clinical leaders and policy-makers, and social media for the public.
COVID-19 vaccination acceptance (uptake, hesitancy, intention to receive and timeliness of the intention to receive) and the determinants among health workers in Ebonyi state, Nigeria: an analytical cross-sectional study
Authors: Omale Ugwu I , Oka Onyinyechukwu U , Amuzie Chidinma I , Uduma Victor U , Adeke Azuka S , Ikegwuonu Cordis O , Nkwo Glory E , Nwali Ugochi I A , Iyare Osarhiemen , Ewah Richard L , Nnachi Olaedo O , Ukpabi Okechukwu O , Okeke Ifeyinwa M
Published: July 2023

Objectives

Health workers are at particular risk of contracting the COVID-19. However, non-acceptance of COVID-19 vaccination has been a noticeable challenge the world over and in Nigeria where supply constraints have also been an issue. We evaluated COVID-19 vaccination acceptance (the uptake, hesitancy, intention to receive and timeliness of the intention to receive) and the determinants, and the predictive power of acceptance factor compared with availability/access factor, among health workers in Ebonyi state.

Methods

We conducted an online-offline survey, between 12 March 2022 and 9 May 2022, among all consenting health workers (clinical/non-clinical, public/private) working/living in Ebonyi state and who were selected by convenience and snowballing techniques. Data were collected using structured self-administered questionnaire distributed via WhatsApp and interviewer-administered questionnaire in KoBoCollect installed in android devices. Data were analysed using descriptive statistics and generalised linear models.

Results

1276 health workers were surveyed. Uptake was 68.2% vaccinated, 47.4% fully vaccinated and 20.9% partially vaccinated. Hesitancy was 22.6% or 71.2% among the unvaccinated (76.3% of hesitancy due to refusal and 23.7% to delay). Intention to receive was 36.0% of which 55.1% gave the intended time (days) to receive with a median (IQR) of 30 days (7–133). The strongest and most important predictor of COVID-19 vaccination acceptance was COVID-19 vaccination expectations and perceptions. Other important predictors were COVID-19/COVID-19 vaccination process experiences and perceptions. Acceptance factor was a stronger predictor compared with availability/access factor.

Conclusion

The slow pace of COVID-19 vaccination coverage among the health workers in Ebonyi state/Nigeria may encounter a bottle-neck due to the high refusal rate among the unvaccinated. COVID-19 vaccination policy interventions in Nigeria and other similar settings should, in addition to sustaining availability and access, prioritise improvement of COVID-19 vaccination expectations and perceptions (regarding importance/safety/effectiveness) and COVID-19 risk communication among the health workers.

Trial registration number

ISRCTN16735844.
Endometrial Origins of Stillbirth (EOS), a case–control study of menstrual fluid to understand and prevent preterm stillbirth and associated adverse pregnancy outcomes: study protocol
Authors: Tindal Kirstin , Filby Caitlin E , Gargett Caroline E , Cousins Fiona , Palmer Kirsten Rebecca , Vollenhoven Beverley , Davies-Tuck Miranda
Published: July 2023

Introduction

Current research aimed at understanding and preventing stillbirth focuses almost exclusively on the role of the placenta. The underlying origins of poor placental function leading to stillbirth, however, remain poorly understood. There is evidence demonstrating that the endometrial environment in which the embryo implants impacts not only the establishment of pregnancy but also the development of some pregnancy outcomes. Menstrual fluid has recently been applied to the study of menstrual disorders such as heavy menstrual bleeding or endometriosis, however, it has great potential in the study of adverse pregnancy outcomes. This study aims to identify differences in menstrual fluid and menstrual cycle characteristics of women who have experienced preterm stillbirth and other associated adverse pregnancy outcomes, compared with those who have not. The association between menstrual fluid composition and menstrual cycle characteristics will also be determined.

Methods and analysis

This is a case–control study of women who have experienced a late miscarriage, spontaneous preterm birth or preterm stillbirth or a pregnancy complicated by placental insufficiency (fetal growth restriction or pre-eclampsia), compared with those who have had a healthy term birth. Cases will be matched for maternal age, body mass index and gravidity. Participants will not currently be on hormonal therapy. Women will be provided with a menstrual cup and will collect their sample on day 2 of menstruation. Primary exposure measures include morphological and functional differences in decidualisation of the endometrium (cell types, immune cell subpopulations and protein composition secreted from the decidualised endometrium). Women will complete a menstrual history survey to capture menstrual cycle length, regularity, level of pain and heaviness of flow.

Ethics and dissemination

Ethics approval was obtained from Monash University Human Research Ethics Committee (27900) on 14/07/2021 and will be conducted in accordance with these conditions. Findings from this study will be disseminated through peer-reviewed publications and conference presentations.
Study protocol for a cluster-randomised controlled trial of hybrid parents and health workers adaptive intervention for optimal routine childhood immunisation coverage in the communities of Ebonyi state, Nigeria: the AGINTOPIC trial protocol
Authors: Omale Ugwu I , Ewah Richard L , Amuzie Chidinma I , Ikegwuonu Cordis O , Nkwo Glory E , Iwegbulam Chimaobi C , Ekwuazi Louisa C
Published: July 2023

Introduction

Vaccine-preventable infectious diseases (VPDs) are major causes of morbidity/mortality among children under 5 years of age worldwide and in Nigeria/Ebonyi state. Routine childhood immunisation is an invaluable prevention strategy for many VPDs. Due to suboptimal coverage and untimely receipt/delay in receipt of vaccinations, outbreaks of VPDs such as measles, yellow fever, diphtheria and others continue to reoccur around the world and in Nigeria/Ebonyi state. This study aims to evaluate the effectiveness of hybrid parents and health workers adaptive intervention in increasing the optimal/timely (cumulative age-appropriate) routine childhood immunisation coverage in the communities in Ebonyi state, Nigeria.

Methods and analyses

A two-arm, parallel, open label, covariate-constrained cluster-randomised controlled trial with 1:1 allocation of 16 geographical clusters (the nearest catchment areas for at least one public primary healthcare (PHC) facility with at least 500 households or a population size of 3000) will be used to evaluate the effects of hybrid/combined parents and PHC workers adaptive engagement compared with control. The primary outcomes are the optimal/timely (cumulative age-appropriate) receipt of the recommended vaccines in the routine childhood immunisation schedule by children aged 5–9 completed months and 10–11 completed months and the age-appropriate vaccines receipt score for the recommended vaccines. The outcomes will be measured through a population-based household survey of at least 15 children aged 5–9 and 10–11 months per cluster at baseline and at the end of the study using a structured interviewer-administered questionnaire in KoBoCollect installed in android devices. All analyses will be done using a cluster-level method on as-randomised basis.

Ethics and dissemination

Ethical approval for the trial was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/01/06/2022–31/05/2023) and verbal consent will be obtained from participants. Study findings will be reported at local/national and international levels as appropriate.

Trial registration number

ISRCTN59811905.
Compliance with ecological momentary assessment programmes in the elderly: a systematic review and meta-analysis
Authors: Yao Lin , Yang Yiqun , Wang Zhi , Pan Xi , Xu Lan
Published: July 2023

Objective

Ecological momentary assessment (EMA) refers to the repeated sampling of information about an individual’s symptoms and behaviours, enabling the capture of ecologically meaningful real-time information in a timely manner. Compliance with EMA is critical in determining the validity of an assessment. However, there is limited evidence related to how the elderly comply with EMA programmes or the factors that are associated with compliance.

Design

Systematic review and meta-analysis.

Data sources

PubMed, Embase, the Cochrane Library and Web of Science were searched up to 17 July 2022.

Eligibility criteria

We included observational studies on EMA in the elderly reported in English.

Data extraction and synthesis

Two investigators independently performed screening and data extraction. Discrepancies were resolved by discussion or a third investigator. A systematic review was carried out to characterise the basic characteristics of the participants and EMA programmes. Random-effects meta-analysis was conducted to assess overall compliance and to explore factors associated with differences in compliance among the elderly.

Results

A total of 20 studies with 2047 participants were included in the systematic review and meta-analysis. Meta-analysis showed that the combined compliance rate was 86.41% (95% CI: 77.38% to 92.20%; I2=96.4%; p<0.001). Subgroup analysis revealed high levels of heterogeneity in terms of the methods used to assess population classification, assessment method and assessment frequency, although these may not be the sources of heterogeneity. Meta-regression analysis showed that population classification and assessment period might have a significant impact on heterogeneity (p<0.05). Egger’s test indicated significant publication bias (p<0.001).

Conclusions

Compliance with EMA programmes is high in the elderly. It is recommended that scholars design reasonable EMA programmes according to the health status of the elderly in the future.
Evaluation framework study assessing the role, applicability and adherence to good practice of planning support tools for allocation of development aid for health in low-income and middle-income countries
Authors: Megiddo Itamar , Blair Shona , Sabei Davood , Ruiz Francis , Morton Alexander D
Published: July 2023

Objectives

Allocation of development aid for health is controversial and challenging. In recent years, several planning-software tools have promised to help decision-makers align resource allocation with their objectives, more clearly connect prioritisation to evidence and local circumstances, and increase transparency and comparability. We aim to explore these tools to provide insight into their fitness for purpose and suggest future directions to fulfil that promise.

Design

We identified seven tools that met the inclusion criteria and developed an evaluation framework to compare them along two dimensions for assessing fitness for purpose: ability to produce analyses adhering to principles laid out in the International Decisions Support Initiative (iDSI) Reference Case for health economic evaluations; and resources required, including expertise and time. We extracted information from documentation and tool use and sent this information to tool developers for confirmation.

Results

We categorise the tools into evidence-generating ones, evidence-syntheses ones and process support ones. Tools’ fitness for purpose varies by the context, technical capacity and time limitation. The tools adhere to several reference case principles but often not to all of them. The source and underlying assumptions of prepopulated data are often opaque. Comparing vertical interventions across diseases and health system strengthening ones remains challenging.

Conclusions

The plethora of tools that aid priority setting in different ways is encouraging. Developers and users should place further emphasis on their ability to produce analyses that adhere to prioritisation principles. Opportunities for further development include using evidence-generating tools and multicriteria decision analysis approaches complimentarily. However, maintaining tool simplicity should also be considered to allow wider access.
Impact of wearable device-based interventions with feedback for increasing daily walking activity and physical capacities in cardiovascular patients: a systematic review and meta-analysis of randomised controlled trials
Authors: Heizmann Anne-Noëlle , Chapelle Céline , Laporte Silvy , Roche Frederic , Hupin David , Le Hello Claire
Published: July 2023

Objective

To systematically review randomised controlled trials (RCTs) using a wearable physical activity monitoring device as an intervention to increase daily walking activity and improve physical capacities in patients with cardiovascular disease (CVD).

Design

Systematic review and meta-analysis of RCTs.

Data sources

PubMed, Embase and Web of Science from inception to June 2022.

Eligibility criteria

Randomised controlled studies including patients with CVD over 18 years of age at the end of a cardiac rehabilitation programme comparing an intervention group using a wearable physical activity monitoring device with feedback with usual care or with a control group receiving no feedback on their physical activity and reporting a change in the daily number of steps and/or a change in the distance covered in the 6-minute walk test (6-MWT) or a change in peak oxygen uptake (V̇O2peak) as endpoints.

Results

Sixteen RCTs were included. The intervention of wearing a physical activity monitoring device with feedback significantly improved daily number of steps compared with controls (standardised mean difference (SMD) 0.85; 95% CI (0.42; 1.27); p<0.01). The effect was greater when the duration of the intervention was less than 3 months (SMD 1.0; 95% CI (0.18; 1.82); p<0.01) than when the duration of the intervention was 3 months or longer (SMD 0.71; 95% CI (0.27; 1.16); p<0.01), but no significant interaction was found between subgroups (p=0.55). 6-MWT distance and V̇O2peakshowed only small effects (SMD 0.34; 95% CI (−0.11; 0.80); p=0.02 and SMD 0.54; 95% CI (0.03; 1.03); p=0.07, respectively).

Conclusion

The use of wearable physical activity monitoring devices appears to help patients with CVD to increase their daily walking activity and thus their physical activity, particularly in the short term.

PROSPERO registration number

CRD42022300423.
Dexmedetomidine after deep brain stimulation for prevention of delirium in elderly patients with Parkinson’s disease: protocol for a single-centre, randomised, double-blind, placebo-controlled trial in China
Authors: Yao Jingxin , Shen Zhongyuan , Jin Hailong , Ma Tingting , Wang Jie , Li Shu , Zeng Min , Liu Xiaoyuan , Peng Yuming
Published: July 2023

Introduction

Parkinson’s disease is one of the most common neurodegenerative diseases. Deep brain stimulation (DBS) can improve motor symptoms in patients with middle and late Parkinson’s disease, reduce the use of levodopa, and thus reduce drug-related side effects. Postoperative delirium can significantly reduce the short-term and long-term quality of life in elderly patients, which can be alleviated by dexmedetomidine (DEX). However, whether prophylactic DEX could reduce the incidence of postoperative delirium in patients with Parkinson’s disease was still unknown.

Methods and analysis

This is a single-centre, randomised, double-blinded, placebo-controlled group trial. A total of 292 patients aged 60 years and above elected for DBS will be stratified according to DBS procedure, subthalamic nucleus or globus pallidus interna, then randomly allocated to the DEX group or the placebo control group with a 1:1 ratio, respectively. In the DEX group, patients will be injected with the DEX continuously with an electronic pump at a rate of 0.1 µg/kg/hour for 48 hours at the beginning of general anaesthesia induction. In the control group, normal saline will be administered at the same rate for patients as in the DEX group. The primary endpoint is the incidence of postoperative delirium within 5 days after surgery. Postoperative delirium is assessed by the combination of the Richmond Anxiety Scale and the Confusion Assessment Method (CAM) for the intensive care unit or the 3-minute diagnostic interview for CAM as applicable. The secondary endpoints include the incidence of adverse events and non-delirium complications, the length of stay in the intensive care unit and hospital and all-cause 30-day mortality after the operation.

Ethics and dissemination

The protocol has been approved by the Ethics Committee of Beijing Tiantan Hospital of Capital Medical University (KY2022-003-03). The results of this study will be disseminated through presentation at scientific conferences and publication in scientific journals.

Trial registration number

NCT05197439.
Magnitude of hypertension and its association with obesity among employees of Wallaga University, Ethiopia: a cross-sectional study
Authors: Feyisa Bikila Regassa , Tamiru Afework , Debelo Sidise , Feyisa Ilili , Tola Edosa Kifle , Tolesa Edosa Jabesa , Negeri Asefa , Shibiru Tesfaye , Galata Alemtsehay , Biru Bayise
Published: July 2023

Objective

To determine the magnitude of hypertension, its association with obesity and the associated factors among employees of Wallaga University, Ethiopia.

Design, setting and participants

This institution-based cross-sectional study was employed among 588 employees of the university. Respondents were selected by stratified random sampling technique and interviewed with the aid of a structured questionnaire.

The main outcome measured

Hypertension and obesity were measured using WHO Stepwise approach and recommendations. We used a stratified random sampling technique to select 588 employees of the university from 3 August 2021 to 15 October 2021. A structured questionnaire and anthropometric measurements were used for data collection. Multivariable logistic regression analysis was used to determine factors independently associated with hypertension. A p value less than or equal to 0.05 and its 95% confidence level was used to declare the statistical significance.

Results

A total of 578 participants consented and completed the study, giving a response rate of 98.3%. The mean age of the respondents was 31.78 years with SD of 5.4. The overall prevalence of hypertension, general obesity and central obesity was 14.4% (95% CI 11.6% to 17.5%), 31.3% (95% CI 27.6% to 35.3%) and 37% (95% CI 33.1% to 41.1%), respectively. Obesity was significantly associated with hypertension (adjusted OR (AOR): 6.3; 95% CI 2.60 to 8.19). Age range from 35 to 46 (AOR 7.01; 95% CI 1.56 to 31.74), age ≥46 years (AOR 8.45; 95% CI 1.14 to 62.04), being non-academic staff (AOR 2.74; 95% CI 1.56 to 4.81), having additional income (AOR 2.48; 95% CI 1.08 to 5.70), physical inactivity (AOR 2.36; 95% CI 1.44 to 3.88) and poor practice of dietary salt consumption (AOR 1.65; 95% CI 1.01 to 2.87) were factors associated with hypertension.

Conclusion

One in seven, more than two in seven and nearly two in six of the employees of Wallaga University were hypertensive, centrally obese and generally obese, respectively. There was a positive association between obesity and hypertension. Comprehensive awareness creation and devising workplace intervention strategies are highly recommended to reduce the hypertension burden and associated obesity.
Inequitable treatment as perceived by international medical graduates (IMGs): a scoping review
Authors: Healey Sunita Joann Rebecca , Fakes Kristy , Nair Balakrishnan R
Published: July 2023

Objectives

This scoping review seeks to detail experiences of inequitable treatment, as self-reported by international medical graduates (IMGs), across time and location.

Design

Scoping review.

Search strategy

Three academic medical databases (MEDLINE, SCOPUS and PSYCINFO) and grey literature (GOOGLE SCHOLAR) were systematically searched for studies reporting first-hand IMG experiences of perceived inequitable treatment in the workplace: discrimination, prejudice or bias. Original (in English) qualitative, quantitative, mixed studies or inquiry-based reports from inception until 31 December 2022, which documented direct involvement of IMGs in the data were eligible for inclusion in the review. Systematic reviews, scoping reviews, letters, editorials, news items and commentaries were excluded. Study characteristics and common themes were identified and analysed through an iterative process.

Results

We found 33 publications representing 31 studies from USA, Australia, UK, Canada, Germany, Finland, South Africa, Austria, Ireland and Saudi Arabia, published between 1982 and 2022. Common themes identified by extraction were: (1) inadequate professional recognition, including unmatched assigned work or pay; (2) perceived lack of choice and opportunities such as limited freedoms and perceived control over own future; (3) marginalisation—subtle interpersonal exclusions, stereotypes and stigma; (4) favouring of local graduates; (5) verbal insults, culturally or racially insensitive or offensive comments; and (6) harsher sanctions. Other themes identified were effects on well-being and proposed solutions to inequity.

Conclusions

This study found evidence that IMGs believe they are subject to numerous common inequitable workplace experiences and that these experiences have self-reported repercussions on well-being and career trajectory. Further research is needed to substantiate correlations and causality in relation to outcomes of well-being and differential career attainment. Furthermore, research into support for IMGs and the creation of more equitable workforce environments is also recommended.
Is there a difference in the analgesic response to intra-articular bupivacaine injection in people with knee osteoarthritis pain with or without central sensitisation? Protocol of a feasibility randomised controlled trial
Authors: Zedan Yasmine , Knaggs Roger , Cooper Dale , Kurien Thomas , Walsh David Andrew , Auer Dorothee P , Scammell Brigitte E
Published: July 2023

Introduction

Pain is the main symptom of osteoarthritis (OA) with approximately 50% of patients reporting moderate-to-severe pain. Total knee replacement (TKR) is the ultimate treatment option to alleviate pain in knee OA. Nevertheless, TKR does not provide complete relief for all as approximately 20% of patients experience chronic postoperative pain. Painful peripheral stimuli may alter the central nociceptive pathways leading to central sensitisation that can influence treatment response in patients with OA. Currently, there is no objective protocol for detecting whether a patient will respond to a given treatment. Therefore, there is a need for a better mechanistic understanding of individual factors affecting pain relief, consequently informing personalised treatment guidelines. The purpose of this research is to examine the feasibility of conducting a full-scale mechanistic clinical trial in painful knee OA investigating the analgesic response to intra-articular bupivacaine between those with or without evidence of central sensitisation.

Methods and analysis

The Understanding Pain mechanisms in KNEE osteoarthritis (UP-KNEE) study is a feasibility, double-blinded, placebo-controlled randomised parallel study in participants with radiographically defined knee OA and with self-reported chronic knee pain. The study involves the following assessments: (1) a suite of psychometric questionnaires; (2) quantitative sensory testing; (3) magnetic resonance imaging (MRI) scan of the knee and brain; (4) a 6-minute walk test; and (5) an intra-articular injection of bupivacaine or placebo (sodium chloride 0.9%) into the index knee. Assessments will be repeated post intra-articular injection apart from the MRI scan of the knee. Our aim is to provide proof of concept and descriptive statistics to power a future mechanistic trial.

Ethics and dissemination

Ethical approval was obtained from the Health Research Authority (HRA) (REC: 20/EM/0287). Results will be disseminated via peer-reviewed journals and scientific conferences. The results will also be shared with lay audiences through relevant channels, such as Pain Centre Versus Arthritis website and patient advocacy groups.

Trial registration number

NCT05561010.
Effects of continuum of care for maternal health service utilisation on intention to use family planning among pastoralist women of Ethiopia: a robust regression analysis and propensity score matching modelling
Authors: Alemayehu Mussie , Medhanyie Araya Abrha , Reed Elizabeth , Kahsay Znabu Hadush , Kalayu Mebrhatu , Mulugeta Afework
Published: July 2023

Objectives

This study examines the effect of continuum care for maternal health service utilisation on intention to use family planning among the pastoralist community in Ethiopia.

Design

A community-based cross-sectional study.

Setting

Data were collected from three districts of the pastoralist community of the Afar region.

Participants

Randomly selected 891 married pastoralist women.

Primary outcome

Intention to use family planning.

Results

Intention to use family planning would increase (β=0.122, 95% CI: 0.036, 0.287) or by 12.2%, if all married pastoralist women received continuum of care for maternal health service utilisation compared with their counterparts. Results from the robust regression analysis indicate that intention to use family planning was higher among women who had a discussion about family planning with their husband (β=0.31, SE=0.035, p<0.001), women who possessed an electronic devices (β=0.096, SE=0.029, p<0.001) and women who had an unmet need for family planning (β=0.056, SE=0.026, p<0.000). However, intention to use family planning was lower for women who were in a polygamous marriage (β=−0.168, SE=0.065, p<0.01). There was a significant linear increase in the score of intention to use family planning for attitude towards family planning (β=0.009, SE=0.001, p<0.000), subjective norm (β=0.003, SE=0.001, p<0.003) and perceived control over family planning (β=0.002, SE=0.008, p<0.024) given other explanatory variables in the model.

Conclusion

Continuum of care for maternal health service utilisation increases pastoralist women’s intention to use family planning. Maximising any opportunity to counsel women who come to health facilities about family planning would be vital to increase their intention to use family planning.

Trial registration number

NCT03450564.