bluuebunny/crossref_metadata_2025 huggingface dataset:
Integration of sex and gender in a continuing professional development course on diabetes and depression: a mixed methods feasibility study
Authors: Deom Tardif Alèxe , Gogovor Amédé , Guay-Bélanger Sabrina , Audet Denis , Parent Nicole , Gaudreau André , Remy-Lamarche Danièle , Vigneault Luc , Ngueta Gérard , Bilodeau André , Légaré France
Published: May 2022

Objectives

Assess the feasibility and impact of a continuous professional development (CPD) course on type 2 diabetes and depression on health professionals’ intention to include sex and gender considerations in patient care.

Design and setting

In collaboration with CPD organisations and patient-partners, we conducted a mixed-methods feasibility controlled trial with postintervention measures in three Canadian provinces.

Participants

Of 178 eligible health professionals, 127 completed questionnaires and 67 participated in semistructured group discussions.

Intervention and comparator

An interactive 1 hour CPD course, codesigned with patient-partners, on diabetes and depression that included sex and gender considerations (innovation) was compared with a similar course that did not include them (comparator).

Outcomes

Feasibility of recruitment and retention of CPD organisations and patient-partners throughout the study; adherence to planned activities; health professionals’ intention to include sex and gender considerations in patient care as measured by the CPD-Reaction questionnaire; and barriers and facilitators using the Theoretical Domains Framework.

Results

All recruited CPD organisations and patient-partners remained engaged throughout the study. All planned CPD courses occurred. Overall, 71% of eligible health professionals participated (63% under 44 years old; 79.5% women; 67.7% practising in French; 66.9% practising in Quebec; 78.8% in urban practice). After training, mean intention scores for the innovation (n=49) and control groups (n=78) were 5.65±0.19 and 5.19±0.15, respectively. Mean difference was −0.47 (CI −0.95 to 0.01; p=0.06). Adjusted for age, gender and practice settings, mean difference was −0.57 (CI −1.09 to −0.05; p=0.03). We identified eight theoretical domains related to barriers and six related to facilitators for providing sex-adapted and gender-adapted diabetes and depression care.

Conclusions

CPD training on diabetes and depression that includes sex and gender considerations is feasible and, compared with CPD training that does not, may prompt health professionals to modify their care. Addressing identified barriers and facilitators could increase intention.

Trial registration number

NCT03928132with ClinicalTrials.gov; Post-results.
Coexisting service-related factors preceding suicide: a network analysis
Authors: Rex Malin , Brezicka Thomas , Carlström Eric , Waern Margda , Ali Lilas
Published: May 2022

Objectives

The overall objective was to analyse service-related factors involved in the complex processes that precede suicide in order to identify potential targets for intervention.

Design and setting

Explorative network analysis study of post-suicide root cause analysis data from Swedish primary and secondary healthcare.

Participants

217 suicide cases reported to the Swedish national root cause analysis database between 2012 and 2017.

Primary and secondary outcome measures

A total of 961 reported incidents were included. Demographic data and frequencies of reported deficiencies were registered. Topology, centrality indices and communities were explored for three networks. All networks have been tested for robustness and accuracy.

Results

Lack of follow-up, evaluations and insufficient documentation issues emerged as central in the network of major themes, as did the contributing factors representing organisational problems, failing procedures and miscommunication. When analysing the subthemes of deficiencies more closely, disrupted treatments and staffing issues emerged as prominent features. The network covering the subthemes of contributing factors also highlighted discontinuity, fragile work structures, inadequate routines, and lack of resources and relevant competence as potential triggers. However, as the correlation stability coefficients for this network were low, the results need further investigation. Four communities were detected covering nodes for follow-up, evaluation, cooperation, and procedures; communication, documentation and organisation; assessments of suicide risk and psychiatric status; and staffing, missed appointments and declined treatment.

Conclusion

The results of this study suggest that healthcare providers may improve patient safety in suicide preventive pathways by taking active measures to provide regular follow-ups to patients with elevated suicide risk. In some cases, declined or cancelled appointments could be a warning sign. Tentative results show organisational instability, in terms of work structure, resources and staffing, as a potential target for intervention, although this must be more extensively explored in the future.
Association of impaired kidney function with mortality in rural Uganda: results of a general population cohort study
Authors: Kalyesubula Robert , Sekitoleko Isaac , Tomlin Keith , Hansen Christian Holm , Ssebunya Billy , Makanga Ronald , Mbonye Moses Kwizera , Seeley Janet , Smeeth Liam , Newton Robert , Tomlinson Laurie A
Published: May 2022

Objective

To determine the association between baseline kidney function and subsequent all-cause mortality.

Design and setting

A general population-based cohort study from rural Uganda.

Participants

People aged 18 years and above with measured baseline estimated glomerular filtration rate (eGFR), recruited from survey rounds in 2011–2012 or 2014–2015 and followed up to March 2019.

Outcome measure

The primary outcome was all-cause mortality, identified through reports from community health workers and verified by verbal autopsy. The association between baseline eGFR category and mortality was determined using multivariable Cox regression.

Results

Of 5812 participants in both rounds, we included 5678 (97.7%) participants with kidney function and mortality data; the median age was 36 years (IQR 24–50), 60.7% were female, 10.3% were hypertensive, 9.8% were HIV-positive and 1.5% were diabetic. During a median follow-up of 5.0 years (IQR 3.7–6.0) there were 140 deaths. In age-adjusted and sex-adjusted analyses, eGFR <45 mL/min/1.73 m2at baseline was associated with a 5.97 (95% CI 2.55 to 13.98) increased risk of mortality compared with those with baseline eGFR >90 mL/min/1.73 m2. After inclusion of additional confounders (HIV, body mass index, diabetes, hypertension, alcohol and smoking status) into the model, eGFR <45 mL/min/1.73 m2at baseline remained strongly associated with mortality (HR 6.12, 95% CI 2.27 to 16.45), although the sample size fell to 3102. Test for trend showed strong evidence (p<0.001) that the rate of mortality increased progressively as the category of baseline kidney function decreased. When very high eGFR was included as a separate category in age-adjusted and sex-adjusted analyses, baseline eGFR ≥120 mL/min/1.73 m2was associated with increased risk of mortality (HR 2.68, 95% CI 1.47 to 4.87) compared with the reference category of 90–119 mL/min/1.73 m2.

Conclusion

In a prospective cohort in rural Uganda we found that impaired baseline kidney function was associated with subsequently increased total mortality. Improved understanding of the determinants of kidney disease and its progression is needed in order to inform interventions for prevention and treatment.
Mental healthcare utilisation by patients before and after receiving paliperidone palmitate treatment: mirror image analyses
Authors: Kadra-Scalzo Giouliana , Ahn Deborah , Bird Alex , Broadbent Matthew , Chang Chin-Kuo , Pritchard Megan , Shetty Hitesh , Taylor David , Hayes Richard , Stewart Robert
Published: May 2022

Objectives

To compare mental healthcare use and healthcare professional (HCP) contacts for patients before and after initiation of paliperidone palmitate.

Setting

The South London and Maudsley NHS Foundation Trust (SLAM) Biomedical Research Centre Clinical Record Interactive Search.

Participants

We identified all adults with a diagnosis of schizophrenia (International Classification of Diseases 10th Revision: F20.x), who had received paliperidone palmitate prescription for at least 365 days and had at least 1 year of recorded treatment from SLAM, prior to the first recorded receipt of paliperidone palmitate.

Primary and secondary outcome measures

Inpatient and community mental healthcare service use, such as inpatient bed days, number of active days in the service, face-to-face and telephone HCP use in the 12 months before and after paliperidone palmitate initiation.

Results

We identified 664 patients initiated on paliperidone palmitate. Following initiation, inpatient bed days were lower, although patients remained active on the service case load longer for both mirror approach 1 (mean difference of inpatient bed days −10.48 (95% CI −15.75 to −5.22); days active 40.67 (95% CI 33.39 to 47.95)) and mirror approach 2 (mean difference of inpatient bed days −23.96 (95% CI −30.01 to −17.92); mean difference of days active 40.69 (95% CI 33.39 to 47.94)). The postinitiation period was further characterised by fewer face-to-face and telephone contacts with medical and social work HCPs, and an increased contact with clinical psychologists.

Conclusions

Our findings indicate a change in the profile of HCP use, consistent with a transition from treatment to possible rehabilitation.
Relationship between frailty and long-term care needs in Chinese community-dwelling older adults: a cross-sectional study
Authors: Chen Rui , Zhao Wen Bo , Zhang Xiao Pei , Liang Hao , Song Na Na , Liu Zhu Yun , Xiao Hui , Peng Xue Ting , Song Yang , Liao Ruo Tong , Luo Wang Hui , Wei Lin
Published: May 2022

Objectives

Our study aimed to investigate the relationship between the severity of frailty and the long-term care (LTC) needs of older adults from Chinese communities.

Design

A cross-sectional study.

Setting

Three Chinese community health centres. All data were collected by trained researchers through face-to-face collection.

Participants

We surveyed a total of 540 older residents who aged 60 or older from community in Guangzhou, China.

Measures

The Chinese version of the Tilburg frailty indicator was used to assess the frailty status of participants. LTC needs was evaluated by Integrated Home Care Services Questionnaire. Using non-adjusted and multivariate adjusted logistic regression analysis to evaluate frailty and LTC needs, then smoothed plots, threshold effect analysis and P for trend were used to further investigate the relationship between them.

Results

The prevalence of frailty was 45.2% among the 540 older adults enrolled (aged 70.4±8.3 years; 65.7% females). 27% had higher LTC needs, which increased to 65.1% for individuals with frailty. Logistic regression analysis showed that frailty was strongly associated with LTC needs (OR 3.06, 95% CI 2.06 to 4.55, p<0.01). In the multivariate model, after adjusting for demographic characteristics, economic situation, activities of daily living and comorbidities, frailty remained significantly associated with LTC needs (OR 2.32, 95% CI 1.39 to 3.88, p<0.01). The smoothed plots showed a nearly linear relationship between frailty and LTC needs. Threshold effect analysis showed that every point increase in frailty, the score of LTC needs increased 1.3 points. The IQR to regroup individuals with frailty. Compared with the first quartile (scores ≤2), the incidence of LTC needs increased with the frailty status (p value for trend <0.01).

Conclusion

There is a linear relationship between frailty and LTC needs. With the increasing degree of frailty, the LTC needs of older adults dramatically increases.
Association between depressive symptoms and cognitive–behavioural therapy receipt within a psychosis sample: a cross-sectional study
Authors: Mason Ava , Irving Jessica , Pritchard Megan , Sanyal Jyoti , Colling Craig , Chandran David , Stewart Robert
Published: May 2022

Objectives

To examine whether depressive symptoms predict receipt of cognitive–behavioural therapy for psychosis (CBTp) in individuals with psychosis.

Design

Retrospective cross-sectional analysis of electronic health records (EHRs) of a clinical cohort.

Setting

A secondary National Health Service mental healthcare service serving four boroughs of south London, UK.

Participants

20 078 patients diagnosed with an International Classification of Diseases, version 10 (ICD-10) code between F20 and 29 extracted from an EHR database.

Primary and secondary outcome measures

Primary: Whether recorded depressive symptoms predicted CBTp session receipt, defined as at least one session of CBTp identified from structured EHR fields supplemented by a natural language processing algorithm. Secondary: Whether age, gender, ethnicity, symptom profiles (positive, negative, manic and disorganisation symptoms), a comorbid diagnosis of depression, anxiety or bipolar disorder, general CBT receipt prior to the primary psychosis diagnosis date or type of psychosis diagnosis predicted CBTp receipt.

Results

Of patients with a psychotic disorder, only 8.2% received CBTp. Individuals with at least one depressive symptom recorded, depression symptom severity and 12 out of 15 of the individual depressive symptoms independently predicted CBTp receipt. Female gender, White ethnicity and presence of a comorbid affective disorder or primary schizoaffective diagnosis were independently positively associated with CBTp receipt within the whole sample and the top 25% of mentioned depressive symptoms.

Conclusions

Individuals with a psychotic disorder who had recorded depressive symptoms were significantly more likely to receive CBTp sessions, aligning with CBTp guidelines of managing depressive symptoms related to a psychotic experience. However, overall receipt of CBTp is low and more common in certain demographic groups, and needs to be increased.
Cohort profile: intimate partner violence and mental health among women from refugee background and a comparison group of Australian-born – the WATCH cohort study
Authors: Rees Susan , Mohsin Mohammed , Moussa Batool , Fisher Jane , Steel Zachary , Nadar Nawal , Hassoun Fatima , Khalil Batoul , Youssef Mariam , Krishna Yalini
Published: May 2022

Purpose

The Women Aware with Their Children study was created because prospective data are required to accurately guide prevention programmes for intimate partner violence (IPV) and to improve the mental health and resettlement trajectories of women from refugee backgrounds in Australia.

Participants

1335 women (685 consecutively enrolled from refugee backgrounds and 650 randomly selected Australian-born) recruited during pregnancy from three public antenatal clinics in Sydney and Melbourne, Australia. The mean age was 29.7 years among women from refugee backgrounds and 29.0 years among women born in the host nation. Main measures include IPV, mood, panic, post-traumatic stress disorder, disability and living difficulties.

Findings to date

Prevalence of IPV at all three time points is significantly higher for refugee-background women. The trend data showed that reported IPV rates among Australian-born women increased from 25.8% at time 1 to 30.1% at time 3, while for refugee-background women this rate declined from 44.4% at time 1 to 42.6% at time 3. Prevalence of major depressive disorder (MDD) at all three time points is higher for refugee-background women. MDD among Australian-born women significantly declined from 14.5% at time 1 to 9.9% at time 3, while for refugee-background women it fluctuated from 25.1% at time 1 to 17.3% at time 2 and to 19.1% at time 3.

Future plans

We are currently examining trajectories of IPV and mental disorder across four time points. Time 4 occurred during the COVID-19 pandemic, enabling a unique opportunity to examine the impacts of the pandemic over time. Time 5 started in August 2021 and time 6 will begin approximately 12 months later. The children at time 5 are in the early school years, providing the capacity to examine behaviour, development and well-being of the index child.
High-risk fertility behaviour and childhood anaemia in sub-Saharan Africa
Authors: Okyere Joshua , Aboagye Richard Gyan , Ahinkorah Bright Opoku , Seidu Abdul-Aziz , Ameyaw Edward Kwabena , Budu Eugene , Zegeye Betregiorgis , Yaya Sanni
Published: May 2022

Objective

This study sought to examine the association between high-risk fertility behaviour and childhood anaemia in sub-Saharan Africa .

Design

An analytical study was conducted using cross-sectional data from mothers with children under age 5 (n=64 512) from 28 sub-Saharan African countries. Multilevel logistic regression models were fitted to examine the association between high-risk fertility behaviour and childhood anaemia. The results were presented using adjusted odds ratios (aORs) with 95% confidence interval (CI).

Setting

Twenty-eight sub-Saharan African countries.

Outcome measure

Childhood anaemia.

Results

The percentage of children with anaemia in the 28 countries was 66.7%. We found that age more than 34 at delivery and short birth interval had significant associations with childhood anaemia. Children of mothers whose most recent delivery occurred after 34 years were less likely to be anaemic compared with those whose most recent delivery occurred before age 34 (aOR=0.89; 95% CI 0.83 to 0.95). We found that children born to mothers with short birth intervals were more likely to be anaemic, compared with those with long birth intervals (aOR=1.08; 95% CI 1.01 to 1.16).

Conclusions

We, therefore, draw the attention of policy makers and programme implementers to invest in policies and programmes aimed at combating childhood anaemia in sub-Saharan Africa to focus on the population at risk, that is, women whose most recent delivery occurred at younger ages and those with short birth intervals. Encouraging contraceptive use and creating awareness about the importance of birth spacing among reproductive-age women would be more helpful.
Calligraphy-based rehabilitation exercise for improving the upper limb function of stroke patients: protocol for an evaluator-blinded randomised controlled trial
Authors: Wu Xiaodi , Zhang Qiang , Qiao Jun , Chen Nan , Wu Xie
Published: May 2022

Introduction

A common complication of stroke is upper limb dysfunction. Chinese calligraphy handwriting (CCH) is an aesthetical exercise developed from the traditional way of writing in China and holds potential to become a rehabilitation method to improve upper limb functions in patients with stroke. This study aims to design a randomised controlled trial to assess the effect of a customised CCH-based exercise for poststroke rehabilitation of upper limb dysfunction.

Methods and analysis

A single-blinded randomised controlled trial will be conducted on 60 stroke patients. The patients will be randomly allocated into three groups: (1) conventional occupational therapy (COT) group, (2) COT+CCH group, (3) COT+Graded Repetitive Arm Supplementary Program (GRASP) group. For the COT group, patients will receive COT treatment of 1 hour/day. For the COT+CCH group, patients will receive 30 mins COT treatment and 30 mins CCH training. For the COT+GRASP group, patients will receive 30 mins COT treatment and 30 mins GRASP training. All the interventions will be performed 5 days per week for a total of 3 weeks. The upper limb functions will be assessed before and after the interventions using a series of rating scales.

Ethics and dissemination

This study has been approved by the Research Ethics Committees of the Second Rehabilitation Hospital of Shanghai (study ID: 2020-32-01) and the Shanghai University of Sport (study ID: 102772021RT043). Results will be directly disseminated to the patients at the end of the study and to the public via publications in peer-reviewed journals and presentations in conferences.

Trial registration number

ChiCTR 2100043036; Chinese Clinical Trials Registry.
Effect of anaesthetic depth on primary postoperative ileus after laparoscopic colorectal surgery: protocol for and preliminary data from a prospective, randomised, controlled trial
Authors: Liu Weifeng , Huang Wenkao , Zhao Bingcheng , Zhuang Peipei , Li Cai , Zhang Xiyang , Chen Wenting , Wen Shikun , Xi Guiyang , Luo Wenchi , Liu Kexuan
Published: May 2022

Introduction

Primary postoperative ileus is one of the principal factors affecting in-hospital recovery after colorectal surgery. Research on the relationship between anaesthetic depth and perioperative outcomes has been attracting growing attention. However, the impact of anaesthetic depth on the recovery of gastrointestinal function after surgery is unclear. We aimed to conduct a single-centre, prospective, randomised, controlled trial to explore the effect of anaesthetic depth on primary postoperative ileus after laparoscopic colorectal surgery.

Methods and analysis

In this single-centre, prospective, patient-blinded and assessor-blinded, parallel, randomised, controlled trial, a total of 854 American Society of Anesthesiologists physical status I-III patients, aged between 18 and 65 years and scheduled for laparoscopic colorectal surgery lasting ≥2 hours, will be randomly assigned to deep anaesthesia group (Bispectral Index (BIS) 30–40) or light anaesthesia group (BIS 45–55). The primary outcome is primary postoperative ileus during the hospital stay. Secondary outcomes were time to gastrointestinal function recovery, another defined postoperative ileus, 15-item quality of recovery score, length of postoperative stay, postoperative 30-day complications and serum concentrations of intestinal fatty acid-binding protein at 6 hours after surgery.

Ethics and dissemination

The protocol was approved by Medical Ethics Committee of Nanfang Hospital, Southern Medical University (Approval number: NFEC-2018–107) prior to recruitment. All participants will provide written informed consent before randomisation. Findings of the trial will be disseminated through peer-reviewed journals and scientific conferences.

Trial registration number

ChiCTR1800018725.
Psychometric properties of the full and short version Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument: a cross-sectional study assessing patient safety culture in Norwegian homecare services
Authors: Viksveen Petter , Røhne Mette , Grut Lisbet , Cappelen Kathrine , Wiig Siri , Ree Eline
Published: May 2022

Objectives

Measure patient safety culture in homecare services; test the psychometric properties of the Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument; and propose a short-version Homecare Services Survey on Patient Safety Culture instrument for use in homecare services.

Design

Cross-sectional survey with psychometric testing.

Setting

Twenty-seven publicly funded homecare units in eight municipalities (six counties) in Norway.

Participants

Five-hundred and forty health personnel working in homecare services.

Interventions

Not applicable.

Primary and secondary outcome measures

Primary: Patient safety culture assessed using the NHSOPSC instrument. Secondary: Overall perception of service users’ safety, service safety and overall care.

Methods

Psychometric testing of the NHSOPSC instrument using factor analysis and optimal test assembly with generalised partial credit model to develop a short-version instrument proposal.

Results

Most healthcare personnel rated patient safety culture in homecare services positively. A 19-item short-version instrument for assessing patient safety culture had high internal consistency, and was considered to have sufficient concurrent and convergent validity. It explained a greater proportion of variance (59%) than the full version (50%). Short-version factors included safety improvement actions, teamwork, information flow and management support.

Conclusion

This study provides a first proposal for a short-version Homecare Services Survey on Patient Safety Culture instrument to assess patient safety culture within homecare services. It needs further improvement, but provides a starting point for developing an improved valid and reliable short-version instrument as part of assessment of patient safety and quality improvement processes.
Impact of endometriosis on women’s life decisions and goal attainment: a cross-sectional survey of members of an online patient community
Authors: Missmer Stacey A , Tu Frank , Soliman Ahmed M , Chiuve Stephanie , Cross Sarah , Eichner Samantha , Antunez Flores Oscar , Horne Andrew , Schneider Beth , As-Sanie Sawsan
Published: May 2022

Objectives

To examine women’s perceptions of endometriosis-associated disease burden and its impact on life decisions and goal attainment.

Design

An anonymous online survey was distributed in October 2018 through the social media network MyEndometriosisTeam.com.

Participants

Women aged 19 years and older living in several English-speaking countries who self-identified as having endometriosis.

Outcome measures

Patients’ perspectives on how endometriosis has affected their work, education, relationships, overall life decisions and attainment of goals. Subanalyses were performed for women who identified as ‘less positive about the future’ (LPAF) or had ‘not reached their full potential’ (NRFP) due to endometriosis.

Results

743 women completed the survey. Women reported high levels of pain when pain was at its worst (mean score, 8.9 on severity scale of 0 (no pain) to 10 (worst imaginable pain)) and most (56%, n=415) experienced pain daily. Women reported other negative experiences attributed to endometriosis, including emergency department visits (66%, n=485), multiple surgeries (55%, n=406) and prescription treatments for symptoms of endometriosis (72%, n=529). Women indicated that they believed endometriosis had a negative impact on their educational and professional achievements, social lives/relationships and overall physical health. Most women ‘somewhat agreed’/‘strongly agreed’ that endometriosis caused them to lose time in life (81%, n=601), feel LPAF (80%, n=589) and feel they had NRFP (75%, n=556). Women who identified as LPAF or NRFP generally reported more negative experiences than those who were non-LPAF or non-NRFP.

Conclusions

Women who completed this survey reported pain and negative experiences related to endometriosis that were perceived to negatively impact major life-course decisions and attainment of goals. Greater practitioner awareness of the impact that endometriosis has on a woman’s life course and the importance of meaningful dialogue with patients may be important for improving long-term management of the disease and help identify women who are most vulnerable.
Health-related quality of life measures in incarcerated populations: protocol for a scoping review
Authors: Talaat Habeba , Bashayan Seniyyeh , J N Raymakers Adam , Bayoumi Ahmed M , Papatheodorou Stefania , Sediqzadah Saadia
Published: May 2022

Introduction

Incarcerated populations represent a vulnerable and marginalised segment of society, with increased health needs and a higher burden of communicable and non-communicable diseases. Traditional population health outcomes do not capture physical, mental, emotional and social well-being. Health-related quality of life (HRQoL) outcomes attempt to measure these important parameters. To date, there has not been a scoping review to summarise the HRQoL literature in the incarcerated population. Thus, we aim to perform such a review to inform health policy decisions in incarcerated populations and support health economic evaluations of interventions in incarcerated populations.

Methods and analysis

We will conduct a scoping review of the literature on the HRQoL in the incarcerated population informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the corresponding PRISMA Extension for Scoping Reviews. The submissions records of six electronic databases with peer-reviewed literature and three health technology assessment agencies will be searched. The search strategy was informed by recommendations for HRQoL reviews. We will include studies that report HRQoL, health state utility values or reference to quality adjusted life years or quality-adjusted life expectancies of incarcerated populations. No assessments of items’ quality will be made, as the purpose of this scoping review is to synthesise and describe the coverage of the evidence. We will also identify knowledge gaps on the HRQoL in the incarcerated population.

Ethics and dissemination

Research ethics approval is not required as primary data will not be collected. The findings of this scoping review will be used to inform health economic analyses for the incarcerated population and will be disseminated through peer-reviewed publications and conference presentations.
Risk of a subsequent diagnosis of inflammatory bowel disease in subjects with ophthalmic disorders associated with inflammatory bowel disease: a retrospective cohort analysis of UK primary care data
Authors: King Dominic , Chandan Joht Singh , Thomas Tom , Denniston Alastair K , Braithwaite Tasanee , Niranthrankumar Krishnarajah , Reulen Raoul , Adderley Nicola , Trudgill Nigel J
Published: May 2022

Objectives

Ophthalmic conditions including anterior uveitis (AU), episcleritis and scleritis may occur in association with the inflammatory bowel diseases (IBD) as ophthalmic extraintestinal manifestations. The aim of this study was to assess the risk of a later IBD diagnosis in those presenting with IBD associated ocular inflammation (IAOI).

Design

Retrospective cohort study.

Setting

Primary care UK database.

Participants

38 805 subjects with an IAOI were identified (median age 51 (38–65), 57% women) and matched to 153 018 subjects without IAOI.

Measures

The risk of a subsequent diagnosis of IBD in subjects with IAOIs compared with age/sex matched subjects without IAOI. HRs were adjusted for age, sex, body mass index, deprivation, comorbidity, smoking, baseline axial arthropathy, diarrhoea, loperamide prescription, anaemia, lower gastrointestinal bleeding and abdominal pain.

Logistic regression was used to produce a prediction model for a diagnosis of IBD within 3 years of an AU diagnosis.

Results

213 (0.6%) subsequent IBD diagnoses (102 ulcerative colitis (UC) and 111 Crohn’s disease (CD)) were recorded in those with IAOIs and 329 (0.2%) (215 UC and 114 CD) in those without. Median time to IBD diagnosis was 882 (IQR 365–2043) days in those with IAOI and 1403 (IQR 623–2516) in those without. The adjusted HR for a subsequent diagnosis of IBD was 2.25 (95% CI 1.89 to 2.68), p<0.001; for UC 1.65 (95% CI 1.30 to 2.09), p<0.001; and for CD 3.37 (95% CI 2.59 to 4.40), p<0.001 in subjects with IAOI compared with those without.

Within 3 years of an AU diagnosis, 84 (0.5%) subjects had a recorded diagnosis of IBD. The prediction model performed well with a C-statistic of 0.75 (95% CI 0.69 to 0.80).

Conclusions

Subjects with IAOI have a twofold increased risk of a subsequent IBD diagnosis. Healthcare professionals should be alert for potential signs and symptoms of IBD in those presenting with ophthalmic conditions associated with IBD.
Cohort profile for the Loma Linda University Health BREATHE programme: a model to study continuously incentivised employee smoking cessation
Authors: Singh Pramil N , Moses Olivia , Shih Wendy , Hubbard Mark
Published: May 2022

Purpose

The purpose of the Loma Linda University Health (LLUH) BREATHE cohort is to test the efficacy of a novel method of continuously incentivising participation in workplace smoking cessation on participation, long-term abstinence, health outcomes, healthcare costs and healthcare utilisation.

Participants

In 2014, LLUH—a US academic medical centre and university—incentivised participation in a workplace smoking cessation programme (LLUH BREATHE) by lowering health plan costs. Specifically, LLUH introduced a Wholeness Health Plan (WHP) option that, for the smokers, continuously incentivises participation in nicotine screening and the LLUH BREATHE smoking cessation programme by offering an ‘opt-in wellness discount’ that consisted of 50%–53% lower out of pocket health plan costs (ie, monthly employee premiums, copayments). This novel ‘continuously incentivised’ model lowers annual health plan costs for smokers who, on an annual basis, attempt or maintain cessation from tobacco use. The annual WHP cost savings for smokers far exceed the value of short-term incentives that have been tested in workplace cessation trials to date. This ongoing health plan option offered to over 16 000 employees has created an open, dynamic LLUH BREATHE cohort of current and former smokers (n=1092).

Findings to date

Our profile of the LLUH BREATHE cohort indicates that after 5 years of follow-up in a prospective cohort study (2014–2019), continuously incentivised smoking cessation produced a 74% participation (95% CI (71% to 77%)) in employer-sponsored smoking cessation attempts that were occurring less than a year after the incentive was offered. The cohort can be purposed to examine the effect of continuously incentivised cessation on cessation outcomes, health plan utilisation/costs, use of electronic nicotine delivery systems, and COVID-19 outcomes.
Experiences of recovery and posthospital care needs of working-age adults after physical trauma: a qualitative focus group study
Authors: Roodbeen Ruud T J , Lugtenberg Marjolein , Pöstges Heide , Lansink Koen W W , Theeuwes Hilco P , de Jongh Mariska A C , Joosen Margot C W
Published: May 2022

Objective

To explore experiences of recovery after physical trauma and identify long-term needs for posthospital care.

Design, participants and setting

A qualitative study was conducted consisting of seven online focus groups among working-age adults who sustained their injury between 9 months and 5 years ago. Trauma patients discharged from a level 1 trauma centre in the Netherlands were divided into three groups based on the type of their physical trauma (monotrauma, polytrauma and traumatic brain injury). Group interviews were transcribed verbatim, and thematic analysis was conducted.

Results

Despite differences in type and severity of their injuries, participants all struggled with the impact that trauma had on various aspects of their lives. They experienced recovery as an unpredictable and inconstant process aimed at resuming a meaningful life. Work was often perceived as an important part of recovery, though the value attributed to work could change over time. Participants struggled to bring the difficulties they encountered in their daily lives and at work to the attention of healthcare professionals (HCPs). While posthospital care needs varied between and across groups, all people stressed the need for flexible access to person-centred, multidisciplinary care and support after hospital discharge.

Conclusions

This study reveals that people with a broad variety of injury experience recovery as a process towards resuming a meaningful life and report the need to expand trauma care to include comprehensive support to live well long term. Person-centred care might be helpful to enable HCPs to take people’s individual long-term needs and life situations into account. Furthermore, providing timely access to coordinated, multidisciplinary care after discharge is advocated. Integrated care models that span a network of multidisciplinary support around the person may help align existing services and may facilitate easy and timely access to the most suitable support for injured people and their loved ones.
Effect of surgical treatment for anorectal melanoma: a propensity score-matched analysis of the Surveillance, Epidemiology, and End Results programme data
Authors: Lei Xiao , Qingqing Luo , Weijie Yuan , Li Peng , Huang Changhao , Kexun Yu , Zihua Chen
Published: May 2022

Objective

Anorectal melanoma (AM) is a rare but aggressive tumour with limited information in the existing literature. This study aimed to assess the effect of surgical treatment for AM and predict the prognosis of affected patients.

Design

A retrospective cohort study.

Setting

Data of patients diagnosed with AM between 1975 and 2016 in the USA were collected from the Surveillance, Epidemiology, and End Results (SEER) database.

Participants

This study enrolled a total of 795 patients with AM from the SEER database and the validation cohort comprised 40 patients with AM enrolled from Chinese institutes.

Primary and secondary outcome measures

Overall survival (OS) and AM-specific survival (AM-SS).

Results

A total of 795 patients with AM diagnosed between 1975 and 2016 were enrolled in this study. Data over the past four decades showed a trend of increase in incidence rate. A nomogram based on a multivariate Cox regression model was generated to predict AM-SS. The C-index of the nomogram was 0.74 (95% CI 0.71 to 0.77) on internal verification. In the validation cohort, the C-index of the nomogram was 0.72 (95% CI 0.68 to 0.76). The results of propensity score matching (PSM) analysis showed that patients who underwent surgical treatment achieved significant survival (OS: log-rank=17.41, p<0.001; AM-SS: log-rank=14.55, p<0.001). Patients who underwent surgery were stratified into local and extended surgery subgroups. AM-SS and OS were also compared after PSM, but the results were not significantly different between the two surgery subgroups (all p>0.05).

Conclusions

The nomogram based on the analysis of SEER data showed good performance in predicting OS and AM-SS. Patients with AM can benefit from surgery; however, extensive surgery and appendectomy may not improve AM-SS or OS.
Risk factors of COVID-19 vertical transmission among pregnant and non-pregnant Filipinos in Metro Manila: a multicentre cohort study protocol
Authors: Llamas-Clark Erlidia F , Singson Rebecca B , Heralde Francisco M , Lumandas Mayan U , Villanueva-Uy Maria Esterlita T , Cagayan Maria Stephanie Fay S , Regencia Zypher Jude G , Baja Emmanuel S
Published: May 2022

Introduction

The novel (COVID-19 was first reported to have originated in Wuhan, China, in December 2019. This new strain, SARS‐CoV‐2, has spread rapidly worldwide, prompting the WHO to declare the COVID-19 outbreak a global pandemic. The main objective of this cohort study is to determine the risk factors of COVID-19, the modes of COVID-19 vertical transmission, and the maternal and fetal outcomes among non-pregnant and pregnant women and their fetuses.

Methods and analysis

This is a multicentre epidemiological study that will involve a prospective cohort. COVID-19 status among consulting non-pregnant and pregnant women in public hospitals in Manila, Philippines, will be determined and monitored for 6–12 months. Swab specimens from the nasopharynx, cervix, rectum, amniotic fluid, placenta, cord blood and breastmilk will be collected during consult and admission for reverse transcription-PCR (RT-PCR) testing. Blood will be collected during the postdelivery period to monitor the women and their neonates for any undue development and determine the antibody development to indicate an infective or non-infective state. Evidence of vertical transmission will be explored with the presence or absence of the virus using the maternal and fetal neonatal RT-PCR and lateral flow antibody status. Descriptive and inferential statistics will be done, including the associations between exposures and risk factors, description of clinical characteristics, and the COVID-19 status of the participants.

Ethics and dissemination

The Single Joint Research Ethics Board of the Department of Health has approved this protocol (SJREB 2020-30). The study results will be disseminated through conference presentations, peer-reviewed articles, and various stakeholder public forums and activities.
Impact of trends and gender disparity in obesity on future type 2 diabetes in Turkey: a mathematical modelling analysis
Authors: Anakök Gül Anil , Awad Susanne F , Çağlayan Çiğdem , Huangfu Peijue , Abu-Raddad Laith J , Unal Belgin , Critchley Julia Alison
Published: May 2022

Background

Using a previously developed and validated mathematical model, we predicted future prevalence of type 2 diabetes mellitus (T2DM) and major modifiable risk factors (obesity, physical inactivity and smoking) stratified by age and sex in Turkey up to the year 2050.

Methods

Our deterministic compartmental model fitted nationally representative demographic and risk factor data simultaneously for Turkish adults (aged 20–79) between 1997 and 2017, then estimated future trends. Our novel approach explored the impact of future obesity trends on these projections, specifically modelling (1) a gradual fall in obesity in women after the year 2020 until it equalled the age-specific levels seen in men and (2) cessation of the rise in obesity after 2020.

Results

T2DM prevalence is projected to rise from an estimated 14.0% (95% uncertainty interval (UI) 12.8% to 16.0%) in 2020 to 18.4% (95% UI 16.9% to 20.9%) by 2050; 19.7% in women and 17.2% in men by 2050; reflecting high levels of obesity (39.7% for women and 22.0% for men in 2050). Overall, T2DM prevalence could be reduced by about 4% if obesity stopped rising after 2020 or by 12% (22% in women) if obesity prevalence among women could be lowered to equal that of men. The higher age-specific obesity prevalence among women resulted in 2 076 040 additional women developing T2DM by the year 2050.

Conclusion

T2DM is common in Turkey and will remain so. Interventions and policies targeting the high burden of obesity (and low physical activity levels), particularly in women, could significantly impact future disease burdens.
Psychometric properties of the French and English short form of the Protective Behavioural Strategies for Marijuana Scale in Canadian university students
Authors: Côté José , Cossette Sylvie , Auger Patricia , Page Gabrielle , Coronado-Montoya Stephanie , Fontaine Guillaume , Chicoine Gabrielle , Rouleau Geneviève , Genest Christine , Lapierre Judith , Pedersen Eric R , Jutras-Aswad Didier
Published: May 2022

Background

The Protective Behavioural Strategies for Marijuana (PBSM-17) scale serves to identify and measure strategies employed by young adults before, during or after cannabis use. After the adaptation and translation of the PBSM-17 into French, a methodological study was conducted to evaluate the psychometric properties of this French version (FV) and of the original English version (EV) in a sample of bilingual Canadian university students.

Methods

A total of 211 cannabis users (mean age=22.1 years) completed a sociodemographic questionnaire, a question on frequency of cannabis use (four categories: 1–3 times a month, once a week, more than once a week, everyday) and both versions (FV and EV) of the PBSM-17.

Results

Both versions had similar internal reliability (α=0.91; α=0.88). The one-factor solution explained 36.46% of the variance for the FV and 42.26% for the EV. As hypothesised, greater use of protective behavioural strategies was related to lower frequency of cannabis use. One-way ANOVA test results revealed a statistically significant difference in use of strategies by frequency of cannabis use for both the FV (F(3, 207)=27.38, p<0.001) and EV (F(3, 207)=29.32, p<0.001). Post hoc comparisons showed that everyday users employed fewer strategies on average than lower-frequency users.

Conclusion

The FV and EV of the PBSM-17 demonstrated satisfactory psychometric properties. The proposed FV of the PBSM-17 is a reliable instrument that could be used for research and clinical purposes. Protective behavioural strategies can serve as indicator of lower-risk cannabis use and could be targeted in prevention interventions.
Vaccine hesitancy and HPV vaccine uptake among male and female youth in Switzerland: a cross-sectional study
Authors: Kiener Laura M , Schwendener Corina L , Jafflin Kristen , Meier Audrey , Reber Noah , Schärli Maurer Susanna , Muggli Franco , Gültekin Nejla , Huber Benedikt M , Merten Sonja , Deml Michael J , Tarr Philip E
Published: May 2022

Objectives

Identifying factors associated with human papillomavirus (HPV) vaccine uptake is essential for designing successful vaccination programmes. We aimed to examine the association between vaccine hesitancy (VH) and HPV vaccine uptake among male and female youth in Switzerland.

Design

With a cross-sectional study, an interview-based questionnaire was used to collect information on sociodemographic factors, vaccination records and to measure the prevalence of VH using the Youth Attitudes about Vaccines scale (YAV-5), a modified version of the Parent Attitudes about Childhood Vaccinations survey instrument.

Setting and participants

Eligible male and female participants, 15–26 years of age, were recruited through physicians’ offices and military enlistment in all three language regions of Switzerland. Of 1001 participants, we included 674 participants with a vaccination record available (415 males and 259 females) in this study.

Primary and secondary outcome measures

The outcome was uptake for HPV vaccine (having received ≥1 dose of HPV vaccine). Covariates were VH, sex, age and other sociodemographics.

Results

151 (58%) female and 64 (15%) male participants received ≥1 dose of HPV vaccine. 81 (31%) female and 92 (22%) male participants were VH (YAV-5-Score >50). The odds for being unvaccinated were higher for VH women than non-VH women, adjusted OR=4.90 (95% CI 2.53 to 9.50), but similar among VH and non-VH men, OR=1.90 (95% CI 0.84 to 4.31). The odds for being unvaccinated were lower for younger men (born on or after 1 July 2002) than older men (born before 1 July 2002), OR=0.34 (95% CI 0.14 to 0.81), but we found no association between age and vaccine uptake for female youth, OR=0.97 (95% CI 0.48 to 1.97).

Conclusions

VH was associated with lower HPV vaccine uptake in female youth but not male youth in our study population in Switzerland. Our findings suggest that issues other than VH contribute to HPV underimmunisation in male youth in Switzerland.
Tuberculosis treatment management in primary healthcare sectors: a mixed-methods study investigating delivery status and barriers from organisational and patient perspectives
Authors: Zhou Jiani , Pu Jie , Wang Qingya , Zhang Rui , Liu Shili , Wang Geng , Zhang Ting , Chen Yong , Xing Wei , Liu Jiaqing , Hu Daiyu , Li Ying
Published: May 2022

Objective

Tuberculosis (TB) treatment management services (TTMSs) are crucial for improving patient treatment adherence. Under the TB integrated control model in China, healthcare workers (HCWs) in the primary healthcare (PHC) sectors are responsible for TTMS delivery. This mixed-method study aimed to explore the status of and barriers to TTMS delivery faced by HCWs in PHC sectors from the health organisational and patient perspectives.

Design

We completed a questionnaire survey of 261 TB healthcare workers (TB HCWs) and 459 patients with TB in the PHC sector and conducted 20 semistructured interviews with health organisational leaders, TB HCWs and patients with TB. SPSS V.22.0 and the framework approach were used for data analysis.

Setting

PHC sectors in Southwest China.

Results

Our results showed that TTMS delivery rate by HCWs in PHC sectors was <90% (88.4%) on average, and the delivery rates of intensive and continuation phase directly observed therapy (DOT) were only 54.7% and 53.0%, respectively. HCWs with high work satisfaction and junior titles were more likely to deliver first-time home visits and DOT services. Our results suggest that barriers to TTMS delivery at the organisational level include limited patient-centred approaches, inadequate resources and incentives, insufficient training, poor cross-sectional coordination, and strict performance assessment. At the patient level, barriers include low socioeconomic status, poor health literacy and TB-related social stigma.

Conclusion

TTMSs in Southwest China still need further improvement, and this study highlighted specific barriers to TTMS delivery in the PHC sector. Comprehensive measures are urgently needed to address these barriers at the organisational and patient levels to promote TB control in Southwest China.