bluuebunny/crossref_metadata_2025 huggingface dataset:
News coverage of Mexico’s front-of-package food label policy
Authors: Ramírez A Susana , Garibay Kesia K , Payán Denise Diaz , Campos Gática Victoria , Merino Salmeron Yolanda
Published: May 2022

Objectives

To examine news coverage of Mexico’s front-of-package food labelling policy.

Methods

We used Lexis Nexis to identify newspaper articles that mention the proposed law in four Mexican newspapers representing politically centre-left and centre-right perspectives. We coded for type and valence of arguments, sources and research evidence cited.

Results

We identified N=361 relevant articles. Coverage of the front-of-package food label policy was primarily news (vs editorial/opinion). While most were neutral in tone, left-leaning newspapers had slightly more positive overall coverage compared with right-leaning newspapers, indicated by publishing more stories in favour of the policy, fewer in opposition, more propolicy arguments and more frequent inclusion of perspectives by government officials and public health advocates. Despite some evidence of bias, there was a general lack of credible opposition to the policy and mention of opponents across newspapers.

Conclusions and policy implications

The relative absence of food and beverage industry stakeholders in news coverage of the food label policy is unexpected given their documented involvement in prior food policy debates. We discuss possible reasons for their conspicuous absence and lessons for public health advocates around the globe.
Ethnic disparities in immunisation: analyses of zero-dose prevalence in 64 countries
Authors: Cata-Preta Bianca O , Santos Thiago M , Wendt Andrea , Hogan Daniel R , Mengistu Tewodaj , Barros Aluisio J D , Victora Cesar G
Published: May 2022

Background

The Sustainable Development Goals (SDGs) recommend stratification of health indicators by ethnic group, yet there are few studies that have assessed if there are ethnic disparities in childhood immunisation in low-income and middle-income countries (LMICs).

Methods

We identified 64 LMICs with standardised national surveys carried out since 2010, which provided information on ethnicity or a proxy variable and on vaccine coverage; 339 ethnic groups were identified after excluding those with fewer than 50 children in the sample and countries with a single ethnic group. Lack of vaccination with diphtheria–pertussis–tetanus vaccine—a proxy for no access to routine vaccination or ‘zero-dose’ status—was the outcome of interest. Differences among ethnic groups were assessed using a χ2test for heterogeneity. Additional analyses controlled for household wealth, maternal education and urban–rural residence.

Findings

The median gap between the highest and lowest zero-dose prevalence ethnic groups in all countries was equal to 10 percentage points (pp) (IQR 4–22), and the median ratio was 3.3 (IQR 1.8–6.7). In 35 of the 64 countries, there was significant heterogeneity in zero-dose prevalence among the ethnic groups. In most countries, adjustment for wealth, education and residence made little difference to the ethnic gaps, but in four countries (Angola, Benin, Nigeria and Philippines), the high–low ethnic gap decreased by over 15 pp after adjustment. Children belonging to a majority group had 29% lower prevalence of zero-dose compared with the rest of the sample.

Interpretation

Statistically significant ethnic disparities in child immunisation were present in over half of the countries studied. Such inequalities have been seldom described in the published literature. Regular analyses of ethnic disparities are essential for monitoring trends, targeting resources and assessing the impact of health interventions to ensure zero-dose children are not left behind in the SDG era.
Emotional intelligence in military medical officers in the Defence Medical Services
Authors: MacEwan Dougal , Gibson A
Published: May 2022

Background

Emotional intelligence (EI) is a concept describing an individual’s ability to understand, process and act accordingly on others’ and one’s own emotions. It is a desirable quality for people working in teams and is beneficial to the individual in many ways. It is increasingly recognised that understanding and developing EI are important to working in the healthcare environment. It becomes especially pertinent in the deployed Defence Medical Services (DMS), where clinicians often fulfil a significant leadership role in a small team.

Methods

This study was performed with the aim of exploring the role of EI in military doctors in the UK DMS. EI was measured in a cohort of 64 military doctors by way of a validated self-assessment questionnaire. Results were tested for differences in EI between different services and career stages.

Results

The survey had an 83% return rate. There was roughly equal distribution between service, career groups and ages across the study population. There were more men than women. The population showed consistently high EI scores compared with control data. There were no statistical differences in EI scores between services or genders. Foundation doctors showed the highest EI scores and consultants the lowest (6.05 vs 5.3).

Conclusion

It was demonstrated that military doctors have consistently high EI score, especially at the most junior level. This suggests that traits deemed desirable by the single service selection processes also pertain to high EI without it being specifically measured for. The dangers of having too high EI and the benefits of having a range of EI within a team were discussed. There were limitations of being unable to obtain qualitative data and not including primary healthcare staff. Several recommendations were set out as to how the DMS may use or further investigate EI with regard to training and recruitment.
Priorities of primary care in disaster medicine
Authors: Makin Seth , Ross D
Published: May 2022

The role of primary care in a disaster has too often been poorly defined and poorly understood. Due to its relative low-cost adaptability and closeness to the community, primary care can treat across multiple medical domains. By interacting with stakeholders from international data collection, state health bodies and secondary care to community groups, primary care can generate effect. Minimal standards are defined by Sphere guidelines to work within international, national and local frameworks. Evolution of the understanding of primary care in disaster medicine has resulted in a greater emphasis on maintaining outputs. In a disaster, effect is maximised by using strong local and wider resiliency frameworks to enable adaptation to new inputs and outputs while continuing continuity of care while moving through the disaster cycle. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue ofBMJ Military Health.
Daily rhythms in right-sided and left-sided temporal lobe epilepsy
Authors: Latini Manuel Facundo , Oddo Silvia , Anzulovich Ana Cecilia , Kochen Silvia
Published: May 2022

Introduction

Epilepsy is closely related to daily rhythms, such as the sleep–wake cycle. The objective of this study was to evaluate the relationship between drug-resistant temporal lobe epilepsy (TLE) and the parameters related to the sleep–wake cycle, seizure time and epilepsy laterality.

Methods

Consecutive patients admitted to the video electroencephalogram unit with a diagnosis of TLE were enrolled. Patients were divided into two groups: those with left TLE (LTLE) and those with right TLE (RTLE). They then remained in the conditions of 12-hour light, 12-hour darkness. Demographic data, treatment, number and time of seizure occurrence, sleep diary, morningness–eveningness questionnaire, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were recorded.

Results

In total, 74 patients with TLE, 43 with LTLE and 31 with RTLE, were studied. RTLE patients showed a significant preference for morningness. Patients treated with benzodiazepines showed worse sleep quality and greater daytime sleepiness. Patients who did not report any clear predominance and patients who reported seizures during wakefulness had significantly more seizures during wakefulness and patients who reported sleep predominance had more seizures during sleep (p>0.001). The LTLE group had a greater number of seizures from 8 to 16 hours, unlike the RTLE group, which had a uniform distribution (p=0.008).

Conclusions

This was a prospective study of patients with drug-resistant TLE performed in a controlled environment to study the impact of daily rhythms, seizure frequency and seizure distribution. Laterality seems to be a key factor in seizure distribution.
Association of multimorbidity and physical activity among older adults in India: an analysis from the Longitudinal Ageing Survey of India (2017–2018)
Authors: Boro Bandita , Saikia Nandita
Published: May 2022

Objective

To examine the association of multimorbidity and physical activity among older adults in India.

Design

A cross-sectional study was conducted using large representative survey data.

Setting and participants

The study used data from the nationally representative ‘Longitudinal Ageing Study in India (LASI),’ conducted during 2017–2018. The study included a total sample of 65 336 older adults aged 45 years and above in India.

Methods

Moderate and vigorous physical activities were measured separately by self-reported questionnaires. Physical activity was calculated as minutes of metabolic equivalent tasks per week. The outcome variable was a categorical variable where 2=the prevalence of more than one morbidity, 1=presence of one morbidity and 0=none. Bivariate analysis and multinomial logistic regression were applied to fulfil the objectives.

Results

27.39% of older adults in India had multimorbidity. 31.02% of older adults did not engage in any moderate physical activities. Also, 59.39% of older adults did not engage in any vigorous physical activities. Older adults reporting low (adjusted relative risk ratio (A RRR): 1.10, 95% CI 1.03 to 1.18) and moderate (A RRR): 1.05, 95% CI 0.98 to 1.13) level of moderate physical activity were significantly more likely to suffer from multimorbidity compared with no involvement in moderate physical activity. However, older adults who reported high (A RRR: 0.79, 95% CI 0.75 to 0.84), moderate (A RRR: 0.88, 95% CI 0.80 to 0.98) and low level of vigorous physical activity (A RRR: 0.94, 95% CI 0.86 to 1.02) had significantly less multimorbidity in comparison to those who never engaged in vigorous physical activity.

Conclusion

Lack of physical activity is associated with multimorbidity among older adults. Physical activity promotion should be adopted as a primary strategy in reducing the burden of morbidity and multimorbidity.
Indoor solid fuel use for cooking and the risk of incidental non-fatal cardiovascular disease among middle-aged and elderly Chinese adults: a prospective cohort study
Authors: Ji Haoqiang , Chen Qian , Wu Ruiheng , Xu Jia , Chen Xu , Du Liang , Chen Yunting , Pan Yuanping , Duan Yuxin , Sun Meng , Zhou Ling
Published: May 2022

Objectives

The harm of indoor air pollution to health has gradually attracted attention, but the effect of indoor air pollution from burning solid fuels on incidental non-fatal cardiovascular disease (CVD) is not well understood. Under these circumstances, this study examined the association between solid fuel use and incidental non-fatal CVD.

Design

The prospective cohort study was conducted in 2011, 2013, 2015 and 2018.

Setting

The nationally representative survey was conducted in 28 provinces of China.

Participants

This study included 13 544 middle-aged and elderly adults without CVD in the baseline survey, and they were followed for 7 years.

Outcome measures

First incidence of non-fatal CVD (heart disease or stroke).

Methods

Based on longitudinal data, Cox proportional hazards models were used to assess the effects of solid fuel use and persistent use on incidental CVD events.

Results

During the 7-year follow-up period, there were 1533 non-fatal CVD cases. A total of 7310 (54%) participants used solid fuel for cooking at the baseline survey, and 2998 (41%) users continued to use solid fuel. Solid fuel use was associated with incidental non-fatal CVD (HR: 1.18; 95% CI: 1.05 to 1.32) compared with clean fuel, and persistent solid fuel use might lead to a higher risk of incidental non-fatal CVD (HR: 1.38; 95% CI: 1.18 to 1.61) and heart disease (HR: 1.49; 95% CI: 1.24 to 1.81). In the subgroup analysis, the relationship remained significant in the female, elderly, rural and hypertensive groups. However, we found no significant interaction between these risk factors and fuel use (all p<0.05).

Conclusions

This cohort study provides evidence for the effects of solid fuel use on incidental non-fatal CVD in middle-aged and elderly Chinese adults. Advocating for the use of clean energy and ventilation stoves is important to cardiovascular health.
Quality improvement in Kangaroo Mother Care: learning from a teaching hospital
Authors: Joshi Amol , Londhe Atul , Joshi Trupti , Deshmukh Laxmikant
Published: May 2022

Background

Kangaroo Mother Care (KMC) is a low-resource, evidence-based, high-impact intervention for low-birth weight (LBW) care. Quality improvement in KMC requires meso-level, macro-level and micro-level interventions. Our institution, a public teaching hospital, hosts a level-II/III neonatal intensive care unit (NICU). The average demand for beds typically exceeds available capacity, with 60% occupancy attributed to LBW patients. There was low uptake of KMC practice at our unit.

Aim statement

In the initial phase, we aimed to improve the coverage of KMC in admitted eligible neonates from a baseline of 20%–80% within 15 days. After a period of complacency, we revised the aim statement with a target of improving the percentage of babies receiving 6-hour KMC from 30% to 80% in 12 weeks.

Methods

We report this quasi-experimental time-series study. With the Point of Care Quality Improvement methodology, we performed Plan-Do-Study-Act (PDSA) cycles to improve KMC practice. We involved all the healthcare workers, mothers and caregivers to customise various KMC tools (KMC book format, KMC bag, mother’s gown) and minimise interruptions. Feedback from all levels guided our PDSA cycles.

Results

The percentage of babies receiving at least 1-hour KMC increased from 20% to 100% within 15 days of August 2017. In the improvement phase, baseline 6-hour KMC coverage of 30% increased to 80% within 12 weeks (October–December 2017). It sustained for more than 2 years (January 2018 till February-2020) at 76.5%±2.49%.

Conclusions

Quality improvement methods helped increase the coverage and percentage of babies receiving 6-hour KMC per day in our NICU. The duration specified KMC coverage should be adopted as the quality indicator of KMC. The training of healthcare workers and KMC provider should include hands-on sessions involving the mother and the baby. Maintaining data and providing suitable KMC tools are necessary elements for improving KMC. Minimising interruption is possible with family support and appropriate scheduling of activities. Having a designated KMC block helps in peer motivation.
An initiative to reduce medication errors in neonatal care unit of a tertiary care hospital, Kolkata, West Bengal: a quality improvement report
Authors: Mondal Sayantan , Banerjee Mukut , Mandal Shrabani , Mallick Asim , Das Nina , Basu Biswanath , Ghosh Ritu
Published: May 2022

Background

Medication errors are an emerging problem in various hospital settings, especially in neonates. A study conducted in the neonatal care unit of a tertiary institute in Kolkata as baseline over 3 months, revealed total error to be around 71.1/100 prescriptions (median medication error percentage: 63%).

Purpose

To assess the occurrences of medication errors and determine efficacy of Point-of-Care Quality improvement (POCQI) model in reducing the same from baseline 63% to less than 10%, in the above setting within next 9 months.

Materials and methods

This quality improvement initiative of quasi-experimental design comprised randomly selected prescriptions and monitoring sheets of neonates admitted in the neonatal care unit, obeying inclusion and exclusion criteria. Medication errors were assessed and categorised using a predesigned and pretested checklist. Interventions were planned after forming a quality improvement team in four plan–do–study–act (PDSA) cycles spanning over 6 weeks each (including training of doctors and nurses, signature and countersignatures of respective healthcare personnel, computer-generated prescriptions and newly designed software-generated prescriptions) as per POCQI model of the WHO and results in post-intervention phase (3 months) were compared.

Results

A total of 552 prescriptions and monitoring sheets of 124 neonates were studied. Median medication error percentages in first, second, third and fourth PDSA cycle were, respectively, 48%, 42%, 30% and 14%. Total error reduced to 10.4/100 prescriptions (p<0.005), with significant reduction in erred dosage, timing, interval, preparation and rate of infusion of drugs in prescriptions of the post-intervention phase.

Conclusion

Implementation of change ideas via PDSA cycles, as per the POCQI model with technological aid, significantly decreased the percentage of medication errors in neonates, which was also sustained in the post-intervention phase and facilitated error-free prescriptions.
Obstetric triage improvement process using the Donabedian model of quality care: a quality improvement initiative
Authors: Naz Sumaira , Saleem Shamila , Shamsul Islam Zaheena , Bhamani Shelina , Sheikh Lumaan
Published: May 2022

Obstetric triage has become one of the most crucial innovations in the field of perinatal care in the past 15 years. In lower- middle- income countries (LMICs), the pregnant patients are seen in a conventional way based on the time of their arrival; this divergent, unbalanced and inequitable approach results in delayed initial evaluation, prolonged length of stay (LOS) and affected clinical outcomes.

This project aimed at implementing an effective and efficient obstetric triage system with improved throughput and care processes within six months to facilitate timely decision making according to the individualized needs of pregnant patients.

A pre-implementation audit was completed for the core evaluation of existing obstetric triage services, followed by a fishbone analysis. Following the Donabedian model for quality care, a quality improvement project was initiated to redesign the obstetric triage system. The project strategy was implemented as part of six PDSA (Plan- Do -Study- Act) cycles to optimize the structure, processes, and obstetric triage outcomes. The triage paradigm moved from time-based care delivery to priority care, and processes were improved based on Angelini’s recommendations of best practices in obstetric triage. During the initial phase of improvement, the identified outcome measures were waiting time of 5 minutes from arrival to initial assessment, LOS of 120 minutes, and acuity-based care for at least 50% of patients. A post-implementation audit was conducted to assess improvements. The results showed that the LOS at triage reduced from 240 min (4 hours) to 60 min (1 hour) within 6 months. Furthermore, wait times for triage decreased significantly to 5 min in 65% of patients, compared with 6% in traditional triage practice.

The results indicate that the traditional triage model of the ‘order of arrival’ process is inefficient in providing adequate obstetric care. This quality initiative facilitated the successful incorporation of the Donabedian model and best practice triage practices and helped achieve desired outcomes of improved LOS and reduced waiting time with acuity-based care. Therefore, the design of an efficient,and the appropriate obstetric triage system can be adopted by other healthcare institutions in a local setting that can facilitate patient centric care.
Exploring paediatricians’ experiences with performance improvement modules and quality improvement
Authors: Hendricks Justin J , Theis Ryan , Mann Keith J , Turner Adam L , Filipp Stephanie L , Leslie Laurel K , Rosenthal Cameron , Byrne Alexandra , Black Erik , Thompson Lindsay A
Published: May 2022

Objective

The American Board of Pediatrics’ (ABP) maintenance of certification (MOC) programme seeks to continue educating paediatricians throughout their careers by encouraging lifelong learning and continued improvement. The programme includes four parts, each centring on a different aspect of medical practice. Part 4 MOC centres on quality improvement (QI). Surveys by the ABP suggest that paediatricians are dissatisfied with aspects of part 4, but their reasons are unclear. This study sought to explore factors contributing to dissatisfaction with part 4 by focusing on performance improvement modules (PIMs), a popular means of achieving part 4 credit.

Methods

The study used cross-sectional purposive sampling drawing from US physicians working in a range of practice settings: private outpatient, hospital, academic and low-income clinics. The sampling frame was divided by practice characteristics and satisfaction level, derived from a five-point Likert item asking about physician satisfaction regarding a recent PIM. In-depth interviews were conducted with 21 physicians, and the interview data were coded, categorised into themes and analysed using a framework analysis approach.

Results

Paediatricians expressed nuanced views of PIMs and remain globally dissatisfied with part 4, although reasons for dissatisfaction varied. Concerns with PIMs included: (1) excessive time and effort; (2) limited improvement and (3) lack of clinically relevant topics. While most agreed that QI is important, participants felt persistently dissatisfied with the mechanics of doing PIMs, especially when QI tasks fell outside of their typical work regimen.

Conclusions

Paediatricians agreed that part 4, PIMs, and QI efforts in general still lack clinical relevance and need to be more easily incorporated into practice workflow. Clinicians specifically felt that PIMs must be directly integrated with physicians’ practice settings in terms of topic, data quality and metrics, and must address practice differences in time and monetary resources for completing large or complex projects.
How to improve hospital admission screening for patients at risk of multidrug-resistant organism carriage: a before-and-after interventional study and cost-effectiveness analysis
Authors: Joubert Dominique , Cullati Stephane , Briot Pascal , Righi Lorenzo , Grauser Damien , Ourahmoune Aimad , Chopard Pierre
Published: May 2022

Background

Infection prevention and control (IPC) is a prioritised task for healthcare workers in emergency department (ED). Here, we examined compliance with admission screening (AS) and additional precautions (AP) measures for patients at risk of infection with multidrug-resistant organisms (MDROs) by using a two-stage, multifaceted educational intervention, also comparing the cost of a developed automated indicator for AS and AP compliance and clinical audits to sustain observed findings.

Methods

In the first stage, staff in the ED of the University Hospitals of Geneva, Switzerland, were briefed on IPC measures (AS and AP). A cross-sectional survey was then conducted to assess barriers to IPC measures. In the second stage, healthcare workers underwent training sessions, and an electronic patient record ‘order-set’ including AS and AP compliance indicators was designed. We compared the cost–benefit of the audits and the automated indicators for AS and AP compliance.

Results

Compliance significantly improved after training, from 36.2% (95% CI 23.6% to 48.8%) to 78.8% (95% CI 67.1% to 90.3%) for AS (n=100, p=0.0050) and from 50.2% (95% CI 45.3% to 55.1%) to 68.5% (95% CI 60.1% to 76.9%) for AP (n=125, p=0.0092). Healthcare workers recognised MDRO screening as an ED task (70.2%), with greater acknowledgment of risk factors at AS considered an ED duty. The monthly cost was higher for clinical audits than the automated indicator, with a reported yearly cost of US$120 203. The initial cost of developing the automated indicator was US$18 290 and its return on investment US$3.44 per US$1 invested.

Conclusion

Training ED staff increased compliance with IPC measures when accompanied by team discussions for optimal effectiveness. An automated indicator of compliance is cheaper and closer to real-time than a clinical audit.
Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project
Authors: McFaul Hilary , Mulgrew Linda , Smyth Justine , Titterington Jill
Published: May 2022

Speech sound disorder (SSD) affects up to 25% of UK children and may impact on: effective communication; the development of relationships; school progression and overall well-being. The evidence base shows that intervention for children with SSD is more effective and efficient when provided intensively in relation to the number of target sounds elicited in sessions (dose) and number of sessions per week (frequency). Southern Health and Social Care (HSC) Trust's baseline intensity of speech and language therapy (SLT) intervention was similar to that often found in current practice across the UK,where ~30 target sounds were elicited (dose) in once weekly sessions (frequency) over a 6-week block, followed by a break from therapy. This quality improvement (QI) project aimed to increase intensity of intervention for children with severe SSD within Southern HSC Trust’s community SLT service to improve outcomes for children and their parents. QI methods supported accurate identification of ten 4–5 year olds with severe SSD and increased the intensity of their intervention over a 12-week period by measuring a range of data and speech outcomes. Findings showed a sustainable increase of dose (number of targets elicited per session) to levels recommended in the research (≥70). However, it was difficult to sustain increased frequency of appointments (to twice weekly) because of contextual factors such as sickness, etc. Accommodating this, measuring days between appointments captured an overall increase in the number of appointments attended across time. Child speech outcomes improved for direct speech measures and parent ratings of intelligibility. The intensive model of intervention has been implemented for children identified with severe SSD across Southern HSC Trust's community service with ongoing audit and development, and findings have been disseminated.
Association of water, sanitation, hygiene and food practices with enteric fever in a paediatric cohort in North India
Authors: Dudeja Nonita , Sinha Bireshwar , Goyal Nidhi , Arya Alok , Revi Anitha , Dutta Ankita , More Deepak , Chakravarty Aparna , Kumar Chandra Mohan , Rongsen-Chandola Temsunaro
Published: May 2022

Background

Our aim was to assess the association of water, sanitation and hygiene (WASH) and food practices with culture-confirmed enteric fever in children <15 years of age.

Methods

We followed a cohort of 6000 children from an urban low socioeconomic neighbourhood in South Delhi for 2 years to estimate burden of culture-confirmed enteric fever. Risk ratios (RRs) were estimated to study the association between WASH practices and enteric fever. We assessed the microbiological quality of drinking water and conducted geospatial analysis to evaluate the distribution of enteric fever cases around households with contaminated drinking water.

Results

A total of 5916 children in 3123 households completed survey. Piped water (82%) was the major source of household drinking water. One-third (32%) of the households treated water before consumption. Almost all households had sanitary toilets (99.9%) and 16% used shared toilets. Consumption of food from street vendors and unnamed ice creams more than once a week was observed in children from 12.7% and 38.4% households, respectively. Eighty culture-confirmed enteric fever cases were reported. The risk of enteric fever was 71% higher in children belonging to households having food from outside once a week or more (RR 1.71, 95% CI 1.00 to 2.94). The RR for enteric fever in children living in households with availability of safe drinking water was 0.75 (95% CI 0.45 to 1.26). We found that 14.8% of the households had presence of coliforms or Escherichia coli in their household drinking water. The odds of having a case of enteric fever within a 5 and 25 m buffer zone around households with contaminated drinking water were 4.07 (95% CI 0.81 to 20.5) and 1.44 (95% CI 0.69 to 3.00), respectively.

Conclusion

In addition to WASH practices, optimal food hygiene may have a role in urban low socioeconomic population to control enteric fever.

Trial registration number

CTRI/2017/09/009719.
Variation in initial health assessment of unaccompanied asylum-seeking children: a cross-sectional survey across England
Authors: Nezafat Maldonado Behrouz , Armitage Alice Jane , Williams Bhanu
Published: May 2022

Objective

To assess variation in current practice of initial health assessments (IHAs) for unaccompanied asylum-seeking children (UASC) across England.

Design

Cross-sectional survey.

Main outcomes measures

Type of routine assessment carried out, threshold to specialist referrals and facilities available to complete IHA.

Results

Eighty-six health professionals responded across England; 47% had received training in UASC IHA and 33% in UASC mental health issues. The majority (80%) of IHAs were conducted with translator support and 7% of participants reported Child and Adolescent Mental Health Services (CAMHS) input. Around half of clinicians (53%) performed tuberculosis and bloodborne virus screening for all UASC, while other infectious diseases (IDs) screening was symptom and risk factor dependent. Overall, 14% of clinicians routinely comment on age assessment and 76% share the IHA report and health plan with UASC. The time allocated for assessment range between 30 and 90 min.

Conclusion

There is significant variation in practice around UASC IHAs across England, notably around CAMHS input, time allocated, translation facilities and ID screening. The results suggest that, an increase in resources available for UASC teams, improved access to specialist services and further training on UASC health are all needed. Guidance that aims to set a best practice framework for UASC IHA delivery such as a ‘one-stop shop’ model would help to standardise UASC IHA across the country.
Assessing Open Science practices in physical activity behaviour change intervention evaluations
Authors: Norris Emma , Sulevani Isra , Finnerty Ailbhe N , Castro Oscar
Published: May 2022

Objectives

Concerns on the lack of reproducibility and transparency in science have led to a range of research practice reforms, broadly referred to as ‘Open Science’. The extent that physical activity interventions are embedding Open Science practices is currently unknown. In this study, we randomly sampled 100 reports of recent physical activity randomised controlled trial behaviour change interventions to estimate the prevalence of Open Science practices.

Methods

One hundred reports of randomised controlled trial physical activity behaviour change interventions published between 2018 and 2021 were identified, as used within the Human Behaviour-Change Project. Open Science practices were coded in identified reports, including: study pre-registration, protocol sharing, data, materials and analysis scripts sharing, replication of a previous study, open access publication, funding sources and conflict of interest statements. Coding was performed by two independent researchers, with inter-rater reliability calculated using Krippendorff’s alpha.

Results

78 of the 100 reports provided details of study pre-registration and 41% provided evidence of a published protocol. 4% provided accessible open data, 8% provided open materials and 1% provided open analysis scripts. 73% of reports were published as open access and no studies were described as replication attempts. 93% of reports declared their sources of funding and 88% provided conflicts of interest statements. A Krippendorff’s alpha of 0.73 was obtained across all coding.

Conclusion

Open data, materials, analysis and replication attempts are currently rare in physical activity behaviour change intervention reports, whereas funding source and conflict of interest declarations are common. Future physical activity research should increase the reproducibility of their methods and results by incorporating more Open Science practices.
End-of-life decisions in neonates and infants: a nationwide mortality follow-back survey
Authors: Dombrecht Laure , Beernaert Kim , Chambaere Kenneth , Cools Filip , Goossens Linde , Naulaers Gunnar , Cornette Luc , Laroche Sabrina , Theyskens Claire , Vandeputte Christine , Van de Broek Hilde , Cohen Joachim , Deliens Luc
Published: May 2022

Objectives

Neonatology has undergone important clinical and legal changes; however, the implications for end-of-life decision-making in seriously ill neonates to date are unknown. Our aim was to examine changes in prevalence and characteristics of end-of-life decisions (ELDs) in neonatology.

Methods

We performed a nationwide mortality follow-back survey in August 1999 to July 2000 and September 2016 to December 2017 in Flanders, Belgium. Data were linked to information from death certificates. For each death under the age of 1, physicians were asked to complete an anonymous questionnaire about which ELDs were made preceding death.

Results

The response rate was 87% in 1999–2000 (253/292) and 83% in 2016–2017 (229/276). The proportion of deaths of infants born before 26 weeks’ gestation was increased (14% vs 34%, p=0.001). Prevalence of ELDs remained stable at 60%, with non-treatment decisions occurring in about 35% of all deaths. Use of medication with an explicit life-shortening intention was prevalent in 7%–10% of all deaths. In early neonatal death (<7 days old) medication with an explicit life-shortening intention decreased from 12% to 6%, in late neonatal death (7–27 days old), it increased from 0% to 26%, and in postneonatal death (>27 days old), it increased from 2% to 10%.

Conclusions

Over a timespan of 17 year, the prevalence of neonatal ELDs has remained stable. A substantial number of deaths was preceded by the intentionally hastening of death by administrating medication. While surveying solely the physician perspective in this paper, there is a need for an open multidisciplinary debate, including, for example, nursing staff and family members, based on clinical as well as ethical and jurisdictional reflections to discuss the need for international guidelines.
Fentanyl titration for cancer pain: continuous subcutaneous injection and a once-daily transdermal patch – case series
Authors: Sakaguchi Tatsuma , Kajiyama Toru , Miyake Mafumi , Katayama Toshiro
Published: May 2022

Objectives

Continuous subcutaneous injection (CSCI) followed by a once-daily transdermal patch is a reasonable strategy for rapid titration of fentanyl in patients with cancer pain who are unable to take oral medication or have renal impairment, but the effectiveness and safety have not been demonstrated.

Methods

Medical records of patients with moderate to severe cancer pain who underwent titration of fentanyl by CSCI between October 2019 and October 2021 at Kitano Hospital, Osaka, Japan, were retrospectively reviewed. The dose of fentanyl was increased to a maximum of 0.05 mg/hour. If the dose was inadequate, the fentanyl patch was added on CSCI. When pain relief was adequate, CSCI was completely converted to the patch.

Results

Thirty-three patients were enrolled. Titration was completed successfully in 28 patients (85%) over a median of 2 days. The average Numeric Rating Scale for pain decreased by at least 66% in 22 patients (67%) and by at least 33% in 7 (21%). After conversion to the patch, two patients (6.1%) required to increase the dose of fentanyl within a week. Two patients (6.1%) experienced moderate drowsiness during titration.

Conclusions

Fentanyl titration by CSCI is an effective and safe method for achieving rapid pain control.
National census of UK endoscopy services 2021
Authors: Ravindran Srivathsan , Thomas-Gibson Siwan , Bano Madeline , Robinson Emma , Jenkins Anna , Marshall Sarah , Ashrafian Hutan , Darzi Ara , Coleman Mark , Healey Chris
Published: May 2022

Introduction

The Joint Advisory Group on Gastrointestinal (GI) Endoscopy (JAG) biennial census provides a unique view of UK endoscopy. The 2021 census was conducted to understand the impact of ongoing pressures, highlighted in the previous census, as well as COVID-19.

Methods

The census was sent to all JAG-registered services in April 2021. Data were analysed across the domains of activity, waiting time targets, workforce, COVID-19, safety, GI bleeding, anaesthetic support, equipment and decontamination. Statistical methods were used to determine associations between domain-specific outcome variables and core demographic data.

Results

321 services completed the census (79.2% response rate). In the first 3 months of 2021, 57.9% of NHS services met urgent cancer waits, 17.9% met routine waits and 13.4% met surveillance waits. Workforce redeployment was the predominant reason cited for not meeting targets. There were significant regional differences in the proportion of patients waiting 6 or more weeks (p=0.001). During the pandemic, 64.8% of NHS services had staff redeployed and there was a mean sickness rate of 8.5%. Services were, on average, at 79.3% activity compared with 2 years ago. JAG-accredited services are more likely to meet urgent cancer waits, with a lower proportion of patient waiting 6 weeks or more (p=0.03). Over 10% of services stated that equipment shortage interfered with service delivery.

Conclusions

Services are adapting to continued pressure and there are signs of a focused response to demand at a time of ongoing uncertainty. This census’ findings will inform ongoing guidance from JAG and relevant stakeholders.
Ustekinumab for the treatment of moderate to severe ulcerative colitis: a multicentre UK cohort study
Authors: Honap Sailish , Al-Hillawi Lulia , Baillie Samantha , Bancil Aaron , Matini Lawrence , Lau Rebecca , Kok Klaartje Bel , Patel Kamal , Walsh Alissa , Irving Peter M , Samaan Mark A
Published: May 2022

Objective

Ustekinumab is an interleukin-12/interleukin-23 receptor antagonist licensed for the treatment of ulcerative colitis (UC). Clinical trial data were promising; however, real-world data are limited. We assessed the safety and effectiveness of ustekinumab in UC in a real-world setting.

Design/method

This was a multicentre, retrospective, observational cohort study between February 2020 and January 2022. Disease activity was assessed using the Simple Clinical Colitis Activity Index (SCCAI). Clinical remission was defined as a SCCAI≤2. The primary endpoints were rates of corticosteroid-free remission (CSFR) at week 16 and at week 26. Objective outcomes, including faecal calprotectin (FCAL), were also collected.

Results

110 patients with UC (65% male; median age 40 (IQR range 29–59); 96% with prior biologic and/or tofacitinib exposure) had a median follow-up of 28 weeks (IQR 17–47). CSFR was 36% (18/50) at week 16% and 33% (13/39) at week 26, corresponding with a significant fall in SCCAI from 6 (IQR 4–8) at baseline to 3 (IQR 0–5) at week 26, p<0.001. By week 16, there was improvement of median FCAL measurements, which fell from a baseline of 610 µg/g (IQR 333–1100) to 102 µg/g (IQR 54–674) at week 16. At the end of follow-up, 15% (17/110) had discontinued treatment; 13 patients due to primary non-response or loss of response, and 1 patient for family planning. Treatment was discontinued in three patients due to adverse events.

Conclusion

In the largest real-world study to date, ustekinumab was effective with a reassuring safety profile in a refractory cohort of patients.
Impact of adverse childhood experiences on the symptom severity of different mental disorders: a cross-diagnostic study
Authors: Gu Wenjie , Zhao Qing , Yuan Chengmei , Yi Zhenghui , Zhao Min , Wang Zhen
Published: May 2022

Background

Adverse childhood experiences have a significant impact on different mental disorders.

Objective

To compare differences in adverse childhood experiences among those with different mental disorders and their relationships in a cross-disorder manner.

Methods

The study included 1513 individuals aged ≥18 years : 339 patients with substance use disorders, 125 patients with schizophrenia, 342 patients with depression, 136 patients with bipolar disorder, 431 patients with obsessive-compulsive disorder (OCD), and 140 healthy controls. The Early Trauma Inventory Self Report-Short Form was used to investigate childhood traumatic experiences, and the Addiction Severity Index, Positive and Negative Syndrome Scale, Hamilton Depression Scale, Young Mania Rating Scale, and Yale-Brown Obsessive-Compulsive Scale were used to assess mental disorder severity. Correlation and multivariate logistic regression were analysed between adverse childhood experiences and clinical features.

Results

Levels of adverse childhood experiences were significantly different among different mental disorders. Moreover, 25.8% of patients with substance use disorders reported childhood trauma, which was significantly higher than found in the other four psychiatric disorder groups. Emotional abuse scores were positively correlated with disease severity: the higher the total trauma score, the more severe the mental disorder.

Conclusions

Adverse childhood experiences are a common phenomenon in those with mental disorders, and the level of trauma affects mental disorder severity. Emotional abuse is closely related to many mental disorders. The incidence or severity of mental disorders can be reduced in the future by reducing the incidence of adverse childhood experiences or by timely intervention in childhood trauma.
Attenuated niacin-induced skin flush response in individuals with clinical high risk for psychosis
Authors: Gan Ranpiao , Wei Yanyan , Wu Guisen , Zeng Jiahui , Hu Yegang , Xu Lihua , Tang Xiaochen , Liu Xiaohua , Liu Haichun , Chen Tao , Wang Jijun , Zhang Tianhong
Published: May 2022

Background

Impaired sensitivity of the skin flush response to niacin is one of the most replicated findings in patients with schizophrenia. However, prior studies have usually focused on postonset psychosis, and little is known about the clinical high-risk (CHR) phase of niacin sensitivity in psychosis.

Aims

To profile and compare the niacin flush response among CHR individuals (converters and non-converters), patients with first-episode schizophrenia (FES) and healthy controls (HCs).

Methods

Sensitivity to four concentrations (0.1–0.0001 M) of aqueous methylnicotinate was tested in 105 CHR individuals, 57 patients with FES and 52 HCs. CHR individuals were further grouped as converters and non-converters according to the 2-year follow-up outcomes. Skin flush response scores were rated on a 4-point scale.

Results

Of the 105 CHR individuals, 21 individuals were lost during the study, leaving 84 CHR individuals; 16 (19.0%) converted to full psychosis at 2 years of follow-up. Flush response scores identified in the CHR samples were characterised as modest degree levels, intermediate between those of HC individuals and patients with FES. The flush responses in the CHR group mimicked the responses observed in the FES group at higher concentrations (0.01 M, 0.1 M) and longer time points (15 min, 20 min); however, these became comparable with the responses in the HC group at the shorter time points and at lower concentrations. The converters exhibited lower mean flush response scores than the non-converters.

Conclusions

Attenuated niacin-induced flushing emerged during the early phase of psychosis. New devices should be developed and verified for objective quantification of skin responses in the CHR population.
Interferon regulatory factor 1 (IRF1) controls the metabolic programmes of low-grade pancreatic cancer cells
Authors: Alfarano Gabriele , Audano Matteo , Di Chiaro Pierluigi , Balestrieri Chiara , Milan Marta , Polletti Sara , Spaggiari Paola , Zerbi Alessandro , Diaferia Giuseppe Riccardo , Mitro Nico , Natoli Gioacchino
Published: May 2022

Objective

Pancreatic ductal adenocarcinomas (PDACs) include heterogeneous mixtures of low-grade cells forming pseudoglandular structures and compact nests of high-grade cells organised in non-glandular patterns. We previously reported that low-grade PDAC cells display high expression of interferon regulatory factor 1 (IRF1), a pivotal transcription factor of the interferon (IFN) system, suggesting grade-specific, cell-intrinsic activation of IFN responses. Here, we set out to determine the molecular bases and the functional impact of the activation of IFN-regulated responses in human PDACs.

Design

We first confirmed the correlation between glandular differentiation and molecular subtypes of PDAC on the one hand, and the expression of IRF1 and IFN-stimulated genes on the other. We next used unbiased omics approaches to systematically analyse basal and IFN-regulated responses in low-grade and high-grade PDAC cells, as well as the impact of IRF1 on gene expression programmes and metabolic profiles of PDAC cells.

Results

High-level expression of IRF1 in low-grade PDAC cells was controlled by endodermal lineage-determining transcription factors. IRF1-regulated gene expression equipped low-grade PDAC cells with distinctive properties related to antigen presentation and processing as well as responsiveness to IFN stimulation. Notably, IRF1 also controlled the characteristic metabolic profile of low-grade PDAC cells, suppressing both mitochondrial respiration and fatty acid synthesis, which may in part explain its growth-inhibiting activity.

Conclusion

IRF1 links endodermal differentiation to the expression of genes controlling antigen presentation and processing as well as to the specification of the metabolic profile characteristic of classical PDAC cells.
Early and long-term outcomes of conventional and valve-sparing aortic root replacement
Authors: Jahangiri Marjan , Mani Krishna , Acharya Metesh , Bilkhu Rajdeep , Quinton Paul , Schroeder Frank , Morgan Robert , Edsell Mark
Published: May 2022

Objective

To determine the early and long-term outcomes of conventional aortic root (ARR) and valve-sparing root replacement (VSRR) using a standard perioperative and operative approach.

Methods

We present prospectively collected data of 609 consecutive patients undergoing elective and urgent aortic root surgery (470 ARR, 139 VSRR) between 2006 and 2020. Primary outcomes were operative mortality and incidence of postoperative complications. Secondary outcomes were long-term survival and requirement for reintervention. Median follow-up was 7.6 years (range 0.5–14.5).

Results

189 patients (31%) had bicuspid aortic valves and 17 (6.9%) underwent redo procedures. Median cross-clamp time was 88 (range 54–208) min with cardiopulmonary bypass of 108 (range 75–296) min. In-hospital mortality was 10 (1.6%), with transient ischaemic attacks/strokes occurring in 1.1%. In-hospital mortality for VSRR was 0.7%. 12 patients (2.0%) required a resternotomy for bleeding and 14 (2.3%) received haemofiltration. Intensive care unit and hospital stay were 1.7 and 7.0 days, respectively. During follow-up, redo surgery for native aortic valve replacement was required in 1.4% of the VSRR group. Overall survival was 95.1% at 3 years, 93.1% at 5 years, 91.2% at 7 years and 88.6% at 10 years.

Conclusions

ARR and VSRR can be performed with low mortality and morbidity as well as a low rate of reintervention during the period of long-term follow-up, if performed by an experienced team with a consistent perioperative approach. This series provides contemporary evidence to balance the risks of aortic aneurysms and their rupture at diameters of <5.5 cm against the risks and benefits of surgery.