bluuebunny/crossref_metadata_2025 huggingface dataset:
Parents’ and healthcare professionals’ experiences and perceptions of parental readiness for resuscitation in Iranian paediatric hospitals: a qualitative study
Authors: Ghavi Arezoo , Hassankhani Hadi , Powers Kelly , Arshadi-Bostanabad Mohammad , Namdar Areshtanab Hossein , Heidarzadeh Mohammad
Published: May 2022

Objective

The aim of this study was to examine parents’ and healthcare professionals’ experiences and perceptions of parental readiness for resuscitation of their child in a paediatric hospital.

Design

This exploratory descriptive qualitative study used content analysis. Participants shared their experiences and perceptions about parental readiness for cardiopulmonary resuscitation through semi-structured and in-depth interviews. MAXQDA 2020 software was also used for data analysis.

Setting

The setting was two large teaching paediatric hospitals in Iran (Este Azerbaijan and Mashhad).

Participants

Participants were 10 parents and 13 paediatric healthcare professionals (8 nurses and 5 physicians). Selection criteria were: (a) parents who experienced their child’s resuscitation crisis at least 3 months prior and (b) nurses and physicians who were working in emergency rooms or intensive care wards with at least 2 years of experience on the resuscitation team.

Results

Participants shared their experiences about parental readiness for resuscitation of their child in four categories: awareness (acceptance of resuscitation and its consequences; providing information about the child’s current condition and prognosis), chaos in providing information (defect of responsibility in informing; provide selective protection of information; hardness in obtaining information), providing situational information (honest information on the border of hope and hopeless; providing information with apathy; providing information as individual; dualism in blaming; assurance to parents; presence of parents to better understand the child’s situation) and psychological and spiritual requirements (reliance on supernatural power; need for access to a psychologist; sharing emotions; collecting mementos).

Conclusion

The results of this study provide insight on the needs of parents and strategies to use to prepare them for their child’s resuscitation crisis, which can be used to enhance family centred care practices in paediatric acute care settings.
COVID-19 pandemic unmasking cardiovascular risk factors and non-communicable diseases among migrant workers: a cross-sectional study in Singapore
Authors: Mattar Shaikh Abdul Matin , Kan Juliana Yin Li , Goh Orlanda Qi Mei , Tan Yuyang , Kumaran Shalini Sri , Shum Koin Lon , Lee Guozhang , Balakrishnan Tharmmambal , Zhu Ling , Chong Chiara Jiamin , Woong Natalie Liling , Lam Amanda Yun Rui , Kang Mei Ling
Published: May 2022

Objectives

This study aims to report the prevalence of cardiovascular risk factors (CVRFs) and other non-communicable diseases among migrant workers in Singapore admitted for COVID-19 infection, to highlight disease burden and the need for changes in health screening and healthcare delivery in this unique population.

Setting

The study was conducted in the largest tertiary hospital in Singapore.

Design

Retrospective cross-sectional study.

Participants

883 migrant workers who had mild or asymptomatic COVID-19 infection admitted to three isolation wards between 6 April 2020 and 31 May 2020 were included in this study.

Outcome measures

The outcome measures were the prevalence of pre-existing and newly diagnosed comorbid conditions and the prevalence of CVRFs—diabetes mellitus, hypertension and hyperlipidaemia—and non-communicable diseases at the time of discharge. The OR of having specific CVRFs depending on country of origin was generated via multivariate logistic regression analysis.

Results

The median age of our study population was 45 years. 17.0% had pre-existing conditions and 25.9% received new diagnoses. Of the new diagnoses, 15.7% were acute medical conditions and 84.3% chronic medical conditions. The prevalence of CVRFs was higher in Southeast Asian and South Asian migrant workers compared with Chinese. The prevalence of non-communicable diseases on discharge was highest among Southeast Asians (49.4%).

Conclusions

The COVID-19 outbreak in a large number of migrant workers in Singapore unmasked a significant disease burden among them, increasing stakeholders’ interests in their welfare. Moving forward, system-level changes are necessary to deliver healthcare sustainably and effect improvements in migrant workers’ health.
Factors associated with marital status of women with genital fistula after childbirth: a retrospective review in nine African countries
Authors: Ngongo Carrie J , Raassen Thomas J I P , Mahendeka Marietta , Bisanzio Donal , Lombard Ladeisha , Bann Carla
Published: May 2022

Objective

To examine characteristics associated with remaining married with fistula.

Design

Retrospective record review and logistic regression.

Setting

Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia and South Sudan.

Participants

Women who developed fistula during childbirth (1975–2017) and sought treatment (1994–2017).

Outcome measure

Self-reported status of living with original husband at time of presentation for fistula repair.

Results

Over half of the women lived with their husbands at the time of fistula treatment (57.2%, 3375/5903). The strongest predictor of remaining married with fistula was either parity at fistula development (adjusted odds ratio [AOR] 1.4–4.4) or living kids at fistula repair (among women who had not given birth between fistula development and repair) (AOR 1.7–4.9). Predicted probability of remaining married declined sharply over the first 2 years of incontinence, levelling out thereafter. Predicted probability of remaining married was lower for women with both urinary and faecal incontinence (AOR 0.68) as compared with women with urinary incontinence alone. Probability of remaining married with fistula declined over time (AOR 1.03–0.57). The woman’s education was not a statistically significant predictor, but the odds of remaining married were 26% higher if the husband had any formal schooling.

Conclusion

Most husbands do not abandon wives with fistula following childbirth. Treatment, counselling, social support and rehabilitation must consider the circumstances of each woman, engaging men as partners where appropriate. Communities and facilities offering fistula repair services should stress the importance of early intervention.
Prevalence and patterns of multimorbidity in chronic diseases in Guangzhou, China: a data mining study in the residents’ health records system among 31 708 community-dwelling elderly people
Authors: Lin Wei-Quan , Yuan Le-Xin , Sun Min-Ying , Wang Chang , Liang En-Min , Li Yao-Hui , Liu Lan , Yang Yun-Ou , Wu Di , Lin Guo-Zhen , Liu Hui
Published: May 2022

Objectives

Examination of the prevalence, influence factors and patterns of multimorbidity among the elderly people in Guangzhou, China.

Design

Cross-sectional study.

Participants

31 708 community-dwelling elderly people aged 65 and over.

Primary and secondary outcome measures

Prevalence, influence factors and patterns of multimorbidity in seven chronic conditions among the participants. A multistage, stratified random sampling was adopted for selection of health records in the residents’ health records system of Guangzhou. Data mining by association rule mining analysis was used to explore the correlations and multimorbidity patterns between seven chronic diseases.

Results

The prevalence of morbidity was 55.0% (95% CI 40.1% to 60.1%) and the multimorbidity was 15.2% (95% CI 12.4% to 18.4%) among the participants. Elderly, women, higher education level, being single, living in urban areas and having medical insurance were more likely to have chronic diseases and multimorbidity. Data mining by association rule mining analysis reveals patterns of multimorbidity among the participants, including coexistence of hypertension and diabetes (support: 12.5%, confidence: 17.6%), hypertension and coronary heart disease (support: 4.4%, confidence: 5.7%), diabetes and coronary heart disease (support: 1.6%, confidence: 5.7%), diabetes, coronary heart disease and hypertension (support: 1.4%, confidence: 4.4%).

Conclusions

A high prevalence of morbidity (especially on hypertension and diabetes) and a relatively low multimorbidity of chronic diseases exist in elderly people. Data mining of residents’ health records will help for strengthening the management of residents’ health records in community health service centres of Guangzhou, China.
Protocol for a systematic review of economic evaluations conducted on gender-transformative interventions aimed at preventing unintended pregnancy and promoting sexual health in adolescents
Authors: Ncube Janet , Adom Theodosia , Nkonki Lungiswa
Published: May 2022

Introduction

In the context of family planning and reproductive health, a gender-transformative approach involves helping communities understand and challenge the social norms that perpetuate inequalities between men and women, and improving women’s access to key services.

The purpose of this systematic review is to synthesise the best available evidence on economic evaluations of gender transformative interventions targeted at preventing unintended pregnancy and promoting sexual health in adolescents, assess the methodological quality of the economic evaluation studies and identify gaps in the evidence.

Methods and analysis

We will search the following bibliographic databases for economic evaluations that meet our selection criteria; PubMed, Cochrane, National Health Service EE database, SCOPUS, CINHAL, Web of Science and Paediatric EE Database. We will additionally conduct a grey literature search. The search will be conducted for the period 1 January 1990 to 31 December 2021. Two independent reviewers will conduct the screening, data extraction and quality assessment. We will consider the following outcomes from economic evaluations; relative resource use, cost and incremental cost-effectiveness ratio, incremental net benefit ratio or net present value, quality-adjusted life-years and disability-adjusted life-years. Quality assessment will be conducted using the Consolidated Health Economic Evaluation Reporting Standards statement and the Consensus on Health Economic Criteria checklist. Results will be reported using summary tables and narratively. Attempts will be made to use the Joanna Briggs Institute three-by-three dominance ranking matrix tool to compare relevant cost-effectiveness studies.

Ethics and dissemination

Ethics approval is not required because the review will not use individual patient data, instead publicly available economic evaluation research studies will be used. However, an ethics exemption was obtained from the Stellenbosch University Health Research Ethics Committee, Reference No: X21/05/012. The results of the systematic review will be published in a peer-reviewed journal and presented at a relevant scientific conference.

PROSPERO registration number

CRD42021264698.
Deep neuromuscular block for minimally invasive lung surgery: a protocol for a systematic review with meta-analysis and trial sequential analysis
Authors: Zheng Jianqiao , Du Li , Deng Xiaoqian , Zhang Lu , Wang Jia , Chen Guo
Published: May 2022

Introduction

Minimally invasive lung surgery (MILS) gradually became the primary surgical therapy for lung cancer, which remains the leading cause of cancer death. Adequate muscle relaxation by deep neuromuscular block (NMB) is particularly necessary for MILS to provide a satisfactory surgical field. However, deep NMB for MILS remains controversial, as one-lung ventilation may provide an acceptable surgical field. Then, we will perform a protocol for a systematic review and meta-analysis to identify the efficacy of deep NMB for MILS.

Methods and analysis

We will search the PubMed, Cochrane Library, Embase, Ovid Medline, Web of Science, Chinese BioMedical Literature, China National Knowledge Infrastructure, VIP and Wanfang databases from inception to March 2022 to identify randomised controlled trials of adult participants undergoing MILS with deep NMB. Studies published in English or Chinese will be considered. The primary outcome will be the surgical conditions according to the surgeon’s perspective. Secondary outcomes will be the incidence of perioperative events and perioperative mortality. Heterogeneity will be assessed by the χ2 test and I2 statistic. Data will be synthesised by both a fixed-effect and a random-effects meta-analysis, with an intention to present the random-effects result if there is no indication of funnel plot asymmetry. Otherwise, metaregression will be used. The Cochrane risk-of-bias tool, trial sequential analysis and Grading of Recommendations Assessment, Development and Evaluation will be used to assess the evidence quality and control the risks of random errors. Funnel plots and Egger’s regression test will be used to assess publication bias.

Ethics and dissemination

Ethical approval was not required for this systematic review protocol. The results will be disseminated through peer-reviewed publications.

PROSPERO registration number

CRD42021254016.
Safety of COVID-19 vaccines in patients with non-communicable diseases: a protocol for systematic review and meta-analysis of randomised controlled trials
Authors: Shi Chengqian , Wu Mizhi , Wang Xinchang , Yang Kepeng
Published: May 2022

Introduction

The COVID-19 global pandemic has posed enormous threats to public health around the world. Vaccines are considered the best therapeutic strategy against the COVID-19 pandemic. However, the adverse reactions of vaccines significantly affect the rates of vaccination and may be more serious in patients with non-communicable diseases (NCDs). This protocol aims to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) which analysed the safety of vaccines in patients with NCDs.

Methods and analysis

This study will be according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A comprehensive search will be carried out to identify registered RCTs in PubMed, Embase, Web of Science, ClinicalTrials.gov and Cochrane Library between 1 January 2020 and 31 May 2022. Selection of trials, data extraction, risk of bias assessment and quality of evidence assessment will be done by two researchers, and disagreements will be resolved by the corresponding author. The primary outcomes are local and systemic adverse events of vaccines in patients with NCDs. Additional outcomes are related events caused by vaccine adverse events, including but not limited to cases of adverse events leading to discontinuation from a dose or withdrawal from participation in the trial. Heterogeneity will be assessed with I2 statistics and data analysis will be conducted with RevMan V.5.4.1.

Ethics and dissemination

This is a protocol and ethical approval is not necessary. The results of this protocol will be disseminated to peer-reviewed publications or conference presentations.

PROSPERO registration number

CRD42021254914.
Methodological approaches for medication error analyses in patient safety and pharmacovigilance reporting systems: a scoping review protocol
Authors: Tchijevitch Olga , Hansen Sebrina Maj-Britt , Bogh Søren Bie , Hallas Jesper , Birkeland Søren
Published: May 2022

Introduction

Medication errors (MEs) are associated with patient harm and high economic costs. Healthcare authorities and pharmacovigilance organisations in many countries routinely collect data on MEs via reporting systems to improve patient safety and for learning purposes. Different approaches have been developed and used for the ME analysis, but an overview of the scope of available methods currently is lacking. This scoping review aimed to identify, explore and map available literature on methods used to analyse MEs in reporting systems.

Methods and analyses

This protocol describes a scoping review, based on the Joanna Briggs Institute methodological framework. A systematic search will be performed in MEDLINE (Ovid), Embase (Ovid), Cinahl (EBSCOhost), Cochrane Central, Google Scholar, websites of the major pharmacovigilance centres and national healthcare safety agencies, and citation search in Scopus in August 2022. All retrieved records are to be independently screened by two researchers on title, abstract and full text, involving a third researcher in case of disagreement. Data will be extracted and presented in descriptive and tabular form. The extraction will be based on information about methods of ME analyses, type of reporting system and information on MEs (medication name, ATC codes, ME type, medication–event categories and harm categories).

Ethics and dissemination

Ethical approval is not required. The results will be disseminated via publication in peer-reviewed journals, scientific networks and relevant conferences.
Financial toxicity in patients with lung cancer: a scoping review protocol
Authors: Fu Liang , Zhuang Minling , Luo Chengcan , Zhu Ruiyun , Wu Bei , Xu Wenxia , Xu Bo , Xu Ruiyan , Ye Xianghong
Published: May 2022

Introduction

Lung cancer has the second-ranked morbidity rate and the first-ranked mortality rate worldwide. With the progression of the cancer condition and the advancement of new treatments, the corresponding medical expenses have risen sharply. Nowadays, financial toxicity has become one of the most common concerns in patients with cancer. However, by far, the full landscape of studies on financial toxicity is unclear in patients with lung cancer. Thus, this scoping review aims to summarise the degree, affecting factors, outcomes and intervention strategies of financial toxicity in patients with lung cancer.

Methods and analysis

This scoping review will be developed following the methodology described in the Joanna Briggs Institute Manual for Evidence Synthesis on scoping review protocol, which was based on Arksey and O’Malley’s methodological framework, Levac et al’s recommendations for applying this framework and Peters et al’s enhancements of the framework. From the day of database building to 31 December 2021, 10 English databases will be searched in the ‘Abstract’ field with three key search terms: “Lung”, “Cancer” and “Financial toxicity”. The studies’ screening and data extraction will be independently performed by two reviewers (MZ and RZ). Any disagreements between the two reviewers (MZ and RZ) will be resolved by consensus, and a third reviewer (BW) will be invited if necessary. The results will be analysed and presented using tables and figures. This scoping review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

Ethics and dissemination

An ethical approval is not required for this scoping review protocol, nor for the scoping review. The results of this scoping review will be disseminated through publication in a peer-reviewed journal or presentation at conferences.

Registration

This scoping review protocol has been registered in the Open Science Framework (https://osf.io/ub45n/?view_only=bb93eb94e1434a0f8196b3b61cffcec2).
Caregiver burden and its associated factors among family caregivers of persons with dementia in Shanghai, China: a cross-sectional study
Authors: Liu Zhijian , Sun Wenjing , Chen Honglin , Zhuang Jianhua , Wu Bei , Xu Hanzhang , Li Peng , Chen Xiaohan , Li Juan , Yin You
Published: May 2022

Objective

To assess the level of caregiver burden and factors associated with it among family caregivers of persons with dementia (PWD) living in communities of Shanghai, China.

Design

Cross-sectional study.

Setting

Communities in Hongkou District of Shanghai, China.

Participants

A random sample of 109 older adults with dementia and their primary family caregivers.

Main outcome measure

Caregiver burden measured by the Caregiver Burden Inventory (CBI), and the Caregivers’ depressive symptom measured by the simplified Chinese version of Self-rating Depression Scale was the outcome variable of the study. The independent variables, including the cognitive function (measured by Montreal Cognitive Assessment (MoCA), sleep quality assessed by the Pittsburgh Sleep Quality Index, abilities of daily life assessed by the Activities of Daily Living Scale, and behavioural and psychological symptoms assessed by the Neuropsychiatric Inventory of PWDs, the community service utilisation (measured by the Community Service Utilisation Measurement), perceived social support (assessed by three questions), positive aspects of caregiving (PAC) (assessed by the PAC) of dementia caregivers, were analysed. Multivariate linear regression was employed to determine the factors related to caregiver burden.

Results

The average level of CBI was 65.92±16.74. The score of MoCA, PAC and perceived social support of caregivers were negatively associated with caregiver burden (β=−0.84, p<0.001, β=−3.61, p=0.03 and β=−1.22, p=0.001, respectively). Community service utilisation was positively associated (β=3.46, p<0.001) with caregiver burden. Perceived social support by the caregiver moderated the relationship between caregiver burden and caregivers’ depression symptoms.

Conclusion

Dementia caregivers experienced a high level of caregiver burden. The cognitive function of PWD, PAC, social support and community service utilisation were factors associated with caregiver burden. Strengthening social support, providing more high-quality home care services, promoting PAC are imperative to reduce caregiver burden.
Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan
Authors: Chen Hsin-Hung , Chern Yahn-Bor , Hsu Chih-Yang , Tang Pei-Ling , Lai Chi-Cheng
Published: May 2022

Objectives

Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular events (CVEs), and kidney transplantation (KT) has been reported to improve risk of CVEs and survival. As the association of KT timing on long-term survival and clinical outcomes remains unclear, we investigated the association of different KT waiting times with clinical outcomes.

Design

Retrospective observational cohort study.

Setting

We conducted an observational cohort study using data from the National Health Insurance Research Database in Taiwan. Adult patients who initiated KT therapy from 1997 to 2013 were included.

Participants

A total of 3562 adult patients who initiated uncomplicated KT therapy were included and categorised into four groups according to KT waiting times after ESRD: group 1 (<1 year), group 2 (1–3 years), group 3 (3–6 years) and group 4 (>6 years).

Primary outcome measures

The main outcomes were composite of all-cause death, non-fatal myocardial infarction or non-fatal stroke, based on the primary diagnosis in medical records during hospitalisation.

Results

Compared with group 1, the adjusted risk of primary outcome events (all-cause death, non-fatal myocardial infarction or non-fatal stroke) increased by 1.67 times in group 2 (95% CI: 1.40 to 2.00; p<0.001), 2.17 times in group 3 (95% CI: 1.73 to 2.71; p<0.001) and 3.10 times in group 4 (95% CI: 2.21 to 4.35; p<0.001). The rates of primary outcome events were 6.7%, 13.4% and 14.0% within 5 years, increasing to 19.5%, 26.3% and 30.8% within 10 years in groups 1, 2 and 3, respectively.

Conclusions

Our results demonstrate that early KT is associated with superior long-term cardiovascular outcomes compared with late KT in selected patients with ESRD receiving uncomplicated KT, suggesting that an early KT could be a better treatment option for patients with ESRD who are eligible for transplantation.
Establishing a multistakeholder research agenda: lessons learned from a James Lind Alliance Partnership
Authors: Jongsma Karin Rolanda , Milota Megan M
Published: May 2022

Objective

The James Lind Alliance (JLA) offers a method for better aligning health and care agenda’s with the needs of patients, carers and clinicians by bringing them together in a Priority Setting Partnership (PSP). In this paper, we draw attention to crucial lessons learnt when establishing such a shared research agenda.

Key arguments

Having specific strategies and plans in place for maximising dialogic processes in a PSP can help facilitate and maintain trust, innovation and equal inclusion.

Conclusion

Eight lessons learnt have been formulated, based on our observations and reflections on the JLA PSP and our expertise on patient participation and participatory research.
Factors associated with preferred place of death among older adults: a qualitative interview study in Tama City, Tokyo, Japan
Authors: Tsuchida Tomoya , Onishi Hirotaka , Ono Yoshifumi , Machino Aco , Inoue Fumiko , Kamegai Manabu
Published: May 2022

Objectives

To analyse the cognitive processes involved in the decision-making of older adults who are not in the end-of-life stage regarding the selection of a preferred place of death.

Design

A qualitative cross-sectional study based on semistructured in-depth interviews. The interview scripts were sectioned by context, then summarised, conceptualised and categorised. Post-categorisation, the relationships between the conceptual factors were examined.

Setting

Tama City, Tokyo, Japan, from November 2015 to March 2016.

Participants

20 long-term care users and their families or care providers were interviewed about their preferred places of death and the factors behind their decisions.

Results

Three categories based on the preferred place of end-of-life care and death were extracted from the interview transcripts: (A) discouraging the decision of a preferred place of death, (B) enhancing the desire for home death and (C) enhancing the desire for a hospital/long-term care facility death. Category A consists of concerns about the caregiver’s health, anxiety about solitary death, and constraints of and concerns about the household budget. Both categories B and C consist of subcategories of reinforcing and inhibiting factors of whether to desire a home death or a hospital/long-term care facility death. If their previous experiences with care at home, a hospital or a care facility were positive, they preferred the death in the same setting. If those experiences were negative, they tend to avoid the death in the same setting.

Conclusions

One’s mindset and decision regarding a preferred place of death include the consideration of economic factors, concerns for caregivers, and experiences of care at home or in a hospital/long-term care facility. Furthermore, health professionals need to be aware of the ambivalence of senior citizens to support their end-of-life decisions.
Development and validation of a diabetes mellitus and prediabetes risk prediction function for case finding in primary care in Hong Kong: a cross-sectional study and a prospective study protocol paper
Authors: Dong Weinan , Cheng Will Ho Gi , Tse Emily Tsui Yee , Mi Yuqi , Wong Carlos King Ho , Tang Eric Ho Man , Yu Esther Yee Tak , Chin Weng Yee , Bedford Laura Elizabeth , Ko Welchie Wai Kit , Chao David Vai Kiong , Tan Kathryn Choon Beng , Lam Cindy Lo Kuen
Published: May 2022

Introduction

Diabetes mellitus (DM) is a major non-communicable disease with an increasing prevalence. Undiagnosed DM is not uncommon and can lead to severe complications and mortality. Identifying high-risk individuals at an earlier disease stage, that is, pre-diabetes (pre-DM), is crucial in delaying progression. Existing risk models mainly rely on non-modifiable factors to predict only the DM risk, and few apply to Chinese people. This study aims to develop and validate a risk prediction function that incorporates modifiable lifestyle factors to detect DM and pre-DM in Chinese adults in primary care.

Methods and analysis

A cross-sectional study to develop DM/Pre-DM risk prediction functions using data from the Hong Kong’s Population Health Survey (PHS) 2014/2015 and a 12-month prospective study to validate the functions in case finding of individuals with DM/pre-DM. Data of 1857 Chinese adults without self-reported DM/Pre-DM will be extracted from the PHS 2014/2015 to develop DM/Pre-DM risk models using logistic regression and machine learning methods. 1014 Chinese adults without a known history of DM/Pre-DM will be recruited from public and private primary care clinics in Hong Kong. They will complete a questionnaire on relevant risk factors and blood tests on Oral Glucose Tolerance Test (OGTT) and haemoglobin A1C (HbA1c) on recruitment and, if the first blood test is negative, at 12 months. A positive case is DM/pre-DM defined by OGTT or HbA1c in any blood test. Area under receiver operating characteristic curve, sensitivity, specificity, positive predictive value and negative predictive value of the models in detecting DM/pre-DM will be calculated.

Ethics and dissemination

Ethics approval has been received from The University of Hong Kong/Hong Kong Hospital Authority Hong Kong West Cluster (UW19-831) and Hong Kong Hospital Authority Kowloon Central/Kowloon East Cluster (REC(KC/KE)-21-0042/ER-3). The study results will be submitted for publication in a peer-reviewed journal.

Trial registration number

US ClinicalTrial.gov: NCT04881383; HKU clinical trials registry: HKUCTR-2808; Pre-results.
Joint trajectories of body mass index and waist circumference in early-life to mid-life adulthood and incident hypertension: the China Health and Nutrition Survey
Authors: Qu Yanlin , Li Chunxia , Lv Jiali , Fan Bingbing , Liu Ying , Su Chang , Zhao Xiangjuan
Published: May 2022

Objective

This longitudinal study aims to identify distinct trajectories of body mass index (BMI) and waist circumference (WC) during 20–60 years old, and explore their joint effect on incident hypertension.

Design

A longitudinal cohort study.

Setting

China Health and Nutrition Survey, 1993–2011.

Participants

The longitudinal cohort included 6571 participants (3063 men) who had BMI and WC repeatedly measured 3–7 times before incident hypertension or loss to follow-up.

Outcomes

Hypertension was defined as systolic blood pressure/diastolic blood pressure>140/90 mm Hg or diagnosis by medical records or taking antihypertensive medication.

Results

Two distinct trajectories were characterised for both BMI and WC: low-increasing and high-increasing. Jointly, subjects were divided into four groups: normal (n=4963), WC-increasing (n=620), BMI-increasing (n=309) and BMI&WC-increasing (n=679). Compared with the normal group, the adjusted HRs and 95% CIs for hypertension were 1.43 (1.19 to 1.74), 1.51 (1.19 to 1.92) and 1.76 (1.45 to 2.14) for WC-increasing, BMI-increasing and BMI&WC-increasing groups, respectively. The model-estimated levels and slopes of BMI and WC were calculated at each age point in 1-year interval according to the model parameters and their first derivatives, respectively. The associations between model-estimated levels and hypertension increased with age, with adjusted ORs and 95% CIs ranging from 0.92 (0.86 to 0.98) to 1.57 (1.47 to 1.67) for BMI and 0.98 (0.92 to 1.05) to 1.44 (1.35 to 1.53) for WC. Conversely, the ORs (95% CIs) of level-adjusted linear slopes decreased with age, ranging from 1.47 (1.38 to 1.57) to 0.97 (0.92 to 1.03) for BMI and 1.36 (1.28 to 1.45) to 0.99 (0.93 to 1.06) for WC.

Conclusions

Our study demonstrates that the joint trajectories of BMI and WC have significant effect on future hypertension risk, and the changing slopes of BMI and WC during young adulthood are independent risk factors. Both BMI and WC should be paid more attention to prevent hypertension, and young adulthood may be a crucial period for intervention.
Risk of COVID-19 re-infection and its predictors (CORES): protocol for a community-based longitudinal cohort study in Vellore, India
Authors: Madhavan Ramya , Paul Jackwin Sam , Babji Sudhir , Kumar Dilesh , Prabhu Savit B , Pulleri Harsha Kandi , Annadorai Ravikiran , Gowda Sampreeth Ravi , John Jacob , Kang Gagandeep
Published: May 2022

Introduction

The incidence of SARS-CoV-2 re-infection has not been widely evaluated in low-income and middle-income countries. Understanding immune responses elicited by SARS-CoV-2 natural infection and factors that lead to re-infection in a community setting is important for public health policy. We aim to investigate the risk of primary infection and re-infection among those without and with evidence of prior infection as defined by the presence of antibodies to SARS-CoV-2 spike protein.

Methods and analysis

A baseline seroprevalence survey will test for SARS-CoV-2 antibodies among healthy adults in Vellore, India. Based on an expected seropositivity rate of 50% in the general population, with annual attack rates of 12%, 6%, 4.8% and 4% among those unvaccinated and seronegative, vaccinated and seronegative, unvaccinated and seropositive, and vaccinated and seropositive, respectively, we will recruit 1200 adults who will be followed up for a total of 24 months. Weekly self-collected saliva samples will be tested by reverse transcription-PCR (RT-PCR) to detect SARS-CoV-2 infections, for a period of 1 year. For any person testing RT-PCR positive, blood samples will be collected within 2 days of RT-PCR positivity and on days 30 and 90 to assess the kinetics and longevity of the antibody responses, B cell memory and T cell memory post-infection. The data will be analysed to estimate seroprevalence at baseline and over time, the risk factors for infection, rates of primary infection and re-infection, and provide a comparison of the rates across groups based on infection and vaccination status.

Ethics and dissemination

The study has been approved by the Institutional Review Board (IRB No: 13585) of Christian Medical College and Hospital, Vellore. The results of the study will be made available through journal publications and conference presentations.

Trial registration number

Central Trial Registry of India: CTRI/2020/11/029438.
Sleep quality and patterns of young West Balkan adults during the third wave of COVID-19 pandemic: a cross-sectional study
Authors: Šljivo Armin , Juginović Alen , Ivanović Katarina , Quraishi Iman , Mulać Ahmed , Kovačević Zorana , Ivanović Stefan , Vuković Miro , Aranza Ivan , Biloš Valentina , Ljuhar Kenan , Drašković Doris , Ćetković Asja , Abdulkhaliq Arian , Dadić Ilma , Begić Edin , Mujičić Ermina , Kulo Ćesić Aida
Published: May 2022

Objectives

To evaluate the sleep patterns among young West Balkan adults during the third wave of the COVID-19 pandemic.

Design and setting

Cross-sectional study conducted using an anonymous online questionnaire based on established sleep questionnaires Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) (February–August 2021).

Participants

Young adults of Bosnia and Herzegovina, Croatia and Serbia.

Results

Of 1058 subjects, mean age was 28.19±9.29 years; majority were women (81.4%) and students (61.9%). Compared with before the pandemic, 528 subjects (49.9%) reported a change in sleeping patterns during the pandemic, with 47.3% subjects reporting sleeping less. Mean sleeping duration during the COVID-19 pandemic was 7.71±2.14 hours with median sleep latency of 20 (10.0–30.0) min. Only 91 (8.6%) subjects reported consuming sleeping medications. Of all, 574 (54.2%) subjects had ISI score >7, with majority (71.2%) having subthreshold insomnia, and 618 (58.4%) PSQI score ≥5, thus indicating poor sleep quality. Of 656 (62.0%) tested subjects, 464 (43.9%) were COVID-19 positive (both symptomatic and asymptomatic) who were 48.8%, next to women (70%), more likely to have insomnia symptoms; and 66.9% were more likely to have poor sleep quality. Subjects using sleep medication were 44 times, and subjects being positive to ISI 15.36 times more likely to have poor sleep quality. In contrast, being a student was a negative independent predictor for both insomnia symptoms and poor sleep quality, and mental labour and not working were negative independent predictors for insomnia symptoms.

Conclusions

During the third wave of the pandemic, sleep patterns were impaired in about half of young West Balkan adults, with COVID-19-positive subjects and being women as positive independent predictors and being a student as negative independent predictor of impaired sleep pattern. Due to its importance in long-term health outcomes, sleep quality in young adults, especially COVID-19-positive ones, should be thoroughly assessed.
Patients’ experiences of being treated for acute illness at home as an alternative to hospital admission: a qualitative study in Denmark
Authors: Bove Dorthe Gaby , Christensen Pernille Edelgaard , Gjersøe Peter , Lavesen Marie
Published: May 2022

Objective

We aimed to investigate the experiences of Danish patients treated at home for an acute illness instead of being hospitalised.

Design

This study had a qualitative design inspired by the methodology of interpretive description. Data were collected through semistructured interviews.

Setting

Home treatment was conducted by a team of nurses (n=10–15) supported by physiotherapists and physicians, all affiliated with an emergency department, located in the capital region of Denmark. Interviews were conducted between August 2020 and April 2021.

Participants

Twenty-one patients, aged 34–94 years, narrated their experiences of being treated at home for an acute illness.

Results

The overarching theme in our analyses was that ‘being the centre of the nurses’ attention provided safety, patient involvement and quality of life during home treatment’. The following six themes emerged from analyses: (1) exclusive attention facilitates involvement and activity; (2) hospitals are for the sick; (3) maintaining a meaningful everyday life; (4) the hospital exudes productivity and busyness; (5) family relations and roles are maintained; (6) and concerns of deterioration.

Conclusions

From a patient’s perspective, home treatment made sense and was perceived as a quality improvement. Being the centre of nurses’ attention induced a sense of safety, involvement and enhanced quality of life among patients during the treatment course for an acute illness.
Vitamin D status in the active duty Navy military personnel: protocol for a systematic review
Authors: Henriques Moisés , Rodrigues Diogo , Sacadura-Leite Ema , Viegas Susana , Serranheira Florentino
Published: May 2022

Introduction

Vitamin D is critical for bone health and its deficiency has been linked to increased incidence and severity of multiple diseases. Even so, vitamin D inadequacy is a major public health problem worldwide. The main source of vitamin D is endogenous cutaneous synthesis through exposure to solar ultraviolet B radiation, which is influenced by several factors, including occupational. The active duty Navy military personnel may be prone to vitamin D inadequacy, but a worldwide overview of vitamin D status in this specific population is still lacking.

Methods and analysis

The CoCoPop mnemonic will be used for determining the inclusion criteria. Scopus, Web of Science and PubMed/Medline will be searched for all studies including 25-hydroxyvitamin D concentrations of the active duty Navy military personnel. Data extraction and quality assessment (Joanna Briggs Institute’s and Downs and Black checklists) will be performed by two reviewers and data will be synthesised in narrative, tabular and map formats.

Ethics and dissemination

This study will not involve human or animal subjects and, thus, does not require ethics approval. The outcomes will be disseminated via publication in a peer-reviewed scientific journal and presentation at a scientific conference.

PROSPERO registration number

CRD42022287057.
Embedded emergency department physical therapy versus usual care for acute low back pain: a protocol for the NEED-PT randomised trial
Authors: Kim Howard S , Muschong Kayla M , Fishman Ivy L , Schauer Jacob M , Seitz Amee L , Strickland Kyle J , Lambert Bruce L , McCarthy Danielle M , Vu My H , Ciolino Jody D
Published: May 2022

Introduction

Low back pain is a common problem and a substantial source of morbidity and disability worldwide. Patients frequently visit the emergency department (ED) for low back pain, but many experience persistent symptoms at 3 months despite frequent receipt of opioids. Although physical therapy interventions have been demonstrated to improve patient functioning in the outpatient setting, no randomised trial has yet to evaluate physical therapy in the ED setting.

Methods and analysis

This is a single-centre cluster-randomised trial of an embedded ED physical therapy intervention for acute low back pain. We used a covariate-constrained approach to randomise individual physicians (clusters) at an urban academic ED in Chicago, Illinois, USA, to receive, or not receive, an embedded physical therapist on their primary treatment team to evaluate all patients with low back pain. We will then enrol individual ED patients with acute low back pain and allocate them to the embedded physical therapy or usual care study arms, depending on the randomisation assignment of their treating physician. We will follow patients to a primary endpoint of 3 months and compare a primary outcome of change in PROMIS-Pain Interference score and secondary outcomes of change in modified Oswestry Disability Index score and patient-reported opioid use. Our primary approach will be a modified intention-to-treat analysis, whereby all participants who complete at least one follow-up data time point will be included in analyses, regardless of their or their physicians’ adherence to their assigned study arm.

Ethics and dissemination

This trial is funded by the US Agency for Healthcare Research and Quality (R01HS027426) and was approved by the Northwestern University Institutional Review Board. All physician and patient participants will give written informed consent to study participation. Trial results will be submitted for presentation at scientific meetings and for publication in peer-reviewed journals.

Trial registration number

ClinicalTrials.gov (NCT04921449)
How common is patient and public involvement (PPI)? Cross-sectional analysis of frequency of PPI reporting in health research papers and associations with methods, funding sources and other factors
Authors: Lang Iain , King Angela , Jenkins Georgia , Boddy Kate , Khan Zohrah , Liabo Kristin
Published: May 2022

Objectives

Patient and public involvement (PPI) in health research is required by some funders and publications but we know little about how common it is. In this study we estimated the frequency of PPI inclusion in health research papers and analysed how it varied in relation to research topics, methods, funding sources and geographical regions.

Design

Cross-sectional.

Methods

Our sample consisted of 3000 research papers published in 2020 in a general health-research journal (BMJ Open) that requires a statement on whether studies included PPI. We classified each paper as ‘included PPI’ or ‘did not include PPI’ and analysed the association of this classification with location (country or region of the world), methods used, research topic (journal section) and funding source. We used adjusted regression models to estimate incident rate ratios of PPI inclusion in relation to these differences.

Results

618 (20.6%) of the papers in our sample included PPI. The proportion of papers including PPI varied in relation to location (from 44.5% (95% CI 40.8% to 48.5%) in papers from the UK to 3.4% (95% CI 1.5% to 5.3%) in papers from China), method (from 38.6% (95% CI 27.1% to 50.1%) of mixed-methods papers to 5.3% (95% CI –1.9% to 12.5%) of simulation papers), topic (from 36.9% (95% CI 29.1% to 44.7%) of papers on mental health to 3.4% (95% CI –1.3% to 8.2%) of papers on medical education and training, and funding source (from 57.2% (95% CI 51.8% to 62.6%) in papers that received funding from the UK’s National Institute for Health Research to 3.4% (95% CI 0.7% to 6.0%) in papers that received funding from a Chinese state funder).

Conclusions

Most research papers in our sample did not include PPI and PPI inclusion varied widely in relation to location, methods, topic and funding source.
Sedentary Behaviour Intervention as a Personalised Secondary Prevention Strategy (SIT LESS) for patients with coronary artery disease participating in cardiac rehabilitation: rationale and design of the SIT LESS randomised clinical trial
Authors: van Bakel B M A , Kroesen S H , Günal A , Scheepmaker A , Aengevaeren W R M , Willems F F , Wondergem R , Pisters M F , Dam J , Janssen A M , de Bruin M , Hopman M T E , Thijssen D H J , Eijsvogels T M H
Published: May 2022

Patients with coronary artery disease (CAD) are more sedentary compared with the general population, but contemporary cardiac rehabilitation (CR) programmes do not specifically target sedentary behaviour (SB). We developed a 12-week, hybrid (centre-based+home-based) Sedentary behaviour IntervenTion as a personaLisEd Secondary prevention Strategy (SIT LESS). The SIT LESS programme is tailored to the needs of patients with CAD, using evidence-based behavioural change methods and an activity tracker connected to an online dashboard to enable self-monitoring and remote coaching. Following the intervention mapping principles, we first identified determinants of SB from literature to adapt theory-based methods and practical applications to target SB and then evaluated the intervention in advisory board meetings with patients and nurse specialists. This resulted in four core components of SIT LESS: (1) patient education, (2) goal setting, (3) motivational interviewing with coping planning, and (4) (tele)monitoring using a pocket-worn activity tracker connected to a smartphone application and providing vibrotactile feedback after prolonged sedentary bouts. We hypothesise that adding SIT LESS to contemporary CR will reduce SB in patients with CAD to a greater extent compared with usual care. Therefore, 212 patients with CAD will be recruited from two Dutch hospitals and randomised to CR (control) or CR+SIT LESS (intervention). Patients will be assessed prior to, immediately after and 3 months after CR. The primary comparison relates to the pre-CR versus post-CR difference in SB (objectively assessed in min/day) between the control and intervention groups. Secondary outcomes include between-group differences in SB characteristics (eg, number of sedentary bouts); change in SB 3 months after CR; changes in light-intensity and moderate-to-vigorous-intensity physical activity; quality of life; and patients’ competencies for self-management. Outcomes of the SIT LESS randomised clinical trial will provide novel insight into the effectiveness of a structured, hybrid and personalised behaviour change intervention to attenuate SB in patients with CAD participating in CR. Trial registration numberNL9263.
Abstracts from International Emergency Medicine Journals
Authors:   EMJ Production
Published: May 2022

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.