bluuebunny/crossref_metadata_2025 huggingface dataset:
Rationale and design for Lowering-hyperUricaemia treatment on cardiovascular outcoMes In peritoNeal diAlysis patients: a prospective, multicentre, double-blind, randomised controlled trial (LUMINA)
Authors: Chen Wei , Huang Naya , Mao Haiping , Yang Xiao , Zhou Qian , Jiang Lanping , Ding Jun , Feng Qiong , Yu Xueqing
Published: October 2020

Introduction

The prevalence of hyperuricaemia in peritoneal dialysis patients is quite high. Studies have demonstrated a correlation between hyperuricaemia and cardiovascular disease and treatment of hyperuricaemia reportedly reduces cardiovascular risk in patients with chronic kidney disease. However, whether hyperuricaemia treatment benefits cardiovascular outcomes in continuous ambulatory peritoneal dialysis (CAPD) patients is not yet known.

Methods and analyses

This prospective, multicentre, double-blind, randomised controlled trial was designed to evaluate the effects of hyperuricaemia treatment on cardiovascular event risk in CAPD patients. Based on a power of 80%, with type I error α=0.05, two-sided test and 1:1 parallel control study, considering a dropout rate of 20%, a total of 548 eligible patients are expected to be randomly assigned to either the hyperuricaemia treatment group (febuxostat) or control group (placebo).

Ethics and dissemination

This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital, Sun Yat-sen University and the ethics committees of other participating institutions. Written informed consent will be obtained from potential trial participants or authorised surrogates.

The findings of the study will be disseminated through publications in peer-reviewed journals, and presentations at national and international conferences.

Trial registration number

NCT03200210. 25 June 2017. The trial was started on 13 July 2017, and is expected to end by 31 December 2022. Till 20 Jan 2020, a total of 548 patients have been recruited.

Protocol version

The protocol version number and date are YLT-1604-V2.0 and 15 December 2016.
Prevalence of physical health conditions and health risk behaviours in people with severe mental illness in South Asia: protocol for a cross-sectional study (IMPACT SMI survey)
Authors: Zavala Gerardo A , Prasad-Muliyala Krishna , Aslam Faiza , Barua Deepa , Haidar Asiful , Hewitt Catherine , Huque Rumana , Mansoor Sonia , Murthy Pratima , Nizami Asad T , Siddiqi Najma , Sikander Siham , Siddiqi Kamran , Boehnke Jan Rasmus
Published: October 2020

Introduction

People with severe mental illness (SMI) die on average 10–20 years earlier than the general population. Most of these deaths are due to physical health conditions. The aim of this cross-sectional study is to determine the prevalence of physical health conditions and their associations with health-risk behaviours, health-related quality of life and various demographic, behavioural, cognitive, psychological and social variables in people with SMI attending specialist mental health facilities in South Asia.

Methods and analysis

We will conduct a survey of patients with SMI attending specialist mental health facilities in Bangladesh, India and Pakistan (n=4500). Diagnosis of SMI will be confirmed using the Mini-international neuropsychiatric interview V.6.0. We will collect information about physical health and related health-risk behaviours (WHO STEPwise approach to Surveillance (STEPS)); severity of common mental disorders (Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder scale (GAD-7)) and health-related quality of life (EQ-5D-5L). We will measure blood pressure, height, weight and waist circumference according to WHO guidelines. We will also measure glycated haemoglobin, lipid profile, thyroid function, liver function, creatinine and haemoglobin. Prevalence rates of physical health conditions and health-risk behaviours will be presented and compared with the WHO STEPS survey findings in the general population. Regression analyses will explore the association between health-risk behaviours, mental and physical health conditions.

Ethics and dissemination

The study has been approved by the ethics committees of the Department of Health Sciences University of York (UK), Centre for Injury Prevention and Rehabilitation (Bangladesh), Health Ministry Screening Committee and Indian Council of Medical Research (India) and National Bioethics Committee (Pakistan). Findings will be disseminated in peer-reviewed articles, in local and international conferences and as reports for policymakers and stakeholders in the countries involved.

Trial registration number

ISRCTN88485933; 3 June 2019.
Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis protocol
Authors: Khumalo Gugulethu Eve , Lutge Elizabeth , Naidoo Praba , Mashamba-Thompson Tivani Phosa
Published: October 2020

Introduction

In sub-Saharan Africa (SSA), Human Immunodeficiency Virus (HIV) is the leading cause of morbidity and mortality. Community healthcare workers (CHWs) worldwide have been reported to be effective in strengthening the HIV programme by providing services such as adherence support, HIV education and safe sex education as part of their roles. The main aim of this meta-synthesis is to synthesise qualitative evidence on studies that have been conducted in SSA countries to understand the barriers to and facilitators of providing HIV services by CHWs across all settings

Methods and analysis

This meta-synthesis will be guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An initial search was conducted on 15 November 2019 for studies published between 2009 and 2019 using the population exposure outcome nomenclature. We searched the EBSCOHost- (ERIC; Health Source-Nursing/Academic Edition), Google Scholar and PubMed databases for the relevant studies. The Ritchie and Spencer framework will be used for data synthesis and the Supporting the Use of Research Evidence Framework analysis will be used to analyse data. We will conduct critical appraisal on selected studies using the Qualitative Assessment and Review Instrument to limit risk of bias.

Ethics and dissemination

This review does not involve any human participants and therefore ethical approval will not be required. We will publish the protocol as well as the findings in any relevant journal and various media namely conferences; symposia, local and international health stakeholders.

PROSPERO registration number

CRD42020160012.

Conclusion

Evidence from this review will provide synthesised evidence to the utilisation of CHWs in HIV services in SSA.
UK cardiac rehabilitation fit for purpose? A community-based observational cohort study
Authors: Ibeggazene Saïd , Moore Chelsea , Tsakirides Costas , Swainson Michelle , Ispoglou Theocharis , Birch Karen
Published: October 2020

Objectives

This study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables.

Design

Observational cohort study.

Setting

Outpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks.

Participants

Sixty patients (45 male/15 female 33–86 years) were recruited following referral to local outpatient CR.

Outcome measures

The primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours.

Results

The mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p<0.001); however, blood pressure, body weight, endothelial function, arterial stiffness and habitual physical activity behaviours were unchanged following 6 weeks of CR (p>0.05).

Conclusion

Patients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.
‘A sword of Damocles’: patient and caregiver beliefs, attitudes and perspectives on presymptomatic testing for autosomal dominant polycystic kidney disease: a focus group study
Authors: Logeman Charlotte , Cho Yeoungjee , Sautenet Benedicte , Rangan Gopala K , Gutman Talia , Craig Jonathan , Ong Albert , Chapman Arlene , Ahn Curie , Coolican Helen , Tze-Wah Kao Juliana , Gansevoort Ron T , Perrone Ronald , Harris Tess , Torres Vincent , Fowler Kevin , Pei York , Kerr Peter , Ryan Jessica , Johnson David , Viecelli Andrea , Geneste Clair , Kim Hyunsuk , Kim Yaerim , Howell Martin , Ju Angela , Manera Karine E , Teixeira-Pinto Armando , Parasivam Gayathri , Tong Allison
Published: October 2020

Background and objectives

Presymptomatic testing is available for early diagnosis of hereditary autosomal dominant polycystic kidney disease (ADPKD). However, the complex ethical and psychosocial implications can make decision-making challenging and require an understanding of patients’ values, goals and priorities. This study aims to describe patient and caregiver beliefs and expectations regarding presymptomatic testing for ADPKD.

Design, setting and participants

154 participants (120 patients and 34 caregivers) aged 18 years and over from eight centres in Australia, France and Korea participated in 17 focus groups. Transcripts were analysed thematically.

Results

We identified five themes: avoiding financial disadvantage (insecurity in the inability to obtain life insurance, limited work opportunities, financial burden); futility in uncertainty (erratic and diverse manifestations of disease limiting utility, taking preventive actions in vain, daunted by perplexity of results, unaware of risk of inheriting ADPKD); lacking autonomy and support in decisions (overwhelmed by ambiguous information, medicalising family planning, family pressures); seizing control of well-being (gaining confidence in early detection, allowing preparation for the future, reassurance in family resilience); and anticipating impact on quality of life (reassured by lack of symptoms, judging value of life with ADPKD).

Conclusions

For patients with ADPKD, presymptomatic testing provides an opportunity to take ownership of their health through family planning and preventive measures. However, these decisions can be wrought with tensions and uncertainty about prognostic implications, and the psychosocial and financial burden of testing. Healthcare professionals should focus on genetic counselling, mental health and providing education to patients’ families to support informed decision-making. Policymakers should consider the cost burden and risk of discrimination when informing government policies. Finally, patients are recommended to focus on self-care from an early age.
The Child and Parent Emotion Study: protocol for a longitudinal study of parent emotion socialisation and child socioemotional development
Authors: Westrupp Elizabeth M , Macdonald Jacqui A , Bennett Clair , Havighurst Sophie , Kehoe Christiane E , Foley Denise , Berkowitz Tomer S , King Gabriella Louise , Youssef George J
Published: October 2020

Introduction

Parents shape child emotional competence and mental health via their beliefs about children’s emotions, emotion-related parenting, the emotional climate of the family and by modelling emotion regulation skills. However, much of the research evidence to date has been based on small samples with mothers of primary school-aged children. Further research is needed to elucidate the direction and timing of associations for mothers and fathers/partners across different stages of child development. The Child and Parent Emotion Study (CAPES) aims to examine longitudinal associations between parent emotion socialisation, child emotion regulation and socioemotional adjustment at four time points from pregnancy to age 12 years. CAPES will investigate the moderating role of parent gender, child temperament and gender, and family background.

Methods and analysis

CAPES recruited 2063 current parents from six English-speaking countries of a child 0–9 years and 273 prospective parents (ie, women/their partners pregnant with their first child) in 2018–2019. Participants will complete a 20–30 min online survey at four time points 12 months apart, to be completed in December 2022. Measures include validated parent-report tools assessing parent emotion socialisation (ie, parent beliefs, the family emotional climate, supportive parenting and parent emotion regulation) and age-sensitive measures of child outcomes (ie, emotion regulation and socioemotional adjustment). Analyses will use mixed-effects regression to simultaneously assess associations over three time-point transitions (ie, T1 to T2; T2 to T3; T3 to T4), with exposure variables lagged to estimate how past factors predict outcomes 12 months later.

Ethics and dissemination

Ethics approval was granted by the Deakin University Human Research Ethics Committee and the Deakin University Faculty of Health Human Research Ethics Committee. We will disseminate results through conferences and open access publications. We will invite parent end users to co-develop our dissemination strategy, and discuss the interpretation of key findings prior to publication.

Trial registeration

Protocol pre-registration: DOI 10.17605/OSF.IO/NGWUY.
What are the contextual risk factors for low colorectal cancer screening uptake in El Paso County, Texas? Spatial cross-sectional analysis
Authors: Salinas Jennifer , Brito Jacquelyn , Rincones Cheyenne , Shokar Navkiran K
Published: October 2020

Objective

This study examines the geographical and socioeconomic factors associated with uptake of colorectal cancer (CRC) screening (colonoscopies or faecal immunochemical test (FIT) testing).

Design

Secondary data analysis.

Setting

The Against Colorectal Cancer in our Community (ACCION) programme was implemented in El Paso County, Texas, to increase screening rates among the uninsured and underinsured.

Participants

We successfully geocoded 5777 who were offered a free colonoscopy or FIT testing kit.

Primary outcome measure

Census-tract CRC screening uptake average.

Results

Medicare recipient mortality (β=0.409, p-value=0.049) and % 65 years or older (β=−0.577, p value=0.000) were significant census tract contextual factors that were associated with the prevalence of CRC screening uptake in the geographically weighted Poisson regression. Neither Latino ethnicity nor immigrant concentration were significant predictors of CRC screening uptake in the ACCION programme. Hot spot analysis demonstrated that there was a significant low-value cluster in South Central El Paso. There was a similar hot spot for % 65 years or older in this same area, suggesting that uptake was lowest in an area that had the highest concentration of older adults.

Conclusion

The results from this study revealed not only feasibility of hot spot analysis but also its utility in geographically tracking successful CRC screening uptake in cancer prevention and intervention programmes.
Development and initial psychometric testing of the Intrahospital Transport Safety Scale in intensive care
Authors: Bergman Lina , Chaboyer Wendy , Pettersson Monica , Ringdal Mona
Published: October 2020

Objective

To develop and evaluate the psychometric properties of a scale measuring patient safety during the intrahospital transport process for intensive care.

Design

The scale was developed based on a theoretical model of the work system and patient safety, and items generated from participant observations. A Delphi study with international experts was used to establish content validity. Next, a cross-sectional study was undertaken to inform item reduction and evaluate construct validity and internal consistency.

Setting

The questionnaire was distributed to healthcare practitioners at 12 intensive care units in Sweden.

Participants

A total of 315 questionnaires were completed. Eligible participants were healthcare practitioners in the included units that performed an intrahospital transport during the study period. Inclusion criteria were (1) transports of patients within the hospital to undergo an examination or intervention, and (2) transports performed by staff from the intensive care unit. We excluded transports to a step-down unit or hospital ward.

Outcome measures

Psychometric evaluation, including item analysis, validity and reliability testing.

Results

Items were reduced from 55 to 24, informed by distributional statistics, initial reliabilities, factor loadings and communalities. The final factor model consisted of five factors, accounting for 59% of variance. All items loaded significantly on only one factor (>0.35). The original conceptual model of teamwork, transport-related tasks, tools and technologies, environment, and organisation was maintained with regrouping of items. Cronbach’s alpha ranged from 0.72 to 0.82 for each subscale (ie, factor).

Conclusions

The present study provides a self-report questionnaire to assess patient safety during intrahospital transport of patients in intensive care. The results indicate acceptable validity and reliability of the scale among a sample of Swedish healthcare practitioners. If further confirmatory testing supports the present results, this scale could be a useful tool to better understand safety prerequisites and improve clinical practice.
Is arthroplaSty bEtter than interNal fixation for undiSplaced femoral nEck fracture? A national pragmatic RCT: the SENSE trial
Authors: Viberg Bjarke , Kold Søren , Brink Ole , Larsen Morten Schultz , Hare Kristoffer Borbjerg , Palm Henrik
Published: October 2020

Introduction

Undisplaced femoral neck fractures (FNFs) are usually treated by internal fixation (IF) but two randomised controlled trials (RCTs) have demonstrated advantages of treatment with arthroplasty. The complication rate was lowered but there were no clinically improved patient-reported outcome measures (PROM), which could be due to underpowering or choice of selected PROM as the studies do appear to report a better functional outcome. We will conduct an RCT comparing IF with arthroplasties in patients aged over 65 years with an undisplaced FNF.

Methods and analysis

All hospitals in Denmark treating patients with hip fracture can provide patients for this study; therefore, the study can be considered a national RCT. Patients over 65 years old with an undisplaced FNF will be screened for eligibility and patients will only be excluded if they are unable to understand the study information (due to dementia or language), if they have a posterior tilt >20°, a pathological fracture or they cannot walk. Participants will be electronically randomised (in alternating blocks of 4 or 6) into either IF or arthroplasty. Postoperative care will follow the department standards.

Primary and secondary outcomes and measuring points have been established in collaboration with patients with hip fracture by focus group interviews. The primary outcome measure is the New Mobility Score assessed after 1 year. Secondary outcomes are the Oxford Hip Score, EuroQol 5 domain (EQ-5D-5L), degree of posterior tilt, pain Verbal Rating Scale, reoperation and mortality.

Ethics and dissemination

The study is approved by the Danish Data Protection Agency (19/7429) and the scientific ethics committee (S-20180036). All participants will sign an informed consent before entering the trial. Because this is a national trial, all relevant healthcare professionals in Denmark will automatically receive the trial results that will be published in international peer-reviewed journals.

Trial registration number

ClinicalTrials.gov Registry (NCT04075461).
Validation of an integrated service model, Health-RESPECT, for older patients in long-term care institution using information and communication technologies: protocol of a cluster randomised controlled trial
Authors: Choi Jung-Yeon , Kim Kwang-il , Kim Hongsoo , Jung Young-il , Oh In-Hwan , Chun Seungyeon , Kim Gi-Soo , Lim Jae-Young , Ko Jin Young
Published: October 2020

Introduction

There is an increased healthcare need to manage institutionalised older patients owing to the ageing population. To overcome substantial future challenges, the Health-RESPECT (caRE Systems for Patients/Elderly with Coordinated care using icT), a new information and communication technologies based integrated management service model, was developed to provide effective management, enable consultation with distant professionals and share medical information between acute care hospitals and long-term care institutions.

Methods and analysis

A cluster randomised controlled trial will be conducted to examine the effectiveness of the Health-RESPECT in older patients with chronic diseases and their medical staff in charge. Intervention involves registration with simple comprehensive geriatric assessment, establishment of an individualised care plan for three chronic diseases (hypertension, diabetes and heart failure), medication and rehabilitation management, periodic video-conference and in-system assessment after intervention period. Primary outcomes are control levels of the three chronic diseases, adequacy of drug management and overall functional status. Patients will be assessed at before and after study period and 3 months after study ended. Analysis will be carried out with an intention-to-treat principle. In addition to evaluate intervention effects, clinical usability and economic evaluation will be assessed.

Ethics and dissemination

The study protocol was reviewed and approved by the Seoul National University Bundang Hospital Institutional Review Board. Study findings will be published in peer-reviewed journals.

Trial registration number

KCT0004360.
Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries
Authors: Gupta Neil , Coates Matthew M , Bekele Abebe , Dupuy Roodney , Fénelon Darius Leopold , Gage Anna D , Getachew Theodros , Karmacharya Biraj Man , Kwan Gene F , Lulebo Aimée M , Masiye Jones K , Mayige Mary Theodory , Ndour Mbaye Maïmouna , Mridha Malay Kanti , Park Paul H , Dagnaw Wubaye Walelgne , Wroe Emily B , Bukhman Gene
Published: October 2020

Context and objectives

Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions.

Design

Secondary analysis of existing cross-sectional survey data.

Setting

We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country.

Outcome measures

We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities.

Results

Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1–2 hypertension (28%–83%). Availability was low for type 1 diabetes (1%–70%), type 2 diabetes (3%–57%), asthma (0%–7%) and acute presentations of diabetes (0%–26%) and asthma (0%–4%). Few hospitals had equipment or medications for heart failure (0%–32%), rheumatic heart disease (0%–23%), hypertensive emergencies (0%–64%) or acute minor surgical conditions (0%–5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability.

Conclusions

Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.
Effects of in-hospital breast feeding on brain function development in preterm infants in China: study protocol for a prospective longitudinal cohort study
Authors: Yang Rui , Zhang Yao , Wang Hua , Xu Xinfen
Published: October 2020

Introduction

Due to immature brain development, preterm infants are more likely to develop neurological developmental defects compared with full-term infants. Most preterm infants without neurodevelopmental damage can eventually reach the same scholastic level as their same-age peers; however, some show persistent impairment. Breast feeding (BF), which is an important public health measure, is of great significance for preterm infants. Various active substances in breast milk promote the development of the brain and central nervous system in premature infants. We present a protocol for a prospective longitudinal cohort study to explore the effect of in-hospital BF on brain development in preterm infants and possible influencing factors.

Methods and analysis

This study will enrol 247 Chinese preterm infants (gestational age: 30–34 weeks) delivered in Women’s Hospital School of Medicine, Zhejiang University, and transferred to the neonatal intensive care unit. Demographic, clinical and in-hospital BF data will be collected through electronic medical records. Moreover, follow-up data will be obtained by telephone, interview or online. Measurements will be obtained using the Breastfeeding Self-Efficacy Scale-Short Form, neuroimaging with functional near-infrared spectroscopy, extrauterine growth restriction and the Ages and Stages Questionnaire. Follow-up will be performed at 3, 6 and 12 months after birth.

Ethics and dissemination

This study has been approved by the Women’s Hospital School of Medicine Zhejiang University Medical Ethics Committee (2019-058). The study results are expected to be published in peer-reviewed journals and reported at relevant national and international conferences.

Trial registration number

ChiCTR1900027648; Pre-results.
Building community resilience to prevent and mitigate community impact of gun violence: conceptual framework and intervention design
Authors: Wang Emily A , Riley Carley , Wood George , Greene Ann , Horton Nadine , Williams Maurice , Violano Pina , Brase Rachel Michele , Brinkley-Rubinstein Lauren , Papachristos Andrew V , Roy Brita
Published: October 2020

Introduction

The USA has the highest rate of community gun violence of any developed democracy. There is an urgent need to develop feasible, scalable and community-led interventions that mitigate incident gun violence and its associated health impacts. Our community-academic research team received National Institutes of Health funding to design a community-led intervention that mitigates the health impacts of living in communities with high rates of gun violence.

Methods and analysis

We adapted ‘Building Resilience to Disasters’, a conceptual framework for natural disaster preparedness, to guide actions of multiple sectors and the broader community to respond to the man-made disaster of gun violence. Using this framework, we will identify existing community assets to be building blocks of future community-led interventions. To identify existing community assets, we will conduct social network and spatial analyses of the gun violence episodes in our community and use these analyses to identify people and neighbourhood blocks that have been successful in avoiding gun violence. We will conduct qualitative interviews among a sample of individuals in the network that have avoided violence (n=45) and those living or working on blocks that have not been a location of victimisation (n=45) to identify existing assets. Lastly, we will use community-based system dynamics modelling processes to create a computer simulation of the community-level contributors and mitigators of the effects of gun violence that incorporates local population-based based data for calibration. We will engage a multistakeholder group and use themes from the qualitative interviews and the computer simulation to identify feasible community-led interventions.

Ethics and dissemination

The Human Investigation Committee at Yale University School of Medicine (#2000022360) granted study approval. We will disseminate study findings through peer-reviewed publications and academic and community presentations. The qualitative interview guides, system dynamics model and group model building scripts will be shared broadly.
Utilisation of health services among urban patients who had an ischaemic stroke with different health insurance - a cross-sectional study in China
Authors: Yang Yong , Man Xiaowei , Nicholas Stephen , Li Shuo , Bai Qian , Huang Lieyu , Ma Yong , Shi Xuefeng
Published: October 2020

Objectives

This study investigates the disparities in the utilisation of patient health services for patients who had a stroke covered by different urban basic health insurance schemes in China.

Design

We conducted descriptive analysis based on a 5% random sample from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) in 2015, supplied by the China Health Insurance Research Association.

Setting

Chinese urban social insurance system.

Participants

A total of 56 485 patients who had a stroke were identified, including 36 487 UEBMI patients and 19 998 URBMI patients.

Primary and secondary outcome measures

The primary outcome measures include annual number of hospitalisations, average length of stay (ALOS) and average hospitalisation cost. Out-of-pocket (OOP) cost is the secondary outcome measure.

Results

The annual mean number of hospitalisations of UEBMI patients was 1.21 and 1.15 for URBMI patients. The ALOS was significantly longer for UEBMI than for URBMI patients (13.93 vs 10.82, p<0.001). Hospital costs were significantly higher for UEBMI than for URBMI patients (US$1724.02 vs US$986.59 (p<0.001), while the OOP costs were significantly higher for URBMI than for UEBMI patients (US$423.17 vs US$407.81 (p<0.001). Patients with UEBMI had higher reimbursement rate than URBMI patients (79.41% vs 66.92%, p<0.001) and a lower self-paid ratio than URBMI patients (23.65% vs 42.89%, p<0.001).

Conclusions

Significant disparities were found in the utilisation of hospital services between UEBMI and URBMI patients. Our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gaps in China’s health insurance schemes.
Cohort profile: molecular signature in pregnancy (MSP): longitudinal high-frequency sampling to characterise cross-omic trajectories in pregnancy in a resource-constrained setting
Authors: Brummaier Tobias , Syed Ahamed Kabeer Basirudeen , Wilaisrisak Pornpimon , Pimanpanarak Mupawjay , Win Aye Kyi , Pukrittayakamee Sasithon , Marr Alexandra K , Kino Tomoshige , Al Khodor Souhaila , Terranegra Annalisa , Carrara Verena I , Nosten Francois , Utzinger Jürg , Chaussabel Damien , Paris Daniel H , McGready Rose
Published: October 2020

Purpose

A successful pregnancy relies on the interplay of various biological systems. Deviations from the norm within a system or intersystemic interactions may result in pregnancy-associated complications and adverse pregnancy outcomes. Systems biology approaches provide an avenue of unbiased, in-depth phenotyping in health and disease. The molecular signature in pregnancy (MSP) cohort was established to characterise longitudinal, cross-omic trajectories in pregnant women from a resource constrained setting. Downstream analysis will focus on characterising physiological perturbations in uneventful pregnancies, pregnancy-associated complications and adverse outcomes.

Participants

First trimester pregnant women of Karen or Burman ethnicity were followed prospectively throughout pregnancy, at delivery and until 3 months post partum. Serial high-frequency sampling to assess whole blood transcriptomics and microbiome composition of the gut, vagina and oral cavity, in conjunction with assessment of gene expression and microbial colonisation of gestational tissue, was done for all cohort participants.

Findings to date

381 women with live born singletons averaged 16 (IQR 15–18) antenatal visits (13 094 biological samples were collected). At 5% (19/381) the preterm birth rate was low. Other adverse events such as maternal febrile illness 7.1% (27/381), gestational diabetes 13.1% (50/381), maternal anaemia 16.3% (62/381), maternal underweight 19.2% (73/381) and a neonate born small for gestational age 20.2% (77/381) were more often observed than preterm birth.

Future plans

Results from the MSP cohort will enable in-depth characterisation of cross-omic molecular trajectories in pregnancies from a population in a resource-constrained setting. Moreover, pregnancy-associated complications and unfavourable pregnancy outcomes will be investigated at the same granular level, with a particular focus on population relevant needs such as effect of tropical infections on pregnancy. More detailed knowledge on multiomic perturbations will ideally result in the development of diagnostic tools and ultimately lead to targeted interventions that may disproportionally benefit pregnant women from this resource-limited population.

Trial registration number

NCT02797327.
Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: frontline versus non-frontline healthcare workers
Authors: Alshekaili Muna , Hassan Walid , Al Said Nazik , Al Sulaimani Fatima , Jayapal Sathish Kumar , Al-Mawali Adhra , Chan Moon Fai , Mahadevan Sangeetha , Al-Adawi Samir
Published: October 2020

Objective

This study aims to assess and compare demographic and psychological factors and sleep status of frontline healthcare workers (HCWs) in relation to non-frontline HCWs.

Design, settings, participants and outcomes

This cross-sectional study was conducted from 8 April 2020 to 17 April 2020 using an online survey across varied healthcare settings in Oman accruing 1139 HCWs.

The primary and secondary outcomes were mental health status and sociodemographic data, respectively. Mental health status was assessed using the Depression, Anxiety, and Stress Scale (DASS-21), and insomnia was evaluated by the Insomnia Severity Index. Samples were categorised into the frontline and non-frontline groups. χ2 and t-tests were used to compare groups by demographic data. The Mantel-Haenszel OR was used to compare groups by mental health outcomes adjusted by all sociodemographic factors.

Results

This study included 1139 HCWs working in Oman. While working during the pandemic period, a total of 368 (32.3%), 388 (34.1%), 271 (23.8%) and 211 (18.5%) respondents were reported to have depression, anxiety, stress and insomnia, respectively. HCWs in the frontline group were 1.5 times more likely to report anxiety (OR=1.557, p=0.004), stress (OR=1.506, p=0.016) and insomnia (OR=1.586, p=0.013) as compared with those in the non-frontline group. No significant differences in depression status were found between the frontline and non-frontline groups (p=0.201).

Conclusions

To our knowledge, this is the first study to explore the differential impacts of the COVID-19 pandemic on different grades of HCWs. This study suggests that frontline HCWs are disproportionally affected compared to non-frontline HCWs, with managing sleep–wake cycles and anxiety symptoms being highly endorsed among frontline HCWs. As psychosocial interventions are likely to be constrained owing to the pandemic, mental healthcare must first be directed to frontline HCWs.
Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study
Authors: Santus Pierachille , Radovanovic Dejan , Saderi Laura , Marino Pietro , Cogliati Chiara , De Filippis Giuseppe , Rizzi Maurizio , Franceschi Elisa , Pini Stefano , Giuliani Fabio , Del Medico Marta , Nucera Gabriella , Valenti Vincenzo , Tursi Francesco , Sotgiu Giovanni
Published: October 2020

Objectives

COVID-19 causes lung parenchymal and endothelial damage that lead to hypoxic acute respiratory failure (hARF). The influence of hARF severity on patients’ outcomes is still poorly understood.

Design

Observational, prospective, multicentre study.

Setting

Three academic hospitals in Milan (Italy) involving three respiratory high dependency units and three general wards.

Participants

Consecutive adult hospitalised patients with a virologically confirmed diagnosis of COVID-19. Patients aged <18 years or unable to provide informed consent were excluded.

Interventions

Anthropometrical, clinical characteristics and blood biomarkers were assessed within the first 24 hours from admission. hARF was graded as follows: severe (partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) <100 mm Hg); moderate (PaO2/FiO2 101–200 mm Hg); mild (PaO2/FiO2 201–300 mm Hg) and normal (PaO2/FiO2 >300 mm Hg).

Primary and secondary outcome measures

The primary outcome was the assessment of clinical characteristics and in-hospital mortality based on the severity of respiratory failure. Secondary outcomes were intubation rate and application of continuous positive airway pressure during hospital stay.

Results

412 patients were enrolled (280 males, 68%). Median (IQR) age was 66 (55–76) years with a PaO2/FiO2 at admission of 262 (140–343) mm Hg. 50.2% had a cardiovascular disease. Prevalence of mild, moderate and severe hARF was 24.4%, 21.9% and 15.5%, respectively. In-hospital mortality proportionally increased with increasing impairment of gas exchange (p<0.001). The only independent risk factors for mortality were age ≥65 years (HR 3.41; 95% CI 2.00 to 5.78, p<0.0001), PaO2/FiO2 ratio ≤200 mm Hg (HR 3.57; 95% CI 2.20 to 5.77, p<0.0001) and respiratory failure at admission (HR 3.58; 95% CI 1.05 to 12.18, p=0.04).

Conclusions

A moderate-to-severe impairment in PaO2/FiO2 was independently associated with a threefold increase in risk of in-hospital mortality. Severity of respiratory failure is useful to identify patients at higher risk of mortality.

Trial registration number

NCT04307459
Classification of aerosol-generating procedures: a rapid systematic review
Authors: Jackson Tanya , Deibert Danika , Wyatt Graeme , Durand-Moreau Quentin , Adisesh Anil , Khunti Kamlesh , Khunti Sachin , Smith Simon , Chan Xin Hui S , Ross Lawrence , Roberts Nia , Toomey Elaine , Greenhalgh Trisha , Arora Isheeta , Black Susannah M , Drake Jonathan , Syam Nandana , Temple Robert , Straube Sebastian
Published: October 2020

In the context of covid-19, aerosol generating procedures have been highlighted as requiring a higher grade of personal protective equipment. We investigated how official guidance documents and academic publications have classified procedures in terms of whether or not they are aerosol-generating. We performed a rapid systematic review using preferred reporting items for systematic reviews and meta-analyses standards. Guidelines, policy documents and academic papers published in english or french offering guidance on aerosol-generating procedures were eligible. We systematically searched two medical databases (medline, cochrane central) and one public search engine (google) in march and april 2020. Data on how each procedure was classified by each source were extracted. We determined the level of agreement across different guidelines for each procedure group, in terms of its classification as aerosol generating, possibly aerosol-generating, or nonaerosol-generating. 128 documents met our inclusion criteria; they contained 1248 mentions of procedures that we categorised into 39 procedure groups. Procedures classified as aerosol-generating or possibly aerosol-generating by ≥90% of documents included autopsy, surgery/postmortem procedures with high-speed devices, intubation and extubation procedures, bronchoscopy, sputum induction, manual ventilation, airway suctioning, cardiopulmonary resuscitation, tracheostomy and tracheostomy procedures, non-invasive ventilation, high-flow oxygen therapy, breaking closed ventilation systems, nebulised or aerosol therapy, and high frequency oscillatory ventilation. Disagreements existed between sources on some procedure groups, including oral and dental procedures, upper gastrointestinal endoscopy, thoracic surgery and procedures, and nasopharyngeal and oropharyngeal swabbing. There is sufficient evidence of agreement across different international guidelines to classify certain procedure groups as aerosol generating. However, some clinically relevant procedures received surprisingly little mention in our source documents. To reduce dissent on the remainder, we recommend that (a) clinicians define procedures more clearly and specifically, breaking them down into their constituent components where possible; (b) researchers undertake further studies of aerosolisation during these procedures; and (c) guideline-making and policy-making bodies address a wider range of procedures.
Decline of ovarian function in patients with rheumatoid arthritis: serum anti-Müllerian hormone levels in a longitudinal cohort
Authors: Brouwer Jenny , Dolhain Radboud J E M , Hazes Johanna M W , Erler Nicole S , Visser Jenny A , Laven Joop S E
Published: October 2020

Objective

Rheumatoid arthritis (RA) often affects women in their fertile age, and is known to compromise female fertility. Serum anti-Müllerian hormone (AMH) levels are a proxy for the total number of primordial follicles, and a reliable predictor of the age at menopause. Our objective was to study the longitudinal intra-individual decline of serum AMH levels in female RA patients.

Methods

Female RA patients from a nationwide prospective cohort (2002–2008) were re-assessed in 2015–2016. Serum AMH levels were measured using the picoAMH assay and compared with healthy controls. A linear mixed model (LMM) was built to assess the effect of RA-related clinical factors on the decline of AMH levels.

Results

A group of 128 women were re-assessed at an age of 42.6±4.4 years, with a median disease duration of 15.8 (IQR 12.7–21.5) years. The time between first and last AMH assessments was 10.7±1.8 (range 6.4–13.7) years. Participants represented a more fertile selection of the original cohort. At follow-up, 39% of patients had AMH levels below the 10th percentile of controls (95% CI 31% to 48%), compared with 16% (95% CI 9.3% to 22%) at baseline. The LMM showed a significant decline of AMH with increasing age, but no significant effect of RA-related factors on AMH.

Conclusion

AMH levels in RA patients showed a more pronounced decline over time than expected, supporting the idea that in chronic inflammatory conditions, reproductive function is compromised, resulting in a faster decline of ovarian function over time and probably an earlier age at menopause.
Effects of dosage of warm mix asphalt additive on stiffness, cracking susceptibility, and moisture sensitivity characteristics
Authors: Materu Salvatory , Shalaby Ahmed , Ghazy Ahmed
Published: October 2020

Warm mix asphalt (WMA) technology has the capability of lowering asphalt mixing and compacting temperature by 30 °C or more without compromising the performance of asphalt pavement. This results to a lower cooling rate that allows for long haul, and sufficient compaction time. The objective of this study is to evaluate the effectiveness of the common chemical additives on the properties of WMA mixtures through field and laboratory testing programs. Three dosages (0.3, 0.5, and 0.7% by weight of asphalt cement) were used without changing the job mix formula. Among the different additive dosage used, 0.5% had a better overall performance. For example, the moisture sensitivity test for the 0.5% WMA indicated the highest tensile strength ratio; subsequently, low moisture damage. All WMA mixtures had low rutting resistance potential and higher cracking resistance compared to conventional mix.
Charged-pion production in $$\mathbf {Au+Au}$$ collisions at $$\sqrt{\mathbf {s}_{\mathbf {NN}}} = 2.4~{\mathbf {GeV}}$$
Authors:   HADES Collaboration, Adamczewski-Musch J. , Arnold O. , Behnke C. , Belounnas A. , Belyaev A. , Berger-Chen J. C. , Blanco A. , Blume C. , Böhmer M. , Bordalo P. , Chernenko S. , Chlad L. , Ciepał I. , Deveaux C. , Dreyer J. , Epple E. , Fabbietti L. , Fateev O. , Filip P. , Fonte P. , Franco C. , Friese J. , Fröhlich I. , Galatyuk T. , Garzón J. A. , Gernhäuser R. , Gläßel S. , Golubeva M. , Greifenhagen R. , Guber F. , Gumberidze M. , Harabasz S. , Heinz T. , Hennino T. , Hlavac S. , Höhne C. , Holzmann R. , Ierusalimov A. , Ivashkin A. , Kämpfer B. , Karavicheva T. , Kardan B. , Koenig I. , Koenig W. , Kohls M. , Kolb B. W. , Korcyl G. , Kornakov G. , Kornas F. , Kotte R. , Kugler A. , Kunz T. , Kurepin A. , Kurilkin A. , Kurilkin P. , Ladygin V. , Lalik R. , Lapidus K. , Lebedev A. , Lopes L. , Lorenz M. , Mahmoud T. , Maier L. , Malige A. , Mangiarotti A. , Markert J. , Matulewicz T. , Maurus S. , Metag V. , Michel J. , Mihaylov D. M. , Morozov S. , Müntz C. , Münzer R. , Naumann L. , Nowakowski K. , Parpottas Y. , Pechenov V. , Pechenova O. , Petukhov O. , Piasecki K. , Pietraszko J. , Przygoda W. , Pysz K. , Ramos S. , Ramstein B. , Rathod N. , Reshetin A. , Rodriguez-Ramos P. , Rosier P. , Rost A. , Rustamov A. , Sadovsky A. , Salabura P. , Scheib T. , Schuldes H. , Schwab E. , Scozzi F. , Seck F. , Sellheim P. , Selyuzhenkov I. , Siebenson J. , Silva L. , Singh U. , Smyrski J. , Sobolev Yu. G. , Spataro S. , Spies S. , Ströbele H. , Stroth J. , Sturm C. , Svoboda O. , Szala M. , Tlusty P. , Traxler M. , Tsertos H. , Usenko E. , Wagner V. , Wendisch C. , Wiebusch M. G. , Wirth J. , Wójcik D. , Zanevsky Y. , Zumbruch P.
Published: October 2020

We present high-statistic data on charged-pion emission from Au + Au collisions at $$\sqrt{s_{\mathrm{NN}}} = 2.4~\hbox {GeV}$$

s
NN

=
2.4

GeV

(corresponding to $$E_{beam} = 1.23~\hbox {A GeV}$$

E

beam

=
1.23

A GeV

) in four centrality classes in the range 0–40% of the most central collisions. The data are analyzed as a function of transverse momentum, transverse mass, rapidity, and polar angle. Pion multiplicity per participating nucleon decreases moderately with increasing centrality. The polar angular distributions are found to be non-isotropic even for the most central event class. Our results on pion multiplicity fit well into the general trend of the available world data, but undershoot by $$2.5~\sigma $$

2.5

σ

data from the FOPI experiment measured at slightly lower beam energy. We compare our data to state-of-the-art transport model calculations (PHSD, IQMD, PHQMD, GiBUU and SMASH) and find substantial differences between the measurement and the results of these calculations.
Resampling algorithms for high energy physics simulations
Authors: Olsson Jimmy , Plätzer Simon , Sjödahl Malin
Published: October 2020

We demonstrate that the method of interleaved resampling in the context of parton showers can tremendously improve the statistical convergence of weighted parton shower evolution algorithms. We illustrate this by several examples showing significant statistical improvement.