bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the prevalence of hypertension and its associated risk factors in a population-based study: Fasa PERSIAN COHORT data
Authors: Bijani Mostafa , Parvizi Saeed , Dehghan Azizallah , Sedigh-Rahimabadi Massih , Rostami-chijan Mahsa , Kazemi Maryam , Naghizadeh Mohammad Mehdi , Ghaemi Alireza , Homayounfar Reza , Farjam Mojtaba
Published: November 2020

Background

A high prevalence rate of hypertension (HTN) and its subsequent serious complications made this disease a major health-treatment concern in many societies. The current study aimed to investigate the prevalence of hypertension and its associated risk factors in Fasa PERSIAN COHORT in south of Iran in 2019.

Methods

This was an analytical-cross sectional study. The study population were the individuals covered by Fasa cohort. Information of the first phase of Fasa Persian cohort in south of Iran was used in this study. Independent t test, chi-square test, analysis of variances, Pearson correlation coefficient, and multiple stepwise regression were used to analyze the obtained data. Thereafter, the data was analyzed using SPSS software version 22, and P value < 0.05 was considered as statistically significant.

Results

Out of 10,111 individuals included in the study, 5546 (54.86%) subjects were women and 4565 (45.16%) other were men. The overall prevalence rate of hypertension was estimated as 46.6%. In the present study, (16/1%) of the participants were with HTN stage 1, and (17/9%) of them were with HTN stage 2. The results show that there were significant positive correlations among HTN and age, BMI, HDL, TG, BUN, ALP, smoking, physical activity, cardiovascular diseases, diabetes, and renal failure (P < 0.5).

Conclusions

Prevalence of HTN in this study population is considerable. Therefore, it is suggested that health system should program some plans to prevent hypertension’s prevalence and eliminate its risk factors.
Statistical methods for the analysis of adverse event data in randomised controlled trials: a scoping review and taxonomy
Authors: Phillips Rachel , Sauzet Odile , Cornelius Victoria
Published: November 2020

Background

Statistical methods for the analysis of harm outcomes in randomised controlled trials (RCTs) are rarely used, and there is a reliance on simple approaches to display information such as in frequency tables. We aimed to identify whether any statistical methods had been specifically developed to analyse prespecified secondary harm outcomes and non-specific emerging adverse events (AEs).

Methods

A scoping review was undertaken to identify articles that proposed original methods or the original application of existing methods for the analysis of AEs that aimed to detect potential adverse drug reactions (ADRs) in phase II-IV parallel controlled group trials. Methods where harm outcomes were the (co)-primary outcome were excluded.

Information was extracted on methodological characteristics such as: whether the method required the event to be prespecified or could be used to screen emerging events; and whether it was applied to individual events or the overall AE profile. Each statistical method was appraised and a taxonomy was developed for classification.

Results

Forty-four eligible articles proposing 73 individual methods were included. A taxonomy was developed and articles were categorised as: visual summary methods (8 articles proposing 20 methods); hypothesis testing methods (11 articles proposing 16 methods); estimation methods (15 articles proposing 24 methods); or methods that provide decision-making probabilities (10 articles proposing 13 methods). Methods were further classified according to whether they required a prespecified event (9 articles proposing 12 methods), or could be applied to emerging events (35 articles proposing 61 methods); and if they were (group) sequential methods (10 articles proposing 12 methods) or methods to perform final/one analyses (34 articles proposing 61 methods).

Conclusions

This review highlighted that a broad range of methods exist for AE analysis. Immediate implementation of some of these could lead to improved inference for AE data in RCTs. For example, a well-designed graphic can be an effective means to communicate complex AE data and methods appropriate for counts, time-to-event data and that avoid dichotomising continuous outcomes can improve efficiencies in analysis. Previous research has shown that adoption of such methods in the scientific press is limited and that strategies to support change are needed.

Trial registration

PROSPERO registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=97442
An assessment of the potential miscalibration of cardiovascular disease risk predictions caused by a secular trend in cardiovascular disease in England
Authors: Pate Alexander , van Staa Tjeerd , Emsley Richard
Published: November 2020

Background

A downwards secular trend in the incidence of cardiovascular disease (CVD) in England was identified through previous work and the literature. Risk prediction models for primary prevention of CVD do not model this secular trend, this could result in over prediction of risk for individuals in the present day. We evaluate the effects of modelling this secular trend, and also assess whether it is driven by an increase in statin use during follow up.

Methods

We derived a cohort of patients (1998–2015) eligible for cardiovascular risk prediction from the Clinical Practice Research Datalink with linked hospitalisation and mortality records (N = 3,855,660). Patients were split into development and validation cohort based on their cohort entry date (before/after 2010). The calibration of a CVD risk prediction model developed in the development cohort was tested in the validation cohort. The calibration was also assessed after modelling the secular trend. Finally, the presence of the secular trend was evaluated under a marginal structural model framework, where the effect of statin treatment during follow up is adjusted for.

Results

Substantial over prediction of risks in the validation cohort was found when not modelling the secular trend. This miscalibration could be minimised if one was to explicitly model the secular trend. The reduction in risk in the validation cohort when introducing the secular trend was 35.68 and 33.24% in the female and male cohorts respectively. Under the marginal structural model framework, the reductions were 33.31 and 32.67% respectively, indicating increasing statin use during follow up is not the only the cause of the secular trend.

Conclusions

Inclusion of the secular trend into the model substantially changed the CVD risk predictions. Models that are being used in clinical practice in the UK do not model secular trend and may thus overestimate the risks, possibly leading to patients being treated unnecessarily. Wider discussion around the modelling of secular trends in a risk prediction framework is needed.
The global prevalence of turnover intention among general practitioners: a systematic review and meta-analysis
Authors: Shen Xing , Jiang Heng , Xu Hongbin , Ye Jun , Lv Chuanzhu , Lu Zuxun , Gan Yong
Published: November 2020

Background

General practitioners (GPs) are the foundation of any primary healthcare system. Their quality and quantity are directly associated with the effectiveness and quality of the health services of a nation. GPs’ shortage and turnover have become an important issue in developed and developing countries.

An accurate estimate of turnover intention prevalence among GPs would have important health policy implications, but the overall prevalence is unknown. We aimed to summarize the global prevalence of turnover intention and associated factors among GPs.

Methods

We systematically reviewed the PubMed, Embase, Web of Science and China National Knowledge Infrastructure (CNKI) databases from their inception up to May 2020, as well as the reference lists of all included studies. We included observational studies that reported data on turnover intention or their prevalence rate among GPs could be calculated based on the information provided. The prevalence rate of the turnover intentions was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I2 statistic. Differences by study level characteristics were estimated via subgroup analysis and meta-regression.

Results

A total of 25 cross-sectional studies were included (a total of 27,285 participants). The prevalence of turnover intention was 0.47 (95% CI: 0.39–0.55). Those having a lower level of salary (OR = 1.38, 95% CI: 1.13–1.63) and job satisfaction (OR = 1.35, 95% CI: 1.12–1.70) or having lower level of morale (OR = 2.68, 95% CI: 1.56–3.80) had a higher intention. In contrast, GPs with a lower level of professional title had a lower turnover intention (OR = 0.81, 95% CI: 0.65–0.98).

Conclusions

In this systematic review, approximately half of the GPs had the intention to leave their current posts worldwide. The factors associated with turnover intention were higher professional title, lower income level, lower job satisfaction and lower morale.
Preoperative low muscle mass is a predictor of falls within 12 months of surgery in patients with lumbar spinal stenosis
Authors: Wada Takashi , Tanishima Shinji , Kitsuda Yuki , Osaki Mari , Nagashima Hideki , Hagino Hiroshi
Published: November 2020

Background

Patients with lumbar spinal stenosis (LSS) may be at high risk of falls due to various factors. No effective fall risk assessments or fall prevention measures have been performed for patients with LSS because only a few studies have evaluated falls in these patients. This study aimed to evaluate the incidence and preoperative predictors of falls within 12 months of surgery in patients with LSS.

Methods

In this prospective study of 82 consecutive preoperative patients with LSS, preoperative demographic data, previous fall history, leg pain, low back pain, Japanese Orthopaedic Association (JOA) score, Hospital Anxiety and Depression Scale (HADS) scores, lower extremity muscle strength, walking speed, grip strength, and muscle mass were assessed at baseline. Falls were assessed at 3, 6, 9, and 12 months after surgery. Participants were categorized as fallers and non-fallers and baseline variables were compared. Binomial logistic regression was used to identify predictors of falls within 12 months of surgery.

Results

Seventy-four patients (90.2%) completed the 12-month follow-up after surgery, of whom 24 patients (32.4%) experienced falls. A higher proportion of fallers were female and had a history of falls compared to non-fallers. Fallers had a significantly lower JOA score and a higher HADS-depression score compared to non-fallers. Fallers had significantly lower tibialis anterior muscle strength, gait speed, grip strength, and skeletal muscle mass index. Fallers had a higher prevalence of low muscle mass compared with non-fallers. The presence of low muscle mass was significantly predictive of falls within 12 months of surgery (odds ratio, 4.46; 95% confidence interval, 1.02–19.63).

Conclusions

Patients with LSS have a high incidence of falls after surgery and preoperative low muscle mass may be a predictor of postoperative falls.
Prevalence of malnutrition inflammation complex syndrome among patients on maintenance haemodialysis at Muhimbili National Hospital in Tanzania: a cross-sectional study
Authors: Bramania Puneet K. , Ruggajo Paschal , Bramania Rimal , Mahmoud Muhiddin , Furia Francis F.
Published: November 2020

Background

Malnutrition, inflammation, and the combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.

Methods

This was a prospective cross-sectional observational study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess MICS and its severity. Data analysis was done using the SPSS 20 software.

Results

Of the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%).

Long-term haemodialysis (> 4 years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p < 0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01–0.97), p < 0.05]. Patients with MICS had significantly lower mean body mass index, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy did not correlate with MICS.

Conclusion

Malnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients.
Diabetes risk status and physical activity in pregnancy: U.S. BRFSS 2011, 2013, 2015, 2017
Authors: Rand Bethany G. , Johnson Tammie M. , Ehrlich Samantha F. , Wideman Laurie , Pivarnik James M. , Richardson Michael R. , Stone Michelle L. , Churilla James R.
Published: November 2020

Background

Pregnant women without complications are advised to engage in physical activity (PA) to mitigate adverse outcomes. Differences may exist among pregnant women of diverging diabetes status in meeting national PA recommendations. We sought to examine differences in aerobic activity (AA) and muscle strengthening activity (MSA) by diabetes risk status (DRS) among pregnant women in the United States.

Methods

The sample (n = 9,597) included pregnant women, age 18–44 years, who participated in the 2011, 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System. Levels of DRS include: no diabetes (ND), high risk for diabetes (HRD) due to self-reported gestational diabetes or pre-diabetes, and overt diabetes due to self-reported, clinically diagnosed diabetes (DM). Odds ratios (ORs) and 95% confidence intervals (CI) for meeting PA recommendations were obtained. Covariates included age, race, education, household child count, alcohol consumption, and smoking status.

Results

Findings revealed that on average, DM had 46.5 fewer minutes of weekly AA compared to ND. Furthermore, a significantly lower OR (0.39; CI 0.19–0.82) for meeting both recommendations was observed in DM as compared to ND after adjustment.

Conclusions

We observed that pregnant women with overt diabetes had a lower odds of engaging in PA, while those at high risk were similar in their PA engagement to ND. Future studies aimed at assessing determinants of PA behavior may help guide efforts to promote exercise in pregnant women with diabetes.
Maternal health behaviors during pregnancy in rural Northwestern China
Authors: Ma Yue , Gao Yujuan , Li Jason , Sun Andrew , Wang Baozhu , Zhang Jun , Dill Sarah-Eve , Medina Alexis , Rozelle Scott
Published: November 2020

Background

Maternal health during pregnancy is a key input in fetal health and child development. This study aims to systematically describe the health behaviors of pregnant women in rural China and identify which subgroups of women are more likely to engage in unhealthy behaviors during pregnancy.

Methods

We surveyed 1088 pregnant women in rural northwestern China on exposure to unhealthy substances, nutritional behaviors, the timing and frequency of antenatal care, and demographic characteristics.

Results

Pregnant women were active in seeking antenatal care and had low rates of alcohol consumption (5.1%), exposure to toxins (4.8%), and exposure to radiation (2.9%). However, tobacco exposure was widespread (40.3%), as was low dietary diversity (61.8%), unhealthy weight gain (59.7%), unhealthy pre-pregnancy BMI (29.7%), and no folic acid intake (17.1%). Maternal education is closely linked to better health behaviors, whereas experience with a previous pregnancy is not.

Conclusions

Tobacco exposure and unhealthy nutritional behaviors are common among pregnant women in rural northwestern China. The findings indicate that in the absence of professional health information, relying on experience of previous pregnancies alone may not help rural women avoid unhealthy maternal behaviors. Maternal health education campaigns targeting nutrition and tobacco exposure during pregnancy may improve maternal, fetal, and child health in rural China.
The age threshold of the 8th edition AJCC classification is useful for indicating patients with aggressive papillary thyroid cancer in clinical practice
Authors: Kaliszewski Krzysztof , Diakowska Dorota , Nowak Łukasz , Wojtczak Beata , Rudnicki Jerzy
Published: November 2020

Background

Papillary thyroid cancer (PTC) is unique among cancers in that patient age is a consideration in staging. One of the most important modifications in the 8th Edition of the American Joint Committee on Cancer (AJCC) classification is to increase the age cut off for risk stratification in PTC from 45 to 55 years. However, whether this cut off is useful in clinical practice remains controversial. In the present study, we assessed how well this new age threshold stratifies patients with aggressive PTC.

Methods

We retrospectively analyzed the clinicopathological features and overall survival rate of patients with PTC admitted to and surgically treated at a single surgical center. The study protocol was divided into two series. In each series all patients (n = 523) were divided in 2 groups according to age cut off. In the first series (cut off 45) patients < 45 (n = 193) vs. ≥45 (n = 330) were compared, and in the second series (cut off 55) patients < 55 (n = 306) vs. ≥55 (n = 217) were compared.

Results

The rate of the prevalence of locally advanced disease (pT3 and pT4) was significantly higher in the patients above 55 years old than in those below 55 years old (p = 0.013). No significant differences were found for this parameter in series with cut off point 45 years old. A significantly higher risk of locally advanced disease T3 + T4 (OR = 4.87) and presence of LNM (N1) (OR = 3.78) was observed in ≥45 years old group (p = 0.021 and p < 0.0001, respectively). More expressive results were found for the patients ≥55 years old group, where the risk of locally advanced disease (T3 + T4) was higher (OR = 5.21) and LNM presence was OR = 4.76 (p < 0.001 and p < 0.0001, respectively). None of the patients below 55 years old showed distant metastasis, but 19 patients above 55 years old showed M1 (p < 0.0001). In older patients group (≥55 years old) we observed deaths related thyroid cancer in 11 individuals.

Conclusions

The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with a poor prognosis, indicating it is likely to be useful in clinical practice.
The use of the Hungarian Test Your Memory (TYM-HUN), MMSE, and ADAS-Cog tests for patients with mild cognitive impairment (MCI) in a Hungarian population: a cross-sectional study
Authors: Garbóczy Szabolcs , Magócs Éva , Szőllősi Gergő József , Harsányi Szilvia , Égerházi Anikó , Kolozsvári László Róbert
Published: November 2020

Background

Mild cognitive impairment (MCI) often presages the development of Alzheimer’s disease (AD). Accurate and early identification of cognitive impairment will substantially reduce the burden on the family and alleviate the costs for the whole society. There is a need for testing methods that are easy to perform even in a general practitioner’s office, inexpensive and non-invasive, which could help the early recognition of mental decline. We have selected the Test Your Memory (TYM), which has proven to be reliable for detecting AD and MCI in several countries. Our study was designed to test the usability of the Hungarian version of the TYM (TYM-HUN) comparing with the Mini-Mental State Examination (MMSE) and the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) in MCI recognition in the Hungarian population.

Methods

TYM test was translated and validated into Hungarian (TYM-HUN) in a previous study. The TYM-HUN test was used in conjunction with and compared with the MMSE and the ADAS-Cog. For our study, 50 subjects were selected: 25 MCI patients and 25 healthy controls (HC). Spearman’s rank correlation was used to analyse the correlation between the scores of MMSE and ADAS-Cog with TYM-HUN and the receiver operating characteristic (ROC) curve was established.

Results

MCI can be distinguished from normal aging using TYM-HUN. We established a ‘cut-off’ point of TYM-HUN (44/45points) where optimal sensitivity (80%) and specificity (96%) values were obtained to screen MCI. The total TYM-HUN scores significantly correlated with the MMSE scores (ρ = 0.626; p < 0.001) and ADAS-Cog scores (ρ = − 0.723; p < 0.001).

Conclusions

Our results showed that the TYM-HUN is a reliable, fast, self-administered questionnaire with the right low threshold regarding MCI and can be used for the early diagnosis of cognitive impairment.
Impact of a community-based pilot intervention to tackle childhood obesity: a ‘whole-system approach’ case study
Authors: Gadsby E. W. , Hotham S. , Eida T. , Lawrence C. , Merritt R.
Published: November 2020

Background

Go-Golborne was a three-year pilot programme to test an innovative, community-based ‘whole system’ approach to preventing overweight in children in Golborne ward, London. Whilst there is a growing interest in local whole systems approaches to obesity, understandings of what they look like in practice are newly emerging. Go-Golborne was designed, implemented and evaluated within this context.

Methods

The evaluation used a case-study design and theory of change approach to assess the effectiveness of the intervention. Height/weight measurements of children in the six participating primary schools were recorded annually for 4 years. For behavioural outcomes, children aged six-11 completed four annual on-line surveys (total 4331 responses). Parents were surveyed in year one and year four (177 responses). Three focus group discussions were held with children aged 10–11 (N = 21); interviews were conducted with parents (N = 11), and school representatives (N = 4). Stakeholders were surveyed twice (37 responses), and interviews were conducted with key stakeholders (N = 11). An extensive range of programme documents were reviewed and additional process data was collected from the programme team. The RE-AIM framework was used to synthesise findings and examine public health impact.

Results

Go-Golborne reached a diverse range of partners across Golborne. Events were attended by over 3360 local children and families and all six primary schools in the ward actively engaged in activities. The proportion of children in the above healthy weight categories remained stable over time. A number of changes in home, school and neighbourhood environments to support healthy behaviour change were evidenced. There was some qualitative evidence of positive changes in children’s behaviours, though significant or sustained changes were not evidenced by the quantitative data.

Conclusions

Go-Golborne helped stakeholders and parents to develop a shared commitment to improving healthy weight in children, to identify barriers to a healthy lifestyle, and to start to make changes in their services/behaviours. The campaigns and changes made at micro-level appeared to be insufficient, in the face of counteracting forces and personal factors, to achieve significant behaviour change within 3 years. This highlights the need for local initiatives to be reinforced by supporting action at regional, national and global levels.
Health literacy levels of British adults: a cross-sectional survey using two domains of the Health Literacy Questionnaire (HLQ)
Authors: Simpson Rebecca M. , Knowles Emma , O’Cathain Alicia
Published: November 2020

Background

A person’s health literacy determines whether they are able to make appropriate health decisions and are able to follow treatment instructions. This is important because low health literacy is associated with mortality and extra costs to the healthcare system. Our aim was to describe the health literacy levels of British adults using a nationally representative population survey, and show how health literacy levels vary by population characteristics.

Methods

A population based cross-sectional survey including questions from two domains from the Health Literacy Questionnaire™: 1) Understanding health information well enough to know what to do, and 2) Ability to actively engage with health care providers. Both domains are made up of 5 Likert style questions with 5 levels ranging from ‘cannot do or always difficult’ (1) to ‘always easy’ (5). The survey was conducted by NatCen in Britain (2018) as part of the annual British Social Attitudes survey. We used weighted descriptive analyses and regression to explore the relationship between population characteristics and health literacy. Weighted analyses were used to ensure the sample was representative of the British population.

Results

A total of 2309 responded to the questionnaire. The mean score for ‘understanding information’ was 3.98 (95% CI: 3.94, 4.02) and for ‘ability to engage’ was 3.83 (95% CI: 3.80, 3.87), where 5 is the highest score. 19.4% had some level of difficulty reading and understanding written health information, and 23.2% discussing health concerns with health care providers. The adjusted logistic regression for ‘understanding information’ showed that those with lower health literacy were more likely to be in the most socially deprived quintile (OR 2.500 95% CI: 1.180, 5.296), have a limiting health condition or disability (OR 4.326 95% CI: 2.494, 7.704), and have no educational qualifications (OR 7.588 95% CI: 3.305, 17.422). This was similar for the ‘ability to engage’ domain.

Conclusions

This study described the distribution of health literacy levels for the British population in 2018. Interventions to improve health literacy will best be targeted at those with lower levels of education, those living in the most deprived areas, and those with a limiting health condition or disability.
A mixed-methods community-based participatory research to explore stakeholder’s perspectives and to quantify the effect of crop residue burning on air and human health in Central India: study protocol
Authors: Trushna Tanwi , Diwan Vishal , Nandi Subroto Shambhu , Aher Satish Bhagwatrao , Tiwari Rajnarayan R. , Sabde Yogesh Damodar
Published: November 2020

Background

Crop residue burning adversely affects air quality and consequently human health. India, being one of the largest agro-economies of the world, produces around 500 Million tonnes of crop residue annually most of which is burnt on-farm. However, integrated studies that simultaneously quantify the effects of crop residue burning while exploring the subjective determinants of the practice are lacking in India. This paper describes the protocol for a longitudinal mixed methods research study employing a community-based participatory approach to fill this gap.

Methods

Both quantitative and qualitative data will be collected in a rural setting of the central Indian province of Madhya Pradesh, over 1 year. A steering committee comprising of the research team and community representatives will be formed. The proportion of cultivable land burnt in one crop burning season will be estimated. The association between crop residue burning, level of ambient air pollutants, and pulmonary function of village residents will be determined. Focus groups, interviews, and participatory rural appraisal methods will be used to explore stakeholder perspectives about crop residue burning. Potential barriers and opportunities for substituting burning with an alternative crop residue management technique will be ascertained as the basis for future interventions. Ethics approval has been obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/BPL/IEC/2019–20/1494, dt 06/01/2020).

Discussion

This manuscript describes the protocol for a novel community-based participatory study to investigate thoroughly the phenomenon of crop residue burning from the perspective of the agricultural community through their active collaboration. The lack of comprehensive evidence regarding the factors responsible for crop residue burning in India underlines the importance of implementing this study protocol to fill in this critical gap in knowledge. While acknowledging that findings of this study will be not generalizable to agricultural communities other than the one studied, it is expected that the study will generate baseline evidence that might be beneficial in developing and implementing an appropriate intervention strategy.
Impact of COVID-19 on the health and psychosocial status of vulnerable older adults: study protocol for an observational study
Authors: Cheung Gary , Rivera-Rodriguez Claudia , Martinez-Ruiz Adrian , Ma’u Etuini , Ryan Brigid , Burholt Vanessa , Bissielo Ange , Meehan Brigette
Published: November 2020

Background

Many countries around the world have adopted social distancing as one of the public health measures to reduce COVID-19 transmissions in the community. Such measures could have negative effects on the mental health of the population. The aims of this study are to (1) track the impact of COVID-19 on self-reported mood, self-rated health, other health and psychosocial indicators, and health services utilization of people who have an interRAI assessment during the first year of COVID-19; (2) compare these indicators with the same indicators in people who had an interRAI assessment in the year before COVID-19; and (3) report these indicators publicly as soon as data analysis is completed every 3 months.

Methods

interRAI COVID-19 Study (iCoS) is an observational study on routinely collected national data using the interRAI Home Care and Contact Assessment, which are standardized geriatric assessment tools mandated for all people assessed for publicly funded home support services and aged residential care in New Zealand. Based on the 2018/19 figures, we estimated there are 36,000 interRAI assessments per annum. We will compare the four post-lockdown quarters (from 25th March 2020) with the respective pre-lockdown quarters. The primary outcomes are self-reported mood (feeling sad, depressed or hopeless: 0 = no, 1 = yes) and self-rated health (0 = excellent, 1 = good, 2 = fair, 3 = poor). We will also analyze sociodemographics, other secondary health and psychosocial indicators, and health services utilization. Descriptive statistics will be conducted for primary outcomes and other indicators for each of the eight quarters. We will compare the quarters using regression models adjusted for demographic characteristics using weights or additional variables. Key health and psychosocial indicators will be reported publicly as soon as data analysis is completed for each quarter in the 12-month post-lockdown period by using a data visualization tool.

Discussion

This rapid translation of routinely collected national interRAI data will provide a means to monitor the health and psychosocial well-being of vulnerable older New Zealanders. Insights from this study can be shared with other countries that use interRAI and prepare health and social services for similar epidemics/pandemics in the future.
Association of environmental factors and high HFMD occurrence in northern Thailand
Authors: Laor Pussadee , Apidechkul Tawatchai , Khunthason Siriyaporn , Keawdounglek Vivat , Sudsandee Suntorn , Fakkaew Krailak , Siriratruengsuk Weerayuth
Published: November 2020

Background

The major population vulnerable to hand, foot and mouth disease (HFMD) is children aged less than 5 years, particularly those who are cared for at day care centers (DCCs). This study aimed to assess the associations of environmental and sanitation factors with high HFMD occurrence rates in DCCs of northern Thailand.

Methods

A case-control study was used to gather information from caregivers and local government administrative officers. DCCs in areas with high and low HFMD occurrence rates were the settings for this study. A validated questionnaire was used to collect environmental and sanitation information from the DCCs. In-depth interviews were used to collect information from selected participants who were working at DCCs and from local government administrative officers on the HFMD capacity and prevention and control strategies in DCCs. Logistic regression analysis was used to determine the associations between many environmental factors and HFMD at the α = 0.05 significance level while the content analysis was used to extract information from the interviews.

Results

Two variables were found to be associated with a high rate of HFMD occurrence: the number of sinks available in restrooms and the DCC size. Children attending DCCs that did not meet the standard in terms of the number of sinks in restrooms had a greater chance of contracting HFMD than children who were attending DCCs that met the standard (AOR = 4.21; 95% CI = 1.13–15.04). Children who were attending a large-sized DCC had a greater chance of contracting HFMD than those attending a small-sized DCC (AOR = 3.28; 95% CI = 1.21–5.18). The yearly budget allocation and the strategies for HFMD control and prevention, including collaborations among stakeholders for HFMD control and prevention in DCCs, were associated with the effectiveness of HFMD control and prevention.

Conclusions

The number of sinks in restrooms and DCC size are major concerns for HFMD outbreaks. Sufficient budget allocation and good collaboration contribute to effective strategies for preventing and controlling HFMD in DCCs.
Migration and family planning in the state with highest total fertility rate in India
Authors: Mahapatra Bidhubhusan , Saggurti Niranjan , Mishra Raman , Walia Monika , Mukherjee Saradiya
Published: November 2020

Background

This study examined the relationship between male out-migration and family planning (FP) behaviour of women in rural Bihar.

Methods

Data was collected from 937 currently married women aged 15–34 years from two districts of Bihar, namely Nawada and Gopalganj. Respondents were selected through a multi-stage systematic sampling and were recruited from both low and high male out-migration blocks. Differences in FP outcomes—use of modern contraceptive methods, intention to use contraceptives in next 12 months and access to FP services—were assessed by volume of migration, husband’s migration status, frequency of return, and duration of husband’s stay at home during visits.

Results

Women with migrant husbands were about 50% less likely to use modern contraceptive methods. Further, the odds of using modern contraceptives was about half among women with migrant husbands if they resided in high out-migration areas (HMA) than low out-migration areas (LMA) (15% vs 29%, AOR: 0·50, p = 0·017). A higher proportion of women with migrant husbands, specifically from HMA, reported greater intention of using contraceptives in next 12 months than their counterparts (37% vs 23%, AOR: 1·83, p = 0·015). Similarly, access to FP services was negatively associated with the volume of male out-migration, specifically for women with migrant husbands.

Conclusions

The migratory environment as well as the migration of husbands affect contraceptive use and access to FP services among women. Given that a significant proportion of married males leave their home states for work, it is imperative that FP programs in migration affected areas plan and implement migration-centric FP implementation strategies.
Once is rarely enough: can social prescribing facilitate adherence to non-clinical community and voluntary sector health services? Empirical evidence from Germany
Authors: Golubinski Veronika , Wild Eva-Maria , Winter Vera , Schreyögg Jonas
Published: November 2020

Background

Non-clinical health interventions provided by the voluntary and community sector can improve patients’ health and well-being and reduce pressure on primary and secondary care, but only if patients adhere to them. This study provides novel insights into the impact of doctor referrals to such services, known as social prescribing, on patients’ adherence to them.

Methods

Using a negative binomial model, we analysed electronic visitor records from a community health advice and navigation service in Germany between January 2018 and December 2019 to determine whether social prescribing was associated with greater adherence to the service (measured in terms of return visits) compared to patients who self-referred. We also explored whether this effect differed according to patient characteristics.

Results

Based on 1734 observations, we found that social prescribing was significantly associated with a greater number of return visits compared to patient self-referrals (p < 0.05). For patients who visited the service because of psychological concerns, the effect of social prescribing was lower. For all other patient characteristics, the effect remained unchanged, suggesting relevance to all other patient groups.

Conclusions

The results of our study indicate that social prescribing may be an effective way to facilitate adherence to non-clinical community and voluntary sector health services. This knowledge is important for policy makers who are deciding whether to implement or expand upon social prescribing schemes.
Isolation of axenic cyanobacterium and the promoting effect of associated bacterium on axenic cyanobacterium
Authors: Gao Suqin , Kong Yun , Yu Jing , Miao Lihong , Ji Lipeng , Song Lirong , Zeng Chi
Published: November 2020

Background

Harmful cyanobacterial blooms have attracted wide attention all over the world as they cause water quality deterioration and ecosystem health issues. Microcystis aeruginosa associated with a large number of bacteria is one of the most common and widespread bloom-forming cyanobacteria that secret toxins. These associated bacteria are considered to benefit from organic substrates released by the cyanobacterium. In order to avoid the influence of associated heterotrophic bacteria on the target cyanobacteria for physiological and molecular studies, it is urgent to obtain an axenic M. aeruginosa culture and further investigate the specific interaction between the heterotroph and the cyanobacterium.

Results

A traditional and reliable method based on solid-liquid alternate cultivation was carried out to purify the xenic cyanobacterium M. aeruginosa FACHB-905. On the basis of 16S rDNA gene sequences, two associated bacteria named strain B905–1 and strain B905–2, were identified as Pannonibacter sp. and Chryseobacterium sp. with a 99 and 97% similarity value, respectively. The axenic M. aeruginosa FACHB-905A (Microcystis 905A) was not able to form colonies on BG11 agar medium without the addition of strain B905–1, while it grew well in BG11 liquid medium. Although the presence of B905–1 was not indispensable for the growth of Microcystis 905A, B905–1 had a positive effect on promoting the growth of Microcystis 905A.

Conclusions

The associated bacteria were eliminated by solid-liquid alternate cultivation method and the axenic Microcystis 905A was successfully purified. The associated bacterium B905–1 has the potentiality to promote the growth of Microcystis 905A. Moreover, the purification technique for cyanobacteria described in this study is potentially applicable to a wider range of unicellular cyanobacteria.
The impact of general self-efficacy and the severity of malocclusion on acceptance of removable orthodontic appliances in 10- to 12-year-old patients
Authors: Naseri Navid , Baherimoghadam Tahereh , Bassagh Niloofar , Hamedani Shahram , Bassagh Elmira , Hashemi Zahra
Published: November 2020

Background

The patients’ acceptance of a treatment plan and their subsequent cooperation play a crucial role in achieving the best results in orthodontic treatments. Evidences show some personality traits such as general self-efficacy (GSE) and some dental traits such as severity of malocclusion are correlated with motivation of orthodontic treatment. These factors may predict the patients’ compliance and acceptance in using removable orthodontic appliances. This cross sectional study was conducted to assess the correlation of GSE and the severity of malocclusion with patients’ acceptance in using removable orthodontic appliances.

Methods

This study recruited 50 patients aged 10–12 years who required removable orthodontic appliances. The severity of malocclusion was determined using the index of orthodontic treatment need (IOTN) before the onset of treatment and GSE of participants were assessed using GSE scale self-report. The acceptance questionnaire was proposed to the patients on first (T1), third (T2), and sixth (T3) month after the delivery of the appliance.

Results

The GSE score had a statistically significant correlation with the total score of the acceptance questionnaire, subscale score of satisfaction with the appliance during eating and oral hygiene practice, duration of usage of the appliance, and interest in using it (P < 0.05). The IOTN had no significant correlation with the acceptance questionnaire.

Conclusions

Our findings substantiate the role of the GSES, concurrently declining the role of the IOTN in prediction of 10–12-year-old children’s acceptance and cooperation in treatment of malocclusion with removable appliances.
Prevalence, virulence and antifungal activity of C. albicans isolated from infected root canals
Authors: Abraham Sheela B. , al Marzooq Farah , Himratul-Aznita Wan Harun , Ahmed Hany Mohamed Aly , Samaranayake Lakshman Perera
Published: November 2020

Background

There is limited data on the prevalence of Candida species in infected root canal systems of human teeth. We attempted to investigate the prevalence, genotype, virulence and the antifungal susceptibility of Candida albicans isolated from infected root canals of patients with primary and post-treatment infections in a UAE population.

Methods

Microbiological samples from 71 subjects with infected root canals were aseptically collected, and cultured on Sabouraud dextrose agar, and C. albicans was identified using multiplex polymerase chain reaction, and the isolates were further subtyped using ABC genotyping system. Their relative virulence was compared using further four archival samples of endodontic origin from another geographical region, and four more salivary isolates, as controls. The virulence attributes compared were biofilm formation, and production of phospholipase and haemolysin, and the susceptibility to nystatin, amphotericin B, ketoconazole, and fluoconazole was also tested.

Results

4 out of 71 samples (5.6%) yielded Candida species. On analysis of variance among the groups, the intracanal isolates, mainly Genotype A, possessed a high degree of phospholipase and haemolysin activity (p < 0.05). The UAE and Finland isolates were stronger biofilm formers and had superior phospholipase production capacity compared with the salivary isolates. All isolates were sensitive to the antifungal chemicals used. The salivary isolates were more sensitive to fluoconazole compared to other groups (p < 0.05).

Conclusion

The prevalence of C. albicans in infected root canals of patients attending a dental hospital in UAE is low. The strains isolated were good biofilm formers, possessed strong phospholipase and haemolysin activity and were mostly of the genotype A. The fact that the root canal isolates possessed significant hydrolase activity, imply that they are equipped with virulence attributes necessary for survival within a harsh intracanal ecosystem.
Development of an international Core Outcome Set (COS) for best care for the dying person: study protocol
Authors:   in collaboration with the iLIVE consortium, Zambrano Sofia C. , Haugen Dagny Faksvåg , van der Heide Agnes , Tripodoro Vilma A. , Ellershaw John , Fürst Carl Johan , Voltz Raymond , Mason Stephen , Daud María L. , De Simone Gustavo , Kremeike Kerstin , Halfdanardottir Svandis Iris , Sigurdardottir Valgerdur , Johnson Jeremy , Allan Simon , Hafeez Haroon , Simões Catarina , Sigurdardottir Katrin Ruth , Rasmussen Birgit H. , Williamson Paula , Eychmüller Steffen
Published: November 2020

Background

In contrast to typical measures employed to assess outcomes in healthcare such as mortality or recovery rates, it is difficult to define which specific outcomes of care are the most important in caring for dying individuals. Despite a variety of tools employed to assess different dimensions of palliative care, there is no consensus on a set of core outcomes to be measured in the last days of life.

In order to optimise decision making in clinical practice and comparability of interventional studies, we aim to identify and propose a set of core outcomes for the care of the dying person.

Methods

Following the COMET initiative approach, the proposed study will proceed through four stages to develop a set of core outcomes: In stage 1, a systematic review of the literature will identify outcomes measured in existing peer reviewed literature, as well as outcomes derived through qualitative studies. Grey literature, will also be included. Stage 2 will allow for the identification and determination of patient and proxy defined outcomes of care at the end of life via quantitative and qualitative methods at an international level. In stage 3, from a list of salient outcomes identified through stages 1 and 2, international experts, family members, patients, and patient advocates will be asked to score the importance of the preselected outcomes through a Delphi process. Stage 4 consists of a face-to-face consensus meeting of international experts and patient/family representatives in order to define, endorse, and propose the final Core Outcomes Set.

Discussion

Core Outcome Sets aim at promoting uniform assessment of care outcomes in clinical practice as well as research. If consistently employed, a robust set of core outcomes for the end of life, and specifically for the dying phase, defined by relevant stakeholders, can ultimately be translated into best care for the dying person. Patient care will be improved by allowing clinicians to choose effective and meaningful treatments, and research impact will be improved by employing internationally agreed clinically relevant endpoints and enabling accurate comparison between studies in systematic reviews and/or in meta-analyses.