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Associations between metal constituents of ambient particulate matter and mortality in England: an ecological study

Por: Lavigne · A. · Freni Sterrantino · A. · Liverani · S. · Blangiardo · M. · de Hoogh · K. · Molitor · J. · Hansell · A.
Objectives

To investigate long-term associations between metal components of particulate matter (PM) and mortality and lung cancer incidence.

Design

Small area (ecological) study.

Setting

Population living in all wards (~9000 individuals per ward) in the London and Oxford area of England, comprising 13.6 million individuals.

Exposure and outcome measures

We used land use regression models originally used in the Transport related Air Pollution and Health Impacts—Integrated Methodologies for Assessing Particulate Matter study to estimate exposure to copper, iron and zinc in ambient air PM. We examined associations of metal exposure with Office for National Statistics mortality data from cardiovascular disease (CVD) and respiratory causes and with lung cancer incidence during 2008–2011.

Results

There were 108 478 CVD deaths, 48 483 respiratory deaths and 24 849 incident cases of lung cancer in the study period and area. Using Poisson regression models adjusted for area-level deprivation, tobacco sales and ethnicity, we found associations between cardiovascular mortality and PM2.5 copper with interdecile range (IDR 2.6–5.7 ng/m3) and IDR relative risk (RR) 1.005 (95%CI 1.001 to 1.009) and between respiratory mortality and PM10 zinc (IDR 1135–153 ng/m3) and IDR RR 1.136 (95%CI 1.010 to 1.277). We did not find relevant associations for lung cancer incidence. Metal elements were highly correlated.

Conclusion

Our analysis showed small but not fully consistent adverse associations between mortality and particulate metal exposures likely derived from non-tailpipe road traffic emissions (brake and tyre wear), which have previously been associated with increases in inflammatory markers in the blood.

Cohort profile: HealthWise Wales. A research register and population health data platform with linkage to National Health Service data sets in Wales

Por: Hurt · L. · Ashfield-Watt · P. · Townson · J. · Heslop · L. · Copeland · L. · Atkinson · M. D. · Horton · J. · Paranjothy · S.
Purpose

Recruitment and follow-up in epidemiological studies are time-consuming and expensive. Combining online data collection with a register of individuals who agree to be contacted about research opportunities provides an efficient, cost-effective platform for population-based research. HealthWise Wales (HWW) aims to facilitate research by recruiting a cohort of individuals who have consented to be informed about research projects, advertising studies to participants, supporting data collection on specific topics and providing access to linked healthcare data for secondary analyses. In this paper, we describe the design of the project, ongoing data collection, methods of data linkage to routine healthcare records, baseline characteristics of participants, the strengths and limitations of the register, and the ways in which the project can support researchers.

Participants

Adults (aged 16 years and above) living or receiving their healthcare in Wales are eligible for inclusion. Participants consent to be contacted for follow-up data collection and for their details to be used to access their routinely collected National Health Service records for research purposes. Data are collected using a web-based application, with new questionnaires added every 6 months. Data collection on sociodemographic and lifestyle factors is repeated at intervals of 2–3 years. Recruitment is ongoing, with 21 779 participants alive and currently registered.

Findings to date

99% of participants have complete information on age and sex, and 64% have completed questionnaires on sociodemographic and lifestyle factors. These data can be linked with national health databases within the Secure Anonymised Information Linkage (SAIL) databank, with 93% of participants matching a record in SAIL. HWW has facilitated the recruitment of 43 826 participants to 15 different studies.

Future plans

The medium-term goal for the project is to enrol at least 50 000 adults. Recruitment strategies are being devised to achieve a study sample that closely models the population of Wales. Potential biosampling methods are also currently being explored.

Mapping the preclinical to clinical evidence and development trajectory of the oncolytic virus talimogene laherparepvec (T-VEC): a systematic review

Por: Lalu · M. · Leung · G. J. · Dong · Y. Y. · Montroy · J. · Butler · C. · Auer · R. C. · Fergusson · D. A.
Objective

This study aimed to conduct a systematic review of preclinical and clinical evidence to chart the successful trajectory of talimogene laherparepvec (T-VEC) from the bench to the clinic.

Design

This study was a systematic review. The primary outcome of interest was the efficacy of treatment, determined by complete response. Abstract and full-text selection as well as data extraction were done by two independent reviewers. The Cochrane risk of bias tool was used to assess the risk of bias in studies.

Setting

Embase, Embase Classic and OvidMedline were searched from inception until May 2016 to assess its development trajectory to approval in 2015.

Participants

Preclinical and clinical controlled comparison studies, as well as observational studies.

Interventions

T-VEC for the treatment of any malignancy.

Results

8852 records were screened and five preclinical (n=150 animals) and seven clinical studies (n=589 patients) were included. We saw large decreases in T-VEC’s efficacy as studies moved from the laboratory to patients, and as studies became more methodologically rigorous. Preclinical studies reported complete regression rates up to 100% for injected tumours and 80% for contralateral tumours, while the highest degree of efficacy seen in the clinical setting was a 24% complete response rate, with one study experiencing a complete response rate of 0%. We were unable to reliably assess safety due to the lack of reporting, as well as the heterogeneity seen in adverse event definitions. All preclinical studies had high or unclear risk of bias, and all clinical studies were at a high risk of bias in at least one domain.

Conclusions

Our findings illustrate that even successful biotherapeutics may not demonstrate a clear translational road map. This emphasises the need to consider increasing rigour and transparency along the translational pathway.

PROSPERO registration number

CRD42016043541.

Prevalence and service assessment of cataract in Tibetan areas of Sichuan Province, China: population-based study

Por: Jiachu · D. · Jin · L. · Jiang · F. · Luo · L. · Zheng · H. · Ji · D. · Yang · J. · Yongcuo · N. · Huang · W. · Yi · J. · Bright · T. · Yip · J. L. · Xiao · B.
Objectives

To assess the prevalence of visual impairment (VI) and blindness (BL) due to cataract and cataract surgical outcomes in remote dispersed and high-altitude Tibetan areas of China.

Design and setting

A cross-sectional study was conducted among people aged 50 and above in Tibetan Autonomous Prefecture of Kandze (TAPK), China, in 2017. The Rapid Assessment of Avoidable Blindness protocol was followed.

Participants

Of 5000 eligible participants, 4764 were examined (response rate 95.3%).

Primary and secondary outcome measures

Cataract VI was defined as lens opacity at visual acuity (VA) levels of

Results

The estimated prevalence of cataract BL was 0.61% (95% CI 0.42 to 0.87). With best corrected VA, the estimated prevalence of SVI from cataract was 0.86% (95% CI 0.63 to 1.17); MVI was 2.39% (95% CI 2.00 to 2.87) and EVI was 5.21% (95% CI 4.61 to 5.87). Women in TAPK had a significantly higher prevalence of cataract BL (0.82%, 95% CI 0.54 to 2.15) than men (0.34%, 95% CI 0.16 to 0.70). Women had lower cataract surgical coverage (CSC) by eyes (60.8%, 95% CI 55.5 to 65.8) compared with men (70.1%; 95% CI 63.7 to 75.7). The prevalence of cataract BL was higher among Tibetan (2.28%; 95% CI 1.98 to 2.62) than Han Chinese (1.01%%; 95% CI 0.54% to 1.87%). Overall CSC by person with BL (by better eye) was 82.0% (95% CI 75.2 to 87.6). Among cataract-operated participants, 71.2% had VA equal to or better than 6/18.

Conclusions

The study detected a low prevalence of VI and BL due to cataract with high CSC in the study area compared with many other places in China. Further actions should be taken to improve cataract surgical outcome.

Barriers to cervical cancer screening and acceptability of HPV self-testing: a cross-sectional comparison between ethnic groups in Southern Thailand

Por: Gottschlich · A. · Nuntadusit · T. · Zarins · K. R. · Hada · M. · Chooson · N. · Bilheem · S. · Navakanitworakul · R. · Nittayaboon · K. · Virani · S. · Rozek · L. · Sriplung · H. · Meza · R.
Background

Cervical cancer rates are higher in low-resourced countries than high, partly due to lower rates of screening. Incidence in Thailand is nearly three times higher than in the USA (16.2 vs 6.5 age-standardised incidence), even with Thailand’s universal health coverage, which includes screening, suggesting that alternative methods are needed to reduce the burden. We investigated barriers to screening, as well as acceptability of self-collection human papillomavirus (HPV) testing as a primary form of cervical cancer screening among Buddhist and Muslim communities in Southern Thailand.

Methods

267 women from the Buddhist district of Ranot and Muslim district of Na Thawi, Songkhla were recruited to complete a survey assessing knowledge and risk factors of HPV and cervical cancer. Participants were offered an HPV self-collection test with a follow-up survey assessing acceptability. Samples were processed at Prince of Songkhla University and results were returned to participants.

Results

267 women participated in the study (132 Buddhist, 135 Muslim), 264 (99%) self-collecting. 98% reported comfort and ease, and 70% preferred it to doctor-facilitated cytology. The main predictor of prior screening was religion (92% Buddhist vs 73% Muslim reporting prior Pap). After adjustment with multivariate logistic models, Muslim women had an OR of prior Pap of 0.30 compared with Buddhist (95% CI: 0.12 to 0.66).

Conclusions

Self-collection HPV testing was highly acceptable across religious groups, suggesting that it could be beneficial for cervical cancer reduction in this region. Focus should be put into educating women from all backgrounds about the importance of screening to further improve screening rates among Thai women.

Relations of magnesium intake to cognitive impairment and dementia among participants in the Womens Health Initiative Memory Study: a prospective cohort study

Por: Lo · K. · Liu · Q. · Madsen · T. · Rapp · S. · Chen · J.-C. · Neuhouser · M. · Shadyab · A. · Pal · L. · Lin · X. · Shumaker · S. · Manson · J. · Feng · Y.-Q. · Liu · S.
Objective

To examine the associations of dietary and supplemental magnesium (Mg) as assessed by a semi-quantitative food frequency questionnaire with cognitive outcomes among ageing women.

Design

This work conducts a prospective cohort study of participants enrolled in the Women’s Health Initiative Memory Study (WHIMS), which was subsequently extended and named WHIMS-Epidemiology of Cognitive Health.

Setting

Forty clinical centres in the USA.

Participants

Postmenopausal women aged 65–79 years without dementia on enrolment.

Main outcome measures

Physician-adjudicated mild cognitive impairment (MCI) and/or probable dementia (PD).

Results

Participants were excluded (n=1006) if they had extreme values of dietary energy intake, had missing or extreme body mass index values, with prevalent MCI/PD at baseline, received only one cognitive assessment or had been followed up for 20 years of follow-up, 765 (11.8%) out of 6473 participants developed MCI/PD. For MCI/PD and MCI, the risks tended to be lower among participants in quintiles Q2–Q5 of Mg consumption compared with those in the lowest quintile. Participants in Q3 had a significantly lower risk of MCI/PD (HR 0.69, 95% CI 0.53 to 0.91) and MCI (HR 0.63, 95% CI 0.45 to 0.87) after multivariate adjustments. No significant association was observed between total Mg intake and PD. The association between total Mg intake, MCI/PD and MCI was non-linear as suggested by the likelihood test.

Conclusions

Total Mg intake between the estimated average requirement and the recommended dietary allowances may associate with a lower risk of MCI/PD and MCI.

Trial registration number

NCT00685009.

Impact of repeat flooding on mental health and health-related quality of life: a cross-sectional analysis of the English National Study of Flooding and Health

Objective

To assess the association between flooding/repeat flooding and: (1) psychological morbidity (anxiety, depression, post-traumatic stress disorder (PTSD)) and (2) health-related quality of life (HRQoL) at 6 months post-flooding.

Design

Cross-sectional analysis of data from the English National Study of Flooding and Health.

Setting

Cumbria, England.

Participants

Questionnaires were sent to 2500 residential addresses at 6 months post-flooding; 590 people responded.

Outcomes

Probable depression was assessed using the Patient Health Questionnaire, probable anxiety using the Generalised Anxiety Disorder scale and probable PTSD using the short-form PTSD checklist (PCL-6). HRQoL was assessed using the EQ-5D-5L. Mental health outcomes were analysed using logistic regression; HRQoL dimensions using ordinal regression; and summary index/Visual Analogue Scale scores using linear regression.

Results

One hundred and nineteen participants had been flooded, over half of whom were experiencing a repeat flooding event (54%; n=64). Mental health outcomes were elevated among flooded compared with unaffected participants (adjusted OR for probable depression: 7.77, 95% CI: 1.51 to 40.13; anxiety: 4.16, 95% CI: 1.18 to 14.70; PTSD: 14.41, 95% CI: 3.91 to 53.13). The prevalence of depression was higher among repeat compared with single flooded participants, but this was not significant after adjustment. There was no difference in levels of anxiety or PTSD. Compared with unaffected participants, those flooded had lower EQ-5D-5L index scores (adjusted coefficient: –0.06, 95% CI: –0.12 to –0.01) and lower self-rated health scores (adjusted coefficient: –6.99, 95% CI: –11.96 to –2.02). There was, however, little difference in HRQoL overall between repeat and single flooded participants.

Conclusions

Interventions are needed to help minimise the impact of flooding on people’s mental health and HRQoL.

Relationships between dipstick proteinuria and risk of hearing impairment among Japanese workers: a prospective cohort study

Por: Umesawa · M. · Hara · M. · Sairenchi · T. · Nagao · M. · Haruyama · Y. · Kobashi · G.
Objectives

Hearing impairment is among the most significant health problems, and the number of adults with hearing impairment is increasing worldwide. Therefore, the prevention of hearing impairment is important. Proteinuria appears to be a risk factor for hearing impairment, but no prospective studies have examined the association between proteinuria and hearing impairment risk. This prospective study aimed to clarify the association between dipstick proteinuria and risk of hearing impairment.

Design

This was a prospective cohort study based on annual health check-up data, 2008–2016.

Setting

Data were collected on 7005 employees of a single company who worked in offices and factories throughout Japan.

Participants

We analysed data from 5699 subjects (88.6% men) who underwent annual health check-ups twice or more from 2008 to 2016, had no missing data, and were free from hearing impairment at baseline. We regarded the first health check-up as the baseline examination.

Primary and secondary outcome measures

Hearing tests were performed using audiometry at two frequencies (1 and 4 kHz) during the health check-ups. Defining total moderate hearing impairment as the inability to respond to 30 dB at 1 kHz and/or 40 dB at 4 kHz, we examined the association between dipstick proteinuria at baseline and risk of hearing impairment at final examination.

Results

Total moderate hearing impairment was noted in 162 (2.8%) subjects. Compared with subjects without proteinuria at baseline, the multivariable adjusted OR (95% CI) was 5.35 (1.87–15.25) for subjects with proteinuria ≥2+, 0.92 (0.40–2.13) for those with proteinuria +/–, and 1.33 (0.63–2.80) for those with proteinuria+ at baseline.

Conclusions

Severe dipstick proteinuria was positively associated with risk of hearing impairment in the future. Our results suggest that medical examinations including urine testing are effective for detecting subjects with high risk of hearing impairment.

Association between syphilis seroprevalence and age among blood donors in Southern China: an observational study from 2014 to 2017

Por: Wu · X. · Guan · Y. · Ye · J. · Fu · H. · Zhang · C. · Lan · L. · Wu · F. · Tang · F. · Wang · F. · Cai · Y. · Yu · W. · Feng · T.
Objective

This study investigated the association between syphilis seroprevalence and age among blood donors, and described the distribution of serological titres among syphilis-infected donors, aiming to confirm the syphilis epidemic characteristics and to promote effective interventions for older adults.

Methods

Data were obtained from the Shenzhen Programme for Syphilis Prevention and Control in 2014–2017. Blood samples were screened using the ELISAs, and confirmed using the Treponema pallidum particle agglutination assay (TPPA) and toluidine red unheated serum test (TRUST).

Results

Among 394 792 blood donors, 733 tested TPPA and TRUST positive (active infection), and 728 tested only TPPA positive (historical infection). The overall prevalence of syphilis seropositivity was 370.1 per 100 000 (95% CI 351.1 to 389.0 per 100 000); the prevalence of active infection was 185.7 per 100 000 (95% CI 172.2 to 199.1 per 100 000). People aged ≥45 years displayed a prevalence of 621.8 per 100 000 in syphilis seropositivity and 280.5 per 100 000 in active infection, which were 3.8 times and 2.4 times higher than that for people aged 2 trend=311.9, p trend2 trend=72.1, p trendtrend

Conclusions

The findings confirm the high prevalence of syphilis among older adults, and suggest the need to increase awareness among healthcare providers and deliver more targeted prevention interventions for older adults to promote early testing.

The structure and predictive value of intrinsic capacity in a longitudinal study of ageing

Por: Beard · J. R. · Jotheeswaran · A. T. · Cesari · M. · Araujo de Carvalho · I.
Objectives

To assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence.

Design

Structural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence.

Settings

Community, United Kingdom.

Participants

2560 eligible participants aged over 60 years.

Main outcome measures

Activities of daily living (ADL) and instrumental activities of daily living (IADL).

Results

One general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively—and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity.

Conclusions

The WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.

Animal-related injuries and fatalities: evidence from a large-scale population-based cross-sectional survey in rural Bangladesh

Por: Bhuiyan · M. A. A. · Agrawal · P. · Wadhwaniya · S. · Li · Q. · Alonge · O. · Rahman · A. F. · Rahman · A.
Objective

This study determines the magnitude and pattern of animal-related injury mortalities and morbidities in rural Bangladesh.

Design and setting

A cross-sectional survey was conducted in 51 Unions of 7 subdistricts of Bangladesh from June 2013 to September 2013.

Participants

A total of approximately 1.17 million individuals across all age and gender profiles were included in the survey. The participants had to be residents of the seven subdistricts and have provided consent to participate in the study.

Primary and secondary outcome measures

Animal-related injury characteristics and demographic information was collected in the study. Frequency, proportion and 95% CIs of variables such as type of animal, type of animal attack, activity of the person prior to attack and the seasonality of the injury were reported. Data was then statistically analysed for associations between injury and sociodemographic characteristics.

Results

The incidence rate of fatal and non-fatal animal-related injuries across all ages were 0.7 (95% CI 0.4 to 1.4) and 1635.3 (95% CI 1612.0 to 1658.0) per 100 000 populations, respectively. Non-fatal animal-related injury rates were highest among adults 18 years and older (1820.6 per 100 000 population (1777.2 to 1865.1)), and in males across all age groups. The most common animal injury was wasp/hornet/bee sting (49%), followed by cow/buffalo (25%), dog bite (9%) and snake bites (9%).

Conclusions

Animal-related injuries are an important public health issue in rural Bangladesh. The incidence of animal-related morbidities was found high in the study area. Males, school-going and productive age groups were at high risk. Immediate attention should be given to prevent these events.

A school-based, multi-faceted health promotion programme to prevent obesity among children: protocol of a cluster-randomised controlled trial (the DECIDE-Children study)

Por: Liu · Z. · Wu · Y. · Niu · W.-Y. · Feng · X. · Lin · Y. · Gao · A. · Zhang · F. · Fang · H. · GAO · P. · Li · H.-J. · Wang · H. · the study team for the DECIDE-children study · Wang · Liu · Lin · Feng · Li · Zhou · Li · Jin · Li · Cheng · Di Wang · Song · Zhou · Xu · Song · Gao · Chen · Shang
Introduction

Obesity is a public health concern that is becoming increasingly more serious worldwide. Effective and sustainable childhood obesity prevention strategies may help to reduce the prevalence of obesity and may have an impact on lifelong health. However, few such strategies have been rigorously evaluated for Chinese children in different regions of China.

Methods and analysis

The Diet, ExerCIse and CarDiovascular hEalth-Children is a cluster-randomised controlled trial that aims to assess the effectiveness and sustainability of a school-based, multi-faceted intervention to prevent obesity among Grade 4 primary school students (8–10 years old) in China. Twenty-four schools (approximately 1200 students) from above average, average and below average developed regions in China will be randomised to an intervention (12 schools) or usual practice (12 schools) group. The intervention will last for one school year (9 months) and consists of activities towards students, parents and school environment. A smartphone application will be used to assist in providing information on, monitoring and providing feedback on the behaviours and body weight of the students. Data will be collected at baseline, 4 months, 9 months and 21 months. The primary outcome will be the difference between groups in the change in students’ body mass index at 9 months after the baseline investigation. The secondary outcomes will include the differences between groups in the changes in anthropometric measures, diet, physical activity levels and other measures at the follow-up visits. A variety of process evaluation methods will be used to evaluate the implementation process of the complex intervention.

Ethics and dissemination

This study was approved by the Peking University Institution Review Board (IRB00001052-18021). The results will be disseminated through publication in peer-reviewed journals, presentations at conferences and in lay summaries provided to school staff and participants.

Trial registration number

NCT03665857.

Discontinuation of non-Vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation: a population-based cohort study using primary care data from The Health Improvement Network in the UK

Por: Ruigomez · A. · Vora · P. · Balabanova · Y. · Brobert · G. · Roberts · L. · Fatoba · S. · Fernandez · O. · Garcia Rodriguez · L. A.
Objective

To determine discontinuation rates, patterns of use and predictors of discontinuation of non-vitamin K antagonist oral anticoagulants (NOACs) among patients with non-valvular atrial fibrillation (NVAF) in the first year of therapy.

Design

Population-based cohort study.

Setting

UK primary care.

Population

11 481 patients with NVAF and a first prescription (index date) for apixaban, dabigatran or rivaroxaban (January 2012 to December 2016) with at least 1 year of follow-up and at least one further NOAC prescription in the year following the index date were identified. 1 year rates and patterns of discontinuation were described.

Primary and secondary outcome measures

Outcome measures were the percentage of patients who, in the first year from starting NOAC therapy, discontinued with their oral anticoagulant (OAC) therapy (discontinuation was defined as a gap in OAC therapy of >30 days); switched OAC within 30 days; discontinued and reinitiated OAC therapy. Predictors of discontinuation were also evaluated.

Results

1 year discontinuation rates according to the index NOAC were 26.1% for apixaban, 40.0% for dabigatran and 29.6% for rivaroxaban. Reinitiation rates were 18.1% for apixaban, 21.7% for dabigatran and 17.3% for rivaroxaban, and switching rates were 2.8% for apixaban, 8.8% for dabigatran and 4.9% for rivaroxaban. More than 93% of reinitiations were with the index NOAC. Patients starting on dabigatran were more likely to switch OAC therapy than those starting on apixaban; ORs 4.28 (95% CI 3.24 to 5.65) for dabigatran and 1.89 (95% CI 1.49 to 2.39) for rivaroxaban. Severely reduced renal function was a predictor of any discontinuation, OR 1.77 (95% CI 1.28 to 2.44).

Conclusion

While the majority of patients with NVAF in the UK initiating NOAC treatment received continuous therapy in the first year of treatment, a substantial proportion of patients experienced gaps in treatment leaving them less protected against thromboembolism during these periods.

Assessing the quality, efficiency and usefulness of the Western Australian population-based Intellectual Disability Exploring Answers (IDEA) surveillance system: a surveillance system evaluation

Por: Strobel · N. A. · Bourke · J. · Leonard · H. · Richardson · A. · Edmond · K. M. · McAullay · D.
Objectives

Our overall aim was to evaluate the Western Australian Intellectual Disability Exploring Answers (IDEA) surveillance system. The primary objective was to evaluate the attributes of the system. The secondary objective was to provide recommendations to data custodians and stakeholders to strengthen the system.

Method

The IDEA system was evaluated using process observation, interviews and secondary data analysis of system attributes: usefulness, simplicity, data quality, acceptability, representativeness, timeliness and stability. 2001 US Centers for Disease Control and Prevention guidelines were used.

Results

We found that the IDEA system was useful, simple, flexible, acceptable, representative, timely and stable. We compared individuals from the IDEA system (n=10 593) with those with cerebral palsy and intellectual disability (ID) (n=582) from another surveillance system. Of the 582 with cerebral palsy and ID, 501 (86.1%) were in the IDEA system and 81 (13.9%) were not. In total, 0.7% of cases (81/10674) with ID were not identified in the IDEA system. There were little differences in cases that were not identified in the IDEA system between Indigenous status, sex and place of residence.

Conclusions

The strengths of the IDEA system include having a high data quality resource contributing to national and international data on ID, strong government support and a dedicated management team. Output from studies linking to IDEA data have had major contributions to the international literature about ID. However, limited resources have prevented it from realising its full potential in relation to translational activities. The IDEA system is a valuable resource to address the needs of people living with ID.

Multimorbidity of chronic non-communicable diseases and its models of care in low- and middle-income countries: a scoping review protocol

Por: Eyowas · F. A. · Schneider · M. · Yirdaw · B. A. · Getahun · F. A.
Introduction

Multimorbidity is the coexistence of two or more chronic non-communicable diseases (NCDs) in a given individual. Multimorbidity is increasing in low- and middle-income countries (LMICs) and challenging health systems. Individuals with multimorbidity are facing the risk of premature mortality, lower quality of life and greater use of healthcare services. However, despite the huge challenge multimorbidity brings in LMICs, gaps remain in mapping and synthesising the available knowledge on the issue. The focus of this scoping review will be to synthesise the extent, range and nature of studies on the epidemiology and models of multimorbidity care in LMICs.

Methods

PubMed (MEDLINE) will be the main database to be searched. For articles that are not indexed in the PubMed, Scopus, PsycINFO and Cochrane databases will be searched. Grey literature databases will also be explored. There will be no restrictions on study setting or year of publication. Articles will be searched using key terms, including comorbidity, co-morbidity, multimorbidity, multiple chronic conditions and model of care. Relevant articles will be screened by two independent reviewers and data will be charted accordingly. The result of this scoping review will be presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guideline.

Ethics and dissemination

This scoping review does not require ethical approval. Findings will be published in peer-reviewed journal and presented at scientific conferences.

Partially randomised patient preference trials as an alternative design to randomised controlled trials: systematic review and meta-analyses

Por: Wasmann · K. A. · Wijsman · P. · van Dieren · S. · Bemelman · W. · Buskens · C.
Objective

Randomised controlled trials (RCT) are the gold standard to provide unbiased data. However, when patients have a treatment preference, randomisation may influence participation and outcomes (eg, external and internal validity). The aim of this study was to assess the influence of patients’ preference in RCTs by analysing partially randomised patient preference trials (RPPT); an RCT and preference cohort combined.

Design

Systematic review and meta-analyses.

Data sources

MEDLINE, Embase, PsycINFO and the Cochrane Library.

Eligibility criteria for selecting studies

RPPTs published between January 2005 and October 2018 reporting on allocation of patients to randomised and preference cohorts were included.

Data extraction and synthesis

Two independent reviewers extracted data. The main outcomes were the difference in external validity (participation and baseline characteristics) and internal validity (lost to follow-up, crossover and the primary outcome) between the randomised and the preference cohort within each RPPT, compared in a meta-regression using a Wald test. Risk of bias was not assessed, as no quality assessment for RPPTs has yet been developed.

Results

In total, 117 of 3734 identified articles met screening criteria and 44 were eligible (24 873 patients). The participation rate in RPPTs was >95% in 14 trials (range: 48%–100%) and the randomisation refusal rate was >50% in 26 trials (range: 19%–99%). Higher education, female, older age, race and prior experience with one treatment arm were characteristics of patients declining randomisation. The lost to follow-up and cross-over rate were significantly higher in the randomised cohort compared with the preference cohort. Following the meta-analysis, the reported primary outcomes were comparable between both cohorts of the RPPTs, mean difference 0.093 (95% CI –0.178 to 0.364, p=0.502).

Conclusions

Patients’ preference led to a substantial proportion of a specific patient group refusing randomisation, while it did not influence the primary outcome within an RPPT. Therefore, RPPTs could increase external validity without compromising the internal validity compared with RCTs.

PROSPERO registration number

CRD42019094438.

Protocol for establishing a child and adolescent twin register for mental health research and capacity building in Sri Lanka and other low and middle-income countries in South Asia

Por: Jayaweera · K. · Craig · J. M. · Zavos · H. M. S. · Abeysinghe · N. · De Alwis · S. · Andras · A. · Dissanayake · L. · Dziedzic · K. · Fernando · B. · Glozier · N. · Hewamalage · A. · Ives · J. · Jordan · K. P. · Kodituwakku · G. · Mallen · C. · Rahman · O. · Zafar · S. · Saxena · A. · Rij
Introduction

Worldwide, 10%–20% of children and adolescents experience mental health conditions. However, most such disorders remain undiagnosed until adolescence or adulthood. Little is known about the factors that influence mental health in children and adolescents, especially in low and middle-income countries (LMIC), where environmental threats, such as poverty and war, may affect optimal neurodevelopment. Cohort studies provide important information on risks and resilience across the life course by enabling tracking of the effects of early life environment on health during childhood and beyond. Large birth cohort studies, including twin cohorts that can be aetiologically informative, have been conducted within high-income countries but are not generalisable to LMIC. There are limited longitudinal birth cohort studies in LMIC.

Methods

We sought to enhance the volume of impactful research in Sri Lanka by establishing a Centre of Excellence for cohort studies. The aim is to establish a register of infant, child and adolescent twins, including mothers pregnant with twins, starting in the districts of Colombo (Western Province) and Vavuniya (Northern Province). We will gain consent from twins or parents for future research projects. This register will provide the platform to investigate the aetiology of mental illness and the impact of challenges to early brain development on future mental health. Using this register, we will be able to conduct research that will (1) expand existing research capacity on child and adolescent mental health and twin methods; (2) further consolidate existing partnerships and (3) establish new collaborations. The initiative is underpinned by three pillars: high-quality research, ethics, and patient and public involvement and engagement (PPIE).

Ethics and dissemination

Ethical approval for this study was obtained from the Ethics Review Committee of Sri Lanka Medical Association and Keele University’s Ethical Review Panel. In addition to journal publications, a range of PPIE activities have been conducted.

The changing temporal association between caesarean birth and neonatal death in Ethiopia: secondary analysis of nationally representative surveys

Por: Yisma · E. · Mol · B. W. · Lynch · J. W. · Smithers · L. G.
Objective

To examine the changing temporal association between caesarean birth and neonatal death within the context of Ethiopia from 2000 to 2016.

Design

Secondary analysis of Ethiopian Demographic and Health Surveys.

Setting

All administrative regions of Ethiopia with surveys conducted in 2000, 2005, 2011 and 2016.

Participants

Women aged 15–49 years with a live birth during the 5 years preceding the survey.

Main outcome measures

We analysed the association between caesarean birth and neonatal death using log-Poisson regression models for each survey adjusted for potential confounders. We then applied the ‘Three Delays Model’ to 2016 survey to provide an interpretation of the association between caesarean birth and neonatal death in Ethiopia.

Results

The adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI: 0.29 to 3.19) in 2000 to 2.81 (95% CI: 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95% CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95% CI) 7.01 (0.92 to 53.36)) in 2016. Aggregate-level analysis revealed that an increased caesarean section rates were correlated with a decreased proportion of neonatal deaths.

Conclusions

A naïve interpretation of the changing temporal association between caesarean birth and neonatal death from 2000 to 2016 is that caesarean section is increasingly associated with neonatal death. However, the changing temporal association reflects improvements in health service coverage and secular shifts in the characteristics of Ethiopian women undergoing caesarean section after complicated labour or severe foetal compromise.

Low-value clinical practices in adult traumatic brain injury: an umbrella review protocol

Por: Tardif · P.-A. · Moore · L. · Lauzier · F. · Farhat · I. · Archambault · P. · Lamontagne · F. · Chasse · M. · Stelfox · H. T. · Gabbe · B. J. · Lecky · F. · Kortbeek · J. · Lessard-Bonaventure · P. · Truchon · C. · Turgeon · A. F.
Introduction

Traumatic brain injury (TBI) leads to 50 000 deaths, 85 000 disabilities and costs $60 billion each year in the USA. Despite numerous interventions and treatment options, the outcomes of TBI have improved little over the last three decades. In a previous scoping review and expert consultation survey, we identified 13 potentially low-value clinical practices in acute TBI. The objective of this umbrella review is to synthesise the evidence on potentially low-value clinical practices in the care of acute TBI.

Methods and analysis

Using umbrella review methodology, we will search Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, International Prospective Register of Systematic Reviews (PROSPERO) and PubMed to identify systematic reviews evaluating the effect of potential intrahospital low-value practices using tailored population, intervention, comparator, outcome and study design questions based on the results of a previous scoping review. We will present data on the methodological quality of these reviews (Assessing the Methodological Quality of Systematic Reviews-2), reported effect sizes and strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation).

Ethics and dissemination

Ethics approval is not required as original data will not be collected. Knowledge users from five healthcare quality organisations and clinical associations are involved in the design and conduct of the study. Results will be disseminated in a peer-reviewed journal, at international scientific meetings and to clinical, healthcare quality and patient–partner associations. This work will support the development of metrics to measure the use of low-value practices, inform policy makers on potential targets for deimplementation and in the long term reduce the use of low-value clinical practices in acute TBI care.

PROSPERO registration number

CRD42019132428.

Healthy Ageing and Biomarkers Cohort Study (HABCS): a cohort profile

Por: Lv · Y. · Mao · C. · Yin · Z. · Li · F. · Wu · X. · Shi · X.
Purpose

The Chinese Longitudinal Healthy Longevity Survey Biomarkers Cohort (Healthy Ageing and Biomarkers Cohort Study (HABCS)) was established to investigate the determinants of healthy aging and mortality among the oldest old in China. Besides collecting health status, behavioural and sociodemographic circumstances, the present study also gathers comprehensive data for the elderly by simultaneously collecting, detecting, analysing blood and urine, respectively.

Participants

HABCS is a community-based longitudinal multiwave study of older men and women aged 65 or above. Baseline survey and the follow-up surveys with replacement for deceased elderly were conducted in eight longevity areas in China, which cover the northern, middle and southern parts of China. Between 2008 and 2017, 6333 participants were included in HABCS, comprising 1385 centenarians, 1350 nonagenarians, 1294 octogenarians, 1577 younger elderly (aged 65–79).

Findings to date

We have found that higher baseline levels of (1) total cholesterol, (2) low-density lipoprotein cholesterol (LDL-C) and (3) superoxide dismutase activity were associated with greater cognitive decline. While (4) higher LDL-C level was associated with lower risk of all-cause mortality. There was a reverse association between (5) plasma vitamin D and cognitive impairment in cross-sectional and prospective study.

Future plans

We are currently exploring the relationships between various biomarkers and different outcomes such as cognitive function and mortality. This longitudinal cohort study will be continued in the future.

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