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Psychological distress among refugees in Germany: a cross-sectional analysis of individual and contextual risk factors and potential consequences for integration using a nationally representative survey

Por: Walther · L. · Kröger · H. · Tibubos · A. N. · Ta · T. M. T. · von Scheve · C. · Schupp · J. · Hahn · E. · Bajbouj · M.
Objectives

Responding to the mental health needs of refugees remains a pressing challenge worldwide. We estimated the prevalence of psychological distress in a large refugee population in Germany and assessed its association with host country factors amenable to policy intervention and integration indicators.

Design

A cross-sectional and population-based secondary analysis of the 2017 wave of the IAB-BAMF-SOEP refugee survey.

Setting

Germany.

Participants

2639 adult refugees who arrived in Germany between 2013 and 2016.

Main outcome measures

Psychological distress involving symptoms of depression, anxiety and post-traumatic stress disorder was measured using the Refugee Health Screener-13.

Results

Almost half of the population surveyed (41.2% (95% CI: 37.9% to 44.6%)) was affected by mild, moderate or severe levels of psychological distress. 10.9% (8.4% to 13.5%) of the population screened positive for severe distress indicative of an urgent need for care. Prevalence of distress was particularly high for females (53.0% (47.2% to 58.8%)), older refugees (aged ≥55, 70.4% (58.5% to 82.2%)) and Afghans (61.5% (53.5% to 69.5%)). Individuals under threat of deportation were at a greater risk of distress than protection status holder (risk ratio: 1.55 (95% CI: 1.14 to 2.10)), single males at a greater risk than males with nuclear families living in Germany (1.34 (1.04 to 1.74)) and those in refugee housing facilities at a greater risk than those in private housing (1.21 (1.02 to 1.43)). Distressed males had a lower likelihood of employment (0.67 (0.52 to 0.86)) and reduced participation in integration courses (0.90 (0.81 to 0.99)). A trend of reduced participation in educational programmes was observed in affected females (0.42 (0.17 to 1.01)).

Conclusion

The finding that a substantial minority of refugees in Germany exhibits symptoms of distress calls for an expansion of mental health services for this population. Service providers and policy-makers should consider the increased prevalence among female, older and Afghan refugees, as well as among single males, residents in housing facilities and those under threat of deportation. The associations between mental health and integration processes such as labour market, educational programme and integration course participation also warrant consideration.

Transmission reduction and prevention with HPV vaccination (TRAP-HPV) study protocol: a randomised controlled trial of the efficacy of HPV vaccination in preventing transmission of HPV infection in heterosexual couples

Por: MacCosham · A. · El-Zein · M. · Burchell · A. N. · Tellier · P.-P. · Coutlee · F. · Franco · E. L.
Introduction

Human papillomavirus (HPV) is a causal agent of malignancies including cervical, vulvar, vaginal, penile, anal and oropharyngeal cancer, as well as benign conditions such as anogenital warts. HPV vaccination protects individuals against infections with the target HPV types and their clinical outcomes. However, little is known about the protection an immunised individual confers to their sexual partner or its impact on HPV transmission dynamics. In this context, the Transmission Reduction and Prevention with HPV vaccination (TRAP-HPV) study was designed to determine the efficacy of an HPV vaccine in reducing transmission of genital and oral HPV infection in sexual partners of vaccinated individuals.

Methods and analysis

The TRAP-HPV study is an ongoing randomised controlled trial among heterosexual couples living in Montreal, Canada. Sexually active couples, aged between 18 and 45 years, who have been in a relationship no longer than 6 months are considered eligible. Participants are independently randomised to receive either the intervention HPV vaccine, Gardasil 9, or a placebo hepatitis A vaccine, Avaxim, creating four vaccination groups among couples: intervention–intervention, intervention–placebo, placebo–intervention and the placebo–placebo. Participants provide genital (vaginal/penile) and oral samples at baseline and five follow-up visits over a 1-year duration. Linear Array HPV genotyping is used to detect 36 HPV types. Cox proportional hazard regression models will be used to estimate the effect of vaccination on HPV transmission.

Ethics and dissemination

The TRAP-HPV study received ethical approval by institutional review boards McGill University, Concordia University and Centre Hospitalier de l’Université de Montréal. Before enrolment, all participants provide informed written consent. Results will be published in peer-reviewed journals and presented at national and international conferences. The generated empirical evidence could be used in mathematical models of vaccination to inform policymakers in Canada and elsewhere.

Trial registration number

NCT01824537.

Role of optimism in adolescent mental health: a protocol for a systematic review

Por: Rincon Uribe · F. A. · Espejo · C. A. N. · Pedroso · J. d. S.
Introduction

Adolescence is a critical period of human development, where adaptive or maladaptive experiences can happen. These experiences are associated with psychological, social, biological and health factors. Previous empirical evidence suggests that mental health is associated with individual assets and positive states, whose presence may become a factor of protection and resistance to mental disorders. Among these, optimism could play a fundamental role in sustaining physical and mental well-being and in dealing with threats potentially harmful to health. Given the rise of research on optimism and its importance in the various health outcomes, it is necessary to initiate processes of compilation and synthesis of this evidence to facilitate the understanding of the importance of this variable on the mental health of adolescents.

Methods and analysis

The included studies will be experimental, observational, cross-sectional and longitudinal focussed on the role of optimism on mental health in adolescents, regardless of whether they belong to clinical or non-clinical populations. This systematic review protocol will be carried out following the Cochrane Manual for systematic reviews and will follow the statement on systematic reviews and meta-analysis of PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Searches will run from October 2019 to March 2020, and will be carried out from the following electronic databases: APA PsycNet, BVS (Biblioteca Virtual em Saúde), Web of Science, PubMed Central and Scopus. Two reviewers will obtain the eligible articles, published from January 2009 onward, to assess the quality of each study and extract the data. For the presentation of the results, a narrative and quantitative synthesis will be carried out that groups the data found.

Ethics and dissemination

The approval of an ethics committee is not required for a systematic review protocol. The results will be presented at congresses in social sciences and psychology and will be published in a peer-reviewed social or health science journal.

PROSPERO registration number

PROSPERO CRD42019142616.

Attentional efficiency does not explain the mental state × domain effect

by Joseph Sweetman, George A. Newman

The reduced importance of intent when judging purity (vs. harm) violations is some of the strongest evidence for distinct moral modules or systems: moral pluralism. However, research has indicated that some supposed differences between purity and harm moral domains are due to the relative weirdness of purity vignettes. This weirdness might lead to a failure to attend to or correctly process relevant mental state information. Such attentional failures could offer an alternative explanation (to separate moral systems) for the reduced exculpatory value of innocent intentions for purity violations. We tested if the different role of intent in each domain was moderated by individual differences in attentional efficiency, as measured by the Attention Network Task. If attentional efficiency explains the reduced exculpatory value of innocent intentions in purity (vs. harm) violations, then we would expect those high (vs. low) in attentional efficiency not to show the reduced exculpatory effect of innocent intentions in the purity (vs. harm) domain. Consistent with moral pluralism, results revealed no such moderation. Findings are discussed in relation to various ways of testing domain-general and domain-specific accounts of the mental state × domain effect, so that we might better understand the architecture of our moral minds.

Factors associated with symptoms of attention deficit hyperactivity disorder among medical students in Cameroon: a web-based cross-sectional study

Por: Njuwa · K. F. · Simo · L. P. · Ntani · L. L. · Forchin · A. N. · Parviel · C. · Tianyi Tianyi · F. L. · Nsah · B. · Agbor · V. N.
Introduction

Attention deficit hyperactivity disorder (ADHD) is a chronic mental disorder that is associated with poor productivity, with a significant impact on the quality of life.

Objectives

To determine factors associated with symptoms of ADHD among medical students in Cameroon.

Design

A web-based cross-sectional study.

Setting

Participants were recruited through a social media platform, WhatsApp, from 24 June to 2 September 2018.

Participants

Medical students aged 18 years and older from seven medical schools in Cameroon. All non-medical students and all medical residents were excluded.

Results

Data from a total of 491 eligible participants were analysed. The median age was 25 (IQR 21–25) years and 54% were of the participants were female. The prevalence of self-reported symptoms of ADHD was 24.4% (95% CI 20.6% to 28.3%). Histories of chronic disease (adjusted OR (AOR) 2.96; 95% CI 1.49 to 5.86, p=0.002), family history of ADHD (AOR 3.38; 95% CI 1.04 to 10.44, p=0.035), severe depression (AOR=3.49; 95% CI 1.82 to 6.77, p

Conclusion

ADHD may be a highly prevalent mental disorder among medical students, and is associated with severe depression, anxiety disorders and chronic diseases. There is a need to conduct a large-scale prospective cohort study with interviews to estimate the true prevalence and incidence of ADHD among medical students in Cameroon, and to determinant the risk factors associated with the disorder.

Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in Southern Sweden

Por: Ramji · R. · Carlson · E. · Brogardh-Roth · S. · Olofsson · A. N. · Kottorp · A. · Rämgard · M.
Objectives

Inequalities in oral health have been on the rise globally. In Sweden, these differences exist not between regions, but among subgroups living in vulnerable situations. This study aims at understanding behavioural change after taking part in participatory oral health promotional activity among families living in socially disadvantaged neighbourhoods in Southern Sweden.

Setting

The current study involved citizens from a socially disadvantaged neighbourhood in Malmö, together with actors from the academic, public and private sectors. These neighbourhoods were characterised by high rates of unemployment, crime, low education levels and, most importantly, poor health.

Participants

Families with children aged 7–14 years from the neighbourhood were invited to participate in the health promotional activities by a community representative, known as a health promoter, using snowball sampling. Between 8 and 12 families participated in the multistage focus groups over 6 months. Data were analysed using qualitative content analysis.

Results

Three main themes emerged from the analysis, providing an understanding of the determinants for behavioural change, including meaningful social interactions, family dynamics and health trajectories. The mothers in the study valued the social aspects of their participation; however, they believed that gaining knowledge in combination with social interaction made their presence also meaningful. Further, the participants recognised the role of family dynamics primarily the interactions within the family, family structure and traditional practices as influencing oral health-related behaviour among children. Participants reported having experienced a change in general health owing to changed behaviour. They started to understand the association between general health and oral health that further motivated them to follow healthier behavioural routines.

Conclusions

The results from this study show that oral health promotion through reflection and dialogue with the communities, together with other stakeholders, may have the potential to influence behavioural change and empower participants to be future ambassadors for change.

Longitudinal Youth in Transition Study (LYiTS): protocol for a multicentre prospective cohort study of youth transitioning out of child and adolescent mental health services at age 18

Por: Cleverley · K. · Bennett · K. J. · Brennenstuhl · S. · Cheung · A. · Henderson · J. · Korczak · D. J. · Kurdyak · P. · Levinson · A. · Pignatiello · A. · Stinson · J. · Voineskos · A. N. · Szatmari · P.
Introduction

Transition between health services is widely recognised as a problematic hurdle. Yet, the factors necessary for successful transition out of child and adolescent mental health services (CAMHS) as youth reach the service boundary at age 18 are poorly understood. Further, fragmentation and variability among the services provided by mental health organisations serve to exacerbate mental illness and create unnecessary challenges for youth and their families. The primary aim of the Longitudinal Youth in Transition Study (LYiTS) is to describe and model changes in psychiatric symptoms, functioning and health service utilisation at the transition out of CAMHS at age 18 and to identify key elements of the transition process that are amendable to interventions aimed at ensuring continuity of care.

Methods and analysis

A prospective longitudinal cohort study will be conducted to examine the association between psychiatric symptoms, functioning and mental health and health service use of youth aged 16–18 as they transition out of child mental health services at age 18. We will recruit a sample of (n=350) participants from child and adolescent psychiatric programmes at two hospital and two community mental health sites and conduct assessments annually for 3 years using standardised measures of psychiatric symptoms, functioning and health service utilisation.

Ethics and dissemination

Ethics approval has been obtained at all four recruitment sites. We will disseminate the results through conferences, open access publications and webinars.

The extent to which family physicians record their patients exercise in medical records: a scoping review

Por: Lindeman · C. · McCurdy · A. · Lamboglia · C. G. · Wohlers · B. · Pham · A. N. Q. · Sivak · A. · Spence · J. C.
Objective

Exercise is an effective modality for the prevention and treatment of chronic conditions and family physicians are the healthcare providers tasked to manage patients’ chronic disease status. However, little is known about the exercise documentation in family-physician records. Therefore, a scoping review was conducted to describe family-physician-recorded exercise-related advice to patients in electronic medical records.

Design

Scoping review.

Setting

Primary care clinics.

Search strategy

PubMed, Medline, SPORTDiscus, Google, Dissertations & Theses Global, OCLC PapersFirst (via First Search) and included references were searched between 1 January 1990 and 10 June 2018. Extracted information included year, geographic origin, data input structure, input frequency and content of exercise inputs in family physicians’ electronic medical records. The primary outcomes are the structure, purpose and frequency of inputs.

Results

Of a possible 1758 documents, 83 remained after a title and abstract scan and 22 after a full-text review. These documents included 32 findings of physical activity/exercise medical record documentation: counselling/advising patients (50.0%), status (12.5%), embedded questionnaires (12.5%), status as a risk factor (12.5%), health promotion documentation (6.3%), inactivity status (3.1%) and grading (3.1%). The frequency of exercise inputs in primary care records vary from as low as 0.4% of patients with documentation of physical activity health promotion inputs to as high as 87.8% of patients with exercise or physical activity status recorded. The majority of included documents (63.6%) were focused on patients with identified chronic conditions.

Conclusion

The findings suggest that the structure and purpose of exercise documentation is often unclear or unspecified. Studies that present exercise information from family-physician medical records tend to focus on patients with specific chronic conditions and present little detail about the field from which information was extracted. The review found that the proportion of patients with physical activity or exercise information is often less than half.

The association of malnutrition with falls and harm from falls in hospital inpatients: Findings from a 5‐year observational study

Abstract

Background

Inpatient falls continue to be a significant clinical issue, and while malnutrition is a known risk factors for falls, few studies have investigated its association with inpatient falls. This study aimed to explore the independent association between malnutrition and fall risk as well as harm from falls in hospital inpatients.

Methods

Malnutrition identified in annual malnutrition audits was combined with inpatient fall data captured through the electronic patient incident reporting system in the 12 months following audit days. Audit data were available for 1,849 inpatients across 2011–2015, and covariate associations between age, gender, BMI, malnutrition, falls and harmful falls were analysed. The reporting of this paper is in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations (see Appendix S1).

Results

The prevalence of malnutrition was 32.4% (n = 543), and 171 (9.2%) inpatients experienced a fall with 0.7% (n = 13) categorised as harmful. In bivariate analysis, patients who fell were more likely to be older (median 79.0 vs. 70.0 years; p < .0001) or malnourished (40.9% vs. 31.5%; p = .021). Malnutrition (p < .0001) and having a lower BMI (p = .026) were significant predictors of harmful falls. Regression modelling demonstrated that only increasing age increased the likelihood of having an inpatient fall (OR 1.022 95% CI 1.021–1.046; p < .0001). Malnourished inpatients were almost 8 times more likely to have a harmful fall than those not malnourished (OR 7.94 95% CI 1.457–43.338; p = .017), independent of age and BMI.

Conclusions

Malnourished patients are more likely to experience a harmful fall. Assessment of malnutrition should be incorporated into fall risk assessments as a way of highlighting those patients at greater risk and to link to nutritional care pathways.

Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia: testing existing methods and development and validation of a novel weighted score

Por: Blackstock · S. · Witham · M. D. · Wade · A. N. · Crampin · A. · Beran · D. · Ogle · G. D. · Davies · J. I.
Objectives

Verbal autopsy (VA) is a useful tool to ascertain cause of death where no other mechanisms exist. We aimed to assess the utility of VA data to ascertain deaths due to uncontrolled hyperglycaemia and to develop a weighted score (WS) to specifically identify cases. Cases were identified by a study or site physician with training in diabetes. These diagnoses were also compared with diagnoses produced by a standard computer algorithm (InterVA-4).

Setting

This study was done using VA data from the Health and Demographic Survey sites in Agincourt in rural South Africa. Validation of the WS was done using VA data from Karonga in Malawi.

Participants

All deaths from ages 1 to 49 years between 1992 and 2015 and between 2002 and 2016 from Agincourt and Karonga, respectively. There were 8699 relevant deaths in Agincourt and 1663 in Karonga.

Results

Of the Agincourt deaths, there were 77 study physician classified cases and 58 computer algorithm classified cases. Agreement between study physician classified cases and computer algorithm classified cases was poor (Cohen’s kappa 0.14). Our WS produced a receiver operator curve with area under the curve of 0.952 (95% CI 0.920 to 0.985). However, positive predictive value (PPV) was below 50% when the WS was applied to the development set and the score was dominated by the necessity for a premortem diagnosis of diabetes. Independent validation showed the WS performed reasonably against site physician classified cases with sensitivity of 86%, specificity of 99%, PPV of 60% and negative predictive value of 99%.

Conclusion

Our results suggest that widely used VA methodologies may be missing deaths due to uncontrolled hyperglycaemia. Our WS may offer improved ability to detect deaths due to uncontrolled hyperglycaemia in large populations studies where no other means exist.

Using population-wide administrative and laboratory data to estimate type- and subtype-specific influenza vaccine effectiveness: a surveillance protocol

Por: Scott · A. N. · Buchan · S. A. · Kwong · J. C. · Drews · S. J. · Simmonds · K. A. · Svenson · L. W.
Introduction

The appropriateness of using routinely collected laboratory data combined with administrative data for estimating influenza vaccine effectiveness (VE) is still being explored. This paper outlines a protocol to estimate influenza VE using linked laboratory and administrative data which could act as a companion to estimates derived from other methods.

Methods and analysis

We will use the test-negative design to estimate VE for each influenza type/subtype and season. Province-wide individual-level records of positive and negative influenza tests at the Provincial Laboratory for Public Health in Alberta will be linked, by unique personal health numbers, to administrative databases and vaccination records held at the Ministry of Health in Alberta to determine covariates and influenza vaccination status, respectively. Covariates of interests include age, sex, immunocompromising chronic conditions and healthcare setting. Cases will be defined based on an individual’s first positive influenza test during the season, and potential controls will be defined based on an individual’s first negative influenza test during the season. One control for each case will be randomly selected based on the week the specimen was collected. We will estimate VE using multivariable logistic regression.

Ethics and dissemination

Ethics approval was obtained from the University of Alberta’s Health Research Ethics Board—Health Panel under study ID Pro00075997. Results will be disseminated by public health officials in Alberta.

Comparative thromboembolic risk in atrial fibrillation with and without a secondary precipitant--Danish nationwide cohort study

Por: Gundlund · A. · Kümler · T. · Bonde · A. N. · Butt · J. H. · Gislason · G. H. · Torp-Pedersen · C. · Kober · L. · Olesen · J. B. · Fosbol · E. L.
Objectives

We compared long-term outcomes in patients with atrial fibrillation (AF) with and without a secondary precipitant.

Design and setting

Retrospective cohort study based on Danish nationwide registries.

Participants

Patients with AF with and without secondary precipitants (1996–2015) were matched 1:1 according to age, sex, calendar year, CHA2DS2-VASc score and oral anticoagulation therapy (OAC), resulting in a cohort of 39 723 patients with AF with a secondary precipitant and the same number of patients with AF without a secondary precipitant. Secondary precipitants included alcohol intoxication, thyrotoxicosis, myocardial infarction, surgery and infection in conjunction with AF.

Primary and secondary outcomes

The primary outcome in this study was thromboembolic events. Secondary outcomes included AF rehospitalisation and death. Long-term risks of outcomes were examined by multivariable Cox regression analysis.

Results

The most common precipitants were infection (55.0%), surgery (13.2%) and myocardial infarction (12.0%). The 5-year absolute risk of thromboembolic events (taking death into account as a competing risk) in patients with AF grouped according to secondary precipitants were 8.3% (alcohol intoxication), 8.5% (thyrotoxicosis), 12.1% (myocardial infarction), 11.6% (surgery), 12.2% (infection), 10.1% (>1 precipitant) and 12.3% (no secondary precipitant). In the multivariable analyses, AF with a secondary precipitant was associated with the same or an even higher thromboembolic risk than AF without a secondary precipitant. One exception was patients with AF and thyrotoxicosis: those not initiated on OAC therapy carried a lower thromboembolic risk the first year of follow-up than matched patients with AF without a secondary precipitant and no OAC therapy.

Conclusions

In general, AF with a secondary precipitant was associated with the same thromboembolic risk as AF without a secondary precipitant. Consequently, this study highlights the need for more research regarding the long-term management of patients with AF associated with a secondary precipitant.

Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis

Objective

To determine the cost-effectiveness of selective digestive decontamination (SDD) as compared to selective oropharyngeal decontamination (SOD) in intensive care units (ICUs) with low levels of antimicrobial resistance.

Design

Post-hoc analysis of a previously performed individual patient data meta-analysis of two cluster-randomised cross-over trials.

Setting

24 ICUs in the Netherlands.

Participants

12 952 ICU patients who were treated with ≥1 dose of SDD (n=6720) or SOD (n=6232).

Interventions

SDD versus SOD.

Primary and secondary outcome measures

The incremental cost-effectiveness ratio (ICER; ie, costs to prevent one in-hospital death) was calculated by comparing differences in direct healthcare costs and in-hospital mortality of patients treated with SDD versus SOD. A willingness-to-pay curve was plotted to reflect the probability of cost-effectiveness of SDD for a range of different values of maximum costs per prevented in-hospital death.

Results

The ICER resulting from the fixed-effect meta-analysis, adjusted for clustering and differences in baseline characteristics, showed that SDD significantly reduced in-hospital mortality (adjusted absolute risk reduction 0.0195, 95% CI 0.0050 to 0.0338) with no difference in costs (adjusted cost difference 62 in favour of SDD, 95% CI –1079 to 935). Thus, SDD yielded significantly lower in-hospital mortality and comparable costs as compared with SOD. At a willingness-to-pay value of 33 633 per one prevented in-hospital death, SDD had a probability of 90.0% to be cost-effective as compared with SOD.

Conclusion

In Dutch ICUs, SDD has a very high probability of cost-effectiveness as compared to SOD. These data support the implementation of SDD in settings with low levels of antimicrobial resistance.

Congenital anomalies and associated risk factors in a Saudi population: a cohort study from pregnancy to age 2 years

Por: Kurdi · A. M. · Majeed-Saidan · M. A. · Al Rakaf · M. S. · AlHashem · A. M. · Botto · L. D. · Baaqeel · H. S. · Ammari · A. N.
Objective

To assess the three key issues for congenital anomalies (CAs) prevention and care, namely, CA prevalence, risk factor prevalence and survival, in a longitudinal cohort in Riyadh, Saudi Arabia.

Setting

Tertiary care centre, Riyadh, Saudi Arabia.

Participants

Saudi women enrolled during pregnancy over 3 years and their 28 646 eligible pregnancy outcomes (births, stillbirths and elective terminations of pregnancy for foetal anomalies). The nested case-control study evaluated the CA risk factor profile of the underlying cohort. All CA cases (1179) and unaffected controls (1262) were followed through age 2 years. Referred mothers because of foetal anomaly and mothers who delivered outside the study centre and their pregnancy outcome were excluded.

Primary outcome measures

Prevalence and pattern of major CAs, frequency of CA-related risk factors and survival through age 2 years.

Results

The birth prevalence of CAs was 412/10 000 births (95% CI 388.6 to 434.9), driven mainly by congenital heart disease (148 per 10 000) (95% CI 134 to 162), renal malformations (113, 95% CI 110 to 125), neural tube defects (19, 95% CI 25.3 to 38.3) and chromosomal anomalies (27, 95% CI 21 to 33). In this study, the burden of potentially modifiable risk factors included high rates of diabetes (7.3%, OR 1.98, 95% CI 1.04 to 2.12), maternal age >40 years (7.0%, OR 2.1, 95% CI 1.35 to 3.3), consanguinity (54.5%, OR 1.5, 95% CI 1.28 to 1.81). The mortality for live births with CAs at 2 years of age was 15.8%.

Conclusions

This study documented specific opportunities to improve primary prevention and care. Specifically, folic acid fortification (the neural tube defect prevalence was >3 times that theoretically achievable by optimal fortification), preconception diabetes screening and consanguinity-related counselling could have significant and broad health benefits in this cohort and arguably in the larger Saudi population.

Competence of healthcare professionals in diagnosing and managing obstetric complications and conducting neonatal care: a clinical vignette-based assessment in district and subdistrict hospitals in northern Bangladesh

Por: Khan · A. N. S. · Karim · F. · Chowdhury · M. A. K. · Zaka · N. · Manu · A. · Arifeen · S. E. · Billah · S. M.
Background

This study assesses the competency of maternal and neonatal health (MNH) professionals at district-level and subdistrict-level health facilities in northern Bangladesh in managing maternal and newborn complications using clinical vignettes. The study also examines whether the professional’s characteristics and provision of MNH services in health facilities influence their competencies.

Methods

134 MNH professionals in 15 government hospitals were interviewed during August and September 2016 using structured questionnaire with clinical vignettes on obstetric complications (antepartum haemorrhage and pre-eclampsia) and neonatal care (low birthweight and immediate newborn care). Summative scores were calculated for each vignette and median scores were compared across different individual-level and health facility-level attributes to examine their association with competency score. Kruskal-Wallis test was performed to identify the significance of association considering a p value

Results

The competency of MNH professionals was low. About 10% and 24% of the health professionals received ‘high’ scores (>75% of total) in maternal and neonatal vignettes, respectively. Medical doctors had higher competency than nurses and midwives (score=11 vs 8 out of 19, respectively; p=0.0002) for maternal vignettes, but similar competency for neonatal vignettes (score=30.3 vs 30.9 out of 50, respectively). Professionals working in health facilities with higher use of normal deliveries had better competency than their counterparts. Professionals had higher competency in newborn vignettes (significant) and maternal vignettes (statistically not significant) if they worked in health facilities that provided more specialised newborn care services and emergency obstetric care, respectively, in the last 6 months.

Conclusions

Despite the overall low competency of MNH professionals, exposure to a higher number of obstetric cases at the workplace was associated with their competency. Arrangement of periodic skill-based and drill-based in-service training for MNH professionals in high-use neighbouring health facilities could be a feasible intervention to improve their knowledge and skill in obstetric and neonatal care.

Parent and family perspectives on home-based newborn care practices in lower-income countries: a systematic review of qualitative studies

Por: Bazzano · A. N. · Felker-Kantor · E. · Eragoda · S. · Kaji · A. · Horlick · R.
Objectives

To understand family and parent perspectives on newborn care provided at home to infants in the first 28 days of life, in order to inform behavioural interventions for improving care in low-income countries, where the majority of newborn deaths occur.

Design

A comprehensive, qualitative systematic review was conducted. MEDLINE/PubMed, Embase and Cumulative Index of Nursing and Allied Health databases were systematically searched for studies examining the views of parents and family members on newborn care at home. The search period included all studies published from 2006 to 2017. Studies using qualitative approaches or mixed-methods studies with substantial use of qualitative techniques in both the methods and analysis sections were included. Studies meeting the inclusion criteria were extracted and evaluated using Critical Appraisal Skills Programme guidelines. Following the initial selection and appraisal, barriers and facilitators to recommended care practices across several domains were synthesised.

Results

Of 411 results retrieved, 37 met both inclusion and quality appraisal criteria for methodology and reporting. Geographical representation largely reflected that of newborn health outcomes globally, with the majority of studies conducted in the region of Sub-Saharan Africa and South Asia. Specific barriers and facilitators were identified among a range of domains including: cord care, drying and wrapping, thermal control, skin to skin contact, hygiene, breast feeding, care-seeking for illness, and low birthweight recognition. Cross cutting facilitators, common to all domains were evident and included

delivery at a health facility, inclusion of female relatives in care counselling, lower healthcare costs, and exposure to newborn care behaviour change messaging in the community.

Conclusions

When designing behavioural interventions to address newborn mortality at scale, policy-makers and practitioners must include barriers and facilitators important to families in low-income settings.

PROSPERO registration number

CRD42016035674.

Designing and evaluating provider results-based financing for tuberculosis care in Georgia: a realist evaluation protocol

Por: Marchal · B. · Giralt · A. N. · Sulaberidze · L. · Chikovani · I. · Abejirinde · I.-O. O.
Introduction

In 2016, Georgian researchers and policymakers were developing a policy to improve the performance of the national tuberculosis (TB) control programme. The research programme ‘Designing and Evaluating Provider Results-Based Financing for Tuberculosis Care in Georgia: Understanding Costs, Mechanisms of Effect and Impact (Results4TB)’ was initiated to inform the policy formulation phase, document the policy implementation and assess the effectiveness, cost-effectiveness and the processes of change. To achieve this, the research team intends to combine an impact evaluation, a cost-effectiveness study and a realist evaluation (RE) within an overarching theory-informed design. This protocol is the RE component of the programme.

Methods

A realist methodological approach will be adopted to guide the research design and evaluation. RE answers the question of ‘what works in which conditions for whom?’ and starts with the development of an initial programme theory (IPT). The IPT will feed into other phases of the realist research cycle (study design, data collection, data analysis and synthesis and theory refinement). Data will be collected in a multiple embedded case study design (five intervention and three control sites) through document reviews, in-depth interviews, non-participant observations and context mapping at facility and national levels. Additional data from other research components (cost-effectiveness and impact evaluation) will aid data triangulation.

Ethics and dissemination

The Institutional Review Boards of the National Centre for Disease Control and Public Health in Georgia (ref. IRB # 2018–019) and the Institute of Tropical Medicine, Antwerp (ref. IRB #- 1240/18) have granted ethical approval to the study.

Trial registration number

ISRCTN14667607

Shared decision‐making in the BREATHE asthma intervention trial: A research protocol

Aim

To evaluate the preliminary effectiveness of the BRief Evaluation of Asthma TH erapy intervention, a 7‐min primary care provider‐delivered shared decision‐making protocol that uses motivational interviewing to address erroneous asthma disease and medication beliefs.

Design

A multi‐centre masked two‐arm group‐randomized clinical trial.

Methods

This 2‐year pilot study is funded (September 2016) by the National Institute of Nursing Research. Eight providers will be randomized to one of two arms: the active intervention (N = 4) or a dose‐matched attention control (N = 4). Providers will deliver the intervention to which they were randomized to 10 Black adult patients with uncontrolled asthma (N = 80). Patients will be followed three months postintervention to test the preliminary intervention effects on asthma control (primary outcome) and on medication adherence, lung function, and asthma‐related quality of life (secondary outcomes).

Discussion

This study will evaluate the preliminary impact of a novel shared decision‐making intervention delivered in a real world setting to address erroneous disease and medication beliefs as a means of improving asthma control in Black adults. Results will inform a future, large‐scale randomized trial with sufficient power to test the intervention's effectiveness.

Impact

Shared decision‐making is an evidence‐based intervention with proven effectiveness when implemented in the context of labour‐ and time‐intensive research protocols. Medication adherence is linked with the marked disparities evident in poor and minority adults with asthma. Addressing this requires a novel multifactorial approach as we have proposed. To ensure sustainability, shared decision‐making interventions must be adapted to and integrated into real‐world settings.

Trial registration: Registered at clincialtrials.gov as NCT03036267 and NCT03300752.

Epidemiology of injuries, treatment (costs) and outcome in burn patients admitted to a hospital with or without dedicated burn centre (Burn-Pro): protocol for a multicentre prospective observational study

Por: Van Lieshout · E. M. · Van Yperen · D. T. · Van Baar · M. E. · Polinder · S. · Boersma · D. · Cardon · A. Y. · De Rijcke · P. A. · Guijt · M. · Klem · T. M. · Lansink · K. W. · Ringburg · A. N. · Staarink · M. · Van de Schoot · L. · Van der Veen · A. H. · Van Eijck · F. C. · Van Eert
Introduction

The Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns or with specific characteristics like older age or comorbidities. Patients not meeting these criteria can also be treated in a hospital without burn centre. Limited information is available about the organisation of care and referral of these patients. The aims of this study are to determine the burn injury characteristics, treatment (costs), quality of life and scar quality of burn patients admitted to a hospital without dedicated burn centre. These data will subsequently be compared with data from patients with

Methods and analysis

In this multicentre, prospective, observational study (cohort study), the following two groups of patients will be followed: 1) all patients (no age limit) admitted with burn-related injuries to a hospital without a dedicated burn centre in the Southwest Netherlands or Brabant Trauma Region and 2) all patients (no age limit) with

Ethics and dissemination

This study has been exempted by the medical research ethics committee Erasmus MC (Rotterdam, The Netherlands). Each participant will provide written consent to participate and remain encoded during the study. The results of the study are planned to be published in an international, peer-reviewed journal.

Trial registration number

NTR6565.

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