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Feasibility of a 6-month pilot randomised controlled trial of resistance training on cognition and brain health in Canadian older adults at-risk for diabetes: study protocol

Por: Furlano · J. A. · Nagamatsu · L. S.

Type 2 diabetes (T2D) is associated with cognitive deficits and increased risk of dementia, and thus individuals at high risk for T2D (ie, those who are overweight or prediabetic) are also at greater risk for cognitive decline. Aerobic exercise is known to preserve and improve cognitive function, but the effects of resistance training (RT) are much less known in older adults. Moreover, research on the effects of RT on cognition and brain health (structure and function) in older adults at-risk for diabetes is limited. To address this question, a 6-month RT intervention is needed. Importantly, before conducting a full-scale randomised controlled trial (RCT), we are conducting a feasibility pilot study to assess potential recruitment rates, adherence and retention in this specific population.

Methods and analysis

We are conducting a 6-month, thrice-weekly RT RCT. Participants (aged 60–80; sedentary; fasting plasma glucose of 6.1–7.0 mmol/L or body mass index ≥25) are randomised into one of two groups: (1) RT or (2) balance and tone (control). Based on other exercise trials using a similar population, we will consider our trial feasible if we have adherence and retention at 70%. Recruitment rate will be measured as time it takes to enrol 20 participants. To assess behavioural and MRI data, we will report descriptive statistics and estimation using a 95% CI.

Ethics and dissemination

Our study has received ethics approval from the Health Sciences Research Ethics Board at Western University. As this is a small pilot study, data will only be made available to other researchers on request. Results from this study will be disseminated via academic publication.

Trial registration number


Effects of accelerated versus standard care surgery on the risk of acute kidney injury in patients with a hip fracture: a substudy protocol of the hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) international randomised controlled

Por: Borges · F. K. · Devereaux · P. J. · Cuerden · M. · Bhandari · M. · Guerra-Farfan · E. · Patel · A. · Sigamani · A. · Umer · M. · Neary · J. · Tiboni · M. · Tandon · V. · Ramokgopa · M. T. · Sancheti · P. · John · B. · Lawendy · A. · Balaguer-Castro · M. · Jenkinson · R. · Sleczka · P. · N

Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI.

Methods and analysis

Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after diagnosis. The primary outcome of this substudy is the development of AKI within 7 days of randomisation. We anticipate at least 1998 patients will participate in this substudy.

Ethics and dissemination

We obtained ethics approval for additional serum creatinine recordings in consecutive patients enrolled at 70 participating centres. All patients provide consent before randomisation. We anticipate reporting substudy results by 2021.

Trial registration number

NCT02027896; Pre-results.

Study protocol: characterising the clinical, epidemiological and aetiological aspects of leptospirosis in Sri Lanka: a hospital based clinico-epidemiological study

Por: Agampodi · S. · Warnasekara · J. · Jayasundara · D. · Senawirathna · I. · Gamage · C. · Kularatne · S. · Siribaddana · S. · Maththias · M. · Vinetz · J.

Sri Lanka has one of the highest incidences of leptospirosis worldwide. We hypothesised that different geographical locations and patient context will have a distinct molecular epidemiology of leptospirosis, based on microgeographical characteristics related to regiona-specific Leptospira predominance. Our objective is to characterise the clinical, epidemiological and molecular aspects of leptospirosis in Sri Lanka to understand disease progression, risk factors and obtain isolates of Leptospira.

Methods and analysis

We designed a multicentre prospective study in Sri Lanka to recruit undifferentiated febrile patients and conduct follow-ups during hospital stays. Patients will be recruited from outpatient departments and medical wards. This study will be conducted at two main sites (Anuradhapura and Peradeniya) and several additional sites (Awissawella, Ratnapura and Polonnaruwa). Blood and urine will be collected from patients on the day of admission to the ward or presentation to the outpatient department. Bedside inoculation of 2–4 drops of venous blood will be performed with Ellinghausen-McCullough-Johnson-Harris (EMJH) semisolid media supplemented with antibiotics. Regionally optimised microscopic agglutination test, culture and qPCR-evidence will be performed to confirm the presence of Leptospira in blood which in turn will confirm the presence of disease. Whole genome sequencing will be carried out for all isolates recovered from patients. Multilocus sequence typing (MLST) will be used for the genotyping of new isolates. Sri Lankan isolates will be identified using three published MLST schemes for Leptospira.

Ethics and dissemination

Ethical clearance for the study was obtained from Ethics Review Committees (ERC), Medicine and Allied Sciences (FMAS), Rajarata University of Sri Lanka (RUSL) and University of Peradeniya. All genomic data generated through this project will be available at GenBank. Anonymised data will be deposited at the ERC, FMAS, RUSL.

Prevalence and risk factors for food allergy in older people: protocol for a systematic review

Por: Laia-Dias · I. · Lozoya-Ibanez · C. · Skypala · I. · Gama · J. M. R. · Nurmatov · U. · Lourenco · O. · Taborda-Barata · L.

Studies suggest that the prevalence of food allergy may be increasing worldwide. Results regarding the prevalence and features of adverse food reactions older people have, however, scarcely been analysed in the literature. Thus, the objective of the present systematic review will be to describe the prevalence of food allergy in older individuals, its risk factors, clinical features, as well as the most frequently and commonly involved foods.

Methods and analysis

We will conduct a systematic review and meta-analysis of the incidence, prevalence and risk factors for food allergy in older individuals. We will search international electronic databases including MEDLINE, EMBASE, Cochrane Library, CINAHL, AMED and ISI Web of Science for published, unpublished and ongoing studies from 1980 toJanuary 2019. There will be no restriction on the language or geography of publication. We will use the critical appraisal skills programme quality assessment tool to appraise the methodological quality of included studies. A descriptive summary with data tables will be elaborated, and if deemed clinically relevant and statistically adequate, meta-analysis using random-effects modelling will be carried out, given the expected clinical, methodological and statistical heterogeneity of studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will guide reporting of the systematic review.

Ethics and dissemination

Since this systematic review will be solely based on published and retrievable literature, no ethics approval will be obtained. This study will allow us to draw up-to-date estimates of the prevalence of adverse food reactions in older individuals, worldwide, besides allowing the identification of its major risk factors, clinical manifestations and predominant foods responsible for such reactions. A multidisciplinary team has been assembled for this systematic review and will participate in relevant dissemination activities, namely reports, publications and presentations.

PROSPERO registration number



A global epidemic of caesarean section has been observed in the last decades, characterized by the high growth of rates internationally (Boerma et al., 2018). When analyzing the Brazilian situation, the evolution of caesarean rates shows an upward growth, in addition to presenting one of the highest caesarean rates found in the world (Betrán et al., 2016). In the 1970s, the first records in Brazil showed a rate of 15.0%, which rose to 40.2% in the 90s and reached the apex in 2014, with 57.0% of births by caesarean (Brasil, 2014a; Victora et al., 2011).

La salud del hombre en la perspectiva de la sexualidad: un relato de experiencia

La salud del hombre ha sido tema ampliamente discutido en los últimos años, especialmente tras la creación de la Política Nacional de Atención Integral a la Salud del Hombre (PNAISH) por el Ministerio de Salud en el año 2009. De esta forma, este artículo tiene por objeto relatar la experiencia de la salud actuación de los residentes multiprofesionales en salud de la familia en la implantación y desarrollo de un grupo de educación en salud con hombres en una Unidad de Salud de la Familia, sobre la temática de la sexualidad. Se determinó la realización de encuentros semanales, con un grupo de hombres de riesgo, que solían encontrarse cerca de sus residencias, en la calzada, debajo de un árbol, ociosos, generalmente alcohólicos, y haciendo uso del tabaco y en su mayoría con problemas sociales, psicológicos y familiares y que no buscaban los servicios de salud. A partir de eso, se inició el proceso de realización de acciones de promoción en salud con los sujetos elegidos. Se percibió la importancia del uso de metodologías innovadoras que traspasen la transferencia de informaciones para abordar cuestiones como la sexualidad, lo que sirvió para estrechar vínculos entre hombres y servicios de salud, así como para discutir cuestiones que todavía se denominan tabúes.

Interaction between leukocyte aldo-keto reductase 1C3 activity, genotypes, biological, lifestyle and clinical features in a prostate cancer cohort from New Zealand

by Nishi Karunasinghe, Eva Symes, Amy Gamage, Alice Wang, Pam Murray, Shuotun Zhu, Megan Goudie, Jonathan Masters, Lynnette R. Ferguson


Aldo-keto reductase 1C3 (AKR1C3) is known for multiple functions including its catalytic activity towards producing extra-testicular androgen. The present study is towards understanding interaction between biological, lifestyle and genetic impacts of AKR1C3 and their influence on clinical factors in a prostate cancer (PC) cohort from New Zealand (NZ).


Characteristics of 516 PC patients were collected from the Auckland Regional Urology Facility, NZ. These men were genotyped for the AKR1C3 rs12529 single nucleotide polymorphism (SNP). The leukocyte AKR1C3 activity was measured in a sub-cohort. Variability of leukocyte AKR1C3 activity between biological, lifestyle and clinical features as well as correlation between biological and clinical features were assessed with and without genetic stratification.


The leukocyte AKR1C3 activity was associated with age at diagnosis (0.51 vs 0.34 μM coumberol units for >69y vs ≤69y, P = 0.03); and with anatomic stage/prognostic grouping among the AKR1C3 rs12529 CC genotype carriers (0.50 vs 28 μM coumberol units among low- and high-risk groups respectively, P = 0.02). Significant correlation between leukocyte AKR1C3 activity and age at PC diagnosis was also observed (correlation coefficient 0.20 and P = 0.02). Ever- smoking impacted both age and PSA at PC diagnosis among AKR1C3 rs12529 GG and CG genotype carriers respectively. Age at diagnosis significantly correlated with PSA at diagnosis in the main (correlation coefficient 0.29, and PAKR1C3 rs12529 CG and GG genotypes in both the main (correlation coefficient 0.30, and P Conclusions

Age dependent PSA thresholds in PC screening could have been valid only in men carrying the AKR1C3 rs12529 CG and GG genotypes in this NZ cohort.

Cohort Profile: Perinatal depression and child socioemotional development ; the Bachpan cohort study from rural Pakistan

Por: Sikander · S. · Ahmad · I. · Bates · L. M. · Gallis · J. · Hagaman · A. · ODonnell · K. · Turner · E. L. · Zaidi · A. · Rahman · A. · Maselko · J.

This is a prospective pregnancy–birth cohort designed to investigate the effects of depression on socioemotional development of children. Perinatal depression is a risk factor for poor child development and for many it has a recurring chronic course. Thus, the exposure to depression can continue through the early years of the child with detrimental developmental outcomes.


Between October 2014 and February 2016, we recruited 1154 pregnant women from a rural subdistrict of Pakistan. Data include longitudinal and repeated measures of maternal psychosocial measures and child growth, cognitive and socioemotional measures. Follow-up include mother–child dyad assessments at 3rd, 6th, 12th, 24th and 36th months of child age. All these follow-ups are community based at the household level. We have competed baseline assessment.

Findings to date

Of the eligible dyads, we followed 885 (76.6%), 929 (91%) and 940 (93.3%) at 3, 6 and 12 months post-childbirth. We include a subsample mother–child dyad DNA and inflammatory biomarkers, 73 and 104, respectively.

Future plans

While we continue to do 24-month and 36-month follow-up assessments, we plan to follow these mother–child dyads up to the age of 7–8 years with some children being exposed to at least 1 year of school environment. Investigators interested in learning more about the study can contact ( and (

Evaluating 3D-printed models of coronary anomalies: a survey among clinicians and researchers at a university hospital in the UK

Por: Lee · M. · Moharem-Elgamal · S. · Beckingham · R. · Hamilton · M. · Manghat · N. · Milano · E. G. · Bucciarelli-Ducci · C. · Caputo · M. · Biglino · G.

To evaluate the feasibility of three-dimensional (3D) printing models of coronary artery anomalies based on cardiac CT data and explore their potential for clinical applications.


Cardiac CT datasets of patients with various coronary artery anomalies (n=8) were retrospectively reviewed and processed, reconstructing detailed 3D models to be printed in-house with a desktop 3D printer (Form 2, Formlabs) using white resin.


A University Hospital (division of cardiology) in the UK.


The CT scans, first and then 3D-printed models were presented to groups of clinicians (n=8) and cardiovascular researchers (n=9).


Participants were asked to assess different features of the 3D models and to rate the models’ overall potential usefulness.

Outcome measures

Models were rated according to clarity of anatomical detail, insight into the coronary abnormality, overall perceived usefulness and comparison to CT scans. Assessment of model characteristics used Likert-type questions (5-point scale from ‘strongly disagree’ to ‘strongly agree’) or a 10-point rating (from 0, lowest, to 10, highest). The questionnaire included a feedback form summarising overall usefulness. Participants’ imaging experience (in a number of years) was also recorded.


All models were reconstructed and printed successfully, with accurate details showing coronary anatomy (eg, anomalous coronary artery, coronary roofing or coronary aneurysm in a patient with Kawasaki syndrome). All clinicians and researchers provided feedback, with both groups finding the models helpful in displaying coronary artery anatomy and abnormalities, and complementary to viewing 3D CT scans. The clinicians’ group, who had substantially more imaging expertise, provided more enthusiastic ratings in terms of models’ clarity, usefulness and future use on average.


3D-printed heart models can be feasibly used to recreate coronary artery anatomy and enhance understanding of coronary abnormalities. Future studies can evaluate their cost-effectiveness, as well as potentially explore other printing techniques and materials.

Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care

Por: Lazzerini · M. · Senanayake · H. · Mohamed · R. · Kaluarachchi · A. · Fernando · R. · Sakalasuriya · A. · Ihsan · F. R. · Saravanabhava · N. · Gamaathige · N. · Jayawardane · M. · Gamage · R. V. · Covi · B. · Wanzira · H. · Businelli · C. · Piccoli · M.

This study was aimed at piloting a prospective individual patient database on hospital deliveries in Colombo, Sri Lanka, and at exploring its use for developing recommendations for improving quality of care (QoC).


Observational study.


De Soysa Maternity Hospital, the largest referral hospital for maternity care in Sri Lanka.

Data collection and analysis

From July 2015 to June 2017, 150 variables were collected for each delivery using a standardised form and entered into a database. Data were analysed every 8 months, and the results made available to local staff. Outcomes of the study included: technical problems; data completeness; data accuracy; key database findings; and use of data.


7504 deliveries were recorded. No technical problem was reported. Data completeness exceeded that of other existing hospital recording systems. Less than 1% data were missing for maternal variables and less than 3% for newborn variables. Mistakes in data collection and entry occurred in 0.01% and 0.09% of maternal and newborn data, respectively. Key QoC indicators identified in comparison with international standards were: relatively low maternal mortality (0.053%); relatively high maternal near-miss cases (3.4%); high rate of induction of labour (24.6%), caesarean section (30.0%) and episiotomy (56.1%); relatively high rate of preterm births (9.4%); low birthweight rate (16.5%); stillbirth (0.97%); and of total deaths in newborn (1.98%). Based on key indicators identified, a list of recommendations was developed, including the use checklists to standardise case management, training, clinical audits and more information for patients. A list of lessons learnt with the implementation of the data collection system was also drawn.


The study shows that the implemented system of data collection can produce a large quantity of reliable information. Most importantly, this experience provides an example on how database findings can be used for discussing hospital practices, identifying gaps and to agree on recommendations for improving QoC.

Factors affecting Pap smear uptake in a maternity hospital: A descriptive cross‐sectional study 影响妇产医院子宫颈抹片检查增长的因素:描述性横断面研究



To understand factors that influence women's decisions to go for Pap smears.


Globally, cervical cancer is the fourth most common cancer among women. In Singapore, cervical cancer is on the rise and has been found to be the eighth highest cause of death among women. Research has shown that regular screening for cervical cancer with Pap smear reduces cervical cancer‐related mortality. However, Pap smear awareness is still limited and its uptake in Singapore is highly opportunistic, requiring the need for a deeper understanding of the factors that influence Pap smear uptake among women in Singapore.


A descriptive cross‐sectional study design was used.


Convenience sampling was used to recruit 350 participants (postnatal women of at least 21 years old) from a local maternity hospital. Data were collected using validated questionnaires. Logistic regression was used to analyse the data.


Demographic factors, such as age, ethnicity and religion, as well as women's beliefs about the effectiveness of Pap smear in detecting cervical cancer, the desire to discover health problems early and considering Pap smear to be painful, were found to be factors significantly influencing Pap smear uptake. Healthcare professionals need to be mindful of these factors to address women's needs to encourage women to go for Pap smears.


Various factors were found to influence Pap smear uptake. Future interventions can take these factors into account for increasing Pap smear awareness.