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The thriving of older people assessment scale: Psychometric evaluation and short‐form development

Abstract

Aim

To evaluate the psychometric properties and performance of the 32‐item Thriving of Older People Assessment Scale (TOPAS) and to explore reduction into a short‐form.

Background

The 32‐item TOPAS has been used in studies of place‐related well‐being as a positive measure in long‐term care to assess nursing home resident thriving; however, item redundancy has not previously been explored.

Design

Cross‐sectional study.

Method

Staff members completed the 32‐item TOPAS as proxy raters for a random sample of Swedish nursing home residents (N = 4,831) between November 2013 ‐ September 2014. Reliability analysis, exploratory factor analysis and item response theory‐based analysis were undertaken. Items were systematically identified for reduction using statistical and theoretical analysis. Correlation testing, means comparison and model fit evaluation confirmed scale equivalence.

Results

Psychometric properties of the 32‐item TOPAS were satisfactory and several items were identified for scale reduction. The proposed short‐form TOPAS exhibited a high level of internal consistency (α = 0.90) and strong correlation (r = 0.98) to the original scale, while also retaining diversity among items in terms of factor structure and item difficulties.

Conclusion

The 32‐item and short‐form TOPAS’ indicated sound validity and reliability to measure resident thriving in the nursing home context.

Impact

There is a lack of positive life‐world measures for use in nursing homes. The short‐form TOPAS indicated sound validity and reliability to measure resident thriving, providing a feasible measure with enhanced functionality for use in aged care research, assessments and care planning for health‐promoting purposes in nursing homes.

Nurses’ perceptions of high‐alert medication administration safety: A qualitative descriptive study

Abstract

Aims

The aim of this study was to determine nurses’ perceptions of supports and barriers to high‐alert medication (HAM) administration safety.

Design

A qualitative descriptive design was used.

Methods

Eighteen acute care nurses were interviewed about HAM administration practices. Registered nurses (RNs) working with acutely ill adults in two hospitals participated in one‐on‐one interviews from July–September, 2017. Content analysis was conducted for data analysis.

Results

Three themes contributed to HAM administration safety: Organizational Culture of Safety, Collaboration, and RN Competence and Engagement. Error factors included distractions, workload and acuity. Work arounds bypassing bar code scanning and independent double check procedures were common. Findings highlighted the importance of intra‐ and interprofessional collaboration, nurse engagement and incorporating the patient in HAM safety.

Conclusions

Current HAM safety strategies are not consistently used. An organizational culture that supports collaboration, education on safe HAM practices, pragmatic HAM policies and enhanced technology are recommended to prevent HAM errors.

Impact

Hospitals incorporating these findings could reduce HAM errors. Research on nurse engagement, intra‐ and interprofessional collaboration and inclusion of patients in HAM safety strategies is needed.

The mental health needs and concerns of older people who identify as LGBTQ+: A narrative review of the international evidence

Abstract

Aims

To synthesize the best available evidence on the experiences and perceptions of older people who identify as LGBTQ+ regarding their mental health needs and concerns.

Design

A narrative review and critical appraisal of qualitative, quantitative and mixed methods studies.

Data sources

A systematic search was undertaken across all of the databases including PsycINFO, MEDLINE, CINAHL and Sociological Abstracts. International studies published in academic journals in the English language, from January 1995 to January 2019 were appraised. Studies had to involve older people identifying as LGBTQ+ and who had experiences mental health issues.

Review Methods

Fourteen papers were selected for inclusion in the systematic review. A narrative analysis of the papers was used by synthesizing the key findings and organizing them into themes and concepts.

Results

Following analysis of the data, the themes that emerged were: (i) LGBTQ+ identity issues (ii) risk and vulnerability factors, (iii) coping strategies and resilience, (iv) interventions and supports.

Conclusion

This review highlights key mental health‐related issues that need to be taken into account in the creation and provision of appropriate, responsive and inclusive supports and services.

This article is protected by copyright. All rights reserved.

How Career Facilitators and Barriers Influence Nurses' Professional Turnover Intention

Abstract

Aims

Our study investigates the influence of career facilitators and barriers on nurses' improvement of their professional capabilities and their professional turnover intention.

Background

Reducing nurses' professional turnover intention could help alleviate the global nursing shortage. Nevertheless, little research has addressed how career facilitators and barriers, nurses' improvement of their professional capabilities and professional turnover intention are related, indicating a gap.

Design

This study used a cross‐sectional design.

Methods

We surveyed 502 out of 2,660 full‐time nurses who worked for a medical centre in Taiwan between January and March 2018. Our items were adapted from Cunningham et al. and Teng et al. and had adequate reliability and validity. Structural equation modeling was used to test the study hypotheses.

Results

Human capital, social capital and discrimination were positively related to intention to improve professional capabilities. Moreover, intention to improve professional capabilities was positively related to action to improve professional capabilities, which was negatively related to professional turnover intention.

Conclusion

Most of the career facilitators and even barriers, boost the improvement of professional capabilities and are useful for retaining nurses in the nursing profession.

Impact

Findings of this study should have an impact on nursing managers by offering them means to retain nurses, e.g., enhancing human capital and social capital among nurses to reduce their turnover intention.

This article is protected by copyright. All rights reserved.

Rationale and design of a statewide telestroke registry: Lone Star Stroke Consortium Telestroke Registry (LeSteR)

Por: Astudillo · C. · Ankrom · C. · Trevino · A. · Malazarte · R. M. · Bambhroliya · A. B. · Savitz · S. · Topel · C. H. · Milling · T. J. · Wu · T.-C.
Introduction

The Lone Star Stroke Consortium Telestroke Registry (LeSteR) currently consisting of 3 academic hub centres and 27 partner spokes is a statewide initiative organised by leading academic health centres in the State of Texas to understand practice patterns of acute stroke management via telestroke (TS) in Texas, a state with one of the largest rural populations in the USA.

Methods and analysis

All patients who had presumed stroke for whom a TS consultation has been obtained in the network are entered into a web-based, Health Insurance Portability and Accountability Act-compliant database from September 2013 to present. Spokes were enrolled into LeSteR in a staggered approach in two data collection phases: a retrospective phase and a prospective phase. Basic clinical, demographic data and relevant time metrics are collected in the retrospective phase. Starting 1 September 2015, additional outcome data including 90-day modified Rankin score, readmission and 90-day disposition are obtained by a standard phone interview. From the registry initiation to 31 December 2017, there are 8089 patients who had suspected stroke in the registry. Over 60% of patients enrolled after 1 September 2015 have reported outcome data. Enrolment is still active for this registry.

Ethics and dissemination

LeSteR is a statewide TS registry organised by academic health centres that will provide significant insight regarding the impact of TS in the State of Texas. Findings from LeSteR will provide data that can be analysed to improve the allocation of healthcare resources using TS to treat stroke in a state with one of the largest rural populations.

Prevalence of common mental health disorders in adults who are high or costly users of healthcare services: protocol for a systematic review and meta-analysis

Por: Jadhakhan · F. · Lindner · O. C. · Blakemore · A. · Guthrie · E.
Introduction

In all healthcare settings, a small proportion of patients account for a large level of healthcare use and associated high healthcare costs. Depression and anxiety are common co-morbidities in patients who are high users of care. The aims of this systematic review are to: (1) estimate the prevalence of anxiety/depression in adults who are high users of general physical healthcare services and/or who accrue high healthcare costs (2) estimate the magnitude of healthcare use associated with the presence of anxiety/depression.

Methods and analysis

This review will include any studies where patients are high users of primary, secondary or emergency healthcare services and/or accrue high healthcare costs. This is the first systematic review to focus on patients who are over the age of 18, whose degree of anxiety/depression has been evaluated with a standardised questionnaire or by a clinical interview generating a diagnosis according to international diagnostic criteria. The review will include eligible studies indexed in Medline, PsychINFO, Embase, Cumulative Index to Nursing and Allied Health Literature, Prospective Register of Systematic Reviews, Cochrane Library from inception to 1 April 2019. We will estimate the prevalence of anxiety/depression in these populations and the magnitude of use associated with anxiety/depression across various general physical healthcare settings. We will provide a narrative description of findings and factors that may influence them. A meta-analysis may be pursued if the degree of heterogeneity across studies is acceptable.

Ethics and dissemination

This systematic review will use data from existing studies, hence no ethical approvals are required. Findings will be disseminated in a peer-reviewed publication and at relevant academic meetings.

PROSPERO registration number

PROSPERO CRD42018102628.

Zoledronate in the prevention of Pagets (ZiPP): protocol for a randomised trial of genetic testing and targeted zoledronic acid therapy to prevent SQSTM1-mediated Pagets disease of bone

Por: Cronin · O. · Forsyth · L. · Goodman · K. · Lewis · S. C. · Keerie · C. · Walker · A. · Porteous · M. · Cetnarskyj · R. · Ranganath · L. R. · Selby · P. L. · Hampson · G. · Chandra · R. · Ho · S. · Tobias · J. H. · Young-Min · S. · McKenna · M. J. · Crowley · R. K. · Fraser · W. D. · Genna
Introduction

Paget’s disease of bone (PDB) is characterised by increased and disorganised bone remodelling affecting one or more skeletal sites. Complications include bone pain, deformity, deafness and pathological fractures. Mutations in sequestosome-1 (SQSTM1) are strongly associated with the development of PDB. Bisphosphonate therapy can improve bone pain in PDB, but there is no evidence that treatment alters the natural history of PDB or prevents complications. The Zoledronate in the Prevention of Paget’s disease trial (ZiPP) will determine if prophylactic therapy with the bisphosphonate zoledronic acid (ZA) can delay or prevent the development of PDB in people who carry SQSTM1 mutations.

Methods and analysis

People with a family history of PDB aged >30 years who test positive for SQSTM1 mutations are eligible to take part. At the baseline visit, participants will be screened for the presence of bone lesions by radionuclide bone scan. Biochemical markers of bone turnover will be measured and questionnaires completed to assess pain, health-related quality of life (HRQoL), anxiety and depression. Participants will be randomised to receive a single intravenous infusion of 5 mg ZA or placebo and followed up annually for between 4 and 8 years at which point baseline assessments will be repeated. The primary endpoint will be new bone lesions assessed by radionuclide bone scan. Secondary endpoints will include changes in biochemical markers of bone turnover, pain, HRQoL, anxiety, depression and PDB-related skeletal events.

Ethics and dissemination

The study was approved by the Fife and Forth Valley Research Ethics Committee on 22 December 2008 (08/S0501/84). Following completion of the trial, a manuscript will be submitted to a peer-reviewed journal. The results of this trial will inform clinical practice by determining if early intervention with ZA in presymptomatic individuals with SQSTM1 mutations can prevent or slow the development of bone lesions with an adverse event profile that is acceptable.

Trial registration number

ISRCTN11616770

Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia--Bangladesh, Pakistan and Sri Lanka

Por: Feng · L. · Jehan · I. · de Silva · H. A. · Naheed · A. · Farazdaq · H. · Hirani · S. · Kasturiratne · A. · Ranasinha · C. D. · Islam · M. T. · Siddiquee · A. T. · Jafar · T. H.
Objective

To determinate the prevalence and correlates of cardiometabolic multimorbidity (CMM), and their cross-country variation among individuals with hypertension residing in rural communities in South Asia.

Design

A cross-sectional study.

Setting

Rural communities in Bangladesh, Pakistan and Sri Lanka.

Participants

A total of 2288 individuals with hypertension aged ≥40 years from the ongoing Control of Blood Pressure and Risk Attenuation- Bangladesh, Pakistan and Sri Lanka clinical trial.

Main outcome measures

CMM was defined as the presence of ≥2 of the conditions: diabetes, chronic kidney disease, heart disease and stroke. Logistic regression was done to evaluate the correlates of CMM.

Results

About 25.4% (95% CI 23.6% to 27.2%) of the hypertensive individuals had CMM. Factors positively associated with CMM included residing in Bangladesh (OR 3.42, 95% CI 2.52 to 4.65) or Sri Lankan (3.73, 95% CI 2.48 to 5.61) versus in Pakistan, advancing age (2.33, 95% CI 1.59 to 3.40 for 70 years and over vs 40–49 years), higher waist circumference (2.15, 95% CI 1.42 to 3.25) for Q2–Q3 and 2.14, 95% CI 1.50 to 3.06 for Q3 and above), statin use (2.43, 95% CI 1.84 to 3.22), and higher levels of triglyceride (1.01, 95% CI 1.01 to 1.02 per 5 mg/dL increase). A lower odds of CMM was associated with being physically active (0.75, 95% CI 0.57 to 0.97). A weak inverted J-shaped association between International Wealth Index and CMM was found (p for non-linear=0.058), suggesting higher risk in the middle than higher or lower socioeconomic strata.

Conclusions

CMM is highly prevalent in rural South Asians affecting one in four individuals with hypertension. There is an urgent need for strategies to concomitantly manage hypertension, cardiometabolic comorbid conditions and associated determinants in South Asia.

Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?

Por: Schneider · P. · Bransford · R. · Harvey · E. · Agel · J.
Objectives

To determine if level 1 evidence from a landmark trial changed practice patterns for treatment of patients with displaced midshaft clavicle fractures.

Design

Retrospective cohort study.

Setting

Two level 1 trauma centres.

Participants

Displaced midshaft clavicle fractures.

Results

686 patients met inclusion criteria. The pretrial cohort (n=108) was 68.5% male, with a mean age of 37.7 (±13.9) years. The post-trial cohort (n=578) was 76.1% male, with a mean age of 41.9 (±12.7) years. There was nearly a 10-fold increase in the patients treated with openreduction and internal fixation (ORIF) in the post-trial cohort (34.1%) compared with the pretrial cohort (3.7%) (p9 (OR=1.6; 95% CI 0.89 to 2.99) or if they were treated at a centre that participated in the Canadian Orthopaedic Trauma Society ( COTS ) trial (OR=5.2; 95% CI 3.31 to 8.21).

Conclusions

This study demonstrated a significant shift towards more frequent ORIF for displaced midshaft clavicle fractures following the COTS trial. Quantifying changes in practice pattern following publication of level 1 evidence is important to further our understanding of the impact large randomised clinical trails are having on clinical practice.

Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study

Por: Quaglio · G. · Tognon · F. · Finos · L. · Bome · D. · Sesay · S. · Kebbie · A. · Di Gennaro · F. · Camara · B. S. · Marotta · C. · Pisani · V. · Bangura · Z. · Pizzol · D. · Saracino · A. · Mazzucco · W. · Jones · S. · Putoto · G.
Objectives

To assess the trends concerning utilisation of maternal and child health (MCH) services before, during and after the Ebola outbreak, quantifying the contribution of a reorganised referral system (RS).

Design

A prospective observational study of MCH services.

Setting

Pujehun district in Sierra Leone, 77 community health facilities and 1 hospital from 2012 to 2017.

Main outcome measures

MCH utililization was evaluated by assessing: (1) institutional deliveries, Cesarean-sections, paediatric and maternity admissions and deaths, and major direct obstetric complications (MDOCs), at hospital level; (2) antenatal care (ANC) 1 and 4, institutional delivery and family planning, at community level. Contribution of a strengthened RS was also measured.

Results

At hospital level, there is a significant difference between trends Ebola versus pre-Ebola for maternal admissions (7, 95% CI 4 to 11, p

Conclusions

A stronger health system compared with other districts in Sierra Leone and a strengthened RS enabled health facilities in Pujehun to maintain service provision and uptake during and after the Ebola epidemic.

Quality appraisal of clinical practice guidelines for diabetes mellitus published in China between 2007 and 2017 using the AGREE II instrument

Por: Gao · Y. · Wang · J. · Luo · X. · Song · X. · Liu · L. · Ke · L. · Liao · Z. · Wang · D. · Mu · Y. · Chen · Y. · Estill · J. A. M.
Objective

The aim of this study was to systematically evaluate the quality of the clinical practice guidelines (CPGs) for diabetes mellitus published in China over the period of January 2007 to April 2017.

Methods

We searched the China National Knowledge Infrastructure, Chinese Biomedical Literature database, VIP database and WanFang databases and guideline websites for CPGs for diabetes mellitus published between January 2007 and April 2017 in China. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and extracted data. We used the the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool (Canadian Institutes of Health Research, Ottawa, Canada) to evaluate the quality of the included guidelines, calculated the scores of each domain and evaluated the consistency among the assessors via use of the intragroup correlation coefficient. And then we compared the results with Chinese CPGs and international CPGs. We conducted a subgroup analysis based on different classification criteria and compared scores of each domain subgroup analyses.

Results

A total of 98 guidelines were identified. The correlation coefficient within the group was 0.93, suggesting that the consistency between the evaluators was good. The scores of the six domains of AGREE II were described in median (IQR) as follows: scope and purpose 53.7 (50.0–59.7), stakeholder involvement 31.5 (27.3–37.0), rigour of development 19.1 (15.3–22.2), clarity of presentation 59.3 (50.0–64.8), applicability 18.1 (13.9–25.7) and editorial independence 0.0 (0.0–0.0). The mean score in each domain of quality of Chinese diabetes CPGs was lower than that of CPGs published worldwide but higher than the mean score of Chinese guidelines of all topics. A funding source, the updated version, organisation and publishers of the guidelines and target fields are all the factors influencing the quality of CPGs to a certain degree.

Conclusions

A large number of Chinese diabetes CPGs have been produced. Their quality remain unsatisfactorily low compared with CPGs worldwide, there is still room for improvement. Chinese guideline developers should pay more attention to the transparency of methodology, and use the AGREE II instrument to develop and report guidelines.

Physical activity and sport participation among adolescents: associations with mental health in different age groups. Results from the Young-HUNT study: a cross-sectional survey

Por: Guddal · M. H. · Stensland · S. O. · Smastuen · M. C. · Johnsen · M. B. · Zwart · J.-A. · Storheim · K.
Objectives

Knowledge of how physical activity (PA) and sport participation are related to mental health throughout adolescence is scarce. Our objective was to describe PA levels and sport participation in a population-based sample of adolescents, and to explore how they relate to mental health in different age groups.

Design

A population-based cross-sectional study.

Setting and participants

The adolescent part of the Nord-Trøndelag Health Study, a Norwegian population-based health survey, conducted from 2006 to 2008. Of 10 464 invited participants (age 13–19 years), 7619 (73%) participated, of whom 3785 (50%) were boys.

Outcome measures

Mental health outcomes included psychological distress assessed using a short version of the Hopkins Symptom Check List Five items, self-esteem assessed using a short version of the Rosenberg Self-Esteem Scale and life satisfaction assessed with a single-item satisfaction with life measure.

Method

Logistic regression models were used to estimate the likelihood of psychological distress, low self-esteem and low life satisfaction, according to self-reported PA level and type of sport participation, stratified by gender and school level (junior vs senior high school).

Results

Fewer senior high school students participated in team sports compared with junior high school students (p

Conclusion

A high PA level was favourably associated with various dimensions of mental health, especially for adolescents in senior high school. Team sport participation may have a positive impact on mental health and should, therefore, be encouraged.

Effectiveness of strategies for nutritional therapy for patients with type 2 diabetes and/or hypertension in primary care: protocol of a systematic review of randomised controlled trials

Introduction

Despite the increasing number of drugs available and various guidelines on the management of type 2 diabetes mellitus (T2DM) and hypertension, an expressive number of patients continue with these diseases uncontrolled. Nutrition therapy (NT) plays a fundamental role in the prevention and management of these comorbidities, as well as in the prevention of complications related to them. The objective of this review is to evaluate the effectiveness of NT strategies in the management of patients with T2DM and/or hypertension in primary care. The selected strategies did not substitute pharmaceutical treatment but instead focused on preventing a sedentary lifestyle and stimulating healthy nutrition.

Methods and analysis

We will perform a systematic review according to Cochrane methodology of randomised controlled trials, wherein patients with T2DM and/or hypertension were allocated into one of the two groups: NT strategy, which may be of dietary quality or energy restriction, and conventional treatment. The primary outcomes will be glycaemic and blood pressure (BP) control, measured by final glycosylated hemoglobin (HbA1c) (%) and BP (mm Hg), respectively. Four general and adaptive search strategies have been created for the Embase, Medline, Latin American and Caribbean Health Sciences Literature (LILACS) and Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases. Two reviewers will independently select eligible studies, assess the risk of bias and extract data from the included studies. Similar outcomes measured in at least two trials will be plotted in the meta-analysis using Review Manager V.5.3. The quality of evidence of the effect estimate of the intervention will be generated according to the Grading of Recommendations Assessment, Development, and Evaluation Working Group.

Ethics and dissemination

As no primary data collection will be undertaken, formal ethical assessment is not required. We plan to present the results of this systematic review in a peer-reviewed scientific journal, conferences and the popular press.

PROSPERO registration number

Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 20 December 2018 (Registration number CRD42018118117).

Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review

Por: Button · K. · Morgan · F. · Weightman · A. L. · Jones · S.
Objective

Musculoskeletal care pathways are variable and inconsistent. The aim of this systematic review was to evaluate the evidence for the clinical and/or cost effectiveness of current care pathways for adults with hip and/or knee pain referred for specialist opinion.

Design

Systematic review.

Data sources

Electronic database searches were carried out in MEDLINE, MEDLINE In-Process, Cumulative Index of Nursing and Allied Health Literature, Embase, PEDro, PubMed, Web of Science, Cochrane Central and Health Management Information Consortium without language restriction from 1990 onwards. Websites were reviewed for grey literature.

Eligibility criteria

All study designs and documents that considered care pathways for adults with musculoskeletal hip and/or knee pain referred for specialist opinion were screened by two reviewers. Risk of bias was assessed using The Critical Appraisal Skills Programme checklist for randomised controlled trials and the Joanna Briggs Institute checklists.

Data extraction and synthesis

Data extraction and quality assessment were performed by one reviewer and checked by a second. Findings are reported narratively.

Results

The titles and abstracts of 1248 articles were screened and 140 full-text articles retrieved. 19 papers reporting 17 studies met the study inclusion criteria. Quality was low due to study design and methodological flaws. Most of the outcomes relate to organisational process at the ‘meso’ level of a whole systems approach.

Conclusion

It can be concluded that the pathway is not linear, containing variations and activity loops. The available evidence suggests that, from the point of referral for specialist opinion, a model is required that integrates the skills of all the different healthcare professionals and streamlining is required to ensure that individuals are seen by the healthcare professional that best meets their needs. There is very limited evidence of patient experience informing knee and hip care pathways.

PROSPERO registration number

CRD42016035510.

Intelligence in young adulthood and alcohol use disorders in a prospective cohort study of Danish men: the role of psychiatric disorders and parental psychiatric history

Por: Just-Ostergaard · E. · Flensborg-Madsen · T. · Knop · J. · Sorensen · H. J. · Becker · U. · Mortensen · E. L.
Objectives

The aims were to estimate the association between intelligence measured in young adulthood and risk of alcohol use disorders (AUD) in men and to investigate the potential modification of this association by psychiatric disorders, parental AUD and parental psychiatric disorders.

Design

Prospective cohort study based on a linkage of intelligence test scores from draft board examinations and register data on AUD diagnoses during 36 years of follow-up.

Setting

Denmark.

Participants

3287 Danish men from the Copenhagen Perinatal Cohort (born 1959–1961) who appeared before the draft board at a mean age of 18.7 years.

Primary outcome measure

First registration with AUD during follow-up was the primary outcome. Information on AUD was based on diagnoses retrieved from national hospital and outpatient treatment registers, defined according to the International Classification of Diseases.

Results

361 (11.0%) men were registered with AUD during follow-up. Low intelligence scores were associated with increased odds of AUD adjusting for parental AUD, parental psychiatric disorders, maternal smoking during pregnancy, birth weight, maternal age at birth, parity and childhood socioeconomic position (OR per SD decrease in intelligence=1.69, 95% CI 1.49 to 1.92). Separate analyses indicated significant interaction (p

Conclusions

The association between intelligence in young adulthood and AUD is modified by other psychiatric disorders as low intelligence is primarily a risk factor for men without other psychiatric disorders. Future studies should take other psychiatric disorders into account when investigating associations between intelligence and AUD.

Effect modification by gender of the influence of obstructive sleep apnoea characteristics on dyslipidaemia in China: a cross-sectional study

Por: Xia · Y. · Zou · J. · Xu · H. · Yi · H. · Guan · J. · Yin · S.
Objectives

Obstructive sleep apnoea (OSA) characteristics differ by gender, possibly affecting any association between OSA and dyslipidaemia. We explored whether gender influenced any association between OSA characteristics and dyslipidaemia.

Methods/Design

This was a cross-sectional, large-scale hospital-based study. Male and female risks of dyslipidaemia by OSA characteristics were assessed with logistic regression. Additive interactions were measured using three indices: the relative excess risk due to interaction, the attributable proportion due to interaction and the synergy index. Multiplicative interaction was evaluated via logistic regression.

Setting

A single secondary-care setting in China.

Participants

3760 patients with OSA.

Primary and secondary outcome measures

Outcomes were male and female risks of dyslipidaemia, and the associated additive and multiplicative interactions between the apnoea–hypopnea index (AHI), the oxygen-desaturation index (ODI), the microarousal index (MAI), and gender.

Results

After controlling for confounding factors, males (but not females) with AHIs>30 were at higher risk of hyper-total cholesterol (TC), hypo-high-density lipoprotein cholesterol (HDL-C) status and a hyper-TC/HDL-C ratio than males with AHIs≤30. Positive additive interactions were evident between the male gender and AHI on a hyper-TC/HDL-C ratio and hypo-HDL-C status. Males with ODIs>40.1 were at higher risk of hypo-HDL-C status and a hyper-TC/HDL-C ratio than males with ODIs≤40.1. Positive additive and multiplicative interactions were evident between male gender and ODI on hyper-TC/HDL-C ratio. Males with MAIs>28.6 were at higher risk of hyper-TC and hyper-low-density lipoprotein cholesterol status than males with MAIs≤28.6, but no statistically significant interactions were apparent between gender and MAI.

Conclusions

Males (but not females) with higher AHIs, ODIs or MAIs were at higher risks of some measures of dyslipidaemia. Positive interactions between male and severe OSA or intermittent hypoxia on some measures of dyslipidaemia were apparent. Thus, dyslipidaemia should be evaluated in patients with OSA, especially males with severe OSA or intermittent hypoxia.

Mental health specialist video consultations for patients with depression or anxiety disorders in primary care: protocol for a randomised controlled feasibility trial

Por: Tönnies · J. · Hartmann · M. · Wensing · M. · Szecsenyi · J. · Icks · A. · Friederich · H.-C. · Haun · M. W.
Introduction

Most people suffering from depression and anxiety disorders are entirely treated in primary care. Due to growing challenges in ageing societies, for example, patients’ immobility and multimorbidity, the transition to specialised care becomes increasingly difficult. Although the co-location of general practitioners and mental health specialists improves the access to psychosocial care, integrated in-person approaches are not practical for rural and single-doctor practices with limited personnel and financial resources. Treating primary care patients via internet-based video consultations by remotely located mental health specialists bears the potential to overcome structural barriers and provide low-threshold care. The aim of this randomised controlled feasibility trial is to investigate the feasibility of implementing of mental health specialist video consultations in primary care practices.

Methods and analysis

Fifty primary care patients with significant depression and/or anxiety symptomatology will be randomised in two groups receiving either the treatment as usual as provided by their general practitioner or up to five video consultations conducted by a mental health specialist. The video consultations focus on (1) systematic diagnosis plus proactive monitoring using validated clinical rating scales, (2) the establishment of an effective working alliance and (3) a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. We will investigate the following outcomes: effectiveness of the recruitment strategies, patient acceptance of randomisation, practicability of the technical and logistical processes related to implementing video consultations in the practices’ workflows, feasibility of the data collection and clinical parameters.

Ethics and dissemination

This trial has undergone ethical scrutiny and has been approved by the Medical Faculty of the University of Heidelberg Ethics Committee (S-634/2018). The findings will be disseminated to the research community through presentations at conferences and publications in scientific journals. This feasibility trial will prepare the ground for a large-scale, fully powered randomised controlled trial.

Trial registration number

DRKS00015812.

Rates of retention of persons with a mental health disorder in outpatient smoking cessation and reduction trials, and associated factors: protocol for a systematic review and meta-analysis

Por: Metse · A. P. · Stockings · E. · Bailey · J. · Regan · T. · Bartlem · K. · Wolfenden · L. · Taylor · G. · Wiggers · J. · Bowman · J.
Introduction

Smoking among persons with a mental health disorder is associated with inequitable health, social and economic burden. Randomised controlled trials (RCTs) are considered the gold standard design for the assessment of healthcare intervention efficacy/effectiveness. However, many RCTs of smoking interventions for persons with a mental health disorder lack rigour due to low participant retention. No systematic review has pooled retention rates in randomised trials of smoking interventions for persons with a mental health disorder or explored associated factors. The aims of the systematic review will therefore be to: (1) summarise overall rates of participant retention in smoking cessation and reduction trials involving persons with a mental health disorder (including for experimental and control groups separately) and (2) determine if retention rates vary according to participant, environmental, researcher and study factors.

Methods and analysis

PsycINFO, EMBASE, MEDLINE, CENTRAL and The Cochrane Tobacco Addiction Review Group Specialised Register will be searched for reports of RCTs of outpatient smoking cessation or reduction interventions for adults with a mental health disorder. The search terms will include MeSH terms and free text words, and there will be no language or date restrictions. All databases will be searched from inception to present. Data will be analysed using the Mantel-Haenszel fixed-effect model, and where substantial heterogeneity (I2 >50%) is detected, DerSimonian & Laird inverse-variance random effects model. Pooled estimates and 95% CIs will be calculated for overall participant retention rates and for intervention and control trial arms separately. Associations between participant retention and participant, environmental, researcher and study factors will be assessed via subgroup analyses and, where sufficient data are obtained, meta-regression.

Ethics and dissemination

This study does not require ethical approval. The findings of this review will be disseminated via publication in a peer-reviewed open access medical journal and presentations at international scientific meetings.

Effects of Iranian healthcare transformation plan on discharge against medical advice rate and related factors in 2012 and 2016

Por: Taghizadieh · A. · Azami-Aghdash · S. · Piri · R. · Naghavi-Behzad · M. · Jabbari Beyrami · H.
Objective

Discharge against medical advice (DAMA) is a critical problem in hospitals and has several consequences for healthcare systems. The aim of this study was to determine and compare the rate of DAMA and its related factors before and after executing the healthcare transformation plan (HTP) in Iran.

Methods

In a two-phase, cross-sectional study, the DAMA information of 200 patients in 2016 (after HTP) and the patients of a previous study in 2012 (before HTP) was compared. Samples were randomly selected from the main referral centre in the north-west of Iran. Data were collected using a validated and reliable questionnaire and analysed using the SPSS V.16 software.

Results

In the post-HTP plan period, the rate of DAMA was 3.9%, while this rate was 5.49% in 2012 (p=0.029). A total of 15% (108 out of 721) of patients in the postreform group and 13.5% (101 out of 747) in the prereform group were rehospitalised (p=0.411). The three main categories of reasons for DAMA in 2012 and 2016 were as follows: patient-related factors, 27% vs 45%; staff-related factors, 33% vs 30%; and hospital-related factors (basic amenities), 40% vs 25%. In both periods, the average scores of patient satisfaction were almost the same; however, satisfaction regarding environmental and human factors in hospitals had changed significantly after HTP (p

Conclusions

There was a decrease in the rate of DAMA after HTP in Iran. Considering DAMA as a multifactorial phenomenon, this might be due to the higher relative satisfaction after HTP, indicating an increase in public confidence in general hospitals.

Impact of caesarean section on breastfeeding indicators: within-country and meta-analyses of nationally representative data from 33 countries in sub-Saharan Africa

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

To examine the impact of caesarean section on breastfeeding indicators—early initiation of breastfeeding, exclusive breastfeeding under 6 months and children ever breastfed (at least once)—in sub-Saharan Africa.

Design

Secondary analysis of Demographic and Health Surveys (DHS).

Setting

Thirty-three low-income and middle-income countries with a survey conducted between 2010 and 2017/2018.

Participants

Women aged 15–49 years with a singleton live last birth during the 2 years preceding the survey.

Main outcome measures

We analysed the DHS data to examine the impact of caesarean section on breastfeeding indicators using the modified Poisson regression models for each country adjusted for potential confounders. For each breastfeeding indicator, the within-country adjusted prevalence ratios (aPR) were pooled in random-effects meta-analysis.

Results

The within-country analyses showed, compared with vaginal birth, caesarean section was associated with aPR for early initiation of breastfeeding that ranged from 0.24 (95% CI 0.17 to 0.33) in Tanzania to 0.89 (95% CI 0.78 to 1.00) in South Africa. The aPR for exclusive breastfeeding under 6 months ranged from 0.58 (95% CI 0.34 to 0.98) in Angola to 1.93 (95% CI 0.46 to 8.10) in Cote d'Ivoire, while the aPR for children ever breastfed ranged from 0.91 (95% CI 0.82 to 1.02) in Gabon to 1.02 (95% CI 0.99 to 1.04) in Gambia. The meta-analysis showed caesarean section was associated with a 46% lower prevalence of early initiation of breastfeeding (pooled aPR, 0.54 (95% CI 0.48 to 0.60)). However, meta-analysis indicated little association with exclusive breastfeeding under 6 months (pooled aPR, 0.94 (95% CI 0.88 to 1.01)) and children ever breastfed (pooled aPR, 0.98 (95% CI 0.98 to 0.99)) among caesarean versus vaginally born children.

Conclusions

Caesarean section had a negative influence on early initiation of breastfeeding but showed little difference in exclusive breastfeeding under 6 months and children ever breastfed in sub-Saharan Africa.

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