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Management of long bone fractures and traumatic hip dislocations in paediatric patients: study protocol for a prospective global multicentre observational cohort registry

Introduction

Management controversy and clinical equipoise exist in treatments of long bone fractures and traumatic hip dislocation in paediatric patients due to the lack of high-quality clinical evidence. This protocol describes the effort of a large prospective global multicentre cohort study (registry) aiming at providing quality data to assist evidence-based treatment decision-making.

Methods and analysis

Eligible paediatric patients (N=750–1000) with open physes suffering from proximal humerus fractures, distal humerus fractures, proximal radius fractures, forearm shaft fractures, traumatic hip dislocations, femoral neck fractures or tibial shaft fractures will be recruited over a period of 24–36 months. Hospitalisation and treatment details (including materials and implants) will be captured in a cloud-based, searchable database. Outcome measures include radiographic assessments, clinical outcomes (such as range of motion, limb length discrepancies and implant removal), patient-reported outcomes (Patient Reported Outcomes Of Fracture, Patient-Reported Outcomes Measurement Information System (PROMIS) and EuroQol-5D (EQ-5D-Y)) and adverse events.

Aside from descriptive statistics on patient demographics, baseline characteristics, types of fractures and adverse event rates, research questions will be formulated based on data availability and quality. A statistical analysis plan will be prepared before the statistical analysis.

Ethics and dissemination

Ethics approval will be obtained before patients are enrolled at each participating site. Patient enrolment will follow an informed consent process approved by the responsible ethics committee. Peer-reviewed publication is planned to disseminate the study results.

Trial registration number

NCT04207892.

Impact of exercise training associated with enalapril treatment on blood pressure variability and renal dysfunctions in an experimental model of arterial hypertension and postmenopause

by Michel Pablo dos Santos Ferreira Silva, Maycon Junior Ferreira, Tânia Plens Shecaira, Danielle da Silva Dias, Débora Conte Kimura, Maria Cláudia Irigoyen, Guiomar Nascimento Gomes, Kátia De Angelis

Objective

In this study, we aimed to investigate the effects of the concurrent exercise training (CET) associated with the enalapril maleate on blood pressure variability (BPV) and renal profile in an experimental model of arterial hypertension (AH) and postmenopause.

Methods

Female ovariectomized spontaneously hypertensive rats (SHR) were distributed into 4 groups (n = 8/group): sedentary (SO), sedentary + enalapril (SOE), trained (TO) and trained + enalapril (TOE). Both enalapril (3mg/kg) and CET (3 days/week) were conducted during 8 weeks. Blood pressure (BP) was directly recorded for BPV analyses. Renal function, morphology, inflammation and oxidative stress were assessed.

Results

The SOE, TO e TOE groups presented decreased systolic BP compared with SO. Both trained groups (TO and TOE) presented lower BPV and increased baroreflex sensitivity (TO: 0.76 ± 0.20 and TOE: 1.02 ± 0.40 vs. SO: 0.40 ± 0.07 ms/mmHg) compared with SO group, with additional improvements in TOE group. Creatinine and IL-6 levels were reduced in SOE, TO and TOE compared with SO group, while IL-10 was increased only in TOE group (vs. SO). Enalapril combined with CET promote reduction in lipoperoxidation (TOE: 1.37 ± 0.26 vs. SO: 2.08 ± 0.48 and SOE: 1.84 ± 0.35 μmol/mg protein) and hydrogen peroxide (TOE: 1.89 ± 0.40 vs. SO: 3.70 ± 0.19 and SOE: 2.73 ± 0.70 μM), as well as increase in catalase activity (vs. sedentary groups). The tubulointerstitial injury was lower in interventions groups (SOE, TO and TOE vs. SO), with potentialized benefits in the trained groups.

Conclusions

Enalapril combined with CET attenuated BPV and baroreflex dysfunctions, probably impacting on end-organ damage, as demonstrated by attenuation in the AH-induced renal inflammations, oxidative stress and morphofunctional impairments in postmenopausal rats.

Reliability and validity assessment of a survey: Measuring satisfaction with cochlear implant rehabilitation services for children in Jordan

by Rana Alkhamra, Hala M. Al-Omari, Hanady A. Bani Hani

Background

Assessing parental satisfaction with healthcare services is crucial, particularly for parents and their children, who are the primary recipients of these services. In the context of Arabic-speaking parents, there is a notable absence of survey instruments tailored to measure their satisfaction. This study seeks to address this gap by validating a survey designed to evaluate parental satisfaction with rehabilitation services (RSs) provided to Jordanian children who have received cochlear implants (CIs).

Methods

The study included 92 participants and followed a four-step methodology: 1) a literature review and expert input; 2) cognitive interviews, pilot testing, and test-retest reliability testing; 3) data collection; 4) validity and reliability assessments.

Results

The survey’s validity was confirmed. Expert input and cognitive interviews improved content validity, and factor analysis established construct validity by revealing six factors explaining 82.33% of the variance in the survey scale. Convergent and discriminant validity were confirmed (composite reliability >0.7 and average variance extracted value >0.5). Cronbach’s α exceeded 0.8 for each factor and reached 0.855 for the total scale. Survey results showed reliance on speech therapy and audiology, varied rehabilitation durations, and progress. Parents expressed overall satisfaction, particularly influenced by technical quality and efficacy/outcome dimensions. Parents’ recommendations to enhance satisfaction with RSs included financial support, improved service accessibility, enhanced service delivery, specialized education, and increased public awareness.

Conclusion

This study validates an Arabic satisfaction survey, emphasizing the significance of multidisciplinary, extended rehabilitation programs, skilled professionals, and positive outcomes. It emphasizes the necessity for improved access to specialized care and collaboration among healthcare, government, and media to shape parental perceptions of RSs. While the findings indicate overall satisfaction, they also reveal challenges faced by parents, highlighting the need for comprehensive support systems. These insights assist healthcare providers and policymakers in enhancing care quality and meeting the needs of CI children’s families, thereby improving the RSs experience in Jordan.

Prolonged screen time in adolescence linked to higher cardiometabolic risk in adulthood

Por: Nauman · J. · Omara · A.

Commentary on: Nagata JM, Lee CM, Lin F, et al. Screen time from adolescence to adulthood and cardiometabolic disease: a prospective cohort study. J Gen Intern Med. 2023 Jan 10. doi: 10.1007/s11606-022-07984-6. Epub ahead of print.

Implications for practice and research

  • Reducing screen time and promoting physical activity among children and adolescents could be a key strategy in preventing cardiometabolic diseases in adulthood.

  • Further research using objective measures of screen time is needed to advance knowledge of dose–response relationship between screen time and cardiometabolic disease risk and to inform future recommendations.

  • Context

    In an increasingly digital world, high prevalence of sedentary behaviour has become a significant concern for public health. It is ubiquitous in various environments, and WHO guidelines1 recommend reducing sedentary behaviour for substantial health benefits. The study by Nagata and colleagues2 investigating the relationship between screen time and...

    Assessment of psychological terror and its impact on mental health and quality of life in medical residents at a reference medical center in Mexico: A cross-sectional study

    by Víctor Manuel Enriquez Estrada, Neftali Eduardo Antonio-Villa, Omar Yaxhemen Bello-Chavolla, Carlos Fredy Cuevas-García, Pedro Luis Vargas Gutiérrez, Irma Sau-Yen Corlay Noriega, Luis Rey García-Cortés

    Background

    Mobbing, particularly in medical residencies, can lead to psychological terror with lasting mental and physical health consequences. Its impact on Mexican residents, however, remains underexplored.

    Aim

    This study aimed to investigate the prevalence and associated factors of psychological terror among medical residents at a medical center in Mexico City.

    Methods

    In a cross-sectional study, medical residents from various specialties were assessed for mobbing domains, quality of life, and anxiety/depression using the Leymann Inventory of Psychological Terror (LIPT), 36-Item Short Form Health Survey, Beck Depression Inventory-II, and Beck Anxiety Inventory, respectively. Psychological terror was defined as a LIPT score ≥ p80. Linear and binomial logistic regression models were used to explore independent predictors of mobbing and psychological terror.

    Results

    Of the 349 participants included (median age: 28; IQR: 27–30 years), 19.5% (95% CI: 15.5%-24.0%) were identified with psychological terror. Furthermore, 39% reported higher-degree trainees as mobbing perpetrators. Women in surgical residencies in their second or fifth year were found to experience higher levels of mobbing. Manifested bullying, workplace stigma, and inappropriate tasks were the most impacted mobbing domains. Anxiety, diminished mental health quality of life, and higher degree of medical specialization were independent predictors of mobbing. Meanwhile, increased anxiety, affiliation to surgical specialties, and being in the second or fifth year of training were identified as predictors of psychological terror.

    Conclusions

    Mobbing and psychological terror are prevalent conditions among medical residents in Mexico. Identification of occupational conditions and adverse psychological stressors can help to improve quality of life and training of medical residents.

    The lived experience of Omani adolescents and young adults with mental illness: A qualitative study

    by Omar Al Omari, Gerald Amandu, Samir Al-Adawi, Zubaida Shebani, Ibtisam Al Harthy, Arwa Obeidat, Khloud Al Dameery, Mohammad Al Qadire, Iman Al Hashmi, Abduallh Al Khawldeh, Mohammed ALBashtawy, Maen Aljezawi

    There is currently limited knowledge about the firsthand experiences of adolescents and young adults with mental health problems and the meanings they ascribe to these experiences, particularly within Arab countries. This study, therefore, aimed to explore the lived experience of Omani adolescents and young adults with a mental health problem. A sample of 15 participants aged 13–22 diagnosed with a range of mental health problems took part in the study. A qualitative interview guide consisting of open-ended questions was used to allow participants to speak in-depth about their experiences. Using the thematic analysis approach to uncover patterns in the data, three major themes emerged: “living in darkness”, “perilous journey” and “uncertain future”. Results show that the progress of adolescents and young adults with mental health problems is characterized by several challenges; the most significant of which is having insufficient knowledge about their illness, leading to unnecessary delays in their treatment. These findings shed light on the breadth and depth of the experience of adolescents and young adults with mental health problems and lay the groundwork for further examinations. Implications lie in the development of approaches for preventing or mitigating difficulties faced by adolescents and young adults with mental health problems.

    Association of biomarkers of enteric dysfunction, systemic inflammation, and growth hormone resistance with seroconversion to oral rotavirus vaccine: A lasso for inference approach

    by Katayi Mwila-Kazimbaya, Samuel Bosomprah, Obvious Nchimunya Chilyabanyama, Caroline Cleopatra Chisenga, Mwelwa Chibuye, Natasha Makabilo Laban, Michelo Simuyandi, Bert Huffer Jr, Miren Iturriza-Gomara, Robert K. M. Choy, Roma Chilengi

    Background

    Rotavirus gastroenteritis remains a leading cause of morbidity and mortality despite the introduction of vaccines. Research shows there are several factors contributing to the reduced efficacy of rotavirus vaccines in low- and middle-income settings. Proposed factors include environmental enteric dysfunction (EED), malnutrition, and immune dysfunction. This study aimed to assess the effect of these factors on vaccine responses using a machine learning lasso approach.

    Methods

    Serum samples from two rotavirus clinical trials (CVIA 066 n = 99 and CVIA 061 n = 124) were assessed for 11 analytes using the novel Micronutrient and EED Assessment Tool (MEEDAT) multiplex ELISA. Immune responses to oral rotavirus vaccines (Rotarix, Rotavac, and Rotavac 5D) as well as a parenteral rotavirus vaccine (trivalent P2-VP8) were also measured and machine learning using the lasso approach was then applied to investigate any associations between immune responses and environmental enteric dysfunction, systemic inflammation, and growth hormone resistance biomarkers.

    Results

    Both oral and parenteral rotavirus vaccine responses were negatively associated with retinol binding protein 4 (RBP4), albeit only weakly for oral vaccines. The parenteral vaccine responses were positively associated with thyroglobulin (Tg) and histidine-rich protein 2 (HRP2) for all three serotypes (P8, P6 and P4), whilst intestinal fatty acid binding protein (I-FABP) was negatively associated with P6 and P4, but not P8, and soluble transferrin receptor (sTfR) was positively associated with P6 only.

    Conclusion

    MEEDAT successfully measured biomarkers of growth, systemic inflammation, and EED in infants undergoing vaccination, with RBP4 being the only analyte associated with both oral and parenteral rotavirus vaccine responses. Tg and HRP2 were associated with responses to all three serotypes in the parenteral vaccine, while I-FABP and sTfR results indicated possible strain specific immune responses to parenteral immunization.

    Asociación entre los niveles de lípidos y las infecciones en las úlceras por presión en el Departamento de Salud del Hospital General de Elche

    Introducción. Las heridas crónicas suponen un grave problema de salud con gran impacto socioeconómico debido a su morbimortalidad y a la afectación de la calidad de vida. Desde hace tiempo se conocen las propiedades de los lípidos en el sistema inmunitario. Un sistema inmunológico débil podría conducir a una infección o cronificación de las heridas. El colesterol es un lípido con importancia cuantitativa en las membranas de las células donde contribuye al mantenimiento de la fluidez de membrana. Unos niveles bajos de colesterol se relacionan con mayor riesgo de padecer infecciones. El objetivo del estudio fue analizar los niveles de lípidos en pacientes con úlceras por presión infectadas. Metodología. Se estudiaron 77 pacientes del Departamento de Salud de Elche Hospital General con úlceras por presión infectadas en un periodo de un año. Resultados. Se ponen de manifiesto diferencias estadísticamente significativas entre pacientes con niveles de C-LDL por debajo de 70mg/dL y pacientes con niveles por encima de 70mg/dL que presentan un CT por debajo de 140mg/dL. Discusión. La investigación futura sobre estos aspectos ayudará a aclarar los mecanismos de transporte del colesterol hacia los tejidos para así protegerlos de las agresiones de los microorganismos.

    ABSTRACT

    Introduction. Chronic wounds are a serious health problem with great socioeconomic impact due to their morbidity and mortality and the affectation of quality of life. The properties of lipids in the immune system have been known for a long time. A weak immune system could lead to infection or chronic wounds. Cholesterol is a quantitatively important lipid in cell membranes where it contributes to maintaining membrane fluidity. Low levels of cholesterol are associated with an increased risk of infections. The objective of the study was to analyze the levels of lipids in patients with pressure ulcers infected. Methodology. 77 patients with infections in pressure ulcers from the Health Department of Elche-General Hospital were studied for one year. Results. Statistically significant differences are revealed between patients with LDL-C levels below 70mg/dL and patients with levels above 70mg/dL. Levels of TC were below 140mg/dL in both groups. Discussion. Future research on these aspects will help clarify the mechanisms of cholesterol transport to the tissues and therefore protect them from microorganism aggressions.

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