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Comorbidities in osteoarthritis (ComOA): a combined cross-sectional, case-control and cohort study using large electronic health records in four European countries

Por: Swain · S. · Kamps · A. · Runhaar · J. · Dell'Isola · A. · Turkiewicz · A. · Robinson · D. · Strauss · V. · Mallen · C. · Kuo · C.-F. · Coupland · C. · Doherty · M. · Sarmanova · A. · Prieto-Alhambra · D. · Englund · M. · Bierma-Zeinstra · S. M. A. · Zhang · W.
Introduction

Osteoarthritis (OA) is one of the leading chronic conditions in the older population. People with OA are more likely to have one or more other chronic conditions than those without. However, the temporal associations, clusters of the comorbidities, role of analgesics and the causality and variation between populations are yet to be investigated. This paper describes the protocol of a multinational study in four European countries (UK, Netherlands, Sweden and Spain) exploring comorbidities in people with OA.

Methods and analysis

This multinational study will investigate (1) the temporal associations of 61 identified comorbidities with OA, (2) the clusters and trajectories of comorbidities in people with OA, (3) the role of analgesics on incidence of comorbidities in people with OA, (4) the potential biomarkers and causality between OA and the comorbidities, and (5) variations between countries.

A combined case–control and cohort study will be conducted to find the temporal association of OA with the comorbidities using the national or regional health databases. Latent class analysis will be performed to identify the clusters at baseline and joint latent class analysis will be used to examine trajectories during the follow-up. A cohort study will be undertaken to evaluate the role of non-steroidal anti-inflammatory drugs (NSAIDs), opioids and paracetamol on the incidence of comorbidities. Mendelian randomisation will be performed to investigate the potential biomarkers for causality between OA and the comorbidities using the UK Biobank and the Rotterdam Study databases. Finally, a meta-analyses will be used to examine the variations and pool the results from different countries.

Ethics and dissemination

Research ethics was obtained according to each database requirement. Results will be disseminated through the FOREUM website, scientific meetings, publications and in partnership with patient organisations.

Sociocultural perspectives on suicidal behaviour at the Coast Region of Kenya: an exploratory qualitative study

Por: Ongeri · L. · Nyawira · M. · Kariuki · S. M. · Theuri · C. · Bitta · M. · Penninx · B. · Newton · C. R. · Tijdink · J.
Objectives

To explore perceived sociocultural factors that may influence suicidality from key informants residing in coastal Kenya.

Design

We used an exploratory qualitative study design.

Setting

Mombasa and Kilifi Counties of Coastal Kenya.

Participants

25 key informants including community leaders, professionals and community members directly and indirectly affected by suicidality.

Methods

We conducted in-depth interviews with purposively selected key informants to collect data on sociocultural perspectives of suicide. Thematic analysis was used to identify key themes using both inductive and deductive processes.

Results

Four key themes were identified from the inductive content analysis of 25 in-depth interviews as being important for understanding cultural perspectives related to suicidality: (1) the stigma of suicidal behaviour, with suicidal victims perceived as weak or crazy, and suicidal act as evil and illegal; (2) the attribution of supernatural causality to suicide, for example, due to sorcery or inherited curses; (3) the convoluted pathway to care, specifically, delayed access to biomedical care and preference for informal healers; and (4) gender and age differences influencing suicide motivation, method of suicide and care seeking behaviour for suicidality.

Conclusions

This study provides an in depth understanding of cultural factors attributed to suicide in this rural community that may engender stigma, discrimination and poor access to mental healthcare in this community. We recommend multipronged and multilevel suicide prevention interventions targeted at changing stigmatising attitudes, beliefs and behaviours, and improving access to mental healthcare in the community.

SARS-CoV-2 seroprevalence among Vancouver public school staff in British Columbia, Canada: a cross-sectional study

Por: Goldfarb · D. M. · Masse · L. C. · Watts · A. W. · Hutchison · S. M. · Muttucomaroe · L. · Bosman · E. S. · Barakauskas · V. E. · Choi · A. · Dhillon · N. · Irvine · M. A. · Reicherz · F. · OReilly · C. · Sediqi · S. · Xu · R. Y. · Razzaghian · H. R. · Sadarangani · M. · Coombs · D. · OB
Objectives

Few studies reported COVID-19 cases in schools during the 2020/21 academic year in a setting of uninterrupted in-person schooling. The main objective was to determine the SARS-CoV-2 seroprevalence among school staff in Vancouver public schools.

Design

Cumulative incident COVID-19 cases among all students and school staff based on public health data, with an embedded cross-sectional serosurvey among a school staff sample that was compared to period, age, sex and geographical location-weighted data from blood donors.

Setting

Vancouver School District (British Columbia, Canada) from kindergarten to grade 12.

Participants

Active school staff enrolled from 3 February to 23 April 2021 with serology testing from 10 February to 15 May 2021.

Main outcome measures

SARS-CoV-2 seroprevalence among school staff, based on spike (S)-based (unvaccinated staff) or N-based serology testing (vaccinated staff).

Results

Public health data showed the cumulative incidence of COVID-19 among students attending in-person was 9.8 per 1000 students (n=47 280), and 13 per 1000 among school staff (n=7071). In a representative sample of 1689 school staff, 78.2% had classroom responsibilities, and spent a median of 17.6 hours in class per week (IQR: 5.0–25 hours). Although 21.5% (363/1686) of surveyed staff self-reported close contact with a COVID-19 case outside of their household (16.5% contacts were school-based), 5 cases likely acquired the infection at school based on viral testing. Sensitivity/Specificity-adjusted seroprevalence in 1556/1689 staff (92.1%) was 2.3% (95% CI: 1.6% to 3.2%), comparable to a sex, age, date and residency area-weighted seroprevalence of 2.6% (95% CI: 2.2% to 3.1%) among 5417 blood donors.

Conclusion

Seroprevalence among staff was comparable to a reference group of blood donors from the same community. These data show that in-person schooling could be safely maintained during the 2020/21 school year with mitigation measures, in a large school district in Vancouver, Canada.

Understanding how food safety risk perception influences dietary decision making among women in Phenom Phnom Penh, Cambodia: a qualitative study

Por: Brown · S. M. · Nguyen-Viet · H. · Grace · D. · Ty · C. · Samkol · P. · Sokchea · H. · Pov · S. · Young · M. F.
Objectives

To determine women’s perception of the risk of food safety and how it relates to diet, health and decision making as part of formative research for a market-based intervention that aims to improve the safety of animal-source foods sold in informal markets.

Design

Qualitative study including in-depth personal interviews with 24 caregivers were conducted and complemented with a second follow-up PhotoVoice interview, which allowed the women to photograph their meals and perceptions of food safety and nutrition. Interview data were analysed using thematic analysis in MAXQDA. Participants were purposively sampled from a larger Safe Food, Fair Food for Cambodia study, conducted from May to August 2018.

Setting

Urban and periurban neighborhoods of Phnom Penh, Cambodia.

Participants

24 female caregivers (mothers and grandmothers) of children under age 5, each interviewed twice.

Findings

A primary food safety concern expressed was that chemicals (pesticides and other agricultural additives) in animal-source foods, fruits and vegetables may impact the health of their families by causing diarrhoea and problems during pregnancy. This fear created a lack of trust in markets, which influenced their food purchasing behaviours and strategies for making the food safer for their families. These mitigation strategies, including food selection and cleaning, vary among the women but are perceived as important to be able to provide their families with what they define as safe meals.

Conclusions

Interventions that wish to decrease rates of foodborne illness and increase animal source food consumption should also address the belief that the food system has been compromised by the addition of pesticides and agricultural additives.

Intimate partner violence educational programmes may improve healthcare professionals knowledge of and readiness to respond to womens experiences of violence

Por: Seymour · R. J. · Jack · S. M.

Commentary on: Kalra N, Hooker L, Reisenhofer S, et al. Training healthcare providers to respond to intimate partner violence against women. Cochrane Database Syst Rev 2021;5:CD012423. doi: 10.1002/14651858.CD012423.PUB2

Implications for practice and research

  • Intimate partner violence (IPV) education programmes for healthcare providers should be regular and augmented by the implementation of system (or institution)-wide resources, pathways and policies to support individuals in successfully addressing women’s experiences of violence.

  • Future evaluations of training programmes should include assessments that measure actual (not just perceived) behavioural outcomes in practice and examine the relationship between providers’ educational outcomes and women’s safety and well-being.

  • Context

    Global estimates indicate that approximately one in three women has experienced physical and/or sexual IPV, or non-partner violence, across their lifespan.1 Experiences of IPV have significant short-term and long-term impacts on women’s physical, mental, sexual and reproductive health, and their children’s well-being. Healthcare...

    Variation in on-scene time of emergency medical services and the extent of the difference of on-scene time between genders: a retrospective population-based registry study in Riyadh Province, Saudi Arabia

    Por: Moafa · H. N. · van Kuijk · S. M. · Moukhyer · M. E. · Alqahtani · D. M. · Haak · H. R.
    Objectives

    To identify the intergender variation of on-scene time (OST) for highly urgent emergency cases conveyed by emergency medical services (EMS) in Saudi Arabia and to assess other predictors of OST and hypothesise for possible factors delaying OST.

    Design

    A retrospective population-based registry study.

    Setting

    Riyadh Province is the largest province in terms of population and the second in terms of geographical area.

    Participants

    All highly urgent transported patients from the scene to emergency departments, be they medical emergencies or trauma emergencies during 2018.

    Outcome measure

    OST difference between men and women transported by EMS.

    Results

    In total, 21 878 patients were included for analysis: 33.9% women and 66.1% men. The median OST for women was 22 min (IQR 15–30) and 18 min (IQR 11–26) for men (p

    Conclusions

    The median OST was longer than 15 min for more than half of transported cases. For medical cases, women had a longer median OST than men. Additional predictors associated with prolonged OST were the patient’s age, area (ie, urban vs rural), type of ambulance vehicle and season. These findings are hypothesis generating and require further studies.

    Quality of refractive error care (Q.REC) in Cambodia, Malaysia and Pakistan: protocol for a cross-sectional unannounced standardised patient study

    Por: Burnett · A. M. · Lee · L. · McGuinness · M. · Varga · B. · Perez Hazel · Y. · Ho · S. M.
    Introduction

    There are 161 million people living with vision impairment, due to uncorrected refractive errors. A further 510 million people are living with near-vision impairment. There is a need for clearly defined indicators that capture the quality of refractive error service outputs and outcomes and provide insights to shape, change and stimulate action. This study aims to evaluate the quality of refractive error care (Q.REC) in Cambodia, Malaysia and Pakistan, by using unannounced standardised patients (USPs) to identify the proportion of prescribed and dispensed spectacles appropriate for people’s refractive error needs and pinpoint/detail opportunities for quality improvement.

    Method and analysis

    A cross-sectional Q.REC study will be conducted in randomly selected optical services in Cambodia (180 services, 900 USP visits), the Klang Valley in Malaysia (66 services, 198 USP visits) and in Jhang, Sahiwal and Khanewal districts of Punjab region/state in Pakistan (64 services, 256 USP visits). USPs will receive baseline refractions by three skilled study optometrists/refractionists trained in the Q.REC protocol. USPs will then visit individual optical services, undergo a refraction, purchase spectacles or lenses (if recommended) and record observations about which elements of a refraction and dispensing were conducted. The study optometrist/refractionist will assess each pair of dispensed spectacles by examining the USP’s aided visual acuity and visual comfort at distance and/or near and compare the lens prescription to the averaged baseline refraction.

    Ethics and dissemination

    This study has been approved by the University of New South Wales Human Research Ethics Committee (HC210102), the National Ethics Committee for Health Research in Cambodia (043 NECHR), National Medical Research Registry and the Medical Research and Ethics Committee (NMRR-21-689-59279) in Malaysia and the College of Ophthalmology & Allied Vision Sciences Ethical Review Board (COAVS 545/2021) in Pakistan. Written informed consent will be obtained from USPs. Service owners will have the opportunity to opt-out verbally or in writing. Results will be disseminated locally through workshops including the relevant local ministry of health personnel and stakeholders, published in peer-reviewed publications and presented at national and international conferences.

    Adolescent stress experiences over time study (ASETS) protocol: design and methods of a prospective longitudinal study of sexual minority adolescents in the USA

    Por: Schrager · S. M. · Mamey · M. R. · Rhoades · H. · Goldbach · J. T.
    Introduction

    Sexual minority adolescents (SMA) report higher rates of anxiety, self-harm, depression and suicide than heterosexual peers. These disparities appear to persist into adulthood and may worsen for certain subgroups, yet the mechanisms that drive these concerns remain poorly understood. Minority stress theory, the predominant model for understanding these disparities, posits that poorer outcomes are due to the stress of living in a violently homophobic and discriminatory culture. Although numerous studies report associations between minority stress and behavioural health in adolescence, no study has comprehensively examined how minority stress may change throughout the course of adolescence, nor how stress trajectories may predict health outcomes during this critical developmental period.

    Methods and analysis

    Between 15 May 2018 and 1 April 2019, we recruited a US national sample of diverse SMA (n=2558) age 14–17 through social media and respondent-driven sampling strategies. A subset of participants (n=1076) enrolled in the longitudinal component and will be followed each 6 months until 1 July 2022. Primary outcomes include symptoms of depression, anxiety and post-traumatic stress disorder; suicidality and self-harm and substance use. The key predictor is minority stress, operationalised as the Sexual Minority Adolescent Stress Inventory. We will use parallel cohort-sequential latent growth curve models to test study hypotheses within a developmental framework.

    Ethics and dissemination

    All participants provided assent to participate, and longitudinal participants provided informed consent at the first follow-up survey after reaching age 18. All study procedures were reviewed and approved by the University of Southern California Social–Behavioral Institutional Review Board, including a waiver of parental permission given the potential for harm due to unintentional ‘outing’ to a parent during the consent process. The final anonymous data set will be available on request, and research findings will be disseminated through academic channels and products tailored for the lay community.

    Interventions for social isolation in older adults who have experienced a fall: a systematic review

    Por: Tricco · A. C. · Thomas · S. M. · Radhakrishnan · A. · Ramkissoon · N. · Mitchell · G. · Fortune · J. · Jiang · Y. · de Groh · M. · Anderson · K. · Barker · J. · Gauthier-Beaupre · A. · Watt · J. · Straus · S. E.
    Objectives

    The objective of our systematic review was to identify the effective interventions to prevent or mitigate social isolation and/or loneliness in older adults who experienced a fall.

    Design

    Systematic review.

    Data sources

    MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Ageline were searched (from inception to February 2020).

    Methods

    Studies were eligible if they described any intervention for social isolation in older adults living in a community setting who experienced a fall, and reported outcomes related to social isolation or loneliness.

    Two independent reviewers screened citations, abstracted data and appraised risk of bias using the Cochrane risk of bias tool. The results were summarised descriptively.

    Results

    After screening 4069 citations and 55 full-text articles, four studies were included. The four studies varied in study design, including a randomised controlled trial, non-randomised controlled trial, an uncontrolled before-after study and a quasiexperimental study. Interventions varied widely, and included singing in a choir, a patient-centred, interprofessional primary care team-based approach, a multifactorial assessment targeting fall risk, appropriate medication use, loneliness and frailty, and a community-based care model that included comprehensive assessments and multilevel care coordination. Outcome measures varied and included scales for loneliness, social isolation, social interaction, social networks and social satisfaction. Mixed results were found, with three studies reporting no differences in social isolation or loneliness after the intervention. Only the multifactorial assessment intervention demonstrated a small positive effect on loneliness compared with the control group after adjustment (B=–0.18, 95% CI –0.35 to –0.02).

    Conclusions

    Few studies examined the interventions for social isolation or loneliness in older adults who experienced a fall. More research is warranted in this area.

    PROSPERO registration number

    CRD42020198487.

    Intrapleural fibrinolysis and DNase versus video-assisted thoracic surgery (VATS) for the treatment of pleural empyema (FIVERVATS): protocol for a randomised, controlled trial - surgery as first-line treatment

    Por: Christensen · T. D. · Bendixen · M. · Skaarup · S. H. · Jensen · J.-U. · Petersen · R. H. · Christensen · M. · Licht · P. · Neckelmann · K. · Bibby · B. M. · Moller · L. B. · Bodtger · U. · Borg · M. H. · Saghir · Z. · Langfeldt · S. · Harders · S. M. W. · Bedawi · E. O. · Naidu · B. · R
    Introduction

    Pleural empyema is a frequent disease with a high morbidity and mortality. Current standard treatment includes antibiotics and thoracic ultrasound (TUS)-guided pigtail drainage. Simultaneously with drainage, an intrapleural fibrinolyticum can be given. A potential better alternative is surgery in terms of video-assisted thoracoscopic surgery (VATS) as first-line treatment. The aim of this study is to determine the difference in outcome in patients diagnosed with complex parapneumonic effusion (stage II) and pleural empyema (stage III) who are treated with either VATS surgery or TUS-guided drainage and intrapleural therapy (fibrinolytic (Alteplase) with DNase (Pulmozyme)) as first-line treatment.

    Methods and analysis

    A national, multicentre randomised, controlled study. Totally, 184 patients with a newly diagnosed community acquired complicated parapneumonic effusion or pleural empyema are randomised to either (1) VATS procedure with drainage or (2) TUS-guided pigtail catheter placement and intrapleural therapy with Actilyse and DNase. The total follow-up period is 12 months. The primary endpoint is length of hospital stay and secondary endpoints include for example, mortality, need for additional interventions, consumption of analgesia and quality of life.

    Ethics and dissemination

    All patients provide informed consent before randomisation. The research project is carried out in accordance with the Helsinki II Declaration, European regulations and Good Clinical Practice Guidelines. The Scientific Ethics Committees for Denmark and the Danish Data Protection Agency have provided permission. Information about the subjects is protected under the Personal Data Processing Act and the Health Act. The trial is registered at www.clinicaltrials.gov, and monitored by the regional Good clinical practice monitoring unit. The results of this study will be published in peer-reviewed journals and presented at various national and international conferences.

    Trial registration number

    NCT04095676.

    Effectiveness and cost-effectiveness of a combined lifestyle intervention compared with usual care for patients with early-stage knee osteoarthritis who are overweight (LITE): protocol for a randomised controlled trial

    Por: Jansen · N. E. J. · Schiphof · D. · Oei · E. · Bosmans · J. · van Teeffelen · J. · Feleus · A. · Runhaar · J. · van Meurs · J. · Bierma-Zeinstra · S. M. A. · van Middelkoop · M.
    Introduction

    Obesity is the most important modifiable risk factor for knee osteoarthritis (KOA). Especially in an early stage of the disease, weight loss is important to prevent further clinical and structural progression. Since 2019, general practitioners (GPs) in the Netherlands can refer eligible patients to a combined lifestyle intervention (GLI) to promote physical activity, healthy nutrition and behavioural change. However, GPs scarcely refer patients with KOA to the GLI potentially due to a lack of evidence about the (cost-)effectiveness. The aim of this study is to determine the (cost-)effectiveness of the GLI for patients with early-stage KOA in primary care.

    Methods and analysis

    For this pragmatic, multi-centre randomised controlled trial, 234 participants (aged 45–70 years) with National Institute for Health and Care Excellence (NICE) guideline diagnosis of clinical KOA and a body mass index above 25 kg/m2 will be recruited using a range of online and offline strategies and from general practices in the Netherlands. Participants will receive nine 3-monthly questionnaires. In addition, participants will be invited for a physical examination, MRI assessment and blood collection at baseline and at 24-month follow-up. After the baseline assessment, participants are randomised to receive either the 24-month GLI programme in addition to usual care or usual care only. Primary outcomes are self-reported knee pain over 24 months, structural progression on MRI at 24 months, weight loss at 24 months, as well as societal costs and Quality-Adjusted Life-Years over 24-month follow-up. Analyses will be performed following the intention-to-treat principle using linear mixed-effects regression models.

    Ethics and dissemination

    Ethical approval was obtained through the Medical Ethical Committee of the Erasmus MC University Medical Center Rotterdam, The Netherlands (MEC-2020-0943). All participants will provide written informed consent. The results will be disseminated through publications in peer-reviewed journals, presentations at international conferences and among study participants and healthcare professionals.

    Trial registration number

    Netherlands Trial Registry (NL9355).

    Knowledge, attitude and practice of community-dwelling adults regarding advance care planning in Malaysia: a cross-sectional study

    Por: Lim · M. K. · Lai · P. S. M. · Lim · P. S. · Wong · P. S. · Othman · S. · Mydin · F. H. M.
    Objectives

    This study aimed to assess the knowledge, attitude and practice (KAP) among community-dwelling adults in Malaysia regarding advance care planning (ACP), and its associated factors.

    Design

    This cross-sectional study was conducted from July–September 2018.

    Setting

    This study was conducted at the University Malaya Medical Centre, Kuala Lumpur, Malaysia.

    Participants

    We recruited community-dwelling adults (ambulatory care patients or their accompanying persons) who were ≥21 years old and able to understand English or Malay. A 1:10 systematic sampling procedure was used. Excluded were community-dwelling adults with intellectual disabilities or non-Malaysian accompanying persons. A trained researcher administered the validated English or Malay Advance Care Planning Questionnaire at baseline and 2 weeks later.

    Primary and secondary outcome measures

    The primary outcome was the KAP regarding ACP. The secondary outcomes were factors associated with KAP.

    Results

    A total of 385/393 community-dwelling adults agreed to participate (response rate 98%). Only 3.1% of the community-dwelling adults have heard about ACP and 85.7% of them felt that discussion on ACP was necessary after explanation of the term. The desire to maintain their decision-making ability when seriously ill (94.9%) and reducing family burden (91.6%) were the main motivating factors for ACP. In contrast, resorting to fate (86.5%) and perceived healthy condition (77.0%) were the main reasons against ACP. Overall, 84.4% would consider discussing ACP in the future. Community-dwelling adults who were employed were less likely to know about ACP (OR=0.167, 95% CI 0.050 to 0.559, p=0.004) whereas those with comorbidities were more likely to favour ACP (OR=2.460, 95% CI 1.161 to 5.213, p=0.019). No factor was found to be associated with the practice of ACP.

    Conclusions

    Despite the lack of awareness regarding ACP, majority of community-dwelling adults in Malaysia had a positive attitude towards ACP and were willing to engage in a discussion regarding ACP after the term ‘ACP’ has been explained to them.

    TACTICS - Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship: evaluating the effectiveness of an 'implementation intervention in providing better patient access to reperfusion therapies: protocol for a non-randomised controlled

    Por: Ryan · A. · Paul · C. L. · Cox · M. · Whalen · O. · Bivard · A. · Attia · J. · Bladin · C. · Davis · S. M. · Campbell · B. C. V. · Parsons · M. · Grimley · R. S. · Anderson · C. · Donnan · G. A. · Oldmeadow · C. · Kuhle · S. · Walker · F. R. · Hood · R. J. · Maltby · S. · Keynes · A. · Delco
    Introduction

    Stroke reperfusion therapies, comprising intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT), are best practice treatments for eligible acute ischemic stroke patients. In Australia, EVT is provided at few, mainly metropolitan, comprehensive stroke centres (CSC). There are significant challenges for Australia’s rural and remote populations in accessing EVT, but improved access can be facilitated by a ‘drip and ship’ approach. TACTICS (Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship) aims to test whether a multicomponent, multidisciplinary implementation intervention can increase the proportion of stroke patients receiving EVT.

    Methods and analysis

    This is a non-randomised controlled, stepped wedge trial involving six clusters across three Australian states. Each cluster comprises one CSC hub and a minimum of three primary stroke centre (PSC) spokes. Hospitals will work in a hub and spoke model of care with access to a multislice CT scanner and CT perfusion image processing software (MIStar, Apollo Medical Imaging). The intervention, underpinned by behavioural theory and technical assistance, will be allocated sequentially, and clusters will move from the preintervention (control) period to the postintervention period.

    Primary outcome

    Proportion of all stroke patients receiving EVT, accounting for clustering.

    Secondary outcomes

    Proportion of patients receiving IVT at PSCs, proportion of treated patients (IVT and/or EVT) with good (modified Rankin Scale (mRS) score 0–2) or poor (mRS score 5–6) functional outcomes and European Quality of Life Scale scores 3 months postintervention, proportion of EVT-treated patients with symptomatic haemorrhage, and proportion of reperfusion therapy-treated patients with good versus poor outcome who presented with large vessel occlusion at spokes.

    Ethics and dissemination

    Ethical approval has been obtained from the Hunter New England Human Research Ethics Committee (18/09/19/4.13, HREC/18/HNE/241, 2019/ETH01238). Trial results will be disseminated widely through published manuscripts, conference presentations and at national and international platforms regardless of whether the trial was positive or neutral.

    Trial registration number

    ACTRN12619000750189; UTNU1111-1230-4161.

    Stakeholders views of supporting asthma management in schools with a school-based asthma programme for primary school children: a qualitative study in Malaysia

    Por: Ramdzan · S. N. · Khoo · E. M. · Liew · S. M. · Cunningham · S. · Pinnock · H. · on behalf of RESPIRE collaborators · Hanafi · Hussein
    Objective

    The WHO Global School Health Initiative aimed to improve child and community health through health promotion programmes in schools, though most focus on preventing communicable disease. Despite WHO recommendations, no asthma programme is included in the Malaysian national school health service guideline. Therefore, we aimed to explore the views of school staff, healthcare professionals and policy-makers about the challenges of managing asthma in schools and the potential of a school asthma programme for primary school children.

    Design

    A focus group and individual interview qualitative study using purposive sampling of participants to obtain diverse views. Data collection was guided by piloted semistructured topic guides. The focus groups and interviews were audiorecorded, transcribed verbatim and analysed using inductive thematic analysis. We completed data collection once data saturation was reached.

    Setting

    Stakeholders in education and health sectors in Malaysia.

    Participants

    Fifty-two participants (40 school staff, 9 healthcare professionals and 3 policy-makers) contributed to nine focus groups and eleven individual interviews.

    Results

    School staff had limited awareness of asthma and what to do in emergencies. There was no guidance on asthma management in government schools, and teachers were unclear about their role in school children’s health. These uncertainties led to delays in the treatment of asthma symptoms/attacks, and suggestions that an asthma education programme and a school plan would improve asthma care. Perceived challenges in conducting school health programmes included a busy school schedule and poor parental participation. A tailored asthma programme in partnerships with schools could facilitate the programme’s adoption and implementation.

    Conclusions

    Identifying and addressing issues and challenges specific to the school and wider community could facilitate the delivery of a school asthma programme in line with the WHO School Health Initiative. Clarity over national policy on the roles and responsibilities of school staff could support implementation and guide appropriate and prompt response to asthma emergencies in schools.

    Improving the quality of the performance and delivery of continuous renal replacement therapy (CRRT) to critically ill patients across a healthcare system: QUALITY CRRT: a study protocol

    Por: Opgenorth · D. · Reil · E. · Lau · V. · Fraser · N. · Zuege · D. · Wang · X. · Bagshaw · S. M. · Rewa · O.
    Introduction

    Continuous renal replacement therapy (CRRT) is a continuous form of dialysis used to support critically ill patients with acute kidney injury. The ideal delivery of CRRT requires ongoing monitoring and reporting to adjust practice and deliver optimal therapy. However, this practice occurs variably.

    Methods

    QUALITY CRRT is a multicentre, prospective, stepped-wedged, interrupted time series (ITS) evaluation of the effectiveness, safety and cost of implementing a multifaceted CRRT quality assurance and improvement programme across an entire healthcare system. This study will focus on the standardisation of CRRT programmes with similar structure, process and outcome metrics by the reporting of CRRT key performance indicators (KPIs). The primary outcome will be the quarterly performance of CRRT KPIs. Secondary outcomes will include patient-centred outcomes and economic outcomes. Analysis will compare pre-implementation and post-implementation groups as well as for the performance of KPIs using an ITS methodology. The health economic evaluation will include a within-study analysis and a longer-term model-based analysis.

    Discussion

    The effective delivery of CRRT to critically ill patients ideally requires a standardised approach of best practice assessment and ongoing audit and feedback of standardised performance measures. QUALITY CRRT will test the application of this strategy stakeholder engagement and stepped-wedged implementation across an entire healthcare system.

    Ethics and dissemination

    This study has received ethics approval. We will plan to publish the results in a peer-reviewed journal.

    Trial registration number

    NCT04221932.

    Protocol version

    1.0 (15 June 2020).

    Impact of the COVID-19 pandemic on vaccine coverage for early childhood vaccines in Alberta, Canada: a population-based retrospective cohort study

    Por: MacDonald · S. E. · Paudel · Y. R. · Kiely · M. · Rafferty · E. · Sadarangani · M. · Robinson · J. L. · Driedger · S. M. · Svenson · L. W. · on behalf of the COVImm study team
    Objective

    To assess the impact of the COVID-19 pandemic on early childhood vaccination coverage in Alberta, Canada.

    Setting

    Alberta, a western Canadian province, which has a population of 4.4 million and approximately 50 000 births annually.

    Design

    In this retrospective cohort study, population-based administrative health data were analysed to determine the vaccination coverage for measles-containing, pertussis-containing and rotavirus vaccines.

    Primary outcome measure

    We measured monthly and cumulative vaccine coverage. We assessed the absolute difference in monthly and cumulative coverage for each vaccine dose by comparing children due for vaccination in each month of 2019 and 2020, with follow-up to determine if missed doses were caught up later.

    Participants

    We included 114 178 children in the 2019 analysis cohort and 106 530 children in the 2020 analysis cohort.

    Results

    Monthly vaccination coverage in 2020 was higher than 2019 until March, when coverage significantly declined. Comparing April 2020 to 2019, coverage was 9.9% (95% CI 7.9% to 12.0%) lower for measles vaccine; 4.9% (95% CI 3.3% to 6.5%), 7.1% (95% CI 5.2% to 9.1%), 5.2% (95% CI 3.1% to 7.4%) and 8.8% (95% CI 6.6% to 10.9%) lower for first, second, third and fourth doses of pertussis-containing vaccine, respectively; and 4.0% (95% CI 2.3% to 5.7%), 7.1% (95% CI 5.1% to 9.2%) and 4.6% (95% CI 2.4% to 6.7%) lower for first, second and third doses of rotavirus vaccine, respectively. Monthly coverage improved during May to July 2020; however, some doses experienced a second decline during September to October 2020. The cumulative coverage analysis showed that the measles-containing vaccine had the largest difference in coverage at the end of follow-up.

    Conclusions

    Children who were due for vaccination early in the pandemic and in Fall 2020, especially those due for measles vaccination, may require additional catch-up.

    Population attributable fractions of modifiable cancer risk factors in Korea: a systematic review protocol

    Por: Han · M. A. · Hwang · E. C. · Jung · J. H. · Kim · S.-H. · Park · S. M.
    Introduction

    The burden of cancer continues to increase worldwide, and cancer is the leading cause of life expectancy reduction and death in Korea. Population attributable fraction (PAF), an epidemiological measure of exposures and health outcomes, could provide information on the public health impacts of exposures in populations. Knowing the PAFs of modifiable risk factors could aid in planning and prioritising strategies to reduce cancer burden in the population. This study aims to summarise systematically the PAF estimates of modifiable cancer risk factors in Korea.

    Methods and analysis

    This review will include studies that determined PAFs of modifiable risk factors on cancer incidence and mortality in Korea. We will define modifiable risk factors as those that can be changed directly by peoples’ conscious actions. We will perform systematic searches in EMBASE, MEDLINE, Cochrane Library and Korean databases (Korean Studies Information Service System, Research Information Sharing Service, KoreaMED, Korean Medical Database, National Assembly Library, and Korea Institute of Science and Technology Information) from their inception to July 2021. Two reviewers will independently screen studies for eligibility, extract data and perform quality assessments of the included studies. We will present the results in a qualitative or descriptive manner and will not perform meta-analyses or other quantitative data synthesis to derive summary estimates of PAFs because we anticipate high variability among PAF estimates.

    Ethics and dissemination

    Ethics approval is not required because we will only use data from published papers. We will disseminate the results through publication in a peer-reviewed journals.

    PROSPERO registration number

    CRD42021268258.

    Subgroup effects of non-surgical and non-pharmacological treatment of patients with hand osteoarthritis: a protocol for an individual patient data meta-analysis

    Por: Thissen · G. C. E. · van Middelkoop · M. · Colaris · J. W. · Selles · R. W. · Dziedzic · K. · Nicholls · E. · Bierma-Zeinstra · S. M. A.
    Introduction

    Hand osteoarthritis (OA) is a common joint disorder in the adult population. No cure for hand OA is known yet, but treatment aims to reduce symptoms. Non-surgical and non-pharmacological therapy interventions can include splinting, patient education, and strengthening and range of movement exercises. However, it is still unclear which treatment is most beneficial for which patient. This study aims to identify subgroups of patients with hand OA that benefit most from the different non-surgical and non-pharmacological treatments.

    Methods and analysis

    We will conduct an individual patient data (IPD) meta-analysis by extracting IPD of eligible published randomised controlled trials (RCTs). A systematic literature search through Embase, Medline and Cochrane was performed on 8 February 2021. The primary outcome will be hand pain, and our secondary outcomes are objective and subjective hand physical functions. Subgroups include age, sex, body mass index, hypermobility and other comorbidities, pain medication, occupation, baseline pain, erosive OA, type and the number of hand joints involved, radiological severity of OA, and duration of symptoms. IPD of RCTs with homogeneous treatment interventions will be pooled and analysed using a two-stage approach to evaluate treatment effect on different subgroups.

    Ethics and dissemination

    No new data will be collected, so research ethical or governance approval is exempt. Findings will be disseminated via national and international conferences, publications in peer-reviewed journals, and summaries posted on websites accessed by the public and clinicians.

    Elucidating symptoms of COVID-19 illness in the Arizona CoVHORT: a longitudinal cohort study

    Por: Khan · S. M. · Farland · L. V. · Catalfamo · C. J. · Austhof · E. · Bell · M. L. · Chen · Z. · Cordova-Marks · F. · Ernst · K. C. · Garcia-Filion · P. · Heslin · K. M. · Hoskinson · J. · Jehn · M. L. · Joseph · E. C. S. · Kelley · C. P. · Klimentidis · Y. · Russo Carroll · S. · Kohler
    Objective

    To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study.

    Setting and design

    This work was conducted within the framework of the Arizona CoVHORT, a longitudinal prospective cohort study conducted among Arizona residents.

    Participants

    Eligible participants were any individual living in Arizona and were recruited from across Arizona via COVID-19 case investigations, participation in testing studies and a postcard mailing effort.

    Primary and secondary outcome measures

    The primary outcome measure was a comparison of the type and frequency of symptoms between COVID-19-positive cases, tested but negative individuals and the general untested population who reported experiencing symptoms consistent with COVID-19.

    Results

    Of the 1335 laboratory-confirmed COVID-19 cases, 180 (13.5%) reported having no symptoms. Of those that did report symptoms, the most commonly reported were fatigue (82.2%), headache (74.6%), aches, pains or sore muscles (66.3%), loss of taste or smell (62.8) and cough (61.9%). In adjusted logistic regression models, COVID-19-positive participants were more likely than negative participants to experience loss of taste and smell (OR 12.1; 95% CI 9.6 to 15.2), bone or nerve pain (OR 3.0; 95% CI 2.2 to 4.1), headache (OR 2.6; 95% CI 2.2 to 3.2), nausea (OR 2.4; 95% CI 1.9 to 3.1) or diarrhoea (OR 2.1; 95% CI 1.7 to 2.6). Fatigue (82.9) and headache (74.9) had the highest sensitivities among symptoms, while loss of taste or smell (87.2) and bone or nerve pain (92.9) had the high specificities among significant symptoms associated with COVID-19.

    Conclusion

    When comparing confirmed COVID-19 cases with either confirmed negative or untested participants, the pattern of symptoms that discriminates SARS-CoV-2 infection from those arising from other potential circulating pathogens may differ from general reports of symptoms among cases alone.

    Exploring the knowledge, attitudes, practices and lived experiences of frontline health workers in the times of COVID-19 : a qualitative study from Bangladesh

    Por: Tune · S. N. B. K. · Islam · B. Z. · Islam · M. R. · Tasnim · Z. · Ahmed · S. M.
    Objective

    This study explored Frontline Health Workers’ (FLWs) knowledge, attitude and practice (KAP) on COVID-19 and their lived experiences, in both their personal and work lives, at the early stage of the pandemic in Bangladesh.

    Design, setting and participants

    This was a qualitative study conducted through telephone interviews in May 2020. A total of 41 FLWs including physicians, nurses, paramedics, community healthcare workers and hospital support staff from 34 public and private facilities of both urban and rural parts of Bangladesh participated in the interview. A purposive sampling technique supplemented by a snowball sampling method was followed to select the participants. The in-depth interviews followed a semi-structured interview guide, and we applied the thematic analysis method for the qualitative data analysis.

    Findings

    Except physicians, the FLWs did not receive any institutional training on COVID-19, including its prevention and management, in most instances. Also, they had no training in the use of personal protective equipment (PPE). Their common source of knowledge was the different websites or social media platforms. The FLWs were at risk while delivering services because patients were found to hide histories and not maintaining safety rules, including physical distancing. Moreover, inadequate supply of PPE, fear of getting infected, risk to family members and ostracisation by the neighbours were mentioned to be quite common by them. This situation eventually led to the development of mental stress and anxiety; however, they tried to cope up with this dire situation and attend to the call of humanity.

    Conclusion

    The uncertain work environment during the COVID-19 pandemic simultaneously affected FLWs’ physical and emotional health in Bangladesh. However, they showed professional devotion in overcoming such obstacles and continued to deliver essential services. This could be further facilitated by a quick and targeted training package on COVID-19, and the provision of supplies for delivering services with appropriate safety precautions.

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