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Hoy — Abril 13th 2021Tus fuentes RSS

Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort study

Por: Jiang · W. · Peng · Y. · Wang · X. · Elbers · C. · Tang · S. · Huang · F. · Chen · B. · Cobelens · F.
Objectives

To examine changes in the screening, diagnosis, treatment and management of drug-resistant tuberculosis (DRTB) patients, and investigate the impacts of DRTB-related policies on patients of different demographic and socioeconomic characteristics.

Design

A retrospective cohort study using registry data, plus a survey on DRTB-related policies.

Setting

All prefecture-level Centres for Disease Control in Zhejiang Province, China.

Main outcome measures

Alongside the care cascade, we examined: (1) reported number of presumptive DRTB patients; (2) percentage of presumptive patients with drug susceptibility testing (DST) records; (3) percentage of DRTB/rifampicin-resistant (RR) patients registered; (4) percentage of RR/multidrug-resistant TB (MDRTB) patients that received anti-DRTB treatment; and (5) percentage of RR/MDRTB patients cured/completed treatment among those treated. Multivariate logistic regressions were conducted to explore the impacts of DRTB policies after adjusting for other factors.

Results

The number of reported presumptive DRTB patients and the percentage with DST records largely increased during 2015–2018, and the percentage of registered patients who received anti-DRTB treatment also increased from 59.0% to 86.5%. Patients under the policies of equipping GeneXpert plus expanded criteria for DST had a higher likelihood of being registered compared with no GeneXpert (adjusted OR (aOR)=2.57, 95% CI: 1.20 to 5.51), while for treatment initiation the association was only significant when further expanding the registration criteria (aOR=2.38, 95% CI: 1.19 to 4.79). Patients with registered residence inside Zhejiang were more likely to be registered (aOR=1.96, 95% CI: 1.52 to 2.52), treated (aOR=3.83, 95% CI: 2.78 to 5.28) and complete treatment (aOR=1.92, 95% CI: 1.03 to 3.59) compared with those outside.

Conclusion

The policy changes on DST and registration have effectively improved DRTB case finding and care. Nevertheless, challenges remain in servicing vulnerable groups such as migrants and improving equity in the access to TB care. Future policies should provide comprehensive support for migrants to complete treatment at their current place of residence.

Educational needs in the COVID-19 pandemic: a Delphi study among doctors and nurses in Wuhan, China

Por: Hou · X. · Hu · W. · Russell · L. · Kuang · M. · Konge · L. · Nayahangan · L. J.
Objective

To identify theoretical and technical aspects regarding treatment, prevention of spread and protection of staff to inform the development of a comprehensive training curriculum on COVID-19 management.

Design

Cross-sectional study.

Setting

Nine hospitals caring for patients with COVID-19 in Wuhan, China.

Participants

134 Chinese healthcare professionals (74 doctors and 60 nurses) who were deployed to Wuhan, China during the COVID-19 epidemic were included. A two-round Delphi process was initiated between March and May 2020. In the first round, the participants identified knowledge, technical and behavioural (ie, non-technical) skills that are needed to treat patients, prevent spread of the virus and protect healthcare workers. In round 2, the participants rated each item according to its importance to be included in a training curriculum on COVID-19. Consensus for inclusion in the final list was set at 80%.

Primary outcome measures

Knowledge, technical and behavioural (ie, non-technical) skills that could form the basis of a training curriculum for COVID-19 management.

Results

In the first round 1398 items were suggested by the doctors and reduced to 67 items after content analysis (treatment of patients: n=47; infection prevention and control: n=20). The nurses suggested 1193 items that were reduced to 70 items (treatment of patients: n=49; infection prevention and control: n=21). In round 2, the response rates were 82% in doctors and 93% in nurses. Fifty-eight items of knowledge, technical and behavioural skills were agreed on by the doctors to include in the final list. For the nurses, 58 items were agreed on.

Conclusions

This needs assessment process resulted in a comprehensive list of knowledge, technical and behavioural skills for COVID-19 management. Educators can use these to guide decisions regarding content of training curricula not only for COVID-19 management but also in preparation for future viral pandemic outbreaks.

Are medical record front page data suitable for risk adjustment in hospital performance measurement? Development and validation of a risk model of in-hospital mortality after acute myocardial infarction

Por: Wu · C. · Zhang · D. · Bai · X. · Zhou · T. · Wang · Y. · Lin · Z. · He · G. · Li · X. · for the China PEACE Collaborative Group · Weng · Xie · Wu · Chen · Li · Wang · Yu · Li · Li · Hao · Zhang · Wu · Zhang · Liu · Wang · Jia · Bate · Qiqige · Jin · Cai · Liu · Xu · He · Yang · Yuan · Wang · Gu
Objectives

To develop a model of in-hospital mortality using medical record front page (MRFP) data and assess its validity in case-mix standardisation by comparison with a model developed using the complete medical record data.

Design

A nationally representative retrospective study.

Setting

Representative hospitals in China, covering 161 hospitals in modelling cohort and 156 hospitals in validation cohort.

Participants

Representative patients admitted for acute myocardial infarction. 8370 patients in modelling cohort and 9704 patients in validation cohort.

Primary outcome measures

In-hospital mortality, which was defined explicitly as death that occurred during hospitalisation, and the hospital-level risk standardised mortality rate (RSMR).

Results

A total of 14 variables were included in the model predicting in-hospital mortality based on MRFP data, with the area under receiver operating characteristic curve of 0.78 among modelling cohort and 0.79 among validation cohort. The median of absolute difference between the hospital RSMR predicted by hierarchical generalised linear models established based on MRFP data and complete medical record data, which was built as ‘reference model’, was 0.08% (10th and 90th percentiles: –1.8% and 1.6%). In the regression model comparing the RSMR between two models, the slope and intercept of the regression equation is 0.90 and 0.007 in modelling cohort, while 0.85 and 0.010 in validation cohort, which indicated that the evaluation capability from two models were very similar.

Conclusions

The models based on MRFP data showed good discrimination and calibration capability, as well as similar risk prediction effect in comparison with the model based on complete medical record data, which proved that MRFP data could be suitable for risk adjustment in hospital performance measurement.

Impact of hierarchical hospital reform on patients with diabetes in China: a retrospective observational analysis

Por: Xu · J. · Wang · X. · Hao · H. · Wang · J. · Nicholas · S.
Objectives

We assess whether China’s diabetes pilot hierarchical diagnosis and treatment reforms shifted patient healthcare-seeking behaviour towards primary health institutions (PHIs) and away from secondary and tertiary hospitals. From the patients’ perspective, we evaluate whether the hierarchical system saw the decline of average hospital cost, out-of-pocket (OOP) expenses and the increase of reimbursement rate in PHIs. From the health system’s perspective, we also assessed whether the share of PHIs in total costs, total visits and reimbursement rate increased and the share of secondary and tertiary hospitals decreased.

Methods

Data were collected from the health insurance bureau of 11 cities in Shandong Province, China between 2015 and 2017, which included 9 118 518 outpatient visits and 622 739 inpatient visits. For both inpatients and outpatients and the health system, we analysed health services-seeking characteristics including hospital costs, hospital visits, OOP expense and reimbursements of hospital costs. Binary logistic regression was conducted to analyse the influencing factors of seeking PHI health services.

Results

PHIs remained the lowest hospital cost provider, but average hospital costs declined across all three healthcare levels of PHIs, secondary hospitals and tertiary hospitals from 2015 to 2017. The hierarchical system aimed to shift patients to PHIs, increasing PHIs’ share of total hospital costs. However, the PHI share of total outpatient costs declined 12.0%, while rising 15.0% in secondary hospitals, the opposite of the goal of the hierarchical medical system. Average outpatient visits rose roughly at the same rate in PHIs (5.1%) as secondary hospitals (6.8%), with no evidence of a shift in patient visits between hospital levels over 2015–2017. Average inpatient visits fell across all levels of hospitals, with no significant difference in the rate of decline between PHIs (9.4%) and secondary (7.5%) and tertiary (7.8%) hospitals. For outpatient and inpatient services, the binary logistic regression showed that over the 2015–2017 period patients with diabetes increasingly used higher level hospitals rather than PHIs (p

Conclusions

The implementation of the hierarchical medical system for patients with diabetes did not achieve its goal of increasing PHI utilisation and decreasing secondary and tertiary hospital utilisation. Enhancing the utilisation of PHIs for diabetes and other patients requires further health reform, including educating patients on PHI use, further reforming the health insurance schemes, improving PHI facilities and encouraging referrals to PHIs from higher level hospitals.

Predictors of poor health and functional recovery following road trauma: protocol of a British Columbian inception cohort study

Por: Shum · L. K. · Chan · H. · Erdelyi · S. · Pei · L. X. · Brubacher · J. R.
Introduction

Road trauma (RT) is a major public health problem affecting physical and mental health, and may result in prolonged absenteeism from work or study. It is important for healthcare providers to know which RT survivors are at risk of a poor outcome, and policy-makers should know the associated costs. Unfortunately, outcome after RT is poorly understood, especially for RT survivors who are treated and released from an emergency department (ED) without the need for hospital admission. Currently, there is almost no research on risk factors for a poor outcome among RT survivors. This study will use current Canadian data to address these knowledge gaps.

Methods and analysis

We will follow an inception cohort of 1500 RT survivors (16 years and older) who visited a participating ED within 24 hours of the accident. Baseline interviews determine pre-existing health and functional status, and other potential risk factors for a poor outcome. Follow-up interviews at 2, 4, 6, and 12 months (key stages of recovery) use standardised health-related quality of life tools to determine physical and mental health outcome, functional recovery, and healthcare resource use and lost productivity costs.

Ethics and dissemination

The Road Trauma Outcome Study is approved by our institutional Research Ethics Board. This study aims to provide healthcare providers with knowledge on how quickly RT survivors recover from their injuries and who may be more likely to have a poor outcome. We anticipate that this information will be used to improve management of all road users following RT. Healthcare resource use and lost productivity costs will be collected to provide a better cost estimate of the effects of RT. This information can be used by policy-makers to make informed decisions on RT prevention programmes.

Birthweight features of the infants of mothers diagnosed with diabetes at different gestational ages in South China from 2014 to 2018: a retrospective study

Por: Huang · X.-x. · Jiang · X.-M. · Zheng · Q.-X. · Chen · X.-Q. · Pan · Y.-Q.
Objectives

The primary purpose was to measure the birth weight of infants of mothers with gestational diabetes (IMGDs) at different gestational ages to develop new reference charts and curves for them. A further purpose was to compare them with those of 159 334 infants in China to provide more accurate reference charts for the diagnosis of suspected abnormal birth weight of IMGDs. The final purpose was to evaluate the key periods for such mothers to control their weight in line with the difference of fetal weight of each two neighbouring gestational ages.

Setting

A specialised hospital in South China

Participants

IMGDs born here from January 2014 to December 2018.

Primary and secondary outcome variables

Birth weight, gestational ages of IMGDs, gender and year of birth.

Results

Data of 14 311 singleton live births at the gestational weeks 25–42 here were collected. The proportions of low birth weight, normal birth weight and macrosomia were 7.26%, 87.04%, and 5.70%, respectively. The proportions of small for gestational age, appropriate for gestational age and large for gestational age were 5.69%, 84.42% and 9.89%, respectively. In the macrosomia group, the mean of all birth weight in 2017 decreased for the first time since 2014. Both the means of birth weight of male infants at gestational weeks 36–41 and of female at weeks 38–40 were greater than that of the 159 334 infants. The increase of each weekly mean of IMGDs at gestational weeks 27–31 and 33–35 was >10% compared with the former. Based on this, new reference charts of birth weight for IMGDs in terms of different gestational age and gender were formulated.

Conclusion

These charts may be applied as reference for more accurate diagnosis and quick treatment of abnormal birth weight. This study showed that the identification of key periods for fetal weight gain was helpful for the management of the weight of women with gestational diabetes.

Efficacy and safety of inulin supplementation for functional constipation: a systematic review protocol

Por: Liu · X. · Yang · Q. · He · Z. · Yao · S.
Introduction

Functional constipation (FC) is a common digestive system disease, with an uptrend in morbidity and mortality, resulting in huge social and economic losses. Although the guidelines recommend lifestyle intervention as a first-line treatment, lifestyle intervention is not widely used in clinic. Inulin can be used as the basic material of functional food. Clinical studies have shown that inulin supplementation is associated with increased frequency of bowel movements, but has certain side effects. Therefore, the efficacy and safety of inulin in the treatment of FC need to be further evaluated.

Methods and analysis

We will search Medline, Web of Science, Embase, China National Knowledge Infrastructure Database, Wanfang Database and China Biomedical Literature Database. We will also search the China Clinical Trial Registry, the Cochrane Central Register of Controlled Trials and related conference summaries. This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RevMan V.5.3.5 will be used for analysis.

Ethics and dissemination

This systematic review will evaluate the efficacy and safety of inulin supplementation for the treatment of FC. All included data will be obtained from published articles, there is no need for the ethical approval, and it will be published in a peer-reviewed journal. Due to lack of a new systematic review in this field, this study will combine relevant randomised controlled trials to better explore the evidence of inulin supplementation in the treatment of FC and guide clinical practice and clinical research.

PROSPERO registration number

CRD42020189234.

New screening tool for neonatal nutritional risk in China: a validation study

Por: Zhou · M. · Li · Y. · Yin · H. · Zhang · X. · Hu · Y.
Objective

A neonatal nutritional risk screening tool (NNRST) was developed by using Delphi and analytic hierarchy processes in China. We verified the accuracy of this tool and analysed whether it effectively screened neonates with nutritional risk.

Design

Prospective validation study.

Setting and participants

In total, 338 neonates who were admitted to the neonatal unit of Children’s Hospital of Chongqing Medical University from May–July 2016 completed the study. Nutritional risk screening and length and head circumference measurements were performed weekly. Weight was measured every morning, and other relevant clinical data were recorded during hospitalisation.

Main outcome measures

We evaluated the sensitivity, specificity, validity, reliability, and positive and negative predictive value of the screening tool. Various characteristics of neonates in different risk groups were analysed to determine the rationality of the nutritional risk classification.

Results

The sensitivity, specificity, and positive and negative predictive values were 85.11%, 91.07%, 60.61% and 97.43%, respectively. The criterion validity was texted by the Spearman correlation analysis (r=0.530) and independent samples non-parametric tests (p=0.000). The content validity (Spearman correlation coefficient) was 0.321–0.735. The inter-rater reliability (kappa value) was 0.890. Among the neonatal clinical indicators, gestational age, birth weight, length, admission head circumference, admission albumin, admission total proteins, discharge weight, discharge length and head circumference decreased with increasing nutrition risk level; the length of stay and the rate of parenteral nutrition support increased with increasing nutrition risk level. In the comparison of complications during hospitalisation, the incidence of necrotising enterocolitis and congenital gastrointestinal malformation increased with increasing nutrition risk level.

Conclusion

The validation results for the NNRST are reliable. The tool can be used to preliminarily determine the degree of neonatal nutritional risk, but its predictive value needs to be determined in future large-sample studies.

Trial registration number

ChiCTR2000033743.

Association between systolic blood pressure trajectories and hypertension risk at late adolescence: results from 10-year longitudinal follow-up in Chinese boys

Por: Wang · X. · Dong · B. · Huang · S. · Yang · Z. · Ma · J. · Hu · J.
Objective

To identify various systolic blood pressure (SBP) trajectories in Chinese boys between 7 and 18 years of age, and to explore their high blood pressure (HBP) risk in their late adolescence years.

Design and settings

A population-based cohort study in Guangdong, China.

Participants

4541 normal tensive boys who started primary school in 2005 in Zhongshan, Guangdong were included.

Outcomes

Blood pressure and relevant measurements were obtained by annual physical examinations between 2005 and 2016. HBP was defined by SBP or diastolic blood pressure ≥95th percentile for children under 13, and BP ≥130/80 mm Hg for children ≥13 years old. Logit regression for panel data and log-binomial regression model was used to estimate the risk of HBP among SBP trajectory groups.

Results

Four distinct SBP trajectory groups via group-based trajectory modelling: low stable (13.0%), low rising (42.4%), rising (37.4%) and high rising (7.3%). The overall incidence rates of HBP during the follow-up ranged from 40.24 (95% CI 36.68 to 44.19)/1000 person-years in the low stable group to 97.08 (95% CI 94.93 to 99.27)/1000 person-years in the high rising group. Compared with children with low stable SBP, those of other SBP trajectories suffered 3.05 (95% CI 2.64 to 3.46) to 4.64 (95% CI 4.18 to 5.09) times of higher risk of HBP in their late adolescence, regardless of their age, body mass index and BP level at baseline.

Conclusions

Subgroups of SBP trajectories existed in Chinese boys, and are related to hypertension risk at late adolescence. Regular physical examinations could help identify those with higher risks at the beginning of pubertal growth.

Discrepancies in self-reported financial conflicts of interest disclosures by physicians: a systematic review

Por: Taheri · C. · Kirubarajan · A. · Li · X. · Lam · A. C. L. · Taheri · S. · Olivieri · N. F.
Background

There is a high prevalence of financial conflicts of interest (COI) between physicians and industry.

Objectives

To conduct a systematic review with meta-analysis examining the completeness of self-reported financial COI disclosures by physicians, and identify factors associated with non-disclosure.

Data sources

MEDLINE, Embase and PsycINFO were searched for eligible studies up to April 2020 and supplemented with material identified in the references and citing articles.

Data extraction and synthesis

Data were independently abstracted by two authors. Data synthesis was performed via systematic review of eligible studies and random-effects meta-analysis.

Main outcomes and measures

The proportion of discrepancies between physician self-reported disclosures and objective payment data was the main outcome. The proportion of discrepant funds and factors associated with non-disclosure were also examined.

Results

40 studies were included. The pooled proportion of COI discrepancies at the article level was 81% (range: 54%–98%; 95% CI 72% to 89%), 79% at the payment level (range: 71%–89%; 95% CI 67% to 89%), 93% at the authorship level (range: 71%–100%; 95% CI 79% to 100%) and 66% at the author level (range: 8%–99%; 95% CI 48% to 78%). The proportion of funds discrepant was 33% (range: 2%–77%; 95% CI 12% to 58%). There was high heterogeneity between studies across all five analyses (I2=94%–99%). Most undisclosed COI were related to food and beverage, or travel and lodging. While the most common explanation for failure to disclose was perceived irrelevance, a median of 45% of non-disclosed payments were directly or indirectly related to the work. A smaller monetary amount was the most common factor associated with nondisclosure.

Conclusions

Physician self-reports of financial COI are highly discrepant with objective data sources reporting payments from industry. Stronger policies are required to reduce reliance on physician self-reporting of financial COI and address non-compliance.

Prognostic model to identify and quantify risk factors for mortality among hospitalised patients with COVID-19 in the USA

Por: Incerti · D. · Rizzo · S. · Li · X. · Lindsay · L. · Yau · V. · Keebler · D. · Chia · J. · Tsai · L.
Objectives

To develop a prognostic model to identify and quantify risk factors for mortality among patients admitted to the hospital with COVID-19.

Design

Retrospective cohort study. Patients were randomly assigned to either training (80%) or test (20%) sets. The training set was used to fit a multivariable logistic regression. Predictors were ranked using variable importance metrics. Models were assessed by C-indices, Brier scores and calibration plots in the test set.

Setting

Optum de-identified COVID-19 Electronic Health Record dataset including over 700 hospitals and 7000 clinics in the USA.

Participants

17 086 patients hospitalised with COVID-19 between 20 February 2020 and 5 June 2020.

Main outcome measure

All-cause mortality while hospitalised.

Results

The full model that included information on demographics, comorbidities, laboratory results, and vital signs had good discrimination (C-index=0.87) and was well calibrated, with some overpredictions for the most at-risk patients. Results were similar on the training and test sets, suggesting that there was little overfitting. Age was the most important risk factor. The performance of models that included all demographics and comorbidities (C-index=0.79) was only slightly better than a model that only included age (C-index=0.76). Across the study period, predicted mortality was 1.3% for patients aged 18 years old, 8.9% for 55 years old and 28.7% for 85 years old. Predicted mortality across all ages declined over the study period from 22.4% by March to 14.0% by May.

Conclusion

Age was the most important predictor of all-cause mortality, although vital signs and laboratory results added considerable prognostic information, with oxygen saturation, temperature, respiratory rate, lactate dehydrogenase and white cell count being among the most important predictors. Demographic and comorbidity factors did not improve model performance appreciably. The full model had good discrimination and was reasonably well calibrated, suggesting that it may be useful for assessment of prognosis.

Prevalence and coprevalence of modifiable risk factors for upper digestive tract cancer among residents aged 40-69 years in Yangzhong city, China: a cross-sectional study

Por: Feng · X. · Hua · Z.-L. · Zhou · Q. · Shi · A.-W. · Song · T.-Q. · Qian · D.-F. · Chen · R. · Wang · G.-Q. · Wei · W.-Q. · Zhou · J.-Y. · Wang · J.-J. · Shao · G. · Wang · X.
Objectives

To describe the prevalence of modifiable risk factors for upper digestive tract cancer (UDTC) and its coprevalence, and investigate relevant influencing factors of modifiable UDTC risk factors coprevalence among residents aged 40–69 years in Yangzhong city, China.

Design

Cross-sectional study.

Participants

A total of 21 175 participants aged 40–69 years were enrolled in the study. 1962 subjects were excluded due to missing age, marital status or some other selected information. Eventually, 19 213 participants were available for the present analysis.

Main outcomes measures

Prevalence and coprevalence of eight modifiable UDTC risk factors (overweight or obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food) were analysed.

Results

The prevalence of overweight/obesity, current smoking, excessive alcohol consumption, insufficient vegetables intake, insufficient fruit intake and the consumption of pickled, fried and hot food in this study was 45.3%, 24.1%, 16.2%, 66.1%, 94.5%, 68.1%, 36.0% and 88.4%, respectively. Nearly all (99.9%) participants showed one or more UDTC risk factors, 98.6% of the participants showed at least two risk factors, 92.2% of the participants had at least three risk factors and 69.7% of the participants had four or more risk factors. Multivariate logistic regression analysis revealed that men, younger age, single, higher education, higher annual family income and smaller household size were more likely to present modifiable UDTC risk factors coprevalence.

Conclusions

The prevalence and coprevalence of modifiable UDTC risk factors are high among participants in Yangzhong city. Extra attention must be paid to these groups who are susceptible to risk factors coprevalence during screening progress. Relative departments also need to make significant public health programmes that aim to decrease modifiable UDTC risk factors coprevalence among residents aged 40–69 years from high-risk areas of UDTC.

Effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohort studies in Brazil: COBra study protocol

Por: Ferraz · D. · Dourado · I. · Zucchi · E. M. · Mabire · X. · Magno · L. · Grangeiro · A. D. · Couto · M. T. · Ferguson · L. · Westin · M. · Alves dos Santos · L. · Preau · M.
Introduction

The COVID-19 pandemic and its control measures have impacted health and healthcare provision in various levels. Physical distancing measures, for instance, may affect sexual health, impacting access to HIV prevention supplies and changing sexual behaviour, as well as mental health, increasing feelings of unsafety and weakening community support ties. These effects can be worsened among socially marginalised groups, such as men who have sex with men (MSM) and transgender women (TGW). Brazil is among the countries most affected by COVID-19 in the world, where control measures have been inconsistently implemented. We aim to investigate the effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult MSM and TGW in Brazil.

Methods

Convergent mixed-method prospective cohort study, nested in two ongoing HIV pre-exposure prophylaxis (PrEP) cohorts in Brazil, named PrEP1519 and Combina. Participants will be invited to answer, at baseline and after 6 months, a questionnaire about the effects of the COVID-19 pandemic on sexual behaviour, HIV prevention and mental health. Data on HIV infection and sexually transmitted infections (STI) will be collected as part of routine follow-up from the cohorts. Main outcome measures (HIV infection, STI and depression symptoms) will be observed within 12 months after baseline. Sample size is estimated at 426 participants. Complementarily, 50 participants will be invited to in-depth interviews through video calls or interactive voice response, and 20 will be invited to chronicle their lives during the pandemic through digital diaries. Triangulation will be done across qualitative methods and with the quantitative data.

Ethics and dissemination

The study was approved by Research Ethics Committees from the Brazilian Universities coordinating the study. Findings will be published in scientific journals and presented at meetings. Informative flyers will be elaborated to communicate study findings to participants and key stakeholders.

Adaptation and evaluation of the Chinese hospital nursing department disaster preparedness scale: a cross-sectional scale development study

Por: Shi · L. · Li · M. · Xu · X. · Wang · Z. · Li · S. · Feng · X.
Aim

The aim of this study was to adapt the Chinese version of Hospital Nursing Department Disaster Preparedness Scale (HNDDPS) and evaluate the psychometric properties among hospital nurses in China. Two specific objectives were (1) to adapt the HNDDPS from Sadiq’s Organisational Disaster Preparedness Scale (SODPS) to fit the context of Chinese hospital nursing system and (2) to establish its validity and reliability.

Design

Instrument design study.

Settings and participants

2657 nurses belonging to 50 nursing organisations of tertiary hospitals spread across seven administrative regions of China.

Methods

We adapted the Chinese version of HNDDPS through translation of the SODPS, back translation and cultural adaptation. Subsequently, we evaluated the validity of the scale through exploratory factor analysis and confirmatory factor analysis (CFA), each performed on half of the original sample. We also evaluated the internal consistency reliability of the scale.

Results

The Chinese version of HNDDPS comprised five dimensions, with 72 items. Exploratory factor analysis yielded five factors explaining 61% of the items’ variance. CFA confirmed five dimensions of the scale and produced appropriate Goodness of Fit Indexes. Cronbach’s α-coefficient was 0.930 for the total scale and ranged from 0.908 to 0.964 for the five dimensions of the scale.

Conclusion

HNDDPS demonstrates good internal consistency and construct validity. It is a promising, valid and reliable tool for nurses and nursing managers to evaluate hospital nursing department disaster preparedness.

Study protocol for the Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI): a multicentre, cluster-randomised, parallel-group, superiority trial of a multifaceted community-family-mother-child intervention to prevent childhood overweight and obes

Por: Wu · Y. · Marc · I. · Bouchard · L. · Ouyang · F. · Luo · Z.-C. · Fan · J. · Dubois · L. · Masse · B. · Zhang · J. · Leung · P. C. K. · Liao · X. P. · Herba · C. M. · Booij · L. · Shen · J. · Lewin · A. · Jiang · H. · Wang · L. · Xu · J. · Wu · W. · Sun · W. · Wu · J. · Li · H. · Lei · C. · Kozyrsky
Introduction

Childhood overweight and obesity (OWO) is a primary global health challenge. Childhood OWO prevention is now a public health priority in China. The Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI), one of four trials being undertaken by the international HeLTI consortium, aims to evaluate the effectiveness of a multifaceted, community-family-mother-child intervention on childhood OWO and non-communicable diseases risk.

Methods and analysis

This is a multicentre, cluster-randomised, controlled trial conducted in Shanghai, China. The unit of randomisation is the service area of Maternal Child Health Units (N=36). We will recruit 4500 women/partners/families in maternity and district level hospitals. Participants in the intervention group will receive a multifaceted, integrated package of health promotion interventions beginning in preconception or in the first trimester of pregnancy, continuing into infancy and early childhood. The intervention, which is centred on a modified motivational interviewing approach, will target early-life maternal and child risk factors for adiposity. Through the development of a biological specimen bank, we will study potential mechanisms underlying the effects of the intervention. The primary outcome for the trial is childhood OWO (body mass index for age ≥85th percentile) at 5 years of age, based on WHO sex-specific standards. The study has a power of 0.8 (α=0.05) to detect a 30% risk reduction in the proportion of children with OWO at 5 years of age, from 24.4% in the control group to 17% in the intervention group. Recruitment was launched on 30 August 2018 for the pilot study and 10 January 2019 for the formal study.

Ethics and dissemination

The study has been approved by the Medical Research Ethics Committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, and the Research Ethics Board of the Centre Intégré Universitaire de Santé et Services Sociaux de l’Estrie–CHUS in Sherbrooke, Canada. Data sharing policies are consistent with the governance policy of the HeLTI consortium and government legislation.

Trial registration number

ChiCTR1800017773.

Protocol version

November 11, 2020 (Version #5).

Identifying multimorbidity patterns of non-communicable diseases in paediatric inpatients: a cross-sectional study in Shanghai, China

Por: Chen · N. · Zhou · L. · Huang · J. · Yu · W. · Chen · C. · Jin · H. · Shi · X. · Yu · Z. · Liu · Q. · Yang · Y. · Wang · Z. · Shi · J.
Objectives

To enhance the understanding of non-communicable disease (NCD) multimorbidity in children who are inpatients by delineating the characteristics of and identifying patterns among paediatric inpatients with multimorbidity in China.

Design

Cross-sectional study.

Setting

Paediatric wards (n=17) in Pudong New Area, Shanghai, China.

Participants

A total of 193 432 paediatric inpatients in the electronic health record systems of 17 hospitals from 2011 to 2016 participated in the study, and 91 004 children with NCDs were extracted and classified based on International Classification of Diseases, 10th version codes.

Main outcome measures

Number of the NCDs and multimorbidity patterns of the paediatric inpatients.

Results

In total, 47.05% (95% CI 46.83 to 47.27) of the paediatric inpatients had one or more chronic diseases, and 16.30% (95% CI 16.14 to 16.46) had multimorbidity. Congenital anomalies accounted for 19.43% (95% CI 19.25 to 19.61) of the principal diagnoses among the paediatric inpatients. Five common multimorbidity patterns were identified: a neurological-respiratory cluster, a neurological-respiratory-ear cluster, a cardiovascular-circulatory cluster, a genitourinary cluster (boy group) and a musculoskeletal-connective cluster (10–18 years age group).

Conclusions

Multimorbidity in paediatric inpatients suggests that decisions about reasonable allocation of paediatric inpatient resources should be fully considered. Multimorbidity patterns in paediatric inpatients revealed that prevention, including innovative treatments targeting children, should be further studied.

SARS-CoV-2 population-based seroprevalence studies in Europe: a scoping review

Por: Grant · R. · Dub · T. · Andrianou · X. · Nohynek · H. · Wilder-Smith · A. · Pezzotti · P. · Fontanet · A.
Objectives

We aimed to review SARS-CoV-2 seroprevalence studies conducted in Europe to understand how they may be used to inform ongoing control strategies for COVID-19.

Design

Scoping review of peer-reviewed publications and manuscripts on preprint servers from January 2020 to 15 September 2020.

Primary measure

Seroprevalence estimate (and lower and upper CIs). For studies conducted across a country or territory, we used the seroprevalence estimate and the upper and lower CIs and compared them to the total number of reported infections to calculate the ratio of reported to expected infections.

Results

We identified 23 population-based seroprevalence studies conducted in Europe. Among 12 general population studies, seroprevalence ranged from 0.42% among residual clinical samples in Greece to 13.6% in an area of high transmission in Gangelt, Germany. Of the eight studies in blood donors, seroprevalence ranged from 0.91% in North-Western Germany to 23.3% in a high-transmission area in Lombardy region, Italy. In three studies which recruited individuals through employment, seroprevalence ranged from 0.5% among factory workers in Frankfurt, Germany, to 10.2% among university employees in Milan, Italy. In comparison to nationally reported cases, the extent of infection, as derived from these seroprevalence estimates, is manyfold higher and largely heterogeneous.

Conclusion

Exposure to the virus in Europe has not reached a level of infection that would prevent further circulation of the virus. Effective vaccine candidates are urgently required to deliver the level of immunity in the population.

Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry

Por: Li · H. · Ye · S.-s. · Wu · Y.-L. · Huang · S.-M. · Li · Y.-X. · Lu · K. · Huang · J.-B. · Chen · L. · Li · H.-Z. · Wu · W.-J. · Wu · Z.-L. · Wu · J.-Z. · Zhong · W.-T. · Xian · W.-C. · Liao · F. · Tung · T.-H. · Wu · Q.-L. · Chen · H. · Yuan · L. · Yang · Z. · Huang · L.-A.
Objectives

We aimed to determine predictors of mortality within 90 days and develop a simple score for patients with mechanical thrombectomy (MT).

Design

Analysis of a multicentre prospective registry.

Setting

In six participating centres, patients who had an acute ischaemic stroke (AIS) treated by MT between March 2017 and May 2018 were documented prospectively.

Participants

224 patients with AIS were treated by MT.

Results

Of 224 patients, 49 (21.9%) patients died, and 87 (38.8%) were independent. Variables associated with 90-day mortality were age, previous stroke, admission National Institutes of Health Stroke Scale (NIHSS), fasting blood glucose and occlusion site. Logistic regression identified four variables independently associated with 90-day mortality: age ≥80 years (OR 3.26, 95% CI 1.45 to 7.33), previous stroke (OR 2.33, 95% CI 1.04 to 5.21), admission NIHSS ≥18 (OR 2.37, 95% CI 1.13 to 4.99) and internal carotid artery or basilar artery occlusion (OR 2.92, 95% CI 1.34 to 6.40). Using these data, we developed predicting 90-day mortality of AIS with MT (PRACTICE) score ranging from 0 to 6 points. The receiver operator curve analysis found that PRACTICE score (area under the curve (AUC)=0.744, 95% CI 0.669 to 0.820) was numerically better than iScore (AUC=0.661, 95% CI 0.577 to 0.745) and Predicting Early Mortality of Ischemic Stroke score (AUC=0.638, 95% CI 0.551 to 0.725) for predicting 90-day mortality.

Conclusions

We developed a simple score to estimate the 90-day mortality of patients who had an AIS treated with MT. But the score needs to be prospectively validated.

Trial registration number

Chinese Clinical Trial Registry (ChiCTR-OOC-17013052).

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Mediating effect of coping style on the relationship between clinical leadership and quality of work life among nurses in tertiary-level hospitals in China: a cross-sectional study

Por: Li · H. · Chang · H. · Tao · Z. · Zhang · D. · Shi · Y. · Li · X.
Objective

To explore the association between clinical leadership and quality of work life, as well as the mediating role of coping style in this relationship.

Setting

Three tertiary-level hospitals in Liaoning Province, China.

Participants

A total of 1209 nurses were recruited for this study. Registered nurses who work full time with at least 1 year of work experience were eligible as subjects. Exclusion criteria were nurses who work indirectly with patients, such as in education, administration or research.

Primary and secondary outcome measures

Questionnaires consisting of the work-related Quality of Life Scale, the Nurse Leadership Scale and the Simplified Coping Style Questionnaire, as well as a demographic data sheet, were used to collect participant information. Pearson’s correlation analysis, hierarchical multiple regression analysis, and asymptotic and resampling strategies were used to analyse the data.

Results

The mean overall quality of work life score among Chinese nurses was 3.50±0.60. After adjusting for demographic characteristics, clinical leadership was positively associated with the score of quality of work life (β=0.55, p

Conclusions

Clinical leadership was positively associated with quality of work life and coping style partially mediated the relationship between clinical leadership and quality of work life among nurses in China. Implementing measures focusing on both clinical leadership and coping style may provide success in improving the quality of work life of nurses.

Identifying the competencies of Chinas paediatric residents: a modified Delphi method study

Por: Wang · Y. · Wang · T. · Wang · A. · Chen · S. · Jiao · L. · Shi · J. · Feng · X. · Meng · K.
Purpose

Standardised Training of Paediatric Resident (STPR) plays an essential role in training qualified paediatricians. Until now, China had no paediatric resident competency index system to effectively guide and evaluate the competence of paediatric residents. This study aimed to establish a competency index system for paediatric residents in China to provide a reference for improving the training system and quality of STPR.

Study design and setting

This study conducted two rounds of Delphi expert consultation survey among paediatric medical experts (n=16), followed by screening, revising and supplementing indicators using the boundary value method. Next, the analytic hierarchy process was used to determine the weight of indicators and finally establish a competency index system for paediatric residents.

Results

The results of the statistical analysis revealed a positive coefficient of 100% for both rounds of expert consultation. The expert authority coefficient values were 0.82 and 0.83, and the expert coordination coefficient test was p

Conclusions

In this study, a competency index system for paediatric residents was constructed following the characteristics and quality requirements for paediatric residents in China and is expected to significantly improve the overall level of paediatricians’ medical service quality and supply.

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