FreshRSS

🔒
❌ Acerca de FreshRSS
Hay nuevos artículos disponibles. Pincha para refrescar la página.
AnteayerTus fuentes RSS

Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

Por: Zeng · L. · Lytvyn · L. · Wang · X. · Kithulegoda · N. · Agterberg · S. · Shergill · Y. · Esfahani · M. A. · Heen · A. F. · Agoritsas · T. · Guyatt · G. H. · Busse · J. W.
Objective

To explore values and preferences towards medical cannabis among people living with chronic pain.

Design

Mixed-methods systematic review.

Data sources

We searched MEDLINE, EMBASE and PsycINFO from inception to 17 March 2020.

Study selection

Pairs of reviewers independently screened search results and included quantitative, qualitative and mixed-methods studies reporting values and preferences towards medical cannabis among people living with chronic pain.

Review methods

We analysed data using meta-narrative synthesis (quantitative findings were qualitised) and tabulated review findings according to identified themes. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence.

Results

Of 1838 initial records, 15 studies proved eligible for review. High to moderate certainty evidence showed that patient’s use of medical cannabis for chronic pain was influenced by both positive (eg, support from friends and family) and negative social factors (eg, stigma surrounding cannabis use). Most patients using medical cannabis favoured products with balanced ratios of tetrahydrocannabinol (THC) and cannabidiol (CBD), or high levels of CBD, but not high THC preparations. Many valued the effectiveness of medical cannabis for symptom management even when experiencing adverse events related to concentration, memory or fatigue. Reducing use of prescription medication was a motivating factor for use of medical cannabis, and concerns regarding addiction, losing control or acting strangely were disincentives. Out-of-pocket costs were a barrier, whereas legalisation of medical cannabis improved access and incentivised use.

Low to very low certainty evidence suggested highly variable values towards medical cannabis among people living with chronic pain. Individuals with pain related to life-limiting disease were more willing to use medical cannabis, and preferred oral over inhaled administration.

Conclusions

Our findings highlight factors that clinicians should consider when discussing medical cannabis. The variability of patients’ values and preferences emphasise the need for shared decision making when considering medical cannabis for chronic pain.

Associations of household food insufficiency with childhood depression and anxiety: a nationwide cross-sectional study in the USA

Por: Zheng · S. · Ngo · A. L. · Forman · M. R. · Barcellos · A. L. · Liao · L. · Ferrara · A. · Zhu · Y.
Objective

Household food insufficiency (HFIS) is a major public health threat to children. Children may be particularly vulnerable to HFIS as a psychological stressor due to their rapid growth and accelerated behavioural and cognitive states, whereas data focusing on HFIS and childhood mental disorders are as-yet sparse. We aimed to examine the associations of HFIS with depression and anxiety in US children.

Design

Cross-sectional study.

Setting

The 2016–2018 National Survey of Children’s Health, a nationally-representative study.

Participants

Primary caregivers of 102 341 children in the USA.

Primary and secondary outcome measures

Physician diagnosed depression and anxiety were assessed by questionnaires administered to primary caregivers of 102 341 children. Multivariable logistic regression models estimated adjusted OR (aOR) for current depression or anxiety associated with HFIS measured through a validated single-item instrument.

Results

Among children aged 3–17 years, 3.2% and 7.4% had parent-reported physician-diagnosed current depression and anxiety, respectively. Compared with children without HFIS, children with HFIS had approximately twofold higher weighted prevalence of anxiety or depression. After adjusting for covariates, children with versus without HFIS had a 1.53-fold (95% CI 1.15 to 2.03) and 1.48-fold (95% CI 1.20 to 1.82) increased odds of current depression and anxiety, respectively. Associations were slightly more pronounced among girls (aOR (95% CI): depression 1.69 (1.16 to 2.48); anxiety 1.78 (1.33 to 2.38)) than boys (1.42 (0.98 to 2.08); 1.32 (1.00 to 1.73); both P-for-interaction

Conclusions

HFIS was independently associated with depression and anxiety among US children. Girls presented slightly greater vulnerability to HFIS in terms of impaired mental health. Children identified as food-insufficient may warrant mental health assessment and possible intervention. Assessment of HFIS among children with impaired mental health is also warranted. Our findings also highlight the importance of promptly addressing HFIS with referral to appropriate resources and inform its potential to alleviate childhood mental health issues.

Identifying factors affecting latent tuberculosis treatment acceptance among healthcare workers: a retrospective analysis in a tertiary care centre

Por: Bar-Meir · M. · Pariente · G. · Romem · A. · Wiener-Well · Y.
Objective

Official guidelines recommend tuberculosis (TB) screening programmes for all healthcare workers (HCWs), along with offering treatment when latent TB infection (LTBI) is diagnosed. However, adherence to treatment among HCWs is lower compared with non-HCWs. The aim of the present study was to examine the rate of LTBI treatment acceptance among HCWs and to characterise the factors associated with non-acceptance.

Design and setting

This was a retrospective cohort study. All HCWs diagnosed with LTBI, who had tuberculin skin test (TST) conversion during their work, between 2000 and 2015, in a single tertiary academic medical centre, and who consented to answer a questionnaire, were enrolled.

Results

Overall, 147 of 219 (67%) with TST conversion agreed to participate. Acceptance rate for LTBI treatment was only 16%. The overall completion rate among those who accepted treatment was 87%. HCWs’ recall of discussing the importance of LTBI treatment with their caregiver had the strongest association with LTBI treatment acceptance: 23 of 52 HCWs (44%) who recalled this discussion accepted treatment (adjusted OR=10.2, 95% CI: 2.2 to 47.6, p=0.003). Knowing the risk of developing TB was associated with 3.7 increased odds to accept treatment (95% CI: 1.2 to 11.8, p=0.02).

Conclusions

LTBI acceptance rate was very low among our HCWs. Focusing on educating HCWs is potentially the key step towards an increased rate of LTBI treatment acceptance.

Association between maternal pregestational glucose level and adverse pregnancy outcomes: a population-based retrospective cohort study

Por: Zeng · M. · He · Y. · Li · M. · Yang · L. · Zhu · Q. · Liu · J. · Mao · Y. · Chen · Q. · Du · J. · Zhou · W.
Objective

To investigate the association between maternal pregestational blood glucose level and adverse pregnancy outcomes.

Design

Retrospective cohort study.

Setting

This study was conducted in the Chongqing Municipality of China between April 2010 and December 2016.

Participants

A total of 60 222 women (60 360 pregnancies) from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project and had pregnancy outcomes were included.

Primary outcome measures

Adverse pregnancy outcomes included spontaneous abortion, induced abortion or labour due to medical reasons, stillbirth, preterm birth (PTB), macrosomia, large for gestational age, low birth weight (LBW) and small for gestational age.

Results

Of the 60 360 pregnancies, rates of hypoglycaemic, normoglycaemia, impaired fasting glycaemia (IFG) and diabetic hyperglycaemic before conception were 5.06%, 89.30%, 4.59% and 1.05%, respectively. Compared with women with normoglycaemia, women with pregestational glucose at the diabetic level (≥7.0 mmol/L) might have a higher rate of macrosomia (6.18% vs 4.16%), whereas pregestational IFG seemed to be associated with reduced risks of many adverse outcomes, including spontaneous abortion, induced abortion due to medical reasons, PTB and LBW. After adjusting for potential confounders, pregestational diabetic hyperglycaemic was remained to be significantly associated with an increased risk of macrosomia (adjusted risk ratio 1.49, 95% CI 1.07 to 2.09). Abnormal maternal glucose levels before pregnancy (either hypoglycaemic or hyperglycaemic) seemed to have no significant negative effect on spontaneous abortion or induced abortion due to medical reasons.

Conclusion

Although without overt diabetes mellitus, women with once diabetic fasting glucose level during their preconception examinations could be associated with an increased risk for macrosomia. Uniform guidelines are needed for maternal blood glucose management during pre-pregnancy care to improve pregnancy outcomes.

Early outcomes of a rural-oriented physician education programme against rural physician shortages in Guangxi province: a prospective cohort study

Por: Shen · Y. · Huang · X. · Li · H. · Chen · E. · Kong · Y. · Yu · J. · Liu · X. · Mobarak · S. A. · Zuo · Y.
Objectives

This study aimed to investigate early outcomes of one of the first medical undergraduate education programmes with a goal of mitigating severe rural physician shortages in China, which was developed by Guangxi Medical University (GXMU) and was called the Rural-oriented Free Tuition Medical Education (RTME)-GXMU programme.

Design

A prospective cohort study comprising a baseline investigation and follow-up research was conducted to dynamically observe the evolution of the RTME-GXMU programme that began since 2010.

Participants

380 RTME-GXMU graduates and 383 non-RTME-GXMU graduates from GXMU who completed trainings between 2015 and 2018 were recruited in the baseline investigation. Among them, 285 RTME-GXMU and 283 non-RTME-GXMU graduates responded to the follow-up research.

Main outcome measures

Graduate practice location, registered specialty, passing rate of the National Medical Licensing Examination (NMLE), specialty of residency programme and contract compliance for the RTME-GXMU graduates.

Results

By the end of 2018, 100% of the 2015 RTME-GXMU graduates enrolled in this study practised in rural township health centres and registered themselves as general practitioners (GPs). All the RTME-GXMU graduates had completed or were attending residency programmes of general practice (GP). The above data stood in stark contrast to that of the non-RTME-GXMU graduates among whom as few as 1.06% worked in rural areas, 2.13% registered as GPs and less than 3% chose GP residency programmes. No significant differences were detected on passing rates of the NMLE between the two groups. Only one RTME-GXMU graduate broke the contract and dropped off the programme.

Conclusions

The RTME-GXMU programme has achieved encouraging early outcomes. Reduced entry score and proper usage of urban primary care institutions are two key approaches contributing to these positive early results.

Nurses experiences of providing care to patients with COVID-19 in the ICU in Wuhan: a descriptive phenomenological research

Por: Hu · F. · Ma · J. · Ding · X.-B. · Li · J. · Zeng · J. · Xu · D. · Pei · J. · Luo · D. · Yang · B. X. · Zhang · H.-Y. · Zhu · X.-P. · Chen · J.
Objectives

This phenomenological study aimed to examine intensive care unit (ICU) nurses’ experiences of caring for patients with COVID-19, and understand better their everyday experiences of patient’ management in the ICU.

Design

A descriptive phenomenological research design was used. Individual interviews were conducted. The data were transcribed verbatim and analysed using Colaizzi’s seven-step framework.

Setting

An ICU with 16 beds in a tertiary hospital in Wuhan, China.

Participants

Nurses who had more than 1 year of experience and had provided care to patients with COVID-19 in ICU for more than 1 week were identified as participants. A total of 13 nurses were interviewed.

Results

An analysis of these significant statements yielded four distinct stages of feelings, thereby revealing the essence of this phenomenon. Worry about being infected and infecting family members was present across in all four stages. The themes associated with the four stages were as follows: initial contradictory feelings, quick adaption to the ‘new working environment’ in the first 1–2 weeks in the ICU, desperation after adaption, holding on and survive.

Conclusions

The nurses reported distinct experiences of providing care to patients with COVID-19 in ICUs. Interventions, such as providing information about the disease, simulation training, emotional support and follow-up care, are needed to help nurses manage patients with COVID-19 and maintain nurses’ health.

Transmission dynamics and the effects of non-pharmaceutical interventions in the COVID-19 outbreak resurged in Beijing, China: a descriptive and modelling study

Por: Cui · X. · Zhao · L. · Zhou · Y. · Lin · X. · Ye · R. · Ma · K. · Jiang · J.-F. · Jiang · B. · Xiong · Z. · Shi · H. · Wang · J. · Jia · N. · Cao · W.
Objective

To evaluate epidemiological characteristics and transmission dynamics of COVID-19 outbreak resurged in Beijing and to assess the effects of three non-pharmaceutical interventions.

Design

Descriptive and modelling study based on surveillance data of COVID-19 in Beijing.

Setting

Outbreak in Beijing.

Participants

The database included 335 confirmed cases of COVID-19.

Methods

To conduct spatiotemporal analyses of the outbreak, we collected individual records on laboratory-confirmed cases of COVID-19 from 11 June 2020 to 5 July 2020 in Beijing, and visitor flow and products transportation data of Xinfadi Wholesale Market. We also built a modified susceptible-exposed-infected-removed model to investigate the effect of interventions deployed in Beijing.

Results

We found that the staff working in the market (52.2%) and the people around 10 km to this epicentre (72.5%) were most affected, and the population mobility entering-exiting Xinfadi Wholesale Market significantly contributed to the spread of COVID-19 (p=0.021), but goods flow of the market had little impact on the virus spread (p=0.184). The prompt identification of Xinfadi Wholesale Market as the infection source could have avoided a total of 25 708 (95% CI 13 657 to 40 625) cases if unnoticed transmission lasted for a month. Based on the model, we found that active screening on targeted population by nucleic acid testing alone had the most significant effect.

Conclusions

The non-pharmaceutical interventions deployed in Beijing, including localised lockdown, close-contact tracing and community-based testing, were proved to be effective enough to contain the outbreak. Beijing has achieved an optimal balance between epidemic containment and economic protection.

In-hospital gastrointestinal bleeding in patients with acute myocardial infarction: incidence, outcomes and risk factors analysis from China Acute Myocardial Infarction Registry

Por: Shi · W. · Fan · X. · Yang · J. · Ni · L. · Su · S. · Yu · M. · Yang · H. · Yu · M. · Yang · Y. · On behalf of China Acute Myocardial Infarction(CAMI) Registry Study Group
Objective

To investigate the incidence of gastrointestinal bleeding (GIB) in patients with acute myocardial infarction (AMI), clarify the association between adverse clinical outcomes and GIB and identify risk factors for in-hospital GIB after AMI.

Design

Retrospective cohort study.

Setting

108 hospitals across three levels in China.

Participants

From 1 January 2013 to 31 August 2014, after excluding 2659 patients because of incorrect age and missing GIB data, 23 794 patients with AMI from 108 hospitals enrolled in the China Acute Myocardial Infarction Registry were divided into GIB-positive (n=282) and GIB-negative (n=23 512) groups and were compared.

Primary and secondary outcome measures

Major adverse cardiovascular and cerebrovascular events (MACCEs) are a composite of all-cause death, reinfarction and stroke. The association between GIB and endpoints was examined using multivariate logistic regression and Cox proportional hazards models. Independent risk factors associated with GIB were identified using multivariate logistic regression analysis.

Results

The incidence of in-hospital GIB in patients with AMI was 1.19%. GIB was significantly associated with an increased risk of MACCEs both in-hospital (OR 2.314; p

Conclusions

GIB is associated with both in-hospital and follow-up MACCEs. Gastrointestinal prophylactic treatment should be administered to patients with AMI who receive primary PCI, thrombolytic therapy or GPIIb/IIIa receptor inhibitor.

Trial registration number

NCT01874691.

Maternal experience of intermittent kangaroo mother care for late preterm infants: a mixed-methods study in four postnatal wards in China

Por: Zhang · B. · Yue · J. · Duan · Z. · Zhao · Y. · Williams · S. · Huang · L. · Zhang · X. · Wu · W. · Zhang · L. · Liu · J. · Zhao · G.
Objective

To describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC project.

Design

A concurrent mixed-methods approach incorporating quantitative maternal questionnaires and qualitative semistructured interviews.

Setting

Four postnatal wards in level-III hospitals based in different provinces of Southeast and Northwest China.

Participants

All 752 mothers who provided intermittent KMC to their late preterm newborns in the four participating postnatal wards consented to participate in the study (quantitative component), as well as six nurses, two obstetricians and two mothers from two of the participating postnatal wards (qualitative component).

Outcome measures

Maternal KMC experiences during a hospital stay, patients’ perceptions of KMC initiation, processes, benefits and challenges.

Results

Most mothers had not heard of KMC before being introduced to it in the postnatal ward. On average, mothers and newborns stayed in postnatal wards for 3.6 days; during their stay, mothers provided an average of 3.5 KMC sessions, which is an average of 1.1 sessions a day. Each KMC session lasted an average of 68 min, though there was much variation in the length of a session. Common reasons given for discontinuing a KMC session included restroom use, infant crying and perceived time limitations. Some mothers would have preferred to provide KMC for longer periods of time and nurses encouraged this. Most mothers experienced no difficulty providing KMC, received support from family and medical staff and intended to continue with KMC postdischarge.

Conclusion

In order to improve the maternal experience of KMC, it is recommended that raising awareness of KMC should be included in antenatal care and after birth. Longer periods of KMC provision should be encouraged, greater privacy should be provided for mothers providing KMC in postnatal wards and family members should be encouraged to support KMC.

Patient satisfaction in China: a national survey of inpatients and outpatients

Por: Liang · H. · Xue · Y. · Zhang · Z.-r.
Objectives

Patient satisfaction is an important indicator of hospital healthcare quality. Little up-to-date information of patient satisfaction in China is available. This study attempts to gain a holistic understanding of patient satisfaction in China and identify the key antecedents of patient satisfaction.

Design

A cross-sectional national survey was conducted in 2018.

Setting

Hospitals in 27 provinces and 4 municipalities in 4 regions of China.

Participants

A random sample of 15 699 patients who visited 1304 hospitals were surveyed, with around 500 from each of the 27 provinces and 4 municipalities.

Primary and secondary outcome measures

The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire was used to measure patients’ overall satisfaction and willingness to recommend the hospital.

Results

We found significant variation in overall patient satisfaction but little variation in hospital recommendation across the four broad regions. Moreover, we examined determinants of patient satisfaction and their likelihood to recommend the hospital. The overall satisfaction for inpatients and outpatients is commonly influenced by communication with doctors (inpatient: β=0.524, p

Conclusions

There are regional differences of patient satisfaction in China. Patient satisfaction is influenced by a variety of hospital factors and province/municipality factors. The influencing factors of patient satisfaction may not motivate patients to recommend the hospital.

Association between serum phosphate and mortality in critically ill patients: a large retrospective cohort study

Por: Chen · Y. · Luo · M. · Xu · H. · Zhao · W. · He · Q.
Objectives

This research aims to explore the impact of serum phosphate on the mortality of critically ill patients.

Design

A retrospective large cohort study.

Setting

Our data were extracted from a publicly accessible database named ‘Multiparameter Intelligent Monitoring in Intensive Care Database III’.

Participants

27 131 patients were included by clear definitions of selection and exclusion criteria.

Interventions

We used initial phosphate at admission as a design variable. Patients were divided into six groups with different serum phosphate levels and five groups at different intensive care unit (ICU) departments.

Primary and secondary outcomes

28-day and 90-day mortality were primary outcomes. All-cause mortality and length of stay ICU were secondary outcomes.

Results

Patients with very-high-normal serum phosphate, hypophosphataemia and hyperphosphataemia had worse outcomes. And the relationship between serum phosphate and the probability of 28-day or 90-day mortality had a linear relationship. After adjustment for potential confounders, hypophosphataemia and hyperphosphataemia were not significantly associated with 28-day or 90-day mortality. Nevertheless, at the medical ICU, hyperphosphataemia was associated with increased 28-day or 90-day mortality (HR=0.64, 95% CI 0.48 to 0.84, p=0.0017; HR=0.72, 95% CI 0.57 to 0.91, p=0.0067, respectively), using group 2 (≥2.5 mg/dL and

Conclusions

Patients with very-high-normal serum phosphate also had worse outcomes, it might be necessary to re-evaluate the definitions of the normal reference range for serum phosphate. Hypophosphataemia and hyperphosphataemia are not the independent risk factors of 28-day or 90-day ICU mortality, which leads us to consider whether phosphate monitoring is not a necessary measure in critically ill patients. But hyperphosphataemia was associated with increased 28-day or 90-day mortality at the medical ICU, which emphasises the potential importance of early diagnosis and treatment of hyperphosphataemia for the patients who were admitted to the medical ICU.

Cost-effectiveness of speech and language therapy plus scalp acupuncture versus speech and language therapy alone for community-based patients with Brocas aphasia after stroke: a post hoc analysis of data from a randomised controlled trial

Por: Liu · Z. · Huang · J. · Xu · Y. · Wu · J. · Tao · J. · Chen · L.
Objective

This study aimed to assess the cost-effectiveness of combined scalp acupuncture therapy with speech and language therapy for patients with Broca’s aphasia after stroke.

Design

A within-trial cost-effectiveness analysis.

Settings

Community health centres.

Subjects

A total of 203 participants with Broca’s aphasia after stroke who had been randomly assigned to receive scalp acupuncture with speech and language therapy (intervention) or speech and language therapy alone (control).

Intervention

Both groups underwent speech and language therapy (30 min per day, 5 days a week, for 4 weeks), while the intervention group simultaneously received scalp acupuncture.

Primary outcomes

All outcomes were collected at baseline, and after the 4-week intervention and 12-week follow-up. Cost-effectiveness measures included the Chinese Rehabilitation Research Center Standard Aphasia Examination (CRRCAE) and Boston Diagnostic Aphasia Examination (BDAE). Cost–utility was evaluated using quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios were expressed, and sensitivity analysis was conducted.

Results

The total cost to deliver the intervention was 4001.72, whereas it was 4323.57 for the control group. The incremental cost-effectiveness ratios showed that the intervention was cost-effective (495.1 per BDAE grade gained; 1.8 per CRRCAE score gained; 4597.1 per QALYs gained) relative to the control over the 12 weeks. The intervention had a 56.4% probability of being cost-effective at the ¥50 696 (6905.87) Gross Domestic Product (GDP) per capita threshold. Sensitivity analyses confirmed the robustness of the results.

Conclusions

Compared with speech and language therapy alone, the addition of scalp acupuncture was cost-effective in Chinese communities. As the costs of acupuncture services in China are likely to differ from other countries, these results should be carefully interpreted and remain to be confirmed in other populations.

Trial registration number

ChiCTR-TRC-13003703.

Comprehensive review of statistical methods for analysing patient-reported outcomes (PROs) used as primary outcomes in randomised controlled trials (RCTs) published by the UKs Health Technology Assessment (HTA) journal (1997-2020)

Por: Qian · Y. · Walters · S. J. · Jacques · R. · Flight · L.
Objectives

To identify how frequently patient-reported outcomes (PROs) are used as primary and/or secondary outcomes in randomised controlled trials (RCTs) and to summarise what statistical methods are used for the analysis of PROs.

Design

Comprehensive review.

Setting

RCTs funded and published by the United Kingdom’s (UK) National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme.

Data sources and eligibility

HTA reports of RCTs published between January 1997 and December 2020 were reviewed.

Data extraction

Information relating to PRO use and analysis methods was extracted.

Primary and secondary outcome measures

The frequency of using PROs as primary and/or secondary outcomes; statistical methods that were used for the analysis of PROs as primary outcomes.

Results

In this review, 37.6% (114/303) of trials used PROs as primary outcomes, and 82.8% (251/303) of trials used PROs as secondary outcomes from 303 NIHR HTA reports of RCTs. In the 114 RCTs where the PRO was the primary outcome, the most used PRO was the Short-Form 36 (8/114); the most popular methods for multivariable analysis were linear mixed model (45/114), linear regression (29/114) and analysis of covariance (13/114); logistic regression was applied for binary and ordinal outcomes in 14/114 trials; and the repeated measures analysis was used in 39/114 trials.

Conclusion

The majority of trials used PROs as primary and/or secondary outcomes. Conventional methods such as linear regression are widely used, despite the potential violation of their assumptions. In recent years, there is an increasing trend of using complex models (eg, with mixed effects). Statistical methods developed to address these violations when analysing PROs, such as beta-binomial regression, are not routinely used in practice. Future research will focus on evaluating available statistical methods for the analysis of PROs.

Relapse prevention group therapy via video-conferencing for substance use disorder: protocol for a multicentre randomised controlled trial in Indonesia

Por: Yamada · C. · Siste · K. · Hanafi · E. · Ophinni · Y. · Beatrice · E. · Rafelia · V. · Alison · P. · Limawan · A. · Shinozaki · T. · Matsumoto · T. · Sakamoto · R.
Background

Substance use disorder (SUD) is a leading contributor to the global burden of disease. In Indonesia, the availability of formal treatment for SUD falls short of the targeted coverage. A standardised therapeutic option for SUD with potential for widespread implementation is required, yet evidence-based data in the country are scarce. In this study, we developed a cognitive behavioural therapy (CBT)-based group telemedicine model and will investigate effectiveness and implementability in a multicentre randomised controlled trial.

Methods

A total of 220 participants will be recruited from the social networks of eight sites in Indonesia: three hospitals, two primary healthcare centres and three rehabilitation centres. The intervention arm will participate in a relapse prevention programme called the Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a newly developed 12-week module based on CBT and motivational interviewing constructed in the Indonesian context. The programme will be delivered by a healthcare provider and a peer counsellor in a group therapy setting via video-conferencing, as a supplement to participants’ usual treatments. The control arm will continue treatment as usual. The primary outcome will be the percentage increase in days of abstinence from the primarily used substance in the past 28 days. Secondary outcomes will include addiction severity, quality of life, motivation to change, psychiatric symptoms, cognitive function, coping, and internalised stigma. Assessments will be performed at baseline (week 0), post-treatment (week 13), and 3 and 12 months post-treatment completion (weeks 24 and 60). Retention, participant satisfaction, and cost-effectiveness will be assessed as the implementation outcomes.

Ethics and dissemination

The study protocol was reviewed and approved by the Ethics Committees of Universitas Indonesia and Kyoto University. The results will be disseminated via academic journals and international conferences. Depending on trial outcomes, the treatment programme will be advocated for adoption as a formal healthcare-based approach for SUD.

Trial registration number

UMIN000042186.

Associations between cardiometabolic risks and physical activity in early adulthood: a cross-sectional study

Por: Yen · H.-Y. · Li · C.
Objectives

Young adults’ physical activity (PA) is a foundation of creating future healthy lifestyles. The purpose of this study was to explore differences in PA, sedentary behaviour, walkability and health beliefs among young adults with different levels of cardiometabolic risks and the influence of moderate-to-vigorous PA.

Design

A cross-sectional study was conducted using a structured questionnaire.

Participants

Totally, 1149 valid responses were received for a response rate of 86.32%. According to the self-reported worst health condition, participants were categorised into healthy adults, and adults at levels 1 (overweight), 2 (obese), 3 (hypertensive, hyperlipidaemic, and/or hyperglycaemic), and 4 (with a diagnosis of cardiometabolic diseases) of cardiometabolic risks.

Primary outcome measures

PA, sedentary time, walkability and health beliefs.

Results

Significant differences in PA (F=3.78, pF=2.39, p

Conclusions

Being aware of body weight changes could be a danger sign of a lack of PA. Developing environmental and psychological strategies to promote engaging in PA is necessary to promote the cardiometabolic health of young adults.

Cost-effectiveness analysis of different screening strategies for colorectal cancer in Guangzhou, southern China: a Markov simulation analysis based on natural community screening results

Por: Zhou · Q. · Li · H.-l. · Li · Y. · Gu · Y.-t. · Liang · Y.-r. · Liu · H.-z. · Li · K. · Dong · H. · Chen · Y.-y. · Lin · G.-z.
Objectives

To evaluate the cost-effectiveness of four different primary screening strategies: high-risk factor questionnaire (HRFQ) alone, single immunochemical faecal occult blood test (iFOBT), double iFOBT and HRFQ+double iFOBT for colorectal cancer (CRC) screening compared with no screening using the Markov model.

Methods

Treeage Pro V.2011 software was used to simulate the Markov model. The incremental cost-effectiveness ratio, which was compared with the willingness-to-pay (WTP) threshold, was used to reflect the cost-effectiveness of the CRC screening method. One-way sensitivity analysis and probabilistic sensitivity analysis were used for parameter uncertainty.

Results

All strategies had greater effectiveness because they had more quality-adjusted life years (QALYs) than no screening. When the WTP was ¥435 762/QALY, all screening strategies were cost-effective compared with no screening. The double iFOBT strategy was the best-buy option compared with all other strategies because it had the most QALYs and the least cost. One-way sensitivity analysis showed that the sensitivity of low-risk adenoma, compliance with colonoscopy and primary screening cost were the main influencing factors comparing single iFOBT, double iFOBT and HRFQ+double iFOBT with no screening. However, within the scope of this study, there was no fundamental impact on cost-effectiveness. Probabilistic sensitivity analysis showed that when the WTP was ¥435 762/QALY, the probabilities of the cost-effectiveness acceptability curve with HRFQ alone, single iFOBT, double iFOBT and HRFQ+double iFOBT were 0.0%, 5.3%, 69.3% and 25.4%, respectively.

Conclusions

All screening strategies for CRC were cost-effective compared with no screening strategy. Double iFOBT was the best-buy option compared with all other strategies. The significant influencing factors were the sensitivity of low-risk polyps, compliance with colonoscopy and cost of primary screening.

Cross-sectional association between long working hours and endoscopic gastritis: the Kangbuk Samsung Health Study

Por: Mun · E. · Lee · Y. · Lee · W. · Park · S.
Objectives

This study aimed to determine the cross-sectional association between long working hours and gastritis diagnosed by endoscopy.

Design

Cross-sectional study.

Setting

Large university hospitals in Seoul and Suwon, South Korea.

Participants

Workers in formal employment who underwent a comprehensive health examination at the Kangbuk Samsung Hospital Total Healthcare Centre clinics in Seoul and Suwon, South Korea, between January 2011 and December 2018. Of the 386 488 participants, 168 391 full-time day workers met the inclusion criteria and were included in the analysis.

Primary outcome measure

Endoscopic gastritis.

Results

The participants were predominantly college graduates or above (88.9%), male (71.2%) and in their 30s (51.1%), and the median age was 36 (IQR 31–42). Approximately 93.2% of participants had positive endoscopic gastritis, and there was a significant association between working hours and positive findings of endoscopic gastritis. The multivariate fully adjusted prevalence ratio (PR) of endoscopic gastritis for participants working >55 hours per week compared with 35–40 hours per week was 1.011 (95% CI 1.007 to 1.015). Furthermore, endoscopic findings were classified into nine subtypes of gastritis, including superficial gastritis, erosive gastritis, atrophic gastritis, intestinal metaplasia and haemorrhagic gastritis increased with longer working hours (p for trends 55 hours per week compared with 35–40 hours per week were 1.019 (95% CI 1.012 to 1.026), 1.025 (95% CI 1.011 to 1.040), 1.017 (95% CI 1.008 to 1.027), 1.066 (95% CI 1.028 to 1.105) and 1.177 (95% CI 1.007 to 1.375), respectively.

Conclusions

Working over 55 hours per week was cross-sectionally associated with positive findings of endoscopic gastritis. The study findings indicated potentially increased risks of superficial gastritis, erosive gastritis, atrophic gastritis, intestinal metaplasia and haemorrhagic gastritis among workers with long working hours (>55 hours per week), supporting the need for further exploration via longitudinal studies.

Impact of night shifts on sleeping patterns, psychosocial and physical well-being among healthcare professionals: a cross-sectional study in a tertiary hospital in Saudi Arabia

Por: Qanash · S. · Alwafi · H. · Barasheed · S. · Bashnaini · S. · Andergiri · R. · Yaghmour · L. · Murad · W. · Shabrawishi · M. · Naser · A. Y. · Alsywid · B.
Background

Shift work and night shifts are very common in healthcare organisations worldwide. However, healthcare professionals doing shift work and night shifts are exposed to several stressors with psychological, social, physical and sleeping consequences. This study aimed to evaluate the effect of night shifts on the psychosocial, physical well-being and sleeping patterns of healthcare professionals in Saudi Arabia.

Methods

We conducted an observational cross-sectional study from July to September 2019 at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Convenience sampling technique was used to recruit healthcare providers to participate in the study. The outcomes measured included the effect of working hours of healthcare workers on psychosocial and physical health, substance use, and sleep quality and patterns. Pearson’s 2 test was used to compare proportions, and Student’s t-test/Analysis of variance (ANOVA) was used to examine the mean differences among different demographic groups.

Results

A total of 352 healthcare providers were involved in the study, of whom only 272 were night shift workers. The mean level of job satisfaction was higher among day shift workers than night shift workers: the mean scores were 3.82 (SD=0.93) and 3.48 (SD=1.04), respectively, p=0.007. Moreover, social life was more adversely affected among night shift workers compared with day shift workers: 3.95 (SD=1.11) and 3.61 (SD=1.25), respectively, p

Conclusion

Quality of life is poor among night shift workers than day shift workers, particularly concerning sleep and social and physical outcomes. Further research is needed to investigate factors associated with the quality of sleep and the psychosocial and physical well-being of healthcare professionals working night shifts.

Hypertensive disorders in pregnancy and risk of asthma in offspring: a systematic review and meta-analysis

Por: Li · P. · Xiong · T. · Hu · Y.
Objectives

The association between hypertensive disorders in pregnancy (HDP) and an increased risk of asthma in offspring remains controversial. No systematic review of this topic has been performed. The aim of this systematic review was to summarise the available evidence regarding the association between HDP and the risk of asthma in offspring.

Design

Systematic review and meta-analysis.

Methods

On the basis of a prepared protocol, a systematic search of PubMed, EMBASE, the Cochrane Library and Web of Science was performed using a detailed search strategy from the database inception to 17 January 2020. Cohort, case–control and cross-sectional studies published in English reporting the diagnoses of maternal HDP and asthma in offspring were included. The Meta-analysis of Observational Studies in Epidemiology guidelines were followed throughout the study. The estimated pooled ORs of HDP and asthma in offspring were calculated from the studies, and the meta-analysis was performed using random-effects models.

Results

Ten cohort studies involving a total of 6 270 430 participants were included. According to the Newcastle-Ottawa Scale, the overall methodological quality was good since 8 studies were of high quality and 2 studies were of moderate quality. After controlling for potential confounders, HDP was associated with a possible increased risk of asthma in offspring, with a pooled adjusted OR (aOR) of 1.19 (95% CI 1.12 to 1.26). The subgroup analyses according to HDP subgroups, sibling design, study quality, study location, offspring ages, singleton status, exposure assessment, outcome assessment and adjusted factors showed similar results.

Conclusions

Exposure to HDP may be associated with an increased risk of asthma in offspring. Further research is needed to verify the results and determine whether the observed relationship is causal.

PROSPERO registration number

CRD42020148250.

Prediction of exacerbation frequency of AECOPD based on next-generation sequencing and its relationship with imbalance of lung and gut microbiota: a protocol of a prospective cohort study

Por: Deng · L. · Yan · J. · Xu · H. · Huang · C. · Lv · Y. · Wu · Q. · Xu · Y. · Chen · X.
Introduction

Patients with frequent acute exacerbation phenotype chronic obstructive pulmonary disease (AECOPD) have a higher hospitalisation rate than infrequent exacerbation, the disease progresses quickly and treatment is more difficult. At present, it is impossible to predict patients with COPD with frequent acute exacerbation phenotypes. The composition of the lower respiratory tract flora and the intestinal flora is closely related to AECOPD, but the specific association mechanism between them is not very clear. This study used metagenomic next-generation sequencing (mNGS) technology to explore the microbial characteristics of the intestinal tract and airways of patients with COPD, and analyse the correlation between the sequencing results and inflammatory factors, immune factors and nutritional factors.

Methods and analysis

This will be a prospective cohort study. We intend to recruit 152 patients with stable COPD. In the baseline, we will detect the participants’ induced sputum and faecal flora through mNGS, and changes in blood immune levels, and the patient’s condition is evaluated. Every 2 months, we will check the number of acute exacerbation through the phone range. After 12 months, we will check again the changes in the blood immune level, evaluate the patient’s condition and count the number of episodes.

Ethics and dissemination

This study has been approved by the ethics committee of Guangdong Provincial Hospital of Traditional Chinese Medicine (approval number ZF2019-219-03). The results of the study will be published in peer-reviewed journals.

Trial registration number

ClinicalTrials.gov Registry (ChiCTR2000032870).

❌