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AnteayerInterdisciplinares

Social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain

Pedro Gullón, Julia Díez, Miguel Cainzos-Achirica, Manuel Franco, Usama Bilal
Gac Sanit. 2021;35:326-32

Resumen - Texto completo - PDF

Thinking green: modelling respirator reuse strategies to reduce cost and waste

Por: Chu · J. · Ghenand · O. · Collins · J. · Byrne · J. · Wentworth · A. · Chai · P. R. · Dadabhoy · F. · Hur · C. · Traverso · G.
Objectives

To compare the impact of respirator extended use and reuse strategies with regard to cost and sustainability during the COVID-19 pandemic.

Design

Cost analysis.

Setting

USA.

Participants

All healthcare workers within the USA.

Interventions

Not applicable.

Main outcome measures

A model was developed to estimate usage, costs and waste incurred by several respirator usage strategies over the first 6 months of the pandemic in the USA. This model assumed universal masking of all healthcare workers. Estimates were taken from the literature, government databases and commercially available data from approved vendors.

Results

A new N95 respirator per patient encounter would require 7.41 billion respirators, cost $6.38 billion and generate 84.0 million kg of waste in the USA over 6 months. One respirator per day per healthcare worker would require 3.29 billion respirators, cost $2.83 billion and generate 37.22 million kg of waste. Decontamination by ultraviolet germicidal irradiation would require 1.64 billion respirators, cost $1.41 billion and accumulate 18.61 million kg of waste. H2O2 vapour decontamination would require 1.15 billion respirators, cost $1.65 billion and produce 13.03 million kg of waste. One reusable respirator with daily disposable filters would require 18 million respirators, cost $1.24 billion and generate 15.73 million kg of waste. Pairing a reusable respirator with H2O2 vapour-decontaminated filters would reduce cost to $831 million and generate 1.58 million kg of waste. The use of one surgical mask per healthcare worker per day would require 3.29 billion masks, cost $460 million and generate 27.92 million kg of waste.

Conclusions

Decontamination and reusable respirator-based strategies decreased the number of respirators used, costs and waste generated compared with single-use or daily extended-use of disposable respirators. Future development of low-cost,simple technologies to enable respirator and/or filter decontamination is needed to further minimise the economic and environmental costs of masks.

Quality of care for peripheral intravenous catheters (PIVCs) in Nepal: a cross-sectional study on feasibility and inter-rater agreement of the Peripheral Intravenous Catheters-mini Questionnaire (PIVC-miniQ) in a tertiary care hospital

Por: Shrestha · S. · Vieler · J. · Haug · N. J. · Afset · J. E. · Hovik · L. H. · Lydersen · S. · Gustad · L. T.
Objectives

There is a lack of data regarding the quality of peripheral intravenous catheter (PIVC)-related care from low-income and middle-income countries, even though the use of PIVCs may lead to local or severe systemic infections. Our main objective was to assess the feasibility and inter-rater agreement on the PIVC-mini Questionnaire (PIVC-miniQ) in a tertiary care hospital in Nepal.

Design

We performed an observational cross-sectional quantitative study using the PIVC-miniQ to collect information on PIVC quality.

Setting

Secondary care in a Nepalese hospital. All patients with PIVCs in selected wards were included in the study and PIVCs were assessed independently by two raters. Eight Nepalese nurses, one Nepalese student and three Norwegian students participated as raters.

Primary and secondary outcome measures

The intraclass correlation coefficient (ICC), positive, negative, absolute agreement, Scott’s pi and sum score were calculated using PIVC-miniQ. We also aimed to describe PIVC quality of care, as it is important to prevent PIVC-associated complications such as phlebitis or catheter-associated bloodstream infections.

Results

A total of 390 patients (409 PIVCs) were included in the study. The ICC between raters was 0.716 for Nepalese raters, 0.644 for Norwegian raters and 0.481 for the pooled data. The most frequently observed problems associated with PIVCs were blood in the intravenous line (51.5%), pain and tenderness on palpation (43.4%), and fixation with opaque tape (38.5%). The average sum score was 3.32 deviations from best practice for PIVCs fixed with non-sterile opaque tape and 2.37 for those fixed with transparent dressing (p

Conclusion

The PIVC-miniQ is a feasible and reliable tool for nurses assessing PIVC quality in hospitalised patients in Nepal. The study revealed gaps in PIVC quality and care that could be improved by providing transparent PIVC dressings for all patients and requiring all PIVC insertions to be documented in patient charts.

Exploring pain interference with motor skill learning in humans: a protocol for a systematic review

Por: Matthews · D. · Elgueta Cancino · E. · Falla · D. · Khatibi · A.
Introduction

Motor skill learning is intrinsic to living. Pain demands attention and may disrupt non-pain-related goals such as learning new motor skills. Although rehabilitation approaches have used motor skill learning for individuals in pain, there is uncertainty on the impact of pain on learning motor skills.

Methods and analysis

The protocol of this systematic review has been designed and is reported in accordance with criteria set out by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Web of Science, Scopus, MEDLINE, Embase and CINAHL databases; key journals; and grey literature will be searched up until March 2021, using subject-specific searches. Two independent assessors will oversee searching, screening and extracting of data and assessment of risk of bias. Both behavioural and activity-dependent plasticity outcome measures of motor learning will be synthesised and presented. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Ethics and dissemination

No patient data will be collected, and therefore, ethical approval was not required for this review. The results of this review will provide further understanding into the complex effects of pain and may guide clinicians in their use of motor learning strategies for the rehabilitation of individuals in pain. The results of this review will be published in a peer-reviewed journal and presented at scientific conferences.

PROSPERO registration number

CRD42020213240.

Systematic review of ecological momentary assessment (EMA) studies of five public health-related behaviours: review protocol

Por: Kwasnicka · D. · Kale · D. · Schneider · V. · Keller · J. · Yeboah-Asiamah Asare · B. · Powell · D. · Naughton · F. · ten Hoor · G. A. · Verboon · P. · Perski · O.
Introduction

Ecological momentary assessment (EMA) involves repeated, real-time assessments of phenomena (eg, cognitions, emotions, behaviours) over a period of time in naturalistic settings. EMA is increasingly used to study both within-person and between-person processes. We will review EMA studies investigating key health behaviours and synthesise: (1) study characteristics (eg, frequency of assessments, adherence, incentives), (2) associations between psychological predictors and behaviours and (3) moderators of adherence to EMA protocols.

Methods and analysis

This review will focus on EMA studies conducted across five public health behaviours in adult, non-clinical populations: movement behaviour (including physical activity and sedentary behaviour), dietary behaviour, alcohol consumption, tobacco smoking and preventive sexual health behaviours. Studies need to have assessed at least one psychological or contextual predictor of these behaviours. Studies reporting exclusively on physiological outcomes (eg, cortisol) or those not conducted under free-living conditions will be excluded. We will search OVID MEDLINE, Embase, PsycINFO and Web of Science using terms relevant to EMA and the selected health behaviours. Reference lists of existing systematic reviews of EMA studies will be hand searched. Identified articles will be screened by two reviewers. This review is expected to provide a comprehensive summary of EMA studies assessing psychological or contextual predictors of five public health behaviours.

Ethics and dissemination

The results will be disseminated through peer-reviewed publications and presentations. Data from included studies will be made available to other researchers. No ethics are required.

PROSPERO registration number

CRD42020168314.

Cross-sectional study of preprints and final journal publications from COVID-19 studies: discrepancies in results reporting and spin in interpretation

Por: Bero · L. · Lawrence · R. · Leslie · L. · Chiu · K. · McDonald · S. · Page · M. J. · Grundy · Q. · Parker · L. · Boughton · S. · Kirkham · J. J. · Featherstone · R.
Objective

To compare results reporting and the presence of spin in COVID-19 study preprints with their finalised journal publications.

Design

Cross-sectional study.

Setting

International medical literature.

Participants

Preprints and final journal publications of 67 interventional and observational studies of COVID-19 treatment or prevention from the Cochrane COVID-19 Study Register published between 1 March 2020 and 30 October 2020.

Main outcome measures

Study characteristics and discrepancies in (1) results reporting (number of outcomes, outcome descriptor, measure, metric, assessment time point, data reported, reported statistical significance of result, type of statistical analysis, subgroup analyses (if any), whether outcome was identified as primary or secondary) and (2) spin (reporting practices that distort the interpretation of results so they are viewed more favourably).

Results

Of 67 included studies, 23 (34%) had no discrepancies in results reporting between preprints and journal publications. Fifteen (22%) studies had at least one outcome that was included in the journal publication, but not the preprint; eight (12%) had at least one outcome that was reported in the preprint only. For outcomes that were reported in both preprints and journals, common discrepancies were differences in numerical values and statistical significance, additional statistical tests and subgroup analyses and longer follow-up times for outcome assessment in journal publications.

At least one instance of spin occurred in both preprints and journals in 23/67 (34%) studies, the preprint only in 5 (7%), and the journal publications only in 2 (3%). Spin was removed between the preprint and journal publication in 5/67 (7%) studies; but added in 1/67 (1%) study.

Conclusions

The COVID-19 preprints and their subsequent journal publications were largely similar in reporting of study characteristics, outcomes and spin. All COVID-19 studies published as preprints and journal publications should be critically evaluated for discrepancies and spin.

Reducing COVID-19 quarantine with SARS-CoV-2 testing: a simulation study

Por: Peng · B. · Zhou · W. · Pettit · R. W. · Yu · P. · Matos · P. G. · Greninger · A. L. · McCashin · J. · Amos · C. I.
Objective

To evaluate the effectiveness of SARS-CoV-2 testing on shortening the duration of quarantines for COVID-19 and to identify the most effective choices of testing schedules.

Design

We performed extensive simulations to evaluate the performance of quarantine strategies when one or more SARS-CoV-2 tests were administered during the quarantine. Simulations were based on statistical models for the transmissibility and viral loads of SARS-CoV-2 infections and the sensitivities of available testing methods. Sensitivity analyses were performed to evaluate the impact of perturbations in model assumptions on the outcomes of optimal strategies.

Results

We found that SARS-CoV-2 testing can effectively reduce the length of a quarantine without compromising safety. A single reverse transcription-PCR (RT-PCR) test performed before the end of quarantine can reduce quarantine duration to 10 days. Two tests can reduce the duration to 8 days, and three highly sensitive RT-PCR tests can justify a 6-day quarantine. More strategic testing schedules and longer quarantines are needed if tests are administered with less-sensitive RT-PCR tests or antigen tests. Shorter quarantines can be used for applications that tolerate a residual postquarantine transmission risk comparable to a 10-day quarantine.

Conclusions

Testing could substantially reduce the length of isolation, reducing the physical and mental stress caused by lengthy quarantines. With increasing capacity and lowered costs of SARS-CoV-2 tests, test-assisted quarantines could be safer and more cost-effective than 14-day quarantines and warrant more widespread use.

Satisfaction with maternity care among recent migrants: an interview questionnaire-based study

Por: Bains · S. · Sundby · J. · Lindskog · B. V. · Vangen · S. · Diep · L. M. · Owe · K. M. · Sorbye · I. K.
Objective

To examine factors associated with recently migrated women’s satisfaction with maternity care in urban Oslo, Norway.

Design

An interview-based cross-sectional study, using a modified version of Migrant Friendly Maternity Care Questionnaire.

Setting

Face-to-face interview after birth in two maternity wards in urban Oslo, Norway, from January 2019 to February 2020.

Participants

International migrant women, ≤5 years length of residency in Norway, giving birth in urban Oslo, excluding women born in high-income countries.

Primary outcome

Dissatisfaction of care during pregnancy and birth, measured using a Likert scale, grouped into satisfied and dissatisfied, in relation to socio-demographic/clinical characteristics and healthcare experiences.

Secondary outcome

Negative healthcare experiences and their association with reason for migration.

Results

A total of 401 women answered the questionnaire (87.6% response rate). Overall satisfaction with maternal healthcare was high. However, having a Norwegian partner, higher education and high Norwegian language comprehension were associated with greater odds of being dissatisfied with care. One-third of all women did not understand the information provided by the healthcare personnel during maternity care. More women with refugee background felt treated differently because of factors such as religion, language and skin colour, than women who migrated due to family reunification.

Conclusions

Although the overall satisfaction was high, for certain healthcare experiences such as understanding information, we found more negative responses. The negative healthcare experiences and factors associated with satisfaction identified in this study have implications for health system planning, education of healthcare personnel and strategies for quality improvement.

Mediating role of coping styles on anxiety in healthcare workers victim of violence: a cross-sectional survey in China hospitals

Por: Ma · Y. · Wang · Y. · Shi · Y. · Shi · L. · Wang · L. · Li · Z. · Li · G. · Zhang · Y. · Fan · L. · Ni · X.
Objective

The purposes of this study were to evaluate the rate of workplace violence in county hospitals in China and its impact on healthcare workers and to explore the relationship between hospital violence, coping styles and anxiety to provide effective procedures for reducing anxiety among healthcare workers.

Methods

The study used stratified sampling to select 1200 healthcare workers from 30 county hospitals in China to conduct a questionnaire survey. Of these, 1030 were valid questionnaires, and the effective response rate was 85.83%. We collected demographic characteristics of our participants and administered the following scales to them: Workplace Violence, Trait Coping Style, Self-rating Anxiety. Data were statistically analysed.

Results

The results showed that 67.28% of healthcare workers in county hospitals in China had experienced workplace violence in the previous 12 months, with prevalent verbal violence (66.12%) followed by physical violence (15.24%). Workplace violence in hospitals was negatively related to positive coping (r=–0.091, p

Conclusions

The incidence of workplace violence among healthcare workers in county-level hospitals in China is relatively high, and there is a correlation between hospital violence, coping styles and anxiety. Positive and negative coping play a mediating role in the impact of hospital violence on healthcare workers’ anxiety. Therefore, hospital administrators should actively promote healthcare workers’ transition to positive coping strategies and minimise the negative impact of anxiety on them.

Longitudinal pre-exposure prophylaxis (PrEP) acceptability, initiation and adherence among criminal justice-involved adults in the USA: the Southern PrEP Cohort Study (SPECS) protocol

Por: LeMasters · K. · Oser · C. · Cowell · M. · Mollan · K. · Nowotny · K. · Brinkley-Rubinstein · L.
Introduction

HIV prevalence among criminal justice (CJ)-involved adults is five times higher than the general population. Following incarceration, CJ-involved individuals experience multilevel barriers to HIV prevention. Pre-exposure prophylaxis (PrEP) is a widely available, daily medication efficacious in preventing HIV. Little is known about PrEP knowledge, acceptability, initiation and sustained use among CJ-involved persons or about how these outcomes vary by multilevel factors. The Southern Pre-Exposure Prophylaxis Study (SPECS) will investigate barriers and facilitators for PrEP initiation and sustained use among CJ-involved adults, building a foundation for PrEP interventions for this underserved population.

Methods and analysis

SPECS uses a mixed-methods sequential design, including a multisite, prospective cohort study in three southern states—North Carolina, Florida and Kentucky—and subsequent qualitative interviews. HIV-negative adults clinically indicated for PrEP with CJ-involvement in the past year (n=660; 220 per site)—will be recruited for four quantitative interviews separated by 6 months, with 18 months of follow-up. Interviews will measure CJ involvement, substance use, sexual behaviours, PrEP acceptability and use, healthcare access and utilisation, support systems and psychological and emotional well-being. We will estimate probabilities of PrEP acceptability and use in a CJ-involved population using descriptive and multivariable analyses. After the follow-up, a subsample that never initiated PrEP, initiated but did not sustain PrEP or sustained PrEP will be asked to participate in a qualitative interview to contextualise their experiences and decisions around PrEP. An inductive approach will guide qualitative analyses.

Ethics and dissemination

PrEP initiation and sustained use rates are unknown among CJ-involved adults. This research will identify individual, social and structural factors that predict PrEP initiation and use. Data generated from the study have the potential to guide research and the development and tailoring of PrEP interventions to CJ-involved populations and provide context to HIV-related outcomes for those with CJ experiences.

Communicating personalised statin therapy-effects as 10-year CVD-risk or CVD-free life-expectancy: does it improve decisional conflict? Three-armed, blinded, randomised controlled trial

Por: Jaspers · N. E. M. · Visseren · F. L. J. · van der Graaf · Y. · Smulders · Y. M. · Damman · O. C. · Brouwers · C. · Rutten · G. E. H. M. · Dorresteijn · J. A. N.
Objective

To determine whether communicating personalised statin therapy-effects obtained by prognostic algorithm leads to lower decisional conflict associated with statin use in patients with stable cardiovascular disease (CVD) compared with standard (non-personalised) therapy-effects.

Design

Hypothesis-blinded, three-armed randomised controlled trial

Setting and participants

303 statin users with stable CVD enrolled in a cohort

Intervention

Participants were randomised in a 1:1:1 ratio to standard practice (control-group) or one of two intervention arms. Intervention arms received standard practice plus (1) a personalised health profile, (2) educational videos and (3) a structured telephone consultation. Intervention arms received personalised estimates of prognostic changes associated with both discontinuation of current statin and intensification to the most potent statin type and dose (ie, atorvastatin 80 mg). Intervention arms differed in how these changes were expressed: either change in individual 10-year absolute CVD risk (iAR-group) or CVD-free life-expectancy (iLE-group) calculated with the SMART-REACH model (http://U-Prevent.com).

Outcome

Primary outcome was patient decisional conflict score (DCS) after 1 month. The score varies from 0 (no conflict) to 100 (high conflict). Secondary outcomes were collected at 1 or 6 months: DCS, quality of life, illness perception, patient activation, patient perception of statin efficacy and shared decision-making, self-reported statin adherence, understanding of statin-therapy, post-randomisation low-density lipoprotein cholesterol level and physician opinion of the intervention. Outcomes are reported as median (25th– 75th percentile).

Results

Decisional conflict differed between the intervention arms: median control 27 (20–43), iAR-group 22 (11–30; p-value vs control 0.001) and iLE-group 25 (10–31; p-value vs control 0.021). No differences in secondary outcomes were observed.

Conclusion

In patients with clinically manifest CVD, providing personalised estimations of treatment-effects resulted in a small but significant decrease in decisional conflict after 1 month. The results support the use of personalised predictions for supporting decision-making.

Trial registration

NTR6227/NL6080.

COVID-19-related attitudes, risk perceptions, preventive behaviours and economic impact in sub-Saharan African countries: implementing a longitudinal phone-based survey protocol in rural Senegalese households

Por: Seror · V. · Maradan · G. · Ba · E.-H. · Cortaredona · S. · Berenger · C. · LHaridon · O. · Sokhna · C. · CO3ELSER group · Ba · Ndiaye · Sokhna · Berenger · Maradan · Seror · Cortaredona · Peretti-Watel · LHaridon · Raude
Introduction

Rural areas are considered safe havens against the increased spread of COVID-19 and associated restrictive measures, especially in contexts where public authorities are not in a position to systematically and substantially ease COVID-19-induced economic shocks. In the current sub-Saharan Africa context, still marked by uncertainty surrounding the spread of COVID-19, we present the protocol of an ongoing longitudinal study aimed at investigating COVID-19-related attitudes, risks perceptions, preventive behaviours and economic impact in rural areas in Senegal.

Methods and analysis

A prospective randomised longitudinal study of 600 households located in three semiurban villages and nine randomly selected rural villages in the Niakhar area (located 135 km East of Dakar). Three ad hoc phone surveys are administered to 600 heads of households, their housewives in charge of managing the household and a relative living temporarily in the household, respectively. In addition to sharing identical sets of questions on several topics (risks perceptions, attitudes to curfew, attitudes to vaccines, beliefs about COVID-19 infection), the three separate survey questionnaires also include other topics (economic impact, local preventive strategies) whose related questions differ between questionnaires. As analysing evolutions is the study’s primary focus, data on all the topics covered will be collected in three waves unless the spread of COVID-19 by mid-2021 justifies extending data collection. The present article presents the study protocol and details about the implementation of the first wave of data collection which started in July 2020. The decision to wait before presenting the protocol was based on the unprecedented context the COVID-19 pandemic.

Ethics and dissemination

The survey’s protocol was approved by the Senegalese National Ethical Committee for Research in Health (131/MSAS/CNERS/Sec) and received authorisation from both the Senegalese Ministry of Health (619/MSAS/DPRS/DR) and the French Commission on Information Technology and Liberties (CNIL 2220771).

Adapting a guided low-intensity behavioural activation intervention for people with dementia and depression in the Swedish healthcare context (INVOLVERA): a study protocol using codesign and participatory action research

Por: Svedin · F. · Brantnell · A. · Farrand · P. · Blomberg · O. · Coumoundouros · C. · von Essen · L. · Aberg · A. C. · Woodford · J.
Introduction

Dementia is a worldwide health concern with incident rates continuing to increase. While depression prevalence is high in people with dementia and psychological interventions such as cognitive behavioural therapy (CBT) are effective, access to psychological interventions remains limited. Reliance on traditional CBT for people with dementia and depression may present difficulties given it is a complex psychological approach, costly to deliver, and professional training time is lengthy. An alternative approach is behavioural activation (BA), a simpler psychological intervention for depression. The present study seeks to work with people with dementia, informal caregivers, community stakeholders, and healthcare professionals, to adapt a guided low-intensity BA intervention for people with dementia and depression, while maximising implementation potential within the Swedish healthcare context.

Methods and analysis

A mixed methods study using codesign, principles from participatory action research (PAR) and normalisation process theory to facilitate the cultural relevance, appropriateness and implementation potential of the intervention. The study will consist of four iterative PAR phases, using focus groups with healthcare professionals and community stakeholders, and semi-structured interviews with people with dementia and informal caregivers. A content analysis approach will be adopted to analyse the transcribed focus groups and semi-structured interviews recordings.

Ethics and dissemination

The study will be conducted in accordance with the Declaration of Helsinki and data handled according to General Data Protection Regulation. Written informed consent will be obtained from all study participants. In accordance with the Swedish Health and Medical Services Act, capacity to consent will be examined by a member of the research team. Ethical approval has been obtained from the Swedish Ethical Review Authority (Dnr: 2020-05542 and Dnr: 2021-00925). Findings will be published in an open access peer-reviewed journal, presented at academic conferences, and disseminated among lay and healthcare professional audiences.

Prophylactic incisional negative pressure wound therapy for gynaecologic malignancies

Abstract

Wound complications are an important cause of postoperative morbidity among patients with gynaecologic malignancies. We evaluated whether the placement of closed-incisional negative pressure therapy (ciNPT) at the time of laparotomy for gynaecologic cancer surgery reduced wound complication rates. A retrospective cohort study with primary wound closure performed by a gynaecologic oncologist was carried out. We evaluated two cohorts of patients who underwent surgery in 2017 with standard closure and patients who underwent surgery in 2019 with the placement of prophylactic ciNPT. Postoperative outcomes were examined. A total of 143 patients were included, 85 (59.4%) vs 58 (40.6%) with standard closure and ciNPT, respectively. The total complication rate in our sample was 38.71%. The rate of surgical complications in patients treated with ciNPT was 6.9% compared with 31.8% (P = .000) in patients treated with standard closure. In the analysis of complications, a significant reduction in infections (17.1%), seromas (15.4%), and wound dehiscence (17.1%) were observed when ciNPT was applied. The median hospital stay was 8 vs 6 days in the standard closure vs ciNPT groups (P = .048). The use of the prophylactic ciNPT following a laparotomy may decrease wound complications and hospital stays in oncological patients. ciNPT could be considered as part of clinical practice in patients at high risk of wound complications, such as patients with gynaecological malignancies.

Does app-based unguided self-management improve mental health literacy, patient empowerment and access to care for people with mental health impairments? Study protocol for a randomised controlled trial

Por: Kerber · A. · Beintner · I. · Burchert · S. · Knaevelsrud · C.
Introduction

Mental disorders pose a huge burden to both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in comorbidity and chronification. Besides limited resources in healthcare systems, the treatment-gap is—to a large extent—caused by within-person barriers impeding early treatment seeking. These barriers include a lack of trust in professionals, fear of stigmatisation, or the desire to cope with problems without professional help. While unguided self-management interventions are not designed to replace psychotherapy, they may support early symptom assessment and recognition by reducing within-person barriers. Digital self-management solutions may also reduce inequalities in access to care due to external factors such as regional unavailability of services.

Methods and analysis

Approximately 1100 patients suffering from mild to moderate depressive, anxiety, sleep, eating or somatisation-related mental disorders will be randomised to receive either a low-threshold unguided digital self-management tool in the form of a transdiagnostic mental health app or care as usual. The primary outcomes will be mental health literacy, patient empowerment and access to care while secondary outcomes will be symptom distress and quality of life. Additional moderator and predictor variables are negative life events, personality functioning, client satisfaction, mental healthcare service use and application of self-management strategies. Data will be collected at baseline as well as 8 weeks and 6 months after randomisation. Data will be analysed using multiple imputation and analysis of covariance employing the intention-to-treat principle, while sensitivity analyses will be based on different multiple imputation parameters and a per-protocol analysis.

Ethics and dissemination

Approval was obtained from the Ethics Committee of the Faculty of Educational Science and Psychology at the Freie Universität Berlin. The results will be submitted to peer-reviewed specialised journals and presented at national and international conferences.

Trial registeration

The trial has been registered in the DRKS trial register (DRKS00022531);Pre-results.

Cross-sectional study of prevalence and risk factors, and a cost-effectiveness evaluation of screening and preventive treatment strategies for latent tuberculosis among migrants in Singapore

Por: Lim · V. W. · Wee · H. L. · Lee · P. · Lin · Y. · Tan · Y. R. · Tan · M. X. · Lin · L. W. · Yap · P. · Chee · C. B. · Barkham · T. · Lee · V. · Chen · M. · Ong · R. T.-H.
Objectives

WHO recommends that low burden countries consider systematic screening and treatment of latent tuberculosis infection (LTBI) in migrants from high incidence countries. We aimed to determine LTBI prevalence and risk factors and evaluate cost-effectiveness of screening and treating LTBI in migrants to Singapore from a government payer perspective.

Design

Cross-sectional study and cost-effectiveness analysis.

Setting

Migrants in Singapore.

Participants

3618 migrants who were between 20 and 50 years old, have not worked in Singapore previously and stayed in Singapore for less than a year were recruited.

Primary and secondary outcome measures

Costs, quality-adjusted life-years (QALYs), threshold length of stay, incremental cost-effectiveness ratios (ICERs), cost per active TB case averted.

Results

Of 3584 migrants surveyed, 20.4% had positive interferon-gamma release assay (IGRA) results, with the highest positivity in Filipinos (33.2%). Higher LTBI prevalence was significantly associated with age, marital status and past TB exposure. The cost-effectiveness model projected an ICER of S$57 116 per QALY and S$12 422 per active TB case averted for screening and treating LTBI with 3 months once weekly isoniazid and rifapentine combination regimen treatment compared with no screening over a 50-year time horizon. ICER was most sensitive to the cohort’s length of stay in Singapore, yearly disease progression rates from LTBI to active TB, followed by the cost of IGRA testing.

Conclusions

For LTBI screening and treatment of migrants to be cost-effective, migrants from high burden countries would have to stay in Singapore for ~50 years. Risk-stratified approaches based on projected length of stay and country of origin and/or age group can be considered.

Association between risk of type 2 diabetes and changes in energy intake at breakfast and dinner over 14 years: a latent class trajectory analysis from the China health and nutrition Survey, 1997-2011

Por: Ren · X. · Gao · J. · Han · T. · Sun · C.
Objective

This study aimed to investigate the association between the trajectories of energy consumption at dinner versus breakfast and the risk of type 2 diabetes (T2D).

Design

Cohort study.

Setting

The study was conducted in China.

Participants

A total of 10 727 adults, including 5239 men and 5488 women, with a mean age of 42.7±11.2 years and a mean follow-up time of 9.1 years, met the study criteria and completed a questionnaire about energy intake and diabetes status from the China Health and Nutrition Survey in 1997–2011.

Primary outcome measures

Participants were divided into subgroups based on the trajectories of the ratio of energy consumption at dinner versus breakfast. Cox multivariate regression models were used to explore the associations between different trajectories and the risk of T2D after adjustment for confounders and their risk factors. Mediation analysis was performed to explore the intermediary effect of triacylglycerol (TG), total cholesterol (TC), uric acid (UA) and apolipoprotein B (ApoB) between the trajectories and the risk of T2D.

Results

For energy consumption at dinner versus breakfast, compared with a low-stable trajectory, the adjusted HR of T2D in low-increasing from early-stage trajectory was 1.29 (95% CI 1.04 to 1.60). TG, TC, UA and ApoB were significantly higher in low-increasing from early-stage trajectory than other trajectories and play partial regulation roles between trajectories and T2D.

Conclusions

This study emphasised the harmful effect of a gradual increase in the ratio of energy consumption at dinner versus breakfast from early stage on the development of T2D and partially mediated by TG, TC, UA and ApoB, highlighting that it is necessary to intake more energy at breakfast compared with dinner to prevent T2D in adults.

Multicentre, randomised clinical trial comparing intravitreal aflibercept monotherapy versus aflibercept combined with reduced-fluence photodynamic therapy (RF-PDT) for the treatment of polypoidal choroidal vasculopathy

Por: Vyas · C. H. · Cheung · C. M. G. · Tan · C. · Chee · C. · Wong · K. · Jordan-Yu · J. M. N. · Wong · T. Y. · Tan · A. · Fenner · B. · Sim · S. · Teo · K. Y. C.
Purpose

To compare the efficacy and safety of intravitreal aflibercept (IVA) monotherapy versus aflibercept combined with reduced-fluence photodynamic therapy (RF-PDT) (IVA+RF-PDT) for the treatment of polypoidal choroidal vasculopathy (PCV).

Methods and analysis

Multicentred, double-masked, randomised controlled trial to compare the two treatment modalities. The primary outcome of the study is to compare the 52-week visual outcome of IVA versus IVA+RF PDT. One hundred and sixty treatment-naïve patients with macular PCV confirmed on indocyanine green angiography will be recruited from three centres in Singapore. Eligible patients will be randomised (1:1 ratio) into one of the following groups: IVA monotherapy group—aflibercept monotherapy with sham photodynamic therapy (n=80); combination group—aflibercept with RF-PDT (n=80). Following baseline visit, all patients will be monitored at 4 weekly intervals during which disease activity will be assessed based on best-corrected visual acuity (BCVA), ophthalmic examination findings, optical coherence tomography (OCT) and angiography where indicated. Eyes that meet protocol-specified retreatment criteria will receive IVA and sham/RF-PDT according to their randomisation group. Primary endpoint will be assessed as change in BCVA at week 52 from baseline. Secondary endpoints will include anatomical changes based on OCT and dye angiography as well as safety assessment. Additionally, we will be collecting optical coherence tomography angiography data prospectively for exploratory analysis.

Ethics and dissemination

This study will be conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki and that are consistent with the ICH E6 guidelines of Good Clinical Practice and the applicable regulatory requirements. Approval from the SingHealth Centralised Institutional Review Board has been sought prior to commencement of the study.

Trial registration number

NCT03941587.

Correlations of impulsivity and aggressive behaviours among adolescents in Shanghai, China using bioecological model: cross-sectional data from Global Early Adolescent Study

Por: Yu · C. · Zhang · J. · Zuo · X. · Lian · Q. · Tu · X. · Lou · C.
Objective

To examine the correlations between impulsivity and aggressive behaviours among Chinese adolescents.

Design

A school-based cross-sectional study.

Setting

Three primary middle schools located in less developed communities of Shanghai.

Participants

1524 adolescents aged 11–16 years.

Measures

The impulsivity was measured by Barratt Impulsivity Scale, and the aggressive behaviours were determined by self-reports. Data were collected through computer-assisted self-interview using tablets. Multivariate Firth logistic regression model was conducted to examine correlations between total, attentional, motor, and non-planning impulsivity and aggressive behaviours, respectively.

Results

Totally, 7.48% of participants reported aggressive behaviours toward others during the past 6 months. The proportion of aggressors among boys and girls was 10.60% and 4.18%, respectively. Results of the multivariate regression suggested the risk of aggressive behaviours was significantly increased among those with the highest tertile of total impulsivity (adjusted OR (aOR)boys=3.14, 95% CI: 1.48 to 6.65; aORgirls=3.74, 95% CI: 1.10 to 12.76) and motor impulsivity (aORboys=2.91, 95% CI: 1.46 to 5.82; aORgirls=3.57, 95% CI: 1.25 to 10.20.), comparing with those with the lowest tertile, for boys and girls, respectively. Besides, younger age, lower social cohesion and being bullied within 6 months were associated with a higher risk of aggressive behaviours among girls. Less family caring and being bullied within 6 months were associated with the risk among boys.

Conclusions

The present study indicates a positive association between impulsivity and aggressive behaviours, with a more salient correlation between motor impulsivity subtrait and aggressive behaviour among both boys and girls. Furthermore, adolescents’ aggressive behaviours were affected by multiple factors from individuals, family, peers and community. Comprehensive intervention strategies such as controlling the aggressor’s impulsivity, helping them better channel their anger, creating a better family, school and neighbourhood environment, and providing support and services for victims of violence are needed.

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