One size does not fit all – a realist review of screening for asymptomatic atrial fibrillation in Indigenous communities in Australia, Canada, New Zealand and United States

Background/Introduction

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and it is increasing in prevalence and incidence globally. True prevalence is underestimated because silent/asymptomatic AF is frequent and under-detected, but can cause stroke. Guidelines recommend opportunistic screening for AF in patients aged ≥65 years old. A growing body of evidence from hospital and community-based studies in Australia, New Zealand, Canada and United States indicates this age limit is lower for Indigenous people. Screening for AF meets the World Health Organisation (WHO) criteria for successful routine screening, yet little is known about successful implementation of AF screening in Indigenous communities in developed countries.

Purpose

The aim of this study is to use a realist approach to identify what works, how, for whom and under what circumstances for AF screening of Indigenous communities in Australia, Canada, New Zealand and United States.

Methods

In the realist review, eight databases were searched for studies targeted at AF screening in Indigenous communities. Realist analysis was used to identify context-mechanism-outcome configurations across 11 included records (reporting on 5 studies). Snowball referencing and grey literature were used to iteratively incorporate evidence to enhance the refined programme theory that was the product of the realist analysis.

Results

The realist review included studies using multiple screening strategies such as using tools to increase screening, using different screening environments and training screeners to provide culturally centred care. The realist analysis identified a number of mechanisms that can improve AF screening in Indigenous communities. The contextual factors enabling AF screening programs in Indigenous communities include wider community engagement, opportunistic non-clinical settings, using portable and easy to use devices, increasing knowledge, motivation and confidence in screening amongst Indigenous healthcare workers as well as improving follow-up protocols for abnormal results tailored to screen setting. Barriers to effective AF screening include time-poor working environments, conflicting cultural issues, navigating communication of abnormal results and logistical issues with device use (Figure 1).

Conclusion(s)

Since the life-course risk for AF in Indigenous population is different, a modified screening strategy needs to be put in place. This realist review provides lessons learned for successful implementation of AF screening programs for Indigenous communities. In order to tackle the gap in cardiovascular burden in Indigenous people, this study calls for action to develop AF screening guidelines for Indigenous populations and provides a guide for policy makers about timely and effective AF screening programs for Indigenous communities.

Funding Acknowledgement

Type of funding sources: None.

What do Australian health consumers believe about commercial advertisements and testimonials? a survey on health service advertising

Background

There has been little examination of consumer attitudes towards the commercial advertising of healthcare services in Australia and how marketing is used by consumers in their health decision-making. In this research, we examined how consumers reported commercial advertising helped them to understand the health services available to them and the influence that marketing had upon their choices.

Methods

A survey instrument using a Likert scale to indicate agreement or disagreement with 21 questions was developed using qualitative interviews before being distributed online within Australia. Sampling of participants was stratified by age, gender and location. The results were subjected to statistical analysis with Spearman Rank Correlation test being used for bivariate analysis.

Results

One thousand five hundred sixty-four complete surveys were collected. The results revealed certain consumer beliefs, for example; the title of ‘Dr’ was believed to indicate skill and high levels of training (81.0%), with 80.3% agreeing incorrectly that use of the title was strictly regulated. Participants reported to have a higher confidence in their own abilities (71.2%) than the public (52.8%) in assessing health advertising. The level of self-confidence increased with higher education level and decreased by age (p < 0.05). Testimonials were reported to be lacking in reliability (67.7%) and that they should not be used in healthcare in the same manner as they are used in other industries. Only 44.8% of participants reported that they felt confident to spot a review that was not written by a genuine user of a service.

Conclusions

The data demonstrated that many health consumers felt that while commercial health advertising was helpful, it was also confusing, with many participants also holding mistaken beliefs around other elements of commercial health advertising. While the advertising of healthcare services might have educational effects and be superficially empowering, advertising is primarily intended to sell, not educate. This research demonstrates that there is significant potential for healthcare advertising to mislead. Future developments in regulatory health advertising policy, and the related ethical frameworks developed by professional healthcare associations, need to consider how the consumers of healthcare services might be better protected from misleading and predatory advertising practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10078-9.

Cross-Sectional Associations Between Dietary Antioxidant Vitamins C, E and Carotenoid Intakes and Sarcopenic Indices in Women Aged 18-79 Years

The prevalence of sarcopenia is increasing in aging populations, so prevention is critical. Vitamins (A, C, E and carotenoids) modify skeletal muscle via protein and collagen synthesis and anti-inflammatory activities. Previous studies have not investigated intake of these vitamins in relation to sarcopenic indices in both younger and older-aged women. Indices of skeletal muscle mass (as fat-free mass (FFM) relative to body size) were measured using DXA and leg explosive power (LEP) using the Nottingham Power Rig in 2570 women aged 18-79 years. Adjusted measures of skeletal muscle were calculated according to quintiles of vitamin C, E, retinol and carotenoid intake, derived from Food Frequency Questionnaires, after stratification by age. Higher vitamin C intake was associated with significantly higher indices of FFM and LEP, (Q5-Q1 = 2.0-12.8%, P < 0.01-0.02). Intakes of total and individual carotenoids were significantly associated with indices of FFM and LEP (Q5-Q1 = 1.0-7.5%). Vitamin E was significantly associated with FFM% and FFM_BMI only. In mutually adjusted analysis with vitamin C, total carotene, vitamin E and protein in the model, the strongest associations were with vitamin C. These associations were stronger in younger women (< 65 years). For the first time, our research shows higher dietary intakes of antioxidant vitamins, particularly vitamin C, is associated with higher skeletal muscle mass and power in free-living women. These findings have relevance for the treatment and prevention of frailty and sarcopenia throughout adulthood.

Improving the operational skills of the health personnel working in the emergency departments

Key messages

There is a huge difference regarding the way in which the emergency system is organized within single countries around Europe. Comparing high-level organisations we have benefited in terms of ideas, projects and potential objectives to be set in order to improve our work and to improve results for patients.

Does lateral lift-off occur in static and dynamic activity in a medially spherical total knee arthroplasty? A pulsed-fluoroscopic investigation

OBJECTIVES

The medially spherical GMK Sphere (Medacta International AG, Castel San Pietro, Switzerland) total knee arthroplasty (TKA) was previously shown to accommodate lateral rollback while pivoting around a stable medial compartment, aiming to replicate native knee kinematics in which some coronal laxity, especially laterally, is also present. We assess coronal plane kinematics of the GMK Sphere and explore the occurrence and pattern of articular separation during static and dynamic activities.

METHODS

Using pulsed fluoroscopy and image matching, the coronal kinematics and articular surface separation of 16 well-functioning TKAs were studied during weight-bearing and non-weight-bearing, static, and dynamic activities. The closest distances between the modelled articular surfaces were examined with respect to knee position, and proportions of joint poses exhibiting separation were computed.

RESULTS

Overall, 1717 joint poses were analyzed. At a 1.0 mm detection threshold, 37 instances of surface separation were observed in the lateral compartment and four medially (p < 0.001). Separation was activity-dependent, both laterally and medially (p < 0.001), occurring more commonly during static deep flexion in the lateral compartment, and during static rotation in the medial compartment. Lateral separation occurred more frequently than medial during kneeling (7/14 lateral vs 1/14 medial; p = 0.031) and stepping (20/1022 lateral vs 0/1022 medial; p < 0.001). Separation varied significantly between individuals during dynamic activities.

CONCLUSION

No consistent association between closest distances of the articular surfaces and knee position was found during any activity. Lift-off was infrequent and depended on the activity performed and the individual knee. Lateral separation was consistent with the design rationale. Medial lift-off was rare and mostly in non-weight-bearing activities.Cite this article: S. Key, G. Scott, J.G. Stammers, M. A. R. Freeman†, V. Pinskerova, R. E. Field, J. Skinner, S. A. Banks. Does lateral lift-off occur in static and dynamic activity in a medially spherical total knee arthroplasty? A pulsed-fluoroscopic investigation. Bone Joint Res 2019;8:207-215. DOI: 10.1302/2046-3758.85.BJR-2018-0237.R1.

Analysis of the Attune tibial tray backside: A comparative retrieval study

Objectives

The Attune total knee arthroplasty (TKA) has been used in over 600 000 patients worldwide. Registry data show good clinical outcome; however, concerns over the cement-tibial interface have been reported. We used retrieval analysis to give further insight into this controversial topic.

Methods

We examined 12 titanium (Ti) PFC Sigma implants, eight cobalt-chromium (CoCr) PFC Sigma implants, eight cobalt-chromium PFC Sigma rotating platform (RP) implants, and 11 Attune implants. We used a peer-reviewed digital imaging method to quantify the amount of cement attached to the backside of each tibial tray. We then measured: 1) the size of tibial tray thickness, tray projections, peripheral lips, and undercuts; and 2) surface roughness (Ra) on the backside and keel of the trays. Statistical analyses were performed to investigate differences between the two designs.

Results

There was no evidence of cement attachment on any of the 11 Attune trays examined. There were significant differences between Ti and CoCr PFC Sigma implants and Attune designs (p < 0.05); however, there was no significant difference between CoCr PFC Sigma RP and Attune designs (p > 0.05). There were significant differences in the design features between the investigated designs (p < 0.05).

Conclusion

The majority of the earliest PFC Sigma designs showed evidence of cement, while all of the retrieved Attune trays and the majority of the RP PFC trays in this study had no cement attached. This may be attributable to the design differences of these implants, in particular in relation to the cement pockets. Our results may help explain a controversial aspect related to cement attachment in a recently introduced TKA design.Cite this article: A. Cerquiglini, J. Henckel, H. Hothi, P. Allen, J. Lewis, A. Eskelinen, J. Skinner, M. T. Hirschmann, A. J. Hart. Analysis of the Attune tibial tray backside: A comparative retrieval study. Bone Joint Res 2019;8:136-145. DOI: 10.1302/2046-3758.83.BJJ-2018-0102.R2.

Transfer function of the rhesus macaque oculomotor system for small-amplitude slow motion trajectories

Two main types of small eye movements occur during gaze fixation: microsaccades and slow ocular drifts. While microsaccade generation has been relatively well studied, ocular drift control mechanisms are unknown. Here we explored the degree to which monkey smooth eye movements, on the velocity scale of slow ocular drifts, can be generated systematically. Two male rhesus macaque monkeys tracked a spot moving sinusoidally, but slowly, along the horizontal or vertical direction. Maximum target displacement in the motion trajectory was 30 min arc (0.5°), and we varied the temporal frequency of target motion from 0.2 to 5 Hz. We obtained an oculomotor “transfer function” by measuring smooth eye velocity gain (relative to target velocity) as a function of frequency, similar to past work with large-amplitude pursuit. Monkey eye velocities as slow as those observed during slow ocular drifts were clearly target motion driven. Moreover, as with large-amplitude smooth pursuit, eye velocity gain varied with temporal frequency. However, unlike with large-amplitude pursuit, exhibiting low-pass behavior, small-amplitude motion tracking was band pass, with the best ocular movement gain occurring at ~0.8–1 Hz. When oblique directions were tested, we found that the horizontal component of pursuit gain was larger than the vertical component. Our results provide a catalog of the control abilities of the monkey oculomotor system for slow target motions, and they also support the notion that smooth fixational ocular drifts are controllable. This has implications for neural investigations of drift control and the image-motion consequences of drifts on visual coding in early visual areas.

NEW & NOTEWORTHY We studied the efficacy of monkey smooth pursuit eye movements for very slow target velocities. Pursuit was impaired for sinusoidal motions of frequency less than ~0.8–1 Hz. Nonetheless, eye trajectory was still sinusoidally modulated, even at velocities lower than those observed during gaze fixation with slow ocular drifts. Our results characterize the slow control capabilities of the monkey oculomotor system and provide a basis for future understanding of the neural mechanisms for slow ocular drifts.

Wear performance of retrieved metal-on-metal Pinnacle hip arthroplasties implanted before and after 2007

Objectives

Previous studies have suggested that metal-on-metal (MoM) Pinnacle (DePuy Synthes, Warsaw, Indiana) hip arthroplasties implanted after 2006 exhibit higher failure rates. This was attributed to the production of implants with reduced diametrical clearances between their bearing surfaces, which, it was speculated, were outside manufacturing tolerances. This study aimed to better understand the performance of Pinnacle Systems manufactured before and after this event.

Methods

A total of 92 retrieved MoM Pinnacle hips were analyzed, of which 45 were implanted before 2007, and 47 from 2007 onwards. The ‘pre-2007’ group contained 45 implants retrieved from 21 male and 24 female patients, with a median age of 61.3 years (interquartile range (IQR) 57.1 to 65.5); the ‘2007 onwards’ group contained 47 implants retrieved from 19 male and 28 female patients, with a median age of 61.8 years (IQR 58.5 to 67.8). The volume of material lost from their bearing and taper surfaces was measured using coordinate and roundness measuring machines. These outcomes were then compared statistically using linear regression models, adjusting for potentially confounding factors.

Results

There was no significant difference between the taper and bearing wear rates of the ‘pre-2007’ and ‘2007 onwards’ groups (p = 0.67 and p = 0.39, respectively). Pinnacles implanted from 2007 onwards were revised after a mean time of 50 months, which was significantly earlier than the ‘pre-2007’ hips (96 months) (p < 0.001). A reduction in the time to revision was present year on year from 2003 to 2011.

Conclusion

We found no difference in the wear rate of these implants based on the year of implantation. The ‘pre-2007’ hips had a two-fold greater time to revision than those implanted after 2007; this may be due to the increased surveillance of MoM hips following UK regulatory advice and several high-profile failures. Interestingly, we observed a decreasing trend in the mean time to revision every year from 2003 onwards.

Cite this article: S. Bergiers, H. S. Hothi, J. Henckel, A. Eskelinen, J. Skinner, A. Hart. Wear performance of retrieved metal-on-metal Pinnacle hip arthroplasties implanted before and after 2007. Bone Joint Res 2018;7:595–600. DOI: 10.1302/2046-3758.711.BJR-2018-0143.R1.

Process evaluation of the midwifery initiated oral health-dental service program: perceptions of pregnant women

BACKGROUND

Pregnant women in Australia seldom seek dental care and are unaware of its importance. To address these gaps the midwifery-initiated oral health dental service (MIOH-DS) program was comprehensive trialled and found effective. The aim of this study was to undertake a process evaluation of the MIOH-DS using the perspectives of pregnant women who participated in the trial.

METHODS

A qualitative research design was utilized, whereby content analysis was undertaken on data from 11 semi-structured interviews with women who participated in the program.

RESULTS

All participants were receptive of the MIOH-DS intervention, and found it to be an acceptable intervention that met their needs, and encouraged future positive oral health practices and health-seeking behaviours. They expressed that midwives were an appropriate professional to conduct oral health assessments, education and referrals to affordable dental services. Although some participants were initially apprehensive towards receiving treatment during pregnancy, dental staff members were able to appropriately educate and reassure them during treatment.

CONCLUSIONS

The MIOH-DS represents a promising and acceptable intervention strategy for pregnant women to promote their oral health. Findings merit further investigation on whether positive outcomes achieved can be sustained when implemented in other national or international settings similar to the study setting.

A retrieval analysis of the Precice intramedullary limb lengthening system

OBJECTIVES

The Precice nail is the latest intramedullary lengthening nail with excellent early outcomes. Implant complications have led to modification of the nail design. The aim of this study was to perform a retrieval study of Precice nails following lower-limb lengthening and to assess macroscopical and microscopical changes to the implants and evaluate differences following design modification, with the aim of identifying potential surgical, implant, and patient risk factors.

METHODS

A total of 15 nails were retrieved from 13 patients following lower-limb lengthening. Macroscopical and microscopical surface damage to the nails were identified. Further analysis included radiology and micro-CT prior to sectioning. The internal mechanism was then analyzed with scanning electron microscopy and energy dispersive x-ray spectroscopy to identify corrosion.

RESULTS

Seven male and three female patients underwent 12 femoral lengthenings. Three female patients underwent tibial lengthening. All patients obtained the desired length with no implant failure. Surface degradation was noted on the telescopic part of every nail design, less on the latest implants. Microscopical analysis confirmed fretting and pitting corrosion. Following sectioning, black debris was noted in all implants. The early designs were found to have fractured actuator pins and the pin and bearings showed evidence of corrosive debris. The latest designs showed evidence of biological deposits suggestive of fluid ingress within the nail but no corrosion.

CONCLUSION

This study confirms less internal corrosion following modification, but evidence of titanium debris remains. We recommend no change to current clinical practice. However, potential reuse of the Precice nail, for secondary limb lengthening in the same patient, should be undertaken with caution.Cite this article: V. C. Panagiotopoulou, K. Davda, H. S. Hothi, J. Henckel, A. Cerquiglini, W. D. Goodier, J. Skinner, A. Hart, P. R. Calder. A retrieval analysis of the Precice intramedullary limb lengthening system. Bone Joint Res 2018;7:476-484. DOI: 10.1302/2046-3758.77.BJR-2017-0359.R1.

A Forward Genetic Screen in Zebrafish Identifies the G-Protein-Coupled Receptor CaSR as a Modulator of Sensorimotor Decision Making

Animals continuously integrate sensory information and select contextually appropriate responses. Here, we show that zebrafish larvae select a behavioral response to acoustic stimuli from a pre-existing choice repertoire in a context-dependent manner. We demonstrate that this sensorimotor choice is modulated by stimulus quality and history, as well as by neuromodulatory systems-all hallmarks of more complex decision making. Moreover, from a genetic screen coupled with whole-genome sequencing, we identified eight mutants with deficits in this sensorimotor choice, including mutants of the vertebrate-specific G-protein-coupled extracellular calcium-sensing receptor (CaSR), whose function in the nervous system is not well understood. We demonstrate that CaSR promotes sensorimotor decision making acutely through Gα_i/o and Gα_q/11 signaling, modulated by clathrin-mediated endocytosis. Combined, our results identify the first set of genes critical for behavioral choice modulation in a vertebrate and reveal an unexpected critical role for CaSR in sensorimotor decision making.

Food addiction in children: Associations with obesity, parental food addiction and feeding practices

Food addiction research in children is limited, and to date addictive-like eating behaviors within families have not been investigated. The aim of this study is to understand factors associated with addictive-like eating in children. The association between food addiction in children with obesity, parental food addiction, and parental feeding practices (i.e., restriction, pressure to eat, monitoring) was investigated. Parents/primary caregivers (aged≥18years) of children aged 5-12years, recruited and completed an online cross-sectional survey including demographics, the Yale Food Addiction Scale (YFAS), and the Child Feeding Questionnaire (CFQ). Parents, reporting on themselves and one of their children, were given a food addiction diagnosis and symptom score according to the YFAS predefined criteria. The total sample consisted of 150 parents/primary caregivers (48% male) and 150 children (51% male). Food addiction was found to be 12.0% in parents and 22.7% in children. In children, food addiction was significantly associated with higher child BMI z-scores. Children with higher food addiction symptoms had parents with higher food addiction scores. Parents of FA children reported significantly higher levels of Restriction and Pressure to eat feeding practices, but not Monitoring. Children with elevated YFAS-C scores may be at greater risk for eating-related issues.

A small molecule screen identifies in vivo modulators of peripheral nerve regeneration in zebrafish

Adult vertebrates have retained the ability to regenerate peripheral nerves after injury, although regeneration is frequently incomplete, often leading to functional impairments. Small molecule screens using whole organisms have high potential to identify biologically relevant targets, yet currently available assays for in vivo peripheral nerve regeneration are either very laborious and/or require complex technology. Here we take advantage of the optical transparency of larval zebrafish to develop a simple and fast pectoral fin removal assay that measures peripheral nerve regeneration in vivo. Twenty-four hours after fin amputation we observe robust and stereotyped nerve regrowth at the fin base. Similar to laser mediated nerve transection, nerve regrowth after fin amputation requires Schwann cells and FGF signaling, confirming that the fin amputation assay identifies pathways relevant for peripheral nerve regeneration. From a library of small molecules with known targets, we identified 21 compounds that impair peripheral nerve regeneration. Several of these compounds target known regulators of nerve regeneration, further validating the fin removal assay. Twelve of the identified compounds affect targets not previously known to control peripheral nerve regeneration. Using a laser-mediated nerve transection assay we tested ten of those compounds and confirmed six of these compounds to impair peripheral nerve regeneration: an EGFR inhibitor, a glucocorticoid, prostaglandin D2, a retinoic acid agonist, an inhibitor of calcium channels and a topoisomerase I inhibitor. Thus, we established a technically simple assay to rapidly identify valuable entry points into pathways critical for vertebrate peripheral nerve regeneration.