Enhancing the outcomes of diabetic vitrectomy with pharmacological adjuvants

This editorial offers insights from a minireview by Venkatesh et al, who explored pharmacological adjuvants for diabetic vitrectomy. Specifically, they synthesized current knowledge and evaluated the efficacy of various adjunctive therapies in improving the outcomes of diabetic retinopathy and managing associated complications. Herein, we highlight the key roles of pharmacological adjuvants in optimizing surgical techniques, minimizing intraoperative challenges, and enhancing postoperative recovery. We further discuss the potential implications of this approach for clinical practice and future research directions in this evolving field. Overall, this editorial underscores the importance of incorporating pharmacological adjuvants into standard diabetic vitrectomy care to improve surgical outcomes and thus patients’ quality of life.

Telemedicine and public health–pearls and pitfalls

We hereby comment on the interesting systematic review by Grewal et al where they have provided an overall picture of the current status of available tele-health programs in the United States with emphasis on the Amazon Clinic. Their analysis is an appreciable effort in discovering the features available and features lacking in these tele-health programs. The concept of tele-health originated to curtail the need for physical attendance of patients at health clinics, and has been beneficial during the coronavirus disease 2019 pandemic. We implore that the pearls and pitfalls of these programs have to be understood by policymakers prior to forming a consensus regarding the availability, accessibility and affordability of these programs as methods of healthcare delivery. Unrestricted proliferation of tele-health programs in their current form may pose threats to patient and provider safety and medicolegal liability. However, patients and providers must work together to improve them to meet their expectations and enable them to provide the best care for the ailing public.

Advancements in diabetic retinopathy: Insights and future directions

This editorial discusses recent advancements and ongoing challenges in diabetic retinopathy, as reviewed by Morya et al in their comprehensive analysis. In their review, Morya et al discussed the pathophysiology of diabetic retinopathy and explored novel treatment modalities. This editorial highlights the importance of these advancements and emphasizes the need for continued research and innovation for the enhanced management of diabetic retinopathy. It also reflects upon the implications of the authors’ review findings for clinical practice and future research directions, underscoring the potential of emerging therapies for improving patient outcomes and providing a deeper understanding of disease mechanisms.

Lesson learnt from 60 years of liver transplantation: Advancements, challenges, and future directions

Over the past six decades, liver transplantation (LT) has evolved from an experimental procedure into a standardized and life-saving intervention, reshaping the landscape of organ transplantation. Driven by pioneering breakthroughs, technological advancements, and a deepened understanding of immunology, LT has seen remarkable progress. Some of the most notable breakthroughs in the field include advances in immunosuppression, a revised model for end-stage liver disease, and artificial intelligence (AI)-integrated imaging modalities serving diagnostic and therapeutic roles in LT, paired with ever-evolving technological advances. Additionally, the refinement of transplantation procedures, resulting in the introduction of alternative transplantation methods, such as living donor LT, split LT, and the use of marginal grafts, has addressed the challenge of organ shortage. Moreover, precision medicine, guiding personalized immunosuppressive strategies, has significantly improved patient and graft survival rates while addressing emergent issues, such as short-term complications and early allograft dysfunction, leading to a more refined strategy and enhanced post-operative recovery. Looking ahead, ongoing research explores regenerative medicine, diagnostic tools, and AI to optimize organ allocation and post-transplantation car. In summary, the past six decades have marked a transformative journey in LT with a commitment to advancing science, medicine, and patient-centered care, offering hope and extending life to individuals worldwide.

Cardiovascular Risk Assessment and Prevention in Cardio-Oncology: Beyond Traditional Risk Factors

This review goes beyond traditional approaches in cardio-oncology, highlighting often-neglected factors impacting patient care. Social determinants, environment, health care access, and gut microbiome significantly influence patient outcomes. Powerful tools like multi-omics and wearable technologies offer deeper insights into real-world experiences. The future lies in integrating these advancements with established practices to achieve precision cardio-oncology care. By crafting tailored therapies and continuously updating comprehensive management plans based on real-time data, we can unlock the full potential of personalized care for all patients.

Practice recommendations for culturally sensitive communication at the end of life in intensive care: A modified eDelphi study

BACKGROUND

Clinicians need specific knowledge and skills to effectively communicate with patients and their family when a patient is dying in the ICU. End-of-life communication is compounded by language differences and diverse cultural and religious beliefs.

AIM

The aim was to develop and evaluate practice recommendations for culturally sensitive communication at the end of life.

METHOD

Modified two-round eDelphi study. An Australian national sample of 58 expert ICU clinicians of nursing and medical backgrounds participated in an online survey to rate the relevance of 13 practice recommendations. Ten clinicians participated in a subsequent expert panel interview to provide face validity and comprehensive details about the practical context of the recommendations. Survey data were analysed using descriptive statistics, interview data using deductive content analysis.

RESULTS

All 13 practice recommendations achieved item content validity index (I-CVI) above 0.8, and scale content validity index (S-CVI) of 0.95, indicating sufficient consensus. Recommendations prioritising use of professional interpreters and nurse involvement in family meetings achieved near perfect agreement amongst participants. Recommendations to facilitate family in undertaking cultural, spiritual and religious rituals and customs, advocate for family participation in treatment limitation discussions, and clinician access to professional development opportunities about culturally sensitive communication also achieved high level consensus.

CONCLUSION

These practice recommendations provide guidance for ICU clinicians in their communication with patients and families from culturally diverse backgrounds.

IMPLICATIONS FOR CLINICAL PRACTICE

Clinicians want practice recommendations that are understandable and broadly applicable across diverse ICU contexts. The high consensus scores confirm these practice recommendations are relevant and feasible to clinicians who provide end-of-life care for patients and their family members. The recommendations also provide clear guidance for ICU leaders, managers and organisational policy makers.

Global emergency medicine research priorities: a mapping review

Recognizing and prioritizing research areas in emergency care is crucial for generating evidence and advancing research programs, aiming to enhance health outcomes for both individuals and populations. The objective of this review is to document global clinical and nonclinical research priorities. The Emergency Medicine Education and Research by Global Experts network, consisting of 22 sites across six continents, conducted a mapping review of publications on emergency medicine research priorities (2000-2022) across seven databases. We included studies with replicable methodologies for determining research priorities, excluding those limited to individual diseases. Three reviewers independently screened, selected, and categorized results into clinical and nonclinical topics. Discrepancies were resolved by an independent investigator and consensus. Outcomes measures and analysis include descriptive analysis of research priorities grouped into clinical and nonclinical topics, characteristics of publications including countries represented in the author list, target audience (such as researchers or policy makers), participants (e.g. patients), and methods (e.g. Delphi) of priority setting. Among 968 screened papers, 57 publications from all WHO regions were included. Most (36, 63%) had authors from only a single country, primarily in North America and Europe. Patient representatives were included in only 10 (18%). Clinical research priorities clustered into resuscitation, cardiology, central nervous system, emergency medical services, infectious disease, mental health, respiratory disease, and trauma. Distribution was broad in North America and Europe but focused on infectious diseases and resuscitation in Africa and Asia. Eleven nonclinical topics included access to care, health policy, screening/triage, social determinants of health, staffing, technology/simulation, shared decision making, cross-sectoral collaboration, education, patient-centered care, and research networks. Nonclinical topics were broad in Europe and America, focused on access to care and health screening in Africa, and mostly absent in other WHO regions. Published research priorities in emergency medicine are heterogeneous and geographically limited, mostly containing groups of authors from the same country. The majority of publications in global research priority setting stem from Western countries, covering a broad spectrum of clinical and nonclinical topics. Research priorities from Africa and Asia tend to focus on specific issues more prevalent in those regions of the world.

Prevalence and Intriguing Clinical Profiles of Autoimmune Inner Ear Diseases in Sudden Sensorineural Hearing Loss

INTRODUCTION

Sudden sensorineural hearing loss (SSNHL) is idiopathic in 70-90% of cases with 10-30% linked to vascular injuries, viral infections, or autoimmune inner ear disease (AIED). AIED contributes to less than 1% of all hearing losses, categorized into primary, affecting only the inner ear, and secondary, associated with systemic autoimmune diseases (SAID). This study examines the prevalence and features of AIED in SSNHL in a tertiary referral center.

MATERIALS AND METHODS

We conducted a prospective study from November 2021 to December 2022 including SSNHL patients who exhibited symptoms like hearing loss or tinnitus. Evaluations included tympanometry, pure tone audiometry, and blood tests, with suspected AIED cases further assessed by rheumatologists using Lobo's diagnostic criteria. Treatment responses were monitored through regular audiometry updates.

RESULTS

Out of 694 SSNHL patients, 43 (6.2%) were diagnosed with AIED, of which 36 (83.7%) had primary AIED and 7 (16.3%) had secondary AIED linked to conditions like Sjögren's syndrome and systemic lupus erythematosus. Treatment response was seen in 19.4% of primary and 42.9% of secondary AIED cases.

CONCLUSION

The prevalence of AIED in SSNHL patients was found to be 6.2%, with a notable fraction also suffering from SAID. Responses to treatment were positive in about a third of these cases, highlighting the importance of interdisciplinary management for this rare yet significant cause of SSNHL.

Knowledge, attitudes and practices of nurses regarding airway clearance in neurocritical illness patients: A cross-sectional study

AIM

We aimed to assess the level of knowledge, attitudes and practices regarding airway clearance among nurses and explore the factors affecting the knowledge, attitudes and practices.

DESIGN

A questionnaire-based cross-sectional study.

BACKGROUND

Airway clearance is an important method of eliminating excess secretions. In neuroscience nursing, nurses are important executors of airway management, and their knowledge, attitudes and practices can influence the effectiveness of airway clearance.

METHODS

This study was conducted from July to September 2023 in four hospitals in Jiangsu Province, China. A structured questionnaire about airway clearance was designed and used to collect the data. The nurses used this questionnaire to self-rate. The STROBE checklist for cross-sectional studies was followed.

RESULTS

The age, work experience, highest educational attainment and technical title of the nurses can significantly influence their knowledge. The age, highest educational attainment and technical title of the nurses can significantly impact their attitudes. Practice scores were significantly influenced by age, work experience, technical title, whether the nurses had received any training on airway clearance techniques, and whether the department developed procedures for implementing the airway clearance technology. Nurses' attitudes were significantly associated with knowledge and practice, and there was no significant correlation between knowledge and practice.

CONCLUSION

This study showed that age, work experience, highest educational attainment and training were related to knowledge, attitudes and practices. These findings suggest that nursing managers can conduct airway clearance training according to age group, working experience and education level of the nurses.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT

The findings show that the level of knowledge, attitudes and practices related to airway clearance in neuroscience nursing among nurses were acceptable, which means that nurses can better perform airway management on patients. These findings serve as a significant reference for designing an airway clearance education for nurses and meet the needs of nurses in clinical nursing practice.

Do Child–Turcotte–Pugh and nutritional assessments predict survival in cirrhosis: A longitudinal study

BACKGROUND

Cirrhotic patients face heightened energy demands, leading to rapid glycogen depletion, protein degradation, oxidative stress, and inflammation, which drive disease progression and complications. These disruptions cause cellular damage and parenchymal changes, resulting in vascular alterations, portal hypertension, and liver dysfunction, significantly affecting patient prognosis.

AIM

To analyze the association between Child–Turcotte–Pugh (CTP) scores and different nutritional indicators with survival in a 15-year follow-up cohort.

METHODS

This was a retrospective cohort study with 129 cirrhotic patients of both sexes aged > 18 years. Diagnosis of cirrhosis was made by liver biopsy. The first year of data collection was 2007, and data regarding outcomes were collected in 2023. Data were gathered from medical records, and grouped by different methods, including CTP, handgrip strength, and triceps skinfold cutoffs. The prognostic values for mortality were assessed using Kaplan–Meier curves and multivariate binary logistic regression models.

RESULTS

The coefficient for CTP was the only statistically significant variable (Wald = 5.193, P = 0.023). This suggests that with a negative change in CTP classification score, the odds of survival decrease 52.6%. The other evaluated variables did not significantly predict survival outcomes in the model. Kaplan–Meier survival curves also indicated that CTP classification was the only significant predictor.

CONCLUSION

Although different classifications showed specific differences in stratification, only CTP showed significant predictive potential. CTP score remains a simple and effective predictive tool for cirrhotic patients even after longer follow-up.

Effect of ligamentum teres uteri preservation in laparoscopic high hernia sac ligation in children with indirect inguinal hernia

BACKGROUND

Routinely separating the ligamentum teres uteri (LTU) intraoperatively remains an unresolved issue for female children undergoing surgery for indirect inguinal hernia (IIH).

AIM

To identify the effect of LTU preservation in laparoscopic high hernia sac ligation (LHSL) in children with IIH.

METHODS

The participants were 100 female children with unilateral IIH admitted from April 2022 to January 2024 to the Pediatric Surgery Department of Zhangzhou Municipal Hospital of Fujian Province. They were categorized based on LTU retention into the control group (n = 45 cases), which underwent LTU ligation intraoperatively, and the experimental group (55 cases), which had the LTU preserved intraoperatively. All children underwent LHSL.

RESULTS

This study comparatively analyzed the operation time, hospitalization time, blood loss, postoperative recurrence rate, and complications (repeated pain in the inguinal region, foreign body sensation in the inguinal region, bloody exudation at the inguinal incision, and incision infection), which were all comparable between the two groups.

CONCLUSION

The above results indicate that LTU preservation during LHSL exerts certain therapeutic benefits for children with IIH. LTU preservation does not increase hospitalization time, blood loss, postoperative recurrence rate, and complications, which is safe and feasible, compared with conventional LTU ligation. LHSL with LTU preservation should be performed if conditions permit, which is worth popularizing.

Advancements in liver retraction techniques for laparoscopic gastrectomy

Traditionally, liver retraction for laparoscopic gastrectomy is done via manual methods, such as the placement of retractors through the accessory ports and using a Nathanson retractor. However, these techniques often posed issues including extra abdominal incisions, risk of liver injury or ischaemia, and the potential for compromised visualization. Over the years, the development of innovative liver retraction techniques has significantly improved the safety and efficacy of laparoscopic gastrectomy and similar other hiatal procedures. This editorial will comment on the article by Lin et al, and compare this to the other liver retractor techniques available for surgeons and highlight the pros and cons of each technique of liver retraction.

Association of selected gene variants with nonsyndromic orofacial clefts in Kuwait

INTRODUCTION AND OBJECTIVES

Non-syndromic orofacial clefts (NSOFCs) are complex congenital abnormalities involving both environmental and genetic factors involved in orofacial development. This study aimed to investigate the genetic association of specific genetic variants at different CYRIA gene loci with the development of NSOFCs in Kuwait.

METHODS

Four genetic variants (rs7552, rs3758249, rs3821949, and rs3917201) at four selected gene loci (CYRIA, FOXE1, MSX1, and TGFB3) were genotyped in a total of 240 DNA samples (patients (n = 114) and random controls (n = 126)) employing TaqMan® allele discrimination assay. For each variant and its genotype, the frequencies were determined and tested for Hardy-Weinberg Equilibrium. Genotype frequencies was compared between patients and controls using Pearson's test. Logistic regression analyses were employed to test for the associations of the four selected variants with the occurrence of NSOFCSs.

RESULTS

Significant differences in the distribution of genotypes between cases and controls, rs7552, rs3821949, and rs3917201 were found to have a positive association with NSOFCs. After adjusting for gender, the GG genotype of the rs7552 variant, the AG genotype of the rs3821949 variant, and the CC genotype of the rs3917201 variant showed nearly a two-fold increased risk of NSOFC (p < 0.05).

CONCLUSION

This study reports significant findings on the contribution and modest effect of CYRIA rs7552, MSX1 rs3821949, and TGFB3 rs3917201 in the development of NSOFCs. Our findings provide further evidence on the molecular mechanism and the role of the selected genes in NSOFCs.

Knowledge, attitude, and perceptions of MENA researchers towards the use of ChatGPT in research: A cross-sectional study

Background

Artificial intelligence (AI) technologies are increasingly recognized for their potential to revolutionize research practices. However, there is a gap in understanding the perspectives of MENA researchers on ChatGPT. This study explores the knowledge, attitudes, and perceptions of ChatGPT utilization in research.

Methods

A cross-sectional survey was conducted among 369 MENA researchers. Participants provided demographic information and responded to questions about their knowledge of AI, their experience with ChatGPT, their attitudes toward technology, and their perceptions of the potential roles and benefits of ChatGPT in research.

Results

The results indicate a moderate level of knowledge about ChatGPT, with a total score of 58.3 ± 19.6. Attitudes towards its use were generally positive, with a total score of 68.1 ± 8.1 expressing enthusiasm for integrating ChatGPT into their research workflow. About 56 % of the sample reported using ChatGPT for various applications. In addition, 27.6 % expressed their intention to use it in their research, while 17.3 % have already started using it in their research. However, perceptions varied, with concerns about accuracy, bias, and ethical implications highlighted. The results showed significant differences in knowledge scores based on gender (p < 0.001), working country (p < 0.05), and work field (p < 0.01). Regarding attitude scores, there were significant differences based on the highest qualification and the employment field (p < 0.05). These findings underscore the need for targeted training programs and ethical guidelines to support the effective use of ChatGPT in research.

Conclusion

MENA researchers demonstrate significant awareness and interest in integrating ChatGPT into their research workflow. Addressing concerns about reliability and ethical implications is essential for advancing scientific innovation in the MENA region.

Extraction, characterization, and use of edible insect oil - A review

Population growth is driving the search for new food sources, including entomophagy, i.e., a diet based on edible insects. Insect powder are rich in essential fatty acids, minerals, vitamins, and bioactive compounds such as antioxidant phenolics. The technologies for extracting oil from insects must be efficient to guarantee high yields. This oil due to its favorable nutritional profile, and lower cost, can be a viable alternative to vegetable and fish oils. Although common in some cultures, the consumption of insects faces resistance in others due to its association with dirt. Efforts are being made to scientifically demonstrate the safety and nutritional benefits of insects as well as their sustainability as a food source. This first review of insect oils focuses on presenting their different characteristics and encouraging the production and use of these products in the food, pharmaceutical, or cosmetics industries.

How Delphi studies in the health sciences find consensus: a scoping review

BACKGROUND

Delphi studies are primarily used in the health sciences to find consensus. They inform clinical practice and influence structures, processes, and framework conditions of healthcare. The practical research-how Delphi studies are conducted-has seldom been discussed methodologically or documented systematically. The aim of this scoping review is to fill this research gap and to identify shortcomings in the methodological presentation in the literature. On the basis of the analysis, we derive recommendations for the quality-assured implementation of Delphi studies.

METHODS

Forming the basis of this scoping review are publications on consensus Delphi studies in the health sciences between January 1, 2018, and April 21, 2021, in the databases Scopus, MEDLINE via PubMed, CINAHL, and Epistemonikos. Included were publications in German and English containing the words "Delphi" in the title and "health" and "consensus" in the title or abstract. The practical research was analyzed for the qualitative content of the publications according to three deductive main categories, to which an influence on the result of Delphi studies can be imputed (expert panel, questionnaire design, process and feedback design).

RESULTS

A total of 287 consensus Delphi studies were included in the review, whereby 43% reported having carried out a modified Delphi. In most cases, heterogeneous expert groups from research, clinical practice, health economics, and health policy were surveyed. In about a quarter of the Delphi studies, affected parties, such as patients, were part of the expert panel. In the Delphi questionnaires it was most common for standardized Likert scales to be combined with open-ended questions. Which method was used to analyze the open-ended responses was not reported in 62% of the Delphi studies. Consensus is largely (81%) defined as percentage agreement.

CONCLUSIONS

The results show considerable differences in how Delphi studies are carried out, making assessments and comparisons between them difficult. Sometimes an approach points to unintended effects, or biases in the individual judgments of the respondents and, thus, in the overall results of Delphi studies. For this reason, we extrapolate suggestions for how certain comparability and quality assurance can be achieved for Delphi studies.

Human or Machine? A Comparative Analysis of Artificial Intelligence-Generated Writing Detection in Personal Statements

INTRODUCTION

This study examines the ability of human readers, recurrence quantification analysis (RQA), and an online artificial intelligence (AI) detection tool (GPTZero) to distinguish between AI-generated and human-written personal statements in physical therapist education program applications.

REVIEW OF LITERATURE

The emergence of large language models such as ChatGPT and Google Gemini has raised concerns about the authenticity of personal statements. Previous studies have reported varying degrees of success in detecting AI-generated text.

SUBJECTS

Data were collected from 50 randomly selected nonmatriculated individuals who applied to the Mayo Clinic School of Health Sciences Doctor of Physical Therapy Program during the 2021-2022 application cycle.

METHODS

Fifty personal statements from applicants were pooled with 50 Google Gemini-generated statements, then analyzed by 2 individuals, RQA, and GPTZero. RQA provided quantitative measures of lexical sophistication, whereas GPTZero used advanced machine learning algorithms to quantify AI-specific text characteristics.

RESULTS

Human raters demonstrated high agreement (κ = 0.92) and accuracy (97% and 99%). RQA parameters, particularly recurrence and max line, differentiated human- from AI-generated statements (areas under receiver operating characteristic [ROC] curve = 0.768 and 0.859, respectively). GPTZero parameters including simplicity, perplexity, and readability also differentiated human- from AI-generated statements (areas under ROC curve > 0.875).

DISCUSSION AND CONCLUSION

The study reveals that human raters, RQA, and GPTZero offer varying levels of accuracy in differentiating human-written from AI-generated personal statements. The findings could have important implications in academic admissions processes, where distinguishing between human- and AI-generated submissions is becoming increasingly important. Future research should explore integrating these methods to enhance the robustness and reliability of personal statement content evaluation across various domains. Three strategies for managing AI's role in applications-for applicants, governing organizations, and academic institutions-are provided to promote integrity and accountability in admission processes.

A prospective multi-site study to evaluate the performance and usability of an oral fluid-based HIV self-test in Canada

BACKGROUND

Blood and oral fluid-based HIV self-tests are important for reaching the undiagnosed living with HIV. The study objectives were to evaluate the oral fluid-based OraQuick® HIV Self-Test (HIV-ST) performance in comparison to laboratory reference testing; determine if laypersons can correctly perform the HIV-ST; document if intended users can successfully interpret pre-made contrived positive, negative, and invalid results; and document if intended users can understand the key messages in the product labeling.

METHODS

This prospective study enrolled consenting adult intended users of HIV self-testing from six community health centres in four Canadian provinces between June 2022 and January 2024. Positive and negative agreement was determined by comparing the results of the HIV self-tests with the results of the laboratory-based "gold standard" Abbott Alinity HIV Antigen/Antibody Combo test. Descriptive statistics were used to summarize usability self-test procedure steps.

RESULTS

Overall, 951 participants were recruited and consented with 911 available for all analyses. With respect to sociodemographics: 84% of participants were between 18-45 years of age, 73% had at least a college education, 48% were Cis-male, 45% were employed; and 26% identified as White, 23% as African, Caribbean or Black, 5% as Indigenous [First Nations, Métis or Inuit], 33% as Asian, and 6% as LatinX. Primary efficacy analysis on the 911 who completed HIV-ST revealed a single confirmed positive participant and a negative percent agreement of 100% (880/880, 95% CI: 99.9-100%) with the comparator method. For usability determination, the average success rate for "critical" steps for completing the test was 94.1%. Approximately 97% of participants found the instructions easy to follow and 98% of participants reported they would use the test again. Of the 465 participants who interpreted the strong positive, weak positive, negative, and invalid pre-made contrived results, the average of correct interpretations ranged from 59-97% CONCLUSIONS: A licensed oral fluid-based HIV self-test in Canada can present an accurate, easy-to-use, and less invasive alternative to blood-based HIV testing. The addition of an oral-fluid self-test along with the current licensed blood-based HIV self-test could help reach the undiagnosed with HIV in Canada and positively impact HIV testing rates overall by offering individuals a choice of self-testing devices.

Visualizing Preosteoarthritis: Updates on UTE-Based Compositional MRI and Deep Learning Algorithms

Osteoarthritis (OA) is heterogeneous and involves structural changes in the whole joint, such as cartilage, meniscus/labrum, ligaments, and tendons, mainly with short T2 relaxation times. Detecting OA before the onset of irreversible changes is crucial for early proactive management and limit growing disease burden. The more recent advanced quantitative imaging techniques and deep learning (DL) algorithms in musculoskeletal imaging have shown great potential for visualizing "pre-OA." In this review, we first focus on ultrashort echo time-based magnetic resonance imaging (MRI) techniques for direct visualization as well as quantitative morphological and compositional assessment of both short- and long-T2 musculoskeletal tissues, and second explore how DL revolutionize the way of MRI analysis (eg, automatic tissue segmentation and extraction of quantitative image biomarkers) and the classification, prediction, and management of OA. PLAIN LANGUAGE SUMMARY: Detecting osteoarthritis (OA) before the onset of irreversible changes is crucial for early proactive management. OA is heterogeneous and involves structural changes in the whole joint, such as cartilage, meniscus/labrum, ligaments, and tendons, mainly with short T2 relaxation times. Ultrashort echo time-based magnetic resonance imaging (MRI), in particular, enables direct visualization and quantitative compositional assessment of short-T2 tissues. Deep learning is revolutionizing the way of MRI analysis (eg, automatic tissue segmentation and extraction of quantitative image biomarkers) and the detection, classification, and prediction of disease. They together have made further advances toward identification of imaging biomarkers/features for pre-OA. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.

Protective and risk factors of anxiety in children and adolescents during COVID-19: A systematic review and three level meta-analysis

BACKGROUND

In order to gain a deepened understanding of the impact of public health emergency and to develop effective interventions and preventions, this study aimed to evaluate risk and protective factors associated with anxiety in children and adolescents and to explore potential moderators in the background of COVID-19 within the framework of socio-ecological model.

METHODS

A literature search was conducted in Web of Science, MEDLINE, PubMed, Scopus, EBSCO, ScienceDirect, Emerald, and CNKI for studies published from early 2020 to early 2023 that examined factors associated with anxiety among children and adolescents with age range of 6 to 17 years old. Random effects models and a three-level meta-analytic approach were used.

RESULTS

In total, 141 articles and 1,018,171 subjects were included, with 1002 effect sizes extracted. 32 protective factors and 48 risk factors were examined, yielding significance for 14 protective factors and 29 risk factors, including individual factors (e.g., gender, logOR = -0.37, 95 % CI [-0.47, -0.27], p < 0.001; age, logOR = -0.12, 95 % CI [-0.22, -0.02], p = 0.02; emotional functioning, logOR = -1.45, 95 % CI [-1.84, -1.05], p < 0.001; pre-existing condition logOR = 0.94, 95 % CI [0.58, 1.30], p < 0.001; electronic device or internet addiction, logOR = 1.81, 95 % CI [0.74, 2.88], p < 0.001), family factors (e.g., family socioeconomic status, logOR = -0.25, 95 % CI [-0.39, -0.10], p < 0.001; family functioning, logOR = -1.31, 95 % CI [-1.60, -1.02], p < 0.001; anxiety level of caregiver, logOR = 1.06, 95 % CI [0.75, 1.37], p < 0.001), community factors (e.g., overall social support, logOR = -0.93, 95 % CI [-1.84, -1.05], p < 0.001; school burden, logOR = 0.56, 95 % CI [0.21, 0.90], p = 0.002), and COVID-19-related factors (e.g., higher exposure risk in local community or city, logOR = 0.48, 95 % CI [0.17, 0.78], p = 0.002; distant learning, logOR = 0.73, 95 % CI [0.19, 1.28], p = 0.008; COVID-19-related distress, logOR = 1.42, 95 % CI [0.55, 2.29], p = 0.001;). The majority of studies showed no publication bias. Age group moderated the relationship between gender and level of anxiety (F (1,96) = 4.42, p = 0.038), and no other moderator showed significance.

LIMITATIONS

This study does not reveal causality but correlation in nature, and our findings should be interpretated with caution.

CONCLUSIONS

Public health emergencies could bring challenges to the mental health of children and adolescents. Prevention and intervention strategies for children and adolescents with high risks, and family-based and community-based programs should be encouraged to buffer the adverse impact on children and adolescents. This study has been prospectively registered at PROSPERO (registration number: CRD42022316746).

Charting the path to the implementation of universal health coverage policy in Nigeria through the lens of Delphi methodology

BACKGROUND

Expanding access to equitable health insurance is an important lever towards the overall strategy for achieving universal health coverage. In Nigeria, health insurance coverage is low with a renewed government action on increasing access to and coverage of high-quality healthcare services to citizens, particularly for the vulnerable and poor population. Therefore, our study co-creates the priorities for expanding health insurance in Nigeria, focusing on key policy reforms, public advocacy, and innovative financing strategies to ensure broader and more equitable coverage for the population.

METHODOLOGY

We employed a Delphi approach methodology through strategic health insurance meetings with a diverse multidisciplinary panel of 125 stakeholders including representatives of accredited Health Insurance Maintenance Organizations, Heads of States Social Health Insurance Agencies, Development Partners representatives, academics, government officials, national health insurance authority expanded management team and experts in health insurance across all the states of Nigeria to recommend specific actions towards health insurance expansion and universal health coverage in Nigeria.

RESULTS

The participants/panels were able to come up with a consensus on 66 priorities for health insurance expansion in Nigeria working with stakeholders within the Nigerian health insurance ecosystem across the 36 states and Nigeria's FCT. From these priorities, seven priority areas and 17 themes were derived that should be considered by the government, policymakers, regulators, and practitioners to deepen health insurance penetration in Nigeria. These seven priority areas that have been identified include enrolment, equity, organizational health and structure, data and technology, quality, market efficiency, and citizen engagement.

CONCLUSION

The priorities identified for health insurance expansion in Nigeria will go a long way in shaping health insurance. We hope that government, policymakers, regulators, and practitioners in the health ecosystem will use these social policy actions to set priorities for increasing health insurance coverage and address inadequacies to accelerate the drive towards the attainment of UHC by 2030.