Prosodic processing post traumatic brain injury - a systematic review

Efficacy and Safety of Direct Oral Anticoagulants for Acute Treatment of Venous Thromboembolism in Older Adults: A Network Meta-Analysis of Randomised Controlled Trials

OBJECTIVE

This systematic review and network meta-analysis aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in adults aged 75 and over undergoing acute venous thromboembolism (VTE) treatment.

METHODS

PubMed, Embase and the CENTRAL were searched up to 25 December 2023. The incidence of VTE recurrence and bleeding events was assessed. Employing a frequentist network meta-analysis approach, interventions not directly compared could be indirectly assessed through the 95% confidence interval (CI), enhancing the interpretability of the search results. The surface under the cumulative ranking curves (SUCRA) was utilized to generate the relative ranking probabilities for each group.

RESULTS

Our study, analysing 6 randomised controlled trials with 3665 patients, compares direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in adults aged 75 and over with acute venous thromboembolism. Edoxaban reduces VTE recurrence risk compared with VKAs (risk ratio [RR] .50, 95% CI 0.27 - .95), while apixaban significantly decreases bleeding risk compared with VKAs (RR .23, 95% CI 0.08 - .69), edoxaban (RR .28, 95% CI 0.09 - .86) and rivaroxaban (RR .28, 95% CI 0.09 - .86). Despite low overall evidence quality, apixaban consistently ranks highest for both efficacy and safety. Findings underscore the nuanced efficacy-safety balance in this population, emphasizing cautious interpretation due to evidence limitations.

CONCLUSION

Apixaban emerges as a favourable choice for acute VTE treatment in the elderly, displaying reduced bleeding risk compared to other treatments while maintaining comparable efficacy. Future studies should explore diverse anticoagulants efficacy and safety in older populations. Additionally, clinical prediction models tailored to geriatric cohorts are crucial for guiding treatment duration decisions.

Current evidence of the economic value of One Health initiatives: A systematic literature review

Funding and financing for One Health initiatives at country level remain challenging as investments commonly require demonstrated evidence of economic value or returns. The objectives of this review were to i) identify, critically analyse and summarise quantitative evidence of the net economic value of One Health initiatives; ii) document methodologies commonly used in the scientific literature; and iii) describe common challenges and any evidence gaps. Scientific databases were searched for published literature following the PRISMA guidelines and an online survey and workshop with subject matter experts were used to identify relevant grey literature. Studies were included if they reported on quantitative costs and benefits (monetary and non-monetary) and were measured across at least two sectors. Relevant publications were analysed and plotted against the six action tracks of the Quadripartite One Health Joint Plan of Action to help classify the initiatives. Ninety-seven studies were included. Eighty studies involved only two sectors and 78 reported a positive economic value or return. Of those studies that reported a positive return, 49 did not compare with a sectoral counterfactual, 28 studies demonstrated an added value of using a cross-sectoral approach, and 6 studies demonstrated an added value of One Health communication, collaboration, coordination, and capacity building. Included studies most frequently related to endemic zoonotic, neglected tropical and vector-borne diseases, followed by health of the environment and food safety. However, diversity in economic analysis methodology between studies included resulted in difficulty to compare or combine findings. While there is a growing body of evidence of the value of One Health initiatives, a substantial part of the evidence still focuses on "traditional" One Health topics, particularly zoonoses. Developing a standardised and practical approach for One Health economic evaluation will facilitate assessment of the added value and gather evidence for One Health to be invested in and endorsed by multiple sectors.

Is Austerity Responsible for the Stalled Mortality Trends Across Many High-Income Countries? A Systematic Review

This article systematically reviews evidence evaluating whether macroeconomic austerity policies impact mortality, reviewing high-income country data compiled through systematic searches of nine databases and gray literature using pre-specified methods (PROSPERO registration: CRD42020226609). Eligible studies were quantitatively assessed to determine austerity's impact on mortality. Two reviewers independently assessed eligibility and risk of bias using ROBINS-I. Synthesis without meta-analysis was conducted due to heterogeneity. Certainty of evidence was assessed using the GRADE framework. Of 5,720 studies screened, seven were included, with harmful effects of austerity policies demonstrated in six, and no effect in one. Consistent harmful impacts of austerity were demonstrated for all-cause mortality, life expectancy, and cause-specific mortality across studies and different austerity measures. Excess mortality was higher in countries with greater exposure to austerity. Certainty of evidence was low. Risk of bias was moderate to critical. A typical austerity dose was associated with 74,090 [-40,632, 188,792] and 115,385 [26,324, 204,446] additional deaths per year. Austerity policies are consistently associated with adverse mortality outcomes, but the magnitude of this effect remains uncertain and may depend on how austerity is implemented (e.g., balance between public spending reductions or tax rises, and distributional consequences). Policymakers should be aware of potential harmful health effects of austerity policies.

Biopsychosocial contexts influence adult cognitive function concurrently and longitudinally

Background

Cognitive aging is a complex process that impacts human behavior. Identifying the factors that preserve cognitive functioning is a public health priority, given that 20% of the US population will be at least 65 years old in the next decade. Biopsychosocial determinants of cognitive decline across the lifespan are often examined as ecological factors that independently moderate cognitive aging, despite the known complexity surrounding these relationships.

Objective

We aimed to address this gap by exploring the synergistic and simultaneous relationship between risk and protective factors on cognitive functioning.

Method

Using the MIDUS study datasets, we examined the relationships among physiological markers, friendship quality, and global cognition functioning, concurrently and longitudinally over ten years. Our participants included 929 healthy (417 men, 512 women) adults (average age at Time 1: 54.6 ± 11.6 years). Exploratory analyses examining the effects of racial minority status were also conducted.

Results

Cross-sectionally, age, and friendship quality moderated the relationship between vagally-mediated heart rate variability (vm-HRV) and cognition such that younger adults with greater friendship quality had a negative relationship between vm-HRV and cognitive performance; our unexpected finding suggests the heart-brain relationship is sensitive to the biopsychosocial environment. Longitudinally, higher IL-6 levels at Time 1 predicted poorer cognitive performance a decade later, but only among those with greater levels of friendship quality, especially for white-identifying individuals.

Conclusions

The relationships among physiological risk factors, social protective factors and cognitive functioning appear to be temporally different during mid-adulthood. Given many of the whole sample findings were not replicated within the racial minority subgroup, we suggest that these relationships should be examined in a larger and more diverse racial minority sample to determine whether this study lacked the power necessary to detect a relationship or if the relationships are in fact different by racial minority sub-group. In addition, future research should overcome the study's reliance on healthy adults and self-report measures of friendship quality by including adults with pre-existing cognitive impairments, and employing more real-time measures of friendship quality, such as daily diary or ecological momentary assessment.

Exploring Cognitive-Pragmatic Heterogeneity Following Acquired Brain Injury: A Cluster Analysis of Hint Comprehension

PURPOSE

Difficulties understanding nonliteral language (especially hints) are frequently reported following acquired brain injury (ABI). Several cognitive mechanisms, such as context processing, executive functions, and theory of mind (ToM), may underlie these disorders. However, their role remains controversial, mainly because of the characteristic heterogeneity of this population. Therefore, our study aimed to identify cognitive-pragmatic profiles in individuals with ABI.

METHOD

A new task of hint comprehension, manipulating executive demand, markers of hints, and ToM and neuropsychological tests were administered to 33 participants with frontal ABI and 33 control participants. Cluster analysis, a method sensitive to profile heterogeneity, was applied and coupled with error analysis.

RESULTS

We highlighted two cognitive-pragmatic profiles. One subgroup of participants with ABI exhibited contextual insensitivity, leading them to infer the utterance meaning based on linguistic decoding alone-literal meaning. This difficulty in understanding hints was associated with deficits in working memory, inhibition, and ToM. The second subgroup of participants with ABI showed difficulty with literal statements, associated with impaired inhibition and ToM. In addition, the two subgroups differed only on the ToM task. This result suggests that various types of ToM deficit (misunderstanding vs. incorrect attribution of mental states) could contribute to the variability of the pragmatic profiles observed (difficulties in interpreting hints vs. literal statements).

CONCLUSION

The experimental design adopted in this study provides valuable insight into the explanatory hypotheses of nonliteral language comprehension disorders and has important clinical implications.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24069516.

Evaluating the hypertension care cascade in middle-aged and older adults in The Gambia: findings from a nationwide survey

Background

Hypertension is a major public health problem in sub-Saharan Africa with poor treatment coverage and high case-fatality rates. This requires assessment of healthcare performance to identify areas where intervention is most needed. To identify areas where health resources should be most efficiently targeted, we assessed the hypertension care cascade i.e., loss and retention across the various stages of care, in Gambian adults aged 35 years and above.

Methods

This study was embedded within the nationally representative 2019 Gambia National Eye Health Survey of adults ≥35 years. We constructed a hypertension care cascade with four categories: prevalence of hypertension (defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, and/or current use of medication prescribed for hypertension); those aware of their diagnosis; those treated; and those with a controlled blood pressure (defined as blood pressure <140/90 mmHg). Analyses were age- and sex-standardised to the population structure of The Gambia. Logistic regression was used to assess the socio-demographic factors associated with prevalence, awareness, treatment and control of hypertension.

Findings

Of 9171 participants with data for blood pressure, the prevalence of hypertension was 47.0%. Among people with hypertension, the prevalence of awareness was 54.7%, the prevalence of hypertension treatment was 32.5%, and prevalence of control was 10.0% with little difference between urban and rural residence. The cascade of care performance was better in women. However, there was no difference in achieving blood pressure control between men and women who were receiving treatment. Female sex, older age and higher body mass index were associated with higher hypertension awareness whilst having an occupation compared to being unemployed was associated with higher odds of being treated. Patients in the underweight category had higher odds of achieving blood pressure control.

Interpretation

There is a high prevalence of hypertension and low performance of the health care system that impact on the hypertension care cascade among middle-aged and older adults in The Gambia. Addressing the full cascade will be paramount especially in reducing the mounting prevalence and improving diagnosis of patients with hypertension, where the greatest dividends will be gained.

Funding

The Queen Elizabeth Diamond Jubilee Trust, Wellcome Trust.

Effects of Bathing Skills Training on Independence and Satisfaction of Older Adults Living in a Nursing Home: A Randomized Controlled Trial

Background

Dependence in bathing is the most common activities of daily living (ADLs) dependency among older adults. The aim of this study was to evaluate the effect of bathing skills training on the independence and satisfaction of older adults living in nursing homes.

Methods

In this randomized controlled trial, 80 participants were assigned randomly to the intervention (n = 40) and control groups (n = 40). The intervention group received 10 weekly bathing skills training sessions, with each session lasting about 60 minutes, while the control group received no direct training. The evaluation was conducted using the Modified Barthel Index (MBI) and the Canadian Occupational Performance Measure (COPM). Analysis of variance for repeated measurements was used to test the effect of intervention at the baseline, post-intervention, and follow-up.

Results

The mean improvement in the MBI was greater for the intervention group (P < 0.001; partial η2 = 0.34), which remained significant at the follow-up (P < 0.001; partial η2 = 0.41). The greater mean change of the COPM-Performance was significant in the intervention group (P < 0.001; partial η2 = 0.17), which remained significant at the follow-up (P < 0.001; partial η2 = 0.19). The greater mean improvement of the COPM-Satisfaction was observed for the intervention group (P < 0.001; partial η2 = 0.36), which remained at the follow-up (P = 0.001; partial η2 = 0.42).

Conclusion

Bathing skills training is effective in improving the ADLs independence and satisfaction in older adults living in nursing homes; thus, it is recommended to be included in the schedules of nursing homes.

Evaluation of Wound Healing Property of the Ethanolic Extract of Glycyrrhiza Glabra on Vero Cell Lines Using In Vitro Scratch Assay Test

Introduction

The successful restoration of damaged tissue requires a complicated, dynamic process called wound healing, which is supported by a wide range of cellular activities. Natural materials generated from medicinal plants have been identified, and their therapeutic potential evaluation has resulted in the development of novel, affordable medicines that can be used to treat a variety of illnesses, including chronic wounds, with limited side effects.

Aims and Objectives

This study aimed to assess the wound-healing property of Glycyrrhiza Glabra (Athimathuram) plant extracts by using an in vitro scratch assay test, as well as to evaluate their cellular toxicity.

Materials and Methods

Using the Soxhlet device, ethanolic extraction of the plant material was done, and the cytotoxicity of the extract on the Vero cell line was examined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. One of the most often utilized mammalian in vitro cell lines in research was Vero cells. To assess the wound healing properties of G. glabra plant extract, an in vitro scratch assay was used, and their potential mechanisms of action were examined.

Results

Even at higher concentrations, the MTT assay showed that G. Glabra plant extracts had no cytotoxic effects on the cells. In vitro scratch assay showed that the healing process of the cell line was increased by 23.33% when compared with the controlled cell lines.

Conclusion

Our research demonstrated that G. glabra has in vitro wound healing capabilities. As a result, G. glabra can be suggested as a possible source of compounds that treat wounds.

Guidance to best tools and practices for systematic reviews

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

Guidance to best tools and practices for systematic reviews

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

Health outcomes, health services utilization, and costs consequences of medicare uninsurance among migrants in Canada: a systematic review

BACKGROUND

Medically uninsured groups, many of them migrants, reportedly delay using healthcare services due to costs and often face preventable health consequences. This systematic review sought to assess quantitative evidence on health outcomes, health services use, and health care costs among uninsured migrant populations in Canada.

METHODS

OVID MEDLINE, Embase, Global Health, EconLit, and grey literature were searched to identify relevant literature published up until March 2021. The Cochrane Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool was used to assess the quality of studies.

RESULTS

Ten studies were included. Data showed that there are differences among insured and uninsured groups in reported health outcomes and health services use. No quantitative studies on economic costs were captured.

CONCLUSIONS

Our findings indicate a need to review policies regarding accessible and affordable health care for migrants. Increasing funding to community health centers may improve service utilization and health outcomes among this population.

A study of the effects of blended learning on university students' critical thinking: A systematic review

One of the basic, constructive needs of humans, which plays a major part in their development is critical thinking. As education is one of the factors in shaping individuals' critical thinking, the present study addresses the effects of blended learning and its subcategories on university students' critical thinking (and its subcategories). The present article is a review study. Data were collected using valid search engines and databases. The keywords which were used included blended learning, integrated learning, blended training, integrated training, critical thinking, critical thinking disposition, and critical thinking skills, as well as the subcategories of blended learning, that is, the flex model, the self-blended model, the enriched virtual model, and the rotation model and its subcategories (the station rotation model, the lab rotation model, the flipped classroom model, and the individual rotation model). The results of 14 sources, out of the selected 15 sources, showed that blended learning and its subcategories, that is, the flex model, the self-blended model, the enriched virtual model, and the rotation model and its subcategories contribute to university students' critical thinking of disposition and skill. One of the essential skills which must be given more serious attention in learning in the twenty-first century is critical thinking. Having the benefits of both lecturing and e-learning, blended learning is a more effective and practical method for promoting critical thinking in university students.

Prevalence of teenage pregnancy and its associated factors in high fertility sub-Saharan Africa countries: a multilevel analysis

BACKGROUND

Teenage pregnancies are persistently high among adolescent women in high fertility countries in sub-Saharan Africa. It has been attributed to the high unmet need for family planning in this population. The aim of this study was to determine the prevalence and factors associated with teenage pregnancy in high fertility countries in sub-Saharan Africa.

METHODS

Data for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 33,391 adolescent girls who had ever had sexual contact were included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors for teenage pregnancy. Finally, the Adjusted Odds Ratio (AOR) with a 95% confidence interval was used to declare as statistically significant.

RESULTS

The overall teenage pregnancy in sub-Saharan Africa high frtility countries was 24.88% (95% CI, 24.42, 25.35). Educational status; no formal education (AOR = 1.39, 95% CI, 1.23, 1.56) and primary education (AOR = 1.45, 95% CI, 1.30, 1.62), not working (AOR = 1.32, 95% CI, 1.21, 1.45), being married (AOR = 67.88, 95% CI, 61.33, 75.12), poor (AOR = 1.47, 95% CI, 1.32, 1.65) and middle wealth quantile (AOR = 1.21, 95% CI, 1.07, 1.35), knowledge about contracptives (AOR = 2.45, 95% CI, 2.19, 2.74), unmet need for family planning (AOR = 2.42, 95% CI, 2.14, 2.74), Angola (AOR = 9.59, 95% CI, 7.82, 11.77), Chad (AOR = 3.05, 95% CI, 2.49, 3.74), DR.Congo (AOR = 3.77, 95% CI, 3.06, 4.65), and Mali (AOR = 1.84, 95% CI, 1.47, 2.28) were factors significantly associated with teenage pregnancy.

CONCLUSIONS

This study found that teenage pregnancy remains a common public health problem in the study areas. Level of education, marital status, occupation, wealth index, unmet need for family planning, knowledge about contraceptives, and country were significantly associated with teenage pregnancy. Hence, for sustainable development goal 3 to be realized by 2030, there must be investment in policy implementation and evaluation, as well as engagement with stakeholders in adolescents' sexual and reproductive health.

Barriers and facilitators of childhood obesity prevention policies: A systematic review and meta-synthesis

Objectives

Childhood obesity is one of the worldwide considerable public health challenges and many factors can play a role in its management. Therefore, this article examined the facilitators and barriers of childhood obesity prevention (COP) policies.

Methods

This systematic review of qualitative studies was conducted via a search of the SCOPUS, PubMed, and Google Scholar databases between 1 January 2010 and 11 February 2022 and examined factors that influence the implementation of COP policies at a community approach.

Results

The parents' reluctance to engage in COP activities, lack of sufficient knowledge, and financial problems were the most reported barriers at the individual level. In addition, the beliefs about COP at the sociocultural level and limited funding and resources, time limitations in stakeholders at the implementation level, and lack of policy support at the structural level were the most frequently reported barriers. Further, effective communication between stakeholders and parents and school staff at the sociocultural level and flexibility of the intervention, delivery of healthy food programs in schools, low-cost and appropriate resources, and the availability of appropriate facilities are the most frequently reported facilitators in the structural level.

Conclusion

Individual, sociocultural, and structural level-related barriers and facilitators influence the implementation of COP policies. Most of the barriers and facilitators in this systematic review were related to the structural level.

The processes of engagement in information-seeking behavior for individuals with diabetes who developed diabetic foot ulcer: A constructivist grounded theory study

To describe the process of engagement in information seeking behavior for individuals with type 1 and type 2 diabetes.

Methodology

Constructivist grounded theory. The data was gathered through thirty semi-structured interviews of participants attending a wound care clinic in Southeast, Ontario, Canada. The waiting period taken to seek appropriate help varied from weeks to months.

Results

"The processes of engagement in information-seeking behavior about diabetes" are organized as follows: 1) discovering diabetes, 2) reactions to the diagnosis, and 3) engaging in self-directed learning. For most participants, the diagnosis of diabetes was unexpected and usually confirmed after a long period of experiencing a diversity of symptoms. The terms used mostly by participants were "I started to wonder" and "Something was wrong with me." After being diagnosed with diabetes, participants sought information to learn about it. Most of them engaged in self-directed learning to acquire knowledge about their illness.

Conclusion

Although the Internet is often used to seek information, healthcare providers and support network also played an important role in supporting participants information-seeking behavior learn about diabetes. The unique needs of people with diabetes must be taken into consideration during their diabetes care journey. These findings call for the need to provide education about diabetes from the time they are diagnosed and direct them to reliable resources of information.

The effect of daidzein on renal injury in ovariectomized rats: interaction of angiotensin receptors and long non-coding RNAs H19, GAS5, MIAT, and Rian

Background

Renin-angiotensin system (RAS) is prominently associated with renal pathophysiology in postmenopausal women. Long non-coding RNAs (lncRNAs) H19, GAS5, MIAT, and Rian have been linked to the pathogenesis of renal injury.

Aims

This study aimed to evaluate the beneficial effects of daidzein on unilateral ureteral obstruction (UUO) induced-renal injury in ovariectomized (OVX) rats through interaction with angiotensin AT1, Mas receptors, and lncRNAs.

Methods

84 female rats were ovariectomized (OVX) two weeks before performing obstruction of the left kidney ureter (UUO). The animals were then randomly divided into four main groups (n=21): Sham+DMSO, UUO+DMSO, UUO+17β-Estradiol (E2) (positive control), and UUO+daidzein. Each main group comprised three subgroups (n=7) and were treated with saline, A779 (MasR antagonist), or losartan (AT1R antagonist) for 15 days. On day 16, the animals were euthanized, and the left kidneys were harvested for histopathology and lncRNAs expression assays.

Results

UUO significantly increased kidney tissue damage score (KTDS) in the UUO rats, increased the expression of H19 and MIAT, and decreased the expression of GAS5 and Rian. Daidzein alone and in co-treatment with losartan or A779 reversed these effects. Daidzein with 1 mg/kg dose was more effective than E2.

Conclusion

Daidzein alone and in co-treatment with A779 and losartan improved renal injury in UUO rats and recovered dysregulated expression of UUO-related lncRNAs through modulating MasR and AT1R receptors, associating with modulation of the expression of lncRNAs. Daidzein could be considered a renoprotective phytoestrogen substitute for E2 therapy in postmenopausal women suffering from renal diseases.

Functionality of self-care for pregnancy mobile applications: A review study

Self-care may help prevent pregnancy complications and mortality by informing parents. Mobile health applications (apps) can help individuals to improve the quality of self-care. Although it has been claimed that mobile apps have various benefits, their functionalities in pregnancy self-care are still unclear. A clear understanding of current apps can help researchers, practitioners, and app developers to identify appropriate functionalities for new development and future refinement of current apps. This review endeavored to identify appropriate functions for pregnancy self-care mobile apps and user interface (UI) features. The scope of this review integrates self-care for pregnancy apps published in Google Play and Cafe Bazaar (an Iranian Android marketplace), popular Android app stores, from July to October 2019 by sing the systematic search technique. All 4196 downloaded apps were installed, and it was found that 76 of them met the inclusion criteria. This way, their features were extracted and categorized by the conventional content analysis. Three main themes and 69 subthemes in terms of apps functionalities and their UI features were extracted as follows: 1) Training materials (maternal and paternal) with 27 subthemes; 2) self-care functionalities (consultations, fetus tracking, clinical examination, supportive assistance, and reminders) with 26 subthemes; and UI features with 16 subtheme. The findings underlined the mHealth solutions for pregnancy self-care and the need for development of the apps regarding the extracted functionalities and UI features; however, controlled trials are needed. It is recommended that transparent reporting of mHealth interventions needs to be prioritized to enable effective interpretation of the extracted data.

The Development and Pilot Study of a Multiple Criteria Decision Analysis (MCDA) to Compare Patient and Provider Priorities around Amputation-Level Outcomes

Background. Patients with chronic limb-threatening ischemia who are facing a lower-limb amputation often require a transmetatarsal amputation (TMA) or a transtibial amputation (TTA). A TMA preserves more of the patient's limb and may provide better mobility but has a lower probability of primary wound healing relative to a TTA and may result in additional amputation surgeries. Understanding the differences in how patients and providers prioritize key outcomes may enhance the amputation decisional process. Purpose. To develop and pilot test a multiple criteria decision analysis (MCDA) tool to elicit patient values around amputation-level selection and compare those with provider perceptions of patient values. Methods. We conducted literature reviews to identify and measure the performance of criteria important to patients. Because the quantitative literature was sparse, we developed a Sheffield elicitation framework exercise to elicit criteria performance from subject matter experts. We piloted our MCDA among patients and providers to understand tool acceptability and preliminarily assess differences in patient and provider priorities. Results. Five criteria of importance were identified: ability to walk, healing after amputation surgery, rehabilitation intensity, limb length, and prosthetic/orthotic device ease. Patients and providers successfully completed the MCDA and identified challenges in doing so. We propose potential solutions to these challenges. The results of the pilot test suggest differences in patient and provider outcome priorities. Limitations. The pilot test study enrolled a small sample of providers and patients. Conclusions. We successfully implemented the pilot study to patients and providers, received helpful feedback, and identified solutions to improve the tool. Implications. Once modified, our MCDA tool will be suitable for wider rollout.

Highlights

Patients and providers have successfully completed our MCDA, and patients feel the MCDA may be useful in clinical practice.We encountered several methodologic challenges and identified approaches to ease participant burden.When data are sparse, using the Sheffield elicitation framework is helpful in creating a performance matrix, although patients relied largely on their amputation experiences to complete the exercise. Blinding the alternatives may help patients better understand the process.

Decision-making and related outcomes of patients with complex care needs in primary care settings: a systematic literature review with a case-based qualitative synthesis

BACKGROUND

In primary care, patients increasingly face difficult decisions related to complex care needs (multimorbidity, polypharmacy, mental health issues, social vulnerability and structural barriers). There is a need for a pragmatic conceptual model to understand decisional needs among patients with complex care needs and outcomes related to decision. We aimed to identify types of decisional needs among patients with complex care needs, and decision-making configurations of conditions associated with decision outcomes.

METHODS

We conducted a systematic mixed studies review. Two specialized librarians searched five bibliographic databases (Medline, Embase, PsycINFO, CINAHL and SSCI). The search strategy was conducted from inception to December 2017. A team of twenty crowd-reviewers selected empirical studies on: (1) patients with complex care needs; (2) decisional needs; (3) primary care. Two reviewers appraised the quality of included studies using the Mixed Methods Appraisal Tool. We conducted a 2-phase case-based qualitative synthesis framed by the Ottawa Decision Support Framework and Gregor's explicative-predictive theory type. A decisional need case involved: (a) a decision (what), (b) concerning a patient with complex care needs with bio-psycho-social characteristics (who), (c) made independently or in partnership (how), (d) in a specific place and time (where/when), (e) with communication and coordination barriers or facilitators (why), and that (f) influenced actions taken, health or well-being, or decision quality (outcomes).

RESULTS

We included 47 studies. Data sufficiency qualitative criterion was reached. We identified 69 cases (2997 participants across 13 countries) grouped into five types of decisional needs: 'prioritization' (n = 26), 'use of services' (n = 22), 'prescription' (n = 12), 'behavior change' (n = 4) and 'institutionalization' (n = 5). Many decisions were made between clinical encounters in situations of social vulnerability. Patterns of conditions associated with decision outcomes revealed four decision-making configurations: 'well-managed' (n = 13), 'asymmetric encounters' (n = 21), 'self-management by default' (n = 8), and 'chaotic' (n = 27). Shared decision-making was associated with positive outcomes. Negative outcomes were associated with independent decision-making.

CONCLUSION

Our results could extend decision-making models in primary care settings and inform subsequent user-centered design of decision support tools for heterogenous patients with complex care needs.

The development of machine learning in lung surgery: A narrative review

Background

Machine learning reflects an artificial intelligence that allows applications to improve their accuracy to predict outcomes, eliminating the need to conduct explicit programming on them. The medical field has increased its focus on establishing tools for integrating machine learning algorithms in laboratory and clinical settings. Despite their importance, their incorporation is minimal in the medical sector yet. The primary goal of this study is to review the development of machine learning in the field of thoracic surgery, especially lung surgery.

Methods

This article used the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA). The sources used to gather data are the PubMed, Cochrane, and CINAHL databases and the Google Scholar search engine.

Results

The study included 19 articles, where ten concentrated on the application of machine learning in especially lung surgery, six focused on the benefits and limitations of machine learning algorithms in lung surgery, and three provided an overview of the future of machine learning in lung surgery.

Conclusion

The outcome of this study indicates that the field of lung surgery has attempted to integrate machine learning algorithms. However, the implementation rate is low, owing to the newness of the concept and the various challenges it encompasses. Also, this study reveals the absence of sufficient literature discussing the application of machine learning in lung surgery. The necessity for future research on the topic area remains evident.

Which type of mind-body exercise is most effective in improving functional performance and quality of life in patients with Parkinson's disease? A systematic review with network meta-analysis

BACKGROUND

Several studies have investigated the effect of mind-body exercise (MBE) on functional performance and health-related quality of life (HRQoL) in Parkinson's disease (PD), but it is still very difficult for clinicians to make informed decision on the best mind-body exercise for PD.

PURPOSE

We analyzed the relative efficacy of MBE (yoga, Tai-Chi, Pilates, Qigong, and dance) in improving functional performance and HRQoL in patients with PD.

METHODS

A systematic review of randomized controlled trials (RCTs) was performed using network meta-analysis (NMA), searching the following databases: Cochrane, Web of Science, and PubMed using specific keywords until December 28, 2021, assessing the effects of MBE on functional performance and HRQoL in patients with PD.

RESULTS

This review included 60 RCTs with 2037 participants. A ranking of MBE for modifying various aspects of functional performance and HRQoL was achieved. Pairwise NMA showed Pilates to be the most effective in improving functional mobility (MD: - 3.81; 95% CI (- 1.55, - 6.07) and balance performance (SMD: 2.83; 95% CI (1.87, 3.78). Yoga (MD: - 5.95; 95% CI (- 8.73, - 3.16) and dance (MD: - 5.87; 95% CI (- 8.73, - 3.01) to be the most effective in improving motor function, whereas Qigong (MD: 0.32; 95% CI (0.00, 0.64) was most effective in improving gait speed. Considering HRQoL, dance was found to be the most effective (SMD: - 0.36; 95% CI (- 0.70, -0.01).

CONCLUSION

MBE should be considered an effective strategy for improving functional performance and HRQoL in patients with PD. The most effective MBE intervention varied with the functional performance domain. Dance was an effective exercise for improving HRQoL among people with PD.

PROSPERO REGISTRATION ID

CRD42022301030.

A metafrontier approach and fractional regression model to analyze the environmental efficiency of alternative tillage practices for wheat in Bangladesh

Among alternative tillage practices, conservation tillage (CT) is a prominent greenhouse gas (GHG) mitigation strategy advocated in wheat cultivation, largely because of its low energy consumption and minimum soil disturbance during cultural operations. This paper examines the agricultural production and GHG emission trade-off of CT vis-à-vis traditional tillage (TT) on wheat farms of Bangladesh. Using a directional distance function approach, the maximum reduction in GHG emissions was searched for within all available tillage technology options, while increasing wheat production as much as possible. The underlying institutional, technical, and other socio-economic factors determining the efficient use of CT were analyzed using a fractional regression model. The average meta-efficiency score for permanent bed planting (PBP) and strip tillage (ST) was  0.89, while that achieved using power tiller operated seeders (PTOS) is 0.87. This indicates that with the given input sets, there is potential to reduce GHG emissions by about 11% for ST and PTOS; that potential is 13% for farmers using PTOS. The largest share of TT farmers cultivate wheat at lower meta-efficiency levels (0.65-0.70) compared to that observed with farmers practicing CT (0.75-0.80). Fractional regression model estimates indicate that an optimal, timely dose of fertilizers with a balanced dose of nutrients is required to reduce GHG emissions. To develop climate smart sustainable intensification strategies in wheat cultivation, it is important to educate farmers on efficient input management and CT together. Agricultural development programs should focus on addressing heterogeneities in nutrient management in addition to tillage options within CT.

Psychological safety in elite sport settings: a psychometric study of the Sport Psychological Safety Inventory

Objectives

Effectively supporting the mental health of elite athletes and coaches requires validated tools that assess not only individual-level factors but organisational-level influences. The aim of this study was to develop a bespoke scale assessing perceived psychological safety within high-performance environments.

Methods

337 elite athletes (M=24.12 years) and 238 elite-level coaches and high-performance support staff (HPSS; M=41.9 years) identified via the Australian Institute of Sport provided data across a range of mental health and well-being domains. Exploratory factor analysis (EFA; n=169 athletes) with parallel analysis identified the Sport Psychological Safety Inventory (SPSI) factor structure. Confirmatory factor analysis (CFA) validated the identified structure in separate validation subsamples of athletes (n=168) and coaches/HPSS (n=238).

Results

EFA identified the 11-item, 3-factor SPSI. Factors assessed domains of the Mentally Healthy Environment, Mental Health Literacy and Low Self-Stigma. All scale items loaded strongly on their specific domain. CFA model fit indices validated scale structure for athletes and coaches/HPSS. Internal consistency and convergent and divergent validity were evident. Logistic regression indicated that incrementally higher Mentally Healthy Environment scores reduced the likelihood of athletes scoring in the ‘moderate’ range of general and athlete-specific distress, with a stronger endorsement of the Low Self-Stigma subscale reducing the likelihood of being identified for athlete-specific distress.

Conclusion

Psychometric properties of the SPSI support scale utility among athletes and coaches/HPSS in elite sports settings, though further psychometric efforts are needed. This brief measure may support benchmarking efforts across elite sporting contexts to improve mental health culture and broader well-being among athletes and coaches/HPSS.

The pharmacist as a public health resource: Expanding telepharmacy services to address social determinants of health during the COVID-19 pandemic

Background

The advent of COVID-19 exacerbated the impact of social determinants of health (SDOH) on patients' ability to manage their health, especially those with chronic conditions. Clinical pharmacists are well positioned to expand the patient care services they already provide to address patients' basic social needs, which may otherwise impede medication access and adherence.

Objectives

The purpose of this exploratory study was to evaluate the feasibility of expanding a comprehensive medication management (CMM) telepharmacy service to include SDOH support. This service was offered as part of four primary care clinics in rural and underserved North Carolina communities. More specifically, the study aimed to describe the expanded service, evaluate stakeholders' experience with the service, and assess short-term impact on patients with diabetes.

Methods

Data collected over the first 4 months of implementation included administrative data used to describe the expanded service; a clinic survey and interviews to assess clinic team members' experience with the service; and patient surveys to evaluate patient satisfaction, as well as impact on SDOH self-efficacy and diabetes quality of life.

Results

Through SDOH screening, the pharmacist identified 26 unresolved COVID-prompted SDOH concerns across 66 patients. These concerns were addressed by the pharmacist through three types of brief interventions, including information provision/education (71%), access to resources (21%), and additional care coordination (7%). Clinic team members perceived the expanded service as highly satisfactory and beneficial. Patients also reported high levels of satisfaction and significantly increased their SDOH self-efficacy and diabetes quality of life as a result of the service.

Conclusion

These data provide preliminary insights into the expanded role that pharmacists can play to address current population health gaps that can directly impact patients' engagement with their medication regimen and overall health status.

The Relationship Between Knowledge, Attitude, Practice, and Fall Prevention for Childhood in Shanghai, China

Background

Early childhood fall is a pressing global public health problem and one of the leading causes of child injury. China has a high proportion of children and a high burden of illness from falls. Therefore, educational interventions to prevent childhood fall would be beneficial.

Methods

We used the outcome of knowledge, attitude and practice questionnaire, which was conducted by Pudong New District of Shanghai Municipal Government, to summarize demographic and baseline characteristics grouped by intervention or not, and analyzed descriptive statistics of continuous and categorical variables. A logistic stepwise function model was established to study the influence of different covariables on the degree of injury, and AIC/BIC/AICC was used to select the optimal model. Finally, we carried out single-factor analysis and established a multifactor model by the stepwise function method.

Results

Attitude and actual behavior scores had significant differences. The intervention and control groups had 20.79 ± 3.20 and 20.39 ± 2.89 attitude scores, respectively. Compared to the control group (5.97 ± 1.32), the intervention group had higher actual behavior scores (5.75 ± 1.50). In the univariate analysis results, fathers' education level, mothers' education level, actual behavior and what cares for children had a significant influence on whether children got injured. In multivariate analysis, attitude had a positive influence on whether injured [odds ratio: 1.13 (1.05–1.21), P &lt; 0.001].

Conclusion

Educational intervention for children and their guardians can effectively reduce the risk of childhood falls, and changes in behavior and attitude are the result of educational influence. Education of childhood fall prevention can be used as a public health intervention to improve children's health.

The best drug supplement for obesity treatment: a systematic review and network meta-analysis

BACKGROUND

Obesity is a complex disease with an increasing prevalence worldwide. There are different weight-management options for obesity treatment, including dietary control, exercise, surgery, and medication. Medications are always associated with different responses from different people. More safety and efficacy of drugs with fewer side effects are valuable for any clinical condition. In this systematic review and network meta-analysis, different anti-obesity drugs are compared to identify the most effective drug.

METHODS

All relevant studies were extracted by searching national and international databases of SID, MagIran, ProQuest, PubMed, Science Direct, Scopus, Web of Science (WoS), and Google Scholar without time limit until October 2020. Finally, the meta-analysis was performed with the 11 remaining studies containing 14 different drug supplements. The standardized mean difference (SMD) was calculated at a 95% confidence interval (CI) to evaluate the effects of each treatment group compared with placebo. A random-effect model was used to evaluate the effect of individual studies on the final result. Heterogeneity and incompatibility of the network were assessed by Cochran's Q and Higgins I², and the Net Heat chart, respectively. Data analysis was performed using R software.

RESULTS

Our results showed that there were significant mean effects in people intervened with Phentermine 15.0 mg + Topiramate 92.0 mg, Phentermine 7.5 mg + Topiramate 46.0 mg, Pramlintide, Naltrexone + Bupropion 32, and Liraglutide, with SMD effects size = - 9.1, - 7.4, - 6.5, - 5.9, - 5.35, respectively.

CONCLUSION

This study was performed to compare the effect of different drugs used for weight loss in obese patients. The most effective drugs for weight loss were phentermine and topiramate, pramlintide, naltrexone, bupropion, and liraglutide compared to placebo treatment, respectively. This study provides new insights into anti-obesity drugs and hopes to shed new light on future research to manage and treat obesity.

Higher-Order Language Dysfunctions in Individuals with Alcohol Use Disorder

Patients with alcohol use disorders (AUD) have difficulties with certain aspects of higher-order language functions (HOLF) but there is no data on a wide range of these functions in this group. Therefore, the aim of this study was to compare different aspects of HOLF in patients with AUD and healthy controls (HC). A total of 31 patients with AUD and 44 HC took part in the study. We assessed HOLF with the Right Hemisphere Language Battery (RHLB) and measured control variables: depression using the Patient Health Questionnaire (PHQ) as well as the speed of processing and executive functions with the Color Trails Test (CTT). Patients with AUD had lower results on nine RHLB tests. Moreover, AUD patients had higher scores on PHQ and longer reaction times on CTT. The differences in most RHLB results remained significant after co-varying the control variables. Patients with AUD have difficulties with making inferences from the text, understanding the meaning of individual words, metaphorical content, and prosody, which may impede the comprehension and production of discourse in which linguistic elements must be integrated with non-verbal cues and contextual information. These disturbances may impact various spheres of everyday life and negatively influence social, private, and professional functioning.

Application of weighting methods for presenting risk-of-bias assessments in systematic reviews of diagnostic test accuracy studies

BACKGROUND

An assessment of the validity of individual diagnostic accuracy studies in systematic reviews is necessary to guide the analysis and the interpretation of results. Such an assessment is performed for each included study and typically reported at the study level. As studies may differ in sample size and disease prevalence, with larger studies contributing more to the meta-analysis, such a study-level report does not always reflect the risk of bias in the total body of evidence. We aimed to develop improved methods of presenting the risk of bias in the available evidence on diagnostic accuracy of medical tests in systematic reviews, reflecting the relative contribution of the study to the body of evidence in the review.

METHODS

We applied alternative methods to represent evaluations with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2), weighting studies according to their relative contribution to the total sample size or their relative effective sample size. We used these methods in four existing systematic reviews of diagnostic accuracy studies, including 9, 13, 22, and 32 studies, respectively.

RESULTS

The risk-of-bias summaries for each domain of the QUADAS-2 checklist changed in all four sets of studies after replacing unit weights for the studies with relative sample sizes or with the relative effective sample size. As an example, the risk of bias was high in the patient selection domain in 31% of the studies in one review, unclear in 23% and low in 46% of studies. Weighting studies according to the relative sample size changed the corresponding proportions to 4%, 4%, and 92%, respectively. The difference between the two weighting methods was small and more noticeable when the reviews included a smaller number of studies with wider range of sample size.

CONCLUSIONS

We present an alternative way of presenting the results of risk-of-bias assessments in systematic reviews of diagnostic accuracy studies. Weighting studies according to their relative sample size or their relative effective sample size can be used as more informative summaries of the risk of bias in the total body of available evidence.

SYSTEMATIC REVIEW REGISTRATIONS

Not applicable.

Explicit Training to Improve Affective Prosody Recognition in Adults with Acute Right Hemisphere Stroke

Difficulty recognizing affective prosody (receptive aprosodia) can occur following right hemisphere damage (RHD). Not all individuals spontaneously recover their ability to recognize affective prosody, warranting behavioral intervention. However, there is a dearth of evidence-based receptive aprosodia treatment research in this clinical population. The purpose of the current study was to investigate an explicit training protocol targeting affective prosody recognition in adults with RHD and receptive aprosodia. Eighteen adults with receptive aprosodia due to acute RHD completed affective prosody recognition before and after a short training session that targeted proposed underlying perceptual and conceptual processes. Behavioral impairment and lesion characteristics were investigated as possible influences on training effectiveness. Affective prosody recognition improved following training, and recognition accuracy was higher for pseudo- vs. real-word sentences. Perceptual deficits were associated with the most posterior infarcts, conceptual deficits were associated with frontal infarcts, and a combination of perceptual-conceptual deficits were related to temporoparietal and subcortical infarcts. Several right hemisphere ventral stream regions and pathways along with frontal and parietal hypoperfusion predicted training effectiveness. Explicit acoustic-prosodic-emotion training improves affective prosody recognition, but it may not be appropriate for everyone. Factors such as linguistic context and lesion location should be considered when planning prosody training.

The correlation between white matter integrity and pragmatic language processing in first episode schizophrenia

Objective: Higher-order language disturbances could be the result of white matter tract abnormalities. The study explores the relationship between white matter and pragmatic skills in first-episode schizophrenia. Methods: Thirty-four first-episode patients with schizophrenia and 32 healthy subjects participated in a pragmatic language and Diffusion Tensor Imaging study, where fractional anisotropy of the arcuate fasciculus, corpus callosum and cingulum was correlated with the Polish version of the Right Hemisphere Language Battery. Results: The patients showed reduced fractional anisotropy in the right arcuate fasciculus, left anterior cingulum bundle and left forceps minor. Among the first episode patients, reduced understanding of written metaphors correlated with reduced fractional anisotropy of left forceps minor, and greater explanation of written and picture metaphors correlated with reduced fractional anisotropy of the left anterior cingulum. Conclusions: The white matter dysfunctions may underlie the pragmatic language impairment in schizophrenia. Our results shed further light on the functional neuroanatomical basis of pragmatic language use by patients with schizophrenia.

Validity and reliability of myotonometry for assessing muscle viscoelastic properties in patients with stroke: a systematic review and meta-analysis

There is a lack of consensus about the measurement of the muscle viscoelastic features in stroke patients. Additionally, the psychometric properties of the most-commonly used clinical tools remain controversial. Our objective is to investigate the validity and reliability of myotonometry to assess viscoelastic muscle features in stroke survivors. Pubmed, PEDro, Scopus and Cinahl were systematically searched to include studies reporting the psychometric properties of myotonometric devices used in people after stroke. The QUADAS-2 and the COSMIN checklists were used to assess the methodological quality of the studies and the psychometric properties of myotonometry. Nine studies were included in the qualitative synthesis and data from five of these were pooled in a meta-analysis. Overall, low to moderate risk of bias and applicability concerns were observed. Pooled data from intra-rater reliability for muscle tone showed a mean coefficient of correlation of 0.915 (95% CI: 0.880-0.940, I 2 = 69.2%) for upper limbs, and a mean coefficient of 0.785 (95%CI: 0.708-0.844, I 2 = 4.02%) for lower limbs. Myotonometry seems to be a valid and reliable complementary tool to assess muscle viscoelastic properties in stroke survivors, although definite conclusions about concurrent validity need further research.

Effect of Housing First on violence-related traumatic brain injury in adults with experiences of homelessness and mental illness: findings from the At Home/Chez Soi randomised trial, Toronto site

OBJECTIVES

People experiencing homelessness have a high prevalence and incidence of traumatic brain injury (TBI) due to violence. Little is known about the effectiveness of interventions to reduce TBI in this population. This study assessed the effect of Housing First (HF) on violence-related TBI in adults with experiences of homelessness and mental illness.

DESIGN

Pragmatic randomised trial.

PARTICIPANTS

381 participants in the Toronto site of the At Home/Chez randomised trial.

INTERVENTION

HF participants were provided with scattered-site housing using rent supplements and supports from assertive community treatment or intensive case management teams (n=218, 57.2%). Control participants had access to treatment as usual (TAU) in the community (n=163, 42.8%).

MAIN OUTCOME MEASURES

Primary outcomes were an incident physical violence-related TBI event and the number of physical violence-related TBI events during the follow-up period (January 2014 to March 2017). Interval-censored survival time regression and zero-inflated negative binomial regression were used to assess the effect of HF on primary outcomes.

RESULTS

Among study participants, 9.2% (n=35) had an incident physical violence-related TBI event, and the mean physical violence-related TBI events was 0.16 (SD ±0.6). Compared with TAU participants, HF participants did not have a significantly lower risk of an incident violence-related TBI event (adjusted HR : 0.58 (95% CI, 0.29 to 1.14)), but they had a significantly lower number of physical violence-related TBI events (unadjusted incidence rate ratio (IRR): 0.22 (95% CI, 0.06 to 0.78); adjusted IRR: 0.15 (95% CI, 0.05 to 0.48)).

CONCLUSION

HF may be a useful intervention to reduce the burden of TBI due to physical violence among homeless individuals with mental illness.

TRIAL REGISTRATION NUMBER

ISRCTN42520374.

Effects of Supervised Early Resistance Training versus standard care on cognitive recovery following cardiac surgery via median sternotomy (the SEcReT study): protocol for a randomised controlled pilot study

Introduction

Mild cognitive impairment is considered a precursor to dementia and significantly impacts upon quality of life. The prevalence of mild cognitive impairment is higher in the post-surgical cardiac population than in the general population, with older age and comorbidities further increasing the risk of cognitive decline. Exercise improves neurogenesis, synaptic plasticity and inflammatory and neurotrophic factor pathways, which may help to augment the effects of cognitive decline. However, the effects of resistance training on cognitive, functional and overall patient-reported recovery have not been investigated in the surgical cardiac population. This study aims to determine the effect of early moderate-intensity resistance training, compared to standard care, on cognitive recovery following cardiac surgery via a median sternotomy. The safety, feasibility and effect on functional recovery will also be examined.

Methods

This study will be a prospective, pragmatic, pilot randomised controlled trial comparing a standard care group (low-intensity aerobic exercise) and a moderate-intensity resistance training group. Participants aged 18 years and older with coronary artery and/or valve disease requiring surgical intervention will be recruited pre-operatively and randomised 1:1 to either the resistance training or standard care group post-operatively. The primary outcome, cognitive function, will be assessed using the Alzheimer’s Disease Assessment Scale and cognitive subscale. Secondary measures include safety, feasibility, muscular strength, physical function, multiple-domain quality of recovery, dynamic balance and patient satisfaction. Assessments will be conducted at baseline (pre-operatively) and post-operatively at 2 weeks, 8 weeks, 14 weeks and 6 months.

Discussion

The results of this pilot study will be used to determine the feasibility of a future large-scale randomised controlled trial that promotes the integration of early resistance training into existing aerobic-based cardiac rehabilitation programs in Australia.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001430325p. Registered on 9 October 2017. Universal Trial Number (UTN): U1111-1203-2131.

Prioritized Criteria for Casualty Distribution following Trauma-related Mass Incidents; a Modified Delphi Study

INTRODUCTION

In the aftermath of mass casualty incidents (MCIs), many decisions need to be made in a fast and influential manner in a high pressure environment to distribute the limited resources among the numerous demands. This study was planned to rank the criteria influencing distribution of casualties following trauma-related MCI.

METHODS

This study utilized a modified Delphi methodology, concentrating on extracted criteria attained from preceding systematic literature reviews. The 114 extracted criteria were classified into eight sections including space, staff, equipment, system and structures, triage, treatment, transport, and uncategorized criteria and were imported into an online survey tool. In the first round, experts were asked to rank each criterion on a five-point Likert scale. The second round incorporated feedbacks from the first round, stating percent and median scores from the panel as a whole. Experts were then called upon to reassess their initial opinions regarding uncertain remarks from the first round, and once again prioritize the presented criteria.

RESULTS

Fifty-seven criteria were regarded as relevant to the following sections: space: 70% (7/10); staff: 44% (4/9); system / structure: 80% (4/5); equipment: 39.1% (9/23); treatment; 66.7% (6/9); triage: 73.7% (14/19); transport: 38.7% (12/31) and other sections: 12.5% (1/8). The first round achieved nearly 98% (n=48) response rate. Of the 114 criteria given to the experts, 68 (almost 60%) were approved. The highest percentage of approval belonged to the system and structures sections (4/5=80%). The response rate for the second round was about 86% (n=42). A consensus could be reached about nearly 84% (57) of the 68 criteria presented to experts.

CONCLUSION

"Casualty Level of Triage on the Scene" and "Number of Available Ambulances" were the two criteria that obtained the highest level of consensus. On the other hand, "gender of casualty", "Number of Non-Medical staff in each Hospital" and "Desire to transport family members together" got lowest level of consensus. This sorted list could be used as a catalogue for developing a decision support system or tool for distribution of victims following mass casualty incidents.

Adolescent traumatic brain injuries: Onset, mechanism and links with current academic performance and physical injuries

Background

Traumatic brain injuries (TBIs) in adolescence are associated with adverse outcomes, but whether the timing of the onset of TBIs leads to greater deficits has not been determined. We evaluate the relationship between the first and most recent TBI, and current academic performance and medically treated physical injuries.

Methods

Data were derived from the 2015 Ontario Student Drug Use and Health Survey (OSDUHS) administered to adolescents in grades 7 to 12 (ages 12 to 18). TBI was defined as a head injury that resulted in loss of conscious for at least five minutes or at least one overnight hospitalization.

Results

One in five students reported having had a history of TBI in their lifetime and were more prevalent in males. Odds ratios were 2 times higher for males to have had their first (or only) and most recent TBI in grades 5 to 8, compared to females. Sports-related TBIs accounted for 41.1% of all TBIs. Hockey related TBIs were more frequent compared to soccer related TBIs. Reports of history of TBI was associated with lower academic performance and more physical injuries. First or only TBI occurring in grades 9–12 (occurring on average between 14 to 19 years of age) had higher significant odds of poorer academic performance than TBIs occurring in earlier grades (younger ages than 14 years old). Students who reported more visits for medical treatment of physical injuries in the past year had higher odds to report a history of TBIs in higher school grades.

Conclusions

Adverse physical and academic outcomes among young TBI survivors are associated with the onset and frequency of history of lifetime TBI. Prevention efforts to minimize TBIs during youth is critical.

Association between uncooperativeness and the glucose metabolism of patients with chronic behavioral disorders after severe traumatic brain injury: a cross-sectional retrospective study

Bakground

Patients with behavioral disorders following severe traumatic brain injury (sTBI) often have disorders of consciousness that make expressing their emotional distress difficult. However, no standard method for assessing the unsettled and unforeseen responses that are associated with behavioral disorders has yet to be established. Because the thalamus is known to play a role in maintaining consciousness and cognition, we used 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) to examine the association between brain glucose metabolism in the thalamus and behavioral disorders.

Methods

We retrospectively analyzed 70 consecutive patients with sTBI who had been involved in motor vehicle accidents. To assess behavioral disorders, we evaluated 18 symptoms using the Brief Psychiatric Rating Scale (BPRS): Emotional Withdrawal, Conceptual Disorganization, Tension, Mannerisms and Posturing, Motor Retardation, Uncooperativeness, Blunted Affect, Excitement, Somatic Concern, Anxiety, Feeling of Guilt, Grandiosity, Depressive Mood, Hostility, Suspiciousness, Hallucinatory Behavior, Unusual Thought Content, and Disorientation. First, we identified clinical characteristics of sTBI patients with behavioral disorders. Next, we retrospectively analyzed 18F-FDG-PET/CT data to assess how thalamic activity was related with abnormal behaviors.

Results

Twenty-six patients possessed the minimum communicatory ability required for psychiatric interview. Among them, 15 patients (57.7%) were diagnosed with behavioral disorder, 14 of whom had reached a stable psychiatric state after about 426.6 days of treatment. Excitement (13 patients) and uncooperativeness (10 patients) were the most frequently observed symptoms. Available 18F-FDG-PET/CT data indicated that thalamic glucose metabolism was imbalanced and lateralized (p = 0.04) in 6 patients who exhibited uncooperativeness.

Conclusions

Behavioral symptoms of excitement and uncooperativeness were common in patients with sTBI, although most symptoms improved as the chronic stage continued. Our data support the idea that imbalanced laterality of glucose metabolism in the thalamus might be related to behavioral disorders characterized by uncooperativeness.

Trial registration

UMIN 000029531. Registered 27 March 2017, retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s13030-018-0125-0) contains supplementary material, which is available to authorized users.