Social Media, Endometriosis, and Evidence-Based Information: An Analysis of Instagram Content

Social media platforms are used for support and as resources by people from the endometriosis community who are seeking advice about diagnosis, education, and disease management. However, little is known about the scientific accuracy of information circulated on Instagram about the disease. To fill this gap, this study analysed the evidence-based nature of content on Instagram about endometriosis. A total of 515 Instagram posts published between February 2022 and April 2022 were gathered and analysed using a content analysis method, resulting in sixteen main content categories, including "educational", which comprised eleven subcategories. Claims within educational posts were further analysed for their evidence-based accuracy, guided by a process which included fact-checking all claims against the current scientific evidence and research. Of the eleven educational subcategories, only four categories (cure, scientific article, symptoms, and fertility) comprised claims that were at least 50% or greater evidence-based. More commonly, claims comprised varying degrees of evidence-based, mixed, and non-evidence-based information, and some categories, such as surgery, were dominated by non-evidence-based information about the disease. This is concerning as social media can impact real-life decision-making and management for individuals with endometriosis. Therefore, this study suggests that health communicators, clinicians, scientists, educators, and community groups trying to engage with the endometriosis online community need to be aware of social media discourses about endometriosis, while also ensuring that accurate and translatable information is provided.

Older adults' perspectives towards optimizing lifestyle behaviors and strategies to support healthy brain ageing during COVID-19 restrictions

Introduction

It is unknown how the impact of COVID-19 restrictions has affected brain healthy behaviors that contribute to dementia risk reduction in older adults. Our aim was to explore perspectives of older adults on lifestyle behaviors that support positive brain health and dementia risk reduction during and following COVID-19 restrictions.

Methods

Community-dwelling older Australians (N = 159) during June to October 2021 (the second wave of COVID-19 restrictions) who had taken part in a pre-post dementia risk reduction intervention program were invited to discuss the impact of COVID-19 on their lifestyle behaviors. Semi-structured interviews explored individual's adaptability to pandemic restrictions, intended behavior changes following restrictions easing, and feedback on the effectiveness of ongoing intervention programs for sustaining brain health. Thematic data analysis was performed using a deductive approach.

Results

Participants had an average age of 73.1 years (SD = 5.6; range: 65-90), majority were female (74.7%), lived in a major city (82.2%) and mean 9.5 years (SD = 1.7) of education. Older adults' views about lifestyle prevention strategies during the pandemic were both positive (e.g., more spare time and adaptive leisure activities) and negative (e.g., social isolation, lack of motivation, adverse emotions). Participants highlighted a continuous conscious effort to adapt certain brain healthy behaviors despite the persistence of adverse impacts of COVID-19 restrictions. Participants also expressed the intention and desire to revert to their previous lifestyle before the COVID-19 pandemic or a sense of the 'new normal'.

Conclusion

This formative research will inform future interventions targeting dementia risk reduction to consider the immediate and lasting effects of COVID-19 restrictions on older adult's lifestyle behavior.

Inhibition of Retinoic Acid Signaling in Proximal Tubular Epithelial cells Protects against Acute Kidney Injury by Enhancing Kim-1-dependent Efferocytosis

Retinoic acid receptor (RAR) signaling is essential for mammalian kidney development, but in the adult kidney is restricted to occasional collecting duct epithelial cells. We now show there is widespread reactivation of RAR signaling in proximal tubular epithelial cells (PTECs) in human sepsis-associated acute kidney injury (AKI), and in mouse models of AKI. Genetic inhibition of RAR signaling in PTECs protects against experimental AKI but is associated with increased expression of the PTEC injury marker, Kim-1. However, Kim-1 is also expressed by de-differentiated, proliferating PTECs, and protects against injury by increasing apoptotic cell clearance, or efferocytosis. We show that the protective effect of inhibiting PTEC RAR signaling is mediated by increased Kim-1 dependent efferocytosis, and that this is associated with de-differentiation, proliferation, and metabolic reprogramming of PTECs. These data demonstrate a novel functional role that reactivation of RAR signaling plays in regulating PTEC differentiation and function in human and experimental AKI.

Graphical abstract

Exploring the relationships between heritage tourism, sustainable community development and host communities' health and wellbeing: A systematic review

Previous studies examining the impact of heritage tourism have focused on specific ecological, economic, political, or cultural impacts. Research focused on the extent to which heritage tourism fosters host communities' participation and enhances their capacity to flourish and support long-term health and wellbeing is lacking. This systematic review assessed the impact of heritage tourism on sustainable community development, as well as the health and wellbeing of local communities. Studies were included if they: (i) were conducted in English; (ii) were published between January 2000 and March 2021; (iii) used qualitative and/or quantitative methods; (iv) analysed the impact of heritage tourism on sustainable community development and/or the health and wellbeing of local host communities; and (v) had a full-text copy available. The search identified 5292 articles, of which 102 articles met the inclusion criteria. The included studies covering six WHO regions (Western Pacific, African, Americas, South-East Asia, European, Eastern Mediterranean, and multiple regions). These studies show that heritage tourism had positive and negative impacts on social determinants of health. Positive impacts included economic gains, rejuvenation of culture, infrastructure development, and improved social services. However, heritage tourism also had deleterious effects on health, such as restrictions placed on local community participation and access to land, loss of livelihood, relocation and/or fragmentation of communities, increased outmigration, increases in crime, and erosion of culture. Thus, while heritage tourism may be a poverty-reducing strategy, its success depends on the inclusion of host communities in heritage tourism governance, decision-making processes, and access to resources and programs. Future policymakers are encouraged to adopt a holistic view of benefits along with detriments to sustainable heritage tourism development. Additional research should consider the health and wellbeing of local community groups engaged in heritage tourism. Protocol PROSPERO registration number: CRD42018114681.

The burden of chronic diseases and patients' preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh

BACKGROUND

Low- and middle-income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh.

METHODS

The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016-2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service-related factors with patients' preferences for healthcare services.

RESULTS

The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%) and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio [RRR] = 0.71; 0.56-0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80-9.86) or affordability of healthcare services (RRR = 3.13; 2.25-4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15-1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70-5.04) than the quality of treatment in the health facility, when compared with private service providers.

CONCLUSIONS

Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management.

PATIENT OR PUBLIC CONTRIBUTION

Our research team includes four researchers (co-authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases.

Protocol for a randomised controlled trial of a family strengthening program to prevent unhealthy weight gain among 5 to 11-year-old children from at-risk families: the Strong Families Trial

Background

Obesity is an increasing health concern in Australia among adult and child populations alike and is often associated with other serious comorbidities. While the rise in the prevalence of childhood obesity has plateaued in high-income countries, it continues to increase among children from disadvantaged and culturally diverse backgrounds. The family environment of disadvantaged populations may increase the risk of childhood obesity through unhealthy eating and lifestyle practices. The Strong Families Trial aims to assess the effectiveness of a mixed behavioural and lifestyle intervention for parents and carers of at-risk populations, i.e. families from culturally diverse and disadvantaged backgrounds, in preventing unhealthy weight gain among children aged 5 to 11 years.

Methods

Eight hundred families from low socio-economic areas in Greater Western Sydney, NSW, and Melbourne, VIC, will be recruited and randomised into a lifestyle intervention or control group. The intervention comprises 90-minute weekly sessions for 6 weeks (plus two-booster sessions) of an integrated, evidence-based, parenting and lifestyle program that accounts for the influences of family functioning. Primary (anthropometric data) and secondary (family functioning, feeding related parenting, physical activity, consumption of healthy foods, health literacy, family and household costs) outcome measures will be assessed at baseline, immediately following the intervention, and 12 months post-intervention.

Discussion

This study will elucidate methods for engaging socially disadvantaged and culturally diverse groups in parenting programs concerned with child weight status.

Trial Registration

This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001019190). Registered 16 July 2019. 

Large-for-gestational age diagnosed during second-trimester anatomy ultrasound and association with gestational diabetes and large-for-gestational age at birth

OBJECTIVES

To determine if large-for-gestational age (LGA) diagnosed during second-trimester ultrasound examination is associated with the development of gestational diabetes mellitus (GDM) and LGA at birth.

METHODS

This was a retrospective cohort study of all pregnant women who underwent a second-trimester anatomy ultrasound examination between 18 and 22 weeks at our institution from 2012 to 2017. Patients were included in the LGA group if estimated fetal weight and/or fetal abdominal circumference was ≥ 90^th percentile for gestational age. Patients with a history of pre-GDM, multiple gestation, preterm delivery, use of betamethasone or fetal anomaly were excluded. The control group consisted of appropriate-for-gestational-age (AGA) pregnancies that were scanned at 18-22 weeks during the study period. AGA was defined as EFW > 10^th percentile and ≤ 89^th percentile. Prenatal and delivery records were reviewed and demographic and outcome variables were collected. Multivariable logistic regression models were applied to assess the impact of LGA diagnosed in the second trimester on the development of GDM and LGA at birth (birth weight ≥ 90^th percentile).

RESULTS

The study population included 756 patients with a LGA fetus and 756 with an AGA fetus on second-trimester ultrasound examination. In patients with a LGA fetus diagnosed during the second-trimester ultrasound examination, the incidence of GDM was 6.0% and the incidence of LGA at birth was 14.9%. Among patients with a LGA fetus in the second trimester, those who developed GDM or LGA at birth were significantly older and were more likely to be obese. Moreover, parity was associated with neonatal LGA (P = 0.0003) but not with GDM (P = 0.82). On multivariable logistic regression analysis with adjustment for age, parity, change in gestational body mass index, obesity, ethnicity and neonatal sex, LGA diagnosed during the second trimester was associated significantly with GDM (adjusted odds ratio (aOR), 2.54; 95% CI, 1.29-5.03; P = 0.007) and LGA at birth (aOR, 6.85; 95% CI, 3.60-13.05; P < 0.0001).

CONCLUSIONS

LGA diagnosed during second-trimester ultrasound examination is associated with the development of GDM and LGA at birth, independent of known risk factors, and could be used to identify these women earlier for intervention. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Using general practice clinical information system data for research: the case in Australia

General practice is often a patient’s first point of contact with the health system and the gateway to specialist services. In Australia, different aspects of the health system are managed by the Commonwealth Government and individual state / territory governments. Although there is a long history of research using administrative data in Australia, this split in the management and funding of services has hindered whole-system research. Additionally, the administrative data typically available for research are often collected for reimbursement purposes and lack clinical information.

General practices collect a range of patient information including diagnoses, medications prescribed, results of pathology tests ordered and so on. Practices are increasingly using clinical information systems and data extraction tools to make use of this information. This paper describes approaches used on several research projects to access clinical, as opposed to administrative, general practice data which to date has seen little use as a resource for research.

This information was accessed in three ways. The first was by working directly with practices to access clinical and management data to support research. The second involved accessing general practice data through collaboration with Primary Health Networks, recently established in Australia to increase the efficiency and effectiveness of health services for patients. The third was via NPS MedicineWise’s MedicineInsight program, which collects data from consenting practices across Australia and makes these data available to researchers.

We describe each approach including data access requirements and the advantages and challenges of each method. All approaches provide the opportunity to better understand data previously unavailable for research in Australia. The challenge of linking general practice data to other sources, currently being explored for general practice data, is discussed.

Finally, we describe some general practice data collections used for research internationally and how these compare to collections available in Australia.

Household dampness and microbial exposure related to allergy and respiratory health in Danish adults

Background: Indoor dampness has consistently been associated with respiratory symptoms and exacerbations. The causal mechanisms may involve increased microbial exposures. However, the evidence regarding the influence of indoor microbial exposures under damp- and non-damp conditions on the risk of asthma and allergy has been inconclusive. Objective: The aim of this study was to investigate the association between dampness and microbial exposure with allergy and respiratory health in Danish adults using a cross-sectional design. Methods: From 1,866 participants of the Health2006 cohort, we selected three non-overlapping groups: 196 at random, 107 with confirmed atopy, and 99 without atopy. Bedroom dust was sampled using electrostatic dust fall collectors and analysed for endotoxin, β-(1,3)-D-glucan, 19 microbial species or groups, and total fungal load. Household moisture-related problems and asthma were self-reported by questionnaire. Atopy was determined by skin-prick-testing and lung function was measured by spirometry. Results: Household moisture damage was positively associated with asthma outcomes, although this was statistically significant only in atopics for self-reported asthma (odds ratio (OR) 3.52; 95%CI 1.01-12.7). Mould odor was positively associated with wheezing (OR 6.05; 95%CI 1.19-30.7) in atopics. Inconsistent associations were found for individual microbial exposures and health outcomes. Inverse associations were observed between microbial diversity and rhinitis in the random sample and both doctor-diagnosed and self-reported asthma in non-atopics. Conclusions: In conclusion, our findings suggest that household moisture damage may increase the risk of asthma and wheeze with mould odor in atopics. In addition, asthma and allergy may be affected by the indoor microbial composition in urban domestic environments. Further studies are needed to identify and understand the causal agents and underlying mechanisms behind the potential effects of environmental microbial exposure on human health.

Beef Flavor Evaluation on Top Loin Steaks, Sirloin Steaks, Chuck Roasts, and 80/20 Ground Beef Over The Retail Case

ObjectivesConsumer acceptability in meat flavor is one of the driving factors of acceptability. Many studies have found factors that affect beef flavor, but little is known about variability of major beef cuts in the retail meat case where meat is displayed, and customers can choose from.Materials and MethodsFour beef cuts (chuck roast, top sirloin steaks, top loin steaks, and 80/20 ground beef) were obtained from retail stores in Miami, Los Angeles, Portland, New York, and Denver within a 2-mo period. The study wanted a variety of samples that were from different production systems or contained certain claims that would be available to customers. The meat was shipped with dry ice and stored at –9°C. For evaluation steaks, roasts, and ground beef were thawed 24 h at 4°C. Prior to cooking, chuck roasts were cut 10.16 × 12.7cm from the center of the roast. Each ground beef sample was formulated into 3, approximately 150 g patties. Chuck roasts were placed in a roasting pan on a roasting rack and 2 cups of water. Beef steaks and ground beef patties were cooked on a stovetop grill and cooked to 71°C, steaks and patties were flipped when temperature reached 35°F. Chuck roasts were cut into 1.27cm cubes with no visible connective tissue, fat, or outside browning. Steaks were cut into 1.27cm cubes with no connective tissue or fat. Ground beef patties were cut into 6 wedges. Panelists were served either 2 wedges or 2 1.27 cm samples for evaluation. An expert trained descriptive flavor and texture sensory panel was conducted where panelists evaluated beef flavors and textures. Beef flavor and texture attributes were analyzed using SAS (version 9.4, SAS Institute, Inc., Cary, NC) and principal component (PCA) bi-plots were generated using XLSTAT (Addinsoft, Inc., Long Island City, NY) using P < 0.05.ResultsChuck roasts were associated with bloody/serumy flavor aromatics. Ground beef patties were clustered with fat-like, overall sweet, green hay, and buttery flavor aromatics. Top sirloin steaks samples were more highly associated with off flavors such as liver, cardboardy, and sour flavor aromatics. Top loin steaks were clustered with positive attributes such as umami, beef flavor identity, and brown, roasted flavor aromatics. For the PCA biplot, factor 1 accounted for 60% and factor 2 accounted for 28% of variation. Ground beef was higher (P < 0.0001) in brown, fat like, green hay, sour milk/sour dairy, flavor aromatics, and had more salty and sweet basic taste than the other cuts. Ground beef patties had the least amount (P < 0.0001) of bloody/serumy, metallic, and liver like flavor aromatics. Chuck roasts had the least (P < 0.0001) beef flavor id, brown, roasted flavor aromatics and salt and umami basic taste. Sirloin steaks had the lowest (P < 0.0001) fat like flavor aromatic and the highest levels (P < 0.0001) of burnt and cardboardy flavor aromatics and bitter and sour basic taste. Sirloin steaks and chuck roasts had more metallic and liver like (P < 0.0001) flavor aromatics than other cuts. Top loin steaks were intermediate in flavor attributes.ConclusionFlavor descriptive attributes of four beef cuts differed. Results indicated that chuck roasts and top sirloin steaks were associated with negative flavor attributes. Ground beef contained sweeter, fat like attributes with exceptions of green hay, while top loin steaks were associated with more positive beef flavor attributes.

Measurements of Daily Energy Intake and Total Energy Expenditure in People with Dementia in Care Homes: The Use of Wearable Technology

OBJECTIVE

To estimate daily total energy expenditure (TEE) using a physical activity monitor, combined with dietary assessment of energy intake to assess the relationship between daily energy expenditure and patterns of activity with energy intake in people with dementia living in care homes.

DESIGN AND SETTING

A cross-sectional study in care homes in the UK.

PARTICIPANTS

Twenty residents with confirmed dementia diagnosis were recruited from two care homes that specialised in dementia care.

MEASUREMENTS

A physical activity monitor (SensewearTM Armband, Body Media, Pittsburgh, PA) was employed to objectively determine total energy expenditure, sleep duration and physical activity. The armband was placed around the left upper triceps for up to 7 days. Energy intake was determined by weighing all food and drink items over 4 days (3 weekdays and 1 weekend day) including measurements of food wastage.

RESULTS

The mean age was 78.7 (SD ± 11.8) years, Body Mass Index (BMI) 23.0 (SD ± 4.2) kg/m2; 50% were women. Energy intake (mean 7.4; SD ± 2.6) MJ/d) was correlated with TEE (mean 7.6; SD ± 1.8 MJ/d; r=0.49, p<0.05). Duration of sleeping ranged from 0.4-12.5 (mean 6.1) hrs/d and time spent lying down was 1.3-16.0 (8.3) hrs/d. On average residents spent 17.9 (6.3-23.4) hrs/d undertaking sedentary activity. TEE was correlated with BMI (r=0.52, p<0.05) and body weight (r=0.81, p<0.001) but inversely related to sleep duration (r=-0.59, p<0.01) and time lying down (r=-0.62, p<0.01). Multiple linear regression analysis revealed that after taking BMI, sleep duration and time spent lying down into account, TEE was no longer correlated with energy intake.

CONCLUSIONS

The results show the extent to which body mass, variable activity and sleep patterns may be contributing to TEE and together with reduced energy intake, energy requirements were not satisfied. Thus wearable technology has the potential to offer real-time monitoring to provide appropriate nutrition management that is more person-centred to prevent weight loss in dementia.

Relative abdominal adiposity is associated with chronic low back pain: a preliminary explorative study

Background

Although previous research suggests a relationship between chronic low back pain (cLBP) and adiposity, this relationship is poorly understood. No research has explored the relationship between abdominal-specific subcutaneous and visceral adiposity with pain and disability in cLBP individuals. The aim of this study therefore was to examine the relationship of regional and total body adiposity to pain and disability in cLBP individuals.

Methods

A preliminary explorative study design of seventy (n = 70) adult men and women with cLBP was employed. Anthropometric and adiposity measures were collected, including body mass index, waist-to-hip ratio, total body adiposity and specific ultrasound-based abdominal adiposity measurements. Self-reported pain and disability were measured using a Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) questionnaires respectively. Relationships between anthropometric and adiposity measures with pain and disability were assessed using correlation and regression analyses.

Results

Significant correlations between abdominal to lumbar adiposity ratio (A-L) variables and the waist-to-hip ratio with self-reported pain were observed. A-L variables were found to predict pain, with 9.1–30.5 % of the variance in pain across the three analysis models explained by these variables. No relationships between anthropometric or adiposity variables to self-reported disability were identified.

Conclusions

The findings of this study indicated that regional distribution of adiposity via the A-L is associated with cLBP, providing a rationale for future research on adiposity and cLBP.

Proposed genitalia contouring guidelines in anal cancer intensity-modulated radiotherapy

OBJECTIVE

Intensity-modulated radiotherapy (IMRT) for anal canal carcinoma (ACC) is associated with favourable toxicity outcomes. Side effects include sexual dysfunction, skin desquamation, pain and fibrosis to perineum and genitalia region. The genitalia are situated anterior to the primary ACC between two inguinal regions providing a challenging structure to avoid. Techniques improving outcomes require robust, consistent genitalia contouring to ensure standardization and production of fully optimized IMRT plans. Official recommendations for genitalia contouring are lacking. We describe a potential genitalia contouring atlas for ACC radiotherapy.

METHODS

Following a review of genitalia CT anatomy, a contouring atlas was generated for male and female patients positioned prone and supine. Particular attention was paid to the reproducibility of the genitalia contour in all planes.

RESULTS

Male and female genitalia positioned prone and supine are described and represented visually through a contouring atlas. Contoured areas in males include penis and scrotum, and in females include clitoris, labia majora and minora. The muscles, bone, prostate, vagina, cervix and uterus should be excluded. The genitalia contour extends laterally to inguinal creases and includes areas of fat and skin anterior to the symphysis pubis for both genders.

CONCLUSION

This atlas provides descriptive and visual guidance enabling more consistent genitalia delineation for both genders when prone and supine. The atlas can be used for other sites requiring radiotherapy planning.

ADVANCES IN KNOWLEDGE

This atlas presents visual contouring guidance for genitalia in ACC radiotherapy for the first time. Contouring methods provide reproducible genitalia contours that allow the provision of accurate dose toxicity data in future studies.