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Short HB, Guare EG, Spanos K, Karakoleva EV, Patel D, Truong N, Huang M, Lehman E, Mendez-Miller M. The Impact of a Student-Led Health Education Clinic on the Health Literacy and Behaviors of a Rural Community in the State of Pennsylvania, USA. J Community Health 2024; 49:458-465. [PMID: 38095814 DOI: 10.1007/s10900-023-01306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 04/02/2024]
Abstract
Rural populations experience a number of disparities that place them at increased risk of morbidity and mortality related to chronic disease, including lower health literacy and greater distance to medical care. Community-based free healthcare education can offer targeted preventive care to these vulnerable populations; however, limited quantitative research exists measuring their impact, specifically on health literacy and likelihood for behavior change. To investigate this, a student-led health education clinic was held in January 2023 in the rural community of Lykens, Pennsylvania by the Student-run and Collaborative Outreach Program for Health Equity (SCOPE). Fifty-five pre- and post-clinic surveys using Likert-style questions measured the knowledge and likelihood of behavioral change for several preventive health topics, including hypertension, diabetes mellitus, cancer screenings, childhood vaccinations, skin cancer, mental health, addiction, and nutrition. From pre- to post-clinic, there was a significant increase in knowledge of hypertension (p = 0.023) and diabetes (p = 0.014), likelihood of attending cancer screenings (p = 0.038), and confidence in identifying cancerous moles (p = < 0.001). There was a non-significant increase in understanding of mental health and nutrition, and no change in understanding of addiction or childhood vaccinations. It is likely that the level of interaction in education provided and relevance of information to participants contributed to effective uptake of information. The results demonstrate an immediate impact on health literacy and likelihood of behavioral change for several important preventive health topics, and advocate for the use of student-run healthcare interventions in addressing the prevalence of chronic disease in rural communities.
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Affiliation(s)
| | - Emma G Guare
- Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Devika Patel
- Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Nishi M, Nagamitsu R, Matoba S. Association between daily step counts and healthy life years: a national cross-sectional study in Japan. BMJ Health Care Inform 2024; 31:e101051. [PMID: 38688685 DOI: 10.1136/bmjhci-2024-101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Despite accumulating evidence concerning the association between daily step counts and mortality or disease risks, it is unclear whether daily step counts are associated with healthy life years. METHODS We used the combined dataset of the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey conducted for a randomly sampled general population in Japan, 2019. Daily step counts were measured for 4957 adult participants. The associations of daily step counts with activity limitations in daily living and self-assessed health were evaluated using a multivariable logistic regression model. The bootstrap method was employed to mitigate uncertainties in estimating the threshold of daily step counts. RESULTS The median age was 60 (44-71) years, and 2592 (52.3%) were female. The median daily step counts were 5650 (3332-8452). The adjusted OR of activity limitations in daily living for the adjacent daily step counts was 0.27 (95% CI 0.26 to 0.27) for all ages and 0.25 (95% CI 0.25 to 0.26) for older adults at the lowest, with the thresholds of significant association at 9000 step counts. The OR of self-assessed unhealthy status was 0.45 (95% CI 0.44 to 0.46) for all ages and 0.42 (95% CI 0.41 to 0.43) for older adults at the lowest, with the thresholds at 11 000 step counts. CONCLUSION Daily step counts were significantly associated with activity limitations in daily living and self-assessed health as determinants of healthy life years, up to 9000 and 11 000 step counts, respectively. These results suggest a target of daily step counts to prolong healthy life years within health initiatives.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Health and Welfare, Kyoto Prefectural Government, Kyoto, Japan
| | - Reo Nagamitsu
- Department of Epidemiology for Community Health and Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Health and Welfare, Kyoto Prefectural Government, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Hoang AT, Nguyen PA, Phan TP, Do GT, Nguyen HD, Chiu IJ, Chou CL, Ko YC, Chang TH, Huang CW, Iqbal U, Hsu YH, Wu MS, Liao CT. Personalised prediction of maintenance dialysis initiation in patients with chronic kidney disease stages 3-5: a multicentre study using the machine learning approach. BMJ Health Care Inform 2024; 31:e100893. [PMID: 38677774 PMCID: PMC11057266 DOI: 10.1136/bmjhci-2023-100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Optimal timing for initiating maintenance dialysis in patients with chronic kidney disease (CKD) stages 3-5 is challenging. This study aimed to develop and validate a machine learning (ML) model for early personalised prediction of maintenance dialysis initiation within 1-year and 3-year timeframes among patients with CKD stages 3-5. METHODS Retrospective electronic health record data from the Taipei Medical University clinical research database were used. Newly diagnosed patients with CKD stages 3-5 between 2008 and 2017 were identified. The observation period spanned from the diagnosis of CKD stages 3-5 until the maintenance dialysis initiation or a maximum follow-up of 3 years. Predictive models were developed using patient demographics, comorbidities, laboratory data and medications. The dataset was divided into training and testing sets to ensure robust model performance. Model evaluation metrics, including area under the curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value and F1 score, were employed. RESULTS A total of 6123 and 5279 patients were included for 1 year and 3 years of the model development. The artificial neural network demonstrated better performance in predicting maintenance dialysis initiation within 1 year and 3 years, with AUC values of 0.96 and 0.92, respectively. Important features such as baseline estimated glomerular filtration rate and albuminuria significantly contributed to the predictive model. CONCLUSION This study demonstrates the efficacy of an ML approach in developing a highly predictive model for estimating the timing of maintenance dialysis initiation in patients with CKD stages 3-5. These findings have important implications for personalised treatment strategies, enabling improved clinical decision-making and potentially enhancing patient outcomes.
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Affiliation(s)
- Anh Trung Hoang
- Nephro-Urology and Dialysis Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Phung-Anh Nguyen
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Thanh Phuc Phan
- International PhD program of Biotech and Healthcare Management,College of Management, Taipei Medical University, Taipei, Taiwan
- University Medical Center, Ho Chi Minh City, Vietnam
| | - Gia Tuyen Do
- Nephro-Urology and Dialysis Center, Bach Mai Hospital, Hanoi, Vietnam
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Huu Dung Nguyen
- Nephro-Urology and Dialysis Center, Bach Mai Hospital, Hanoi, Vietnam
| | - I-Jen Chiu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Chu-Lin Chou
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Ko
- Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Huang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Global Health & Health Security Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Chia-Te Liao
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
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Mertens HL, Kaifie A. [Nutrition counseling in medical practices-a cross-sectional study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03870-0. [PMID: 38639815 DOI: 10.1007/s00103-024-03870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION The purpose of this study was to assess the status of nutrition care and counseling in German medical practices, including physicians' nutrition interest and knowledge, existing obstacles, and possible ways of improving nutrition care. METHODS After development and a two-stage pretest, questionnaires with 32 items were distributed to all resident doctors of general medicine, internal medicine, gynecology and obstetrics, orthopedics, and occupational medicine in Aachen (n = 360) in early spring 2022. RESULTS The response rate was 29.2% and n = 105 participants were included in the analysis. During their consultation hours, 85.7% of the doctors conducted nutrition counseling (NC). While doctors estimated that 39.5% of their patients need NC, they counseled only 28.1%. General practitioners spent an average of 13 min on NC; all other specialties spent 9.5 min. Most participants felt well informed about healthy nutrition (95.2%). Nutrition was of high personal interest to 57.7% of the participants, and 47.6% considered it important for their work as a doctor. Barriers preventing better NC included the lack of nutrition education during medical studies (89.5%) and specialist training (79.6%), and the lack of time (75.2%). Most participants were willing to conduct more NC if they were paid better and had more time for NC during their working hours. DISCUSSION Doctors consider NC a relevant part of their work, despite many barriers. To make better use of NC as a measure for treating and preventing common diseases, improvements like better nutrition education for doctors, better funding, and more time for NC are required.
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Affiliation(s)
- Hannah Luisa Mertens
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - Andrea Kaifie
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Alcalá HE, Ng AE, Tkach N, Yue D, Sharif M. Disparities in Screening for Adverse Childhood Experiences. J Am Board Fam Med 2024; 37:73-83. [PMID: 38272536 DOI: 10.3122/jabfm.2023.230262r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Screening for adverse childhood experiences (ACEs) in the clinical setting is set to become more commonplace with continued efforts to reimburse clinicians for screening. However, an examination of disparities in ACEs screening and related attitudes and beliefs is needed. METHODS Using the 2021 California Health Interview Survey (CHIS), this study examined if several measures of socioeconomic status, access to care and identities were associated with 3 outcomes: 1) getting screened for ACEs by a clinician; 2) beliefs about the importance of screening and 3) satisfaction with efforts to address the impacts of ACEs. Logistic regressions were used to estimate odds of the outcomes. RESULTS Black, Latinx, and Asian individuals had lower odds of being screened for ACEs than non-Hispanic Whites. A recent doctor's visit, higher burden of ACEs, and serious psychological distress were associated with higher odds of being screened. Latinx individuals, women, bisexual individuals, those with a recent doctor's visit and those with serious psychological distress had higher odds of believing clinicians asking about ACEs was very important, relative to their counterparts. Latinx individuals, American Indian or Alaska native individuals, Asian individuals, those with higher educational attainment and those with serious psychological distress had lower odds of being very satisfied with providers' efforts to address the impact of ACEs, relative to their counterparts. CONCLUSIONS Efforts to expand ACEs screening should consider the disparities in screening that currently exist. Given the wide-ranging impacts that ACEs have on health, an equitable approach to screening is necessary.
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Affiliation(s)
- Héctor E Alcalá
- From the Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD (HEA), University of Maryland, College Park, Department of Epidemiology and Biostatistics, College Park, MD (AEN), New York Institute of Technology, Old Westbury, New York (NT), University of Maryland, College Park, Department of Health Policy and Management, College Park, MD (DY), University of Washington, Seattle, Department of Epidemiology, Hans Rosling Center for Population Health, Seattle, WA (MS).
| | - Amanda E Ng
- From the Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD (HEA), University of Maryland, College Park, Department of Epidemiology and Biostatistics, College Park, MD (AEN), New York Institute of Technology, Old Westbury, New York (NT), University of Maryland, College Park, Department of Health Policy and Management, College Park, MD (DY), University of Washington, Seattle, Department of Epidemiology, Hans Rosling Center for Population Health, Seattle, WA (MS)
| | - Nicholas Tkach
- From the Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD (HEA), University of Maryland, College Park, Department of Epidemiology and Biostatistics, College Park, MD (AEN), New York Institute of Technology, Old Westbury, New York (NT), University of Maryland, College Park, Department of Health Policy and Management, College Park, MD (DY), University of Washington, Seattle, Department of Epidemiology, Hans Rosling Center for Population Health, Seattle, WA (MS)
| | - Dahai Yue
- From the Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD (HEA), University of Maryland, College Park, Department of Epidemiology and Biostatistics, College Park, MD (AEN), New York Institute of Technology, Old Westbury, New York (NT), University of Maryland, College Park, Department of Health Policy and Management, College Park, MD (DY), University of Washington, Seattle, Department of Epidemiology, Hans Rosling Center for Population Health, Seattle, WA (MS)
| | - Mienah Sharif
- From the Department of Behavioral and Community Health, University of Maryland, College Park, College Park, MD (HEA), University of Maryland, College Park, Department of Epidemiology and Biostatistics, College Park, MD (AEN), New York Institute of Technology, Old Westbury, New York (NT), University of Maryland, College Park, Department of Health Policy and Management, College Park, MD (DY), University of Washington, Seattle, Department of Epidemiology, Hans Rosling Center for Population Health, Seattle, WA (MS)
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Afonso J, Reurink G, Clemente FM, Ramirez-Campillo R, Pizzari T, Andrade R. Revisiting the hamstring injury prevention and rehabilitation literature: filling the gaps! Br J Sports Med 2024; 58:243-244. [PMID: 38071509 DOI: 10.1136/bjsports-2023-106878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 03/10/2024]
Affiliation(s)
- José Afonso
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal
| | - Guus Reurink
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- The Sport Physician Group, Department of Sports Medicine, OLVG, Amsterdam, The Netherlands
| | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Tania Pizzari
- La Trobe University La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Renato Andrade
- Porto Biomechanics Laboratory (LABIOMEP), Porto, Portugal
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal
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Heerey JJ, van Klij P, Agricola R, Dijkstra HP, Plass L, Crossley KM, Kemp JL. Preventing hip osteoarthritis in athletes: is it really a mission impossible? Br J Sports Med 2024:bjsports-2023-107584. [PMID: 38423751 DOI: 10.1136/bjsports-2023-107584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Pim van Klij
- Department of Sports Medicine, Isala Hospital, Zwolle, Overijssel, The Netherlands
| | - Rintje Agricola
- Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Hendrik P Dijkstra
- Medical Education Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lindsey Plass
- Plass PT & Performance, Chicago, Illinois, USA
- The University of Chicago Medicine, Chicago, Illinois, USA
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Kang HY, Choe EK. Clinical Strategies in Gene Screening Counseling for the Healthy General Population. Korean J Fam Med 2024; 45:61-68. [PMID: 38528647 DOI: 10.4082/kjfm.23.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 03/27/2024] Open
Abstract
The burgeoning interest in precision medicine has propelled an increase in the use of genome tests for screening purposes within the healthy population. Gene screening tests aim to pre-emptively identify those individuals who may be genetically predisposed to certain diseases. However, as genetic screening becomes more commonplace, it is essential to acknowledge the unique challenges it poses. A prevalent issue in this regard is the occurrence of falsepositive results, which can lead to unnecessary additional tests or treatments, and psychological distress. Additionally, the interpretation of genomic variants is based on current research evidence, and can accordingly change as new research findings emerge, potentially altering the clinical significance of these variants. Conversely, a further prominent concern regards false assurances in genetic testing, as genetic tests can yield false-negative results, potentially posing a significant clinical risk. Moreover, the results obtained for the same disease can vary among different genetic testing services, due to differences in the types of variants assessed, the scope of tests, analytical methods, and the algorithms used for predicting diseases. Consequently, whereas genetic testing holds significant promise for the future of medicine, it poses unique challenges. If conducted without a full understanding of its implications, genetic testing may fail to achieve its purpose potentially hindering effective health management. Therefore, to ensure a comprehensive understanding of the implications of genetic testing within the general population, sufficient discussion and careful consideration should be given to counseling based on gene test results.
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Affiliation(s)
- Hae Yeon Kang
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Eun Kyung Choe
- Department of Surgery, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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Bolling C, Tomás R, Verhagen E. 'Considering the reality, I am very lucky': how professional players and staff perceive injury prevention and performance protection in women's football. Br J Sports Med 2024:bjsports-2023-106891. [PMID: 38378261 DOI: 10.1136/bjsports-2023-106891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To explore the beliefs and perceptions of professional female footballers and staff regarding injury prevention and performance protection in professional women's football. METHODS This qualitative study applied semistructured interviews with 18 participants from 3 top-tier teams from 2 countries (Portugal and England) and 4 nationalities, including 2 physiotherapists, 5 players, 3 team doctors, 2 head coaches, 3 strength and conditioning coaches, 2 managers, and 1 head of performance. Data analysis applied constant comparison analysis, using principles of grounded theory. There were no major differences in the perspectives of players and staff, and the findings are presented together. RESULTS Identifying and reporting injuries and recognising potential injury risk factors were mentioned to influence the prevention of injury. Participants stated that the growth and evolution of women's football could influence injury risk. Before reaching the professional level, exposure to potential risk factors, such as lack of recovery, limited awareness and opportunities for prevention (eg, preventive exercises and load management strategies), was believed to impact players' injury risk. Players further described their experiences and the 'bumpy road' to becoming a professional player, their current context and potential future improvements for women's football regarding injury prevention and performance protection. CONCLUSION Professional female football players face different injury risks during different moments of their careers. According to elite players and staff, amateur and semiprofessionals have limited resources and lack injury prevention strategies. Professional players and staff perceived the current preventive measures as good and relied on the value of individualised care and a multidisciplinary approach. In the future, more resources and structured injury prevention strategies are needed in youth and non-professional levels of women's football to reduce injury risk and allow more players to reach their maximal performance.
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Affiliation(s)
- Caroline Bolling
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Rita Tomás
- Portuguese Football Federation, Cruz Quebrada, Portugal
| | - Evert Verhagen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Abohashem S, Nasir K, Munir M, Sayed A, Aldosoky W, Abbasi T, Michos ED, Gulati M, Rana JS. Lack of leisure time physical activity and variations in cardiovascular mortality across US communities: a comprehensive county-level analysis (2011-2019). Br J Sports Med 2024; 58:204-212. [PMID: 38212043 DOI: 10.1136/bjsports-2023-107220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To investigate the associations between county-level proportions of adults not engaging in leisure-time physical activity (no LTPA) and age-adjusted cardiovascular mortality (AACVM) rates in the overall US population and across demographics. METHODS Analysing 2900 US counties from 2011 to 2019, we used the Centers for Disease Control and Prevention (CDC) databases to obtain annual AACVM rates. No LTPA data were sourced from the CDC's Behavioural Risk Factor Surveillance System survey and county-specific rates were calculated using a validated multilevel regression and poststratification modelling approach. Multiple regression models assessed associations with county characteristics such as socioeconomic, environmental, clinical and healthcare access factors. Poisson generalised linear mixed models were employed to calculate incidence rate ratios (IRR) and additional yearly deaths (AYD) per 100 000 persons. RESULTS Of 309.9 million residents in 2900 counties in 2011, 7.38 million (2.4%) cardiovascular deaths occurred by 2019. County attributes such as socioeconomic, environmental and clinical factors accounted for up to 65% (adjusted R2=0.65) of variance in no LTPA rates. No LTPA rates associated with higher AACVM across demographics, notably among middle-aged adults (standardised IRR: 1.06; 95% CI (1.04 to 1.07)), particularly women (1.09; 95% CI (1.07 to 1.12)). The highest AYDs were among elderly non-Hispanic black individuals (AYD=68/100 000). CONCLUSIONS Our study reveals a robust association between the high prevalence of no LTPA and elevated AACVM rates beyond other social determinants. The most at-risk groups were middle-aged women and elderly non-Hispanic black individuals. Further, county-level characteristics accounted for substantial variance in community LTPA rates. These results emphasise the need for targeted public health measures to boost physical activity, especially in high-risk communities, to reduce AACVM.
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Affiliation(s)
- Shady Abohashem
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts, USA
- Epidemiology Department, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Khurram Nasir
- Department of Cardiology Houston Methodist DeBakey Heart, Vascular Center, Houston, Texas, USA
| | - Malak Munir
- Department of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Sayed
- Department of Medicine, Ain Shams University, Cairo, Egypt
| | - Wesam Aldosoky
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Taimur Abbasi
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jamal S Rana
- Department of Cardiology and Division of Research, The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
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Spitzer EG, Stearns-Yoder KA, Hoffberg AS, Bailey HM, Miller CJ, Simonetti JA. A Systematic Review of Lethal Means Safety Counseling Interventions: Impacts on Safety Behaviors and Self-Directed Violence. Epidemiol Rev 2024:mxae001. [PMID: 38324739 DOI: 10.1093/epirev/mxae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
For lethal means safety counseling interventions (LMSC) to reduce population-level suicide rates, interventions must be deployed across many settings and populations. We conducted a systematic search in six databases to review the current state of LMSC interventions across study designs, settings, messengers, populations, and injury prevention levels (e.g., universal). Eligibility criteria were: any individual or group receiving a LMSC intervention involving a human-to-human component aiming to influence adult behaviors related to lethal suicide methods, and outcome assessment of storage behaviors and/or suicidal self-directed violence (SDV). Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool. A descriptive synthesis approach was used for analysis. Twenty-two studies were included that reported medication and/or firearm storage behaviors and/or SDV following LMSC. Fourteen of the 19 studies assessing behavioral change reported a significant improvement in safe storage behaviors, and all studies measuring acceptability reported that participants found the interventions favorable. Quality of evidence was limited. No studies were rated low risk of bias, and 77% were rated high risk of bias. There was substantial heterogeneity in the settings, populations, injury prevention levels, delivery methods, and intervention elements. Many included studies focused on caregivers of pediatric populations, and few studies assessed SDV outcomes. Higher quality trials conducted across a variety of settings, particularly those focusing on adults at risk of suicide, are needed. There was no funding for this review, and it was preregistered on the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42021230668).
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Affiliation(s)
- Elizabeth G Spitzer
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado
| | - Kelly A Stearns-Yoder
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado
| | - Adam S Hoffberg
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado
| | - Hannah M Bailey
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado
- Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colorado
- Program for Injury Prevention, Education & Research, Colorado School of Public Health, Aurora, Colorado
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12
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Abuelazm MT, Elzeftawy MA, Kamal MA, Badr H, Gamal M, Aboulgheit M, Abdelazeem B, Abd-Elsalam S, Abouzid M. Protective efficacy and safety of radiation-attenuated and chemo-attenuated Plasmodium Falciparum sporozoite vaccines against controlled and natural malaria infection: a systematic review and meta-analysis of randomized controlled trials. Infection 2024:10.1007/s15010-024-02174-4. [PMID: 38319556 DOI: 10.1007/s15010-024-02174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/01/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND OBJECTIVE Despite the significant burden of Plasmodium falciparum (Pf) malaria and the licensure of two vaccines for use in infants and young children that are partially effective in preventing clinical malaria caused by Pf, a highly effective vaccine against Pf infection is still lacking. Live attenuated vaccines using Pf sporozoites as the immunogen (PfSPZ Vaccines) hold promise for addressing this gap. Here we review the safety and efficacy of two of the most promising PfSPZ approaches: PfSPZ Vaccine (radiation attenuated PfSPZ) and PfSPZ-CVac (chemo-attenuated PfSPZ). METHODS We conducted a systematic review and meta-analysis by searching PubMed, EMBASE, SCOPUS, CENTRAL, and WOS until 22nd December 2021. We included randomized controlled trials (RCTs) of these two vaccine approaches that measured protection against parasitaemia following controlled human malaria infection (CHMI) in malaria-naive and malaria-exposed adults or following exposure to naturally transmitted Pf malaria in African adults and children (primary outcome) and that also measured the incidence of solicited and unsolicited adverse events as indicators of safety and tolerability after vaccination (secondary outcome). We included randomized controlled trials (RCTs) that measured the detected parasitaemia after vaccination (primary outcome) and the incidence of various solicited and unsolicited adverse events (secondary outcome). The quality of the included RCTs using the Cochrane ROB 1 tool and the quality of evidence using the GRADE system were evaluated. We pooled dichotomous data using the risk ratio (RR) for development of parasitemia in vaccinees relative to controls as a measure of vaccine efficacy (VE), including the corresponding confidence interval (CI). This study was registered with PROSPERO (CRD42022308057). RESULTS We included 19 RCTs. Pooled RR favoured PfSPZ Vaccine (RR: 0.65 with 95% CI [0.53, 0.79], P = 0.0001) and PfSPZ-table (RR: 0.42 with 95% CI [0.27, 0.67], P = 0.0002) for preventing parasitaemia, relative to normal saline placebo. Pooled RR showed no difference between PfSPZ Vaccine and the control in the occurrence of any solicited adverse event (RR: 1.00 with 95% CI [0.82, 1.23], P = 0.98), any local solicited adverse events (RR: 0.73 with 95% CI [0.49, 1.08], P = 0.11), any systemic solicited adverse events (RR: 0.94 with 95% CI [0.75, 1.17], P = 0.58), and any unsolicited adverse event (RR: 0.93 with 95% CI [0.78, 1.10], P = 0.37). CONCLUSION PfSPZ and PfSPZ-CVacs showed comparable efficacy. Therefore, they can introduce a promising strategy for malaria prophylaxis, but more large-scale field trials are required to sustain efficacy and yield clinically applicable findings.
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Affiliation(s)
| | | | | | - Helmy Badr
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | | | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Rokietnicka 3, 60-806, Poznan, Poland.
- Doctoral School, Poznan University of Medical Sciences, Poznan, Poland.
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13
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Dayao JKO, Duffy CEL, Cristiano AM, Kallenberg G'R, Linke SE. Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system. Fam Med Community Health 2024; 12:e002608. [PMID: 38307706 PMCID: PMC10840037 DOI: 10.1136/fmch-2023-002608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE Exercise is Medicine (EIM) is a global initiative encouraging healthcare providers to routinely assess and promote physical activity (PA) among patients. The objective of this study was to evaluate the feasibility, adoption, implementation and effectiveness of EIM from patient, clinician and healthcare staff perspectives using a combination of electronic health record (EHR), survey and interview data. DESIGN This study used a combination of the Practical Robust Implementation and Sustainability Model (PRISM) and the Learning Evaluation model to implement EIM. Data captured from the EHR, including Physical Activity Vital Sign (PAVS) scores, and data collected from qualitative surveys and interviews were used to evaluate the programme's Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM, which is embedded within PRISM) from provider, staff and patient perspectives. SETTING Five primary care clinics within a large academic health system. PARTICIPANTS A total of 24 443 patients from all participating clinics had at least one PAVS score during the study period. A total of 17 clinicians completed surveys, and 4 clinicians, 8 medical assistants and 9 patients completed interviews. RESULTS Implementation fidelity metrics varied widely between components and across clinics but were generally consistent over time, indicating a high degree of programme maintenance. Fidelity was highest during the first 6 months of the COVID-19 pandemic when most visits were virtual. Mean PAVS scores increased from 57.7 (95% CI: 56 to 59.4) to 95.2 (95% CI: 91.6 to 98.8) min per week at 6 months for patients not meeting PA guidelines at baseline and decreased from 253.84 (95% CI: 252 to 255.7) to 208.3 (95% CI: 204.2 to 212.4) min per week at 6 months for patients meeting PA guidelines at baseline. After EIM implementation, clinician-estimated time spent discussing PA with patients increased for 35% of providers and stayed the same for 53%. CONCLUSION Overall, this study established EIM's feasibility, adoption, implementation and maintenance in routine primary care practice within a large academic health system. From a population health perspective, EIM is a model to emulate to help primary care providers efficiently address healthy lifestyle behaviours in routine primary care visits.
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Affiliation(s)
- John Kevin Ong Dayao
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Caroline E L Duffy
- Milken Institute of Public Health, The George Washington University, Washington, District of Columbia, USA
- The University of Texas Medical Branch at Galveston School of Medicine, Galveston, Texas, USA
- Scripps Family Medicine Residency, Scripps Mercy Hospital Chula Vista, Chula Vista, California, USA
| | - Amalia M Cristiano
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Gene 'Rusty' Kallenberg
- Department of Family Medicine, University of California San Diego, La Jolla, California, USA
| | - Sarah E Linke
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Department of Family Medicine, University of California San Diego, La Jolla, California, USA
- Omada Health, San Francisco, California, USA
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Gori S, Frayle H, Pagan A, Soldà M, Romagnolo C, Insacco E, Laurino L, Matteucci M, Sordi G, Busato E, Zorzi M, Maggino T, Del Mistro A. Exploring conservative management for cervical intraepithelial neoplasia grade 2 in organised cervical cancer screening programmes: a multicentre study in Italy. Fam Med Community Health 2024; 12:e002595. [PMID: 38307701 PMCID: PMC10840026 DOI: 10.1136/fmch-2023-002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024] Open
Abstract
Cervical intraepithelial neoplasia grade 2 (CIN2) lesions may regress spontaneously, offering an alternative to immediate treatment, especially for women of childbearing age (15-45 years).We conducted a prospective multicentre study on conservative CIN2 management, with semiannual follow-up visits over 24 months, biomarkers' investigation and treatment for progression to CIN3+ or CIN2 persistence for more than 12 months. Here, we assess women's willingness to participate and adherence to the study protocol.The study was set in population-based organised cervical cancer screening.From April 2019 to October 2021, 640 CIN2 cases were diagnosed in women aged 25-64 participating in the screening programmes.According to our predefined inclusion and exclusion criteria, 228 (35.6%) women were not eligible; 93 (22.6%) of the 412 eligible refused, and 319 (77.4%) were enrolled. Refusal for personal reasons (ie, desire to become pregnant, anxiety, difficulty in complying with the study protocol) and external barriers (ie, residence elsewhere and language problems) accounted for 71% and 17%, respectively. Only 9% expressed a preference for treatment. The primary ineligibility factor was the upper age limit of 45 years. After enrolment, 12 (4%) women without evidence of progression requested treatment, 125 (39%) were lost to follow-up (mostly after 6-12 months) and 182 (57%) remained compliant. Remarkably, 40% of enrolees did not fully adhere to the protocol, whereas only 5% (20/412) of the eligible women desired treatment.Our study demonstrates a good acceptance of conservative management for CIN2 lesions by the women, supporting its implementation within cervical screening programmes.
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Affiliation(s)
- Silvia Gori
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Helena Frayle
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | | | | | | | - Egle Insacco
- Obstetrics and Gynecology, Azienda Ospedale Università, Padova, Italy
| | | | - Mario Matteucci
- Obstetrics and Gynecology, Azienda Ospedale Università, Padova, Italy
| | | | | | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
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15
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Kristensen AMD, Pareek M, Kragholm KH, McEvoy JW, Torp-Pedersen C, Prescott EB. Long-term aspirin adherence following myocardial infarction and risk of cardiovascular events. Eur Heart J Qual Care Clin Outcomes 2024:qcae009. [PMID: 38305132 DOI: 10.1093/ehjqcco/qcae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND AIMS Aspirin is considered mandatory after myocardial infarction (MI). However, its long-term efficacy has been questioned. This study investigated the effectiveness of long-term aspirin after MI. METHODS Patients ≥ 40 years with MI from 2004-2017 who were adherent to aspirin one year after MI were included from Danish nationwide registries. At 2, 4, 6, and 8 years after MI, continued adherence to aspirin was evaluated. Absolute and relative risks of MI, stroke, or death at 2 years from each timepoint were calculated using multivariable logistic regression analysis with average treatment effect modeling standardized for age, sex, and comorbidities. Subgroup analyses were stratified by sex and age > and ≤ 65 years. RESULTS Among 40 114 individuals included, the risk of the composite endpoint was significantly higher for nonadherent patients at all timepoints. The absolute risk was highest at 2-4 years after MI for both adherent (8.34%, 95% confidence interval [CI]: 8.05-8.64%) and nonadherent patients (10.72%, 95% CI: 9.78-11.66%). The relative risk associated with nonadherence decreased from 4 years after index-MI and onwards: 1.41 (95% CI: 1.27-1.55) at 4-6 years and 1.21 (95% CI: 1.06-1.36) at 8-10 years (Ptrend = 0.056). Aspirin nonadherence in women and individuals > 65 years was not associated with increased risk. Pinteraction at each of the timepoints: Age-<0.001, <0.001, 0.002, 0.51; Sex - 0.25, 0.02, 0.02, 0.82. CONCLUSION Nonadherence to long-term aspirin was associated with increased risk of MI, stroke, or death, but not in women or individuals > 65 years. The risk decreased from 4 years after MI with near statistical significance.
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Affiliation(s)
| | - Manan Pareek
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - John William McEvoy
- National Institute for Prevention and Cardiovascular Health, School of Medicine, University of Galway, Ireland
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital-North Zealand Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Eva Bossano Prescott
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Fazal M, Chidiac C, Ahmad R, Issa O, Hodgman E, Garcia AV. Characteristics and trends of pediatric firepit burns: insights for prevention and safety. World J Pediatr Surg 2024; 7:e000700. [PMID: 38298825 PMCID: PMC10828845 DOI: 10.1136/wjps-2023-000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction As fire pits grow in popularity, so do the associated burn injuries. Our study examines pediatric fire pit burns characteristics to raise awareness and promote safety precautions. Methods We conducted a retrospective review of pediatric patients (≤21 years) with firepit burns at a tertiary care hospital from 2016 to 2021. Results Eighty-four patients were identified, of whom 70.2% were male, with a median age of 62 months. The median percent total body surface area burned was 2% (interquartile range (IQR)=1-4). Thirty-five (41.7%) patients were admitted and 7 (8.3%) underwent grafting. Neck and trunk burns had the highest grafting rates (66% and 33%, respectively). The hands (41.7%) and the lower extremities (27.4%) were the most frequently burned body areas. The leading causes of burns were ashes/hot coals (34.5%), flames (31.0%), and direct contact (25.0%), often resulting from falling into the fire (59.5%) or running or playing in activities near it (26.2%). Thirty-five (41.7%) were admitted for inpatient management, while 49 (58.3%) were treated as outpatient. Eleven (13.2%) underwent at least one reconstructive surgery, 7 (8.4%) had at least one rehabilitation visit, and 65 (77.4%) had follow-up clinic visits. The median length of stay was 2 days (IQR=1.0-3.5). The peak months for burns were from August through October (n=40, 46.0%), with an increase observed from 10 cases in 2016 to 20 cases in 2020. Conclusions Given the significant proportion of firepit burns resulting from unsafe fire behaviors, it is crucial that caretakers are aware of proper firepit safety precautions. Level of evidence III.
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Affiliation(s)
- Maria Fazal
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Charbel Chidiac
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Raheel Ahmad
- Division of the Biological Sciences, University of Chicago, Chicago, Illinois, USA
| | - Oussama Issa
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Erica Hodgman
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Alejandro V Garcia
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Filipas DK, Labban M, Beatrici E, Stone BV, Qian Z, D Andrea V, Ludwig TA, Reis LO, Cole AP, Trinh QD. Exploring preventive care practices among unvaccinated individuals in the United States during the COVID-19 pandemic. Vaccine 2024; 42:441-447. [PMID: 38184391 DOI: 10.1016/j.vaccine.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Building on a Canadian study associating unvaccinated individuals to increased car accidents, we examined the relationship between COVID-19 vaccination status and US preventive care practices. METHODS We queried the 2021 National Health Interview Survey. First, we fitted a model to identify respondent-level factors associated with receipt of at least one COVID-19 vaccination. Second, we fitted a survey-weighted logistic regression model adjusted for respondent-level characteristics to examine whether the receipt of at least one COVID-19 vaccination predicted the receipt of preventive care services. Preventive care services assessed included serum cholesterol, glucose, and blood pressure measurements, as well as guideline-concordant cancer screening including breast, cervical, colorectal, and prostate cancer screening. RESULTS Factors predicting receipt of COVID-19 vaccination were age (adjusted Odds Ratio (aOR) 1.03; 95 % confidence interval (CI) [1.03-1.03]), Hispanic (aOR 1.25; 95 % CI [1.08-1.44]), and non-Hispanic Asian (aOR 3.52; 95 % CI [2.74-4.52]) ethnicity/race, and history of cancer (aOR 1.61; 95 % CI [1.13-2.30]). Unvaccinated respondents were less likely to have received serum cholesterol (aOR 0.69; 95 % CI [0.50-0.70), serum glucose (aOR 0.65; 95 % CI [0.56-0.75]), or blood pressure measurements (aOR 0.47; 95 % CI [0.33-0.66]); and were less likely to have received breast cancer (aOR 0.35; 95 % CI [0.25-0.48]), colorectal cancer (aOR 0.52; 95 % CI [0.46-0.60]) and prostate cancer screening (aOR 0.61; 95 % CI [0.48-0.76]). There was no significant association between unvaccinated respondents receiving cervical cancer screening (aOR 0.96; 95 % CI [0.81-1.13]; p = 0.616). CONCLUSION Non-receipt of COVID-19 vaccination was associated with non-receipt of preventive care services including cancer screening. Further studies are needed to assess if this association is due to system-level factors or reflects a general distrust of medical preventive care amongst this population.
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Affiliation(s)
- Dejan K Filipas
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany
| | - Muhieddien Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Edoardo Beatrici
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Benjamin V Stone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Zhiyu Qian
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Vincent D Andrea
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Tim A Ludwig
- University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany
| | - Leonardo O Reis
- UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, Sao Paulo State, Brazil
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
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Jalepalli SK, Gupta P, Dekker ALAJ, Bermejo I, Kar S. Development and validation of multicentre study on novel Artificial Intelligence-based Cardiovascular Risk Score (AICVD). Fam Med Community Health 2024; 12:e002340. [PMID: 38238156 PMCID: PMC10806469 DOI: 10.1136/fmch-2023-002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Cardiovascular diseases (CVD) are one of the most prevalent diseases in India amounting for nearly 30% of total deaths. A dearth of research on CVD risk scores in Indian population, limited performance of conventional risk scores and inability to reproduce the initial accuracies in randomised clinical trials has led to this study on large-scale patient data. The objective is to develop an Artificial Intelligence-based Risk Score (AICVD) to predict CVD event (eg, acute myocardial infarction/acute coronary syndrome) in the next 10 years and compare the model with the Framingham Heart Risk Score (FHRS) and QRisk3. METHODS Our study included 31 599 participants aged 18-91 years from 2009 to 2018 in six Apollo Hospitals in India. A multistep risk factors selection process using Spearman correlation coefficient and propensity score matching yielded 21 risk factors. A deep learning hazards model was built on risk factors to predict event occurrence (classification) and time to event (hazards model) using multilayered neural network. Further, the model was validated with independent retrospective cohorts of participants from India and the Netherlands and compared with FHRS and QRisk3. RESULTS The deep learning hazards model had a good performance (area under the curve (AUC) 0.853). Validation and comparative results showed AUCs between 0.84 and 0.92 with better positive likelihood ratio (AICVD -6.16 to FHRS -2.24 and QRisk3 -1.16) and accuracy (AICVD -80.15% to FHRS 59.71% and QRisk3 51.57%). In the Netherlands cohort, AICVD also outperformed the Framingham Heart Risk Model (AUC -0.737 vs 0.707). CONCLUSIONS This study concludes that the novel AI-based CVD Risk Score has a higher predictive performance for cardiac events than conventional risk scores in Indian population. TRIAL REGISTRATION NUMBER CTRI/2019/07/020471.
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Affiliation(s)
| | | | - Andre L A J Dekker
- Department of Radiation Oncology (Maastro), Maastricht University, Maastricht, Netherlands
| | - Inigo Bermejo
- Department of Radiation Oncology (Maastro), Maastricht University, Maastricht, Netherlands
| | - Sujoy Kar
- Apollo Hospitals, Hyderabad, Telangana, India
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Williams A, Chu K, Uptegraft C, Duncan J. An Introduction to Clinical Informatics for Early Medical Learners Using Colorectal Cancer Screening. MedEdPORTAL 2024; 20:11379. [PMID: 38196824 PMCID: PMC10774475 DOI: 10.15766/mep_2374-8265.11379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/11/2023] [Indexed: 01/11/2024]
Abstract
Introduction Clinical informatics is an important component of the AMA-endorsed third pillar of undergraduate medical education, health systems science. Discrete educational opportunities for clinical informatics and health systems science among early learners are lacking in medical school curricula. Methods We developed and evaluated a multistep, 2.5-hour activity during the gastroenterology module to introduce these topics to preclerkship medical students. A didactic session introducing clinical informatics and clinical decision support and reviewing health promotion and screening concepts was followed by small-group activities. Students worked through a series of exercises culminating in the generation of a clinical decision support tool based on the United States Preventive Services Task Force (USPSTF) colorectal cancer screening recommendations. Results Between 2022 and 2023, 326 first-year medical students participated in this workshop. Feedback was predictably mixed. In 2022, 88% of postclass survey respondents confirmed having a better clinical informatics understanding after the workshop. In 2023, students reported a statistically significant increase in their self-reported understanding of the role of clinical informatics, clinical decision support, and USPSTF colorectal cancer recommendations. Discussion Clinical decision support is a viable pathway for introduction of clinical informatics, health systems science, and public health/prevention topics. Our educational approach offers an interactive introduction to this group of topics that can benefit future physicians. While colon cancer provides a robust option for the clinical situation, this activity could be modified to fit into many different clinical scenarios, allowing for interdisciplinary education during either undergraduate or graduate medical education.
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Affiliation(s)
- Alan Williams
- Associate Professor, Department of Family Medicine, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
| | - Kasi Chu
- Assistant Professor, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
| | - Colby Uptegraft
- Clinical Branch Chief, Health Informatics Directorate, Defense Health Agency
| | - Joshua Duncan
- Assistant Professor, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
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Sharma P, Khanna D, Pradhan S, Birur P. Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention. Fam Med Community Health 2023; 11:e002397. [PMID: 38105243 PMCID: PMC10729271 DOI: 10.1136/fmch-2023-002397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE Despite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for oral, breast and cervical cancer prevention in a rural community at the primary care level of Northern India and its policy implications. DESIGN This was a camp-based project conducted for 1 year, using oral visual examination, clinical breast examination and visual inspection of cervix by application of 5% acetic acid according to primary healthcare operational guidelines. During the project, screen-positive participants were followed through reverse navigation. Information about socio-demographic profile, clinical and behavioural history and screening were collected. Predictors for screen-positivity and follow-up compliance were identified through multivariable analysis. SETTINGS Based on the aim of project, one of the remotely located and low socioeconomic rural blocks, having 148 villages (estimated population of 254 285) in Varanasi district, India was selected as the service site. There is an established healthcare delivery and referral system as per the National Health Mission of Government of India. Oral, breast, gallbladder and cervical cancers are the leading cancers in the district. PARTICIPANTS We invited all men and women aged 30-65 years residing in the selected block for the last 6 months for the screening camps. Unmarried women, women with active vaginal bleeding, those currently pregnant and those who have undergone hysterectomy were excluded from cervical cancer screening. RESULTS A total of 14 338 participants were screened through 190 camps and the majority (61.9%) were women. Hindu religion, tobacco use, intention to quit tobacco and presence of symptoms were significantly associated with screen-positivity. Nearly one-third (220; 30.1%) of the screened-positives complied with follow-up. Young age and illiteracy were significantly associated with lower compliance. CONCLUSION Poor follow-up compliance, despite the availability of tertiary cancer care, patient navigation, free transportation and diagnostic services, calls for research to explore the role of contextual factors and develop pragmatic interventions to justify 'close the care gap'. Community cancer screening needs strengthening through cancer awareness, establishing referral system and integration with the National Tobacco Control and Cancer Registry Programmes.
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Affiliation(s)
- Priyanka Sharma
- Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, Uttar Pradesh, India
| | - Divya Khanna
- Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, Uttar Pradesh, India
| | - Satyajit Pradhan
- Radiation Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, Uttar Pradesh, India
| | - Praveen Birur
- KLE Society's Institute of Dental Sciences, Bangalore, Karnataka, India
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21
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Comendador L, Jiménez-Villamizar MP, Losilla JM, Sanabria-Mazo JP, Mateo-Canedo C, Cebrià AI, Sanz A, Palao DJ. Effect of synchronous remote-based interventions on suicidal behaviours: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e075116. [PMID: 38056944 PMCID: PMC10711844 DOI: 10.1136/bmjopen-2023-075116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Suicide is among the leading causes of preventable death worldwide. The impact of suicide affects the personal, social and economic levels. Therefore, its prevention is a priority for public health systems. Previous studies seem to support the efficacy of providing active contact to people who have made a suicide attempt. The current systematic review and meta-analysis aims to investigate the efficacy of distance suicide prevention strategies implemented through synchronous technology-based interventions. METHODS AND ANALYSIS This protocol is designed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The bibliographical searches were conducted in the databases PubMed, PsycINFO, Scopus and Web of Science in April 2022, with no restrictions on the time of publication and limited to publications in English or Spanish. The search strategy was performed using free-text terms and Medical Subject Headings terms: suicide, follow-up, synchronous, remote, telehealth, telephone, hotline, video-conference and text message. Two reviewers will independently conduct study screening, selection process, data extraction and risk of bias assessment. The analysis and synthesis of the results will be both qualitative and quantitative. A narrative synthesis, presented in a comprehensive table, will be performed and meta-analysis will be conducted, as appropriate, if sufficient data are provided. ETHICS AND DISSEMINATION The present review and meta-analysis will not require ethical approval, as it will use data collected from previously published primary studies. The findings of this review will be published in peer-reviewed journals and widely disseminated. PROSPERO REGISTRATION NUMBER CRD42021275044.
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Affiliation(s)
- Laura Comendador
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Parc Taulí Research and Innovation Institute, Sabadell, Spain
| | - María Paola Jiménez-Villamizar
- Department of Basic, Developmental, and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Josep-Maria Losilla
- Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan P Sanabria-Mazo
- Department of Basic, Developmental, and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Corel Mateo-Canedo
- Department of Basic, Developmental, and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Ana Isabel Cebrià
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Parc Taulí Research and Innovation Institute, Sabadell, Spain
| | - Antoni Sanz
- Department of Basic, Developmental, and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Diego J Palao
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Parc Taulí Research and Innovation Institute, Sabadell, Spain
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22
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Gill VS, Tummala SV, Boddu SP, Brinkman JC, McQuivey KS, Chhabra A. Biomechanics and situational patterns associated with anterior cruciate ligament injuries in the National Basketball Association (NBA). Br J Sports Med 2023; 57:1395-1399. [PMID: 37648410 DOI: 10.1136/bjsports-2023-107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Perform a comprehensive video analysis of all anterior cruciate ligament (ACL) injuries in National Basketball Association (NBA) athletes from 2006 to 2022 to determine the associated biomechanics, injury mechanism and game situation. METHODS NBA players diagnosed with an ACL tear from 2006 to 2022 were identified and videos of each injury evaluated by two reviewers. Visual evaluation included assessment of joint kinematics at three time points: initial contact of the injured leg with the ground (IC), 33 milliseconds later (IC+33) and 66 milliseconds later (IC+66). Game situation was assessed qualitatively. RESULTS Videos of 38 out of 47 (80.9%) ACL tears were obtained. 9 injuries were non-contact, while 29 involved indirect contact. Between IC and IC+33, average knee valgus increased from 5.1° to 12.0° and knee flexion increased from 12.6° to 32.6°. At all time points, the majority of injuries involved trunk tilt and rotation towards the injured leg, hip abduction and neutral foot rotation. The most common game situations for injury included the first step when attacking the basket following picking up the ball (n=13), landing following contact in the air (n=11) and jump stop (n=5). CONCLUSION Three major mechanisms predominate ACL tears in NBA players: the first step following picking up the ball when attacking, landing and jump stops. None of the injuries reviewed demonstrated direct contact to the knee, emphasising the importance of body kinematics in this injury pattern. The increase in knee valgus and knee flexion between IC and IC+33 should be noted as a possible precipitant to injury.
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Affiliation(s)
- Vikram S Gill
- School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sayi P Boddu
- School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Kade S McQuivey
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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23
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Barden C. Injury epidemiology and prevention in youth rugby union (PhD Academy Award). Br J Sports Med 2023; 57:1407-1408. [PMID: 37185216 DOI: 10.1136/bjsports-2023-106844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Craig Barden
- Department for Health, University of Bath, Bath, UK
- School of Natural, Social and Sport Sciences, University of Gloucestershire, Gloucester, UK
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24
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Mountjoy M, Junge A, Bindra A, Blauwet C, Budgett R, Currie A, Engebretsen L, Hainline B, McDuff D, Purcell R, Putukian M, Reardon CL, Soligard T, Gouttebarge V. Surveillance of athlete mental health symptoms and disorders: a supplement to the International Olympic Committee's consensus statement on injury and illness surveillance. Br J Sports Med 2023; 57:1351-1360. [PMID: 37468210 DOI: 10.1136/bjsports-2022-106687] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/21/2023]
Abstract
In 2019, the International Olympic Committee (IOC) published a consensus statement outlining the principles for recording and reporting injury and illness in elite sport. The authors encouraged sport federations to adapt the framework to their sport-specific context. Since this publication, several sports have published extensions to the IOC consensus statement.In response to a paucity of epidemiological data on athlete mental health, the IOC mental health working group adapted the IOC consensus statement on injury and illness surveillance to improve the capturing of athlete mental health data. In addition to the members of the working group, other experts and athlete representatives joined the project team to address gaps in expertise, and to add stakeholder perspective, respectively. Following an in-person meeting, the authors worked remotely, applying the scientific literature on athlete mental health to the IOC injury and illness surveillance framework. A virtual meeting was held to reach consensus on final recommendations.Practical outcomes based on the analysis of the scientific literature are provided with respect to surveillance design, data collection and storage, data analysis and reporting of athlete mental health data. Mental health-specific report forms for athlete and health professional utilisation are included for both longitudinal and event-specific surveillance.Ultimately, this publication should encourage the standardisation of surveillance methodology for mental health symptoms and disorders among athletes, which will improve consistency in study designs, thus facilitating the pooling of data and comparison across studies. The goal is to encourage systematic surveillance of athlete mental health.
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Affiliation(s)
- Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Medical and Scientific Department-Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Astrid Junge
- Center for Health in Performing Arts, MSH Medical School Hamburg, Hamburg, Germany
| | - Abhinav Bindra
- Olympic Champion and IOC Athletes Commission Member, Deharadun, Punjab, India
| | - C Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Alan Currie
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Exercise, Sport and Rehabilitation Therapies, University of Sunderland, Sunderland, UK
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - David McDuff
- Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rosemary Purcell
- Elite Sport and Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Margot Putukian
- Chief Medical Officer, Major League Soccer, Princeton, New Jersey, USA
| | - Claudia L Reardon
- Department of Psychiatry, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Vincent Gouttebarge
- Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Section Sports Medicine, University of Pretoria, Pretoria, South Africa
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
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25
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White L, Losciale JM, Squier K, Guy S, Scott A, Prior JC, Whittaker JL. Combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5 million females. Br J Sports Med 2023; 57:1195-1202. [PMID: 37225254 DOI: 10.1136/bjsports-2022-106519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Assess the association between combined hormonal contraceptives (CHC) use and musculoskeletal tissue pathophysiology, injuries or conditions. DESIGN Systematic review with semiquantitative analyses and certainty of evidence assessment, guided by the Grading of Recommendations Assessment, Development and Evaluation approach. DATA SOURCES MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to April 2022. ELIGIBILITY Intervention and cohort studies that assessed the association between new or ongoing use of CHC and an outcome of musculoskeletal tissue pathophysiology, injury or condition in postpubertal premenopausal females. RESULTS Across 50 included studies, we assessed the effect of CHC use on 30 unique musculoskeletal outcomes (75% bone related). Serious risk of bias was judged present in 82% of studies, with 52% adequately adjusting for confounding. Meta-analyses were not possible due to poor outcome reporting, and heterogeneity in estimate statistics and comparison conditions. Based on semiquantitative synthesis, there is low certainty evidence that CHC use was associated with elevated future fracture risk (risk ratio 1.02-1.20) and total knee arthroplasty (risk ratio 1.00-1.36). There is very low certainty evidence of unclear relationships between CHC use and a wide range of bone turnover and bone health outcomes. Evidence about the effect of CHC use on musculoskeletal tissues beyond bone, and the influence of CHC use in adolescence versus adulthood, is limited. CONCLUSION Given a paucity of high certainty evidence that CHC use is protective against musculoskeletal pathophysiology, injury or conditions, it is premature and inappropriate to advocate, or prescribe CHC for these purposes. PROSPERO REGISTRATION NUMBER This review was registered on PROSPERO CRD42021224582 on 8 January 2021.
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Affiliation(s)
- Lynita White
- Tall Tree Physiotherapy and Health Centre, Vancouver, British Columbia, Canada
| | - Justin M Losciale
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Guy
- City Sport + Physiotherapy Clinic, Vancouver, British Columbia, Canada
| | - Alex Scott
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, The University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jackie L Whittaker
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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26
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Novogrodsky E, Haramati LB, Villasana-Gomez GM, Goldman J, Rosenfeld C, Rosenblum JK, Sayre JW, Hoyt AC, Goldin JG, Milch HS. Lung Cancer Screening Among Mammography Patients: Knowledge, Eligibility, Participation, and Interest. J Am Board Fam Med 2023; 36:557-564. [PMID: 37321658 DOI: 10.3122/jabfm.2022.220423r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To determine lung cancer screening eligibility, knowledge, and interest and to quantify the effect of the expanded 2021 lung cancer screening eligibility criteria among women presenting for screening mammography, a group with demonstrable interest in cancer screening. METHODS A single-page survey was distributed to patients presenting for screening mammography, from January-March 2020 and June 2020-January 2021, at 2 academic medical centers on the East and West Coasts. The population served by the East Coast institution has greater poverty, greater ethnic/racial diversity, and lower education levels. Survey questions included age, smoking history, lung cancer screening knowledge, participation, and interest. Lung cancer screening eligibility was determined for both 2013 and 2021 USPSTF guidelines. Descriptive statistics were calculated, and data were compared between groups using the Chi-square test, Mann-Whitney nonparametric test, and the 2-sample t test. RESULTS 5512 surveys were completed; 33% (1824) of women reported a history of smoking-30% (1656) former smokers and 3% (156) current smokers. Among women with a smoking history, 7% (127/1824) were eligible for lung cancer screening using 2013% and 11% (207/1824) using the 2021 USPSTF criteria. Interest in lung cancer screening was high (73%; 151/207) among eligible women using 2021 USPSTF criteria, but only 42% (87/207) had heard of lung cancer screening and only 28% (57/207) had received prior LDCT screening. CONCLUSION Eligible screening mammography patients reported high levels of interest in lung cancer screening but low levels of knowledge and participation. Linking mammography and LDCT appointments may improve lung cancer screening participation.
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Affiliation(s)
- Eitan Novogrodsky
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM).
| | - Linda B Haramati
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM)
| | - Geraldine M Villasana-Gomez
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM)
| | - Jessica Goldman
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM)
| | - Cyril Rosenfeld
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM)
| | - Jessica K Rosenblum
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM)
| | - James W Sayre
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM)
| | - Anne C Hoyt
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM)
| | - Jonathan G Goldin
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM)
| | - Hannah S Milch
- From the Department of Radiology, Montefiore Medical Center, Bronx, New York (EN, JG,); Albert Einstein College of Medicine, Bronx, New York (EN, LBH, GMV, JG, CR, JKR); Departments of Radiology and Medicine, Montefiore Medical Center, Bronx, New York (LBH); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut (LBH), Department of Radiology, Jacobi Medical Center, Bronx, New York (GMV, CR, JKR); Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California (JWS, ACH, JGG, HSM)
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27
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Eliason PH, Galarneau JM, Kolstad AT, Pankow MP, West SW, Bailey S, Miutz L, Black AM, Broglio SP, Davis GA, Hagel BE, Smirl JD, Stokes KA, Takagi M, Tucker R, Webborn N, Zemek R, Hayden A, Schneider KJ, Emery CA. Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. Br J Sports Med 2023; 57:749-761. [PMID: 37316182 DOI: 10.1136/bjsports-2022-106656] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk. DESIGN This systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Eight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review. ELIGIBILITY CRITERIA Study inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English. RESULTS In total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high ('++') or acceptable ('+') quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies. CONCLUSIONS Policy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC. PROSPERO REGISTRATION NUMBER CRD42019152982.
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Affiliation(s)
- Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ash T Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Patrick Pankow
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Stuart Bailey
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Lauren Miutz
- Health and Sport Science, University of Dayton, Dayton, Ohio, USA
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Gavin A Davis
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Brent E Hagel
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Keith A Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
| | - Michael Takagi
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Ross Tucker
- School of Management Studies, University of Cape Town, Rondebosch, South Africa
| | - Nick Webborn
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Roger Zemek
- Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Gribben V, Chang AY, Ling P, Rasmussen J, Tebb K, Fuentes-Afflick E, Marbin J. Impact of a Multidisciplinary Curriculum Training Students and Residents in Tobacco Cessation Strategies for Adult Caregivers of Children. MedEdPORTAL 2023; 19:11313. [PMID: 37228253 PMCID: PMC10203095 DOI: 10.15766/mep_2374-8265.11313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/25/2023] [Indexed: 05/27/2023]
Abstract
Introduction Children's exposure to secondhand smoke is an underaddressed public health threat. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) is a validated framework that trains pediatric providers to screen, counsel, refer to quitlines, and prescribe tobacco cessation medications to adult caregivers of children. Methods A physician champion at a major urban academic center delivered a longitudinal didactic curriculum of CEASE principles to medical and nurse practitioner students and pediatrics and family medicine residents. At the end of each session, participants completed an anonymous survey measuring changes in self-perceived knowledge, comfort, and familiarity with smoking cessation skills and concepts. Using a separate end-of-year questionnaire, we also surveyed a group of pediatric residents to compare the impact of CEASE training on clinical practice. Finally, we tracked the number of referrals to the state's quitline for the duration of the training. Results Fifty-two trainees (55% students, 45% residents) responded to the evaluation survey administered immediately following training. There were statistically significant improvements in median scores after CEASE training for comfort in screening, counseling, motivational interviewing, referring to smokers' helplines, and providing caregivers with nicotine replacement therapy (NRT) prescriptions. Fifty-one percent of pediatric residents (41 of 80) responded to the end-of-year survey, which showed statistically significant differences in the number of patients/caregivers offered a referral to California's quitline and prescription of NRT according to completion of CEASE training. Discussion CEASE training successfully improved the self-efficacy of health professions students and residents in smoking cessation techniques for adult caregivers of children.
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Affiliation(s)
- Valerie Gribben
- Assistant Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Andrew Y. Chang
- Clinical Instructor, Department of Medicine, Stanford University Medical Center; Postdoctoral Research Fellow, Stanford Cardiovascular Institute, Stanford University
| | - Pamela Ling
- Director, Center for Tobacco Control Research and Education, University of California, San Francisco; Professor, Department of Medicine, University of California, San Francisco, School of Medicine
| | - Jennifer Rasmussen
- Quality Improvement Analyst, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Kathleen Tebb
- Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Elena Fuentes-Afflick
- Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine; Vice Dean, University of California, San Francisco, School of Medicine at Zuckerberg San Francisco General Hospital and Trauma Center
| | - Jyothi Marbin
- Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine; Director, UC Berkeley-UCSF Joint Medical Program
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Klöwer M, Edouard P, Niess AM, Racinais S, Pitsiladis YP, Pappenberger F, Hollander K. Forecasting feels-like temperatures as a strategy to reduce heat illnesses during sport events. Br J Sports Med 2023; 57:559-561. [PMID: 36882307 DOI: 10.1136/bjsports-2022-106413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Milan Klöwer
- Atmospheric, Oceanic, and Planetary Physics, University of Oxford, Oxford, UK
- Earth, Atmospheric and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Pascal Edouard
- Inter-university Laboratory of Human Movement Biology (EA 7424), Université Jean Monnet, Lyon 1, Université Savoie Mont-Blanc, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
| | - Andreas M Niess
- Department of Sports Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Sebastien Racinais
- Research and Scientific Support, ASPETAR - Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | - Karsten Hollander
- IInstitute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
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30
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Bhadoria AS, Mohapatra A, Gupta R, Chawla YK, Kant R, Nundy S. Preventive hepatology: An ounce of prevention or pounds of cure to curb liver diseases. J Family Med Prim Care 2023; 12:419-421. [PMID: 37122647 PMCID: PMC10131973 DOI: 10.4103/jfmpc.jfmpc_2225_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 05/02/2023] Open
Abstract
Liver diseases are now the leading cause of both morbidity and mortality profile globally with rising trends due to unhealthy lifestyle. Most of the liver diseases are preventable. Scientific evidences have well supported and documented that almost 90 percent of all major liver diseases are either the manifestations of asymptomatic hepatitis virus infections or poor lifestyle choices leading to accumulation of fat in liver that could be detected even before they present themselves as chronic liver diseases. Understanding liver diseases as a preventable disease and practising necessary preventive measures will help in lowering the risks of various types of liver diseases as well as liver cancer.
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Affiliation(s)
- Ajeet S. Bhadoria
- Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Address for correspondence: Dr. Ajeet S. Bhadoria, Associate Professor, Community and Family Medicine, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India. E-mail:
| | | | - Rohit Gupta
- Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Ravi Kant
- Ex-Director, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Samiran Nundy
- President, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Edouard P, Mendiguchia J, Guex K, Lahti J, Prince C, Samozino P, Morin JB. Sprinting: a key piece of the hamstring injury risk management puzzle. Br J Sports Med 2023; 57:4-6. [PMID: 35927000 DOI: 10.1136/bjsports-2022-105532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Pascal Edouard
- Inter-University Laboratory of Human Movement Biology, Univ Lyon, UJM-Saint-Etienne, Saint-Etienne, France .,Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Center, Barañain, Spain
| | - Kenny Guex
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Swiss Athletics, Haus des Sports, Ittigen, Switzerland
| | - Johan Lahti
- LAMHESS, Université Côte d'Azur, Nice, France
| | - Caroline Prince
- Inter-university Laboratory of Human Movement Biology, EA 7424, Univ Savoie Mont Blanc, Chambéry, France.,Physiotherapy department and motion analysis lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - Pierre Samozino
- Inter-university Laboratory of Human Movement Biology, EA 7424, Univ Savoie Mont Blanc, Chambéry, France
| | - Jean-Benoît Morin
- Inter-University Laboratory of Human Movement Biology, Univ Lyon, UJM-Saint-Etienne, Saint-Etienne, France.,Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
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Lindblom H, Sonesson S, Torvaldsson K, Waldén M, Hägglund M. Extended Knee Control programme lowers weekly hamstring, knee and ankle injury prevalence compared with an adductor strength programme or self-selected injury prevention exercises in adolescent and adult amateur football players: a two-armed cluster-randomised trial with an additional comparison arm. Br J Sports Med 2023; 57:83-90. [PMID: 36316115 PMCID: PMC9872240 DOI: 10.1136/bjsports-2022-105890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the preventive efficacy of an extended version of the Knee Control injury prevention exercise programme (IPEP) compared with an adductor strength programme and to a comparison group using a self-selected IPEP in amateur adolescent and adult male and female football players. METHODS Two-armed cluster-randomised trial with an additional non-randomised arm. All 251 amateur teams (players 14-46 years) in one regional football district were approached. Teams meeting inclusion criteria were randomised to (1) extended Knee Control or (2) an adductor strength programme. Teams already using an IPEP were allocated to a comparison group and received no new intervention. Players responded to weekly questionnaires about football exposures and injuries during a 7-month season. RESULTS Seventeen teams in the extended Knee Control, 12 in the adductor and 17 in the comparison group participated, with 502 players. For the primary outcomes, no difference in injury incidence in three lower-limb injury locations combined (hamstring, knee and ankle) was seen between extended Knee Control and the adductor group, whereas extended Knee Control had 29% lower incidence than the comparison group (incidence rate ratio 0.71, 95% CI 0.52 to 0.98). No between-group differences in groin injury incidence were seen. The weekly injury prevalence rates in the three lower limb locations combined (hamstring, knee and ankle) were 17% lower (prevalence rate ratio (PRR) 0.83, 95% CI 0.69 to 1.00) and 26% lower (PRR 0.74, 95% CI 0.63 to 0.87) in extended Knee Control compared with the adductor and comparison groups, respectively. CONCLUSION No difference in injury incidence was seen between the extended Knee Control and the adductor programme whereas extended Knee Control reduced injury incidence by nearly one-third compared with a self-selected IPEP. Players in extended Knee Control had lower injury prevalence compared with an adductor or self-selected IPEP. TRIAL REGISTRATION NUMBER NCT04272047; Clinical trials.
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Affiliation(s)
- Hanna Lindblom
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Sport Without Injury ProgrammE (SWIPE). Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sofi Sonesson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Sport Without Injury ProgrammE (SWIPE). Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kalle Torvaldsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Sport Without Injury ProgrammE (SWIPE). Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Markus Waldén
- Sport Without Injury ProgrammE (SWIPE). Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,GHP Ortho & Spine Center Skåne, Malmö, Sweden
| | - Martin Hägglund
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Sport Without Injury ProgrammE (SWIPE). Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Norton ZS, Olson KB, Sanguino SM. Addressing Vaccine Hesitancy Through a Comprehensive Resident Vaccine Curriculum. MedEdPORTAL 2022; 18:11292. [PMID: 36654981 PMCID: PMC9792628 DOI: 10.15766/mep_2374-8265.11292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Vaccine hesitancy can lead to incomplete vaccination, increased risk of vaccine-preventable diseases, and distrust or conflict between physicians and patients. Yet many physicians are uncomfortable navigating vaccine hesitancy and educating vaccine-hesitant patients and families. We developed a vaccine hesitancy curriculum to increase vaccine knowledge, comfort, and communication skills in pediatric residents. METHODS The curriculum consisted of four interactive 40-minute sessions delivered to pediatric residents over 10 months. The first two sessions discussed recommended childhood vaccines, the third session examined common vaccine misconceptions, and the final session reviewed vaccine hesitancy-specific communication skills, incorporating practice through role-playing. Residents completed pre- and posttests assessing knowledge and comfort as well as receiving a standardized patient (SP) assessment of vaccine-specific communication skills after the curriculum. RESULTS Thirty-five residents were in the educational intervention group and 35 in a control group. Pretest scores did not differ significantly between the groups. The mean knowledge score for the intervention group increased from 47% on the pretest to 66% on the posttest. The mean self-reported comfort score (1 = low comfort, 5 = high comfort) for the intervention group increased from 2.9 on the pretest to 3.8 on the posttest. The control group showed no difference between pre- and posttest scores for knowledge or comfort. The mean postintervention SP assessment score was significantly higher for the intervention group (78%) than the control group (52%). DISCUSSION Implementation of a comprehensive vaccine hesitancy curriculum resulted in improved vaccine knowledge, self-reported comfort, and communication skills among pediatric residents.
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Affiliation(s)
- Zarina S. Norton
- Assistant Professor, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago; Assistant Professor, Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Kaitlyn B. Olson
- General Pediatrician, Department of Pediatrics, Cottage Children's Medical Center
| | - Sandra M. Sanguino
- Associate Professor, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago; Associate Professor, Department of Medical Education, and Senior Associate Dean for Medical Education, Northwestern University Feinberg School of Medicine
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Minato-Inokawa S, Hashiguchi A, Honda M, Tsuboi-Kaji A, Takeuchi M, Kitaoka K, Kurata M, Wu B, Kazumi T, Fukuo K. Weight trajectories since birth, current body composition and metabolic traits in young, normal-weight Japanese women with high percentage body fat. BMJ Open Diabetes Res Care 2022; 10:10/6/e003045. [PMID: 36564085 PMCID: PMC9791389 DOI: 10.1136/bmjdrc-2022-003045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION We tested whether normal-weight obesity might be associated with weight trajectories, body composition and metabolic traits. RESEARCH DESIGN AND METHODS Body size trajectory since birth, body composition at age 20 years and metabolic traits were compared cross-sectionally among normal-weight Japanese women with low (<25.0%, n=67), normal (25.0-34.9%, n=160) and high (≥35.0 %, n=24) percentage body fat. Multivariate logistic regression analyses were used to identify most important determinants of normal-weight obesity (high percentage body fat). RESULTS Fasting glucose averaged <84 mg/dL, homeostasis model assessment-insulin resistance <1.4 and triglyceride <70 mg/dL and did not differ among three groups. However, waist and trunk/leg fat ratio were higher, and weight-adjusted skeletal muscle mass was lower in normal-weight obesity. Serum and LDL cholesterol, apolipoprotein B (ApoB) and high-sensitivity C reactive protein were higher, and apolipoprotein A1 was lower in normal-weight obesity compared with the other two groups, whereas HDL cholesterol did not differ. Weight gain from birth to age 12 years was higher in normal-weight obesity. In multivariate logistic regression analyses, weight gain until 12 years (OR: 1.17,95% CI 1.02 to 1.34, p=0.02), ApoB (OR: 1.15, 95% CI 1.06 to 1.24, p<0.001) and weight-adjusted skeletal muscle mass (OR: 0.22, 95% CI 0.10 to 0.49, p<0.001) were associated with normal-weight obesity independently of trunk/leg fat ratio, high-sensitivity C reactive protein and apolipoprotein A1. CONCLUSIONS Normal-weight obesity may be associated with early childhood growth, lower skeletal muscle mass and higher serum ApoB in young Japanese women through mechanisms unrelated to abdominal adiposity, inflammation and insulin resistance.
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Affiliation(s)
- Satomi Minato-Inokawa
- Eiyo kagakukenkyujo, Mukogawa Joshi Daigaku, Nishinomiya, Japan
- Laboratory of Community Health and Nutrition, Department of Bioscience, Graduate School of Agriculture, Ehime University, Matsuyama, Ehime, Japan
- Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
| | - Asami Hashiguchi
- Department of Food Sciences and Nutrition, Mukogawa Joshi Daigaku, Nishinomiya, Japan
| | - Mari Honda
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Joshi Daigaku, Nishinomiya, Hyogo, Japan
- Department of Health, Sports, and Nutrition, Faculty of Health and Welfare, Kobe Women's University, Kobe, Hyogo, Japan
| | - Ayaka Tsuboi-Kaji
- Eiyo kagakukenkyujo, Mukogawa Joshi Daigaku, Nishinomiya, Japan
- Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
| | - Mika Takeuchi
- Eiyo kagakukenkyujo, Mukogawa Joshi Daigaku, Nishinomiya, Japan
| | - Kaori Kitaoka
- Eiyo kagakukenkyujo, Mukogawa Joshi Daigaku, Nishinomiya, Japan
- Department of Advanced Epidemiology, Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Miki Kurata
- Eiyo kagakukenkyujo, Mukogawa Joshi Daigaku, Nishinomiya, Japan
- Department of Food Sciences and Nutrition, Mukogawa Joshi Daigaku, Nishinomiya, Japan
| | - Bin Wu
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Joshi Daigaku, Nishinomiya, Hyogo, Japan
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tsutomu Kazumi
- Eiyo kagakukenkyujo, Mukogawa Joshi Daigaku, Nishinomiya, Japan
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Joshi Daigaku, Nishinomiya, Hyogo, Japan
- Department of Medicine, Kohan Kakogawa Hospital, Kakogawa, Hyogo, Japan
| | - Keisuke Fukuo
- Eiyo kagakukenkyujo, Mukogawa Joshi Daigaku, Nishinomiya, Japan
- Department of Food Sciences and Nutrition, Mukogawa Joshi Daigaku, Nishinomiya, Japan
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Joshi Daigaku, Nishinomiya, Hyogo, Japan
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Esna-Ashari F, Saffari N, Parsapour H, Rezapur-Shahkolai F. Factors Associated with Breast Cancer Mammographic Screening Behavior among Iranian Women. Asian Pac J Cancer Prev 2022; 23:4073-4078. [PMID: 36579987 PMCID: PMC9971457 DOI: 10.31557/apjcp.2022.23.12.4073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Indexed: 12/30/2022] Open
Abstract
Breast cancer is one of the most common diseases of women, which can increase the survival of patients with its early diagnosis. Despite the existence of relatively sensitive methods of early detection of breast cancer, such as mammography, statistics show that a small number of women perform mammography according to the recommended clinical guidelines. Using the health belief model, this study aims to determine the factors affecting mammography among women teachers in Hamedan. METHODS This study was conducted on 458 female teachers aged 40 years and older of Hamadan city, in western part of Iran, during October to December of 2019. The participants were asked about the factors affecting mammography based on the health belief model. Questionnaires were completed by self-reported method and analyzed by SPSS software at 95% confidence interval. RESULTS The average age of the study participants was 46±4.1 years. Among the participants, about 41.5% had performed mammography at least once. In univariate analysis, the constructs of the health belief model generally predicts performing mammography between 35 and 49 percent. In multivariate analysis, age 46 to 50 years, having supplementary insurance, history of breast disease, perceived barriers with odds ratio of 3.4, 3.4, 10.6 and .89, respectively, were significantly related to mammography. CONCLUSIONS Female teachers over 45 years of age with a history of breast disease, if they do not have financial or other barriers to do mammography, perform breast cancer screening.
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Affiliation(s)
- Farzaneh Esna-Ashari
- Department of Community Medicine, School of Medicine and Research Center for Social Determinants of Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Narges Saffari
- General Physician, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Hamideh Parsapour
- Department of Obstetrics and Gynecology, Fatemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Forouzan Rezapur-Shahkolai
- Department of Public Health, School of Public Health and Research Center of Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.,For Correspondence:
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Yeung KF, Lee YQ, Chong MFF, Gandhi M, Lam AYR, Julianty S, Tan GCS, Ho ETL, Goh SY, Tan GSW, Shum EJW, Finkelstein EA, Jafar TH, van Dam RM, Teoh YL, Thumboo J, Bee YM. Baseline characteristics of participants in the Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) Program. BMJ Open Diabetes Res Care 2022; 10:10/5/e002966. [PMID: 36220198 PMCID: PMC9558793 DOI: 10.1136/bmjdrc-2022-002966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) Program is a diabetes prevention trial comparing the diabetes conversion rate at 3 years between the intervention group, which receives the incentivized lifestyle intervention program with stepwise addition of metformin, and the control group, which receives the standard of care. We describe the baseline characteristics and compare Pre-DICTED participants with other diabetes prevention trials cohort. RESEARCH DESIGN AND METHODS Participants were aged between 21 and 64 years, overweight (body mass index (BMI) ≥23.0 kg/m2), and had pre-diabetes (impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT)). RESULTS A total of 751 participants (53.1% women) were randomized. At baseline, mean (SD) age was 52.5 (8.5) years and mean BMI (SD) was 29.0 (4.6) kg/m2. Twenty-three per cent had both IFG and IGT, 63.9% had isolated IGT, and 13.3% had isolated IFG. Ethnic Asian Indian participants were more likely to report a family history of diabetes and had a higher waist circumference, compared with Chinese and Malay participants. Women were less likely than men to meet the physical activity recommendations (≥150 min of moderate-intensity physical activity per week), and dietary intake varied with both sex and ethnicity. Compared with other Asian diabetes prevention studies, the Pre-DICTED cohort had a higher mean age and BMI. CONCLUSION The Pre-DICTED cohort represents subjects at high risk of diabetes conversion. The study will evaluate the effectiveness of a community-based incentivized lifestyle intervention program in an urban Asian context.
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Affiliation(s)
- Kar-Fu Yeung
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Yu Qi Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mary Foong Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences, Brenner Centre for Molecular Medicine, Agency for Science, Technology, and Research (A*STAR), Singapore
| | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
- Biostatistics, Singapore Clinical Research Institute, Singapore
- The Center for Child Health Research, Tampere University, Tampere, Finland
| | - Amanda Yun Rui Lam
- Department of Endocrinology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Diabetes Centre, Singapore
| | - Selly Julianty
- SingHealth Duke-NUS Diabetes Centre, Singapore
- Regional Health System Office, SingHealth, Singapore
| | | | - Emily Tse Lin Ho
- Department of Endocrinology, Singapore General Hospital, Singapore
- Regional Health System Office, SingHealth, Singapore
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Gavin Siew Wei Tan
- SingHealth Duke-NUS Diabetes Centre, Singapore
- Surgical Retinal Department, Singapore National Eye Centre, Singapore
| | | | - Eric A Finkelstein
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Tazeen H Jafar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Nutrition and Exercise Sciences and Epidemiology, Milken Institute School of Public Health, George Washington University, Washington DC, Washington DC, USA
| | - Yee Leong Teoh
- Ministry of Health Office of Healthcare Transformation, Government of Singapore, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Diabetes Centre, Singapore
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Alexander JLN, Culvenor AG, Johnston RRT, Ezzat AM, Barton CJ. Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials. Br J Sports Med 2022; 56:1307-1319. [PMID: 36150753 DOI: 10.1136/bjsports-2022-105553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of interventions to prevent and manage knee injuries in runners. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus up to May 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials (RCTs) with a primary aim of evaluating the effectiveness of intervention(s) to prevent or manage running-related knee injury. RESULTS Thirty RCTs (18 prevention, 12 management) analysed multiple interventions in novice and recreational running populations. Low-certainty evidence (one trial, 320 participants) indicated that running technique retraining (to land softer) reduced the risk of knee injury compared with control treadmill running (risk ratio (RR) 0.32, 95% CI 0.16 to 0.63). Very low-certainty to low-certainty evidence from 17 other prevention trials (participant range: 24 -3287) indicated that various footwear options, multicomponent exercise therapy, graduated running programmes and online and in person injury prevention education programmes did not influence knee injury risk (RR range: 0.55-1.06). In runners with patellofemoral pain, very low-certainty to low-certainty evidence indicated that running technique retraining strategies, medial-wedged foot orthoses, multicomponent exercise therapy and osteopathic manipulation can reduce knee pain in the short-term (standardised mean difference range: -4.96 to -0.90). CONCLUSION There is low-certainty evidence that running technique retraining to land softer may reduce knee injury risk by two-thirds. Very low-certainty to low-certainty evidence suggests that running-related patellofemoral pain may be effectively managed through a variety of active (eg, running technique retraining, multicomponent exercise therapy) and passive interventions (eg, foot orthoses, osteopathic manipulation). PROSPERO REGISTRATION NUMBER CRD42020150630.
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Affiliation(s)
- James L N Alexander
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Evado Studios, Nelson Bay, New South Wales, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Richard R T Johnston
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Allison M Ezzat
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia .,Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Tang X, Brinton RD, Chen Z, Farland LV, Klimentidis Y, Migrino R, Reaven P, Rodgers K, Zhou JJ. Use of oral diabetes medications and the risk of incident dementia in US veterans aged ≥60 years with type 2 diabetes. BMJ Open Diabetes Res Care 2022; 10:10/5/e002894. [PMID: 36220195 PMCID: PMC9472121 DOI: 10.1136/bmjdrc-2022-002894] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/16/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Studies have reported that antidiabetic medications (ADMs) were associated with lower risk of dementia, but current findings are inconsistent. This study compared the risk of dementia onset in patients with type 2 diabetes (T2D) treated with sulfonylurea (SU) or thiazolidinedione (TZD) to patients with T2D treated with metformin (MET). RESEARCH DESIGN AND METHODS This is a prospective observational study within a T2D population using electronic medical records from all sites of the Veterans Affairs Healthcare System. Patients with T2D who initiated ADM from January 1, 2001, to December 31, 2017, were aged ≥60 years at the initiation, and were dementia-free were identified. A SU monotherapy group, a TZD monotherapy group, and a control group (MET monotherapy) were assembled based on prescription records. Participants were required to take the assigned treatment for at least 1 year. The primary outcome was all-cause dementia, and the two secondary outcomes were Alzheimer's disease and vascular dementia, defined by International Classification of Diseases (ICD), 9th Revision, or ICD, 10th Revision, codes. The risks of developing outcomes were compared using propensity score weighted Cox proportional hazard models. RESULTS Among 559 106 eligible veterans (mean age 65.7 (SD 8.7) years), the all-cause dementia rate was 8.2 cases per 1000 person-years (95% CI 6.0 to 13.7). After at least 1 year of treatment, TZD monotherapy was associated with a 22% lower risk of all-cause dementia onset (HR 0.78, 95% CI 0.75 to 0.81), compared with MET monotherapy, and 11% lower for MET and TZD dual therapy (HR 0.89, 95% CI 0.86 to 0.93), whereas the risk was 12% higher for SU monotherapy (HR 1.12 95% CI 1.09 to 1.15). CONCLUSIONS Among patients with T2D, TZD use was associated with a lower risk of dementia, and SU use was associated with a higher risk compared with MET use. Supplementing SU with either MET or TZD may partially offset its prodementia effects. These findings may help inform medication selection for elderly patients with T2D at high risk of dementia.
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Affiliation(s)
- Xin Tang
- Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Roberta Diaz Brinton
- UA Center for Innovation in Brain Science, The University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Zhao Chen
- Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Leslie V Farland
- Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Yann Klimentidis
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Raymond Migrino
- Division of Cardiology, The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
- Division of Endocrinology, Phoenix VA Health Care System, Phoenix, Arizona, USA
| | - Peter Reaven
- Division of Endocrinology, Phoenix VA Health Care System, Phoenix, Arizona, USA
- Division of Endocrinology, The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Kathleen Rodgers
- Department of Pharmacology and Toxicology, The University of Arizona, Tucson, Arizona, USA
| | - Jin J Zhou
- Department of Medicine, University of California, Los Angeles, California, USA
- Department of Biostatistics, University of California, Los Angeles, California, USA
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Agaku IT, Dimaggio A, Fishelov A, Brathwaite A, Ahmed S, Malinowski M, Long T. SARS-CoV-2 infections and attitudes towards COVID-19 vaccines among healthcare workers in the New York Metropolitan area, USA. Fam Med Community Health 2022; 10:e001692. [PMID: 35896283 PMCID: PMC9334692 DOI: 10.1136/fmch-2022-001692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Because of their increased interaction with patients, healthcare workers (HCWs) face greater vulnerability to COVID-19 exposure than the general population. We examined prevalence and correlates of ever COVID-19 diagnosis and vaccine uncertainty among HCWs. DESIGN Cross-sectional data from the Household Pulse Survey (HPS) conducted during July to October 2021. SETTING HPS is designed to yield representative estimates of the US population aged ≥18 years nationally, by state and across selected metropolitan areas. PARTICIPANTS Our primary analytical sample was adult HCWs in the New York Metropolitan area (n=555), with HCWs defined as individuals who reported working in a 'Hospital'; 'Nursing and residential healthcare facility'; 'Pharmacy' or 'Ambulatory healthcare setting'. In the entire national sample, n=25 909 HCWs completed the survey. Descriptive analyses were performed with HCW data from the New York Metropolitan area, the original epicentre of the pandemic. Multivariable logistic regression analyses were performed on pooled national HCW data to explore how HCW COVID-19-related experiences, perceptions and behaviours varied as a function of broader geographic, clinical and sociodemographic characteristics. RESULTS Of HCWs surveyed in the New York Metropolitan area, 92.3% reported being fully vaccinated, and 20.9% had ever been diagnosed of COVID-19. Of the subset of HCWs in the New York Metropolitan area not yet fully vaccinated, 41.8% were vaccine unsure, 4.5% planned to get vaccinated for the first time soon, 1.6% had got their first dose but were not planning to receive the remaining dose, while 52.1% had got their first dose and planned to receive the remaining dose. Within pooled multivariable analysis of the national HCW sample, personnel in nursing/residential facilities were less likely to be fully vaccinated (adjusted OR, AOR 0.79, 95% CI 0.63 to 0.98) and more likely to report ever COVID-19 diagnosis (AOR 1.35, 95% CI 1.13 to 1.62), than those working in hospitals. Of HCWs not yet vaccinated nationally, vaccine-unsure individuals were more likely to be White and work in pharmacies, whereas vaccine-accepting individuals were more likely to be employed by non-profit organisations and work in ambulatory care facilities. Virtually no HCW was outrightly vaccine-averse, only unsure. CONCLUSIONS Differences in vaccination coverage existed by individual HCW characteristics and healthcare operational settings. Targeted efforts are needed to increase vaccination coverage.
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Affiliation(s)
- Israel T Agaku
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- COVID-19 Test and Trace Corps, New York, New York, USA
| | | | | | | | - Saief Ahmed
- COVID-19 Test and Trace Corps, New York, New York, USA
| | | | - Theodore Long
- COVID-19 Test and Trace Corps, New York, New York, USA
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Barden C, Hancock MV, Stokes KA, Roberts SP, McKay CD. Effectiveness of the Activate injury prevention exercise programme to prevent injury in schoolboy rugby union. Br J Sports Med 2022; 56:812-817. [PMID: 35387776 DOI: 10.1136/bjsports-2021-105170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The efficacious Activate injury prevention exercise programme has been shown to prevent injuries in English schoolboy rugby union. There is now a need to assess the implementation and effectiveness of Activate in the applie setting. METHODS This quasi-experimental study used a 24-hour time-loss injury definition to calculate incidence (/1000 hours) and burden (days lost/1000 hours) for individuals whose teams adopted Activate (used Activate during season) versus non-adopters. The dose-response relationship of varying levels of Activate adherence (median Activate sessions per week) was also assessed. Player-level rugby exposure, sessional Activate adoption and injury reports were recorded by school gatekeepers. Rate ratios (RR), adjusted by cluster (team), were calculated using backwards stepwise Poisson regression to compare rates between adoption and adherence groups. RESULTS Individuals in teams adopting Activate had a 23% lower match injury incidence (RR 0.77, 95% CI 0.55 to 1.07), 59% lower training injury incidence (RR 0.41, 95% CI 0.17 to 0.97) and 26% lower match injury burden (95% CI 0.46 to 1.20) than individuals on non-adopting teams. Individuals with high Activate adherence (≥3 sessions per week) had a 67% lower training injury incidence (RR 0.33, 95% CI 0.12 to 0.91) and a 32% lower match injury incidence (RR 0.68, 95% CI 0.50 to 0.92) than individuals with low adherence (<1 session per week). While 65% of teams adopted Activate during the season, only one team used Activate three times per week, using whole phases and programme progressions. CONCLUSION Activate is effective at preventing injury in English schoolboy rugby. Attention should focus on factors influencing programme uptake and implementation, ensuring Activate can have maximal benefit.
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Affiliation(s)
- Craig Barden
- Department for Health, University of Bath, Bath, UK .,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | | | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK.,Rugby Football Union, Twickenham, UK
| | | | - Carly D McKay
- Department for Health, University of Bath, Bath, UK.,Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK
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41
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Calonge-Pascual S, Casajús Mallén JA, González-Gross M. Physical exercise training in the syllabus of Bachelor of Science in nursing degrees: An environmental scan. Contemp Nurse 2022; 58:192-211. [PMID: 35587562 DOI: 10.1080/10376178.2022.2080088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Scientific evidence regarding the effectiveness of physical activity (PA) in the prevention and treatment of chronic diseases is increasing. Healthcare systems are trying to increase exercise prescription treatments. However, it is not clear if health professionals are sufficiently trained. Aim: to analyze the contents related to PA and exercise in the prevention and treatment of chronic diseases in the syllabus of the Bachelor of Science in Nursing at all Spanish universities. Methods: A systematic environmental scan that included a web page search of curricular guide programs of all Spanish universities offering the Bachelor of Science in Nursing was undertaken for the 2017-18 academic course. The assessment of the European Credit Transfer System (ECTS) about physical activity and/or exercise health-related benefits in the prevention or treatment of chronic diseases was performed by two experts in a peer-review process. ECTS of Practicum and Bachelor thesis were not included in the analysis. Results: In the mean, the Bachelor of Science in Nursing dedicated 5.82% (5.01% mandatory and 0.82% voluntary) of a total of 240 ECTS (ranging from 0 to 45 ECTS). The majority of contents were related to PA promotion; in contrast, contents related to exercise prescription are neglectable. Five Spanish universities do not offer any academic teaching to physical activity on prescription. Conclusions: A great disparity between universities was identified. In general, acquired knowledge seems scarce for PA promotion and exercise prescription in primary healthcare staff. Nurses would need additional physical activity on prescription training to improve PA promotion and exercise prescription knowledge as a coadjutant non-pharmacological treatment for non-communicable chronic diseases at Primary Healthcare settings.
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Affiliation(s)
- Sergio Calonge-Pascual
- ImFINE Research Group. Department of Health and human performance, Faculty of Physical Activity and Sport Sciences-INEF. Universidad Politécnica de Madrid, C/Martín Fierro 7. Room:603. 28040 Madrid. Spain; telephone: + 34 913364134; Twitter: @SpainEIM
| | - José Antonio Casajús Mallén
- GENUD Research Group. Department of Physiatrist and Nursing, Faculty of Health Sciences. University of Zaragoza, Domingo Miral s/n, 50009 Zaragoza. Spain; telephone: + 34 976761719; e-mail:
| | - Marcela González-Gross
- ImFINE Research Group. Department of Health and human performance, Faculty of Physical Activity and Sport Sciences-INEF. Universidad Politécnica de Madrid, C/Martín Fierro 7. Room:603. 28040 Madrid. Spain; telephone: + 34 913364134; Twitter: @SpainEIM
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Schrempf M, Polat Erdeniz S, Kramer D, Jauk S, Veeranki SPK, Ribitsch W, Leodolter W, Rainer PP. Development of an Architecture to Implement Machine Learning Based Risk Prediction in Clinical Routine: A Service-Oriented Approach. Stud Health Technol Inform 2022; 293:262-269. [PMID: 35592992 DOI: 10.3233/shti220379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients at risk of developing a disease have to be identified at an early stage to enable prevention. One way of early detection is the use of machine learning based prediction models trained on electronic health records. OBJECTIVES The aim of this project was to develop a software solution to predict cardiovascular and nephrological events using machine learning models. In addition, a risk verification interface for health care professionals was established. METHODS In order to meet the requirements, different tools were analysed. Based on this, a software architecture was created, which was designed to be as modular as possible. RESULTS A software was realised that is able to automatically calculate and display risks using machine learning models. Furthermore, predictions can be verified via an interface adapted to the need of health care professionals, which shows data required for prediction. CONCLUSION Due to the modularised software architecture and the status-based calculation process, different technologies could be applied. This facilitates the installation of the software at multiple health care providers, for which adjustments need to be carried out at one part of the software only.
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Affiliation(s)
- Michael Schrempf
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria.,Medical University of Graz, Graz, Austria
| | | | - Diether Kramer
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria
| | - Stefanie Jauk
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria
| | - Sai P K Veeranki
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria
| | - Werner Ribitsch
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria.,Medical University of Graz, Graz, Austria
| | - Werner Leodolter
- Steiermärkische Krankenanstaltengesellschaft m.b.H., Graz, Austria.,Medical University of Graz, Graz, Austria
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Ross JAD, Barron E, McGough B, Valabhji J, Daff K, Irwin J, Henley WE, Murray E. Uptake and impact of the English National Health Service digital diabetes prevention programme: observational study. BMJ Open Diabetes Res Care 2022; 10:10/3/e002736. [PMID: 35504697 PMCID: PMC9066480 DOI: 10.1136/bmjdrc-2021-002736] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/27/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION 'Healthier You', the National Health Service (NHS) diabetes prevention programme (DPP) offers adults in England at high risk of type 2 diabetes (T2DM) an evidence-based behavioral intervention to prevent or delay T2DM onset. This study assesses the impact of a pilot digital stream of the DPP (DDPP) on glycated hemoglobin (HbA1c) and weight. RESEARCH DESIGN AND METHODS A service evaluation employing prospectively collected data in a prospective cohort design in nine NHS local pilot areas across England. Participants were adults with non-diabetic hyperglycemia (NDH) (HbA1c 42-47 mmol/mol or fasting plasma glucose 5.5-6.9 mmol/L) in the 12 months prior to referral. The DDPP comprised five digital health interventions (DHI). Joint primary outcomes were changes in HbA1c and weight between baseline and 12 months. HbA1c and weight readings were recorded at referral (baseline) by general practices, and then at 12-month postregistration. Demographic data and service variables were collected from the DHI providers. RESULTS 3623 participants with NDH registered for the DDPP and of these, 2734 (75%) were eligible for inclusion in the analyses. Final (12-month) follow-up data for HbA1c were available for 1799 (50%) and for weight 1817 (50%) of registered participants. Mean change at 12 months was -3.1 (-3.4 to -2.8) kg, p<0.001 for weight and -1.6 (-1.8 to -1.4) mmol/mol, p<0.001 for HbA1c. Access to peer support and a website and telephone service was associated with significantly greater reductions in HbA1c and weight. CONCLUSIONS Participation in the DDPP was associated with clinically significant reductions in weight and HbA1c. Digital diabetes prevention can be an effective and wide-reaching component of a population-based approach to addressing type 2 diabetes prevention.
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Affiliation(s)
- Jamie Anne Dolan Ross
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | | | - Jonathan Valabhji
- NHS England and Improvement, London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - William E Henley
- Health Statistics Group, Institute of Health Research, University of Exeter, Exeter, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
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Plotzker RE, Barnell GM, Wiley DJ, Stier EA, Jay N. Provider Preferences for Anal Cancer Prevention Screening: Results of the International Anal Neoplasia Society Survey. Tumour Virus Res 2022; 13:200235. [PMID: 35183808 PMCID: PMC9006639 DOI: 10.1016/j.tvr.2022.200235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023] Open
Abstract
Objective This study explores provider preferences regarding anal cancer screening indications, initiation age, tools, and referral threshold to high resolution anoscopy (HRA). Methods International Anal Neoplasia Society affiliates were invited to complete an online survey. Options for initiation age and tools were delineated by sub-groups. HRA referral thresholds separately queried recommendations by patient immune status. Results One hundred forty respondents participated. Although consensus was lacking with regard to specific screening initiation age, more respondents recommended younger initiation ages for men who have sex with men (MSM) living with HIV (LWH) compared with MSM not LWH (p < 0.01). “No age threshold” ranged 44-55% among sub-groups with lower genital tract disease. Cytology and digital anorectal exam (DARE) were the most frequently selected tools for all sub-groups (ranges 77-90% and 74-86%, respectively). HRA was recommended significantly more frequently for MSM LWH (58%) and patients with vulvar cancer (52%) compared to others (p < 0.01). “Any [test] abnormality” was more often selected as indication for HRA for immunocompromised (56%) and immunocompetent (46%) patients than a specific cytology test result (29%, 36% respectively). Conclusion Cytology and DARE were preferred screening tools; screening initiation age and HRA referral threshold showed less consensus. Evidence-based guidelines are needed and may lead to more consistent screening practices.
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Affiliation(s)
- Rosalyn E Plotzker
- UCSF ANCRE Center, Mount Zion Hospital, 1600 Divisadero Street, 3rd Floor, San Francisco, CA 94115 USA.
| | - Gregory M Barnell
- Kaiser Permanente, Oakland Medical Center, Department of Surgery, 3600 Broadway, Suite 38, Oakland, CA 94611, USA.
| | - Dorothy J Wiley
- UCLA School of Nursing, 700 Tiverton Avenue, Factor Building Room #4242, Los Angeles, CA 90095-6918 USA.
| | - Elizabeth A Stier
- Boston University School of Medicine, Boston Medical Center, 771 Albany Street, Dowling 4, Boston, MA 02118 USA.
| | - Naomi Jay
- UCSF ANCRE Center, Mount Zion Hospital, 1600 Divisadero Street, 3rd Floor, San Francisco, CA 94115 USA.
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Shani M, Schonmann Y, Comaneshter D, Lustman A. The Relationship Between Patient Medication Adherence and Following Preventive Medicine Recommendation. J Am Board Fam Med 2021; 34:1157-62. [PMID: 34772770 DOI: 10.3122/jabfm.2021.06.210202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To study the relationship between adherence to chronic medications and adherence to preventive medicine recommendations among persons with diabetes mellitus and hypertension. METHODS Data were collected from the Clalit database included all members of Clalit aged 50 to 74 years, diagnosed with diabetes mellitus or hypertension before 2016 and treated with at least 1 medication (statins hypotensive or antidiabetic drugs) during 2017. We analyzed all the monthly prescriptions that were filled during 2017. We determined personal adherence rates by calculating each individual's average adherence rate to all the prescribed medications. Adherence rates were stratified by quintiles. We checked whether each person included followed the Israeli recommendations for influenza vaccine, colon cancer screening, and mammography. RESULTS Of 268,792 persons, 81.1% had hypertension, and 59.5% had diabetes; 40.6% had diabetes and hypertension. The mean age was 63.7 years; 50.6% were men. The mean number of medications used was 2.2 ± 1.1. An adherence rate of ≤20% was found in 4.2%, and >80% in 42.5%. Overall, 59.6% had received an influenza vaccine, 68.0% had undergone colon cancer screening, and 75.2% of the women had undergone mammography. Increased adherence to medications was associated with increased adherence to preventive recommendations. For persons in the study cohort, adjusted odds ratios comparing the highest to the lowest quintile of medication adherence were 1.52 (1.46-1.59) for influenza vaccine, 1.59 (1.53-1.66) for colon cancer screen, and 1.35 (1.27-1.44) for mammography. DISCUSSION A positive association was observed between adherence to chronic medications and adherence to preventive medicine among persons with hypertension and diabetes.
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Stevens N, Cambon L, Alla F. [Innovative transformation of the health system through a preventive transition]. Rev Epidemiol Sante Publique 2021; 69:235-240. [PMID: 34053796 DOI: 10.1016/j.respe.2021.04.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/14/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022] Open
Abstract
Given today's evolution of the healthcare system, organizational transformations, technological developments and major challenges, innovation has taken on primordial importance. In this context and with considerable support, many experimentations have taken place. Unfortunately, few have managed to scale up. What results is a congeries of innovations without a future, possibly avoidable squandering of resources, a number of missed opportunities, and the grim prospect of inventor burnout. As regards prevention, innovation is at the heart of an anticipated "preventive transition" of the health system that has yet to achieve operational status. In this article we attempt to redesign the contours of innovation in health, considering it first and foremost in regard to its social utility. We will go on to explore the limitations of innovative practices that delay the arrival of advances in health. Four types of obstacles appear: faulty evaluation; insufficient dialogue between researchers, stakeholders and decision-makers; lack of visibility and, finally, conceptions and perceptions of innovation characterized by tunnel vision. In the concluding section of this paper, we will present several tracks through which the innovation process could be impelled to drive health system transformation. They consist in: (i) incorporating an evaluative and comprehensive research into innovation processes, (ii) elaborating "bottom-up" approaches giving special consideration to innovations instigated by stakeholders and brought to fruition under real-life conditions, (iii) breaking from standardization by thinking from the outset of the adaptability of innovations and, finally, (iv) tying in the experimental approach with a decision-making process.
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Affiliation(s)
- N Stevens
- Bordeaux Population Health Research Center. UMR 1219 CIC-EC 1401, Université de Bordeaux, Bordeaux, France.
| | - L Cambon
- Bordeaux Population Health Research Center. UMR 1219 CIC-EC 1401, Université de Bordeaux, Bordeaux, France; Chaire de prévention, ISPED, Université de Bordeaux, Bordeaux, France
| | - F Alla
- Bordeaux Population Health Research Center. UMR 1219 CIC-EC 1401, Université de Bordeaux, Bordeaux, France; Département Prévention, CHU, Bordeaux, France
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Thompson B. Role of Environmental Genetics in Preventive Medicine: An Interview with Daniel W. Nebert, MS, MD. Yale J Biol Med 2021; 94:183-191. [PMID: 33795996 PMCID: PMC7995936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Brian Thompson
- To whom all correspondence should be addressed:
Brian Thompson,
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Jacobs NN, Calvo L, Dieringer A, Hall A, Danko R. Motivational Interviewing Training: A Case-Based Curriculum for Preclinical Medical Students. MedEdPORTAL 2021; 17:11104. [PMID: 33598544 PMCID: PMC7880250 DOI: 10.15766/mep_2374-8265.11104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/21/2020] [Indexed: 05/30/2023]
Abstract
Introduction With the rise of chronic medical problems involving lifestyle behaviors and the benefits of patient involvement in preventative care, medical students need to learn how to help patients change health risk behaviors and improve patient involvement in order to improve health outcomes. Motivational interviewing (MI) is a patient-centered therapeutic approach that is effective in the treatment of lifestyle behaviors and diseases. Methods This 2-hour didactic training session, along with a 3-hour case-based practice session involving role-plays and a 3-hour evaluated session utilizing standardized patients, was delivered to 68 preclinical medical students. Knowledge, attitudes, and self-efficacy were evaluated via pre- and posttraining surveys, and satisfaction with the training was assessed upon completion. Results Students who completed both pre- and postsurveys (n = 48) showed a statistically significant improvement in knowledge of MI (t = -29.73, df = 47, p < .001), attitudes regarding implementing MI in health care settings (t = -3.04, df = 47, p < .005), and self-efficacy (t = -10.699, df = 47, p < .001) in talking with patients about behavior change. Students were also highly satisfied with the MI training package (M of 4.4, SD = 0.6, out of 5.0). Discussion A training package to teach preclinical medical students about MI was effective in helping students learn the knowledge and skills necessary to deliver MI in a broad range of clinical cases.
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Affiliation(s)
- N. Nicole Jacobs
- Associate Professor, Department of Psychiatry and Behavioral Sciences, and Associate Dean of Diversity and Inclusion, University of Nevada, Reno School of Medicine
| | - Lisa Calvo
- Associate Professor, Department of Internal Medicine, and Associate Dean of Medical Education, University of Nevada, Reno School of Medicine
| | - Aaron Dieringer
- Assistant Professor, Department of Family and Community Medicine, University of Nevada, Reno School of Medicine
| | - Ali Hall
- Trainer and Consultant, Motivational Interviewing Network of Trainers (MINT)
| | - Reka Danko
- Clinical Assistant Professor, Department of Internal Medicine, University of Nevada, Reno School of Medicine
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Fernandes M, Majoni M, Garg AX, Dubois L. Systematic Review and Meta-Analysis of Preventative Strategies for Acute Kidney Injury in Patients Undergoing Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2021; 74:419-430. [PMID: 33548402 DOI: 10.1016/j.avsg.2020.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/09/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGOUND To assess the effect of various preventative interventions for reducing the incidence of postoperative acute kidney injury (AKI) in patients undergoing elective abdominal aortic aneurysm (AAA) repair. METHODS We included randomized controlled trials of 10 patients or more which tested a preventative intervention versus standard therapy or placebo in patients undergoing elective AAA repair using the open or endovascular approach. Studies including mixed patient populations such as those with aortic occlusive disease, thoracoabdominal aneurysms or ruptured aneurysms were ineligible for review. We searched Medline (1966-2019), EMBASE (1947-2019), CINAHL (1961-2019), Web of Science (1945-2019), Scopus (1966-2019), and The Cochrane Library (1996-2019) for trials available as published manuscripts in English. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Where possible we pooled the results of similar interventions using random effects meta-analysis. RESULTS We included 17 trials involving 1443 participants. Most trials were small, single-center studies, with varying definitions of AKI and a high or moderate risk of bias. The preventative strategies with possible protective effects were mannitol, a composite of antioxidant supplements, an open extraperitoneal approach, and human atrial natriuretic peptide (hANP). Curcumin, methylprednisolone, carbon dioxide contrast medium, hemodynamic monitoring and N-acetylcysteine were found to be ineffective. Six trials with a total of 355 participants reported on remote ischemic preconditioning (RIPC) and our meta-analysis showed no statistically significant difference between RIPC and standard treatment (OR 1.20, 95% CI 0.37, 3.89); although the results should be interpreted with caution due to considerable statistical heterogeneity (I2 = 70%). None of the interventions studied significantly reduced receipt of renal replacement therapy (RRT). CONCLUSIONS Interventions that have shown some potential to reduce AKI after AAA repair include mannitol, a composite of antioxidant supplements, an open extraperitoneal approach and hANP. These conclusions are limited by the small size, high risk of bias and inconsistency of the included trials. Large, high quality, multi-center randomized trials will help determine which interventions are effective in reducing the incidence of postoperative AKI among patients undergoing elective AAA repair.
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Affiliation(s)
- Michaela Fernandes
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Melissa Majoni
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Luc Dubois
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada; Division of Vascular Surgery, London Health Sciences Centre, London, Ontario, Canada.
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QUARANTA GIANLUIGI, DI PUMPO MARCELLO, LA MILIA DANIELEIGNAZIO, WACHOCKA MALGORZATA, PATTAVINA FABIO, VINCENTI SARA, DAMIANI GIANFRANCO, LAURENTI PATRIZIA, MOSCATO UMBERTO, BRUNO STEFANIA, BONINTI FEDERICA, TUTI FEDERICA, SEZZATINI ROMINA. A management model for Hospital Hygiene Unit: evidence-based proactive surveillance of potential environmental sources of infection in order to prevent patient's risk. J Prev Med Hyg 2021; 61:E628-E635. [PMID: 33628970 PMCID: PMC7888400 DOI: 10.15167/2421-4248/jpmh2020.61.4.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/04/2020] [Indexed: 12/03/2022]
Abstract
INTRODUCTION The aim of this study is to describe a proactive surveillance system of food, water and environmental surfaces, in order to avoid Healthcare-Associated Infections (HAIs) from hospital environment. METHODS It is a retrospective descriptive study. The surveillance system consists of two integrated phases: pre-analytic and post-analytic. The activities are distinguished in ordinary control activities, performed after scheduled and shared surveys, and compliance activities, performed when it is necessary to establish the adequacy of the destination use, for example opening a new ward. RESULTS A total of 1,470 Samples were collected and 539 Reports were generated across the five-year study period. Water for human consumption procedure: a statistically significant trend was found only in the total number of Samples collected (p < 0.001). Legionella spp. infection water risk procedure: all Samples and Reports, with the exception of Compliance Report Samples, showed a statistically significant trend (p < 0.001). Pseudomonas aeruginosa water risk procedure: only Ordinary Reports and Compliance Report Samples trend were statistically significant (p = 0.002 and p = 0.028 respectively). Effectiveness of surface sanitization procedure: no trend was statistically significant (p < 0.05). Hospital catering and food surfaces procedure: Samples and Reports yearly number was constant, no trend analysis was performed. HAIs prevalence was never over 5% in the hospital under study. CONCLUSIONS This surveillance system of water, food and environmental surfaces represents an innovative way of approaching hospital safety for patients and personnel because it overcomes the limitations due to a classic approach limited to a laboratory analytic phase only, according to the best available scientific evidence.
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Affiliation(s)
- GIANLUIGI QUARANTA
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - MARCELLO DI PUMPO
- Università Cattolica del Sacro Cuore, Roma, Italy
- Correspondence: Marcello Di Pumpo, Università Cattolica del Sacro Cuore, largo Francesco Vito 1, 00168 Rome, Italy - Tel. +39 06 30154396 - E-mail:
| | | | | | - FABIO PATTAVINA
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - SARA VINCENTI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - GIANFRANCO DAMIANI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - PATRIZIA LAURENTI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - UMBERTO MOSCATO
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - STEFANIA BRUNO
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - FEDERICA BONINTI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - FEDERICA TUTI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - ROMINA SEZZATINI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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