Nyt fra tidsskrifterne
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Ingen søgeord valgt.
39 emner vises.
Zhang, J., Ji, S., Ma, X., Yu, L., Jing, Y.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objective
We aimed to determine the association between meteorological factors and sudden sensorineural hearing loss (SSNHL) audiogram configurations.
Design
Retrospective review of medical records from 1 October 2007 to 31 December 2018.
Setting
A tertiary hospital.
Participants
510 patients with SSNHL who had data on the exact date of SSNHL onset and underwent audiological evaluation within 14 days were included.
Primary and secondary outcome measures
Daily values of meteorological factors, including maximum and minimum temperature, mean temperature and its day-to-day change, diurnal temperature range, atmospheric pressure, mean and maximum wind speed and relative humidity, and seasonal distributions.
Results
Among the 510 patients (259 women (50.8%); mean (SD) age, 46.4 (15.5) years), 108 (21.2%) displayed ascending patterns, 143 (28.0%) displayed descending patterns, 129 (25.3%) displayed flat patterns and 130 (25.5%) displayed profound patterns of audiograms. The diurnal temperature range on the day of SSNHL onset in patients with profound patterns was significantly higher than that in patient with ascending (mean difference (MD), 2.2°C; 95% CI, 0.7°C to 3.7°C; p=0.001) and descending (MD, 1.5°C; 95% CI, 0.1°C to 2.9°C; p=0.031) patterns. The relative humidity was the highest on the day of SSNHL onset in patients with ascending patterns and showed a significant difference compared with that in patients with profound patterns (MD, 8.0%; 95% CI, 0.7% to 15.3%; p=0.026). Seasonal distribution did not differ among patients with different audiogram configurations.
Conclusions
Profound audiogram patterns correlated with high diurnal temperature range, while ascending audiogram patterns correlated with high relative humidity in patients with SSNHL. No correlation was observed between seasons and audiogram configurations.
Læs mere Tjek på PubMedKausto, J., Rosenström, T. H., Ervasti, J., Pietiläinen, O., Kaila-Kangas, L., Rahkonen, O., Harkko, J., Väänänen, A., Kouvonen, A., Lallukka, T.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objective
An intervention was carried out at the occupational healthcare services (OHS) of the City of Helsinki beginning in 2016. We investigated the association between the intervention and employee sick leaves using interrupted time series analysis.
Design
Register-based cohort study with a quasi-experimental study design.
Setting
Employees of the City of Helsinki.
Participants
We analysed individual-level register-based data on all employees who were employed by the city for any length of time between 2013 and 2018 (a total 86 970 employees and 3 014 075 sick leave days). Sick leave days and periods that were OHS-based constituted the intervention time series and the rest of the sick leave days and periods contributed to the comparison time series.
Intervention
Recommendations provided to physicians on managing pain and prescribing sick leave for low back, shoulder and elbow pain.
Outcome measures
Number of sick leave days per month and sick leave periods per year.
Results
For all sick leave days prescribed at OHS, there was no immediate change in sick leave days, whereas a gradual change showing decreasing number of OHS-based sick leave days was detected. On average, the intervention was estimated to have saved 2.5 sick leave days per year per employee. For other sick leave days, there was an immediate increase in the level of sick leave days after the intervention and a subsequent gradual trend showing decreasing number of sick leave days.
Conclusions
The intervention may have reduced employee sick leaves and therefore it is possible that it had led to direct cost savings. However, further evidence for causal inferences is needed.
Læs mere Tjek på PubMedSt John, P. D., Menec, V., Tate, R., Newall, N. E., Cloutier, D., O'Connell, M.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objectives
Previous studies on depression in rural areas have yielded conflicting results. Features of rural areas may be conducive or detrimental to mental health. Our objective for this study was to determine if there are rural–urban disparities in depressive symptoms between those living in rural and urban areas of Canada.
Design
We conducted a cross-sectional analysis of a prospective cohort study, which is as representative as possible of the Canadian population—the Tracking Cohort of the Canadian Longitudinal Study on Aging. For this cohort, data were collected from 2010 to 2014. Data were analysed and results were obtained in 2020.
Participants
21 241 adults aged 45–85.
Measures
Rurality was grouped as urban (n=11 772); peri-urban (n=2637); mixed (n=2125; postal codes with both rural and urban areas); and rural (n=4707). Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression. We considered age, sex, education, marital status and disease states as potential confounding factors.
Results
The adjusted beta coefficient was –0.24 (95% CI –0.42 to –0.07; p=0.01) for rural participants, –0.17 (95% CI –0.40 to 0.05; p=0.14) for peri-urban participants and –0.30 (95% CI –0.54 to –0.05; p=0.02) for participants in mixed regions, relative to urban regions. Risk factors associated with depressive symptoms were similar in rural and urban regions.
Conclusions
The small differences in depressive symptoms among those living in rural and urban regions are unlikely to be relevant at a clinical or population level. The findings do suggest some possible approaches to reducing depressive symptoms in both rural and urban populations. Future research is needed in other settings and on change in depressive symptoms over time.
Læs mere Tjek på PubMedFalcaro, M., Osborn, D., Hayes, J., Coyle, G., Couperthwaite, L., Weich, S., Walters, K. R.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objectives
To investigate delivery of smoking cessation interventions, recorded quit attempts and successful quitting rates within primary care in smokers with depression or severe mental illness (SMI) compared with those without.
Design
Longitudinal cohort study using primary healthcare records.
Setting
English primary care.
Participants
882 849 patients registered with participating practices recorded as current smokers during 2007–2014, including three groups: (1) 13 078 with SMI, (2) 55 630 with no SMI but recent depression and (3) 814 141 with no SMI nor recent depression.
Outcomes
Recorded advice to quit smoking, referrals to smoking cessation services, prescriptions for smoking cessation medication, recorded quit attempts and changes of smoking status.
Results
The majority (>70%) of smokers had recorded smoking cessation advice. This was consistently higher in those with SMI than the other cohorts of patients, although the gap greatly reduced in more recent years. Increases in smoking cessation advice over time were not accompanied by increases in recorded attempts to quit or changes of smoking status. Overall nicotine replacement therapy prescribing by general practitioners (GPs) was higher in those with SMI (10.1%) and depression (8.7%) than those without (5.9%), but a downward time trend was observed in all groups. Bupropion and varenicline prescribing was very low and lower for those with SMI. Few smokers (<5%) had referrals to stop smoking services, though this increased over time, but no significant differences were observed between those with and without mental health problems.
Conclusions
There was no evidence of consistent inequalities in access to GP-delivered smoking cessation interventions for people with mental health conditions. Smoking cessation advice was widely reported as taking place in all groups. In order to address the widening gap in smoking prevalence in those with poor mental health compared with those without, the emphasis should be on addressing the quality of advice and support given.
Læs mere Tjek på PubMedRogers, C. R., Brooks, E., Curtin, K., De Vera, M. A., Qeadan, F., Rogers, T. N., Petersen, E., Gallagher, P., Pesmen, C., Johnson, W., Henley, C., Hickman, W., Newcomb, E., Korous, K. M., Handley, M. A.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Th last two decades have seen a twofold increase in colorectal cancer (CRC) incidence among individuals under the recommended screening age of 50 years. Although the origin of this early-onset CRC (EOCRC) spike remains unknown, prior studies have reported that EOCRC harbours a distinct molecular and clinical phenotype in younger individuals. The sharp increase in EOCRC incidence rates may be attributable to a complex interplay of factors, including race; lifestyle; and ecological, sociodemographic and geographical factors. However, more research that address psychosocial experiences and accounts for lifestyle-related behaviours before, during and after an EOCRC diagnosis are warranted. This study aims to develop and pilot test a theory-driven, community-based intervention to increase awareness of EOCRC, reduce its associated risk factors and improve early detection among adults aged 18–49 years.
Methods and analysis
Guided by the Behaviour Change Wheel, we will use a multistage mixed-methods study design. We will pilot a sequential mixed-methods intervention study as follows: (1) First, we will analyse linked quantitative data from the Utah Cancer Registry and National Cancer Institute Surveillance, Epidemiology and End Results registry, linked to state-wide demographic and vital records in the Utah Population Database to identify EOCRC hotspots in Utah by examining the EOCRC incidence and survival variance explained by personal and county-level factors. (2) Next, we will conduct one-on-one interviews with 20 EOCRC survivors residing in EOCRC hotspots to ascertain psychosocial and lifestyle challenges that accompany an EOCRC diagnosis. (3) Finally, we will consider existing evidence-based approaches, our integrated results (quantitative +qualitative) and community action board input to design a community-based intervention to increase EOCRC awareness that can feasibly be delivered by means of outdoor mass media, and via social media. We will pilot the multicomponent media campaign with a quasiexperimental design among 17 EOCRC hotspot residents and 17 EOCRC ‘coldspot’ residents.
Ethics and dissemination
Ethics approval was obtained from the University of Utah Institutional Review Board (IRB_00138357). Signed informed consent will be obtained from all participants prior to any data collection. Study results will be disseminated through CRC community blogs, targeted infographics, conference presentations at national and international professional conferences and publications in peer-reviewed journals. Final intervention-specific data will be available on reasonable request from the corresponding author.
Trial registration number
NCT04715074.
Læs mere Tjek på PubMedElliott, D., Blencowe, N. S., Cousins, S., Zahra, J., Skilton, A., Mathews, J., Paramasivan, S., Hoffmann, C., McNair, A. G., Ochieng, C., Richards, H., Hossaini, S., Scroggie, D. L., Main, B., Potter, S., Avery, K., Donovan, J., Blazeby, J. M.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
The development of innovative invasive procedures and devices are essential to improving outcomes in healthcare. However, how these are introduced into practice has not been studied in detail. The Lotus study will follow a wide range of ‘case studies’ of new procedures and/or devices being introduced into NHS trusts to explore what information is communicated to patients, how procedures are modified over time and how outcomes are selected and reported.
Methods and analysis
This qualitative study will use ethnographic approaches to investigate how new invasive procedures and/or devices are introduced. Consultations in which the innovation is discussed will be audio-recorded to understand information provision practice. To understand if and how procedures evolve, they will be video recorded and non-participant observations will be conducted. Post-operative interviews will be conducted with the innovating team and patients who are eligible for the intervention. Audio-recordings will be audio-recorded, transcribed verbatim and analysed thematically using constant comparison techniques. Video-recordings will be reviewed to deconstruct procedures into key components and document how the procedure evolves. Comparisons will be made between the different data sources.
Ethics and dissemination
The study protocol has Health Research Authority (HRA) and Health and Care Research Wales approval (Ref 18/SW/0277). Results will be disseminated at appropriate conferences and will be published in peer-reviewed journals. The findings of this study will provide a better understanding of how innovative invasive procedures and/or devices are introduced into practice.
Læs mere Tjek på PubMedMohamed-Yassin, M.-S., Baharudin, N., Abdul-Razak, S., Ramli, A. S., Lai, N. M.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Dyslipidaemia is one of the established risk factors for cardiovascular disease. Evidence from large-scale trials showed that effective treatment of dyslipidaemia can reduce all-cause and coronary mortality. To date, there is no published systematic review on the worldwide prevalence of dyslipidaemia in adults. We propose to perform a systematic review on the global prevalence of dyslipidaemia in adults 18 years and older.
Methods and analysis
We will identify observational studies through comprehensive literature searches. We will search: MEDLINE, Cochrane Central Register of Controlled Trials for published studies and trial registries including the WHO International Trial Registry Platform and ClinicalTrials.gov. Two reviewers will independently screen the titles and abstracts, attain full text of eligible articles, extract data, and appraise the quality and bias of the included studies. Disagreement among the authors will be resolved by discussion leading to a consensus. Next, we will perform a narrative synthesis of the study results. Study heterogeneity will be assessed using I2 statistics. If I2 is high (≥75%), and plausible heterogeneity contributors are found, we will divide the studies into appropriate subgroups for pooling of results or assess the association of plausible covariates and the prevalence estimates using meta-regression. If I2<75%, we will undertake meta-analysis using the random-effects model and transform all prevalence estimates using the Freeman-Tukey transformation for pooling, to obtain a synthesised point estimate of prevalence with its 95% confidence. We will then back-transform the point estimate, and report our results using the back-transformed figures.
Ethics and dissemination
Ethics approval is not a requirement as this study is based on available published data. Results of this systematic review will be presented at conferences, shared with relevant health authorities, and published in a peer-reviewed journal. These results may help quantify the magnitude of dyslipidaemia globally, and guide preventative and therapeutic interventions.
PROSPERO registration number
CRD42020200281
Læs mere Tjek på PubMedChristmals, C. D., Aziato, L., Rispel, L. C.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objective
Nursing regulators are important governance structures for nurses who are critical to the achievement of universal health coverage (UHC). This study examined the perspectives of the heads of nursing education institutions (NEIs) in Ghana and South Africa on the functioning and effectiveness of the respective nursing regulators.
Design
This was a cross-sectional survey.
Setting
This study was conducted in Ghana and South Africa
Participants
Heads of accredited NEIs in Ghana (n=65) and in South Africa (n=39).
Results
In South Africa, the mean score for overall functioning of the South African Nursing Council (SANC) was 4.6 (SD 1.97), whereas the mean score for overall functioning of the Nursing and Midwifery Council of Ghana (N&MC) was 7.1 (SD 1.7) (p<0.0001). Similarly, the mean score for effectiveness of the SANC by NEIs was 5.1, compared with the mean effectiveness score of 7.2 for the N&MC (p<0.001).
Compared to the SANC, the heads of NEIs scored the N&MC higher on each of the six functional areas of policy-making (Ghana=7.06; SA=4.56); accreditation (Ghana=7.40; SA=4.10) legal and disciplinary actions (Ghana=6.45; SA=5.52); examination (Ghana=7.84; SA=5.00); registration (Ghana=8.27; SA=5.96) and communication and transparency (Ghana=6.87; SA=6.05).
Conclusion
Both the N&MC and SANC are well-established regulators and are vital to ensure that the nursing workforce in each country is able to deliver quality healthcare, thereby contributing to UHC and population health improvements. However, the study findings suggest the need for concerted efforts to improve the functioning and effectiveness of the regulators, especially the SANC. The six functional areas could guide the necessary improvements in regulator functioning and effectiveness, in partnership with relevant stakeholders.
Læs mere Tjek på PubMedManivannan, S., Spencer, R., Marei, O., Mayo, I., Elalfy, O., Martin, J., Zaben, M.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objectives
Acute subdural haematoma (ASDH) is a devastating pathology commonly found on CT brain scans of patients with traumatic brain injury. The role of surgical intervention in the elderly has been increasingly questioned due to its associated morbidity and mortality. Therefore, a systematic review and meta-analysis of the literature to quantify the mortality and functional outcomes associated with surgical management of ASDH in the elderly was performed.
Design/setting
A multidatabase literature search between January 1990 and May 2020, and meta-analysis of proportions was performed to quantify mortality and unfavourable outcome (Glasgow Outcome scale 1–3; death/ severe disability) rates.
Participants
Studies reporting patients aged 60 years or older.
Interventions
Craniotomy, decompressive craniectomy, conservative management.
Outcome measures
Mortality and functional outcomes (discharge, long-term follow-up (LTFU)).
Results
2572 articles were screened, yielding 21 studies for final inclusion and 15 for meta-analysis. Pooled estimates of mortality were 39.83% (95% CI 32.73% to 47.14%; 10 studies, 308/739 patients, I2=73%) at discharge and 49.30% (95% CI 42.01% to 56.61%; 10 studies, 277/555 patients, I2=63%) at LTFU. Mean duration of follow-up was 7.1 months (range 2–12 months). Pooled estimate of percentage of poor outcomes was 81.18% (95% CI 75.61% to 86.21%; 6 studies, 363/451 patients, I2=45%) at discharge, and 79.25% (95% CI 72.42% to 85.37%; 8 studies, 402/511 patients, I2=66%) at LTFU. Mean duration of follow-up was 6.4 months (range 2–12 months). Potential risk factors for poor outcome included age, baseline functional status, preoperative neurological status and imaging parameters.
Conclusions
Outcomes following surgical evacuation of ASDH in patients aged 60 years and above are poor. This constitutes the best level of evidence in the current literature that surgical intervention for ASDH in the elderly carries significant risks, which must be weighed against benefits.
PROSPERO registration number
CRD42020189508.
Læs mere Tjek på PubMedGirma, B., Nigussie, J.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objective
This study aimed to assess the magnitude of preterm neonatal mortality in hospitals and associated factors in northern Ethiopia.
Design
Institutional-based cross-sectional study.
Setting
Comprehensive specialised hospitals in the Tigray region, northern Ethiopia.
Participants
Preterm neonates admitted in Ayder and Aksum comprehensive specialised hospitals
Primary outcome
Magnitude of preterm neonatal mortality.
Secondary outcome
Factors associated with preterm neonatal mortality
Result
This study was conducted from 1 April 2019 to 15 May 2019 among 336 participants with a response rate of 96.8%. The magnitude of preterm neonatal mortality was 28.6% (95% CI: 24.0 to 33.7). In multivariable logistic regression, respiratory distress syndrome (adjusted odd ratio (AOR)=2.85; 95% CI: 1.35 to 6.00), apnoea of prematurity (AOR=5.45; 95% CI: 1.32 to 22.5), nulli parity (AOR=3.63; 95% CI: 1.59 to 8.24) and grand parity (AOR=3.21; 95% CI: 1.04 to 9.94) were significant factors associated with preterm neonatal mortality. However, receiving Kangaroo mother care (AOR=0.08; 95% CI: 0.03 to 0.20) and feeding initiated during hospitalisation (AOR=0.07; 95% CI: 0.03 to 0.15) were protective against preterm neonatal mortality.
Conclusions
The magnitude of preterm neonatal mortality in hospitals was still high. Interventions geared towards curbing preterm in-hospital neonatal mortality should strengthen early diagnosis and treatment of preterm newborns with respiratory distress syndrome and apnoea of prematurity; while concomitantly reinforcing the implementation of kangaroo care and early feeding initiation is important.
Læs mere Tjek på PubMedHughes, D. A., Skiadas, K., Fitzsimmons, D., Anderson, P., Heald, A.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objective
Medicines with limited evidence of effectiveness are prime candidates for disinvestment. However, investment in further research may be preferable to deimplementation, given that the absence of evidence is not evidence of absence, and research can inform formulary decisions. A case in point is liothyronine, which is sometimes prescribed to levothyroxine-treated patients who continue to experience hypothyroid symptoms. It is a putative low value medicine, associated with uncertainties in both clinical and cost-effectiveness. The aim was to assess the cost-effectiveness of liothyronine in this context, and estimate the value of conducting further research.
Design
Cost utility and value of information analyses.
Setting
Primary care within the National Health Service in the UK.
Participants
Fifty-four levothyroxine-treated patients with persistent symptoms of hypothyroidism.
Interventions
Liothyronine plus levothyroxine versus levothyroxine alone.
Primary and secondary outcome measures
Incremental cost per quality-adjusted life year (QALY) gained, and the expected monetary value of sample information.
Results
20/54 (37%) of patients who responded to the survey reported severe problems in carrying out usual activities of everyday living and 12/54 (22%) reported severe anxiety or depression symptoms. Mean (SD) utility was 0.53 (0.23). The differences in expected total, 10-year costs and QALYs between a treatment strategy of liothyronine/levothyroxine combination therapy, and levothyroxine alone, was £12 053 and 1.014, respectively. The incremental cost-effectiveness ratio of £11 881 per QALY gained was sensitive to the price of liothyronine. The probability of liothyronine/levothyroxine combination therapy being cost effective at a threshold of £20 000 per QALY was 0.56. The value of reducing uncertainty in the efficacy of treatment was £3.64 m per year in the UK.
Conclusions
A definitive clinical trial to confirm clinical effectiveness may be preferable to immediate disinvestment, and would be justified given the value of the information gained far exceeds the cost.
Læs mere Tjek på PubMedLauffenburger, J. C., Yom-Tov, E., Keller, P. A., McDonnell, M. E., Bessette, L. G., Fontanet, C. P., Sears, E. S., Kim, E., Hanken, K., Buckley, J. J., Barlev, R. A., Haff, N., Choudhry, N. K.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Achieving optimal diabetes control requires several daily self-management behaviours, especially adherence to medication. Evidence supports the use of text messages to support adherence, but there remains much opportunity to improve their effectiveness. One key limitation is that message content has been generic. By contrast, reinforcement learning is a machine learning method that can be used to identify individuals’ patterns of responsiveness by observing their response to cues and then optimising them accordingly. Despite its demonstrated benefits outside of healthcare, its application to tailoring communication for patients has received limited attention. The objective of this trial is to test the impact of a reinforcement learning-based text messaging programme on adherence to medication for patients with type 2 diabetes.
Methods and analysis
In the REinforcement learning to Improve Non-adherence For diabetes treatments by Optimising Response and Customising Engagement (REINFORCE) trial, we are randomising 60 patients with suboptimal diabetes control treated with oral diabetes medications to receive a reinforcement learning intervention or control. Subjects in both arms will receive electronic pill bottles to use, and those in the intervention arm will receive up to daily text messages. The messages will be individually adapted using a reinforcement learning prediction algorithm based on daily adherence measurements from the pill bottles. The trial’s primary outcome is average adherence to medication over the 6-month follow-up period. Secondary outcomes include diabetes control, measured by glycated haemoglobin A1c, and self-reported adherence. In sum, the REINFORCE trial will evaluate the effect of personalising the framing of text messages for patients to support medication adherence and provide insight into how this could be adapted at scale to improve other self-management interventions.
Ethics and dissemination
This study was approved by the Mass General Brigham Institutional Review Board (IRB) (USA). Findings will be disseminated through peer-reviewed journals, clinicaltrials.gov reporting and conferences.
Trial registration number
Clinicaltrials.gov (NCT04473326).
Læs mere Tjek på PubMedZhang, Y., Hu, H., Li, X., Lou, J., He, X., Jiang, Y., Fang, J.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
To date, there has been a lack of knowledge about the status, reporting completeness and methodological quality of pilot trials in the acupuncture field. Thus, this systematic review protocol aims to: (1) investigate publication trends and aspects of feasibility evaluated in acupuncture pilot trials; (2) identify the proportion of acupuncture pilot trials that lead to definitive trials and (3) assess the reporting completeness and methodological quality of pilot trials in acupuncture.
Methods and analysis
Studies of acupuncture pilot randomised controlled trials published from 2011 to 2021 will be retrieved in seven databases in January 2022, including PubMed, Web of Science, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database and Chinese Biomedical Literature Database. The methodological quality and reporting completeness of all included studies will be assessed using the risk of bias 2.0 tool (RoB 2) and the Consolidated Standards of Reporting Trials (CONSORT) extension to randomised pilot and feasibility trials, respectively. For the primary analysis, publication trends, aspects of feasibility and the proportion of pilot trials that lead to definitive trials will be analysed. A quantitative analysis of the methodological quality and reporting completeness of the included trials will be implemented by calculating the percentage of items reported in each domain of RoB 2 and CONSORT. The secondary analysis will adopt a regression analysis to identify factors associated with the reporting completeness.
Ethics and dissemination
Ethical approval is not required for this study. This study is planned to be submitted to a peer-reviewed academic journal.
Læs mere Tjek på PubMedBerney, A., Carrard, V., Berney, S., Schlegel, K., Gaume, J., Gholam, M., Bart, P.-A., Preisig, M., Wac, K., Schmid Mast, M., Bourquin, C.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Physician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students’ interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients.
Methods and analysis
This project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1–6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills.
Ethics and dissemination
The project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.
Læs mere Tjek på PubMedBradbury, M., O'Brien, C., Giles, N., Fenton, S., Neilson, S., Duda, J. L.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Non-ambulant children and young people with physical disabilities are at high risk of experiencing negative health outcomes associated with sedentary time. A previous scoping review summarising evidence relating to sedentary behaviours of children with physical disabilities identified the need for validated methods of measuring physical activity of children who use wheelchairs and evaluation of interventions to reduce sedentary time. The scoping review did not assess the quality of evidence relating to this topic, therefore its validity remains unclear. No reviews focussing on non-ambulant children and young people up to the age of 25 years have been undertaken.
The objectives of this systematic search and review are to:
Identify all peer-reviewed articles relating to sedentary behaviour of non-ambulant children and young people.
Categorise the articles according to study design and four subquestions relating to (i) measurement, (ii) patterns, (iii) associated risks and (iv) interventions to reduce sedentary time or behaviour.
Critically appraise quality of the articles using established critical appraisal tools.
Summarise the evidence for each subquestion. Describe its cumulative strength and identify knowledge gaps.
Methods and analysis
This protocol was developed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. The research questions, inclusion/exclusion criteria and search terms have been developed a priori using the ‘Population, Concept and Context’ framework. Online databases will be systematically searched to identify peer-reviewed articles published between 1996 and 2021. Two reviewers will screen, categorise and critically appraise the articles. Data extraction and analysis will be verified by the second reviewer.
Results will be reported as a best evidence synthesis, with reference to the PRISMA checklist.
Ethics and dissemination
Ethical approval is not required. The review will be submitted to an appropriate peer-reviewed journal.
Registration
The review is registered on the Open Science Framework database. DOI: https://doi.org/10.17605/OSF.IO/SQXJB. Any protocol amendments will be recorded in the Open Science Framework database.
Læs mere Tjek på PubMedQuarshie, E. N.-B., Oppong Asante, K., Andoh-Arthur, J.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Self-harm and suicidal behaviour represent major global health problems, which account for significant proportions of the disease burden in low-income and middle-income countries, including Ghana. This review aims to synthesise the available and accessible evidence on prevalence estimates, correlates, risk and protective factors, the commonly reported methods and reasons for self-harm and suicidal behaviour in Ghana.
Methods and analysis
We will conduct a systematic review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (2009) recommendations. Regional and global electronic databases (African Journals OnLine, African Index Medicus, APA PsycINFO, Global Health, MEDLINE and PubMed) will be searched systematically up to December 2021 for observational studies and qualitative studies that have reported prevalence estimates, correlates, risk and protective factors, methods and reasons for self-harm and suicidal behaviour in Ghana. The electronic database searches will be supplemented with reference harvesting and grey literature searching in Google Scholar and ProQuest Dissertations & Theses Global for postgraduate dissertations. Only records in English will be included. The Mixed Methods Appraisal Tool (2018) will be used to assess the methodological quality of included studies. Meta-analysis or narrative synthesis or both will be used, contingent on the extent of heterogeneity across eligible observational studies.
Ethics and dissemination
Considering that this is a systematic review of accessible and available literature, we will not seek ethical approval. On completion, this review will be submitted to a peer-reviewed journal, be disseminated publicly at (mental) health conferences with focus on self-harm and suicide prevention. The important findings would also be shared with key national stakeholder groups in Ghana: Ghana Association for Suicide Prevention, Ghana Mental Health Authority, Ghana Psychological Association, Centre for Suicide and Violence Research, Accra and the Parliamentary Select Committee on Health.
Prospero registration number
CRD42021234622.
Læs mere Tjek på PubMedRubio, R., Palacios, B., Varela, L., Fernandez, R., Camargo Correa, S., Estupinan, M. F., Calvo, E., Jose, N., Ruiz Munoz, M., Yun, S., Jimenez-Marrero, S., Alcoberro, L., Garay, A., Moliner, P., Sanchez-Fernandez, L., Soria Gomez, M. T., Hidalgo, E., Enjuanes, C., Calero-Molina, E., Rueda, Y., San Saturnino, M., Garcimartin, P., Lopez-Ibor, J. V., Segovia-Cubero, J., Comin-Colet, J.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objectives
To gather insights on the disease experience of patients with heart failure (HF) with reduced ejection fraction (HFrEF), and assess how patients’ experiences and narratives related to the disease complement data collected through standardised patient-reported outcome measures (PROMs). Also, to explore new ways of evaluating the burden experienced by patients and caregivers.
Design
Observational, descriptive, multicentre, cross-sectional, mixed-methods study.
Setting
Secondary care, patient’s homes.
Participants
Twenty patients with HFrEF (New York Heart Association (NYHA) classification I–III) aged 38–85 years.
Measures
PROMs EuroQoL 5D-5L (EQ-5D-5L) and Kansas City Cardiomyopathy Questionnaire and patient interview and observation.
Results
A total of 20 patients with HFrEF participated in the study. The patients’ mean (SD) age was 72.5 (11.4) years, 65% were male and were classified in
NYHA functional classes I (n=4), II (n=7) and III (n=9). The study showed a strong impact of HF in the patients’ quality of life (QoL) and disease experience, as revealed by the standardised PROMs (EQ-5D-5L global index=0.64 (0.36); Kansas City Cardiomyopathy Questionnaire total symptom score=71.56 (20.55)) and the in-depth interviews. Patients and caregivers often disagreed describing and evaluating perceived QoL, as patients downplayed their limitations and caregivers overemphasised the poor QoL of the patients. Patients related current QoL to distant life experiences or to critical moments in their disease, such as hospitalisations. Anxiety over the disease progression is apparent in both patients and caregivers, suggesting that caregiver-specific tools should be developed.
Conclusions
PROMs are an effective way of assessing symptoms over the most recent time period. However, especially in chronic diseases such as HFrEF, PROM scores could be complemented with additional tools to gain a better understanding of the patient’s status. New PROMs designed to evaluate and compare specific points in the life of the patient could be clinically more useful to assess changes in health status.
Læs mere Tjek på PubMedOtth, M., Drozdov, D., Hügli, C., Scheinemann, K.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
A high proportion of survivors of childhood and adolescent cancer experience chronic medical conditions — late effects. Most studies on late effects have a retrospective or questionnaire-based design, which leads to unavoidable limitations such as missing data or different severity coding and grading of late effects. We, therefore, need prospective data, including standardised severity coding and grading. ‘Young Survivors at KSA’ aims to close this gap by assessing frequency, severity, risk factors and longitudinal changes of late effects in childhood cancer survivors prospectively and in a standardised way.
Methods and analysis
Within the ‘Young Survivors at KSA’ registry, we collect data from regular follow-up visits in a comprehensive database prospectively and repeatedly from start of the study and retrospectively at most until January 2016. We classify and grade the severity of late effects according to the Common Terminology Criteria for Adverse Events version 4.0 modified by Hudson et al. The outcome variables correspond to results from risk-stratified organ examinations, performed according to the Children’s Oncology Group guidelines version 5.0 and the recommendations by the International Guideline Harmonization Group. We collect the exposure variables from the patients’ medical history, including detailed information on cancer diagnosis and treatment. We analyse the data in an exposure-driven and organ system-driven approach. We start recruitment with patients treated at the Kantonsspital Aarau, Switzerland. However, our design allows the inclusion of additional national centres later.
Ethics and dissemination
‘Young Survivors at KSA’ is approved by the Ethikkommission Nordwest- und Zentralschweiz, reference number AO_2020–00012. The results of this study will be presented at scientific meetings, including meetings with childhood cancer survivors and published in peer-reviewed and if possible open access journals. New insights gained from the study will be used directly in clinical practice.
Trial registration number
ClinicalTrials.gov NCT04811794; https://clinicaltrials.gov/ct2/show/study/NCT04811794
Læs mere Tjek på PubMedLicchetta, L., Trivisano, M., Baldin, E., Mohamed, S., Raschi, E., Mostacci, B., Zenesini, C., Contin, M., Vigevano, F., Bisulli, F., Tinuper, P., Vignatelli, L.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Epilepsy is a chronic condition requiring consistent follow-up aimed at seizure control, and monitoring of anti-seizure medication (ASM) levels and side effects. Telemedicine (TM) offers invaluable support to patient follow-up, guaranteeing the prompt availability of a team of experts for persons with epilepsy (PWE) widely distributed across the country. Although many health institutions have endorsed the use of TM, robust data on effectiveness, safety and costs of TM applied to epilepsy are lacking. TELEmedicine for EPIlepsy Care (TELE-EPIC) will evaluate the effectiveness of video consultation (VC) via TM compared with usual care (UC) for the monitoring of PWE (TELE-EPIC_RCT). Moreover, TELE-EPIC will apply an innovative Volumetric Absorptive Microsampling (VAMS) device for quantitation of ASM through finger prick blood sampling as an alternative to venipuncture sampling (TELE-EPIC_VAMS).
Methods and analysis
TELE-EPIC_RCT is a multicentre, open, pragmatic two-arm randomised controlled trial prospectively including adult and paediatric outpatients with established diagnosis of epilepsy consecutively attending the Epilepsy Centres of Bologna and Rome, respectively. The primary outcome is the non-inferiority of VC on seizure control compared with UC after an 18-month follow-up. Secondary outcomes are adherence to treatment, ASM-related adverse events, quality of life, mood disorders, patient and caregiver satisfaction, safety and costs. TELE-EPIC_VAMS is a cross-validation study for blood ASM quantitation through a novel, VAMS-based device, comparing (1) VAMS versus plasma samples (reference standard method); and (2) nurse-collected versus self-collected blood by VAMS device.
Ethics and dissemination
The study has been approved by the local ethics committee (349-2019-SPER-AUSLBO). Complete information about the state of project, relevant events and results will be regularly updated on the project’s webpage on ClinicalTrials.gov. The project’s results and data on the potential impact of TM in epilepsy will be disseminated on social media. A closeout meeting will be convened for the communication and dissemination of the project, highlighting its main achievements and impacts.
Trial registration number
NCT04496310
Læs mere Tjek på PubMedSmith, S. L., Nyirandagijimana, B., Hakizimana, J., Levy, R. P., Bienvenu, R., Uwamwezi, A., Hakizimfura, O., Uwimana, E., Kundu, P., Mpanumusingo, E., Nshimyiryo, A., Rusangwa, C., Kateera, F., Mukasakindi, H., Raviola, G.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Evidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settings. In 2017, Partners In Health adapted PM+ for delivery by primary care nurses in rural Rwanda and began integrating PM+ into health centres in collaboration with the Rwandan Ministry of Health, using established implementation strategies for mental health integration into primary care (Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH MH)). A gap in the evidence regarding whether low-intensity psychological interventions can be successfully integrated into real-world primary care settings and improve outcomes for common mental disorders remains. In this study, we will rigorously evaluate the delivery of PM+ by primary care nurses, supported by MESH MH, as it is scaled across one rural district in Rwanda.
Methods and analysis
We will conduct a hybrid type 1 effectiveness-implementation study to test the clinical outcomes of routinely delivered PM+ and to describe the implementation of PM+ at health centres. To study the clinical effectiveness of PM+, we will use a pragmatic, randomised multiple baseline design to determine whether participants experience improvement in depression symptoms (measured by the Patient Health Questionnaire-9) and functioning (measured by the WHO-Disability Assessment Scale Brief 2.0) after receiving PM+. We will employ quantitative and qualitative methods to describe and evaluate PM+ implementation outcomes using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, using routinely collected programme data and semistructured interviews.
Ethics and dissemination
This evaluation was approved by the Rwanda National Ethics Committee (Protocol #196/RNEC/2019) and deemed exempt by the Harvard University Institutional Review Board. The results from this evaluation will be useful for health systems planners and policy-makers working to translate the evidence base for low-intensity psychological interventions into practice.
Læs mere Tjek på PubMedBroom, J., Broom, A., Kenny, K., Post, J. J., Konecny, P.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Objectives
Despite escalating antimicrobial resistance (AMR), implementing effective antimicrobial optimisation within healthcare settings has been hampered by institutional impediments. This study sought to examine, from a hospital management and governance perspective, why healthcare providers may find it challenging to enact changes needed to address rising AMR.
Design
Semistructured qualitative interviews around their experiences of antimicrobial stewardship (AMS) and responsiveness to the requirement for optimisation. Data were analysed using the framework approach.
Setting
Two metropolitan tertiary-referral hospitals in Australia.
Participants
Twenty hospital managers and executives from the organisational level of department head and above, spanning a range of professional backgrounds and in both clinical and non-clinical roles, and different professional streams were represented.
Results
Thematic analysis demonstrated three key domains which managers and executives describe, and which might function to delimit institutional responsiveness to present and future AMR solutions. First, the primacy of ‘political’ priorities. AMR was perceived as a secondary priority, overshadowed by political priorities determined beyond the hospital by state health departments/ministries and election cycles. Second, the limits of accreditation as a mechanism for change. Hospital accreditation processes and regulatory structures were not sufficient to induce efficacious AMS. Third, a culture of acute problem ‘solving’ rather than future proofing. A culture of reactivity was described across government and healthcare institutions, precluding longer term objectives, like addressing the AMR crisis.
Conclusion
There are dynamics between political and health service institutions, as well as enduring governance norms, that may significantly shape capacity to enact AMS and respond to AMR. Until these issues are addressed, and the field moves beyond individual behaviour modification models, antimicrobial misuse will likely continue, and stewardship is likely to have a limited impact.
Læs mere Tjek på PubMedBerg, S. K., Herning, M., Schjodt, I., Thorup, C. B., Juul, C., Svendsen, J. H., Jorgensen, M. B., Risom, S. S., Christensen, S. W., Thygesen, L., Rasmussen, T. B.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Patients with cardiac disease often experience anxiety (prevalence about 20%–25%) and have a doubled mortality risk when suffering from anxiety compared with patients without anxiety. This calls for interventions aiming to reduce anxiety.
Methods and analysis
The Heart & Mind Trial consists of three parts: (1) screening of all hospitalised and outpatient cardiac patients with arrhythmia, heart failure or ischaemic heart disease at four university hospitals in Denmark using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A); Patients scoring ≥8 is invited to participate; (2) Assessment of the type of anxiety by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders and (3) Randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive–behavioural therapy (CBT) performed by a CBT-trained cardiac nurse plus usual care or, usual care alone. The primary outcome is anxiety measured with HADS-A at 5 months. Secondary outcomes include anxiety symptoms measured with Becks Anxiety Inventory and heart rate variability. Exploratory outcomes measured at 12 months include blood cortisol (stress response), blood C reactive protein (stress response), health-related quality of life, readmission, mortality and attributable direct costs. A total of 336 patients will be included. The primary analyses are based on the intention-to-treat principle. For the primary outcome, we will use a linear regression model. For the long-term outcomes, mixed regression models will be used including repeated measurements.
Ethics and dissemination
The trial is performed in accordance with the Declaration of Helsinki. All patients must give informed consent prior to participation and the trial is initiated after approval by the Danish Data Protection Agency (P-2020-894) and the National Committee on Health Research Ethics (H-20066739). Positive, neutral and negative results of the trial will be published.
Trial registration number
NCT04582734.
Læs mere Tjek på PubMedBrunet, J., Price, J., Baillot, A.
BMJ Open, 3.12.2021
Tilføjet 4.12.2021
Introduction
Improving body image may help to enhance the quality of life of women diagnosed with breast cancer. Although evidence suggests psychosocial interventions can effectively improve body image in this population, no review to date has assessed their feasibility or acceptability. This manuscript reports the protocol for a review summarising current evidence for the feasibility and acceptability of psychosocial interventions for body image targeting women diagnosed with breast cancer and the study methods used to evaluate the interventions in question to provide recommendations to optimise the success and sustainability of psychosocial interventions for body image and future studies. Results will also help to identify gaps in the existing evidence to provide direction for future research.
Methods and analysis
We searched the following databases for articles published in the English language from January 2000 to June 2021 using a systematic search strategy: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, PsychINFO and EMBASE. This search will be supplemented with a manual search of reference lists from relevant systematic reviews and included articles. Eligible studies will include peer-reviewed publications reporting on feasibility and acceptability in the evaluation of psychosocial interventions for body image targeting women diagnosed with breast cancer. All study designs are eligible, although articles are required to have reported on an intervention evaluation. Two reviewers will independently carry out study selection, extraction of quantitative and qualitative data and quality assessment. Data will be summarised in a narrative review and thematic analysis.
Ethics and dissemination
No ethical approval is required because this is a protocol for a systematic review. On completion, results will be submitted for publication in a peer-reviewed scientific journal and for presentation at a relevant conference.
Trial registration
This protocol has been registered in the Prospective Register of Systematic Reviews international registry (ID: CRD42021269062, 11 September 2021).
Læs mere Tjek på PubMedBerg, N., Kiviruusu, O., Grundström, J., Huurre, T., Marttunen, M.
BMJ Open, 2.12.2021
Tilføjet 4.12.2021
Purpose
This cohort profile describes the Stress, development and mental health study (TAM), which is a cohort study investigating risk and protective factors as well as longitudinal associations regarding mental health and well-being from adolescence to midlife. This interdisciplinary cohort study operates, for example, in the fields of public health, social medicine, psychiatry and the life course perspective.
Participants
In 1981 (n=2242, 98.0% of the target population), 1982 (n=2191, 95.6%) and 1983 (n=2194, 96.7%) during school classes, surveys were conducted to all Finnish-speaking pupils (mostly born 1967) in the Tampere region in Finland. Participants of the school study at age 16 in 1983 (n=2194) comprised the base population for the longitudinal data and were followed-up using postal questionnaires in the years 1989, 1999, 2009 and 2019 at ages 22 (n=1656, 75.5% of the age 16 participants), 32 (n=1471, 67.0%), 42 (n=1334, 60.8%) and 52 (n=1160, 52.9%).
Findings to date
The self-reported questionnaires include information on physical and mental health (eg, depression and mood disorders, anxiety disorders), health behaviour and substance misuse (eg, alcohol, tobacco and exercise), socioeconomic conditions, psychosocial resources (eg, self-esteem), social relationships and support, life events, etc. The numerous studies published to date have examined mental health and various factors from several perspectives such as risk and protective factors, individual developmental paths (eg, trajectories) and pathway models (mediation and moderation).
Future plans
Current and future research areas include, for example, longitudinal associations between mental health (eg, depressive symptoms, self-esteem) and (1) substance use (alcohol and tobacco), (2) family transitions (eg, parenthood, relationship status) and (3) retirement. Next follow-up is planned to be conducted at the latest at age 62 in 2029. Before that it is possible to link the data with cause-of-death register.
Læs mere Tjek på PubMedGebremedhin, A. T., Tessema, G. A., Regan, A. K., Pereira, G. F.
BMJ Open, 2.12.2021
Tilføjet 4.12.2021
Objective
To examine if the association between interpregnancy interval (IPI) and pregnancy complications varies by the presence or absence of previous complications.
Design and setting
Population-based longitudinally linked cohort study in Western Australia (WA).
Participants
Mothers who had their first two (n=252 368) and three (n=96 315) consecutive singleton births in WA between 1980 and 2015.
Outcome measures
We estimated absolute risks (AR) of preeclampsia (PE) and gestational diabetes (GDM) for 3–60 months of IPI according to history of each outcome. We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 3, 6, 12, 24, 36, 48 and 60 months, with 18 months as reference.
Results
Risks of PE and GDM were 9.5%, 2.6% in first pregnancies, with recurrence rates of 19.3% and 41.5% in second pregnancy for PE and GDM, respectively. The AR of GDM ranged from 30% to 43% across the IPI range for mothers with previous GDM compared with 2%–8% for mothers without previous GDM. For mothers with no previous PE, greater risks were observed for IPIs at 3 months (RR 1.24, 95% CI 1.07 to 1.43) and 60 months (RR 1.40, 95% CI 1.29 to 1.53) compared with 18 months. There was insufficient evidence for increased risk of PE at shorter IPIs of <18 months for mothers with previous PE. Shorter IPIs of <18 months were associated with lower risk than at IPIs of 18 months for mothers with no previous GDM.
Conclusions
The associations between IPIs and risk of PE or GDM on subsequent pregnancies are modified by previous experience with these conditions. Mothers with previous complications had higher absolute, but lower RRs than mothers with no previous complications. However, IPI remains a potentially modifiable risk factor for mothers with previous complicated pregnancies.
Læs mere Tjek på PubMedGausman, J., Abu Sabbah, E., Othman, A., Hamad, I. L., Dabobe, M., Langer, A.
BMJ Open, 2.12.2021
Tilføjet 4.12.2021
Introduction
Sexual and gender-based violence (SGBV) is a major public health concern in Jordan, especially among youth. Social acceptance of SGBV is alarmingly high, including among youth. Refugee populations may be at particular risk given limited social support and access to health services combined with increased social and economic pressure and vulnerability. Further research is needed to understand how norms are embodied and reproduced at individual, interpersonal and community levels through relationships between partners, families, peers and community leaders. This study seeks to provide data on attitudes and norms in communities and across youth social networks in order to support gender transformative approaches that seek to change harmful social norms that perpetuate acceptance of SGBV.
Methods and analysis
This study will collect egocentric data from 960 youth in Jordan (480 men and 480 women) aged between 18 years and 24 years. Individuals will be asked about their perceptions of norms relating to SGBV in their community as well as their perceptions of the attitudes held by up to 15 individuals within their social network. Data will also be collected on the social, economic and demographic variables, refugee status, experience of depression and anxiety, and social support. We will use multilevel analysis to examine individual and group-level associations. We will also assess other network attributes, such as homophily, the role of social engagement, social learning and social support in the transmission of norms and attitudes.
Ethics and dissemination
Ethical approval was obtained from the Institutional Review Boards of the Harvard T.H. Chan School of Public Health and the University of Jordan. Rigorous ethical protections will be followed with regard to confidentiality and respondent safety. We intend to publish peer-reviewed papers of our findings in addition to a variety of tools and resources targeting diverse audiences, including policy and technical briefs.
Læs mere Tjek på PubMedNatalia C. Rosas, Trevor Lithgow
Trends in Microbiology, 3.12.2021
Tilføjet 4.12.2021
The cell envelope is essential for survival and adaptation of bacteria. Bacterial membrane proteins include the major porins that mediate the influx of nutrients and several classes of antimicrobial drugs. Consequently, membrane remodelling is closely linked to antimicrobial resistance (AMR). Knowledge of bacterial membrane protein biogenesis and turnover underpins our understanding of bacterial membrane remodelling and the consequences that this process have in the evolution of AMR phenotypes. At the population level, the evolution of phenotypes is a reversible process, and we can use these insights to deploy evolutionary principles to resensitize bacteria to existing antimicrobial drugs.
Læs mere Tjek på PubMedMalaria Journal, 3.12.2021
Tilføjet 4.12.2021
Abstract
Background
Thailand is committed to eliminating malaria by 2024. From 2013 to 2020, the total number of malaria cases have decreased, from 37,741 to 4474 (an 88.1% reduction). However, infections with Plasmodium knowlesi, a monkey malarial pathogen that can also infect humans, have been increasingly observed. This study focused on the molecular analysis of P. knowlesi parasites causing malaria in Thailand.
Methods
Under Thailand’s integrated Drug Efficacy Surveillance (iDES), which includes drug-resistance monitoring as part of routine case-based surveillance and responses, specimens were collected from malaria patients (n = 966) between 2018 and 2020. Thirty-one mono P. knowlesi infections (3.1%), most of which were from eastern and southern Thailand, were observed and confirmed by nested PCR assay and DNA sequencing. To evaluate whether these pathogens were from different lineages, cluster analysis based on seven microsatellite genotyping markers and the merozoite surface protein 1 (pkmsp1) gene was carried out. The P. knowlesi pyrimethamine resistance gene dihydrofolate reductase (pkdhfr) was sequenced and homology modelling was constructed.
Results
The results of analysing the seven microsatellite markers and pkmsp1 sequence demonstrated that P. knowlesi parasites from eastern Thailand were of the same lineage as those isolated in Cambodia, while the parasites causing malaria in southern Thailand were the same lineage as those isolated from Malaysia. The sequencing results for the pkdhfr genes indicated the presence of two mutations, Arg34Leu and a deletion at position 105. On analysis with homology modelling, the two mutations were not associated with anti-malarial drug resistance.
Conclusions
This report compared the genetic populations of P. knowlesi parasites in Thailand from 2018 to 2020 and have shown similar lineages as those isolated in Cambodia and Malaysia of P. knowlesi infection in Thailand and demonstrated that the P. knowlesi parasites were of the same lineages as those isolated in Cambodia and Malaysia. The parasites were also shown to be sensitive to pyrimethamine.
Læs mere Tjek på PubMedMalaria Journal, 3.12.2021
Tilføjet 4.12.2021
Abstract
Background
As part of malaria prevention and control efforts, the distribution and density of malaria mosquitoes requires continuous monitoring. Resources for long-term surveillance of malaria vectors, however, are often limited. The aim of the research was to evaluate the value of citizen science in providing insight into potential malaria vector hotspots and other malaria relevant information, and to determine predictors of malaria vector abundance in a region where routine mosquito monitoring has not been established to support vector surveillance.
Methods
A 1-year citizen science programme for malaria mosquito surveillance was implemented in five villages of the Ruhuha sector in Bugesera district, Rwanda. In total, 112 volunteer citizens were enrolled and reported monthly data on mosquitoes collected in their peridomestic environment using handmade carbon-dioxide baited traps. Additionally, they reported mosquito nuisance experienced as well as the number of confirmed malaria cases in their household.
Results
In total, 3793 female mosquitoes were collected, of which 10.8% were anophelines. For the entire period, 16% of the volunteers reported having at least one confirmed malaria case per month, but this varied by village and month. During the study year 66% of the households reported at least one malaria case. From a sector perspective, a higher mosquito and malaria vector abundance was observed in the two villages in the south of the study area. The findings revealed significant positive correlations among nuisance reported and confirmed malaria cases, and also between total number of Culicidae and confirmed malaria cases, but not between the numbers of the malaria vector Anopheles gambiae and malaria cases. At the sector level, of thirteen geographical risk factors considered for inclusion in multiple regression, distance to the river network and elevation played a role in explaining mosquito and malaria mosquito abundance.
Conclusions
The study demonstrates that a citizen science approach can contribute to mosquito monitoring, and can help to identify areas that, in view of limited resources for control, are at higher risk of malaria.
Læs mere Tjek på PubMedMalaria Journal, 3.12.2021
Tilføjet 4.12.2021
Abstract
Background
Access to healthcare is important in controlling malaria burden and, as a result, distance or travel time to health facilities is often a significant predictor in modelling malaria prevalence. Adding new health facilities may reduce overall travel time to health facilities and may decrease malaria transmission. To help guide local decision-makers as they scale up community-based accessibility, the influence of the spatial allocation of new health facilities on malaria prevalence is evaluated in Bunkpurugu-Yunyoo district in northern Ghana. A location-allocation analysis is performed to find optimal locations of new health facilities by separately minimizing three district-wide objectives: malaria prevalence, malaria incidence, and average travel time to health facilities.
Methods
Generalized additive models was used to estimate the relationship between malaria prevalence and travel time to the nearest health facility and other geospatial covariates. The model predictions are then used to calculate the optimisation criteria for the location-allocation analysis. This analysis was performed for two scenarios: adding new health facilities to the existing ones, and a hypothetical scenario in which the community-based healthcare facilities would be allocated anew. An interactive web application was created to facilitate efficient presentation of this analysis and allow users to experiment with their choice of health facility location and optimisation criteria.
Results
Using malaria prevalence and travel time as optimisation criteria, two locations that would benefit from new health facilities were identified, regardless of scenarios. Due to the non-linear relationship between malaria incidence and prevalence, the optimal locations chosen based on the incidence criterion tended to be inequitable and was different from those based on the other optimisation criteria.
Conclusions
This study findings underscore the importance of using multiple optimisation criteria in the decision-making process. This analysis and the interactive application can be repurposed for other regions and criteria, bridging the gap between science, models and decisions.
Læs mere Tjek på PubMedCarlucci, James G.; De Schacht, Caroline; Graves, Erin; González, Purificación; Bravo, Magdalena; Yu, Zhihong; Amorim, Gustavo; Arinze, Folasade; Silva, Wilson; Tique, Jose A.; Sardella Alvim, Maria Fernanda; Simione, Beatriz; Fernando, Anibal Naftal; Wester, C. William
Journal of Acquired Immune Deficiency Syndromes, 24.11.2021
Tilføjet 4.12.2021
Background:
Historically, antiretroviral therapy (ART) initiation was based on CD4 criteria, but this has been replaced with "Test-and-Start" (T&S) wherein all people living with HIV are offered ART. We describe the baseline immunologic status among children relative to evolving ART policies in Mozambique.
Methods:
This retrospective evaluation was performed using routinely collected data. Children living with HIV (CLHIV; 5-14 years) with CD4 data in the period of 2012-2018 were included. ART initiation “policy periods” corresponded to implementation of evolving guidelines: in Period 1 (2012-2016), ART was recommended for CD4
Læs mere Tjek på PubMedDong, Tony; Rana, Mariam N.; Longenecker, Chris T.; Rajagopalan, Sanjay; Kim, Chang H.; Al-Kindi, Sadeer G.
Journal of Acquired Immune Deficiency Syndromes, 24.11.2021
Tilføjet 4.12.2021
Introduction:
Low-density lipoprotein cholesterol (LDL-C) is typically estimated from total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). The Friedewald, Martin-Hopkins, and National Institute of Health [NIH] equations are widely used but may estimate LDL-C inaccurately in certain patient populations, such as those with HIV. We sought to investigate the utility of machine learning for LDL-C estimation in a large cohort of women with and without HIV.
Methods:
We identified 7397 direct LDL-C measurements (5219 HIV, 2127 uninfected controls, 51 seroconvertors) from 2414 participants (age 39.4 ± 9.3 years) in the Women's Interagency HIV Study, and estimated LDL-C using the Friedewald, Hopkins and NIH equations. We also optimized five machine learning methods (Linear Regression, Random Forest, Gradient Boosting, Support Vector Machine and Neural Network) using 80% of the data (training set). We compared the performance of each method utilizing root mean square error (RMSE), mean absolute error (MAE) and coefficient of determination (R2) in the holdout (20%) set.
Results:
Support Vector Machine (SVM) outperformed all 3 existing equations and other machine learning methods, achieving lowest RMSE, MAE and highest R2 (11.79, 7.98 mg/dL, 0.87 respectively, compared with Friedewald equation: 12.45, 9.14 mg/dL, 0.87). SVM performance remained superior in subgroups with and without HIV, with non-fasting measurements, in LDL 400 mg/dL.
Conclusions:
In this proof-of-concept study, SVM is a robust method that predicts directly measured LDL-C more accurately than clinically used methods in women with and without HIV. Further studies should explore the utility in broader populations.
Corresponding author: Sadeer Al-Kindi, MD, Assistant Professor of Medicine, Harrington Heart and Vascular Institute, University Hospitals/Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, Email: sadeer.al-kindi@uhhospitals.org, Phone: 216-844-1000
Conflicts of interest: There are no potential conflicts (financial, professional, or personal) to disclose by any of the authors.
* Chang Kim and Sadeer Al-Kindi contributed equally.
Funding: Sadeer Al-Kindi is funded by the University Hospitals Informatics Research Grant and the Visconsi Research Scholar Fund.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedIoanna A. Rota, Adam E. Handel, Stefano Maio, Fabian Klein, Fatima Dhalla, Mary E. Deadman, Stanley Cheuk, Joseph A. Newman, Yale S. Michaels, Saulius Zuklys, Nicolas Prevot, Philip Hublitz, Philip D. Charles, Athina Soragia Gkazi, Eleni Adamopoulou, Waseem Qasim, Edward Graham Davies, Imelda Hanson, Alistair T. Pagnamenta, Carme Camps, Helene M. Dreau, Andrea White, Kieran James, Roman Fischer, Opher Gileadi, Jenny C. Taylor, Tudor Fulga, B. Christoffer Lagerholm, Graham Anderson, Erdinc Sezgin, Georg A. Holländer
Science Advances, 3.12.2021
Tilføjet 3.12.2021
Science Advances, <a href="https://www.science.org/toc/sciadv/7/49">Volume 7, Issue 49</a>, December 2021.
Læs mere Tjek på PubMedJacob T. Heggestad, Rhett J. Britton, David S. Kinnamon, Simone A. Wall, Daniel Y. Joh, Angus M. Hucknall, Lyra B. Olson, Jack G. Anderson, Anna Mazur, Cameron R. Wolfe, Thomas H. Oguin, Bruce A. Sullenger, Thomas W. Burke, Bryan D. Kraft, Gregory D. Sempowski, Christopher W. Woods, Ashutosh Chilkoti
Science Advances, 3.12.2021
Tilføjet 3.12.2021
Science Advances, <a href="https://www.science.org/toc/sciadv/7/49">Volume 7, Issue 49</a>, December 2021.
Læs mere Tjek på PubMedLeeuwen, E. H. v., Taris, T., van Rensen, E. L. J., Knies, E., Lammers, J.-W.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Objective
The COVID-19 pandemic places an enormous demand on physicians around the world. The aim of this study was to examine the impact of the COVID-19 pandemic on physicians’ work experiences and their ability and willingness to continue working in their profession until retirement (ie, their employability).
Design
A longitudinal comparative design was used. Survey data were collected on three moments: before (May 2019), in the early phase (May 2020) and in a later phase (November 2020) of the COVID-19 pandemic. Time effects were tested using repeated-measures analyses of variance and one-way analyses of variance.
Setting
This study took place among physicians of two hospitals in a large city in the Netherlands.
Participants
165 hospital physicians with surgical, medical and other specialties participated in this study.
Results
Physicians’ employability significantly increased from the time prior to the COVID-19 pandemic, compared with the period during this pandemic. Employability differs among physicians with surgical, medical and other specialties. Furthermore, physicians experienced a lower emotional, physical and quantitative workload during the first peak of the COVID-19 pandemic, compared with before the pandemic. Moreover, physicians experienced the most stress from the impact of COVID-19 on their work in general and from combining work and private life.
Conclusions
This study shows that physicians’ employability and work experiences are affected by the COVID-19 pandemic. Work experiences vary for physicians with different specialties. These varieties stress the importance of attention for physicians’ individual needs and challenges regarding working during the COVID-19 pandemic and the possibility of continuing work in the aftermath of this crisis. Based on this, physicians can be offered tailor-made solutions. This is important to maintain a healthy and employable workforce, which is essential for a sustainable healthcare system.
Læs mere Tjek på PubMedGomez, G. B., Siapka, M., Conradie, F., Ndjeka, N., Garfin, A. M. C., Lomtadze, N., Avaliani, Z., Kiria, N., Malhotra, S., Cook-Scalise, S., Juneja, S., Everitt, D., Spigelman, M., Vassall, A.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Objectives
Patients with highly resistant tuberculosis have few treatment options. Bedaquiline, pretomanid and linezolid regimen (BPaL) is a new regimen shown to have favourable outcomes after six months. We present an economic evaluation of introducing BPaL against the extensively drug-resistant tuberculosis (XDR-TB) standard of care in three epidemiological settings.
Design
Cost-effectiveness analysis using Markov cohort model.
Setting
South Africa, Georgia and the Philippines.
Participants
XDR-TB and multidrug-resistant tuberculosis (MDR-TB) failure and treatment intolerant patients.
Interventions
BPaL regimen.
Primary and secondary outcome measures
(1) Incremental cost per disability-adjusted life years averted by using BPaL against standard of care at the Global Drug Facility list price. (2) The potential maximum price at which the BPaL regimen could become cost neutral.
Results
BPaL for XDR-TB is likely to be cost saving in all study settings when pretomanid is priced at the Global Drug Facility list price. The magnitude of these savings depends on the prevalence of XDR-TB in the country and can amount, over 5 years, to approximately US$ 3 million in South Africa, US$ 200 000 and US$ 60 000 in Georgia and the Philippines, respectively. In South Africa, related future costs of antiretroviral treatment (ART) due to survival of more patients following treatment with BPaL reduced the magnitude of expected savings to approximately US$ 1 million. Overall, when BPaL is introduced to a wider population, including MDR-TB treatment failure and treatment intolerant, we observe increased savings and clinical benefits. The potential threshold price at which the probability of the introduction of BPaL becoming cost neutral begins to increase is higher in Georgia and the Philippines (US$ 3650 and US$ 3800, respectively) compared with South Africa (US$ 500) including ART costs.
Conclusions
Our results estimate that BPaL can be a cost-saving addition to the local TB programmes in varied programmatic settings.
Læs mere Tjek på PubMedKhare, S., Pathak, A., Purohit, M. R., Sharma, M., Marrone, G., Tamhankar, A. J., Stalsby Lundborg, C., Diwan, V.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Objectives
To explore the healthcare-seeking pathways, antibiotic prescribing and determine the sociodemographic factors associated with healthcare-seeking behaviour (HSB) of caregivers for common illnesses in under-5 (U-5) children in rural Ujjain, India.
Study design
Prospective cohort study.
Study setting and study sample
The cohort included 270 U-5 children from selected six villages in rural demographic surveillance site, of the R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. A community-based cohort was visited two times weekly for over 113 weeks (August 2014 to October 2016) to record the HSB of caregivers using HSB diaries. Sociodemographic information was also solicited.
Primary and secondary outcome measures
Primary outcomes: first point of care, healthcare-seeking pathway and quantify antibiotic prescribing for the common acute illnesses.
Secondary outcome
HSB risk factors were determined using mixed-effects multinomial logistic regression.
Results
A total of 60 228 HSB follow-up time points for 270 children were recorded with a total of 2161 acute illness episodes. The most common illnesses found were respiratory tract infections (RTI) (69%) and gastrointestinal tract infections (8%). No healthcare was sought in 33% of illness episodes, mostly for RTIs. The most common healthcare-seeking pathway was to informal healthcare providers (IHCPs, 49% of illness episodes). The adjusted relative risk for obtaining no treatment, home treatment and treatment by IHCPs was higher for RTIs (aRR=11.54, 1.82 and 1.29, respectively), illiterate mothers (aRR=2.86, 2.38 and 1.93, respectively), and mothers who were homemakers (aRR=2.90, 4.17 and 2.10, respectively). Socioeconomic status was associated with HSB, with the highest aRR for no treatment in the lowest two socioeconomic quintiles (aRR=6.59 and 6.39, respectively). Antibiotics were prescribed in 46% (n=670/1450) illness episodes and the majority (85%, n=572/670) were broad spectrum.
Conclusion
In our rural cohort for many acute episodes of illnesses, no treatment or home treatment was done, which resulted in overall reduced antibiotic prescribing. The most common healthcare-seeking pathway was to visit IHCPs, which indicates that they are major healthcare providers in rural areas. Most of the antibiotics were prescribed by IHCPs and were commonly prescribed for illnesses where they were not indicated.
Læs mere Tjek på PubMedWahidiyat, P. A., Yo, E. C., Wildani, M. M., Triatmono, V. R., Yosia, M.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Introduction
Thalassaemia is an inherited blood disorder, for which definitive treatments remain largely inaccessible. The recommended approach to reduce the disease burden is by prevention through screening. Currently, the implementation of thalassaemia preventive measures is poorly regulated in Indonesia. Thalassaemia prevention and education are best targeted to the youth, but information on their awareness towards thalassaemia is limited. This study aims to investigate the knowledge, attitude and practice (KAP) towards thalassaemia among Indonesian youth.
Methods
This observational study took place between January and May 2021. An online questionnaire was disseminated to Indonesian youth aged 15–24. Eligible respondents included carriers, unaffected individuals and individuals with unknown carrier status. The questionnaire comprised 28 questions to assess KAP. A cut-off of 75% was used to categorise participant’s KAP into poor or negative and good or positive. Descriptive statistics, 2 test, logistic regression and Pearson correlation were performed for data analysis.
Results
A total of 906 responses were gathered, and 878 were analysed. Most respondents had poor knowledge (62.1%), positive attitude (83.3%) and poor practice (54.4%) towards thalassaemia. The results implied that respondents had limited understanding regarding the types of thalassaemia and the difference between asymptomatic carriers and individuals without the thalassaemia trait. Many (82.6%) believed they were not carrying thalassaemia trait despite the fact that most (95.7%) never got tested. Age, education, gender, residence and family income were key factors that correlated with or predicted the youth’s KAP towards thalassaemia. Older respondents and women were more likely to have good KAP.
Conclusion
Thalassaemia screening targeted to the youth is urgently needed, and future interventions must consider sociodemographic factors that may affect how they perceive the disease. Social media appeals to the youth as an important source of information, but school, parents and health professionals should also be involved in delivering education about thalassaemia.
Læs mere Tjek på PubMedShapiro, G. K., Tong, E., Nissim, R., Zimmermann, C., Allin, S., Gibson, J., Li, M., Rodin, G.
BMJ Open, 3.12.2021
Tilføjet 3.12.2021
Introduction
Canadians have had legal access to medical assistance in dying (MAiD) since 2016. However, despite substantial overlap in populations who request MAiD and who require palliative care (PC) services, policies and recommended practices regarding the optimal relationship between MAiD and PC services are not well developed. Multiple models are possible, including autonomous delivery of these services and formal or informal coordination, collaboration or integration. However, it is not clear which of these approaches are most appropriate, feasible or acceptable in different Canadian health settings in the context of the COVID-19 pandemic and in the post-pandemic period. The aim of this qualitative study is to understand the attitudes and opinions of key stakeholders from the government, health system, patient groups and academia in Canada regarding the optimal relationship between MAiD and PC services.
Methods and analysis
A qualitative, purposeful sampling approach will elicit stakeholder feedback of 25–30 participants using semistructured interviews. Stakeholders with expertise and engagement in MAiD or PC who hold leadership positions in their respective organisations across Canada will be invited to provide their perspectives on the relationship between MAiD and PC; capacity-building needs; policy development opportunities; and the impact of the COVID-19 pandemic on the relationship between MAiD and PC services. Transcripts will be analysed using content analysis. A framework for integrated health services will be used to assess the impact of integrating services on multiple levels.
Ethics and dissemination
This study has received ethical approval from the University Health Network Research Ethics Board (No 19-5518; Toronto, Canada). All participants will be required to provide informed electronic consent before a qualitative interview is scheduled, and to provide verbal consent prior to the start of the qualitative interview. Findings from this study could inform healthcare policy, the delivery of MAiD and PC, and enhance the understanding of the multilevel factors relevant for the delivery of these services. Findings will be disseminated in conferences and peer-reviewed publications.
Læs mere Tjek på PubMed