Participation Group Research Articles

Improved adherence to statins following pictorial intervention. Sub study of visualization of subclinical atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA)

Abstract Introduction VIPVIZA is a prospective, randomised controlled trial with open label and masked evaluators, integrated in Västerbotten intervention programme (VIP), a population-based CVD screening and prevention programme examining 40,50,60-year-olds. In VIPVIZA subclinical atherosclerosis was identified by ultrasound and pictorial information about carotid plaque presence, carotid thickness and risk assessment was provided to participants and their physicians. After examination, participants were randomized to pictorial information (intervention) or as usual care (control). Previous studies from VIPVIZA have shown that the time to initiation of statins is lower and the proportion of statin users is higher in the intervention group. Purpose To study whether the pictorial risk information intervention made participants with pre intervention prescription of statins more adherent to statin treatment. Method During 2013–2016, 3532 participants in VIPVIZA were screened by carotid ultrasound examination, of which 46% had plaque, 546 had expedited prescriptions of statins (ATC codes: C10AAxx, C10B, C10BA, C10BX) prior to inclusion. Participants were followed from inclusion until 3-year follow-up examination. Adherence calculations were based on Swedish prescription drug registry (PDR). For adherence calculations we assumed that medication is used as prescribed. Dose change of same medication is considered, and number of days' supply is recalculated if a dispensing event contains a change of dose. The new dose comes into effect the day of dispensing a prescription with a dose change. For the follow-up period the number of days with potential use (based on supply) is divided by days from baseline examination until 3-year examination, yielding a value in the interval [0,1] where 0 is non adherent and 1 perfect adherence. Remaining supply of medication at the end of follow-up period is disregarded. Adherence was also dichotomised at 0.8. Results The average adherence to statins was higher in the intervention group for participants with carotid plaque, 0.844 vs 0.773, confidence interval 95% for mean difference (−0.125, −0.018), p=0.009. The intervention group with carotid plaque had the best adherence of all subgroups, but the difference in adherence within the intervention group (plaque vs no plaque) was non-significant. With respect to sex the difference in mean adherence between intervention and control for males was 0.826–0.795 while for females 0.815–0.742. With dichotomised adherence the increase in the intervention group is significant for females, p=0.027. See table 1. Conclusion Providing information about subclinical atherosclerosis increases adherence to statins, especially in participants with plaque and females. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Research Council

Burden of caregiving of alcohol related liver disease patients: a possible role of training and caregiver groups frequency. Proposal of a method, preliminary results.

The patient with alcohol related liver disease (ALD) is an extremely complex patient who can be affected by various problems: alcohol use disorders (AUDs) (intoxication or withdrawal syndrome), psychopathological manifestations, hepatic encephalopathy (HE), family and social discomfort. Burden of caregiving for this type of patient is particularly severe. For this reason we propose our own working model. Thirty-one informal caregivers (ICs) of patients with ALD (28 females; mean age: 51±11) recruited in the period September-November 2021 followed prospectively were evaluated retrospectively. Those who completed all the steps (initial information/ training meeting), participation in support groups for caregivers and participation in self-help groups for AUD (club of alcoholics in treatment, anonymous family members, other realities) were selected (31/71: 43%). ICs underwent Zarit Burden Interview and a semi-structured interview. From the semi-structured interview, emotional, organizational, but also constructive reflections emerge. Zarit Score (ZS) was found to be light or nil in the 13% (4/31), moderate in the 22.5% (7/31), severe in the 32% (10/31) and very serious in the 32% (10/31). The parameters that most influenced initial ZS are the presence of HE and primitive psychiatric comorbidity (PC). By dividing the caregivers into two groups (<or equal 40 or >40) odds ratio is 2.4231 (95% CI: 0.4059-14.4637) in the presence of HE and odds ratio is 5.3846 (95% CI: 0.5666 to 51.1738) in the presence of PC. After the frequency to the caregiver groups (CGs) (at least 4) the ZS is significantly decreased (49.9±18 vs. 34±11; t=4.1966; P<0.0001) and this regardless of the presence of HE, PC or active alcohol consumption. While waiting to increase the number of cases and to submit it to a more in-depth verification, we suggest to other health organizations to use and verify this organizational/ relational method for primary ICs, in an attempt to optimize the health and social health activity in a complex medical sector (ALD) in constant growth.

Partisipasi Masyarakat dalam Program Gerakan Tanam dan Pelihara 50 Juta Pohon terhadap Tingkat Penjualan Bibit Tanaman Hutan di Provinsi Jawa Barat (Suatu Kasus pada Pengada/Pengedar Bibit Tanaman Hutan di Provinsi Jawa Barat)

This study aims to determine how the implementation of The Movement of 50 Million Trees Planting and Caring (GTPP) program in terms of the volume of sales of seeds to forest plant seed suppliers/distributors, types of seeds, area and percentage of each community participation group; the effect of the GTPP program on the level of seed sales to forest plant seed suppliers/distributors in West Java; as well as the variable of community participation which has the most influence on the level of seed sales to forest plant seed suppliers/distributors in West Java Province. The results showed that community participation in the implementation of the GTPP program based on data for the period 2020 to 2021 seen from the type of seed the most were Sengon seedlings as many as 5,233,197 stems, with the most sales by CV. Putra Dilan Jaya as many as 2,013,768 stems and based on the largest area is from Sukabumi Regency as many as 3,485,988 stems. Based on the results of statistical tests for the average difference of the variables of community participation in the GTPP program, namely participating in providing seeds for marriage, birthday, making STNK/PKB for R2 vehicles, making STNK/PKB for R4 vehicles, Graduation, promotion, ASN and Business Entities obtaining permits (IMB/Business Permits and others) there is a significant average difference. The variable of community participation that has the most influence on the sale of tree seedlings is the Business Entity that obtains a permit (IMB/Business Permit and others), with the highest average sales of 4205 or 55.43% of tree seedlings and has a significant average difference. with other variables.

No difference in sports participation and patient-reported functional outcomes between total knee arthroplasty and unicompartmental knee arthroplasty at minimum 2-year follow-up in a matched control study

PurposeThe purpose of this study was to compare (1) sports participation and type of sports activity between TKA and UKA patients; (2) functional outcome and activity level between TKA and UKA; and (3) survivorship of the prosthesis in both the groups.MethodsProspectively collected data were obtained from an arthroplasty database to identify patients who underwent primary TKA and UKA. Both the cohorts of TKA and UKA were matched, controlling for age, sex, BMI and preoperative patient-reported outcomes, which include Oxford Knee Score (OKS), Tegner activity level, and visual analog scale (VAS) for pain score. After matching the two groups, 287 TKA and 69 UKA cases were available to be included in the study. Patients were evaluated pre- and postoperatively at 2 years for sports participation and sports preference, patient-reported outcomes, activity levels, and improvement in knee pain.ResultsThe mean age of the TKA and UKA groups were 75.7 ± 8.1 and 74.2 ± 8.8, respectively. There was no significant difference between the two groups concerning the demographic variables. Significant improvement was noted in the weekly sports participation at the final follow-up compared to preoperative sports participation in both the TKA and UKA groups (p < 0.05). All patients were able to return to their desired sporting activity. No significant difference was noted between the two groups in sports participation preoperatively and postoperatively (p > 0.05). OKS, Tegner activity level and VAS for pain demonstrated a significant improvement from preoperative to 2 years postoperatively (p < 0.05). However, preoperative and postoperative patient-reported outcomes did not differ significantly between the TKA and UKA groups (p > 0.05). No case of revision surgery was found at a 2-year follow-up in both groups.ConclusionTraditionally, in isolated medial compartment osteoarthritis, UKA has been considered to be the procedure with better functional outcomes, but the current study demonstrates that when confounding factors are controlled, both TKA and UKA are effective, and offer similar functional outcomes and result in similar improvement in sports participation. These findings will be helpful to counsel the patients to choose the best suitable operative procedure between UKA and TKA.Level of evidenceLevel 3.

The influence of involving patients in postoperative pain treatment decisions on pain-related patient-reported outcomes: A STROBE-compliant registering observational study.

The evidence regarding the influence of allowing patients to participate in postoperative pain treatment decisions on acute pain management is contradictory. This study aimed to identify the role of patient participation in influencing pain-related patient-reported outcomes (PROs). This is a cross-sectional study. The data were provided by PAIN OUT (www.pain-out.eu). A dataset specific to adult Chinese patients undergoing orthopedic surgery was selected. The PROs were assessed on postoperative day 1. The patient participant was assessed using an 11-point scale. Participants who reported >5 were allocated to the “participation” group, and those who reported ≤5 were allocated to the “nonparticipation” group. A 1:1 propensity score matching was conducted. The primary outcome was the desire for more pain treatment. All other items of PROs were the secondary outcomes comprising pain intensity, interference of pain with function, emotional impairment, adverse effects, and other patient perception. From February 2014 to November 2020, 2244 patients from 20 centers were approached, of whom 1804 patients were eligible and 726 pairs were matched. There was no significant difference between the groups in the desire for more pain treatment either before (25.4% vs 28.2%, risk ratio [95% CI]: 0.90 [0.77, 1.05], P = .18) or after matching (26.7% vs 28.8%, risk ratio [95% CI]: 0.93 [0.79, 1.10], P = .43). After matching, patients in the participation group reported significantly better PROs, including pain intensity (less time spent in severe pain [P < .01]), emotional impairment (less anxiety [P < .01]), interference with function (less interference with sleep [P < .01]), adverse effects (less drowsiness [P = .01]), and patient perception (more pain relief [P < .01] and more satisfaction [P < .01]), than the nonparticipation group. Patient participation in pain treatment decisions was associated with improved pain experience but failed to mitigate the desire for more treatment.

The effect of the participatory heat education and awareness tools (HEAT) intervention on agricultural worker physiological heat strain: results from a parallel, comparison, group randomized study

BackgroundFarmworkers are at risk of heat-related illness (HRI). We sought to: 1) evaluate the effectiveness of farmworker Spanish/English participatory heat education and a supervisor decision-support mobile application (HEAT intervention) on physiological heat strain; and 2) describe factors associated with HRI symptoms reporting.MethodsWe conducted a parallel, comparison group intervention study from May–September of 2019 in Central/Eastern Washington State, USA. We used convenience sampling to recruit adult outdoor farmworkers and allocated participating crews to intervention (n = 37 participants) and alternative-training comparison (n = 38 participants) groups. We measured heat strain monthly using heart rate and estimated core body temperature to compute the maximum work-shift physiological strain index (PSImax) and assessed self-reported HRI symptoms using a weekly survey. Multivariable linear mixed effects models were used to assess associations of the HEAT intervention with PSImax, and bivariate mixed models were used to describe factors associated with HRI symptoms reported (0, 1, 2+ symptoms), with random effects for workers.ResultsWe observed larger decreases in PSImax in the intervention versus comparison group for higher work exertion levels (categorized as low, low/medium-low, and high effort), after adjustment for maximum work-shift ambient Heat Index (HImax), but this was not statistically significant (interaction − 0.91 for high versus low/medium-low effort, t = − 1.60, p = 0.11). We observed a higher PSImax with high versus low/medium-low effort (main effect 1.96, t = 3.81, p < 0.001) and a lower PSImax with older age (− 0.03, t = − 2.95, p = 0.004), after covariate adjustment. There was no clear relationship between PSImax and the number of HRI symptoms reported. Reporting more symptoms was associated with older age, higher HImax, 10+ years agricultural work, not being an H-2A guest worker, and walking > 3 min to get to the toilet at work.ConclusionsEffort level should be addressed in heat management plans, for example through work/rest cycles, rotation, and pacing, in addition to education and other factors that influence heat stress. Both symptoms and indicators of physiological heat strain should be monitored, if possible, during periods of high heat stress to increase the sensitivity of early HRI detection and prevention. Structural barriers to HRI prevention must also be addressed.Trial registrationClinicalTrials.gov Registration Number: NCT04234802, date first posted 21/01/2020.

Using photovoice to explore women's experiences of a women-only prevention and recovery care service in Australia.

Women should be able to access mental health services that are safe, free from harassment and abuse. Yet, research indicates that women experiencing mental health issues are often not safe in mixed gender environments, and especially in inpatient settings. This qualitative study draws on a photo-elicitation method ('photovoice') and semi-structured interviews to explore women's experiences of a sub-acute women-only prevention and recovery care (PARC) service in Australia. Twelve women experiencing mental health issues were recruited via an aftercare peer support group for recent service participants. The women took photographs guided by the central question: 'What were your experiences of a women-only prevention and recovery care service?' They then shared these photographs with the researchers and each other, and described them in detail. Four key themes were identified by thematic analysis of the photovoice visual and narrative data: (a) Only women can understand what women go through; (b) I feel safer with no men around due to my history of trauma; (c) This environment feels safe, making it easier to talk and (d) Staff are accessible and make time for me to talk about difficult topics. Woven throughout the women's narratives was the expressed desire to feel safe and supported during the process of recovering. Aspects of service delivery that contributed to these feelings and facilitated shared support were also valued in this setting. These findings indicate that access to women-only services and peer support are not only valued by women experiencing mental health issues, but need to be more widely available to support their recovery. They also underline the importance of a trauma-informed approach for improving the gender sensitivity of services.

Participation of patients during arthroscopic partial meniscectomy is conducive to postoperative rehabilitation and satisfaction: a single-center retrospective study

PurposeTo evaluate the effect of patient participation in arthroscopic partial meniscectomy (APM) on rehabilitation and patient satisfaction.MethodsA total of 86 patients of traumatic longitudinal vertical meniscus tears, between January 2017 and December 2020 at the First Affiliated Hospital of Zhejiang Chinese Medical University, met the inclusion and exclusion criteria. The patients in the intraoperative participation group (n = 33) were awake and could watch the screen during APM and communicate with the surgeon in the surgery; patients who underwent APM in the traditional mode were classified as the traditional group(n = 53). The differences in exercise adherence, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and satisfaction at follow-up were compared. In the intraoperative participation group, the mean age of the patients was 26.97 ± 5.63 years and the follow-up time was 25.12 ± 6.23 months. In the traditional group, the mean age of the patients was 29.21 ± 5.29 years and the follow-up time was 25.08 ± 6.70 months.ResultsThe intraoperative participation group reported a better result in exercise adherence (78.79% VS 50.94%, p = 0.012). As secondary outcomes, Patients in the intraoperative participation group demonstrated better scores on the KOOS domains of pain (79.80 ± 6.38 VS 76.26 ± 5.33, p = 0.007), Symptoms (59.41 ± 5.27 VS 56.74 ± 5.97, p = 0.038), and QOL (65.91 ± 10.72 VS 60.26 ± 9.34, p = 0.012), as compared to these in the traditional group. There were no significant differences in the KOOS domains of Sport (72.88 ± 8.20 VS 72.64 ± 7.70, P = 0.892), and ADL (89.47 ± 3.50 VS 87.87 ± 4.50 p = 0.085). what’s more, in the intraoperative participation group, the results of satisfaction (96.97% VS 81.13%, p = 0.025) were also significantly better.ConclusionThe mode of participation of patients during APM can improve patients’ exercise adherence, reduce pain, improve symptoms and improve patients’ satisfaction as well as the quality of life. More work is needed to develop this mode further.

How We Perceive and Trust Advice from Virtual Humans: The Influence of Voice Quality

Due to the increase in virtual humans as a pedagogical agent, this study investigates how perceptions of virtual humans are affected by voice quality in understanding a budgeting scenario where trust is essential to learning and application. Eighty-six participants were randomly assigned to three conditions where voice quality for a virtual human varied (human voice, low quality text-to-speech, high quality text-to-speech) when narrating a financial literacy course. Measures of trust and course comprehension were collected. Results of the learning assessment suggest no difference in comprehension based on voice quality of a virtual human. No differences were observed between the voice quality groups in participants' perception of trust, the abilities to facilitate learning, credibility of the agent, human-likeness of the agent, or how engaging the agent was. This is possibly due to the lower age demographic who have become increasingly exposed to virtual human voices through popular platforms such as Tik-Tok.).

Rebuffing the “Hard to Reach” Narrative: How to Engage Diverse Groups in Participation for Resilience

Across three years (2017–2020), the ESRC Seminar series, “Civil Agency, Society and Climate Adaptation to Weather Extremes” (CASCADE-NET) critically examined the changing role of civil society in extreme weather adaptation. One full-day seminar explored “less heard voices” within Civil Society, considering ways of engaging diverse groups in resiliency, knowledge exchange, and capacity building. A small interdisciplinary group from the seminar followed up with a roundtable discussion, conducted online, discussing first who the less-heard voices in society are, and how labels, such as “vulnerable” and “hard to reach”, might need to be reappraised, and concluding that it is often those in power who make themselves “hard to reach” and who fail to listen. The group then discussed how deeper engagement with citizens and communities can be achieved through improved relationships and networks. Finally, the roundtable discussed how the succession of crises affecting the UK (and other settings) could, paradoxically, present an opportune moment to press the case for a more joined-up and inclusive civil society. The concluding section summarizes key insights from the roundtable and identifies opportunities to rethink engagement with “hard to reach” groups. To answer our question of “how to” engage diverse groups, we conclude with the action points to change the orientation of the powerful to (i) be genuinely open to listening to, and acting upon the voices of less heard groups; (ii) listen on the terms of groups who are voicing their experience, rather than force them into pre-arranged consultation formats; (iii) engage early, widely and frequently; (iv) build trust by demonstrating willingness to listen, through actions; (v) tackle historical mistrust, unequal resources, experiences of neglect or exploitation that undermine groups’ interest in engaging with the powerful. A transformation in orientation to community engagement is in order if we are to produce effective, locally attuned, collective action in the face of social shocks.

Effects of Early ASL Exposure on Fingerspelling Accuracy in Deaf Adults

D/deaf children of Deaf parents reportedly begin learning finger-spelling as young as thirteen months old, but deaf children born to hearing, nonsigning parents lack natural access to the native (spoken) language of their families, often exhibiting later language development. Forty-four deaf adults participated in a fingerspelling test of decoding-encoding pseudowords. The participants offered self-reported demographic information, including age at initial American Sign Language (ASL) exposure and parent hearing status. Analysis of variance using post hoc grouping of participants revealed significantly higher scores on the fingerspelling test among participants with early ASL exposure (p = .000; ηp2 = 0.45), and those with two D/deaf parents (p = .002; ηp2 = 0.23). Development and refinement of a fingerspelling test to be used with both D/deaf and hearing, native, and developing signers should benefit professionals working with D/deaf and hearing children and their D/deaf or hearing parents.

Strengthening citizen science partnerships with frontline sanitation personnel to study and tackle plastic pollution

The COVID-19 outbreak has boosted demand for and use of personal protective equipment (PPE) and other single-use plastics, adding to the environment's already high levels of plastic pollution and endangering biota. Estimating the relative abundance of PPE wastes that end up in the environment is crucial and has remained a challenge for COVID-19 researchers. Citizen science has been utilized in recent studies to monitor and collect data using volunteers, and it has proven to be a valuable approach even in difficult situations. The expansion of citizen scientific participation groups is important in light of the growing anthropogenic impacts of plastic pollution. To date, frontline sanitary personnel are often overlooked and underutilized in a citizen science perspective, yet they serve critical roles in maintaining cleanliness in key environmental settings (e.g., beaches and streets) both during and beyond the pandemic. This paper explores and emphasizes the advantages and need of including frontline sanitary personnel into citizen science for the benefit of both researchers and communities, as well as to encourage long-term goals in global plastic litter monitoring, thereby exemplifying citizen science opportunities. Recommendations are made to design in order to improve the future status of citizen science development.

Effectiveness of Social Support for Community-Dwelling Elderly with Depression: A Systematic Review and Meta-Analysis.

Depression in the elderly is an important health factor that requires intervention in the form of social support resources. The purpose of this study was to conduct a systematic review, while synthesizing available evidence on what kind of social support, such as social participation and social connection/network, is effective for depression in the elderly. We performed a quality assessment of the included studies using the revised Risk of Bias for Non-randomized Studies tool and a meta-analysis of studies published up to 14 May 2021. Of the 3449 studies, 52 were relevant to this study. The various types of social resource applications reported in these were classified into three types: social support, social participation, and social connection/network. The social support group had significantly lower depression compared to the control group (0.72 [0.65, 0.81], p < 0.00001, I2 = 92%). There was a significant decrease in depression in the social participation group compared to the control group (0.67 [0.56, 0.80], p < 0.00001, I2 = 93%) (2.77 [1.30, 5.91], p = 0.008, I2 = 97%) (0.67 [0.56, 0.80], p < 0.00001, I2 = 93%). Finally, the social connection/network group showed decreased depression compared to the control group (2.40 [1.89, 3.05], p < 0.00001, I2 = 24%) (0.83 [0.76, 0.90], p < 0.00001, I2 = 94%). The results of this systematic review confirmed the effects of various social support interventions in reducing depression among the elderly living in the community.

Social participation of community-dwelling older adults in western China: A latent profile analysis.

ObjectiveSocial participation has become a policy framework to address population aging. However, little is known about the social participation of older adults in western China, and extensive, multicenter, regional research is lacking. This research investigated the profiles of social participation of older adults in western China and explored the characteristics and factors influencing social participation.MethodThis cross-sectional study was conducted in 3 provinces (Chongqing, Sichuan, and Inner Mongolia) in western China from March 2021 to December 2021 and included 3,456 participants aged 60 years or older. Social participation was assessed using the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA). Latent profile analysis (LPA) was performed to extract latent classes of social participation among older adults in western China. The chi-square test and multinomial regression analyses were used to identify differences between these classes.ResultsThree social participation classes were identified by LPA: high social participation (25.2%), moderate social participation (55.1%), and low social participation (19.7%). Being older, having a primary school education level, having mobility or speaking impairment, using assistive devices, and having a chronic disease were highly associated with the low social participation class (P < 0.05). Furthermore, older adults with no dependence (OR = 0.018, 95% CI = 0.005–0.062) or mild dependence (OR = 0.039, 95% CI = 0.011–0.139) in activities of daily living (ADLs) were less likely to be in the low social participation class. Older adults who were cared for by non-spouse primary caregivers were more likely to be assigned to the moderate social participation group (OR = 2.097, 95% CI = 1.501–2.930) than to the high social participation group.ConclusionsMost older adults in western China have a moderate level of social participation. Advanced age, reduced ADL ability, reduced speech ability, reduced mobility, and non-spouse care are related to the level of social participation. Healthcare professionals should pay attention to the predictors for different classes, identifying high-risk groups as early as possible.

Retinal and Choroidal Thinning—A Predictor of Coronary Artery Occlusion?

Introduction. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) allowed visualization of retina and choroid to nearly the capillary level; however, the relationship between systemic macrovascular status and retinal microvascular changes is not yet known well. Aim. Our purpose was to assess the impact of retinal optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) parameters on prediction of coronary heart disease (CHD) in acute myocardial infarction (MI) and chronic three vessel disease (3VD) groups. Methods. This observational study included 184 patients—26 in 3VD, 76 in MI and 82 in healthy participants groups. Radial scans of the macula and OCTA scans of the central macula (superficial (SCP) and deep (DCP) capillary plexuses) were performed on all participants. All participants underwent coronary angiography. Results. Patients in MI groups showed decreased parafoveal total retinal thickness as well as GCL+ retinal thickness. Outer circle total retinal thickness and GCL+ retinal thickness were lowest in the 3VD group. The MI group had thinner, while 3VD the thinnest, choroid. A decrease in choroidal thickness and vascular density could predict 3VD. Conclusions. A decrease in retinal and choroidal thickness as well as decreased vascular density in the central retinal region may predict coronary artery disease. OCT and OCTA could be a significant, safe, and noninvasive tool for the prediction of coronary artery disease.

Mastery learning program to teach sleep study scoring.

Scoring a polysomnogram is an essential skill for sleep medicine trainees to meet Accreditation Council for Graduate Medical Education Sleep Medicine Milestones. Appraisal is based on faculty evaluation rather than objective competency assessment. We developed a computer-based polysomnogram scoring curriculum, utilizing the mastery learning method, then compared achievement of competency using the new curriculum against standard institutional training. The scoring program consisted of a pretest assessment, sequential acquisition of knowledge utilizing online modules, a posttest, and competency assessment. Fellows needed to demonstrate mastery of each module before moving ahead. Competency was demonstrating ≥ 90% on interscorer reliability assessment on 5 studies (out of up to 10 attempts). Participating fellows were assigned to Mastery Learning Participants (MLP) or Traditional Learning Participants (TLP) groups and completed the program within the first 1-3 months of training. Of 87 fellows enrolled in the program, 75 participants completed the program (40 MLP and 35 TLP). Among completers, there was no difference in the proportion that achieved competency (MLP 90.0% vs TLP 97.1%; P = .36) or studies needed to achieve competency (MLP 7.25 ± 1.3 vs TLP 7.41 ± 1.3; P = .60). Pretest scores were not significantly different between groups (MLP 61.2% ± 15.9 vs TLP 57.6% ± 16.6; P = .35), but MLP posttest scores were higher than TLP (MLP 80.9% ± 8.8 vs TLP 76.4% ± 9.8; P = .04). We demonstrated similar outcomes utilizing a novel, computer-based modular interactive course compared to traditional methods of teaching polysomnogram scoring. We used a mastery learning paradigm and set specific objective competency levels for this skill. Epstein LJ, Plante DT, Rosen IM. Mastery learning program to teach sleep study scoring. J Clin Sleep Med. 2022;18(12):2745-2750.

Effects of Levothyroxine Therapy on Pregnancy and Neonatal Outcomes in Subclinical Hypothyroidism.

PurposeTo assess the effects of levothyroxine (LT4) therapy on pregnancy and neonatal outcomes in pregnant women with subclinical hypothyroidism (SCH) who had different thyroid peroxidase antibody (TPOAb) status.MethodsThe data of pregnant women from the Chengdu Hospital of Integrated Traditional Chinese and Western Medicine between January 2017 and August 2019 were collected. SCH was defined as 11.88 < free thyroxine (FT4) < 20.06pmol/L in conjunction with thyroid-stimulating hormone (TSH) >4.00 mU/L. Some clinical characteristics have been collected, including body mass index (BMI) before pregnancy, number of pregnancies, number of miscarriages (spontaneous abortion), parity, family history of diabetes, history of smoking, history of drinking, TSH, FT4, and TPOAb levels. The prevalence of pregnancy and neonatal outcomes in the LT4 and non-LT4 groups, and in the LT4 and euthyroid control groups were compared, respectively. Univariate and multivariate logistic regression analyses were used to assess the effects of LT4 therapy on pregnancy and neonatal outcomes in SCH pregnant women with TPOAb.ResultsA total of 985 subjects were enrolled and divided into LT4 group with 478 patients, non-LT4 group with 156 patients and euthyroid control group with 351 patients. The prevalence of amniotic fluid abnormalities and premature delivery in the LT4 group was lower than that in the non-LT4 group in participants with TPOAb-positive (TPOAb+). After adjusting age, BMI prior to pregnancy, number of pregnancies, number of miscarriages, parity, TSH and FT4 level, the SCH pregnant women with TPOAb+ in the LT4 group had a lower risk of amniotic fluid abnormalities and premature delivery than that in the non-LT4 group.ConclusionLT4 therapy could reduce the risk of premature delivery and amniotic fluid abnormalities in the SCH pregnant women with TPOAb+. However, more randomized trials are required to confirm this association before the unequivocal advocacy of LT4 therapy in pregnant women with SCH.

Behaviourally informed, patient-led interventions to reduce missed appointments in general practice: a 12-month implementation study.

Scalable, positive, behaviourally informed interventions may help people remember to attend their primary care appointment or cancel in good time, but have not yet been implemented long term. To examine effects of social norms and making active commitments on missed and cancelled appointments in primary care over 12 months and explore implementation factors. A mixed-methods design evaluation and implementation study led by a Patient Participation Group (PPG) member in a large GP practice in the West Midlands. Following a 6-month baseline, waiting room notices were redesigned to emphasise positive social norms for desired behaviours. When booking appointments, receptionists were trained to invite patients to (i) verbally actively commit to cancelling if needed; (ii) write down their own appointment details. Monthly missed appointments (MAs) and cancellations were statistically compared with baseline averages and seasonally equivalent months. To explore implementation, reception staff completed a knowledge, attitude, and behaviour questionnaire at 9 months, analysed descriptively. Study team field notes were thematically analysed. Across 12 intervention months there was a mean of 37.67 fewer MAs per month (20% reduction) and 102.66 more cancellations (21.07% increase) compared with 6-month baseline means [MAs t(11) = -6.15, P < 0.001; cancellations t(11) = 3.637, P = 0.004] with statistically significant differences in seasonally equivalent months [MAs t(5) = -4.65, P = 0.006; cancellations t(5) = 3.263, P = 0.022]. Receptionists (n = 12) reported implementing the strategies except when facing pressures; knowledge and attitudes varied. Behaviourally informed interventions reduced primary care MAs longer term; PPGs and practice teams can work together on quality improvement projects with support from leaders to prioritise and embed new practices.

Selection bias in clinical studies of first-episode psychosis: A follow-up study

ObjectivesSelection bias is a concern in studies on psychotic disorders due to high dropout rates and many eligibility criteria for inclusion. We studied how representative the first-episode psychosis study sample in the Turku Early Psychosis Study (TEPS) was. MethodsWe screened 3772 consecutive admissions to the clinical psychiatric services of Turku Psychiatry, Finland, between October 2011 and June 2016. A total of 193 subjects had first-episode psychosis and were suitable for TEPS. Out of 193 subjects, 101 participated (PA) and 92 did not participate (NPA) in TEPS due to refusal or contact problems. We retrospectively used patient register data to study whether NPA and PA groups differed in terms of clinical outcomes during 1-year follow-up. ResultsIn overall sample, the NPA group had a significantly higher rate of discontinuation of clinical treatment than the PA group (48.9 % vs 29.7 %, p = 0.01). In the hospital-treated subsample chi-square tests did not indicate statistically significant differences between the NPA and PA groups in the rate of involuntary care (69.7 % vs 62.7 %, p = 0.34), coercive measures (36.0 % vs 22.7 %, p = 0.06), and readmissions during the follow-up (41.5 % vs 33.8 %, p = 0.31), respectively. ConclusionThe differences in clinical outcomes and treatment characteristics in the non-participating and participating groups were relatively modest. The results do not support a major sample selection bias that would complicate the interpretation of results in this first-episode psychosis study.

Childhood trauma, interleukin-17, C-reactive protein, metabolism, and psychosocial functioning in bipolar depression

• Clinical, anthropometrics, and laboratory variables were assessed in bipolar disorder and controls. • Participants ( N = 167) groups: currently in, or no in depressive episode, controls. • In depressive episode ( N = 58): more childhood trauma, obesity, inflammation, impairment. • Childhood sexual abuse positively correlated with obesity, inflammation, impairment. • Limitations: retrospective data collection, small sample, cross-sectional study.