Health Institutions Research Articles

Music therapy Embedded in the Life Of Dementia Inpatient Care (MELODIC) to help manage distress: A mixed methods study protocol for co-designing a complex intervention

ABSTRACT Introduction Best practice guidelines state that psychosocial interventions should be the first line of treatment for people with dementia who are experiencing distress. However, little research explores psychosocial support for those experiencing the most complex symptoms of distress in inpatient mental health wards. Music therapy may reduce behaviours of distress and staff report it to be helpful, yet interventions are not common in the National Health Service (NHS) in the United Kingdom, and the type and method of delivery vary. Methods and design This study, funded by the National Institute for Health and Care Research, will co-develop and pilot a standardised protocol and guide, MELODIC (Music Therapy Embedded in the Life Of Dementia Inpatient Care), for music therapy in NHS inpatient mental health dementia wards. Two reviews, using realist and systematic methods, will be conducted to increase understanding of the current evidence base. Focus groups will then be facilitated to explore experiences of distress and the use of music on wards. MELODIC v1 will then be co-designed with experts by experience and stakeholders, and piloted on two NHS wards with differing experiences of music therapy. Mixed methods data collection will support protocol and theory refinement and establish the appropriateness of the methods to inform a future trial. Ethical approval has been received for all research activities. Discussion The protocol and findings will be disseminated in academic, clinical and public spaces. MELODIC can then be tested for feasibility and acceptability, with clinical and cost-effectiveness ultimately established in a definitive randomised controlled trial. Registration Realist review: CRD42023409635; systematic review: CRD42023429983.

Human resource management in homecare in England: managing people for safe care during crisis

BackgroundHuman resource management (HRM) of healthcare organisations plays an important role in improving the continuity of care, managing staff, and ensuring patient safety. During COVID-19, there were several HR-related issues, creating a significant challenging situation for health and social care institutions. This study explored the HRM issues that are associated with the patient safety in homecare, and how homecare providers have responded to these HR-related challenges during the COVID-19 pandemic. The aim of this is to explore the role of HRM practices in helping care organisations operate efficiently and supporting their workforce to adapt to future disruptive changes and crises.MethodsQualitative strategies include narrative inquiry involving gathering information in the form of storytelling by the research participants. Between February 2021 and December 2021, data were collected through semi-structured interviews of 31 participants, including homecare staff (homecare transition practitioners, homecare social workers, and carers), family members, and service users in England.ResultsThe research identified key HRM challenges during the pandemic, including staff shortages, high turnover, ineffective communication, occupational stress for front-line carers, and lack of training, all adversely affecting the safety of homecare patients. In response, homecare providers employed strategies like opportunistic recruitment, digital technology for training and communication, and flexible work arrangements to mitigate these issues.ConclusionsSeveral implications are proposed, with the over-riding aim of ensuring effective management of HRM practices in responding to address key areas: staffing, performance management, and training. Homecare providers should utilise short-term adaptive recruitment strategies, while also focusing on long-term workforce development and resilience to effectively respond to current and future care needs. Prioritising staff well-being for retention and care quality are crucial. Homecare providers are encouraged to offer flexible work arrangements and digital communication methods, all while being mindful of preventing technostress and digital exhaustion among their staff. They also need to bridge training gaps and employ effective delivery methods to equip healthcare workers with essential skills, thereby enhancing resilience and adaptability in homecare.

Time to act? Is the new era of gut hormone-based pharmacotherapy an opportunity to rethink the tier-based UK obesity care model?

Obesity, like type 2 diabetes, is a complex, often life limiting disease influenced by genetics and modern environment. However, unlike diabetes, the provision of integrated, holistic care for people with obesity in the UK remains underdeveloped, despite the growing prevalence of obesity and increasing availability of effective treatments for weight loss. The current tier-based approach to obesity management, although based around a multidisciplinary model, can be fragmented with significant geographical variations in care. The recent approval of new pharmacotherapies by the National Institute for Health and Care Excellence offers an opportunity to rethink and reshape the approach to obesity management. This article provides a review of the current tier-based system for obesity care in UK and proposes alternative models aimed at improving efficiency, promoting equity, and enhancing person-centred outcomes.

Effectiveness Study of a Cultural Adaptation of Cognitive-Behavioural Therapy-Based Application for Depressive Symptoms in College Students: A Randomised Controlled Trial.

Studies on mental health applications among college students lack empirical evidence regarding mobile application usage's intensity, duration and frequency. To evaluate the effectiveness of a cognitive-behavioural therapy (CBT)-based mobile application in ameliorating depressive symptoms among college students. A randomised controlled trial was conducted at three universities. Undergraduates aged ≥ 20 years with self-reported depressive symptoms were recruited and randomly assigned to the control and intervention groups. The outcomes include changes in depressive symptoms, suicidal ideation, help-seeking attitudes and emotional self-awareness at 4 (T1), 8 (T2) and 12 (T3) weeks. An intention-to-treat analysis was conducted. Of the 91 participants, 46 in the intervention group exhibited a significant decline in depressive symptoms at T1 and lower patterns of symptom changes at T2 and T3. No significant differences were observed in the other outcomes; however, higher help-seeking attitude, emotional self-awareness and lower suicidal ideation after T0 were observed for those who used the application for 12 weeks. The advantages of a brief application-based intervention to promote college students' psychological health are outlined. School nursing managers could use the application to improve the college mental health systems and support collegial teacher-student relationships. Further studies should enhance application usage to manage depressive symptoms. The study was approved by the Research Ethics Committee of the National Taiwan University Hospital (No. 202108098RINB, Date of approval: Oct 27, 2021) and the National Institutes of Health (No. NCT05188950).

Acupuncture for hypoxic ischemic encephalopathy in neonates.

Peripartum asphyxia affects three to five per 1000 live births, with moderate or severe hypoxic ischemic encephalopathy (HIE) occurring in 0.5 to 1 per 1000 live births, and is associated with high mortality and morbidity. Therapeutic hypothermia is an effective treatment, but alternative therapies such as acupuncture are also used. To determine the benefits and harms of acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure) on mortality and morbidity in neonates with HIE, compared with 1) no treatment, 2) placebo or sham treatment, 3) any pharmacologic treatment, or 4) different types of acupuncture. We searched CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the WHO ICTRP in March 2023. We conducted a search of the grey literature to identify reports of trials conducted by or referenced in research by CORDIS EU, National Institute for Health and Care Excellence (NICE), and NHSGGC Paediatrics for Health Professionals. We also checked the reference lists of relevant articles to identify additional studies. We included randomized controlled trials (RCTs) or quasi-RCTs and cluster-randomized trials. We included studies where participants were term infants (37 weeks or greater) and late preterm infants (34 + 0 to 36 + 6 weeks' gestation) 10 days of age or less, with evidence of peripartum asphyxia. We included studies on acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure). We included studies where acupuncture was compared with: 1) no treatment; 2) placebo or sham treatment; 3) any pharmacologic treatment; or 4) different types of acupuncture. We used standard Cochrane methods. Our primary outcomes were all-cause mortality at the latest follow-up, major neurodevelopmental disability in children aged 18 to 24 months and aged 3 to 5 years, adverse events until hospital discharge, and length of hospital stay. We included four studies (enrolling 464 infants) that compared acupuncture with no treatment. The studies ranged in size from 60 to 200 infants. Three studies were conducted in China and one in Russia. None of the four studies reported on any of the prespecified outcomes of our review. We did not identify any ongoing studies. There is limited availability of studies addressing this specific population. The included studies did not assess mortality, long-term neurodevelopmental outcomes, or adverse effects of acupuncture. We are unable to draw any conclusions about the benefits and harms of acupuncture for HIE in neonates. In light of the current limitations, clinicians are urged to approach the use of acupuncture in neonates with HIE cautiously, as there is no evidence to support its routine application. The available trials assessed surrogate outcomes that have a relatively small impact on newborns, and failed to report important outcomes such as mortality and long-term neurodevelopmental outcomes. Other available trials were performed on older infants who had experienced neonatal HIE. Given the lack of available evidence, well-designed randomized controlled trials with relevant outcomes such as mortality and neurodevelopmental outcomes are essential to evaluate the efficacy and safety of acupuncture for HIE in neonates.

Bridging the critical gap between infectious disease blood donation screening and connection to healthcare services: the American Chagas disease example.

Chagas disease (Trypanosoma cruzi infection) affects ~ 290,000 USA residents and is included in routine blood donation screening panels. Donors are notified of positive T. cruzi-screening results, deferred from donation, and given limited information for next steps. Individuals living with undiagnosed, uncommon infections often face substantial barriers in accessing physicians with infectious disease competency, confirmatory testing, and continuum of care after the point of blood donor deferral. We assessed 46T. cruzi-deferred donors' experience following deferral, highlight donor challenges, and provide public health institution opportunities to support cases of rare transfusion-transmitted infections in the USA.

Stigma related to podoconiosis in Ethiopia: a systematic review

BackgroundPodoconiosis, one of the neglected tropical diseases (NTDs), affects barefoot people in impoverished regions and contributes to poverty by having negative impacts on economic output, education, and disability. Podoconiosis has enormous social, psychological, and economic implications for the affected individuals. Social stigmatization of people with the disease is widespread, and patients are restricted from schools, local meetings, mosques, and churches and not allowed to marry into unaffected families. Therefore, this study aimed to systematically review the stigma related to podoconiosis in Ethiopia.MethodsThe Preferred Items for Systematic Reviews and Meta-analysis (PRISMA-2020) guidelines were followed. PubMed/Medline, Scopus, Web of Science, Google Scholar, and Google databases were searched. Articles published in the English language from inception to 2023 were included. Data were extracted by using a pre-prepared Excel sheet, and a narrative synthesis of the findings was done. This review was registered in the PROSPERO International Prospective Register of Systematic Reviews with registration number CRD42024510091.ResultsA total of 19 studies were included in this systematic review. This systematic review identified different types of stigmas reported from individuals with podoconiosis. The types of stigmas identified were enacted, felt, and internalized stigma and social stigmas, including exclusion from different social occurrences such as idir, meetings, funerals, and churches/mosques. Stigma also prevented patients with podoconiosis from visiting health institutions for the treatment of the disease and using health services for other cases.ConclusionsStigma among podoconiosis patients is widely distributed in Ethiopia. Different types of stigmas were identified among the patients. Extensive work needs to be done to prevent the disease and stigma. Strengthening works on community awareness about the disease help to ensure that it does not get transmitted from affected individuals to others.Systematic review registrationPROSPERO, identifier CRD42024510091.

To Consent and to Refuse Electroconvulsive Therapy: A Study of Consent Documents and Court Orders in the Province of Quebec, Canada

The objective of this article is to offer a critical analysis of policies and practices concerning consent and refusal of electroconvulsive therapy (ECT) in terms of their compliance with the legal principles concerning consent to treatment. Using the province of Quebec, Canada, as a case study, we first identified consenting documents and court orders for ECT treatments; we then critically appraised them using National Institute for Health and Care Excellence guidelines on ECT as a gold standard. We find that consent documents suffer lack of clarity and transparency regarding ECT’s medical indication, risks, and benefits. The review of court orders reveals a paucity of information pertaining to the diagnosis, clinical indications, benefits, and potential risks associated with ECT for patients who lack the capacity for consent.

Analyzing lipid profiles and dyslipidemia prevalence in hypertensive patients: a cross-sectional study from primary community health institutions

BackgroundA significant proportion of hypertensive patients also suffer from comorbid dyslipidemia, which critically influences their treatment outcomes and overall prognosis. Given its implications, the lipid profiles of hypertensive individuals warrant increased attention for more effective clinical management.MethodsWe analyzed data from 92,443 hypertensive patients registered at primary community health institutions in 2021. Employing a cross-sectional study design, we assessed the distribution of lipid levels and the prevalence of various dyslipidemia subtypes. Stepwise forward logistic regression was used to identify factors associated with dyslipidemia, adjusting for gender, age, body size, and other relevant characteristics.ResultsAccording to the 2023 Chinese Guidelines for the Management of Lipids, the overall prevalence of dyslipidemia was 37.5%. Subtype analysis revealed prevalence of high total cholesterol (TC) at 11.2%, high triglycerides (TG) at 16.0%, low high-density lipoprotein cholesterol (HDL-C) at 16.0%, and high low-density lipoprotein cholesterol (LDL-C) at 10.2%. TG abnormalities were more common among males (16.8%), whereas TC abnormalities predominated in females (14.4%). Notably, hypertensive patients with diabetes had higher levels of TG compared to non-diabetics (p = 0.009). Those with stroke and liver disease comorbidities exhibited lower TG levels than their counterparts (p = 0.018 and p < 0.001, respectively). Additionally, HDL-C levels were significantly lower in hypertensives with diabetes, coronary artery disease, and central obesity (p < 0.001, p = 0.026, p < 0.001, respectively). Regression analysis indicated that dyslipidemia prevalence correlates significantly with gender, age, diabetes, coronary heart disease, stroke, family history of hypertension, body mass index (BMI), central obesity, frequency of physical activity, smoking status, regular alcohol consumption, and abdominal ultrasound findings.ConclusionOur study underscores the necessity of rigorous lipid monitoring and analysis of dyslipidemia-influencing factors for the development of effective health management strategies within the community. There is a critical need to examine lipid profiles comprehensively and implement targeted therapeutic interventions aimed at managing hyperlipidemia, a modifiable risk factor for cardiovascular disease.

Spatial variation and associated factors of home delivery among reproductive age group women in Ethiopia, evidence from Performance Monitoring for Action Ethiopia Survey 2019, spatial and multilevel logistic regression analysis

IntroductionHome birth is described as a delivery that takes place at home without the presence of a skilled birth attendant. In 2017, nearly 295,000 mothers died from various pregnancy and childbirth-related problems, accounting for approximately 810 maternal deaths per day. Therefore, this study aims to investigate the spatial distributions of home birth and associated factors in Ethiopia using the Performance Monitoring for Action Survey (PMAS) 2019) to get information that helps to take geographic-based interventions and can assist health planners and policymakers in developing particular measures to reduce home deliveries.MethodIn PMA-ET 2019, a community-based cross-sectional study was conducted in collaboration with Addis Ababa University, Johns Hopkins University, and the Federal Ministry of Health from September 2019 to December 2019, in Ethiopia. A multi-stage cluster sampling procedure was employed to draw from the stratified 2019 PMAS sample. A weighted total of 5,796 women were included in this study. ArcGIS version 10.7 software was used to visualize the spatial analysis. In addition, STATA version 14 of the statistical software was used for multilevel analysis The Bernoulli model was applied using Kulldorff's SaTScan version 9.6 software to identify significant purely spatial clusters for home delivery in Ethiopia. Intra-class Correlation Coefficient (ICC), Likelihood Ratio (LR) test, Median Odds Ratio (MOR), and deviance (−2LLR) values were used for model comparison and fitness. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value <0.05 in the multilevel logistic model were used to declare significant factors associated with home delivery.ResultThe spatial distribution of home delivery was non-random in Ethiopia. Statistically significant high hotspots of home delivery were found in Somali, Afar, Sidama, most of South Nation Nationality and People Region (SNNP), most parts of Amhara, south west Ethiopia, and Oromia region. In the multilevel logistic regression model; Women from the lowest wealth quintile were 1.68 times [AOR = 1.68; 95% CI: 1.31, 2.15] higher odds of giving birth at home as compared to their counterparts. Regarding maternal educational status, mothers who had no education, primary education, and secondary education had 9.91 times [AOR = 9.91, 95% CI: 5.44, 18.04], 6.62 times [AOR = 6.62, 95% CI: 3.65, 12.00] and 2.99 times [AOR = 2.99, 95% CI: 1.59, 5.63] higher odds of giving birth at home compared to mothers who attained higher education, respectively. In addition, community-level factors were significantly associated with home delivery, women who had high community-level poverty were 1.76 times [AOR = 1.76; 95% CI: 1.14, 2.72] higher odds of home delivery compared to women who had low community-level poverty.ConclusionHome delivery was statistically found to be a significantly high hot spot in Somalia, Afar, Sidama, most of the South Nation Nationality and People area (SNNP), most of Amhara, southwest Ethiopia, and the Oromia region of Ethiopia. Significant factors associated with home delivery in Ethiopia were women with lower levels of education, poor wealth, living in rural areas, high levels of community poverty, divorced or separated widowed marital status, and older maternal ages. Therefore, health institutions, health professionals, National and regional policymakers health planners community leaders and all concerned should give priority to the identified hot spot clusters to design an effective intervention program to reduce home delivery.

Production of face protectors by 3d printing: distribution of PPE to face the coronavirus

Purpose: The aim of this study is to produce face shields using 3D printing, contributing to the personal protection of healthcare professionals from both public and private health institutions amid the coronavirus pandemic. Theorical framework: At the beginning of the Covid-19 pandemic, it became common for health professionals to report on the scarcity of Personal Protective Equipment (PPE) in their work, which resulted in the high level of contamination of those involved in the front line. The face shield stood out as one of the missing PPEs, important for the health and safety of workers as they offer a physical barrier to contamination by secretions. Methodology/Approach: For this purpose, through the Center for Robotics, Innovation, and Entrepreneurship (CRIE), the prototyping laboratory of the Federal Institute of Minas Gerais campus Governador Valadares (IFMG-GV), different models of face shields were tested. The model that provided the greatest comfort for users was selected, while also requiring less printing time and using less raw material. The production was carried out in accordance with Resolution 356/2020 of the National Health Surveillance Agency (ANVISA), which authorized and decentralized the production of large industries in an extraordinary and temporary manner. Findings: Requirements for the manufacture, importation, and acquisition of medical devices were defined. In total, 223 face shields were produced and donated to the city's healthcare system, serving the Unimed Hospital, the Medical Association, and other local hospitals. Research, practical & social implications: From the action, the IFMG-GV, as a public educational institution, played its role by providing support to local society, influenced by the consequences of the pandemic. Keywords: Covid-19; Face shield printing; 3d printing.

Oral Propranolol in the Treatment of Cutaneous Infantile Hemangioma in Children: A 3-Years Retrospective Study

Background: Infantile hemangioma is the most common vascular tumor in children. The primary pharmacological agent currently utilized for its treatment is propranolol, which demonstrates efficacy and minimal and non-severe side effects. Objective: To investigate the therapeutic outcomes and adverse effects of orally administered propranolol in the treatment of infantile hemangioma. Additionally, to explore patient data regarding disease manifestations and progression. Material and Methods: Retrospective data collection from medical records of patients diagnosed with cutaneous infantile hemangioma and treated at the National Children’s Health Institute for a duration of three years, between January 1, 2018 and December 31, 2020, was done. Results: The present study included 180 patients with infantile hemangioma. The male-to-female ratio was 1 to 2.3. The median age at diagnosis and treatment initiation was four months, ranging from 1 week to 18 months. Premature infants accounted for 28 cases (15.6%). The most common locations were the head, face, and neck with 67.8%, trunk with 16.1%, and limbs with 16.1%. The most prevalent complications were ulcerations for 12.2% and visual field defects for 0.6%. The average duration of propranolol treatment was 13.01 months. Favorable response was noted in 173 patients (96%) at the 2-week follow-up. By the 6-month follow-up, all patients exhibited positive treatment responses. Adverse effects were reported in two cases, including hypoglycemic seizure and irritability. Conclusion: Oral propranolol demonstrates favorable outcomes in treating infantile hemangioma. However, vigilant monitoring for severe adverse effects, particularly hypoglycemia-induced seizures must be done. Guardians must be informed and deeply concerned not to administer propranolol on an empty stomach, in the presence of poor feeding, or in poor physical condition. Keywords: Oral propranolol; Infantile hemangioma; Adverse events; Hypoglycemia

Ergonomic risk assessment of lifting operations by mud mixing operators at oil rigs

Oil rigs require mud as a drilling fluid to make boreholes into the earth for crude oil exploration. The operator movements in drilling rigs are repeated bending, lifting of sacks for mud mixing, pushing and/or pulling of sacks and working in hazardous body postures. This study adopts risk assessment tools such as rapid entire body assessment and the revised National Institute for Occupational Safety and Health lifting equation to analyse the risks in postures of the mud mixing operator. Also, the study develops a digital human model of the mud mixing operator using Jack digital human modelling for simulating selected tasks associated with mud mixing operation. Finally, lower back analysis and static strength prediction are performed using a digital human Jack model. Safety of mud mixing operators can be improved with the results obtained from the study, thereby reducing non-productive time reports in drilling operations.

Relative Citation Ratio Among Pediatric Orthopaedic Surgeons: Examining the Factors Associated With Higher Scores.

Academic scholarship is often valued by clinicians, peers, and intuitions. Quantifying the effect of research publications is challenging. Various metrics have been used to assess this. This study aimed to examine the relatively new research metric, relative citation ratio (RCR), introduced by the National Institutes of Health, for pediatric orthopaedic surgeons to establish the benchmarking of research effect within the field and understand the distribution and basis for the use of this metric among pediatric orthopaedic surgeons. The RCR indices were assessed for members of the Pediatric Orthopaedic Society of North America using the iCite online web service. The mean RCR (mRCR, the yearly average RCR) and weighted RCR (wRCR, the cumulative RCR score) were assessed for each member. This information was used to perform univariate and two multivariate ordinary least squares regressions for the two metrics. Independent variables were physician sex, years since receiving national provider identifier, MD versus DO degree, whether the physician had a PhD, and geographic region of practice (Northeast, Southeast, Midwest, West, and Southwest). A total of 770 pediatric orthopaedic physicians were identified. The median [interquartile range] wRCR was 15.6 [4.9 to 54.2], and median mRCR was 1.4 [1.0 to 1.9]. Multivariable squares regression for wRCR showed an independently increased wRCR associated with male sex (39.11), PhD (23.32), years since receiving national provider identifier (4.51), and northeast region (48.44). However, these trends were not notable for mRCR where only southeast region was notable. Although each has its caveats, both mRCR and wRCR have a place in evaluating an author's publication history and other research metrics. Furthermore, it is important to know the overall research metrics within a field to allow for inter- and intraspecialty comparisons. Understanding RCR is helpful because it allows for new comparisons within and across fields and career lengths.

Decreased urinary excretion of norepinephrine and dopamine in autonomic synucleinopathies.

Autonomic synucleinopathies feature autonomic failure and intracellular deposition of the protein alpha-synuclein. Three such conditions are the Lewy body diseases (LBDs) Parkinson's disease (PD) and pure autonomic failure (PAF) and the non-LBD synucleinopathy multiple system atrophy (MSA). These diseases all entail catecholaminergic abnormalities in the brain, sympathetically innervated organs, or both; however, little is known about renal catecholaminergic functions in autonomic synucleinopathies. We measured urinary excretion rates of the sympathetic neurotransmitter norepinephrine, the hormone epinephrine, the autocrine-paracrine substance dopamine, the catecholamine precursor 3,4-dihydroxyphenylalanine (DOPA), 3,4-dihydroxyphenylglycol (DHPG, the main neuronal metabolite of norepinephrine), and 3,4-dihydroxyphenylacetic acid (DOPAC, a major dopamine metabolite), in PD, PAF, and MSA groups and controls. Data were reviewed from all research participants who had urine collections (usually 3.5 h) at the National Institutes of Health (NIH) Clinical Center from 1995 to 2024. The control cohort had neither autonomic failure nor a movement disorder. Norepinephrine excretion rates were decreased compared with controls in PD (p = 0.0001), PAF (p < 0.0001), and MSA (p < 0.0001). Dopamine excretion was also decreased in the three groups (PD: p = 0.0136, PAF: p = 0.0027, MSA: p = 0.0344). DHPG excretion was decreased in PD (p = 0.0004) and PAF (p = 0.0004) but not in MSA. DOPA and epinephrine excretion did not differ among the study groups. Autonomic synucleinopathies involve decreased urinary excretion rates of norepinephrine and dopamine. Since virtually all ofurinary dopamine in humans is derived from circulating DOPA, the low rates of urinary norepinephrine and dopamine excretion may reflect dysfunctions in the renal sympathetic noradrenergic system, the DOPA-dopamine autocrine-paracrine system, or both systems.

Social determinants of health as risk factors for keratoconus in the All of Us database

Background/aimsClinical risk factors for keratoconus (KCN) have previously been established. While the impact of the social determinants of health on the epidemiology and pathophysiology of KCN has been explored, further...

Analysis of Physical Activity Using Wearable Health Technology in US Adults Enrolled in the All of Us Research Program: Multiyear Observational Study.

To date, no studies have examined adherence to the 2018 Physical Activity Guidelines for Americans (PAGA) in real-world longitudinal settings using objectively measured activity monitoring data. This study addresses this gap by using commercial activity monitoring (Fitbit) data from the All of Us dataset. The primary objectives were to describe the prevalence of adherence to the 2018 PAGA and identify associated sociodemographic determinants. Additionally, we compared 3 distinct methods of processing physical activity (PA) data to estimate adherence to the 2008 PAGA. We used the National Institutes of Health's All of Us dataset, which contains minute-level Fitbit data for 13,947 US adults over a 7-year time span (2015-2022), to estimate adherence to PAGA. A published step-based method was used to estimate metabolic equivalents and assess adherence to the 2018 PAGA (ie, ≥150 minutes of moderate- to vigorous-intensity PA per week). We compared the step-based method, the heart rate-based method, and the proprietary Fitbit-developed algorithm to estimate adherence to the 2008 PAGA. The average overall adherence to the 2018 PAGA was 21.6% (3006/13,947; SE 0.4%). Factors associated with lower adherence in multivariate logistic regression analysis included female sex (relative to male sex; adjusted odds ratio [AOR] 0.66, 95% CI 0.60-0.72; P<.001); BMI of 25.0-29.9 kg/m2 (AOR 0.53, 95% CI 0.46-0.60; P<.001), 30-34.9 kg/m2 (AOR 0.30, 95% CI 0.25-0.36; P<.001), or ≥35 kg/m2 (AOR 0.13, 95% CI 0.10-0.16; P<.001; relative to a BMI of 18.5-24.9 kg/m2); being aged 30-39 years (AOR 0.66, 95% CI 0.56-0.77; P<.001), 40-49 years (AOR 0.79, 95% CI 0.68-0.93; P=.005), or ≥70 years (AOR 0.74, 95% CI 0.62-0.87; P<.001; relative to being 18-29 years); and non-Hispanic Black race or ethnicity (AOR 0.63, 95% CI 0.50-0.79; P<.001; relative to non-Hispanic White race or ethnicity). The Fitbit algorithm estimated that a larger percentage of the sample (10,307/13,947, 73.9%; 95% CI 71.2-76.6) adhered to the 2008 PAGA compared to the heart rate method estimate (4740/13,947, 34%; 95% CI 32.8-35.2) and the step-based method (1401/13,947, 10%; 95% CI 9.4-10.6). Our results show significant sociodemographic differences in PAGA adherence and notably different estimates of adherence depending on the algorithm used. These findings warrant the need to account for these disparities when implementing PA interventions and the need to establish an accurate and reliable method of using commercial accelerometers to examine PA, particularly as health care systems begin integrating wearable device data into patient health records.

Cross-Sectional Survey Analysis of Institutional Research Partnerships in Complementary and Integrative Health: Identifying Barriers and Facilitators.

Objective: Collaboration between complementary and integrative health (CIH) institutions and research-intensive (R1) institutions has been successfully undertaken in the United States, resulting in federally funded research projects, educational programs, and faculty development. The aim of this cross-sectional survey study was to explore the barriers and facilitators to establishing and maintaining such collaborative partnerships. Methods: A 32-question survey was sent to participants recruited through author contacts and resources, literature review, and database searches. Participants were required to be researchers and affiliates who attempted, completed, or had current collaborative endeavors involving CIH and R1 institutions. Data were collected in the research electronic data capture (REDCap) system and descriptive quantitative and qualitative data analysis was undertaken. Results: A total of 26 unique entries were included in the final data analysis; four of which were paired entries (one from an R1 institution and one from a CIH institution) to make up two dyad data collections. Eighty-one percent of the participants had senior leadership roles at CIH institutions representing five CIH disciplines-East Asian medicine (acupuncture and Traditional Chinese Medicine), chiropractic medicine, massage therapy, naturopathy, and yoga. Collaborative research projects were often (>38%) in response to specific project funding mechanisms. Over 60% of the collaborations also included educational activities and faculty development. Collaborations resulted in multiple different types of benefits to both institutions but were not without associated challenges. Conclusion: Collaborations between R1 and CIH institutions can be cooperative, productive, and mutually beneficial. Funding mechanisms supporting R1 and CIH collaboration increase CIH research productivity as well as the development of innovative research methodology to study the real-world practice of CIH therapies, whole systems, and whole person health. CIH researchers would greatly benefit from such funding, allowing access to research infrastructure, professional development, and the provision of protected time to conduct research.

Predictive analysis of lung function in school-age children born with very low birthweight, according to the definition used of bronchopulmonary dysplasia. A retrospective observational analysis.

To determine the predictive value of the definition of bronchopulmonary dysplasia (BPD) on spirometric parameters of very low birthweight (VLBW) children of school age between 1 January 2008 and 31 December 2016. In this longitudinal retrospective observational study, we analyse a cohort of children admitted to a neonatal intensive care unit between 1 January 2008 and 31 December 2016. All newborns weighing <1500 g and born before 32 weeks of gestational age were included in the study (VLBW newborns). The existence of BPD was established retrospectively according to the definitions proposed by the National Institutes of Health (NIH) in 2001 and the National Institute of Child Health and Human Development (NICHD) in 2018. Lung function of the school-age cohort was evaluated prospectively as FEV1, FVC, FEF25-75% and FEV1/FVC by spirometry. The predictive analysis was performed by multivariate linear regression. Of the 145 children included in the study cohort, 60 were diagnosed with BPD according to the NIH definition and 36 according to that of the NICHD. Lung function was reduced by about 20% in patients with BPD, irrespective of the definition applied. However, the predictive regression model only produced a statistically significant fit with the spirometric variables when the NIH definition was adopted. Our findings highlight the value of continuing to consider oxygen requirements at 28 days of chronological age in the definition of BPD, in order to obtain higher quality predictions of lung function parameters assessed later, during school age.

Waning success: a 2013–2022 spatial and temporal trend analysis of malaria in Ethiopia

BackgroundDespite consecutive decades of success in reducing malaria transmission, Ethiopia went off track towards its goal of malaria elimination by 2030, as outlined in the NMCP malaria strategy. Recent malaria outbreaks in Ethiopia are attributed to the emergence and spread of diagnostic and drug-resistant Plasmodium falciparum, increased insecticide resistance in major vectors and the spread of invasive Anopheles stephensi. The effects of the COVID-19 pandemic, environmental anomalies and internal conflicts have also potentially played a role in increasing malaria transmission. This study aimed to evaluate the contribution of environmental factors and An. stephensi to the spatiotemporal trends of recent malaria cases in Ethiopia.MethodsClinical malaria case data reported weekly between January 2013 and January 2023 were obtained from the Ethiopian Public Health Institute (EPHI), Addis Ababa. A negative binomial regression model was used to explain the variability and potential overdispersion in the weekly number of malaria cases reported across Ethiopian administrative zones. This model incorporated fixed effects for selected environmental factors and random effects to capture temporal trends, zone specific seasonal patterns, spatial trends at the zone level, and the presence of An. stephensi and its impact.ResultsOur negative binomial regression model highlighted 56% variability in the data and slightly more than half (55%) was due to environmental factors, while the remainder was captured by random effects. A significant nationwide decline in malaria risk was observed between 2013 and 2018, followed by a sharp increase in early 2022. Malaria risk was higher in western and northwestern zones of Ethiopia compared to other zones. Zone-specific seasonal patterns, not explained by environmental factors, were grouped into four clusters of seasonal behaviours. The presence of An. stephensi was not shown to have any significant impact on malaria risk.ConclusionsUnderstanding the spatial and temporal drivers of malaria transmission and therefore identifying more appropriate malaria control strategies are key to the success of any malaria elimination and eradication programmes in Ethiopia. Our study found that approximately 50% of malaria risk variability could be explained by environmental, temporal, and spatial factors included in the analysis, while the remaining variation was unexplained and may stem from other factors not considered in this study. This highlights the need for a better understanding of underlying factors driving local malaria transmission and outbreaks, to better tailor regional programmatic responses.Graphical