Lower Quality Scores Research Articles

Association of antibiotics therapy during pregnancy with spontaneous miscarriage: a systematic review and meta-analysis.

This systematic review and meta-analysis of observational studies were conducted to assess the association between antibiotics use during pregnancy and spontaneous miscarriage. A systematic search of online databases as well as reference lists of retrieved studies were performed up to September 2018 to identify observational studies that investigated the association between antibiotics use and spontaneous miscarriage. The retrieved studies were assessed for methodological quality. Pooled relative risk (RR) and 95% confidence intervals were calculated using DerSimonian and Laird method. Random-effects meta-analysis was used to account for conceptual heterogeneity. Sensitivity analysis was performed to assess the robustness of pooled estimates using Stata software. Of 1435 retrieved studies, 89 were reviewed in depth and 12 (8 prospective cohort and 4 population-based case-control studies) met the criteria for inclusion in a systematic review with 1,084,792 participants and 7015 cases of spontaneous miscarriage. Finally, 11 studies were included in the meta-analysis (one study was not included in the meta-analysis owing to methodological issues and low-quality score). Overall percentage of miscarriage in women who received antibiotics was 2.6%. After adjusting for important potential confounders, use of macrolides (RR: 1.42; 95% CI 1.04, 1.93), quinolones (RR: 2.48; 95% CI 1.46, 4.20), and tetracyclines (RR: 2.57; 95% CI 1.95, 3.38) during pregnancy were significantly associated with spontaneous miscarriage. In macrolides class, a significant positive association was found between clarithromycin and spontaneous miscarriage (RR: 1.98; 95% CI 1.46, 2.70). Sensitivity analysis demonstrated the consistency of the results, indicating that the meta-analysis model was robust. Findings support a significant positive association between use of macrolides (especially clarithromycin), quinolones, and tetracyclines during pregnancy and spontaneous miscarriage, although it should be interpreted with caution in the context of limitations of the available data. International register for systematic reviews; PROSPEROCRD42018093465.

Effects of fentanyl–lidocaine–ketamine versus sufentanil–lidocaine–ketamine on the isoflurane requirements in dogs undergoing total ear canal ablation and lateral bulla osteotomy

ObjectiveTo compare the isoflurane-sparing effects of sufentanil–lidocaine–ketamine (SLK) and fentanyl–lidocaine–ketamine (FLK) infusions in dogs undergoing total ear canal ablation and lateral bulla osteotomy (TECA–LBO). Study designRandomized blinded clinical study. AnimalsA group of 20 client-owned dogs undergoing TECA–LBO. MethodsIntravenous (IV) administration of lidocaine (3 mg kg–1) and ketamine (0.6 mg kg–1) with fentanyl (5.4 μg kg–1; n = 10; FLK group) or sufentanil (0.72 μg kg–1; n = 10; SLK group) was immediately followed by the corresponding constant rate infusion (CRI) (lidocaine 3 mg kg–1 hour–1; ketamine 0.6 mg kg–1 hour–1; either fentanyl 5.4 μg kg–1 hour–1 or sufentanil 0.72 μg kg–1 hour–1). Anaesthesia was induced with propofol 3–5 mg kg–1 IV and was maintained with isoflurane. End-tidal isoflurane concentration (Fe′Iso) was decreased in 0.2% steps every 15 minutes until spontaneous movements were observed (treated with propofol 1 mg kg–1 IV) or an increase of > 30% in heart rate or mean arterial pressure from baseline occurred (treated with rescue fentanyl or sufentanil). Quality of recovery and pain were assessed at extubation using the short-form Glasgow Composite Pain Scale (SF-GCPS), Colorado State University Canine Acute Pain scale (CSU-CAP), and visual analogue scale (VAS). Data were analysed with analysis of variance, t tests, Fisher test and Spearman coefficient (p < 0.05). ResultsFe′Iso decreased significantly in SLK group (45%; p = 0.0006) but not in FLK (15%; p = 0.1135) (p = 0.0136). SLK group had lower scores for recovery quality (p = 0.0204), SF-GCPS (p = 0.0071) and CSU-CAP (p = 0.0273) than FLK at extubation. Intraoperative rescue analgesia and VAS were not significantly different between groups. Conclusions and clinical relevanceCompared with FLK infusion, CRI of SLK at these doses decreased isoflurane requirements, decreased pain scores and improved recovery quality at extubation in dogs undergoing TECA–LBO.

The impact of armed conflict on cancer among civilian populations in low- and middle-income countries: a systematic review.

BackgroundArmed conflicts are increasingly impacting countries with a high burden of cancer. The aim of this study is to systematically review the literature on the impact of armed conflict on cancer in low- and middle-income countries (LMICs).MethodsIn November 2019, we searched five medical databases (Embase, Medline, Global Health, PsychINFO and the Web of Science) without date, language or study design restrictions. We included studies assessing the association between armed conflict and any cancer among civilian populations in LMICs. We systematically re-analysed the data from original studies and assessed quality using the Newcastle-Ottawa Scale. Data were analysed descriptively by cancer site.ResultsOf 1,543 citations screened, we included 20 studies assessing 8 armed conflicts and 13 site-specific cancers (total study population: 70,172). Two-thirds of the studies were of low methodological quality (score <5) and their findings were often conflicting. However, among outcomes assessed by three or more studies, we found some evidence that armed conflict was associated with increases in the incidence and mortality of non-specific cancers, breast cancer and cervical cancer. Single studies reported a positive association between armed conflict and the incidence of stomach and testicular cancers, some as early as 3 years after the onset of conflict. Some studies reported a post-conflict impact on time to diagnosis.ConclusionOur findings support the need for more rigorous longitudinal and cohort studies of populations in and immediately post-conflict to inform the development of basic packages of cancer services, and post-conflict cancer control planning and development.

Association of Provider Performance with Changes in Insurance Networks

Medicaid managed care plans change provider networks frequently, yet there is no evidence about the performance of exiting providers relative to those that remain. To investigate the association between provider cost and quality and network exit. Observational study with provider network directory data linked to administrative claims from managed care plans in Tennessee's Medicaid program during the period 2010-2016. 1,966,022 recipients assigned to 9593 unique providers. Exposures were risk-adjusted total costs of care and nine measures from the Healthcare Effectiveness Data and Information Set (HEDIS) were used to construct a composite annual indicators of provider performance on quality. Outcome was provider exit from a Medicaid managed care plan. Differences in quality and cost between providers that exited and remained in managed care networks were estimated using a propensity score model to match exiting to nonexiting providers. Over our study period, we found that 21% of participating providers exited at least one of the Medicaid managed care plans in Tennessee. As compared with providers that remained in networks, those that exited performed 3.8 percentage points [95% CI, 2.3, 5.3] worse on quality as measured by a composite of the nine HEDIS quality metrics. However, 22% of exiting providers performed above average in quality and cost and only 29% of exiting providers had lower than average quality scores and higher than average costs. Overall, exiting providers had lower aggregate costs in terms of the annual unadjusted cost of care per-member-month - $21.57 [95% CI, - $41.02, - $2.13], though difference in annual risk-adjusted cost per-member-month was nonsignificant. Providers exiting Medicaid managed care plans appear to have lower quality scores in the year prior to their exit than the providers who remain in network. Our study did not show that managed care plans disproportionately drop high-cost providers.

Factores asociados a la calidad de la atención en población adulta afiliada a la Seguridad Social: El caso peruano

Objetivo: Identificar factores asociados a calidad percibida de atención en la población adulta afiliada al Seguro Social en Salud (EsSalud). Material y métodos: Analizamos la Encuesta Nacional Socioeconómica de Acceso a la Salud de los Asegurados de EsSalud. La calidad percibida fue evaluada en consultorio externo, hospitalización y emergencias. Reportamos razones de medias ajustadas (RMa) estimadas mediante regresión de Poisson múltiple. Resultados: Estar empleado (RMa=0,98; IC95% 0,96-0,99), no conocer los servicios que brinda EsSalud (RMa=0,97; IC95% 0,95-1,00), no recibir información sobre los derechos como usuarios (RMa=0,95; IC95% 0,93-0,98), valorar como bajo el nivel de accesibilidad al EESS (RMa=0,97; IC95% 0,95-0,99) y no sentirse cómodo en el EESS al que acude (RM=0,92; IC95% 0,91-0,94) fueron factores asociados a menor puntaje de calidad percibida en consultorio externo. En hospitalización, tener entre 40-59 años (RMa=0,93; IC95% 0,88-0,97), contar con un índice de riqueza bajo (RMa=0,92; IC95% 0,87-0,97), no haber recibido información sobre los derechos como usuarios (RMa=0,90; IC95% 0,84-0,95) y no sentirse cómodos en el EESS (RMa=0,92; IC95% 0,89-0,96) se asociaron a menor puntuación de calidad. En emergencia, no sentirse cómodo en el EESS (RMa=0,89; IC95% 0,93-1,00) fue el único factor asociado a una menor puntuación de calidad percibida. Conclusiones: Identificamos factores relativos a los usuarios y a la oferta de servicios independientemente asociados a calidad percibida de atención, los cuales pueden ser considerados por los tomadores de decisiones para la mejor gestión de EsSalud.

Preconceptional diet quality is associated with birth outcomes among low socioeconomic status minority women in a high-income country.

Studies of the association between maternal nutrition and birth outcomes have investigated differing nutrients, maternal socioeconomic conditions, and timing within the reproductive cycle; and have produced inconsistent results. We evaluated the association of preconceptional maternal dietary intake with birth outcomes among low socioeconomic status ethnic minority women in a high-income country. In this prospective cohort study, habitual preconceptional dietary intake was assessed among pregnant Bedouin Arab women in Israel (n = 384), using a short culturally specific, targeted food frequency questionnaire. Multiple nutrients (protein, lysine, calcium, iron, zinc, folate, omega-3 fatty acids) were evaluated simultaneously via a diet quality score derived from principal component analysis. Multivariable logistic regression was used to test associations between the diet quality score and a composite adverse birth outcomes variable, including preterm birth, low birth weight and small for gestational age. Sixty-nine women (18%) had adverse birth outcomes. Women with low preconceptional diet quality scores had low intakes of nutrient-rich plant foods, bioavailable micronutrients, and complete proteins. In multivariable analysis, a woman at the 10th percentile of the diet quality score had a 2.97 higher odds (95% CI 1.28-6.86) of an adverse birth outcome than a woman at the 90th percentile. Low diet quality during the preconceptional period was associated with adverse birth outcomes among low socioeconomic status minority women in a high-income country. The results have implications for the development of appropriate intervention strategies to prevent adverse birth outcomes, and the promotion of adequate nutrition throughout the child-bearing years.

Severe symptoms and very low quality-of-life among outpatients newly diagnosed with advanced cancer: data from a multicenter cohort study

PurposeThe aim of this study was to identify symptoms of severe intensity or very low scores for quality of life (QoL) domains in newly diagnosed outpatients with advanced cancer.MethodsThis multicenter cohort study from a state-wide palliative care network included adult outpatients with advanced cancer diagnosed within the preceding 8 weeks from four comprehensive cancer centers (DRKS00006162, registered on 19 May 2014). We used the Palliative Outcome Scale (POS), Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment of Cancer QoL Questionnaire-C30. For each questionnaire, cut-off scores defined symptoms and QoL domains that were considered “severe” or “very low.”ResultsOf 3155 patients screened, 481/592 (81.3%) were analyzed (mean age 62.4; women n = 245, 50.9%). We identified 324/481 (67.4%) patients experiencing at least one severe symptom or a very low QoL domain (median 2; range 0 to 16). Role functioning (n = 180, 37.4%), fatigue (n = 162, 33.7%), and social functioning (n = 126, 26.2%) were most commonly affected. QoL was very low in 89 patients (18.5%). Women experienced more anxiety symptoms, fatigue, and had lower POS scores. Patients often mentioned physical symptoms and fears of adverse events resulting from disease-modifying therapies (e.g., chemotherapy) as most relevant problems.ConclusionsAlready within the first 8 weeks after diagnosis, the majority of patients reported at least one severe symptom or a very low QoL domain. Gender differences were evident. The findings illustrate the value of early routine assessment of patient burden and the development of multi-professional and interdisciplinary palliative care.

Multilevel social factors and NICU quality of care in California

ObjectiveOur objective was to incorporate social and built environment factors into a compendium of multilevel factors among a cohort of very low birth weight infants to understand their contributions to inequities in NICU quality of care and support providers and NICUs in addressing these inequities via development of a health equity dashboard.Study designWe examined bivariate associations between NICU patient pool and NICU catchment area characteristics and NICU quality of care with data from a cohort of 15,901 infants from 119 NICUs in California, born 2008–2011.ResultNICUs with higher proportion of minority racial/ethnic patients and lower SES patients had lower quality scores. NICUs with catchment areas of lower SES, higher composition of minority residents, and more household crowding had lower quality scores.ConclusionMultilevel social factors impact quality of care in the NICU. Their incorporation into a health equity dashboard can inform providers of their patients’ potential resource needs.

Prevalence of Functional Gastrointestinal Disorders among School-aged Children and adolescents, A Multicenter Study

Abstract Background The term Functional Gastrointestinal Disorder ‘(FGID)’ defines several and variable combinations of recurrent or chronic gastrointestinal (GI) symptoms that do not have an identified underlying pathophysiology. Without an objective marker, the classification of FGIDs depends on symptoms. The aim of the Work: To measure the prevalence of FGIDs among a representative sample of school-aged children/adolescents aging 4-18 years, to determine the socio-demographic characteristics of children affected by FGID and to assess the effect of FGIDs on health-related quality of life concerning both the child and the parent/caregiver. Patients and Methods The present cross-sectional study included 1082 Egyptian children/adolescents with age varying between 4-18 yrs. They were randomly selected among those attending primary, preparatory and secondary schools at Cairo, El-Gharbya and El-Sharqia governorates in the period from September 2017 to September 2018. Each child was subjected to clinical history taking, assessment of socioeconomic standard of family, assessment for presence of FGIDs using an Arabic translation of “Rome 4 diagnostic Questionnaire for pediatric functional GI disorders” and using Arabic translation of HRQOL score which included social and school functioning to study the effect of FGIDs on quality of life of children and parents. Results Mean age for screened children was 8.05 ± 3.03 years. 574 (53.1%) were males. The prevalence of FGIDs among studied children was 30.4%. Irritable bowel syndrome (IBS) was the most common type of FGIDs (11.6%), followed by functional constipation (8.4%), then functional dyspepsia (4.6%). Late order of birth and more members in the family, lower income per capita were all significantly related to positive FGID diagnosis. Children with FGID had lower scores for health-related quality of life (HRQOL). Conclusion FGIDs are common in school-aged Egyptian children/adolescents; IBS is the most common. Risk factors associated with having FGID include increased family members and decreased income per capita. FGIDs adversely affect the HRQOL of patients.

Clinically relevant factors associated with quantitative optical coherence tomography angiography metrics in deep capillary plexus in patients with diabetes

BackgroundTo test clinically relevant factors associated with quantitative artifact-free deep capillary plexus (DCP) metrics in patients with diabetes mellitus (DM).Methods563 eligible eyes (221 with no diabetic retinopathy [DR], 135 with mild DR, 130 with moderate DR, and 77 with severe DR) from 334 subjects underwent optical coherence tomography-angiography (OCT-A) with a swept-source OCT (Triton DRI-OCT, Topcon, Inc., Tokyo, Japan). Strict criteria were applied to exclude from analysis those DCP images with artifacts and of poor quality, including projection artifacts, motion artifacts, blurriness, signal loss, B-scan segmentation error, or low-quality score. A customized MATLAB program was then used to quantify DCP morphology from the artifact-free DCP images by calculating three metrics: foveal avascular zone (FAZ), vessel density (VD), and fractal dimension (FD).Results166 (29.5%) eyes were excluded after quality control, leaving in the analysis 397 eyes (170 with no DR, 101 with mild DR, 90 with moderate DR, 36 with severe DR) from 250 subjects. In the multiple regression models, larger FAZ area was associated with more severe DR (β = 0.687; p = 0.037), shorter axial length (AL) (β = − 0.171; p = 0.003), thinner subfoveal choroid thickness (β = − 0.122; p = 0.031), and lower body mass index (BMI) (β = − 0.090; p = 0.047). Lower VD was associated with more severe DR (β = − 0.842; p = 0.001), shorter AL (β = 0.107; p = 0.039), and poorer visual acuity (VA) (β = − 0.133; p = 0.021). Lower FD was associated with more severe DR (β = − 0.891; p < 0.001) and with older age (β = − 0.142; p = 0.004).ConclusionsQuantitative artifact-free DCP metrics are associated with VA, DR severity, AL, subfoveal choroidal thickness, age, and BMI in diabetic patients. The effects of ocular and systemic factors should be considered for meaningful interpretations of DCP changes in DM patients.

Psychosocial and physical long-term outcome in patients with a history of takotsubo cardiomyopathy or myocardial infarction - a multi-centered case control study

ABSTRACT Physical long-term impacts of Takotsubo Cardiomyopathy (TTC) remain controversial and an underestimation of their severity becomes increasingly evident. Even less is known about mental long-term impacts of TTC. This study aims at a better understanding of the physical and mental long-term effects of TTC in comparison to myocardial infarctions (MI). On average 5 years after disease onset, 68 TTC patients and 68 age- and sex-matched MI patients were assessed for disease-related quality of life, depression, anxiety, chronic stress, social support, resilience, and life events prior to disease onset. Scores of TTC and MI patients were compared to each other and to normative references values. Regression analyses were used to evaluate the predictive value of the number of life events prior to disease onset for physical and mental long-term outcomes. Both groups displayed higher scores in depression and anxiety, higher levels of chronic stress, and lower scores in physical and mental quality of life in comparison to norm samples, while social support did not differ from norms. No differences between the two patient groups were observed. Within both groups, the majority of patients (TTC: 69.1%; MI: 60.3%) reported stressful life events prior to disease onset. In TTCs and MIs, the number of events had a significant impact on long-term mental health and chronic stress. Notably, both patient collectives scored higher in resilience than healthy controls. Results suggest negative long-term impacts of TTC on mental and physical wellbeing, comparable to those of MI. Besides a good somatic-medical care, psychotherapeutic support, including the development of functional coping strategies, might be warranted for TTC patients. The long-term impact of TTC should be taken as serious as that of MI.

The evaluation of anxiety, depression and quality of life scores of children and adolescents with familial Mediterranean fever.

This study aimed to evaluate the anxiety, depression and quality of life scores of children and adolescents diagnosed with familial Mediterranean fever (FMF) and compare these scores with the ones of healthy controls. The study group comprised of 130 children and adolescents diagnosed with FMF with a mean age of 12.6 ± 2.58 and control group comprised of 121 healthy controls with a mean age of 11.8 ± 2.84. Both groups were evaluated with child depression inventory (CDI), screen for child anxiety related emotional disorders (SCARED), pediatric quality of life inventory TM 4.0 (PedsQL™ 4.0) questionnaires. The severity of FMF was assessed by Pras scoring system as mild, moderate and severe disease. The comparisons of these three subgroups of FMF were made in terms of anxiety, depression and quality of life. Children and adolescents with FMF had significantly higher median scores of anxiety than healthy controls. The median scores of depression and quality of life were similar between both groups. Patients with a depression score of 19 or above had significantly higher scores of anxiety and longer duration of disease than the patients with a depression score below 19. While the patients with a severe course of FMF had higher median scores of depression and anxiety, they had significantly lower median scores of quality of life. According to our evaluation, patients with FMF had higher anxiety scores and as the disease become severe, not only anxiety scores but also features of depression become overt. An early apprehension of the mood changes of these patients may have a positive influence in the management of FMF. So, a close collaboration between child and adolescent psychiatrist and pediatric rheumatologist is essential for all over well-being of children and adolescents with FMF.

Quality of life in people with ongoing symptoms of coeliac disease despite adherence to a strict gluten-free diet

People with Coeliac disease who suffer persistent symptoms despite adherence to a gluten-free diet are at a greater risk of a reduced health related quality of life. The purpose of this paper is to report the quality of life experienced by this specific group of patients in Australia. A Coeliac Disease Specific Questionnaire (CDQ) was administered to 45 people who were enrolled in a clinical trial and reported persistent symptoms of Coeliac disease despite adherence to a strict gluten free diet. The clinical trial was based in New South Wales, Australia. The instrument used was a subscale and total scores of a CDQ measuring health related quality of life. At baseline the overall mean CDQ score was 147 ± 3.31 (optimum 196) consisting of 4 subscales; gastrointestinal 33 ± 0.88, emotional 32.9 ± 0.99, worries 39.8 ± 0.79 and social 41 ± 6.12 each with a potential score of 49. The health related quality of life of people reporting persistent symptoms of Coeliac disease despite adherence to a gluten free diet is sub-optimal with concerningly low scores for emotional quality.

What factors affect patients\u2019 access to healthcare? Protocol for an overview of systematic reviews

BackgroundThe importance of access to healthcare for all is internationally recognised as a global goal, high on the global agenda. Yet inequalities in health exist within and between countries which are exacerbated by inequalities in access to healthcare. In order to address these inequalities, we need to better understand what drives them. While there exists a wealth of research on access to healthcare in different countries and contexts, and for different patient groups, to date no attempt has been made to bring this evidence together through a global lens. This study aims to address that gap by bringing together evidence of what factors affect patients’ access to healthcare and exploring how those factors vary in different countries and contexts around the world.MethodsAn overview of reviews will be conducted using a comprehensive search strategy to search four databases: Medline, Embase, Global Health and Cochrane Systematic Reviews. Additional searches will be conducted on the Gates Foundation, the World Health Organisation (WHO) and World Bank websites. Titles and abstracts will be screened against the eligibility criteria and full-text articles will be obtained for all records that meet the inclusion criteria or where there is uncertainty around eligibility. A data extraction table will be developed during the review process and will be piloted and refined before full data extraction commences. Methodological quality/risk of bias will be assessed for each included study using the AMSTAR 2 tool. The quality assessment will be used to inform the narrative synthesis, but a low-quality score will not necessarily lead to study exclusion.DiscussionFactors affecting patients’ ability to access healthcare will be identified and analysed according to different country and context characteristics to shed light on the importance of different factors in different settings. Results will be interpreted accounting for the usual challenges associated with conducting such reviews. The results may guide future research in this area and contribute to priority setting for development initiatives aimed at ensuring equitable access to healthcare for all.Systematic review registrationPROSPERO CRD42019144775

Noncontrast Magnetic Resonance Angiography Clinical Application in Pre-Liver Transplant Recipients With Impaired Renal Function.

Image evaluation of the vascular architecture is essential before living donor liver transplantation (LDLT). However, the use of contrast-enhanced study in recipients with impaired renal function is limited due to the risk of acute kidney injury and nephrogenic systemic fibrosis. Therefore, a contrast medium-free method is both valuable and necessary for preoperative vascular evaluation. Recent literature reported inflow-sensitive inversion recovery (IFIR) magnetic resonance angiography (MRA) without the use of a contrast medium to be a reproducible and noninvasive tool to assess hepatic vasculature with adequate-to-good image quality. The purpose of this study is to clinically apply IFIR MRA preoperatively in LDLT recipients. We retrospectively reviewed 31 LDLT recipients with renal function impairment from March 2013 to August 2018 who received IFIR MRA as a pretransplant vascular architecture evaluation and who underwent a subsequent LDLT. The image findings were assessed for subjective image quality and were compared with intraoperative findings. Our results showed that the pretransplant vascular anatomy was well correlated with intraoperative findings in all recipients. Successful ratings with image quality scores ≥2 for proper hepatic arteries (PHAs), portal veins, and inferior vena cavas (IVCs) were 100.0%, 96.8%, and 93.5%, respectively. Readable ratings with imaging quality score ≥1 for left and right hepatic arteries and gastroepiploic arteries were 83.9%, 96.7%, and 22.6%, respectively. We also found that recipients with higher Model for End-Stage Liver Disease scores (>23) had lower image quality scores for PHAs (P=0.003) and IVCs (P= 0.046). However, images were still satisfactory for pre-liver transplantation (LT) vascular evaluation. In conclusion, in pre-LT recipients with impaired renal function, IFIR MRA is a feasible and reproducible image modality.

Relationship between quality of life, self-esteem and depression in people after kidney transplantation

to assess the relationship between health-related quality of life with depression and self-esteem of people after kidney transplantation. a cross-sectional study of 47 outpatients from October 2016 to February 2017. The following tools were applied: The Medical Outcomes Study 36-Item Short-Form Health Survey, Beck Depression Inventory and Rosenberg Self-Esteem Scale. Descriptive statistics and Spearman correlation were used. women had lower scores for health-related quality of life. Young adults, people with up to one and a half years of transplantation and those who had dialysis for more than one year had higher scores. the health-related quality of life of people with chronic kidney disease after transplantation ranged from good to excellent. The presence of depression was not identified. The relationship of data indicates that the higher the quality of life, the better the self-esteem assessment.

A content analysis of the quality and behaviour change techniques of smartphone apps promoting the Mediterranean diet

AbstractThe popularity of smartphone apps is rising globally. However, the quality of widely available health apps and their effectiveness to promote behaviour change, by incorporating behavioural change techniques (BCTs) that have been suggested to result in behaviour change, is questionable. The aim of this study was to conduct a content analysis of smartphone apps that utilise the Mediterranean diet (MD), a dietary pattern linked to numerous health benefits, to promote healthy dietary behaviours. The specific objectives were to evaluate the quality of these apps and their use of BCTs. The iTunes Store and Google Play were searched for all available apps (free and requiring payment to download) promoting the MD. Apps were excluded if they were not available in English, did not focus only on the MD or the download process was corrupt. The Mobile App Rating Scale (MARS) was used to assess app engagement, functionality, aesthetics and information quality (the average of which represents a quality mean score (QMS)) and subjective quality. The Abraham &amp; Michie behaviour change taxonomy was adapted to create a 20-item checklist to assess the presence of BCTs in the eligible apps. Thirty nine apps (64.1% of which were free to download) were analysed. The overall QMS was 2.96 ± 0.46. The lowest and highest scored QMS constructs were engagement (2.42 ± 0.62) and functionality (3.95 ± 0.45), respectively, whilst the overall mean subjective quality score was 1.71 ± 0.51 (scores’ range 1–5). Apps were scored higher for aesthetics if they required payment (3.14 vs. 2.78, p = 0.047). Apps incorporated an average of 3.10 ± 1.87 BCTs, with no difference in the number of BCTs present according to platform or cost. From the five BCTs that have been suggested to promote behaviour change, ‘self-monitoring’ was present in six apps, ‘intention formation’ in 15 and ‘goal setting’ in one. None of the apps incorporated the ‘review of behavioural goals’ and ‘feedback on performance’ BCTs. The total QMS score was positively associated with the presence of BCTs (r = 0.409, p = 0.008). Based on the MARS assessment, apps promoting the MD that are available in the public domain were of moderate quality. In contrast, the low presence, particularly of efficacious, BCTs and low subjective quality scores suggest that apps are actually of poor quality and potentially not effective in promoting behaviour change towards an MD diet. These findings provide important insights for the future development of high-quality apps to promote the MD at population level.

Microbiome data analysis with applications to pre-clinical studies using QIIME2: Statistical considerations

Diversity analysis and taxonomic profiles can be generated from marker-gene sequence data with the help of many available computational tools. The Quantitative Insights into Microbial Ecology Version 2 (QIIME2) has been widely used for 16S rRNA data analysis. While many articles have demonstrated the use of QIIME2 with suitable datasets, the application to pre-clinical data has rarely been talked about. The issues involved in the pre-clinical data include the low-quality score and small sample size that should be addressed properly during analysis. In addition, there are few articles that discuss the detailed statistical methods behind those alpha and beta diversity significance tests that researchers are eager to find. Running the program without knowing the logic behind it is extremely risky. In this article, we first provide a guideline for analyzing 16S rRNA data using QIIME2. Then we will talk about issues in pre-clinical data, and how they could impact the outcome. Finally, we provide brief explanations of statistical methods such as group significance tests and sample size calculation.

The state of mental digi-therapeutics: A systematic assessment of depression and anxiety apps available for Arabic speakers

BackgroundMental disorders are a major public health problem leading to premature mortality, homelessness, addiction problems, poor physical health, and suicide. The prevalence of mental disorders in Arab countries, is high. The proliferation and ubiquity of smartphones and their apps in the Arab world may be the long-awaited for digital therapeutic for mental health disorders. However, the evidence about the availability and characteristics of mental health apps available to Arabic speakers remains poor. ObjectiveTo conduct a systematic assessment of the features of depression and anxiety mobile apps available for Arabic speakers. MethodsA critical review of all the currently available depression and anxiety apps, available free of charge to Arabic speakers. The apps are evaluated using the Mobile App Rating Scale (MARS). Further, a categorization of apps’ main functions, inspired by the mhGAP guidelines, is developed to classify the apps based on their main functions. ResultsA total of 23 apps are identified with far more apps available on the Google Play Store (n = 21) versus only two apps on the iOS App Store. The majority of the apps (n = 16) provide general information about either anxiety, depression, or both. Six apps are of spiritual nature mainly referring to the Islamic faith and the Holy Quran, with one app referring to the Christian faith. Another five apps provide advice on alternative treatments, mainly concerning herbal medicine recipes. Only two apps provided utilities for users, specifically about medication reminders. ConclusionsMental health digi-threaputics have huge potentials to transform mental health care delivery. However, more empirical studies are needed to assure their quality and efficacy. The results of this study clearly highlight the current gaps to address the needs of Arabic speakers; only 23 apps were identified in this study, mostly with low app quality scores. There is a need to involve expert healthcare professionals in the development of mental health apps and for healthcare providers to empower patients through discussing apps that are useful and discern them from those that can potentially cause harm.

PSX-30 Influence of cut, breed type and supplementation on consumer ratings of pasture-raised lamb

Abstract Consumer ratings and influence of cut, breed type and feed supplementation on sensory attributes of lamb meat were investigated. Lamb cuts (leg, loin, rib and foreshank) were obtained from purebred hair sheep (PB; n = 18; Barbados Blackbelly or St. Croix) and crossbred wool × hair sheep ram lambs (CB; n = 17; Dorset × Barbados Blackbelly or Dorset × St. Croix) rotationally grazed for 77 d in late spring on tall fescue only (PS) or supplemented with soy hull (SH) or corn gluten (CG) at 2.0% of BW (DM basis) at individual feeding stations. Lambs were harvested at 10 mo of age. Customers (n = 170) of a local food hub randomly received two different cuts of lamb and were asked to complete a survey rating each cut for qualitative characteristics (1=extremely undesirable to 9=extremely desirable) before and after cooking. Customer demographics and diet habits were also recorded. Responses were analyzed using PROC NPAR1WAY and GLM procedures of SAS; survey response rate was 66% (113/170). Cut of lamb did not influence attributes. Breed type affected pre-cooking aroma (CB &amp;gt; PB; P &amp;lt; 0.05); tended to affect pre-cooking quality (CB &amp;gt; PB; P = 0.07); and affected after-cooking texture (PB &amp;gt; CB; P &amp;lt; 0.01). Diet affected (P &amp;lt; 0.05) pre-cooking texture (SH &amp;gt; CG &amp;gt; PS; P &amp;lt; 0.02) and tended to influence after cooking juiciness (PS &amp;lt; SH = CG; P = 0.09). Before-cooking attributes were influenced by a breed x diet interaction (P &amp;lt; 0.05) with CB x PS and PB x CG consistently receiving lower scores for color, texture, appearance, quality and ease of preparation. After-cooking aroma was lower (P &amp;lt; 0.05) for CB x SH and PB x PS compared to PB x CG lambs only. Results indicate that breed type and supplementation, but not type of cut, selectively influenced consumer sensory ratings of pasture raised hair sheep lamb.