Multinational Studies Research Articles

Karel Maršál 1943-2023.

It is with sadness that we received the message that Karel Maršál passed away on March 6, 2023. Karel Maršál, MD, PhD, Professor Emeritus at Lund University and Director of the WHO Collaborating Center in Lund, was born in Prague, former Czechoslovakia, in 1943. After completing his undergraduate studies at Charles University in Prague, he and his fiancée Lida moved as political refugees to Sweden in 1968. They came to Malmö General Hospital in 1973, where Karel gained his specialty in obstetrics and gynecology. Already then, Malmö was a nursery for research on fetal physiology and monitoring, and Karel was soon involved. He defended his PhD thesis, “Ultrasonic Measurements of Fetal Breathing Movements in Man”, at Lund University in 1977. With the introduction of Doppler ultrasonography to measure blood flow velocity, an era of prolific research commenced, leading to a growing international collaboration under Karel's leadership. In a series of PhD theses, normal fetal circulation was mapped to form the basis for the clinical assessment of the compromised fetus, and for studying the effects of medications and smoking during pregnancy. Experimental work on fetal lambs added further insights into circulatory pathophysiology. The introduction of routine ultrasound in Malmö in 1972 paved the way for identifying and studying fetal growth restriction and its underlying circulatory changes, today a major clinical field. Karel was the Head of the Perinatal Division at the University Hospital in Malmö and his personality as an enthusiastic, persevering, and meticulous scientist earned him a professorship in Malmö in 1991. In 1997, Karel moved to Lund to become Professor in Obstetrics and Gynecology, and later head of the clinical department. In 1995, he became Honorary Professor at Charles University in Prague, Czech Republic. He also served as Director of the undergraduate program of the Medical School at Lund University and as Chief Medical Officer in the county of Skåne, Sweden. Karel was the main tutor of 21 PhD students and co-tutor of another 14 research students. He published 354 original papers, 132 book chapters and reviews, and 14 textbooks. He was editor or co-editor of the Journal of Maternal and Fetal Investigation, of Fetal and Maternal Medicine Review, and of Seminars in Fetal and Neonatal Medicine, and was a member of the editorial board of 10 international scientific journals. His primary areas of experience and research were in perinatology, obstetrics, fetal monitoring, obstetric and gynecologic ultrasound, Doppler ultrasound, fetal physiology, ultrasound safety, and obstetric quality assurance. Throughout the years, Karel's research was supported by numerous grants, among them from the prestigious Swedish Research Council. He was the principal investigator in numerous national and international multicenter studies, such as the EXPRESS study on extremely preterm infants in Sweden, and he was national coordinator for Sweden in three EU studies. Karel served as president of the International Society of Ultrasound in Obstetrics and Gynecology, he was an honorary member of various national and international institutions and a board member of European Federation of Societies for Ultrasound in Medicine and Biology, World Federation for Ultrasound in Medicine and Biology, and other societies. In the past, he was the main organizer of 15 international scientific congresses, including two world congresses on ultrasound in obstetrics and gynecology. He received several prestigious awards, such as the Ian Donald Gold Medal and the Haackert Gold Medal in Prenatal Medicine. Karel was elected Doctor Honoris Causae at universities in Olomouc, Czech Republic, and Poznan, Poland. He was course leader of 38 national and international postgraduate courses in perinatal medicine, obstetrics, ultrasound, and obstetric Doppler ultrasound. His last participation in such an event was in February 2023. Karel's wife, Lida, gave him unending support throughout his career. Had Karel not injured his leg in a skiing accident, their paths may never have crossed. He had to take a break from medical school, and when he returned to his studies, he and Lida became classmates. Innumerable mothers and children all over the globe have benefited from Karel's ground-breaking scientific work, leadership, and deeds. His 50-year career as a clinician, scientist, teacher, coach, role model, and—most of all—the best friend of the unborn baby is now at an end. Among his friends and co-workers, he will be vividly remembered as a quietly jovial, sharp-witted gentleman with a human perspective and a friendly attitude toward each of us. He is sorely missed.

Erratum for Karlowsky et al., "In Vitro Susceptibility of Gram-Negative Pathogens to Cefiderocol in Five Consecutive Annual Multinational SIDERO-WT Surveillance Studies, 2014 to 2019".

Erratum for Karlowsky et al., "In Vitro Susceptibility of Gram-Negative Pathogens to Cefiderocol in Five Consecutive Annual Multinational SIDERO-WT Surveillance Studies, 2014 to 2019".

Incidence of syndromes associated with Frontotemporal Lobar Degeneration (S19.004)

Incidence of syndromes associated with Frontotemporal Lobar Degeneration (S19.004)

Updated normative data for the EORTC QLQ-C30 in the general Dutch population by age and sex: a cross-sectional panel research study

PurposeThe European Organisation for Research and Treatment of Cancer (EORTC) quality of life core questionnaire (QLQ-C30) is a validated and widely-used Patient-Reported Outcome Measure for measuring the health-related quality of life (HRQoL) of cancer patients. To facilitate interpretation of results obtained in studies using the EORTC QLQ-C30, we generated normative data for the Dutch general population, stratified by age and sex.MethodsDutch participants were selected from a larger cross-sectional online panel research study collecting EORTC QLQ-C30 general population normative data across 15 countries. EORTC QLQ-C30 raw scores based on a 4-point response scale were transformed to linear scores ranging from 0 to 100. Transformed scores were weighted based on the United Nations population distribution statistics and presented by age and sex/age. Differences in scale scores of ≥ 10 points in HRQoL were applied to indicate clinical relevance.ResultsOne thousand respondents completed the online survey. Stratified by age, clinically meaningful differences were observed, with worse physical functioning scores and better emotional functioning scores with increased age. Symptom scores remained stable across age groups, except for small age differences observed for fatigue, nausea/vomiting, diarrhoea, and financial difficulties. Stratified by sex/age, men generally scored better for both functioning and symptoms. However, these differences were not clinically meaningful.ConclusionsThese updated normative EORTC QLQ-C30 for the Dutch general population can be used to better interpret HRQoL data obtained from Dutch cancer patients. Being part of a larger international study, these data can further be used for inter-country comparisons in multi-national studies.

Investigating the Psychosocial Impact of COVID-19 Among the Sexual and Gender Minority Population: A Systematic Review and Meta-Analysis.

Purpose: The purpose of this study was to utilize a systematic review and meta-analysis to assess the existing body of literature to understand the mental health impacts of the coronavirus disease-19 (COVID-19) pandemic among sexual and gender minority (SGM) people. Methods: The search strategy was developed by an experienced librarian and used five bibliographical databases, specifically PubMed, Embase, APA PsycINFO (EBSCO), Web of Science, and LGBTQ+ Source (EBSCO), for studies (published 2020 to June, 2021) examining the psychological impact of the COVID-19 pandemic among SGM people. Articles were screened by two reviewers. The quality of the articles was assessed using the National Institutes of Health quality assessment tool for observational studies. A double extraction method was used for data abstraction. Heterogeneity among studies was assessed by I2 statistic. The random-effects model was utilized to obtain the pooled prevalence. Publication bias was assessed by Funnel plot and Egger's linear regression test. Results: Of a total of 37 studies, 15 studies were included in the meta-analysis with 17,973 SGM participants. Sixteen studies were U.S. based, seven studies were multinational studies, and the remaining studies were from Portugal, Brazil, Chile, Taiwan, the United Kingdom, France, Italy, Canada, and several other countries. A majority of studies used psychometric valid tools for the cross-sectional surveys. The pooled prevalence of anxiety, depression, psychological distress, and suicidal ideation was 58.6%, 57.6%, 52.7%, and 28.8%, respectively. Conclusions: Findings of this study serve as evidence to develop appropriate interventions to promote psychological wellbeing among vulnerable population subgroups, such as SGM individuals.

Development and Validation of a Prediction Model for Future Estimated Glomerular Filtration Rate in People With Type 2 Diabetes and Chronic Kidney Disease

Type 2 diabetes increases the risk of progressive diabetic kidney disease, but reliable prediction tools that can be used in clinical practice and aid in patients' understanding of disease progression are currently lacking. To develop and externally validate a model to predict future trajectories in estimated glomerular filtration rate (eGFR) in adults with type 2 diabetes and chronic kidney disease using data from 3 European multinational cohorts. This prognostic study used baseline and follow-up information collected between February 2010 and December 2019 from 3 prospective multinational cohort studies: PROVALID (Prospective Cohort Study in Patients with Type 2 Diabetes Mellitus for Validation of Biomarkers), GCKD (German Chronic Kidney Disease), and DIACORE (Diabetes Cohorte). A total of 4637 adult participants (aged 18-75 years) with type 2 diabetes and mildly to moderately impaired kidney function (baseline eGFR of ≥30 mL/min/1.73 m2) were included. Data were analyzed between June 30, 2021, and January 31, 2023. Thirteen variables readily available from routine clinical care visits (age, sex, body mass index; smoking status; hemoglobin A1c [mmol/mol and percentage]; hemoglobin, and serum cholesterol levels; mean arterial pressure, urinary albumin-creatinine ratio, and intake of glucose-lowering, blood-pressure lowering, or lipid-lowering medication) were selected as predictors. Repeated eGFR measurements at baseline and follow-up visits were used as the outcome. A linear mixed-effects model for repeated eGFR measurements at study entry up to the last recorded follow-up visit (up to 5 years after baseline) was fit and externally validated. Among 4637 adults with type 2 diabetes and chronic kidney disease (mean [SD] age at baseline, 63.5 [9.1] years; 2680 men [57.8%]; all of White race), 3323 participants from the PROVALID and GCKD studies (mean [SD] age at baseline, 63.2 [9.3] years; 1864 men [56.1%]) were included in the model development cohort, and 1314 participants from the DIACORE study (mean [SD] age at baseline, 64.5 [8.3] years; 816 men [62.1%]) were included in the external validation cohort, with a mean (SD) follow-up of 5.0 (0.6) years. Updating the random coefficient estimates with baseline eGFR values yielded improved predictive performance, which was particularly evident in the visual inspection of the calibration curve (calibration slope at 5 years: 1.09; 95% CI, 1.04-1.15). The prediction model had good discrimination in the validation cohort, with the lowest C statistic at 5 years after baseline (0.79; 95% CI, 0.77-0.80). The model also had predictive accuracy, with an R2 ranging from 0.70 (95% CI, 0.63-0.76) at year 1 to 0.58 (95% CI, 0.53-0.63) at year 5. In this prognostic study, a reliable prediction model was developed and externally validated; the robust model was well calibrated and capable of predicting kidney function decline up to 5 years after baseline. The results and prediction model are publicly available in an accompanying web-based application, which may open the way for improved prediction of individual eGFR trajectories and disease progression.

Epidemiological characteristics of respiratory viruses in hospitalized children during the COVID-19 pandemic in southwestern China.

Multinational studies have reported that the implementation of nonpharmaceutical interventions (NPIs) to control severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission coincided with the decline of other respiratory viruses, such as influenza viruses and respiratory syncytial virus. To investigate the prevalence of common respiratory viruses during the coronavirus disease 2019 (COVID-19) pandemic. Respiratory specimens of children with lower respiratory tract infections (LRTIs) hospitalized at the Children's Hospital of Chongqing Medical University from January 1, 2018 to December 31, 2021 were collected. Seven common pathogens, including respiratory syncytial virus (RSV), adenovirus (ADV), influenza virus A and B (Flu A, Flu B), and parainfluenza virus types 1-3 (PIV1-3), were detected by a multiplex direct immunofluorescence assay (DFA). Demographic data and laboratory test results were analyzed. 1) A total of 31,113 children with LRTIs were enrolled, including 8141 in 2018, 8681 in 2019, 6252 in 2020, and 8059 in 2021.The overall detection rates decreased in 2020 and 2021 (P < 0.001). The detection rates of RSV, ADV, Flu A, PIV-1, and PIV-3 decreased when NPIs were active from February to August 2020, with Flu A decreasing most predominantly, from 2.7% to 0.3% (P < 0.05). The detection rates of RSV and PIV-1 resurged and even surpassed the historical level of 2018-2019, while Flu A continued decreasing when NPIs were lifted (P < 0.05). 2) Seasonal patterns of Flu A completely disappeared in 2020 and 2021. The Flu B epidemic was observed until October 2021 after a long period of low detection in 2020. RSV decreased sharply after January 2020 and stayed in a nearly dormant state during the next seven months. Nevertheless, the detection rates of RSV were abnormally higher than 10% in the summer of 2021. PIV-3 decreased significantly after the COVID-19 pandemic; however, it atypically surged from August to November 2020. The NPIs implemented during the COVID-19 pandemic affected the prevalence and seasonal patterns of certain viruses such as RSV, PIV-3, and influenza viruses. We recommend continuous surveillance of the epidemiological and evolutionary dynamics of multiple respiratory pathogens, especially when NPIs are no longer necessary.

Surviving Sepsis Campaign.

Surviving Sepsis Campaign.

Global mean potassium intake: a systematic review and Bayesian meta-analysis

PurposeIncreasing potassium intake, especially in populations with low potassium intake and high sodium intake, has emerged as an important population-level intervention to reduce cardiovascular events. Current guideline recommendations, such as those made by the World Health Organisation, recommend a potassium intake of > 3.5 g/day. We sought to determine summary estimates for mean potassium intake and sodium/potassium (Na/K) ratio in different regions of the world.MethodsWe performed a systematic review and meta-analysis. We identified 104 studies, that included 98 nationally representative surveys and 6 multi-national studies. To account for missingness and incomparability of data, a Bayesian hierarchical imputation model was applied to estimating summary estimates of mean dietary potassium intake (primary outcome) and sodium/potassium ratio.ResultsOverall, 104 studies from 52 countries were included (n = 1,640,664). Mean global potassium intake was 2.25 g/day (57 mmol/day) (95% credible interval (CI) 2.05–2.44 g/day), with highest intakes in Eastern and Western Europe (mean intake 3.53g/day, 95% CI 3.05–4.01 g/day and 3.29 g/day, 95% CI 3.13–3.47 g/day, respectively) and lowest intakes in East Asia (mean intake 1.89 g/day; 95% CI 1.55–2.25 g/day). Approximately 31% (95% CI, 30–41%) of global population included have an estimated potassium intake > 2.5 g/day, with 14% (95% CI 11–17%) above 3.5 g/day.ConclusionGlobal mean potassium intake (2.25 g/day) falls below current guideline recommended intake level of > 3.5 g/day, with only 14% (95% CI 11–17%) of the global population achieving guideline-target mean intake. There was considerable regional variation, with lowest mean potassium intake reported in Asia, and highest intake in Eastern and Western Europe.

Italian cross-cultural adaptation of the patient-reported outcome measure of ataxia.

The patient-reported outcome measure of ataxia (PROM-Ataxia) is the first patient-reported questionnaire specifically developed for use in patients with cerebellar ataxia. The scale was recently designed and validated in English language, and it consists of 70 items encompassing all aspects associated with the patient experience, including physical and mental health and their consequences on activities of daily living. The aim of the study was to translate and culturally adapt into Italian the PROM-Ataxia questionnaire, before assessing its psychometric properties. We translated and culturally adapted into Italian the PROM-Ataxia following the ISPOR TCA Task Force guidelines. The questionnaire was field tested via cognitive interviews with users. The Italian patients found that the questionnaire was complete, and no significant contents related to the physical, mental, and functional dimensions were missing. Some items were found redundant or ambiguous. Most of the identified issues pertained to semantic equivalence, and a few to conceptual and normative equivalence, while the questionnaire did not contain any idiomatic expression. The translation and cultural adaptation of the PROM-Ataxia questionnaire in the Italian patient population represent the pre-requisite for the subsequent psychometric validation of the scale. This instrument may be valuable for cross-country comparability that would allow the merging of the data in collaborative multinational research studies.

Serial Urinary C-C Motif Chemokine Ligand 14 and Risk of Persistent Severe Acute Kidney Injury

Retrospective observational study. Data derived from two multinational ICU studies (Ruby and Sapphire). Critically ill patients with early stage 2-3 AKI. None. We analyzed three consecutive uCCL14 measurements at 12-hour intervals after diagnosis of stage 2-3 AKI by Kidney Disease Improving Global Outcomes criteria. Primary outcome was persistent severe AKI, defined as 72 consecutive hours of stage 3 AKI, death, or receipt of dialysis prior to 72 hours. uCCL14 was measured using the NEPHROCLEAR uCCL14 Test on the Astute 140 Meter (Astute Medical, San Diego, CA). Based on predefined, validated cutoffs, we categorized uCCL14 as: low (≤ 1.3 ng/mL), medium (> 1.3 to ≤ 13 ng/mL), or high (> 13 ng/mL). Seventy-five of 417 patients with three consecutive uCCL14 measurements developed persistent severe AKI. Initial uCCL14 category strongly correlated with primary endpoint and, in most cases (66%), uCCL14 category was unchanged over the first 24 hours. Compared with no change and accounting for baseline category, decrease in category was associated with decreased odds of persistent severe AKI (odds ratio [OR], 0.20; 95% CI, 0.08-0.45; p < 0.001) and an increase in category with increased odds (OR, 4.04; 95% CI, 1.75-9.46; p = 0.001). In one-third of patients with moderate to severe AKI uCCL14 risk category altered over three serial measurements and such changes were associated with altered risk for persistent severe AKI. Serial CCL-14 measurement may detect progression or resolution of underlying kidney pathology and help refine AKI prognosis.

Differences in Quality of Life between German and Dutch Patients with Prostate Cancer Treated with Robot-assisted Radical Prostatectomy: Implications for International Multicenter Randomized Controlled Trials

BackgroundAs a local treatment for prostate cancer (PCa), robot-assisted radical prostatectomy (RARP) may have a quality of life (QoL) benefit over open surgery. Recent analyses revealed substantial between-country differences in the function and symptom scale scores for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), which is typically used to assess patient-reported QoL. Such differences could have implications for multinational studies in PCa. ObjectiveTo examine whether nationality is significantly associated with patient-reported QoL. Design, setting, and participantsThe study cohort comprised Dutch and German patients with PCa treated with RARP in a single high-volume prostate center from 2006 to 2018. Analyses were restricted to patients who were preoperatively continent with at least one follow-up time point. Outcome measurements and statistical analysisQoL was measured in terms of the global Quality of Life (QL) scale score and the overall summary score for the EORTC QLQ-C30. Linear mixed models for repeated-measures multivariable analyses (MVAs) were used to examine the association between nationality and both the global QL score and the summary score. MVAs were further adjusted for QLQ-C30 baseline values, age, Charlson comorbidity index, preoperative prostate-specific antigen, surgical expertise, pathological tumor and nodal stage, Gleason grade, degree of nerve-sparing, surgical margin status, 30-d Clavien-Dindo grade complications, urinary continence recovery, and biochemical recurrence/postoperative radiotherapy. Results and limitationsFor Dutch (n = 1938) versus German (n = 6410) men, the mean baseline scores were 82.8 versus 71.9 for the global QL scale score and 93.4 versus 89.7 for the QLQ-C30 summary score. Urinary continence recovery (QL: +8.9, 95% confidence interval [CI] 8.1–9.8; p < 0001) and Dutch nationality (QL: +6.9, 95% CI 6.1–7.6; p < 0001) were the strongest positive contributors to the global QL and summary scores, respectively. The main limitation is the retrospective study design. In addition, our Dutch cohort may not be representative of the general Dutch population and reporting bias cannot be ruled out. ConclusionsOur findings provide observational evidence under specific conditions involving the same setting for patients of two different nationalities suggesting that cross-national patient-reported QoL differences appear to be real and may need to be taken into consideration in multinational studies. Patient summaryWe observed differences in the quality-of-life scores reported by Dutch and German patients with prostate cancer after they underwent robot-assisted removal of the prostate. These findings should be taken into consideration in cross-national studies.

Analysis of international research trends in online music education

본 연구는 온라인 음악교육의 기초 연구로서 해외 온라인 관련 음악교육의 연구 동향 고찰을 목적으로 한다. 국제 전문 학술지에 수록된 온라인 음악교육 관련 연구 75편을 연도와 국가, 연구 주제 및 대상, 연구 방법의 범주에서 분석한 결과는 다음과 같았다. 첫째, 2000년대 이후 출간된 온라인 관련 음악교육 연구는 2000년대 10.7%, 2010년대 41.3%로 증가하였으며, 2020년대에는 2020년부터 2022년의 3년간임에도 불구하고 48.0%를 차지하는 급격한 증가를 보였다. 둘째, 온라인 관련 음악교육 연구가 가장 활발하게 이루어지는 나라는 미국으로 전체 연구의 29.3%를 차지하였으며, 다음으로 영국과 다국적 연구가 각각 9.3%를 차지하였다. 셋째, 가장 많이 연구된 주제는 온라인 교수·학습 방법으로 41.3%를 차지하였으며, 다음으로 온라인 교육에 대한 인식 및 경험이 29.3%로 나타났다. 이외에도 온라인 음악교육에서 미디어와 기술 측면을 고찰한 연구와 교사교육 연구도 수행되었다. 넷째, 연구 대상은 두 가지 이상의 연구 대상이 참여한 복합 대상의 비중이 28.0%로 가장 높았으며, 다음으로 교사가 25.3%로 나타났다. 다섯째, 연구 방법은 질적 연구가 54.7%로 과반수를 차지하였고, 다음으로 양적, 질적 자료를 모두 활용한 혼합 연구가 24.0%로 나타났다.This pilot study aims to examine international research trends in online music education. The following categories of online music education studies published in professional journals were analyzed: year of publication, author's country, research topic, subject, and research method. The results were as follows: first, a total of 75 studies on online music education published showed a steady increase of 10.7% in the 2000's and 41.3% in the 2010's, followed by a rapid increase during the 2020's. Papers published from 2020-2022 accounted for a high proportion, 48%, of the total articles. Second, research on online music education is most active in the United States, accounting for 29.3% of the total research. Next, British and multinational studies accounted for 9.3% each. Third, the most frequently examined topic was teaching and learning methods, 41.3%, followed by perceptions and experience of online education, 29.3%. Studies on media and technology also accounted for 16%, and research on teacher education accounted for 13.3%.ﾠA variety of subjects, such as students, teachers, professional musicians, and adults of various ages and vocations, participated in the studies and the results showed that a combination among the groups was the highest (28%), followed by teachers at 25.3%. Fifth, qualitative research accounted for the majority, 54.7%, followed by mixed method, 24%.

Incidence of Syndromes Associated With Frontotemporal Lobar Degeneration in 9 European Countries

Diagnostic incidence data for syndromes associated with frontotemporal lobar degeneration (FTLD) in multinational studies are urgent in light of upcoming therapeutic approaches. To assess the incidence of FTLD across Europe. The Frontotemporal Dementia Incidence European Research Study (FRONTIERS) was a retrospective cohort study conducted from June 1, 2018, to May 31, 2019, using a population-based registry from 13 tertiary FTLD research clinics from the UK, the Netherlands, Finland, Sweden, Spain, Bulgaria, Serbia, Germany, and Italy and including all new FTLD-associated cases during the study period, with a combined catchment population of 11 023 643 person-years. Included patients fulfilled criteria for the behavioral variant of frontotemporal dementia (BVFTD), the nonfluent variant or semantic variant of primary progressive aphasia (PPA), unspecified PPA, progressive supranuclear palsy, corticobasal syndrome, or frontotemporal dementia with amyotrophic lateral sclerosis (FTD-ALS). Data were analyzed from July 19 to December 7, 2021. Random-intercept Poisson models were used to obtain estimates of the European FTLD incidence rate accounting for geographic heterogeneity. Based on 267 identified cases (mean [SD] patient age, 66.70 [9.02] years; 156 males [58.43%]), the estimated annual incidence rate for FTLD in Europe was 2.36 cases per 100 000 person-years (95% CI, 1.59-3.51 cases per 100 000 person-years). There was a progressive increase in FTLD incidence across age, reaching its peak at the age of 71 years, with 13.09 cases per 100 000 person-years (95% CI, 8.46-18.93 cases per 100 000 person-years) among men and 7.88 cases per 100 000 person-years (95% CI, 5.39-11.60 cases per 100 000 person-years) among women. Overall, the incidence was higher among men (2.84 cases per 100 000 person-years; 95% CI, 1.88-4.27 cases per 100 000 person-years) than among women (1.91 cases per 100 000 person-years; 95% CI, 1.26-2.91 cases per 100 000 person-years). BVFTD was the most common phenotype (107 cases [40.07%]), followed by PPA (76 [28.46%]) and extrapyramidal phenotypes (69 [25.84%]). FTD-ALS was the rarest phenotype (15 cases [5.62%]). A total of 95 patients with FTLD (35.58%) had a family history of dementia. The estimated number of new FTLD cases per year in Europe was 12 057. The findings suggest that FTLD-associated syndromes are more common than previously recognized, and diagnosis should be considered at any age. Improved knowledge of FTLD incidence may contribute to appropriate health and social care planning and in the design of future clinical trials.

Validity, reliability and responsiveness of the French translation of the Patient-Rated Wrist Evaluation Questionnaire (PRWE)

IntroductionThe patient-rated wrist evaluation questionnaire (PRWE) is a specific wrist questionnaire, developed in Canada that has been validated and proved reliable and sensitive. It assesses pain and function. Unfortunately, there was no validated French-language version. It is important that a translation should be methodologically rigorous, as both linguistic and cultural factors come into play. ObjectiveTo produce a French-language version of the PRWE, culturally adapted to the French-speaking populations of Europe and North America. Materials and methodsA validated protocol was used to produce a French-language version of the PRWE (PRWE-Fr) that would be culturally acceptable for the French-speaking populations of Europe and North America. Reliability and responsiveness analyses were performed and PRWE-Fr scores were compared to F-QuickDASH-D/S (French translation of short-form Disabilities of the Arm, Shoulder and Hand-Disability/Symptoms) scores to assess validity. ResultsA French-language version of the PRWE (PRWE-Fr) was accepted by a multinational committee, then validated in 65 French-speaking subjects, divided into 2 groups for analyses. A strong positive correlation was found between PRWE-Fr and F-QuickDASH-D/S scores. Comparison of results between two PRWE-Fr sessions at a 1-week interval found a very strong correlation (ρ=0.93; r2=0.868; p<0.001). The intraclass correlation coefficient for total PRWE-Fr score demonstrated excellent reliability (ICC: 0.93; 95% CI: [0.859; 0.969]; p<0.001). Responsiveness analysis revealed greater sensitivity to change than for the F-QuickDASH-D/S (standardized response mean [SRM], 1.14 versus 1.04 respectively). DiscussionA French-language version of the PRWE was produced and validated for use in French-speaking populations. It should facilitate evaluation of results in French-speaking settings, collaboration in multinational studies and comparison between studies performed in different countries. Level of evidenceII; Multicenter cohort study.

Risk stratification of sudden cardiac death in asymptomatic female Brugada syndrome patients: A literature review.

Risk stratification in Brugada syndrome remains a difficult problem. Given the male predominance of this disease and their elevated risks of arrhythmic events, affected females have received less attention. It is widely known that symptomatic patients are at increased risk of sudden cardiac death (SCD) than asymptomatic patients, while this might be true in the male population; recent studies have shown that this association might not be significant in females. Over the past few decades, numerous markers involving clinical symptoms, electrocardiographic (ECG) indices, and genetic tests have been explored, with several risk-scoring models developed so far. The objective of this study is to review the current evidence of clinical and ECG markers as well as risk scores on asymptomatic females with Brugada syndrome. Gender differences in ECG markers, the yield of genetic findings, and the applicability of risk scores are highlighted. Various clinical, electrocardiographic, and genetic risk factors are available for assessing SCD risk amongst asymptomatic female BrS patients. However, due to the significant gender discrepancy in BrS, the SCD risk amongst females is often underestimated, and there is a lack of research on female-specific risk factors and multiparametric risk scores. Therefore, multinational studies pooling female BrS patients are needed for the development of a gender-specific risk stratification approach amongst asymptomatic BrS patients.

Acute kidney injury in Jamaicans with sickle cell disease hospitalized with COVID-19 infection.

Despite a high occurrence of acute kidney injury (AKI) with COVID-19 infection, there are no data on its incidence in sickle cell disease (SCD). We performed a single-center retrospective chart review of persons aged >1 year with SCD, COVID-19 infection and no prior dialysis requirement hospitalized from June 1, 2020 to May 31, 2022. Demographics, clinical, laboratory characteristics and outcomes were abstracted. AKI was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria. Of 38 patients meeting study criteria (60.6% female, mean age ± SD 38.6 ± 15.9 years), 3 (7.9%) were COVID vaccinated. Fifty-five percent (55%) developed AKI with 7.9% (n= 3) requiring dialysis. Participants with AKI were older (44.9 versus 30.8 years, p= 0.005), with a higher proportion having baseline chronic kidney disease (52% versus 0%, p = 0.001). Severe COVID infection [age-adjusted odds ratio (aOR): 8.93, 95%CI: 1.73-45.99, p = 0.033], red cell transfusion (aOR 7.92, 1.47-42.69) and decrease in hemoglobin per unit from baseline (aOR 2.85, 1.24-2.28) were associated with AKI. Five persons died in hospital, with AKI resulting in higher median length of stay (12 versus 5 days, p = 0.007). Targeted COVID-19 preventative measures and multinational longitudinal studies to ascertain the impact of AKI and COVID-19 infection in SCD are needed.

Developing a new improved yoga therapy treatment for asthma

ABSTRACT Background: Bronchial asthma afflicts many millions of people worldwide, with multinational studies finding over 4% of young adults on asthma medication. Prescribed medication may alleviate symptoms but does not cure. The complementary system of yoga therapy has developed yoga practice modules that improve symptoms, but are cumbersome, and lead to high dropout rates. Results: We report the development of a new, shorter yoga module that achieved zero dropouts over a 90-day randomized controlled trial. Discussion: All yoga breathing exercises could be done standing or sitting in a chair, making the module suitable not just for young adults, but for all ages.

World-wide variations in tests of cognition and activities of daily living in participants of six international randomized controlled trials

BackgroundBetter understanding of worldwide variation in simple tests of cognition and global function in older adults would aid the delivery and interpretation of multi-national studies of the prevention of dementia and functional decline. MethodIn six RCTs that measured cognition with the mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and activities of daily living (ADL) with the Standardised Assessment of Everyday Global Activities (SAGEA), we estimated average scores by global region with multilevel mixed-effects models. We estimated the proportion of participants with cognitive or functional impairment with previously defined thresholds (MMSE≤24 or MoCA≤25, SAGEA≥7), and with a country-standardised z-score threshold of cognitive or functional score of ≤-1. ResultsIn 91,396 participants (mean age 66.6 years [SD 7.8], 31% females) from seven world regions, all global regions differed significantly in estimated cognitive function (z-score differences 0.11–0.45, p<0.001) after accounting for individual-level factors, centre and study. In different regions, the proportion of trial participants with MMSE≤24 or MoCA≤25 ranged from 23–36%; the proportion below a country-standardised z-score threshold of ≤1 ranged from 10–14%. The differences in prevalence of impaired IADL (SAGEA≥7) ranged from 2–6% and by country-standardised thresholds from 3–6%. ConclusionsAccounting for country-level factors reduced large differences between world regions in estimates of cognitive impairment. Measures of IADL were less variable across world regions, and could be used to better estimate dementia prevalence in large studies.

MAPPING THE INTERPLAY OF SOCIAL HEALTH AND COGNITIVE FUNCTIONING: A MIXED RESEARCH KNOWLEDGE SYNTHESIS

Abstract Introduction Dementia is a syndrome with complex underlying bio-psycho-social mechanisms relevant for prevention and intervention. This work presents a mixed research knowledge synthesis, mapping the multidimensional interplay of social health and cognitive functioning in dementia. Methods Data integration from 1) systematic review, 2) group model building workshops, (3) iterative integration of multi-national cohort studies (4) ongoing revisions of the social health concept via expert discussions. Results The map comprises more than 50 markers, clustered in six domains (social health, psychological pathways, physiological pathways, health behavior pathways, brain/cognitive reserve, cognitive functioning). The social health domain is structured in six sub-domains representing a novel conceptual understanding. Three pathways (physiological, psychological, health behavior) reflect principal mechanisms connecting social health with brain/cognitive reserve and cognitive functioning. Conclusion The map depicts dynamic relationships between social health and cognitive functioning that can serve as a basis for recommendations, both for prevention and for improved dementia care.