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The use of donated expressed breast milk (DBM) is encouraged in South Africa, with donor milk banks and legislated policies and programmes available in hospitals serving populations with a high HIV prevalence. Concerns over poor attitudes amongst mothers towards DBM seem to persist. A cross-sectional mixed-methods approach was used in a cohort of mothers of neonates in a regional hospital. Between April 2021 and January 2022, survey data on knowledge, awareness and attitudes towards DBM was collected. Qualitative data from open-ended questions were thematically analysed. Comparative analysis using independent sample t-tests and logistic regression to determine differences in variables and to understand associations related to knowledge was conducted. A total of 163 mothers with a mean (SD) age of 27.1 ± 6.3 years were included; 49.7% of mothers had post-high-school qualifications, 82.8% were unemployed and 87.0% received social security. Some 64.4% had inadequate knowledge of DBM. Awareness of DBM had the strongest association with better knowledge concerning DBM and AdjOR (25.25 95% CI 10.60–68.40; p < 0.001). Negative attitudes towards DBM were largely driven by a lack of knowledge regarding human immunodeficiency virus (HIV) screening of donor mothers and fears of HIV transmission when using DBM. Lack of awareness concerning DBM was associated with poor knowledge of DBM, which may drive poor uptake of this critical nutritional source for at-risk neonates. Implementing targeted awareness programmes on DBM, which begin in the antenatal period and specifically address HIV screening of donor mothers, could address the poor uptake of DBM. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis is a major cause of mortality worldwide. Prisoners in Guiana have multiple risk factors. The primary objective of this study was to describe tuberculosis occurring in prison and after release in French Guiana between 2008 and 2020. Secondary objectives were to identify tuberculosis risk factors and determine annual incidences. Methods: A retrospective cohort study of tuberculosis cases was carried out at the Guiana prison between 2008 and 2020. Data were collected from prison registers and cross-referenced with the list of tuberculosis notifications in French Guiana. Results: A total of 36 cases of tuberculosis were studied. Incidence was high, at 263/100,000 per year, higher than elsewhere in France and comparable to that in Brazil. Despite visibly effective screening on entry, with little evidence of intra-prison circulation of tuberculosis, 39% of patients were diagnosed within two years of leaving prison (76% were symptomatic). This could be explained by the high prevalence of latent forms (LTI). Discussion: Continued screening on entry, in combination with annual radiological and clinical screening, and reinforced follow-up on release seem indicated to improve patient management and the search for possible LTI. [ABSTRACT FROM AUTHOR]

The meaning of randomization tests has become obscure in statistics education and practice over the last century. This article makes a fresh attempt at rectifying this core concept of statistics. A new term—"quasi-randomization test"—is introduced to define significance tests based on theoretical models and distinguish these tests from the "randomization tests" based on the physical act of randomization. The practical importance of this distinction is illustrated through a real stepped-wedge cluster-randomized trial. Building on the recent literature on randomization inference, a general framework of conditional randomization tests is developed and some practical methods to construct conditioning events are given. The proposed terminology and framework are then applied to understand several widely used (quasi-)randomization tests, including Fisher's exact test, permutation tests for treatment effect, quasi-randomization tests for independence and conditional independence, adaptive randomization, and conformal prediction. for this article are available online. [ABSTRACT FROM AUTHOR]

Objective: A study was undertaken to explore the differences in nutrition knowledge, attitudes, beliefs and practices and their correlations among adults in both urban and rural communities in the Free State province of South Africa. Design: This study forms part of the cross-sectional Assuring Health for All in the Free-State (AHA-FS) study. Setting: The AHA-FS study is conducted in urban and rural parts of the Free State province of South Africa. The rural and urban stages of the study were conducted in 2007 and 2009, respectively. Subjects: The sample included 846 adult household members, aged between 25 and 65 years, from both rural and urban areas of the Free State province. Outcome measures: Nutrition knowledge, attitudes, beliefs and practices were measured. Results: The sample included predominantly females (78.2%). Rural adults had significantly better nutrition knowledge (p < 0.001), positive attitudes (p < 0.001) and positive beliefs (p < 0.001) and their nutrition knowledge and attitudes (r = 0.27, p < 0.001), nutrition knowledge and beliefs (r = 0.16, p < 0.001), and nutrition attitudes and beliefs (r = 0.38, p < 0.001) were significantly correlated with each other. However, nutrition knowledge, attitudes and beliefs were not correlated with nutrition practices among our sample in either the urban or rural setting. Conclusion and implication: The results of the current study confirm that relevant and culturally acceptable nutrition education interventions for translating nutrition-related knowledge, attitudes and beliefs into practices are required. [ABSTRACT FROM AUTHOR]

The existence of multiple forms of malnutrition is a growing problem in developing countries. Children living in the Eastern Cape have a relatively high prevalence of cardiovascular disease (CVD) risk factors and food insecurity, suggesting the possibility of the several coexisting forms of malnutrition. Due to the negative long-term consequences of undernutrition, overnutrition and, to a greater extent, a combination of both, it is important for this issue to be identified early in children and addressed. This study was undertaken to investigate the prevalence of the different forms of malnutrition in children living in the Eastern Cape province. Secondary analysis of a cross-sectional sample of 237 school-aged children, aged 6–18 years, in the Eastern Cape province of South Africa was conducted. The variables included in the analysis were the demographic data, anthropometric data and biochemical data, specifically blood profiles related to micronutrient deficiencies and CVD risk factors. Fisher's exact test was used to compare the prevalence rates of several coexisting forms of malnutrition in the children. All data analysis was conducted in R version 4.0.3 and statistical significance was set at 0.05. In children with overweight/obesity, 13.6% had a micronutrient deficiency, while 37.71% of the children within the normal weight range had coexisting micronutrient deficiencies and CVD risk factors. The prevalence of folate deficiency was 73.0%, iron deficiency 6.3%, and hyperglycaemia was at 10.6%. Fisher's exact test was used to compare the prevalence rates between genders and no statistically significant differences were observed. Further research is needed to understand the relatively high prevalence of CVD risk factors in these children within the normal weight range and to investigate how dietary intake contributes to the overall double burden of malnutrition in children. [ABSTRACT FROM AUTHOR]

To compare the safety and accuracy of three dry needling locations in the piriformis muscle using human donors. Observational dissection study of embalmed human donors. A licensed physical therapist of 17 years clinical experience and 5 years teaching dry needling placed three needles in a medial, midpoint, and lateral location of 14 piriformis muscles of seven embalmed human donors. Block dissection allowed for observation of tissues the needles traversed and recording of the structures that the needles pierced. The lateral needle pierced piriformis in 3/14 trials, and contacted sciatic nerve in 0/14 trials. The medial needle pierced both piriformis and sciatic nerve in 11/14 trials. The midpoint needle pierced the piriformis in 11/14 trials, and contacted sciatic nerve in 3/14 trials. Fisher's Exact test (p < 0.001) found a nonrandom association between dry needle placement, and dry needle contact. When dry needling the piriformis, a lateral approach can avoid the sciatic nerve, but cannot accurately pierce the piriformis tendon. Furthermore, while a midpoint and medial approach finds the piriformis muscle with the same accuracy, the midpoint location avoided the sciatic nerve more often. [ABSTRACT FROM AUTHOR]

Approximately 2–10% of pregnant women experience subclinical hypothyroidism during pregnancy. Although some studies have shown that primary hypothyroidism increases the risk of gestational diabetes mellitus (GDM), there are contradictory results. Hence, this study aimed to determine the relationship between hypothyroidism and GDM. This is a retrospective cohort study in which the researchers followed up 340 pregnant women (170 with hypothyroidism as exposed group and 170 without hypothyroidism as unexposed group) for GDM. To analyse the data, chi-square, Fisher's exact test and independent t-test were employed. The incidence of GDM in the hypothyroidism group was higher than that of the group without hypothyroidism (11.8% vs. 10.6%, p = 0.731). Moreover, the risk of GDM (95% CI:0.61; 2.02) was 1.11 times higher among women with hypothyroidism. However, the observed association was not statistically significant. The mean two-hour oral glucose tolerance test (OGTT) level in pregnant women with hypothyroidism (108.94 ± 19.89 mg/dl) was significantly higher than in the other group (104.49 ± 18.43 mg/dl) with a p-value of 0.033. This study displayed that the risk of GDM is 11% higher among women with hypothyroidism. Furthermore, the difference in the mean two-hour OGTT level in pregnant women with hypothyroidism was 4.4 mg/dl higher than in the other group. [ABSTRACT FROM AUTHOR]

Baricitinib is an oral selective Janus kinase 1/2 inhibitor approved for moderate-to-severe atopic dermatitis (AD) in adults. To evaluate absolute Eczema Area and Severity Index (EASI) and SCORing of Atopic Dermatitis (SCORAD) outcomes over 16 weeks and to link disease severity categories to quality of life (QoL) improvements. This post-hoc analysis included patients enrolled in Phase3 monotherapy (BREEZE-AD1/AD2) and topical corticosteroid (TCS) combination therapy (BREEZE-AD7) trials and analyzed baricitinib 2 and 4 mg vs. placebo. Categorical outcomes were analyzed using Fisher's exact test. Significantly more baricitinib-treated patients reached EASI ≤ 7 and SCORAD < 25 as early as week 1 in monotherapy and week 2 in TCS combination therapy, compared to placebo. Significant response vs. placebo was sustained until week 16 for EASI ≤ 7 (AD1/2 [p-value vs. placebo]: 2 mg = 19.9%, 4 mg = 25.4% [p = 0.001] and AD7: 2 mg = 40.4% [p = 0.087], 4 mg = 48.6% [p = 0.003]) and SCORAD < 25 (AD1/2: 2 mg = 12.2%, 4 mg = 19.4% [p = 0.001] and AD7: 2 mg = 30.3% [p = 0.025], 4 mg = 34.2% [p = 0.004]) severity categories. These effects were accompanied by rapid improvements in QoL. Baricitinib-treated patients rapidly achieved recommended absolute EASI and SCORAD treatment outcomes which were sustained until week 16. Improvements in QoL were greater than EASI severity categories reflected, indicating that physician-assessed scores do not necessarily correlate with patients' impression of AD severity. [ABSTRACT FROM AUTHOR]

Globally, rapid economic development, urbanisation, and nutrition transitions have led to rising levels of malnutrition in all forms. The study objective was to document the prevalence of overweight/obesity, underweight, stunting, and anaemia among Samoan children in 2019–2020. Children from the Ola Tuputupua'e "Growing Up" in Samoa study at ages 5–11 years with complete physical assessments were included. Overweight/obesity, underweight, and stunting were classified using World Health Organisation Z-scores for body mass index-for-age (BMIZ> +1), weight-for-age (WAZ< −2SD), and height-for-age (HAZ< −2SD), respectively. Anaemia was defined as haemoglobin concentration <11.5 g/dL. Prevalence was compared by child age, sex, and census region of residence (representing urbanicity and exposure to nutrition transition) using Wilcoxon two-sample, Chi-square, or Fisher's exact tests. The prevalence of overweight/obesity, underweight, stunting, and anaemia was 36.2%, 0.5%, 1.6%, and 31.6%, respectively. Overweight/obesity in children was positively associated with age and highly prevalent in periurban and urban regions. While children living in the rural region with the lowest exposure to nutrition transition had the highest prevalence of mild-to-moderate stunting, anaemia prevalence was lower compared to those in the urban region. No sex differences in malnutrition were observed. Moderate-to-high levels of overweight/obesity and anaemia call for comprehensive intervention strategies. [ABSTRACT FROM AUTHOR]

Objective: This study compares the access time and procedural-related complications in CVC insertion via ultrasound guidance versus the landmark technique. Methods: A prospective cohort study was performed in the emergency department of a tertiary care hospital from January 2016 to December 2018. Patients with the indication of CVC insertion were included. Primary outcomes included access time and total procedure time; secondary outcomes included post-procedural complications. Seldinger's Technique was adopted for CVC insertion in both groups. For qualitative variables, chi-squared and Fisher's exact tests were applied, and quantitative variables were reported as mean and standard deviation. Differences were assessed by the independent t-test and the Mann-Whitney test. Results: A total of 252 patients were enrolled and divided into exposed (ultrasound-guided technique) and unexposed (landmark guided technique) groups. Insertion of CVC on the first attempt was successful in 82 patients (62.1%) in the ultrasound group and in 68 patients (56.7%) in the landmark group. The mean access time (seconds) in the exposed group was 21.9 and in the unexposed group was 29.9 with a mean difference of only 8 seconds. The total procedural time (in minutes) was 32.2 versus 22.7 sequentially with a mean difference of 9.5 minutes. Fewer venipuncture attempts and arterial pricks were recorded in the exposed group (1.4 and 10/132) as compared to the unexposed group (1.8 and 36/120). Conclusion: Ultrasonographical-inserted CVC had a higher success rate with fewer postprocedural complications but required longer total procedural time with inappreciable access time. Subjects: Health & Society; Health Conditions; Medicine [ABSTRACT FROM AUTHOR]

Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower – and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18–75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict. [ABSTRACT FROM AUTHOR]

There is a dearth of evidence-based post-rape clinical care interventions tailored for refugee adolescents and youth in low-income humanitarian settings. Comics, a low-cost, low-literacy and youth-friendly method, integrate visual images with text to spark emotion and share health-promoting information. We evaluated a participatory comic intervention to increase post-exposure prophylaxis (PEP) knowledge and acceptance, and prevent sexual and gender-based violence, in Bidi Bidi refugee settlement, Uganda. Following a formative qualitative phase, we conducted a pre-test post-test pilot study with refugee youth (aged 16–24 years) (n = 120). Surveys were conducted before (t0), after (t1), and two-months following (t2) workshops. Among participants (mean age: 19.7 years, standard deviation: 2.4; n = 60 men, n = 60 women), we found significant increases from t0 to t1, and from t0 to t2 in: (a) PEP knowledge and acceptance, (b) bystander efficacy, and (c) resilient coping. We also found significant decreases from t0 to t1, and from t0 to t2 in sexual violence stigma and depression. Qualitative feedback revealed knowledge and skills acquisition to engage with post-rape care and violence prevention, and increased empathy to support survivors. Survivor-informed participatory comic books are a promising approach to advance HIV prevention through increased PEP acceptance and reduced sexual violence stigma with refugee youth. Trial registration: ClinicalTrials.gov identifier: NCT04656522. [ABSTRACT FROM AUTHOR]

Parity is a prognostic variable when considering trial of labor after cesarean section (TOLAC). This study aimed to determine whether grandmultiparous patients are at increased risk of poor TOLAC outcomes such as uterine rupture. A retrospective cohort was conducted at a single university-affiliated medical center with approximately 10,000 deliveries per year. The study group included women post one cesarean section who attempted TOLAC carrying a singleton fetus in vertex presentation. We divided the cohort into three groups: group 1 – women who had a parity of 1; group 2 – parity of 2–4; group 3 – parity of 5 and above. The primary outcome was successful VBAC. Secondary outcomes included mode of delivery, uterine rupture, and combined maternal and neonatal adverse outcomes. Data were analyzed using Fisher's exact test, Chi-square test, ANOVA, and paired t-test. Five thousand four hundred and forty-seven women comprised the study group: group 1 – 879 patients, group 2 – 2374 patients, and group 3 − 2194 patients. No significant between-group differences were found in gestational age at delivery. Rates of a successful VBAC were 80.6%, 95.4%, and 95.5%, respectively. Group 1 were more likely to have a failed TOLAC compared to group 2 (OR 5.02, 95% CI 3.9–6.5, p<.001) and group 3 (OR 5.17, 95% CI 4.0–6.7, p<.001). There was no increased risk of failed TOLAC when comparing groups 2 and 3 (OR 1.03; 95% CI 0.8–1.4, p=.89). Operative delivery rate differed significantly between all three groups; 25.1%, 6.2%, and 3.6%, for groups 1, 2, and 3, respectively (p<.001). The rate of uterine rupture was significantly higher in group 1 compared to group 2 (1.02% vs. 0.29% p=.02) and group 3 (1.02% vs. 0.2%, p=.01, respectively). There were no differences between group 2 and group 3 (0.29% vs. 0.2% p=.78). Grandmultiparity is not associated with an increased risk of uterine rupture during TOLAC. [ABSTRACT FROM AUTHOR]

Down syndrome (DS) is a neurodevelopmental disorder of known genetic cause, with a wide array of oral and systemic manifestations. The aim of the present study is to determine the level of oral hygiene status and practice of a group of individuals with DS in Benghazi/Libya. In this cross–sectional study 124 individuals were recruited from The Rehabilitation Centre of Special Needs in the city of Benghazi, Libya. Questionnaires were distributed among the attendees, covering oral health aspects and diet habits. Oral examination was conducted to evaluate oral health status among individuals with DS. The data were analysed descriptively and inferentially (including Chi-square test and Fisher's exact test) using the Statistical Package for Social Science version 20 (SPSS). Most of DS individuals brush their teeth once daily (62%), spending less than one minute in brushing (44%). For diet habits, more than half (55%) eat sweet snacks between meals. For the dental status, 47% of the subject had zero DMFT, followed by score 2 in 21%. The highest percentage in Oral hygiene Index (OHI) was scored 1 by 46% of participants. The zero CPITN score was seen in 54.5%. Our results have shown a weaker tendency of DS towards oral hygiene. This should strengthen our goal of guiding and encouraging parents of individuals with DS to be more cautious in providing help and supervision of their individuals' practice of oral health care. [ABSTRACT FROM AUTHOR]

Background and aim: To analyse the sensitisation profile to molecular components of mites allergens with the use of ALEX2 Allergy Explorer test in Atopic dermatitis (AD) patients. Method: The complete dermatological and allergological examination including the examination of the sensitisation to molecular components with ALEX2 Allergy Explorer testing was performed. For the statistical analysis, we used Fisher's Exact. Results and conclusion: The sensitisation to mites increases with AD severity. The central role in atopic march may play the molecular component Der f 2 and Der p 23. The results of our study confirm the important role of Der p 5 and Der p 7 in subgroup of patients suffering from bronchial asthma. The specific immunotherapy should focus on the components of NPC2 family and Der p 23 in AD patients. Our results may be helpful in planning hyposensitisation, treatment and immunotherapy. [ABSTRACT FROM AUTHOR]

The aim is to evaluate the sensitivity, specificity and positive predictive value of ALEX2 Allergy Explorer test in patients suffering from atopic dermatitis and reactions to egg. We compared the results of specific IgE to allergen reagents (molecular components) with reactions to egg in the open exposure test (OET) (history); the sensitivity, specificity and positive predictictive value were calculated with Fisher's Exact test. Altogether 100 atopic dermatitis patients were examined. The reaction to egg was confirmed in 19 patients (19%). We confirmed significant relation between the results of specific IgE to Gal d 1, Gal d 2, Gal d 3, Gal d 5, Gal d white and Gal d yolk and the results of the OET/history; the sensitivity is in the range 21.05–52.63%. We recommend to evaluate food allergy to egg in patients with severe atopic dermatitis even with negative specific IgE for molecular components. [ABSTRACT FROM AUTHOR]

The aim of our study is the evaluation of the relation between the sensitisation to molecular components of moulds and yeast and the occurrence of food hypersensitivity reactions in atopic dermatitis patients. The food reactions were confirmed in an open exposure test (history); the sensitisation to allergen reagents (molecular components) of moulds and yeast was confirmed with ALEX2 Allergy Explorer Multiplex examination. The relation between the sensitisation to molecular components of fungi and the food hypersensitivity reactions was evaluated with the use of Fisher's exact test. One hundred atopic dermatitis patients were included in the study (48 men and 52 women with an average age of 40.9 years). In patients with reaction to hazelnuts, walnuts, peanuts, fish and egg, the significantly higher level of specific IgE to Asp f 3, Cla h 8, Alt a 6, Alt a 1, Mala s 6 and Asp f 6 was confirmed. [ABSTRACT FROM AUTHOR]

The sensitivity of ALEX2 Allergy Explorer test in patients suffering from atopic dermatitis and clinical reactions to fish/shrimps was evaluated. We compared the results of specific IgE to allergen reagents (molecular components) and clinical reactions in the open exposure test (patient's history); the sensitivity was calculated with Fisher's Exact test (Rates and Confidence Intervals 95% C. I., value, lower, upper). Altogether 100 atopic dermatitis patients were examined. We confirmed significant relationship between the results of specific IgE to allergen reagents (molecular components) of fish and the results open exposure test/history; the sensitivity is in the range of 33.3% (7.49%–70.07%)–44.4% (13.7%–78.80%). We did not confirm the significant relationship between the results of specific IgE to allergen reagents (molecular components) of shrimps and the results open exposure test/history; the sensitivity is in the range of 0%–40% (5.27%–85.34%). [ABSTRACT FROM AUTHOR]

Numerous quality-improvement projects including healthcare professional training are conducted globally every year, but there is a gap between the knowledge obtained in the training and its implementation in practice and policy. A quality-improvement programme was conducted in eastern Democratic Republic of Congo (DRC) to reduce maternal and neonatal mortality and morbidity. This study explores the implementation process, mechanisms of impact, and outcomes of a training intervention addressing labour and birth management and involving healthcare providers in an urban health zone in eastern part of DRC. In 2019, master trainers were educated and in turn trained facilitators from seven participating healthcare facilities, which received the necessary equipment. Data comprised statistics on maternal and neonatal birth outcomes for the years before and after the training intervention, and focus group discussions (n = 18); and interviews (n = 2) with healthcare professionals, at the end of (n = 52) and after the training intervention (n = 59), respectively. The analysis was guided by a process evaluation framework, using descriptive statistics and content analysis. The three-pillar training intervention using a low-dose, high-frequency approach was successfully implemented in terms of fidelity, dose, adaptation, and reach. Several improved care routines were established, including improved planning, teamwork, and self-reflection skills, as well as improved awareness of the influence of the care environment, of having a respectful encounter, and of allowing a companion to be present with the birthing woman. The proportions of emergency caesareans decreased and of vaginal births increased without an increase in maternal and neonatal complications. The findings of this study are encouraging and provide learnings for other healthcare facilities in DRC as well as other low-income countries. When designing similar training interventions, it is crucial to consider contextual factors such as incentives and to measure more salutogenic outcomes. [ABSTRACT FROM AUTHOR]

Objective: Investigate the relationships between endopelvic fascial edema and its influencing factors after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids. Methods: This retrospective study included 688 women with uterine fibroids treated by USgHIFU; based on post-treatment MRI, the patients were divided into two groups: endopelvic fascial edema group and nonedema group. The specific location of fascial edema of each patient was also recorded. Fascial edema and fibroid features and treatment parameters were set as the dependent and independent variables, respectively, and the correlations were studied using univariate and multivariate analyses. The relationship between the pain-related adverse events and location of fascial edema was analyzed by v2 and fisher’s exact tests. Results: Edema and nonedema groups had 556 and 112 patients, respectively. Among the edema patients, posterior fascial edema incidence was the highest. Multifactorial analysis showed that the energy efficiency factor (EEF), fibroid location, and enhancement type were positively associated with endopelvic fascial edema (p < 0.05), while the distance from dorsal surface of the fibroid to sacrum was negatively correlated (p < 0.001). Patients with anterior, posterior and perirectal, and right lateral fascial edemas were associated with lower abdominal pain, sacrococcygeal pain, and leg numbness/ pain, respectively. Conclusion: Post-USgHIFU ablation, patients were prone to developing endopelvic fascial edema, and some of them experienced pain-related adverse events. The fibroid location, its types of contrast enhancement, the distance from the dorsal surface of the fibroid to the sacrum, and EEF were the influencing factors resulting in the endopelvic fascial edema after USgHIFU ablation. [ABSTRACT FROM AUTHOR]

Access to abortion throughout much of Mexico has been restricted. Fondo Maria is an abortion accompaniment fund that provides informational, logistical, financial, and emotional support to people seeking abortion care in Mexico. This cross-sectional study examines the factors that influenced decision-making and contributed to delays in accessing care and explores experiences with Fondo Maria's support among women living outside Mexico City (CDMX). We describe and compare the experiences of women across the sample (n = 103) who were either supported by Fondo Maria to travel to CDMX to obtain an abortion (n = 60), or self-managed a medical abortion in their home state (n = 43). Data were collected between January 2017 and July 2018. Seventy-seven percent of participants reported that it was difficult to access abortion care in their home state and 34% of participants indicated they were delayed in accessing care, primarily due to a lack of financial support. The majority of participants (58%) who travelled to CDMX for their abortion did so because it seemed safer. The money/cost of the trip was the most commonly cited reason (33%) why participants who self-managed stayed in their home state. Eighty-seven percent of participants said Fondo Maria's services met or exceeded their expectations. Our data suggest that people seeking abortion and living outside CDMX face multiple and overlapping barriers that can delay care-seeking and influence decision-making. Abortion accompaniment networks, such as Fondo Maria, offer a well-received model of support for people seeking abortion in restrictive states across Mexico. [ABSTRACT FROM AUTHOR]

Simulation-Based Education (SBE) simulates specific physiological characteristics of a patient, allowing student practice in developing clinical skills and assessment of skill competency. Literature is limited regarding SBE's effectiveness in curriculum enrichment. This study investigated Blood Pressure (BP) measuring proficiency of second-year medical students with first-year SBE training and a second-year review, by comparing data from Simulation-Based assessments in 2017 and 2019. Second-year medical students measured BP on three manikin arms, associated with distinct clinical contexts (healthy young male, young female experiencing hypotension, and older male suffering hypertension and diabetes). All manikins' BP settings were independent of clinical context. In January 2019, 108 second-year medical students who received traditional training, as well as SBE in 2017 and Simulation-Based practice in 2018, were divided into four groups (n = 32, 24, 24, and 28), with two groups each assessed on consecutive days. The proportions of correct BP values in each of three contexts were compared between experiments in 2017 and 2019. Additionally, systolic (SBP) and diastolic (DBP) blood pressure results were stratified into three groups: lower than setting value, correct, and higher than setting vgalue, with proportions for each group compared for the 2017 and 2019 studies using Fisher's Exact Tests. In Case Two and Three, the proportion of correct BP values significantly increased from 2017 (Case Two: 51%; Case Three: 55%) to 2019 (Case Two: 73%; Case Three: 75%). Additionally, proportions of students who reported lower SBP values than setting values were significantly decreased in Case One and Two, with five failing all contexts. Second-year student BP measurement skills were improved, not only due to repeated Simulation-Based practice but advancing basic science knowledge and mastery experience in ongoing curriculum. Simulation-Based assessment provided an effective tool for evaluating skill retention and proficiency in medical training. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the methodology, interpretation, and perceived value of Spurling's test toward diagnosis/classification and treatment. Methods: An anonymous web-based survey was made available to physical therapist members of the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Based on video demonstrations of technique and symptom distribution, questions included preferred method, criteria for test interpretation, and perceived value of Spurling's test and other examination findings toward clinical decision-making. Professional profile data were also collected. Results: Among the 452 participants completing the survey, no method of testing was preferred by more than 37%, with ipsilateral lateral flexion, rotation, and extension with compression being most frequently preferred followed by ipsilateral lateral flexion with compression at 32%. Proximal provocation of symptoms only without distal symptoms was interpreted as a positive test by 67%. Participants rated Spurling's test of moderate to low value toward diagnosis/classification and treatment. Discussion: Inconsistency with methodology and interpretation of Spurling's test is suggested to be pervasive in physical therapist practice. While an optimal test methodology has yet to be identified, result interpretation does have a basis for clarification toward diagnosis/classification and reduction of unwanted variance in practice. [ABSTRACT FROM AUTHOR]

Developments in the field of health and the changing characteristics of society have revealed the concept of medical ethics, which ethically evaluates the studies dealing with human life and produces solutions. The aim of this study was to evaluate the awareness of healthcare personnel in the Faculty of Dentistry of Dicle University about 'the legal responsibilities of dental practitioners' and 'rights of patients'. The study included 150 volunteers who were healthcare workers in the Faculty of Dentistry, Dicle University, between June and July 2019. The subjects were randomly selected from five different professional groups and data were collected using a single data collection form. All items on the form were graded using a 5-point Likert-type response. In the statistical analyses, Pearson's Chi-square, Yates' Chi-square and the Fisher Exact tests were used. The questionnaire responses showed that 61.3% of the study participants had received training on patients' rights and 56.7% had information about the legal responsibilities of dentists. The rate of dentists who had received training was below average and 38.9% of the dentists reported not having any information about their own legal responsibilities. A positive response was given to the items on the questionnaire by 58% and a negative responseby 33%. The responses to some items were seen to have been affected by variables such as age, gender and professional group. Although some confusion was experienced by the healthcare personnel about patients' rights and the legal responsibilities of dentists, the levels of awareness of medical ethics were evaluated as satisfactory. [ABSTRACT FROM AUTHOR]

The off-label use of medicines is neither prohibited nor explicitly allowed, according to the current European Union (EU) pharmaceutical legislation. This can cause confusion in physicians' practice as well as lead to patients' dissatisfaction. The purpose of this survey is to assess the knowledge and experience of Bulgarian physicians with the off-label use of medicines. The survey was performed at the beginning of 2020 in the biggest private hospital in South-Central Bulgaria. Ninety-six physicians from the inpatient and outpatient medical care participated in the survey and answered 10 questions. The data analysis was performed using the statistical program SPSS v19.0. The results are described as numbers and percentages for the qualitative variables and mean value (median due to their distribution) and a variance measure (range) for the quantitative ones. The distribution of the variables was tested with the Kolmogorov–Smirnov test. The evaluation of the relationships between the qualitative variables was performed using the χ2 test or the Fisher's exact test, where applicable. The results showed that most of the participants (81%) have never prescribed medicines off-label and believe it is not allowed to use medicines off-label (73%). Physicians strongly support the introduction of clear rules for the off-label use (88%). In conclusion, physicians practicing outside of the capital city demonstrated good level of knowledge, but relatively low awareness and little experience with the off-label use of medicines. They feel also, uncertainty in their prescribing activities when they use medicines off-label and strongly support introduction of clear rules for the off-label use. [ABSTRACT FROM AUTHOR]

Application of the exact statistical inference frequently leads to non-standard probability distributions of the considered estimators or test statistics. The exact distributions of many estimators and test statistics can be specified by their characteristic functions, as is the case for the null distribution of the Bartlett's test statistic. However, analytical inversion of the characteristic function, if possible, frequently leads to complicated expressions for computing the distribution function and the corresponding quantiles. An efficient alternative is the well-known method based on numerical inversion of the characteristic functions, which is, however, ignored in popular statistical software packages. In this paper, we present the explicit characteristic function of the corrected Bartlett's test statistic together with the computationally fast and efficient implementation of the approach based on numerical inversion of this characteristic function, suggested for evaluating the exact null distribution used for testing homogeneity of variances in several normal populations, with possibly unequal sample sizes. [ABSTRACT FROM AUTHOR]

A disease prevalence can be estimated by classifying subjects according to whether they have the disease. When gold-standard tests are too expensive to be applied to all subjects, partially validated data can be obtained by double-sampling in which all individuals are classified by a fallible classifier, and some of individuals are validated by the gold-standard classifier. However, it could happen in practice that such infallible classifier does not available. In this article, we consider two models in which both classifiers are fallible and propose four asymptotic test procedures for comparing disease prevalence in two groups. Corresponding sample size formulae and validated ratio given the total sample sizes are also derived and evaluated. Simulation results show that (i) Score test performs well and the corresponding sample size formula is also accurate in terms of the empirical power and size in two models; (ii) the Wald test based on the variance estimator with parameters estimated under the null hypothesis outperforms the others even under small sample sizes in Model II, and the sample size estimated by this test is also accurate; (iii) the estimated validated ratios based on all tests are accurate. The malarial data are used to illustrate the proposed methodologies. [ABSTRACT FROM AUTHOR]

Unmet need for postpartum contraception in rural Nepal remains high and expanding access to sexual and reproductive healthcare is essential to achieving universal healthcare. We evaluated the impact of an integrated intervention that employed community health workers aided by mobile technology to deliver patient-centred, home-based antenatal and postnatal counselling on postpartum modern contraceptive use. This was a pre–post-intervention study in seven village wards in a single municipality in rural Nepal. The primary outcome was modern contraceptive use among recently postpartum women. We performed a multivariable logistic regression to examine contraceptive use among postpartum women pre- and one-year post-intervention. We conducted qualitative interviews to explore the implementation process. There were 445 postpartum women in the pre-intervention group and 508 in the post-intervention group. Modern contraceptive use increased from 29% pre-intervention to 46% post-intervention (p < 0.0001). Adjusting for age, caste, and household expenditure, time since delivery and sex of child in the index pregnancy, postpartum women one-year post-intervention had twice the odds (OR 2.3; CI 1.7, 3.1; p < 0.0001) of using a modern contraceptive method as compared to pre-intervention. Factors at the individual, family, and systems level influenced women's contraceptive decisions. The intervention contributed to increasing contraceptive use through knowledge transfer, demand generation, referrals to healthcare facilities, and follow-up. A community-based, patient-centred contraceptive counselling intervention supported by mobile technology and integrated into longitudinal care delivered by community health workers appears to be an effective strategy for improving uptake of modern contraception among postpartum women in rural Nepal. [ABSTRACT FROM AUTHOR]

Anti-angiogenic therapies are an important class of anti-cancer treatment drugs. However, their efficacy is limited to certain tumors and would benefit from identifying a biomarker predictive of therapeutic response. TP53 (tumor protein p53) is a tumor suppressor gene frequently mutated in cancer and implicated in cell-cycle regulation, apoptosis, and angiogenesis. Data from 7,525 unique tumor samples (representing 30 tumor cohorts) were retrieved from the TCGA database to analyze the relationship between TP53-mutation status and VEGFA (vascular endothelial growth factor A) expression. Univariate analyses were done using a Mann-Whitney univariate test or Fisher's exact test. Parameters with a p-value (p)≤0.1 in univariate analysis were selected for follow-up multivariate analyses, including TP53-mutation status, cancer cohorts, cancer subtypes, and VEGFA expression. Our analysis demonstrates statistically significant increases in VEGFA mRNA tissue expression in TP53-mutated adenocarcinomas (but not in squamous cancers) compared to TP53 wild-type tumors. This association holds true in multivariate analyses and remains independent of HIF-1α and MDM2 overexpression. Our findings provide additional evidence that TP53 mutations are linked to the VEGF pathway, potentially offering insight into the mechanism behind increased sensitivity to anti-angiogenic therapies observed in some TP53-mutant tumors. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) is a major cause of mortality and morbidity in Europe. CHD is usually caused by atherosclerosis. Despite extensive studies that have identified a large number of genetic variants, strong evidence of association with CHD are not easily replicable in different populations. Two DNA pools were constructed: one with 32 Bulgarian centenarians and one with 61 young healthy Bulgarian individuals. The pools were whole-exome sequenced and variants were annotated and quality filtered (89,810 filtered variants). Allele frequencies were estimated and Fisher's exact test was used to evaluate the significance of allele frequency differences between the two pools. Two publicly available databases, Ensembl and DisGeNET, were used as a source of 2025 CHD-associated variants (CHD-AVs). These single nucleotide polymorphisms were screened in our data and 158 variants in 133 genes were found. ToppGene pathways analysis of genes called in both pools discovered participation of 37 genes in 9 significantly over-represented pathways. Eight variants in these 37 genes have significantly higher frequency in young individuals, and are nominated for CHD association. Variants called only in the young individuals pool (13 variants) are also nominated for association with CHD. Based on sufficiently unambiguous literature data, from the nominated variants, we prioritize five as associated with CHD in the studied Bulgarian sample. Centenarian genomes can be used to provide additional information regarding the clinical relevance of genetic variants reported as associated with CHD. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Indolent B-cell non-Hodgkin lymphomas (iNHLs) are considered incurable. Rituximab maintenance and yttrium-90 ibritumomab tiuxetan (90Y-IT) consolidation are promising post-remission therapies. However, only one randomized phase II trial has compared their efficacies and adverse effects. Here, we compared the efficacy and safety of 90Y-IT consolidation and rituximab maintenance in iNHL patients. METHODS: We retrospectively examined 75 iNHL patients with complete or partial response after initial chemotherapy between January 2008 and December 2018. Twenty-seven patients received 90Y-IT consolidation and 48 received rituximab maintenance (every 2 months for 2 years). Progression-free survival (PFS), overall survival (OS), and time to next treatment (TTNT) were estimated from the start of the treatment, and adverse effects were evaluated. RESULTS: After a median 3.6-year follow-up, the 5-year PFSs of the 90Y-IT consolidation and rituximab maintenance groups were 75.5% and 82.4%, respectively (log-rank test, p = 0.839), and the 5-year OSs were 100% and 97.8%, respectively (log-rank test, p = 0.465). The corresponding median TTNTs were not reached (log-rank test, p = 0.804). The commonest adverse effect with 90Y-IT consolidation was hematotoxicity; lower rates and grades of cytopenia were observed in patients who received rituximab maintenance. Secondary malignancies were observed in 1 patient (4%) who received 90Y-IT consolidation and 2 patients (4.2%) who received rituximab maintenance (Fisher's exact test, p > 0.99). CONCLUSION:90Y-IT consolidation and rituximab maintenance were similar with respect to PFS, OS, and TTNT. However, the features and grades of adverse effects significantly differed. Patient-specific characteristics should be considered when deciding post-remission treatments. [ABSTRACT FROM AUTHOR]

Objective: Immunoglobulin D (IgD) levels are often elevated in patients with autoimmune diseases. However, the oncogenic activities of IgD and IgD receptor (IgDR) in diffuse large B-cell lymphoma (DLBCL) have not been reported in detail. Therefore, we aimed to investigate the expression of IgD and IgDR in patients with DLBCL. Methods: Membrane IgD (mIgD) and IgDR expression in tissue samples was analyzed using IHC, mIgD and IgDR expression on peripheral blood mononuclear cells (PBMCs) was analyzed by FCM, and secreted IgD (sIgD) level was analyzed by ELISA. Fisher's exact test and Spearman correlation analysis were used to evaluate the relationship between IgD, IgDR, and clinical parameters. Results: The pathological lymph nodes of 34 patients with DLBCL were studied, and mIgD and IgDR expression was found in 16 and 19 patients. mIgD and IgDR expression was upregulated in patients with DLBCL and mIgD expression was significantly associated with IgDR expression. Further correlation analysis showed that mIgD expression was correlated with serum β2-MG level and Hans algorithm as germinal center B (GCB), whereas IgDR expression correlated with serum LDH level, IPI score and GCB. ELISA showed that sIgD level was significantly increased in DLBCL patients and it correlated with serum β2-MG and LDH levels. FCM showed that mIgD and IgDR expression in PBMCs of patients with DLBCL was significantly higher than that in healthy controls. Conclusion: Our findings suggest that overexpression of IgD and IgDR is an abnormal activation state in DLBCL. [ABSTRACT FROM AUTHOR]

Objectives: We conducted a secondary analysis of a prospective, observational cohort study to (1) report the prevalence of Directional Preference (DP) constructs at first examination for patients with cervical spine challenges, and (2) determine the association between DP constructs and clinical outcomes at discharge from physical therapy. Methods: We analyzed data collected from 718 consecutive patients who presented to outpatient, private practice clinics with primary complaints of non-specific neck pain; 200 patients met the inclusion criteria and completed first examination and discharge data. Statistical analysis determined the association between DP constructs at first examination and clinical outcomes at discharge. Results: The findings in this investigation were that (1) the most prevalent DP constructs at first examination were related to ROM and pain intensity including Patient Reported Improvement in ROM (79.5%), Increase in Spine ROM (32.5%), and Pain Intensity Change (15.0%), (2) all DP groups improved and met the MCID for disability and pain intensity change at discharge except for the group that did not exhibit Increase in Spine ROM for pain intensity, (3) no clinically significant differences in pain intensity or disability existed between DP groups at discharge, and (4) 28.5% and 6.5% of patients exhibited a relative increase in cervical spine extension and flexion ROM, respectively, post-repeated movement testing on the first examination. Discussion: The most prevalent DP constructs at first examination were related to ROM and pain intensity, and each was associated with a comparable clinical trajectory in terms of pain and disability outcomes at discharge. The findings of this study help Mechanical Diagnosis and Therapy (MDT) providers understand the common DP constructs encountered in routine clinical practice and their relation to pain and disability outcomes for patients with cervical spine challenges. Level of Evidence: 2b [ABSTRACT FROM AUTHOR]

Introduction: Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity. Method: A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI. Results: The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%. Discussion: Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample. [ABSTRACT FROM AUTHOR]

We introduce a method—called Fisher exact scanning (FES)—for testing and identifying variable dependency that generalizes Fisher's exact test on 2 × 2 contingency tables to R × C contingency tables and continuous sample spaces. FES proceeds through scanning over the sample space using windows in the form of 2 × 2 tables of various sizes, and on each window completing a Fisher's exact test. Based on a factorization of Fisher's multivariate hypergeometric (MHG) likelihood into the product of the univariate hypergeometric likelihoods, we show that there exists a coarse-to-fine, sequential generative representation for the MHG model in the form of a Bayesian network, which in turn implies the mutual independence (up to deviation due to discreteness) among the Fisher's exact tests completed under FES. This allows an exact characterization of the joint null distribution of the p-values and gives rise to an effective inference recipe through simple multiple testing procedures such as Šidák and Bonferroni corrections, eliminating the need for resampling. In addition, FES can characterize dependency through reporting significant windows after multiple testing control. The computational complexity of FES is approximately linear in the sample size, which along with the avoidance of resampling makes it ideal for analyzing massive datasets. We use extensive numerical studies to illustrate the work of FES and compare it to several state-of-the-art methods for testing dependency in both statistical and computational performance. Finally, we apply FES to analyzing a microbiome dataset and further investigate its relationship with other popular dependency metrics in that context. Supplementary materials for this article are available online. [ABSTRACT FROM AUTHOR]

Objectives: To preliminarily investigate in patients with a primary complaint of non-acute knee pain for ≥ 1 month: 1) the proportion of patients with non-acute knee pain classified by Mechanical Diagnosis and Therapy (MDT) as Spinal Derangements, 2) the number of sessions taken to identify the concluding classification, and 3) the ability of MDT classifications, demographics, and symptomatic baselines to predict pain reduction at 1-month follow-up.Methods: This study reviewed data from outpatients managed with MDT. For modeling knee pain reduction at the 1-month follow-up, 3 MDT provisional or concluding classifications (Spinal Derangement, Knee Derangement, and Non-Derangement) and the following variables were included: 1) gender, 2) symptom duration, 3) presence of low back pain (LBP), 4) the Japanese Knee Osteoarthritis Measure, 5) average pain intensity at the initial session using a 0-10 numerical rating scale, and 6) the Kellgren-Lawrence grade.Results: Data from 101 patients were extracted. The percentage of patients with the concluding classification of Spinal Derangement was 44.6%. This was greater in those patient's reporting concomitant LBP (p = .002) and without radiographic findings of knee osteoarthritis (p < .001). A concluding classification was determined by the fourth session in 80% of patients. Multiple regression modeling demonstrated that only the concluding classification significantly predicted the knee pain reduction at the 1-month follow-up.Discussion: These findings suggest the importance of careful screening assessments of the lumbar spine and the importance of detecting Derangements throughout the follow-up sessions for patients with a primary complaint of knee pain. [ABSTRACT FROM AUTHOR]

Objectives: A cross-sectional study was undertaken at Lancers Road Clinic, Durban, South Africa to determine body composition, haemoglobin, serum albumin and serum high sensitivity C-reactive protein (hs-CRP) levels in asymptomatic ART-naive HIV positive adults. Methods: All eligible adults attending the clinic were sampled. Body composition was assessed using deuterium dilution. Descriptive statistics, Wilcoxon rank-sum test, chi-square test, Fisher’s exact test and Spearman’s rank correlation coefficient were used for data analysis. Results: A total of 84 participants (CD4 count: 542.5 ± 145 cell/mm3) enrolled. The mean body mass index (BMI) was 29.5 (± 6.4) kg/m2 and the mean fat mass percentage was 44.9 (± 18.7). The prevalence of overweight (26.2%, 22/84) and obesity (46.4%, 39/84) was high. Mean haemoglobin (Hb) levels were 12.0 ± 1.6 g/dl. Mild, moderate and severe anaemia was present in 21.4% (18/84), 20.2% (17/84) and 1.2% (1/84) of patients, respectively. Mean albumin levels (36.2 ± 3.8 g/l) were on the borderline low range of normal with mildly depleted albumin levels being present in a third (32.1%, 27/84) of patients. The mean hs-CRP levels (5.5 ± 7.2 mg/l) were high. Conclusion: In this cohort of patients, wasting was not associated with HIV as the prevalence of overweight/obesity was high and followed the population trend in SA. This seemingly well, asymptomatic population of people living with HIV was at an increased risk of morbidity, progression and death due to the compounding factors of overweight/obesity, hypoalbuminemia, raised hs-CRP levels and anaemia. [ABSTRACT FROM AUTHOR]

Objective:To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). Design:Cross-sectional study using a multilingual anonymous questionnaire. Setting:Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday–Friday, 08:00–23:00) during 2 weeks in September 2009. Subjects:We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). Main outcome measures:Patients’ reasons for attending an emergency outpatient clinic versus their RGP. Results:Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46–4.46)] and Asia [OR = 2.32 (95% CI: 1.42–3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. Conclusions and implications:Access to primary care provided by an RGP affects patients’ use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services.KEY POINTSAccess to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients’ use of emergency health care services.The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP.A frequent reason for native Norwegians attending a general emergency outpatient clinic during the daytime is having an RGP outside Oslo.Lack of affiliation with the RGP scheme is a frequent reason for attending a general emergency outpatient clinic among immigrants. [ABSTRACT FROM PUBLISHER]

R. A. Fisher, the father of modern statistics, proposed the idea of fiducial inference during the first half of the 20th century. While his proposal led to interesting methods for quantifying uncertainty, other prominent statisticians of the time did not accept Fisher’s approach as it became apparent that some of Fisher’s bold claims about the properties of fiducial distribution did not hold up for multi-parameter problems. Beginning around the year 2000, the authors and collaborators started to reinvestigate the idea of fiducial inference and discovered that Fisher’s approach, when properly generalized, would open doors to solve many important and difficult inference problems. They termed their generalization of Fisher’s idea as generalized fiducial inference (GFI). The main idea of GFI is to carefully transfer randomness from the data to the parameter space using an inverse of a data-generating equation without the use of Bayes’ theorem. The resulting generalized fiducial distribution (GFD) can then be used for inference. After more than a decade of investigations, the authors and collaborators have developed a unifying theory for GFI, and provided GFI solutions to many challenging practical problems in different fields of science and industry. Overall, they have demonstrated that GFI is a valid, useful, and promising approach for conducting statistical inference. The goal of this article is to deliver a timely and concise introduction to GFI, to present some of the latest results, as well as to list some related open research problems. It is authors’ hope that their contributions to GFI will stimulate the growth and usage of this exciting approach for statistical inference. Supplementary materials for this article are available online. [ABSTRACT FROM AUTHOR]

The article presents a randomized clinical trial study conducted to evaluate the immediate effects of soft tissue mobilization (STM) versus therapeutic ultrasound (US) in patients with neck and arm pain and with neural mechanical sensitivity. Topics covered include details relating to the study design and examination procedures used in the study, the outcome measures used in the study, and details relating to the results obtained from the study.

Causal inference in completely randomized treatment-control studies with binary outcomes is discussed from Fisherian, Neymanian, and Bayesian perspectives, using the potential outcomes model. A randomization-based justification of Fisher’s exact test is provided. Arguing that the crucial assumption of constant causal effect is often unrealistic, and holds only for extreme cases, some new asymptotic and Bayesian inferential procedures are proposed. The proposed procedures exploit the intrinsic nonadditivity of unit-level causal effects, can be applied to linear and nonlinear estimands, and dominate the existing methods, as verified theoretically and also through simulation studies. Supplementary materials for this article are available online. [ABSTRACT FROM AUTHOR]

Objective. Sexual problems are common in people with diabetes. It is unknown whether early detection of diabetes and subsequent intensive multifactorial treatment (IT) are associated with sexual health. We report the prevalence of low sexual desire and low sexual satisfaction among people with screen-detected diabetes and compare the impact of intensive multifactorial treatment with the impact of routine care (RC) on these measures. Design. A cross-sectional analysis of the ADDITION-Denmark trial cohort six years post-diagnosis. Setting. 190 general practices around Denmark. Subjects. A total of 968 patients with screen-detected type 2 diabetes. Main outcome measures. Low sexual desire and low sexual satisfaction. Results. Mean (standard deviation, SD) age was 64.9 (6.9) years. The prevalence of low sexual desire was 53% (RC) and 54% (IT) among women, and 24% (RC) and 25% (IT) among men. The prevalence of low sexual satisfaction was 23% (RC) and 18% (IT) among women, and 27% (RC) and 37% (IT) among men. Among men, the prevalence of low sexual satisfaction was significantly higher in the IT group than in the RC group, p = 0.01. Conclusion. Low sexual desire and low satisfaction are frequent among men and women with screen-detected diabetes, and IT may negatively impact men's sexual satisfaction. [ABSTRACT FROM AUTHOR]

The article presents a study focused on the development of an assessment tool for the clinical reasoning (CR) in orthopaedic manual physical therapy (OMPT) by using the theory-informed technique. Topics related to the study that are discussed includes use of modified Delphi method in the study, international education standards used in the assessment criteria and psychometric theory.

Objective. To study the effects of a health check by a nurse alone or combined with an exercise intervention in middle-aged men at increased cardiovascular risk. Design. A randomized controlled trial. Setting and intervention. Primary care in Kirkkonummi municipality with 36 000 inhabitants. A health check by a nurse alone or combined with an exercise intervention to controls with no intervention was compared. Subjects. A total of 168 men aged 35 to 45 years with at least two cardiovascular risk factors and physical activity (PA) frequency < 3 times a week. Main outcome measures. Metabolic syndrome (MetS) as defined by International Diabetes Federation/American Heart Association and self-reported PA frequency. Results. Overall, focusing on health increased physical activity frequency in middle-aged men. After one year, 19% had increased PA to ≥ 3 times a week (95% CI 12-26). All study groups increased PA to ≥ 3 times: 26% of men in the exercise intervention group, 15% of men in the health check group, and 16% of controls. The differences between the groups were not statistically significant. The intervention did not have any meaningful impact on MetS or other cardiovascular outcomes at one-year follow up. Conclusions. Physical activity increased in all study groups of middle-aged men in this health-promotion trial. The interventions had no effect on metabolic syndrome or other cardiovascular outcomes in the participants. The trial increased awareness and collaboration in physical activity promotion among municipal health care and exercise services. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care. Design. Prospective observational study with follow-up. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden. Patients. All patients ≥ 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days. Main outcome measures. Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre. Results. A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA. Conclusion. The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases. [ABSTRACT FROM AUTHOR]

Objective. To study coping differences between young and experienced GPs in primary care who experience medical errors and uncertainty. Design. Questionnaire-based survey (self-assessment) conducted in 2011. Setting. Finnish primary practice offices in Southern Finland. Subjects. Finnish GPs engaged in primary health care from two different respondent groups: young (working experience ≤ 5years, n = 85) and experienced (working experience > 5 years, n = 80). Main outcome measures. Outcome measures included experiences and attitudes expressed by the included participants towards medical errors and tolerance of uncertainty, their coping strategies, and factors that may influence (positively or negatively) sources of errors. Results. In total, 165/244 GPs responded (response rate: 68%). Young GPs expressed significantly more often fear of committing a medical error (70.2% vs. 48.1%, p = 0.004) and admitted more often than experienced GPs that they had committed a medical error during the past year (83.5% vs. 68.8%, p = 0.026). Young GPs were less prone to apologize to a patient for an error (44.7% vs. 65.0%, p = 0.009) and found, more often than their more experienced colleagues, on-site consultations and electronic databases useful for avoiding mistakes. Conclusion. Experienced GPs seem to better tolerate uncertainty and also seem to fear medical errors less than their young colleagues. Young and more experienced GPs use different coping strategies for dealing with medical errors. Implications. When GPs become more experienced, they seem to get better at coping with medical errors. Means to support these skills should be studied in future research. [ABSTRACT FROM AUTHOR]

Objective. To explore how well physicians and patients predict sick-listing duration and the correspondence between their respective predictions. To study possible gender differences concerning prediction accuracy. Design. Prospective observational study. Setting. Two medium-sized primary care centres (PCC) in western Sweden. Subjects. GPs at the PCCs and attending patients sick-listed for > 14 days. Main outcome measures. Sick-listing duration; patients' and GPs' predictions of the total duration of the individual patient's sick-listing. Results. A total of 127 patients (93 women, 34 men, mean age 45 years) and 10 GPs participated in the study. Neither the GPs nor the patients were able to predict the interval until return to work with high accuracy. The GPs' and the patients' perceptions concurred in only 26% of cases. There was a significant difference in the correspondence between the GPs' and patients' respective predictions of sick-listing duration compared with the actual duration. GPs' predictions were more accurate for medium-length duration (1.5-6 months), while patients' predictions were more accurate for long-duration (> 6 months) sick-listing. Patients with less education predicted long duration of sick-listing more accurately than those with more education. There was no significant difference between male and female patients' accuracy of prediction, or between GPs' accuracy of prediction of male vs. female patients' sick-listing duration. Conclusions. Prediction of total sick-listing duration was hard for both GP and patient; their respective predictions corresponded in only one-quarter of the cases. No gender differences were observed in the accuracy of prediction. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the prevalence of central overweight and obesity in students of the University for Development Studies in Tamale, Ghana. Lifestyle factors associated with central overweight and obesity were also investigated in this study population. Design: A cross-sectional study design was employed. Setting: School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana. Subjects: A sample of 552 students was randomly selected to participate. Method: Waist and hip circumference was measured with appropriate tools and computed into a waist-to-hip ratio (WHR). Demographic and socio-cultural factors, such as age, sex, smoking status and coffee and alcohol consumption, were recorded. Physical activity was assessed using the World Health Organization Global Physical Activity Questionnaire. Results: Generally, 29.3% of the participants had a normal WHR (44.1% males, 3.0% females). 60.9% (55.9% males, 69.7% females) were centrally overweight and 9.8% (0.0% males, 27.3% females) centrally obese. Age and smoking status were not associated with central overweight and obesity. Being female was significantly associated with a higher prevalence of central obesity. The prevalence of central obesity was 13.9% in non-coffee drinkers, 6.7% in coffee drinkers, 11% in non-alcohol drinkers and 0% in alcohol drinkers. Almost 95% of centrally obese participants engaged in light or moderate physical activity, and 5.6% in vigorous physical activity (p-value < 0.0001). Conversely, 55% of normal weight participants engaged in light or moderate physical activity and 44% in vigorous physical activity (p-value 0.0008). Conclusion: Physical activity, female gender, alcohol and coffee consumption were associated with central obesity. [ABSTRACT FROM AUTHOR]

Design: Randomized clinical trial. Objectives: To determine the effectiveness of seated thoracic manipulation versus targeted supine thoracic manipulation on cervical spine pain and flexion range of motion (ROM). There is evidence that thoracic spine manipulation is an effective treatment for patients with cervical spine pain. This evidence includes a variety of techniques to manipulate the thoracic spine. Although each of them is effective, no research has compared techniques to determine which produces the best outcomes. Methods: A total of 39 patients with cervical spine pain were randomly assigned to either a seated thoracic manipulation or targeted supine thoracic manipulation group. Pain and flexion ROM measures were taken before and after the intervention. Results:Pain reduction (post-treatment--pre-treatment) was significantly greater in those patients receiving the targeted supine thoracic manipulation compared to the seated thoracic manipulation (P<0.05). Although not significant, we did observe greater improvement in flexion ROM in the targeted supine thoracic manipulation group. The results of this study indicate that a targeted supine thoracic manipulation may be more effective in reducing cervical spine pain and improving cervical flexion ROM than a seated thoracic manipulation. Future studies should include a variety of patients and physical therapists (PTs) to validate our findings. [ABSTRACT FROM AUTHOR]

Objective. Infantile colic is a painful condition in the first months of infancy. Acupuncture is used in Scandinavia as a treatment for infantile colic. A randomized controlled trial was carried out with the aim of testing the hypothesis that acupuncture treatment has a clinically relevant effect for this condition. Design. A prospective, blinding-validated, randomized controlled multicentre trial in general practice. Research assistants and parents were blinded. Setting. 13 GPs' offices in Southern Norway. Intervention. Three days of bilateral needling of the acupuncture point ST36, with no treatment as control. Subjects. 113 patients were recruited; 23 patients were excluded, and 90 randomized; 79 diaries and 84 interviews were analysed. Main outcome measures. Difference in changes in crying time during the trial period between the intervention and control group. Results. The blinding validation questions showed a random distribution with p = 0.41 and 0.60, indicating true blinding. We found no statistically significant difference in crying time reduction between acupuncture and control group at any of the measured intervals, nor in the main analysis of differences in changes over time (p = 0.26). There was a tendency in favour of the acupuncture group, with a non-significant total baseline-corrected mean of 13 minutes (95% CI -24 to + 51) difference in crying time between the groups. This was not considered clinically relevant, according to protocol. Conclusion. This trial of acupuncture treatment for infantile colic showed no statistically significant or clinically relevant effect. With the current evidence, the authors suggest that acupuncture for infantile colic should be restricted to clinical trials. [ABSTRACT FROM AUTHOR]