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Background: Noise exposures are associated with a host of adverse health effects, yet these exposures remain inadequately characterized in many industrial operations, including paper mills. We assessed noise at four paper mills using three measures: (i) personal noise dosimetry, (ii) area noise measurements, and (iii) questionnaire items addressing several different aspects of perceived noise exposure. Methods: We assessed exposures to noise characterized using the three measures and compared the relationships between them. We also estimated the validity of each of the three measures using a novel application of the Method of Triads, which does not appear to have been used previously in the occupational health literature. Results: We collected 209 valid dosimetry measurements and collected perceived noise exposure survey items from 170 workers, along with 100 area measurements. We identified exposures in excess of 85 dBA at all mills. The dosimetry and area noise measurements assigned to individual subjects generally showed good agreement, but for some operations within mill, large differences between the two measures were observed, and a substantial fraction of paired measures differed by >5 dB. Perceived noise exposures varied greatly between the mills, particularly for an item related to difficulty speaking in noise. One perceived noise exposure item related to difficulty hearing due to noise showed strong and significant correlations with both dosimetry and area measurements. The Method of Triads analysis showed that dosimetry measures had the highest estimated validity coefficient (0.70), and that the best performing perceived exposure measure had validity that exceeded that of area measurements (0.48 versus 0.40, respectively). Conclusions: Workers in Swedish pulp mills have the potential for exposures to high levels of noise. Our results suggest that, while dosimetry remains the preferred approach to exposure assessment, perceived noise exposures can be used to evaluate potential exposures to noise in epidemiological studies. [ABSTRACT FROM AUTHOR]

Background Previous meta-analyses have indicated that aspirin could affect breast cancer outcomes, particularly when taken post-diagnostically. However, several recent studies appear to show little to no association between aspirin use and breast cancer mortality, all-cause mortality, or recurrence. Aims This study aims to conduct an updated systematic review and meta-analysis on the associations of pre-diagnostic and post-diagnostic aspirin use with the aforementioned breast cancer outcomes. It also looks, through subgroup analyses and meta-regressions, at a range of variables that could explain the associations between aspirin use and breast cancer outcomes. Results In total, 24 papers and 149 860 patients with breast cancer were included. Pre-diagnostic aspirin use was not associated with breast-cancer-specific mortality (HR 0.98, 95% CI, 0.80-1.20, P =.84) or recurrence (HR 0.94, 95% CI, 0.88-1.02, P =.13). Pre-diagnostic aspirin was associated with non-significantly higher all-cause mortality (HR 1.27, 95% CI, 0.95-1.72, P =.11). Post-diagnostic aspirin was not significantly associated with all-cause mortality (HR 0.87, 95% CI, 0.71-1.07, P =.18) or recurrence (HR 0.89, 95% CI, 0.67-1.16, P =.38). Post-diagnostic aspirin use was significantly associated with lower breast-cancer-specific mortality (HR 0.79, 95% CI, 0.64-0.98, P =.032). Conclusions The only significant association of aspirin with breast cancer outcomes is lower breast-cancer-specific mortality in patients who used aspirin post-diagnostically. However, factors such as selection bias and high inter-study heterogeneity mean that this result should not be treated as conclusive, and more substantial evidence such as that provided by RCTs is needed before any decisions on new clinical uses for aspirin should be made. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) promotion in healthcare systems is one of the priority areas highlighted by the World Health Organization, which recognizes that progress has been slow largely due to a lack of awareness and investment while requiring a system-based approach. Community pharmacies are one of the health structures that are more easily accessible to populations, thus constituting an ideal venue for developing health promotion activities. This research aimed to describe PA-enabling interventions developed in community pharmacies by pharmacists. Methods: An electronic search was performed in PubMed, Scopus, Web of Science, Cochrane and reference lists of the different papers until June 2023. Studies were eligible if performed in community pharmacies by pharmacists, focused on interventions aimed at increasing PA levels and if at least one PA-specific outcome was measured at two different time points. Results: We identified 7076 publications in the initial search, plus 31 records identified through backward citation tracking from relevant studies. After an initial screening, 236 were selected for full-text analysis. Of the 29 selected papers, 10 presented a low risk of bias for the measurement of PA levels. PA outcomes were generally self-reported outcomes where the change in terms of the percentage of individuals considered active or who increased PA because of the intervention. Conclusion: Several interventions to improve PA through community pharmacies were found although with a high level of heterogeneity and with only few with a low risk of bias. More targeted research that aims to capture PA levels and support the training of healthcare professionals is needed. [ABSTRACT FROM AUTHOR]

Background and objective There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older patients, determine the scope of existing research and identify research gaps in the literature. Methods We undertook a systematic scoping review guided by the Arksey and O'Malley framework and reported in line with the PRISMA-ScR checklist. A systematic search was conducted of Scopus, CINAHL, MEDLINE, PubMed and Cochrane library databases to identify articles published between 2001 and 2021. Study selection criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible articles. A data-charting form was then developed to facilitate thematic analysis. Narrative synthesis then involved identifying major themes and subthemes from the data. Results We identified and reviewed 65 studies, and included 25. We identified five categories: 'field triage', 'ageing impacts', 'decision-making', 'paramedic' awareness' and 'paramedic's behaviour'. Undertriage and overtriage (sensitivity and specificity) were commonly cited as poorly investigated field-triage subthemes. Ageing-related physiologic changes, comorbidities and polypharmacy were the most widely researched. Inaccurate decision-making and poor early identification of major injuries were identified as potentially influencing patient outcomes. Conclusion This is the first study reviewing the published evidence on prehospital trauma care for older patients and identifying research priorities for future research. Field-triage tools, paramedics' knowledge about injuries in the older population, and understanding of paramedics' negative behaviours towards older patients were identified as key research priorities. [ABSTRACT FROM AUTHOR]

Background: With the increasing number of people affected by multiple chronic conditions, it is essential for public-health professionals to promote strategies addressing patient needs for coordinated care. We aim to explore preference heterogeneity for better-coordinated care delivery models in Swiss older adults, and identify profiles of individuals more open to healthcare reforms. Methods: A DCE (discrete choice experiment) survey was developed online and on paper for the Swiss adults aged 50þ, following best practice. To elicit preferences, we estimated a latent class model allowing grouping individuals with similar preferences into distinct classes, and examined what background characteristics contributed to specific class membership. Results: The optimal model identified three classes with different openness to reforms. Class 1 (49%) members were concerned with premium increases and were in favour of integrated care structures with care managed by interprofessional teams. Individuals in class 2 (19%) were younger, open to reforms, and expressed the needs for radical changes within the Swiss healthcare system. Class 3 respondents (32%) were strongly reluctant to changes. Conclusions: Our study goes beyond average preferences and identifies three distinct population profiles, a majority open to reforms on specific aspects of care delivery, a smallest group in favour radical changes, and a third strongly against changes. Therefore, tailored approaches around healthcare reforms are needed, e.g. explaining the role of interprofessional teams in coordinating care, electronic health records and insurance premium variation. [ABSTRACT FROM AUTHOR]

Background Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. Methods In the VOICE community—a European healthcare centre cluster intending to address VBHC from theory to practice—information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. Results Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. Conclusions To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions. [ABSTRACT FROM AUTHOR]

Background Despite the growing utilization of data-driven methods to investigate multimorbidity patterns, there is currently no consensus or guidance on the conditions to include when identifying patterns. This scoping review aims to systematically examine the nature of conditions included in existing studies using data-driven techniques. Methods A comprehensive search of three electronic databases (MEDLINE, Web of Science and Scopus) was conducted to identify relevant publications from inception to 28 February 2022 using predefined search terms and inclusion/exclusion criteria. The reference lists and citations of relevant papers were also searched. Results Among 7326 search results, 5444 relevant articles were identified. After screening against the eligibility criteria, 60 articles were included in the review. Half of the reviewed studies reported selection criteria for conditions, with prevalence in the population of interest being the most common criterion (40%). Most studies included at least one neurological [59 (98.3%)], musculoskeletal [58 (96.7%)], respiratory [57 (95.0%)] or mental health [56 (93.3%)] condition. In contrast, only a small proportion of studies included skin [17 (28.3%)], infections [14 (23.3%)] or autoimmune conditions [10 (16.7%)]. Nine conditions (hypertension, diabetes, cancer, arthritis, COPD, asthma, depression, stroke and osteoporosis) were included by more than half of the studies. Conclusions This review highlights the considerable heterogeneity among the conditions included in analyses of multimorbidity patterns. Researchers should provide a clear rationale for the selection of conditions to facilitate comparisons across studies and ensure reproducibility, as well as consider selecting a diverse range of conditions to capture the complexity of multimorbidity. [ABSTRACT FROM AUTHOR]

Background Lenvatinib plus pembrolizumab significantly improved efficacy compared with chemotherapy in patients with advanced endometrial cancer (aEC) regardless of microsatellite instability status or histologic subtype, who had disease progression following prior platinum-based therapy, in Study-309/KEYNOTE-775. The safety profile of the combination was generally consistent with that of each monotherapy drug and of the combination in patients with endometrial cancer and other solid tumors. Given the medical complexity of patients with aEC, this paper aims to characterize key adverse reactions (ARs) of the combination treatment and review management strategies, providing a guide for AR management to maximize anticancer benefits and minimize treatment discontinuation. Materials and Methods In Study-309/KEYNOTE-775, patients received lenvatinib (20 mg orally once daily) plus pembrolizumab (200 mg intravenously every 3 weeks) or chemotherapy (doxorubicin or paclitaxel). The incidence and median time to the first onset of ARs, dose modifications, and concomitant medications are described. Key ARs characterized include hypothyroidism, hypertension, fatigue, diarrhea, musculoskeletal disorders, nausea, decreased appetite, vomiting, stomatitis, weight decreased, proteinuria, and palmar-plantar erythrodysesthesia syndrome. Results As expected, the most common any-grade key ARs included: hypothyroidism, hypertension, fatigue, diarrhea, and musculoskeletal disorders. Grades 3-4 key ARs with incidence ≥10% included: hypertension, fatigue, and weight decreased. Key ARs first occurred within approximately 3 months of treatment initiation. AR management strategies consistent with the prescribing information and the study protocol are discussed. Conclusion Successful AR management strategies for lenvatinib plus pembrolizumab include education of the patient and entire treatment team, preventative measures and close monitoring, and judicious use of dose modifications and concomitant medications. Clinicaltrials.gov ID NCT03517449 [ABSTRACT FROM AUTHOR]

Background Alcohol increases cancer risk, but less is known about public awareness of this link. This scoping review summarizes recent findings on the public awareness of alcohol as a cancer risk factor in European Union and UK. Methods Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched for papers containing data on awareness of alcohol as cancer risk factor in EU or UK published between January 2017 and December 2022, and complemented with grey literature searches. Results In total, 45 studies were included covering 18 EU countries (Austria, Belgium, Cyprus, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, Netherlands, Poland, Romania, Slovakia, Slovenia, Spain, Sweden) and UK, presenting data collected between 2009 and 2022. Studies covered general population (17 studied a nationally representative sample), women, health professionals, patients and young people. Awareness of alcohol causing cancer in general was higher and studied more often than awareness of alcohol's impact on specific cancers. Among the EU general population, awareness of the link between alcohol and breast cancer ranged between 10% and 20%, head and neck cancer 15–25%, colorectal and oesophagus cancer 15–45% and liver cancer 40%. Awareness was higher among young people and specialized health professions and lower among women (the latter specifically for the breast cancer). Conclusions While awareness rates varied depending on the exact question wording, many studies showed low awareness of the alcohol-cancer link, especially for specific types such as breast and colon cancer. Public should be better informed about alcohol consumption-related cancer risk. [ABSTRACT FROM AUTHOR]

This study compared the reliability and validity of student scores from paper–pencil and e-based assessments using the "maze" and "silent reading fluency" (SRF) tasks. Forty students who were deaf and hard of hearing and reading between the second and fifth grade reading levels and their teachers (n  = 21) participated. For maze, alternate form reliability coefficients obtained from correct scores and correct scores adjusted for guessing ranged from r  = .61 to.84 (p s  <  .01); criterion-related validity coefficients ranged from r  = .33 to.67 (most p s < .01). For SRF, reliability coefficients obtained from correct scores ranged from r  = .50 to.75 (p s  <  .01); validity ranged from r  = .25 to.72. Differences between student performance on paper–pencil and e-based conditions were generally non-significant for maze; significant differences between conditions for SRF favored the paper–pencil condition. Findings suggest that maze holds promise, with inconclusive results for SRF. [ABSTRACT FROM AUTHOR]

Objective: To validate an ion exchange high-pressure liquid chromatography (HPLC) method for measuring glycated hemoglobin (HbA1c) in gingival crevicular blood (GCB) spotted on filter paper, for use in screening dental patients for diabetes. Methods: We collected the GCB specimens for this study from the oral cavities of patients during dental visits, using rigorous strategies to obtain GCB that was as free of debris as possible. The analytical performance of the HPLC method was determined by measuring the precision, linearity, carryover, stability of HbA1c in GCB, and correlation of HbA1c results in GCB specimens with finger-stick blood (FSB) specimens spotted on filter paper. Results: The coefficients of variation (CVs) for the inter- and intrarun precision of the method were less than 2.0%. Linearity ranged between 4.2% and 12.4%; carryover was less than 2.0%, and the stability of the specimen was 6 days at 4ºC and as many as 14 days at -70ºC. Linear regression analysis comparing the HbA1c results in GCB with FSB yielded a correlation coefficient of 0.993, a slope of 0.981, and an intercept of 0.13. The Bland-Altman plot showed no difference in the HbA1c results from the GCB and FSB specimens at normal, prediabetes, and diabetes HbA1c levels. Conclusion: We validated an HPLC method for measuring HbA1c in GCB; this method can be used to screen dental patients for diabetes. [ABSTRACT FROM AUTHOR]

Objective Utilities are values of health-related quality of life (HRQoL) based on patient preference for a health status. The purpose of this study was to compare indirect measures to a directly elicited utility. Design Cross-sectional study. Setting and Patients Emory Spine Center and the Emory Center for Chronic Pain at Crawford Long Hospital. Patients at least 18 years of age with chronic pain, defined as pain that persists beyond the normal time of healing, usually beyond 6 months. Measures Chronic pain subjects completed a paper-based, self-administered time trade-off ( TTO) survey, EQ-5 D survey, and a face-to-face ( FTF) TTO interview. Current pain severity was graded using the Numeric Rating Scale-11, subsequently stratified into no (0), mild (1-3), moderate (4-6), and severe (7-10) pain. Results Paired t test comparing FTF TTO and proxy utility measures stratified by severity revealed FTF TTO utility values significantly higher than EQ-5 D utility values for all pain severities (overall mean difference 0.18, standard deviation [ SD] 0.30, P < 0.001; Pearson's correlation 0.34, P < 0.0001); FTF TTO utility values were lower than paper TTO utility values, reaching statistical significance for mild and moderate pain (overall mean difference 0.09, SD 0.29, P = 0.0006; Pearson's correlation 0.38, P < 0.0001). Conclusions This study demonstrates that the EQ-5 D overestimates, whereas the paper version of TTO underestimates, the impact of pain on HRQoL compared with the directly elicited FTF TTO utility. Our findings provide preliminary evidence that utilities vary by method, and directly elicited utility values differ from indirectly elicited measures. [ABSTRACT FROM AUTHOR]

Background The term 'long COVID' describes ongoing symptoms and conditions experienced by people infected with SARS-CoV-2. This paper illustrates how a public health approach was used to influence and inform the development of post-COVID services across two Integrated Care Systems (ICSs). Methods A literature review was conducted between October and December 2020 to identify prevalence estimates for long COVID. The prevalence estimates were applied to locally available data on the susceptible population to estimate the number of people with long COVID. They were also used to develop a dashboard to predict fluctuations in the number of people experiencing persistent symptoms over time. Results A substantial number of people in each ICS may have experienced persistent symptoms or complications as a result of COVID-19. In Lancashire and South Cumbria, it is estimated that 33 000 people may have experienced post-COVID-19 syndrome since the beginning of the pandemic, which will include respiratory or cardiovascular complications. Conclusions The findings have been valuable in informing early service developments, engaging with managers and clinicians, and supporting applications for funding at a local level. Continued attention to emergent evidence on this topic will be vital in refining estimates and supporting service planning in the longer term. [ABSTRACT FROM AUTHOR]

Introduction: risk-stratifying older people accessing urgent care is a potentially useful first step to ensuring that the most vulnerable are able to access optimal care from the start of the episode. While there are many risk-stratification tools reported in the literature, few have addressed the practical issues of implementation. This review sought evidence about the feasibility of risk stratification for older people with urgent care needs. Methods: medline was searched for papers addressing risk stratification and implementation (feasibility or evaluation or clinician acceptability). All search stages were conducted by two reviewers, and selected papers were graded for quality using the CASP tool for cohort studies. Data were summarised using descriptive statistics only. Results: about 1872 titles of potential interest were identified, of which 1827 were excluded on title/abstract review, and a further 43 after full-text review, leaving four papers for analysis. These papers described nine tools, which took between 1 and 10 minutes to complete for most participants. No more than 52% of potentially eligible older people were actually screened using any of the tools. Little detail was reported on the clinical acceptability of the tools tested. Discussion: the existing literature indicates that commonly used risk-stratification tools are relatively quick to use, but do not cover much more than 50% of the potential population eligible for screening in practice. Additional work is required to appreciate how tools are likely to be used, by whom, and when in order to ensure that they are acceptable to urgent care teams. [ABSTRACT FROM AUTHOR]

Objectives This scoping review identifies research in musculoskeletal disorders that uses high frequency follow-up of symptoms. The aim was to investigate whether symptom variability is investigated as a predictor of disease outcome and how intensive follow-up methods are used in musculoskeletal research. Methods Embase, MEDLINE and PsycInfo were searched using OVID, and the Institute of Electrical and Electronic Engineers was also searched using the Institute of Electrical and Electronic Engineers Xplore search engine. Studies were systematically reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses, but no meta-analysis was done because the priority in this study is to identify gaps in available literature. Results Twenty-one papers were included. There was a mean of 54 patients per study (s. d. of 27.7). Two-thirds of the papers looked at how a symptom influences another in the short-term (subsequent assessment in the same day or next day), but none looked at the long-term. Only one study considered symptom variability investigating how higher variability in pain (defined by the s. d.) is associated with higher average pain severity and lower average sleep quality. Conclusion The methodology of musculoskeletal disorder research has changed from completing paper booklets to using electronic data capture (smartphones). There has also been a trend of collecting more intensive longitudinal data, but very little research utilizes these data to look at how symptom variability affects symptom outcomes. This demonstrates a gap in research where furthering understanding of this will help clinicians decide on the most important symptom to address in future patients. [ABSTRACT FROM AUTHOR]

Parents or caregivers of children who are deaf or hard of hearing are required to make complex and rational decisions soon after the confirmation of hearing loss. Ways of facilitating decision-making have been a focus within the healthcare sector for two decades and shared decision-making is now widely viewed as the standard for good clinical care. A systematic literature review was undertaken to identify the extent to which the principles of shared decision-making and informed choice have been implemented for parents when they make decisions related to their children with permanent hearing loss. Five databases were searched for peer-reviewed papers describing the results of original research published from 2000 to 2017, yielding 37 relevant papers. Studies were reviewed using the three phases of decision-making—information exchange, deliberation, and implementation. Two decisions dominated these studies—implantable devices and communication modality. Most papers dealt with decision-making in the context of bilateral hearing loss, with only one study focusing on unilateral hearing loss. The review identified gaps where further research is needed to ensure the lessons learnt in the broader decision-making literature are implemented when parents make decisions regarding their child who is deaf or hard of hearing. [ABSTRACT FROM AUTHOR]

To investigate trends observed in a decade of published research on multimodality PET(/CT)+MR imaging in abdominal oncology, and to explore how these trends are reflected by the use of multimodality imaging performed at our institution. First, we performed a literature search (2009–2018) including all papers published on the multimodality combination of PET(/CT) and MRI in abdominal oncology. Retrieved papers were categorized according to a structured labelling system, including study design and outcome, cancer and lesion type under investigation and PET-tracer type. Results were analysed using descriptive statistics and evolutions over time were plotted graphically. Second, we performed a descriptive analysis of the numbers of MRI, PET/CT and multimodality PET/CT+MRI combinations (performed within a ≤14 days interval) performed during a similar time span at our institution. Published research papers involving multimodality PET(/CT)+MRI combinations showed an impressive increase in numbers, both for retrospective combinations of PET/CT and MRI, as well as hybrid PET/MRI. Main areas of research included new PET-tracers, visual PET(/CT)+MRI assessment for staging, and (semi-)quantitative analysis of PET-parameters compared to or combined with MRI-parameters as predictive biomarkers. In line with literature, we also observed a vast increase in numbers of multimodality PET/CT+MRI imaging in our institutional data. The tremendous increase in published literature on multimodality imaging, reflected by our institutional data, shows the continuously growing interest in comprehensive multivariable imaging evaluations to guide oncological practice. The role of multimodality imaging in oncology is rapidly evolving. This paper summarizes the main applications and recent developments in multimodality imaging, with a specific focus on the combination of PET+MRI in abdominal oncology. [ABSTRACT FROM AUTHOR]

Background and Aim The aim of this systematic review was to quantify the association between frailty and COVID-19 in relation to mortality in hospitalised patients. Methods Medline, Embase, Web of Science and the grey literature were searched for papers from inception to 10 September 2020; the search was re-run in Medline up until the 9 December 2020. Screening, data extraction and quality grading were undertaken by two reviewers. Results were summarised using descriptive statistics, including a meta-analysis of overall mortality; the relationships between frailty and COVID-19 mortality were summarised narratively. Results A total of 2,286 papers were screened resulting in 26 being included in the review. Most studies were from Europe, half from the UK, and one from Brazil; the median sample size was 242.5, median age 73.1 and 43.5% were female. In total, 22/26 used the Clinical Frailty Scale; reported mortality ranged from 14 to 65%. Most, but not all studies showed an association between increasing frailty and a greater risk of dying. Two studies indicated a sub-additive relationship between frailty, COVID-19 and death, and two studies showed no association. Conclusions Whilst the majority of studies have shown a positive association between COVID-19-related death and increasing frailty, some studies suggested a more nuanced understanding of frailty and outcomes in COVID-19 is needed. Clinicians should exert caution in placing too much emphasis on the influence of frailty alone when discussing likely prognosis in older people with COVID-19 illness. [ABSTRACT FROM AUTHOR]

Background Declines in cardiorespiratory fitness (CRF) and muscle mass are both associated with advancing age and each of these declines is associated with worse health outcomes. Resistance exercise training (RET) has previously been shown to improve muscle mass and function in the older population. If RET is also able to improve CRF, as it has been shown to do in younger populations, it has the potential to improve multiple health outcomes in the expanding older population. Methods This systematic review aimed to identify the role of RET for improving CRF in healthy older adults. A search across CINAHL, MEDLINE, EMBASE and EMCARE databases was conducted with meta-analysis performed on eligible papers to identify improvements in established CRF parameters (VO2 peak, aerobic threshold (AT), 6-minute walking distance test (6MWT) following RET intervention. Main eligibility criteria included older adults (aged over 60), healthy cohorts (disease-specific cohorts were excluded) and RET intervention. Results Thirty-seven eligible studies were identified. Meta-analysis revealed a significant improvement in VO2 peak (MD 1.89 ml/kg/min; 95% confidence interval (CI) 1.21–2.57 ml/kg/min), AT (MD 1.27 ml/kg/min; 95% CI 0.44–2.09 ml/kg/min) and 6MWT (MD 30.89; 95% CI 26.7–35.08) in RET interventions less than 24 weeks. There was no difference in VO2 peak or 6MWT in interventions longer than 24 weeks. Discussion This systematic review adds to a growing body of evidence supporting the implementation of RET in the older population for improving whole-body health, particularly in time-limited timeframes. [ABSTRACT FROM AUTHOR]

For at least the past 5 decades, population genetics, as a field, has worked to describe the precise balance of forces that shape patterns of variation in genomes. The problem is challenging because modeling the interactions between evolutionary processes is difficult, and different processes can impact genetic variation in similar ways. In this paper, we describe how diversity and divergence between closely related species change with time, using correlations between landscapes of genetic variation as a tool to understand the interplay between evolutionary processes. We find strong correlations between landscapes of diversity and divergence in a well-sampled set of great ape genomes, and explore how various processes such as incomplete lineage sorting, mutation rate variation, GC-biased gene conversion and selection contribute to these correlations. Through highly realistic, chromosome-scale, forward-in-time simulations, we show that the landscapes of diversity and divergence in the great apes are too well correlated to be explained via strictly neutral processes alone. Our best fitting simulation includes both deleterious and beneficial mutations in functional portions of the genome, in which 9 % of fixations within those regions is driven by positive selection. This study provides a framework for modeling genetic variation in closely related species, an approach which can shed light on the complex balance of forces that have shaped genetic variation. [ABSTRACT FROM AUTHOR]

Aims Cardiovascular magnetic resonance parametric mapping enables non-invasive quantitative myocardial tissue characterization. Human myocardium has normal ranges of T1 and T2 values, deviation from which may indicate disease or change in physiology. Normal myocardial T1 and T2 values are affected by biological sex. Consequently, normal ranges created with insufficient numbers of each sex may result in sampling biases, misclassification of healthy values vs. disease, and even misdiagnoses. In this study, we investigated the impact of using male normal ranges for classifying female cases as normal or abnormal (and vice versa). Methods and results One hundred and forty-two healthy volunteers (male and female) were scanned on two Siemens 3T MR systems, providing averaged global myocardial T1 and T2 values on a per-subject basis. The Monte Carlo method was used to generate simulated normal ranges from these values to estimate the statistical accuracy of classifying healthy female or male cases correctly as 'normal' when using sex-specific vs. mixed-sex normal ranges. The normal male and female T1- and T2-mapping values were significantly different by sex, after adjusting for age and heart rate. Conclusion Using 15 healthy volunteers who are not sex specific to establish a normal range resulted in a typical misclassification of up to 36% of healthy females and 37% of healthy males as having abnormal T1 values and up to 16% of healthy females and 12% of healthy males as having abnormal T2 values. This paper highlights the potential adverse impact on diagnostic accuracy that can occur when local normal ranges contain insufficient numbers of both sexes. Sex-specific reference ranges should thus be routinely adopted in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives Pleuroparenchymal fibroelastosis (PPFE) is characterized by predominantly upper lobe pleural and subjacent parenchymal fibrosis; PPFE features were described in patients with rheumatic autoimmune diseases (RAID). A systematic literature review was performed to investigate the prevalence, prognosis and potential association of PPFE with previous immunosuppression in RAID. Methods EMBASE, Web of Science and PubMed databases were questioned from inception to 1 September 2019. Articles published in English and addressing PPFE in patients with RAID were selected. Results Twenty out of 794 papers were selected with a total of 76 cases of RAID-PPFE patients (20 SSc, 9 RA, 6 IIM6 primary SS, 5 overlap syndromes, 3 ANCA-associated vasculitides, 2 granulomatosis with polyangiitis, 1 microscopic polyangiitis, 1 UCTD, 1 SLE, 1 GCA and 21 patients with non-specified RAID). Dyspnoea was the most frequently reported symptom (37/48 patients, 77%). Patients frequently presented with a restrictive pattern and decline in diffusing lung capacity for carbon monoxide. During the follow-up, 7/12 patients had progression at imaging, 22/39 presented a generic clinical worsening, 19/38 had a functional deterioration and 15/43 remained stable. Conclusion The present systematic literature review confirms that PPFE features are present in RAID. Rheumatologists should be aware of this new radiological pattern that holds a bad prognosis. [ABSTRACT FROM AUTHOR]

Background frailty is common in older adults and associated with poor outcomes following illness. Although stroke is predominantly a disease of older people, our knowledge of frailty in stroke is limited. We aimed to collate the literature on acute stroke and frailty to estimate the prevalence of pre-stroke frailty and its associations with outcomes. Methods paired researchers searched multidisciplinary electronic databases for papers describing frailty and acute stroke. We assessed risk of bias using Newcastle-Ottawa tools appropriate to study design. We created summary estimates of pre-stroke frailty using random effects models. We collated whether studies reported significant positive associations between frailty and clinical outcomes in adjusted models. Results we included 14 studies (n  = 27,210 participants). Seven studies (n  = 8,840) used a frailty index approach, four studies (n  = 14,924) used Hospital Frailty Risk Scores. Pooled prevalence of pre-stroke frailty was 24.6% (95% confidence interval, CI: 16.2–33.1%; low quality evidence, downgraded due to heterogeneity, bias). Combining frailty and pre-frailty (nine studies, n  = 23,827), prevalence of any frailty syndrome was 66.8% (95%CI: 49.9–83.7%). Seven studies were at risk of bias, from participant selection or method of frailty assessment. Pre-stroke frailty was associated with all adverse outcomes assessed, including longer-term mortality (positive association in 6 of 6 studies reporting this outcome; odds ratio: 3.75 [95%CI: 2.41–5.70]), length of admission (3 of 4 studies) and disability (4 of 6 studies). Conclusions despite substantial heterogeneity, whichever way it is measured, frailty is common in patients presenting with acute stroke and associated with poor outcomes. This has implications for the design of stroke services and pathways. [ABSTRACT FROM AUTHOR]

Few studies exist on the early care and education (ECE) of children who are deaf in low-to-middle-income countries, and none examine the roles of deaf adults in such provision. A research base is needed to inform contextually sensitive "deaf-infused" models of ECE in such contexts that build on indigenous deaf community experience, knowledge, and local expertise. This paper discusses the development of ECE in Ghana in sub-Saharan Africa focusing specifically on the perspectives of deaf adults on their roles in ECE support and leadership. Seventeen deaf adults with different leadership and advocacy roles in Ghana were interviewed about their perceptions of ECE priorities in this context, and the role of deaf adults in the development and delivery of early support. The participants expressed diverse views on ECE for the children and their families and suggested ways of building capacity and leadership among deaf adults to support ECE for the children and their families. [ABSTRACT FROM AUTHOR]

Background Child malnutrition remains a matter of concern in India as the current levels are high and the decline is slow. National Family Health Survey (NFHS–4, 2015-16) data, for the first time, provides credible, good quality data at district level on social, household and health characteristics. Methods Techniques of spatial analysis on data in respect of 640 districts were used to identify spatial characteristics of the nutrition levels for children in the 0–60-month age group. Further, the principal component analysis (PCA) was used to identify 7 important correlates of the malnutrition out of 21 relevant components provided in the NFHS-4. The paper further uses three techniques, ordinary least squares (OLS), spatial lag model (SLM) and spatial error model (SEM) to assess the strength of correlation between the malnutrition levels and the shortlisted correlates. Results The use of SLM and SEM shows improvement in the strength of the association (high R -square) compared to OLS. Women's height and Iodized salt in stunting, child anaemia in wasting, women's height and child anaemia in underweight were found to be significant factors (P  < 0.01) along with spatial autoregressive constant. Conclusions Such analysis, in combination with PCA, has shown to be more effective in prioritizing the programme interventions for tackling child malnutrition. [ABSTRACT FROM AUTHOR]

Background most people living with dementia (PLWD) will develop incontinence problems with associated harmful consequences. Well-contained incontinence is often the main treatment goal. It would therefore be expected that poorly contained incontinence would have a negative impact. Aim to investigate differences in how well-contained or poorly contained incontinence impacts on the experience of living with incontinence for PLWD at home and their carers. Design secondary analysis of a qualitative study. Methods semi-structured interviews were undertaken with PLWD, carers and healthcare professionals (continence or dementia nurses). PLWD and carers were recruited via www.joindementiaresearch.nihr.ac.uk and via dementia/carer groups. Nurses were recruited via their employers. Interviews were recorded and transcribed verbatim. Framework analysis was used. Results forty-five people (twenty-six carers, two PLWD, nine continence nurses and eight dementia nurses) participated. Despite poorly contained incontinence, some PLWD/carer dyads appeared relatively unaffected by incontinence. Conversely, one or both members of some dyads who achieved good containment found incontinence care highly challenging. Four themes were identified, together forming a preliminary model of incontinence containment and impact, as follows: Well-contained incontinence, lower negative impact Well-contained incontinence, higher negative impact Poorly contained incontinence, higher negative impact Poorly contained incontinence, lower negative impact Conclusion reliable containment is an important goal for PLWD living at home and their carers, but it is not the only goal. Other factors, such as behaviours that challenge or carer coping strategies, can mean that even well-contained incontinence can have a negative impact. This paper proposes a preliminary model for evaluation. [ABSTRACT FROM AUTHOR]

Objectives Remission (REM) or low disease activity (LDA) is the treatment target in psoriatic arthritis (PsA). The objective of this study was to assess the reporting and prevalence of REM/LDA in published studies of PsA. Methods This was a systematic literature review of all clinical papers published in PubMed, EMBASE or Cochrane database in English between 2012 and 2019 in the field of PsA. Data were collected regarding reporting of REM/LDA by very low disease activity/minimal disease activity (VLDA/MDA), Disease Activity index for Psoriatic Arthritis (DAPSA), or Disease Activity Score 28 joints (DAS28). The pooled rates of REM and LDA by each definition were calculated by random effect meta-analysis. Results In all, 258 publications (corresponding to 114 651 patients), of which 81 (31%) were randomized controlled trials, were analysed: patients' mean age was 49.4 ( 4.4) years; with a mean disease duration of 8.5 ( 3.8) years. REM/LDA was reported in 91/258 (35.3%) publications. VLDA/MDA was used in 61/91 (67.0%) studies, DAPSA in 27/91 (29.6%) and DAS28 in 28/91 (30.7%), with 40/91 (43.9%) papers reporting several of these definitions. The pooled prevalence (lower–upper limits) of REM was 13.1% (10.9–15.4), 23.1% (16.8–30.1) and 42.1% (33.9–50.4) using VLDA, DAPSA-REM and DAS28, respectively. For LDA the pooled prevalence was 36.3% (32.3–40.5), 52.8% (41.8–63.6) and 60.4% (52.5–68.0) using MDA, DAPSA-LDA and DAS28, respectively. Conclusion REM/LDA status was reported in only1/3 of recent studies on PsA, with important variations in the frequency of these outcomes according to the definition used: 13.1–42.1% for REM, and 36.3–60.4% for LDA. This highlights the need for consensus. [ABSTRACT FROM AUTHOR]

Objective To investigate medication prescription patterns among children with JIA, including duration, sequence and reasons for medication discontinuation. Methods This study is a single-centre, retrospective analysis of prospective data from the electronic medical records of JIA patients receiving systemic therapy aged 0–18 years between 1 April 2011 and 31 March 2019. Patient characteristics (age, gender, JIA subtype) and medication prescriptions were extracted and analysed using descriptive statistics, Sankey diagrams and Kaplan–Meier survival methods. Results Over a median of 4.2 years follow-up, the 20 different medicines analysed were prescribed as monotherapy (n  = 15) or combination therapy (n  = 48 unique combinations) among 236 patients. In non-systemic JIA, synthetic DMARDs were prescribed to almost all patients (99.5%), and always included MTX. In contrast, 43.9% of non-systemic JIA patients received a biologic DMARD (mostly adalimumab or etanercept), ranging from 30.9% for oligoarticular persistent ANA-positive JIA, to 90.9% for polyarticular RF-positive JIA. Among systemic JIA, 91.7% received a biologic DMARD (always including anakinra). When analysing medication prescriptions according to their class, 32.6% involved combination therapy. In 56.8% of patients, subsequent treatment lines were initiated after unsuccessful first-line treatment, resulting in 68 unique sequences. Remission was the most common reason for DMARD discontinuation (44.7%), followed by adverse events (28.9%) and ineffectiveness (22.1%). Conclusion This paper reveals the complexity of pharmacological treatment in JIA, as indicated by: the variety of mono- and combination therapies prescribed, substantial variation in medication prescriptions between subtypes, most patients receiving two or more treatment lines, and the large number of unique treatment sequences. [ABSTRACT FROM AUTHOR]

Objective Physical therapy is placing new emphasis on how the profession might contribute to improving population health. However, little is known about the nature of population-based practice (PBP) of physical therapists. Therefore, the purpose of this study was to develop a view of PBP from the perspective of physical therapists engaged in it. Methods Twenty-one physical therapists participating in PBP were interviewed. Qualitative descriptive analysis was used to summarize results. Results Most of the reported PBP was at the community and individual level, and the most common types of PBP were health teaching and coaching, collaboration and consultation, and screening and outreach. Three topic areas were identified (with respective themes): characteristics of PBP (meeting group or community needs, promotion and prevention, access, and movement), preparation for PBP (core vs elective, experiential learning, social determinants of health, and health behavior change), and rewards and challenges of PBP (intrinsic rewards, funding and resources, professional recognition, and complexity of behavior change). Conclusion PBP in physical therapy presents practitioners with rewards and challenges as they work to improve the health of populations. Impact Physical therapists who are currently engaged in PBP are, in effect, defining the role of the profession in improving health at a population level. The information in this paper will help the profession move from a theoretical view of the role of physical therapists in improving population health to understanding what this role looks like in practice. [ABSTRACT FROM AUTHOR]

Background Lowering the strength of alcohol products could lead to less alcohol being bought and drunk. In its prevention White Paper, the UK Government aims to promote a significant increase in the availability of alcohol-free and low-alcohol products by 2025. Methods Through descriptive analysis and ARIMA modelling of >4 million alcohol purchases from 69 803 British households, we study the potential impact of lower strength alcohol products in reducing household purchases of grams of alcohol over 2015–2019. Households are divided into predominantly beer, wine or spirits purchasers. Results Over 5 years, there were decreases in purchases of grams of alcohol within beer amongst beer-purchasing households and increases in purchases of grams of alcohol within wine and spirits amongst, respectively, wine- and spirits-purchasing households. Almost all the changes were due to beer-purchasing households buying less regular strength beer, and wine and spirits-purchasing households buying, respectively, more regular strength wine and spirits, rather than increases in purchases of no- and low-alcohol products. Conclusions In general, lower strength alcohol products have not contributed to British households buying fewer grams of alcohol over the 5-year follow-up period during 2015–2019. [ABSTRACT FROM AUTHOR]

Background Smoking rates in Greece are the highest recorded among OECD countries, but the historical and life-course evolution of smoking patterns is largely unknown. The present paper addresses this gap. Methods We produce nationally representative life-course trajectories of smoking and related mortality of eight generations of Greek men and women. We estimate the smoking–mortality correlation conditional on several confounders and project the estimates forward. Results We show that smoking prevalence among Greek men has plateaued at >60% for all but the youngest generation. For women, smoking prevalence is relatively lower, lags by several generations and follows a hump-shaped pattern. Smoking-attributable mortality is currently peaking for men (nearing 40% of total deaths) and is rising for women. We estimate that it takes ~20 years of smoking to maximize the smoking–mortality correlation (at 0.48 for men and 0.32 for women). Based on this estimation, we forecast that mortality rates will begin falling within the current decade. Conclusions The breadth of the Greek smoking epidemic has been high by international standards, reflecting the ineffective tobacco control efforts in the country. While smoking popularity fell during the Great Recession, policy vigilance is necessary to prevent a relapse once the economy recovers. [ABSTRACT FROM AUTHOR]

The development of tools for power and sample-size calculations for mediation analysis has lagged far behind the development of methods. The accompanying paper by Rudolph et al. (Am J Epidemiol. 2020;189(12):1559–1567) is a helpful contribution in using simulations as a tool for power calculations for more complex methods and settings. Much work remains to be done in the development of easy-to-use packages and simple online websites for carrying out power and sample-size calculations for mediation analysis. Much remains to be learned with respect to the relative power of different methods in different settings. There will likely be feedback between these 2 important frontiers of the tools we have available and of our understanding of power when conducting mediation analysis. [ABSTRACT FROM AUTHOR]

Background: ambulatory blood pressure monitoring (ABPM) may be helpful for the management of hypertension, but little is known about its tolerability in people with dementia. Objective: to review the published evidence to determine the tolerability of ABPM in people with dementia. Methods: English language search conducted in MEDLINE and EMBASE, using Ambulatory blood pressure' AND 'Dementia' (and associated synonyms) from 1996 to March 2015. Inclusion criteria: people diagnosed with dementia AND in whom blood pressure was measured using ABPM. The initial search was undertaken using title and abstract reviews, with selected papers being agreed for inclusion by two reviewers. Potentially eligible papers were assessed, and high-quality papers were retained. Two reviewers agreed the abstracted data for analysis. Meta-analysis was used to combine results across studies. Results: of the 221 screened abstracts, 13 studies (6%) met inclusion criteria, 5 had sufficient data and were of sufficient quality, involving 461 participants, most of whom had mild--moderate dementia. 77.7% (95% CI 62.2-93.2%) were able to tolerate ABPM; agreement with office BP was moderate to weak (two studies only--coefficients 0.3-0.38 for systolic blood pressure and 0.11-0.32 for diastolic blood pressure). One study compared home BP monitoring by a relative or ambulatory BP monitoring with office BP measures and found high agreement (ϗ 0.81). The little available evidence suggested increased levels of dementia being associated with reduced tolerability. Conclusions: ABPM is well tolerated in people with mild-moderate dementia and provides some additional information over and above office BP alone. However, few studies have addressed ABPM in people with more severe dementia. [ABSTRACT FROM AUTHOR]

Objective This study aims at reviewing novel coronavirus disease (COVID-19) datasets extracted from PubMed Central articles, thus providing quantitative analysis to answer questions related to dataset contents, accessibility and citations. Methods We downloaded COVID-19-related full-text articles published until 31 May 2020 from PubMed Central. Dataset URL links mentioned in full-text articles were extracted, and each dataset was manually reviewed to provide information on 10 variables: (1) type of the dataset, (2) geographic region where the data were collected, (3) whether the dataset was immediately downloadable, (4) format of the dataset files, (5) where the dataset was hosted, (6) whether the dataset was updated regularly, (7) the type of license used, (8) whether the metadata were explicitly provided, (9) whether there was a PubMed Central paper describing the dataset and (10) the number of times the dataset was cited by PubMed Central articles. Descriptive statistics about these seven variables were reported for all extracted datasets. Results We found that 28.5% of 12 324 COVID-19 full-text articles in PubMed Central provided at least one dataset link. In total, 128 unique dataset links were mentioned in 12 324 COVID-19 full text articles in PubMed Central. Further analysis showed that epidemiological datasets accounted for the largest portion (53.9%) in the dataset collection, and most datasets (84.4%) were available for immediate download. GitHub was the most popular repository for hosting COVID-19 datasets. CSV, XLSX and JSON were the most popular data formats. Additionally, citation patterns of COVID-19 datasets varied depending on specific datasets. Conclusion PubMed Central articles are an important source of COVID-19 datasets, but there is significant heterogeneity in the way these datasets are mentioned, shared, updated and cited. [ABSTRACT FROM AUTHOR]

Public health agencies are increasingly concerned with ensuring that they are maximizing limited resources by delivering effective programs to enhance population-level health outcomes. Preventing mis-implementation (ending effective activities prematurely or continuing ineffective ones) is necessary to sustain public health efforts and resources needed to improve health and well-being. The purpose of this paper is to identify the important qualities of leadership in preventing mis-implementation of public health programs. In 2019, 45 state health department chronic disease employees were interviewed via phone and audio-recorded, and the conversations were transcribed verbatim. Thematic analysis focused on items related to mis-implementation and the manners in which leadership were involved in continuing ineffective programs. Final themes were based on a Public Health Leadership Competency Framework. The following themes emerged from their interviews regarding the important leadership competencies to prevent mis-implementation: '(1) leadership and communication; (2) collaborative leadership (3) leadership to adapt programs; (4) leadership and organizational learning and development; and (5) political leadership'. This first of its kind study showed the close interrelationship between mis-implementation and leadership. Increased attention to public health leader competencies might help to reduce mis-implementation in public health practice and lead to more effective and efficient use of limited resources. [ABSTRACT FROM AUTHOR]

Aims Many parents in contact with children's social care services misuse alcohol however do not meet the threshold for specialist alcohol treatment, and typically do not receive appropriate support for their needs. Brief alcohol interventions have been found to be effective in healthcare settings, however, it is unknown whether the brief intervention structure delivered within health settings would transfer well into children's social care. This paper aims to examine the characteristics of brief intervention for alcohol misusing parents which social care practitioners consider to be important and acceptable to implement in this sector. Methods We assessed preferences for, and acceptability of, brief alcohol intervention with parents in contact with children's social care using a discrete choice experiment. We recruited 205 children's social care practitioners from London and the North East of England. Data were analysed using mixed logit which accounted for repeated responses. Findings Six attributes showed statistically significant coefficients, suggesting that a brief intervention with these attributes would encourage implementation. These were: level of alcohol-related risk targeted; intervention recipient; timing of intervention; duration of sessions; number of sessions and intervention structure. The attribute of most importance identified based on the attribute with the largest coefficient in the conditional logit model was risk level. Conclusions Brief alcohol interventions delivered to parents in social care should focus on the impact upon children and the wider family, they should be a flexible part of on-going casework and should be more intensive and less structured. [ABSTRACT FROM AUTHOR]

Objective The field of pain-related research has gained more attention as the prevalence of chronic pain increased over the years. The objective of this research was to identify highly cited papers, as well as contributors, to pain-related research. Design Pain-related articles published from 1900 to 2011 were screened, and highly cited papers, with at least 100 citations since publication, were identified and selected for a bibliometric analysis. The total number of papers, authorship, and collaboration statistics are presented for countries, institutions, and authors. To assess contributions, a new indicator, the major contributor index ( MCI), was used. Citation trends for all papers, as well as for top papers, are presented. Results A total of 7,327 articles, 2.4% of all pain-related articles, had received at least 100 citations since publication. In recent decades, top-cited articles have reached a citation peak more quickly, and have shown a more-rapid decreasing trend, compared with top-cited articles from earlier decades. The leading countries were United States, UK, Canada, and Germany. The leading institutions were Harvard University, University of California, San Francisco, University of Texas, and University of Washington. MCI varied among leading institutions, as well as among individual authors. Conclusions An indicator like the MCI can provide a proxy for the contributions made by an individual or institution. It reflects the independent research ability and leadership. In future evaluations of institution or individual performances, the MCI should be included, together with the number of total papers, to provide a better profile of research performance. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to investigate the effects of breathing frequency and flow rate on the total inward leakage (TIL) of an elastomeric half-mask donned on an advanced manikin headform and challenged with combustion aerosols. Methods: An elastomeric half-mask respirator equipped with P100 filters was donned on an advanced manikin headform covered with life-like soft skin and challenged with aerosols originated by burning three materials: wood, paper, and plastic (polyethylene). TIL was determined as the ratio of aerosol concentrations inside (Cin) and outside (Cout) of the respirator (Cin/Cout) measured with a nanoparticle spectrometer operating in the particle size range of 20–200nm. The testing was performed under three cyclic breathing flows [mean inspiratory flow (MIF) of 30, 55, and 85 l/min] and five breathing frequencies (10, 15, 20, 25, and 30 breaths/min). A completely randomized factorial study design was chosen with four replicates for each combination of breathing flow rate and frequency. Results: Particle size, MIF, and combustion material had significant (P < 0.001) effects on TIL regardless of breathing frequency. Increasing breathing flow decreased TIL. Testing with plastic aerosol produced higher mean TIL values than wood and paper aerosols. The effect of the breathing frequency was complex. When analyzed using all combustion aerosols and MIFs (pooled data), breathing frequency did not significantly (P = 0.08) affect TIL. However, once the data were stratified according to combustion aerosol and MIF, the effect of breathing frequency became significant (P < 0.05) for all MIFs challenged with wood and paper combustion aerosols, and for MIF = 30 l/min only when challenged with plastic combustion aerosol. Conclusions: The effect of breathing frequency on TIL is less significant than the effects of combustion aerosol and breathing flow rate for the tested elastomeric half-mask respirator. The greatest TIL occurred when challenged with plastic aerosol at 30 l/min and at a breathing frequency of 30 breaths/min. [ABSTRACT FROM AUTHOR]

We assessed human papillomavirus (HPV) prevention practices and HPV literacy of pediatricians, family physicians and medical students in North Carolina. An online survey was distributed to physicians in 2018, and paper surveys were collected among medical students in 2019. Surveys measured HPV literacy, HPV prevention practices and HPV prevention self-efficacy. In terms of comfort, 27% of medical students and 24% of physicians anticipated having an uncomfortable conversion when recommending the vaccine to patients. Most physicians (76%, n  = 230) followed the HPV vaccine age recommendation guidelines; however, those with higher HPV vaccine knowledge were more compliant with the guidelines (P  < 0.01). Female physicians were more likely to start routinely recommending the HPV vaccine to women (84%, n  = 134 versus 72%, n  = 92) and men (81%, n  = 127 versus 71%, n  = 84) between the ages of 9 and 12 years (P  < 0.05). Only 27%, n  = 73 of physicians and 18%, n  = 19 of medical students followed/knew the 'provider-driven' HPV-recommended style. Female physicians were more likely to use this communication style (32%, n  = 48 versus 20%, n  = 23, P  = 0.03). HPV prevention curriculum should be incorporated into medical programs. The gender-related practice patterns found indicate a need for training of male providers specifically. Quality improvement efforts are needed for all physicians to strengthen vaccine communication, recommendation practices and guideline adherence. [ABSTRACT FROM AUTHOR]

Background There is a strong national drive within the UK government and National Health Service for social prescribing. Previous research studies have mainly focused on service user perspectives and evaluating their experiences. There is limited evidence on how the general public perceive and understand what social prescribing is and how these views could influence service planning and delivery. This paper seeks to understand perceptions of social prescribing within the wider community. Methods Semi-structured focus groups were conducted with 37 members of the public in four areas in north-west England. We explored public awareness and understanding of social prescribing. Results Limited knowledge of the term social prescribing was found amongst participants as well as limited involvement in community discussions of the topic. Concerns were raised about the short-term nature of activities and the need for adequate resourcing to support continuity of service provision. The social prescribing link worker was considered to be important in supporting engagement with services and it was preferred this role was undertaken by people with local knowledge. Conclusions The findings provide evidence of public perspectives on social prescribing and highlight how wider community perceptions can supplement service user feedback to support social prescribing service planning, commissioning and delivery. [ABSTRACT FROM AUTHOR]

Background Policy responses to the Global Financial Crisis emphasized wide-ranging fiscal austerity measures, many of which have been found to negatively impact health outcomes. This paper investigates change in patterns of mortality at local authority level in England (2010–11 to 2017–18) and the relation with fiscal austerity measures. Methods Data from official local authority administrative records are used to quantify the gap between observed deaths and what was anticipated in the 2010-based subnational population projections. Regression analyses are used to explore the relation between excess deaths, austerity and wider process of population change at local authority level. Results We estimate 231 707 total excess deaths, the majority of which occurred since 2014–15 (89%) across the majority of local authorities (91%). Austerity is positively associated with excess deaths. For working age adults, there is a clear gradient to the impact of austerity, whereas for older adults, the impact is more uniform. Conclusions Fiscal austerity policies contributed to an excess of deaths for older people and widened social inequalities for younger populations. These results call for an end to all austerity measures and require further research into areas with the highest total excess deaths as a priority following the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background Preventative interventions may be effective in reducing and preventing symptoms of mental ill health in children and young people. However, there is a paucity of research in this area that explores the views of young people. This paper reports on a qualitative study to inform the future development of attractive and appropriate early and preventative school-based mental health interventions. Methods Semi-structured interviews were conducted with a purposive sample of 12 young people aged 14–17 in North East England. Interviews were audio-recorded, transcribed, anonymised and analysed following a thematic approach. Results Four key themes were identified, relevant to those providing, designing and commissioning early and preventative mental health interventions in schools: 'mental health literacy', 'risk factors for wellbeing decline', 'experience of school-based support' and 'recommendations for future support'. Conclusions Young people have varying levels of mental health literacy, but are able to identify academic stress, bullying and the transition from primary to secondary school as leading causes of worry. Young people want more regular and in-depth mental health education, tailored levels of support in school and improved training for teachers. [ABSTRACT FROM AUTHOR]

Background Students are a vulnerable group for the indirect impact of the COVID-19 pandemic, particularly their mental health. This paper examined the cross-national variation in students' depressive symptoms and whether this can be related to the various protective measures implemented in response to the initial stage of the COVID-19 outbreak. Methods Student data stem from the COVID-19 International Student Well-being Study, covering 26 countries during the first wave of the COVID-19 pandemic. Country-level data on government responses to the COVID-19 pandemic were retrieved from the Oxford COVID-19 Tracker. Multilevel analyses were performed to estimate the impact of the containment and economic support measures on students' depressive symptoms (n  =   78 312). Results School and workplace closures, and stay-at-home restrictions were positively related to students' depressive symptoms during the COVID-19 pandemic, while none of the economic support measures significantly related to depressive symptoms. Countries' scores on the index of these containment measures explained 1.5% of the cross-national variation in students' depressive symptoms (5.3%). This containment index's effect was stable, even when controlling for the economic support index, students' characteristics, and countries' epidemiological context and economic conditions. Conclusions Our findings raise concerns about the potential adverse effects of existing containment measures (especially the closure of schools and workplaces and stay-at-home restrictions) on students' mental health. [ABSTRACT FROM AUTHOR]

Background: weak grip strength is a key component of sarcopenia and is associated with subsequent disability and mortality. We have recently established life course normative data for grip strength in Great Britain, but it is unclear whether the cut points we derived for weak grip strength are suitable for use in other settings. Our objective was to investigate differences in grip strength by world region using our data as a reference standard. Methods: we searched MEDLINE and EMBASE for reporting age- and gender-stratified normative data for grip strength. We extracted each item of normative data and converted it on to a Z-score scale relative to our British centiles. We performed meta-regression to pool the Z-scores and compare them by world region. Findings: our search returned 806 abstracts. Sixty papers met inclusion criteria and reported on 63 different samples. Seven UN regions were represented, although most samples (n = 44) were based in developed regions. We extracted 726 normative data items relating to 96,537 grip strength observations. Normative data from developed regions were broadly similar to our British centiles, with a pooled Z-score 0.12 SDs (95% CI: 0.07, 0.17) above the corresponding British centiles. By comparison, normative data from developing regions were clearly lower, with a pooled Z-score of -0.85 SDs (95% CI: -0.94, -0.76). Interpretation: our findings support the use of our British grip strength centiles and their associated cut points in consensus definitions for sarcopenia and frailty across developed regions, but highlight the need for different cut points in developing regions. [ABSTRACT FROM AUTHOR]

Aims This paper analyses the content of news media messages on drinking during pregnancy in Australia over an 18-year period to understand whether and how the nature of messages communicated to women has changed over time. Methods Factiva was used to search Australian newspapers from 2000 to 2017, resulting in a sample of 1394 articles from the 18 major national and state-based newspapers. Content analysis of articles was undertaken, and Poisson regression analysis was used to assess changes over time. Results The largest number of articles on drinking during pregnancy was published in 2007. Themes that significantly increased over time included Harms to the Child (from 0.97% in 2008 to 29.69% in 2015) and Prevention Initiatives (from 0% in 2005 to 12.50% in 2017). Articles endorsing women not consuming alcohol during pregnancy significantly increased over time (from 20.69% in 2001 to 53.78% in 2013), matched by a decreasing trend in the proportion of articles presenting mixed advice (from 15.93% in 2009 to 0% in 2017). The largest number of articles adopted no position in relation to women's consumption. Conclusions A stronger abstinence message during pregnancy has been communicated through Australian newspaper media over time. The mixed messaging and large number of articles not endorsing a position on consumption may reflect the inconclusiveness of the evidence on harms from low to moderate levels of alcohol consumption during pregnancy. Opportunities remain for researchers to work with public health advocates to disseminate balanced messages based on evidence-based research. [ABSTRACT FROM AUTHOR]

Background Exposure to cold is known to be associated with severe health impacts. The primary epidemiological evidence for this is the seasonal variation in mortality. However, there is a paucity of directly measured data for personal cold temperature exposure. This paper develops the concept of experienced temperature, and reports how it varies with season, demographics and housing factors. Methods This study uses data from 77 743 UK Biobank participants. A novel method to directly measure participant's exposure to low temperatures using a thermistor in a wrist-worn activity monitor is described. These readings are combined with demographic and housing factor variables in a multiple regression model to understand underlying relationships. Results The study reveals a significant difference in experienced temperature of ~1.8°C between the periods of coldest and hottest external temperature. A number of demographic differences were also observed—such as people of Chinese ethnic background experiencing 0.65°C lower temperatures than other groups. Conclusions This paper presents primary evidence for a seasonal variation in experienced temperature. This variation likely contributes to cold related mortality and morbidity. It is hypothesized that this relationship would be less strong in countries which suffer fewer impacts of cold winter temperatures. [ABSTRACT FROM AUTHOR]

This paper reviews the use of descriptive statistics to describe the participants included in a study. It discusses the practicalities of incorporating statistics in papers for publication in Age and Aging, concisely and in ways that are easy for readers to understand and interpret. [ABSTRACT FROM AUTHOR]

Background Compared to national averages, the Gold Coast, Australia, has a proportionately higher number of children entering their first year of primary school with 'at risk' or 'vulnerable' language skills. This paper investigates the distribution of paediatric speech-language pathology (SLP) services on the Gold Coast, relative to children's language and cognitive skills, and socioeconomic status (SES). Methods SLP service locations were identified through national association data and a manual search and mapped against SES and Australian Early Development Census data, for language and cognitive skills. Results Data for 7595 children was included, with 943 (12.4%) at risk and 780 (12.6%) vulnerable for language and cognitive skills. A total of 75 SLPs were identified (85.3% private, 14.6% public), which is 1 SLP to every 23 children who might have current or impending speech, language and communication needs. Fewer services were available in areas where vulnerable children were located and most were private providers, leading to further potential barriers to service access. Conclusions The number of SLP services located on the Gold Coast is inadequate to meet the needs of children with language and cognitive skill vulnerabilities. Consideration of how services might be distributed is explored and warrants further consideration. [ABSTRACT FROM AUTHOR]

Local coalitions can advance public health initiative but have not been widely used or well-studied in low- and middle-income countries. This paper provides (i) an overview of an ongoing matched-pairs community-randomized controlled trial in 28 communities in Armenia and Georgia (N = 14/country) testing local coalitions to promote smoke-free policies/enforcement and (ii) characteristics of the communities involved. In July–August 2018, key informants (e.g. local public health center directors) were surveyed to compare their non-communicable disease (NCD) and tobacco-related activities across countries and across condition (intervention/control). More than half of the informants (50.0–57.1%) reported their communities had programs addressing hypertension, diabetes, cancer and human papilloma virus, with 85.7% involving community education and 32.1% patient education programs. Eleven communities (39.3%) addressed tobacco control, all of which were in Georgia. Of those, all included public/community education and the majority (72.7–81.8%) provided cessation counseling/classes, school/youth prevention programs, healthcare provider training or activities addressing smoke-free environments. Informants in Georgia versus Armenia perceived greater support for tobacco control from various sectors (e.g. government, community). No differences were found by condition assignment. This paper provides a foundation for presenting subsequent analyses of this ongoing trial. These analyses indicate wide variability regarding NCD-related activities and support across communities and countries. [ABSTRACT FROM AUTHOR]

Aims Alcohol consumption (AC) may cause workplace absence, but the findings of individual studies vary markedly. To date, no dose–response meta-analysis (DRMA) of the relationship between AC and sickness absence (SA) has been completed. This paper aims to estimate the dose–response relationship between AC and the risk of SA based on published observational studies. Methods We used DRMA and modelling to investigate the effects of varying doses of AC (including heavy episodic drinking (HED)) on SA. Results The meta-analysis included 21 studies (12 cohort studies and 9 cross-sectional). It showed that HED, risky (20–40 g of alcohol/day) and high-risk (>40 g of alcohol/day) drinkers had an elevated risk of SA when compared with light-to-moderate drinkers for both sexes. Those who abstained from alcohol had a higher risk of SA than those who drink moderately. Conclusions Our results indicate that risky, high-risk drinking and HED may increase the risk of absenteeism. The implementation of population-based strategies may be appropriate to address the burdens of alcohol-related SA. Additionally, economic evaluations of alcohol policies should incorporate their impacts on SA. However, the current literature has substantial limitations, relying on modestly designed studies from just a few settings and more studies are needed—especially those that measure abstention in more nuanced ways. [ABSTRACT FROM AUTHOR]