Slower Skeletal Muscle Oxygenation Kinetics in Adults With Complex Congenital Heart Disease

BackgroundAdults with complex congenital heart disease (CHD) show reduced aerobic exercise capacity and impaired skeletal muscle function compared with healthy peers. Peripheral muscle factors are presumed to be important contributors to the aerobic capacity, but the mechanisms are poorly understood. The aim of the present study was to investigate differences between adults with CHD and controls in muscle oxygenation kinetics at rest, and during and after exercise.MethodsSeventy-four patients with complex CHD (mean age 35.6 ± 14.3 years, female n = 22) were recruited. Seventy-four age- and sex-matched subjects were recruited as controls. Muscle oxygenation was successfully determined on the anterior portion of the deltoid muscle using near-infrared spectroscopy in 65 patients and 71 controls. Measurements were made at rest, during isotonic shoulder flexions (0-90°) to exhaustion, and during recovery.ResultsThe patients with CHD performed fewer shoulder flexions (40 ± 17 vs 69 ± 40; P < 0.001), had lower muscle oxygen saturation (StO₂) at rest (58 ± 18% vs 69 ± 18%; P < 0.001), slower desaturation rate at exercise onset (?9.7 ± 5.9 vs ?15.1 ± 6.5% StO₂ × 3.5 s^?1, P <0.001), and slower resaturation rate post exercise (4.0 ± 2.7 vs 5.4 ± 3.6% StO₂ × 3.5 s^?1; P = 0.009) compared with the controls.ConclusionsIn comparison with age- and sex-matched controls, adults with complex CHD had slower oxygenation kinetics. This altered skeletal muscle metabolism might contribute to the impaired skeletal muscle endurance capacity shown and thereby also to the reduced aerobic capacity in this population.     

Assessment of the knowledge,attitudes, and practices among UNRWA health staff in Jordan concerning mental health programme pre-implementation: a cross-sectional study

Background

Mental health is a major public health priority, particularly among refugees worldwide. The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) started to integrate mental health and psychosocial support (MHPSS) into its primary health-care services in Jordan in late 2017. This baseline study aimed to assess the knowledge, attitudes, practices, and perceived barriers among UNRWA health staff regarding the implementation of the MHPSS programme.

Impact des facteurs psychosociaux sur la santé mentale du personnel de nettoyage

Purpose

To describe the relationship between psychosocial factors and mental health among housekeepers.

An Introduction to Health Disparities for the Practicing Radiologist

A substantial and growing body of literature explores health disparities in radiology and imaging. The term “health disparities” refers to health differences related to disadvantages experienced by vulnerable populations, often caused by underlying social determinants of health. As such, health disparities are often closely tied to issues of social justice. Radiologists can work to reduce health disparities in different ways, including through supporting education, diversity and inclusion efforts, disparities research, and advocacy.     

Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy

ObjectivesTo describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered “low-value”, and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations.MethodsWe analyzed 2002–2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression.ResultsFrom 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: ?3.1%; 95%CI ?4.7, ?1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: ?2.2%; 95%CI ?3.0, ?1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: ?0.6%; 95%CI ?2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI ?1.9, 2.0]; ?0.9% [95%CI ?3.1, 1.3]; and ?1.2% [95%CI ?5.3, 2.9], respectively).ConclusionsBefore and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.     

Impact and implementation of active case finding for tuberculosis in homeless populations: a systematic review

BackgroundIdentifying tuberculosis in homeless populations through active case finding (ACF) is recommended to address health inequalities and contribute to wider control strategies for tuberculosis. We aimed to assess the effectiveness of ACF.MethodsThis systematic review assessed studies on ACF done in countries with low or medium burden of tuberculosis across Europe, the USA, and Australia. We systematically searched EMBASE, CINAHL Plus, ASSIA, Pro-Quest, Scopus, and the Cochrane Library and grey literature for English language publications up to Jan 5, 2019 (no earlier date limit). We used concepts of “ACF”, “tuberculosis”, and “homeless person”. We identified studies that analysed ACF and reported on our outcome measures, in homeless populations, in low-burden and medium-burden countries. ACF screening included testing for latent tuberculosis infection (LTBI) or active tuberculosis affecting any site. Studies into outbreak control or other populations were excluded. Primary study outcomes were the effectiveness of ACF (using population measures of tuberculosis prevalence or incidence) and interventions to improve ACF uptake and completion of the diagnostic pathway. Secondary outcomes were yield of ACF, cost-effectiveness, and characteristics of participants.Findings21 studies met the inclusion criteria. Study heterogeneity precluded meta-analysis. Three time-trend analyses produced some evidence that ACF was effective, because it was associated with reductions in tuberculosis incidence, prevalence, or clustering. A modelling study also showed that ACF was more effective than passive case finding in reducing population tuberculosis burden. Material incentives have the strongest evidence for improving uptake of ACF, with mixed evidence for peer educators. Observational evidence shows professional support and mandatory screening might also enhance uptake, and additional community-based support improves completion of the diagnostic pathway. Across all studies, the yield of screening (defined as the proportion of screened individuals who test positive) ranged from 1·5% to 57% for LTBI (total 41 684 individuals screened), and 0–3·1% for active tuberculosis (total 91 771 individuals screened). ACF can be cost-effective; population prevalence and screening modalities are determinants of cost-effectiveness. Considering ACF participants, subgroups most likely to be diagnosed with tuberculosis appeared less likely to accept screening.InterpretationACF should be considered in both tuberculosis and homelessness strategies, with evidence-based interventions to improve implementation. Outcomes varied widely, meaning programmes must be tailored to local populations. Strengths of our study include generalisable results to homeless populations from diverse settings. Limitations include restriction to the English language, the fairly low grade of the evidence identified, and the low number of studies screening for LTBI or using newer screening tests.FundingThe South West Public Health Training Programme.     

Reliability and validity of the Japanese version of the Biological Rhythms Interview of assessment in neuropsychiatry-self report for delayed sleep-wake phase disorder

ObjectiveThe Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) might be applicable for assessing delayed sleep-wake phase disorder (DSWPD). We aimed to investigate the reliability and validity of the Japanese version of the BRIAN self-report (J-BRIAN-SR) in DSWPD patients and determine a cutoff score to identify the presence of the disorder.MethodsWe enrolled 60 newly diagnosed DSWPD outpatients and 64 age-matched healthy controls. We used Cronbach's alpha for internal reliability to evaluate J-BRIAN-SR. We confirmed the reliability of the A test and re-test using Pearson's correlation coefficient in the controls. We used confirmatory factor analysis to evaluate the factor structure of J-BRIAN-SR and referenced the Morningness-Eveningness Questionnaire (MEQ) to check concurrent validity. We analyzed the receiver operating characteristic curve (ROC) to determine the J-BRIAN-SR cutoff point for the presence of DSWPD.ResultsThe 18-component scores of the J-BRIAN-SR had an overall reliability coefficient (Cronbach's alpha) of 0.82. We confirmed a high test-retest reliability using an intraclass correlation coefficient (r = 0.84). The correlation between J-BRIAN-SR and MEQ was 0.38 (p = 0.003). The J-BRIAN-SR that we extracted by exploratory factor analysis consisted of three factors. A score of 40 points provided a sensitivity of 80.0% and a specificity of 75.6% for the positivity of DSWPD.ConclusionsThe results of the present study revealed that J-BRIAN-SR is a valid and reliable instrument for screening and evaluating the severity of DSWPD. Our findings will be useful to physicians and patients in Japan and those in clinical settings.     

Impact of Spinal Manipulation on Lower Extremity Motor Control in Lumbar Spinal Stenosis Patients: A Small-Scale Assessor-Blind Randomized Clinical Trial

ObjectiveThe purpose of this study was to quantify the impact of a single lumbar spinal manipulation (SM) intervention on the leg movement performance of degenerative lumbar spinal stenosis (LSS) patients in a small-scale registered randomized clinical trial.MethodsParticipants with LSS (n = 14) were tested at baseline for pain, lumbar range of motion, and behavioral or kinematic motor performance (using an established Fitts’ Law foot-pointing task), then underwent covariate adaptive randomization to receive SM or no intervention. Postintervention all dependent measures were repeated. Experimenters were blinded to patient group allocation. University ethics board approval was attained.ResultsFor the primary outcome movement time, there was no significant difference between groups. As predicted by Fitts’ Law, all participants had longer movement times as task difficulty increased. Secondary kinematic outcomes yielded no significant between-group differences. Consistent with Fitts’ Law, kinematic measures changed significantly with task difficulty. Pairwise comparisons revealed the kinematic variables were more adversely affected by greater movement amplitudes than target size changes. No exploratory differences in pain or lumbar range of motion were observed.ConclusionChanges in motor performance were not observed in this chronic pain population after a single SM intervention compared with a control group. Given the sample size, the study may have been underpowered to detect meaningful differences. Fitts’ Law was observed for the lower extremity–pointing task for an LSS population and may provide an objective measure of motor performance.