Time to delivery: Transfers for threatened preterm labour and prelabour rupture of membranes in Western Australia

Objective

To describe the outcomes of patients transferred to King Edward Memorial Hospital (KEMH) with signs of labour at preterm gestations.

Design

A retrospective observational study of the 69 cases transferred to KEMH during 2015.

Setting

Patient transfers from all locations across Western Australia (WA) to the sole tertiary perinatal centre in Perth.

Participants

Pregnant women within WA with threatened or actual preterm labour (PTL) or preterm prelabour rupture of membranes (PPROM) between 23 and 32 weeks gestation.

Main outcome measures

The occurrence of delivery during the admission and time‐to‐delivery as well as length of admission and association between clinical factors and time‐to‐delivery.

Results

The percentage of the study population delivered during the admission following transfer was 72.5%. Eighty‐six per cent of those who delivered did so within 72 hours of transfer. The median time from transfer to delivery was 1 day. Sixty‐three per cent of those who did not deliver during the admission progressed to 36 weeks gestation. Patients transferred with PPROM were less likely to deliver during the admission compared to those with uterine activity (50% versus 19.6%, P = 0.007) and nulliparas were more likely to deliver (93.5% versus 55.3%, P < 0.001).

Conclusion

The majority of women transferred with signs of PTL progress to delivery during the same admission with the highest risk of delivery being the first 72 hours following transfer. If the pregnancy is ongoing at 72 hours, there is a reasonable chance of progression to late preterm gestation supporting the return of woman to their place of origin for antenatal care following discharge.     

Effect of time interval between food intake and exercise on substrate oxidation during exercise in obese and lean children

Background & aims

Exercise induces adaptations in fat metabolism favourable to the treatment of obesity. However, time interval between meal and exercise alters substrate bioavailability and oxidation during exercise. The aim of this study was therefore to investigate the effect of time interval between food intake and exercise on substrate oxidation rates in obese and lean children.

Methods

The metabolic responses to exercise of nine obese children (10.3 ± 1.8 years; %body fat: 36.1 ± 6.1) and seven lean children (9.2 ± 1.6 years; %body fat: 22.2 ± 4.1) were compared 1 h (time interval 1, TI1) and 3 h (TI3) after a standardized breakfast.

Results

Despite significantly lower plasma glucose and insulin concentrations and large effect size suggesting a higher plasma FFA availability (lean, 1.43, obese 0.98), fat oxidation was not significantly increased in TI3 compared to TI1 in both lean and obese children. Fat oxidation contributed marginally to energy expenditure during exercise (<20%) in both conditions and groups but was moderately increased during TI3 compared to TI1 in lean children (effect size: 0.54).

Conclusions

The low contribution of fat oxidation to energy expenditure during exercise in obese and lean children fed 3 h before exercise questions the efficacy of moderate intensity exercise to favourably affect fat balance.     

Frontline work and racial disparities in social and economic pandemic stressors during the first COVID-19 surge

Objective

To assess the magnitude of racial–ethnic disparities in pandemic-related social stressors and examine frontline work's moderating relationship on these stressors.

Data Sources

Employed Californians' responses to the Institute for Governmental Studies (IGS) poll from April 16–20, 2020, were analyzed. The Pandemic Stressor Scale (PSS) assessed the extent to which respondents experienced or anticipated problems resulting from the inability to pay for basic necessities, job instability, lacking paid sick leave, unavailability of childcare, and reduced wages or work hours due to COVID-19.

Study Design

Mixed-effects generalized linear models estimated (1) racial–ethnic disparities in pandemic stressors among workers during the first COVID-19 surge, adjusting for covariates, and (2) tested the interaction between race–ethnicity and frontline worker status, which includes a subset of essential workers who must perform their job on-site, to assess differential associations of frontline work by race–ethnicity.

Data Collection

The IGS poll data from employed workers (n = 4795) were linked to the 2018 Centers for Disease Control and Prevention Social Vulnerability Index at the zip code level (N = 1068).

Principal Findings

The average PSS score was 37.34 (SD = 30.49). Whites had the lowest PSS score (29.88, SD = 26.52), and Latinxs had the highest (50.74, SD = 32.61). In adjusted analyses, Black frontline workers reported more pandemic-related stressors than White frontline workers (PSS = 47.73 vs. 36.96, p < 0.001). Latinxs reported more pandemic stressors irrespective of frontline worker status. However, the 5.09-point difference between Latinx frontline and non-frontline workers was not statistically different from the 4.6-point disparity between White frontline and non-frontline workers.

Conclusion

Latinx workers and Black frontline workers disproportionately reported pandemic-related stressors. To reduce stress on frontline workers during crises, worker protections like paid sick leave, universal access to childcare, and improved job security are needed, particularly for those disproportionately affected by structural inequities, such as racially minoritized populations.     

Patient and public perspectives of community pharmacies in the United Kingdom: A systematic review

Background

The United Kingdom has been at the forefront of enhancing pharmacist roles and community pharmacy services, particularly over the past decade. However, patient and public awareness of community pharmacy services has been limited.

Objective

To identify and synthesize the research literature pertaining to patient and public perspectives on: existing community pharmacy services, extended pharmacist roles and strategies to raise awareness of community pharmacy services.

Search strategy

Systematic search of 8 electronic databases; hand searching of relevant journals, reference lists and conference proceedings.

Inclusion criteria

UK studies investigating patient or public views on community pharmacy services or pharmacist roles from 2005 to 2016.

Data extraction and synthesis

Data were extracted into a grid and subjected to narrative synthesis following thematic analysis.

Main results

From the 3260 unique papers identified, 30 studies were included. Manual searching identified 4 additional studies. Designs using questionnaires (n = 14, 41%), semi‐structured interviews (n = 8, 24%) and focus groups (n = 6, 18%) made up the greatest proportion of studies. Most of the studies (n = 28, 82%) were published from 2010 onwards and covered perceptions of specific community pharmacy services (n = 31). Using a critical appraisal checklist, the overall quality of studies was deemed acceptable. Findings were grouped into 2 main themes “public cognizance” and “attitudes towards services” each with 4 subthemes.

Discussion and conclusions

Patients and the public appeared to view services as beneficial. Successful integration of extended pharmacy services requires pharmacists’ clinical skills to be recognized by patients and physicians. Future research should explore different approaches to increase awareness.     

Occupational kneeling and radiographic tibiofemoral and patellofemoral osteoarthritis

Background  

The objective of our study was to evaluate the association between occupational kneeling and compartment specific radiographic tibiofemoral (TF) and patellofemoral (PF) osteoarthritis (OA).     

The effect of phosphatidylserine administration on memory and symptoms of attention‐deficit hyperactivity disorder: a randomised,double‐blind,placebo‐controlled clinical trial

Background

Attention‐deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioural disorder of childhood, affecting 3–5% of school‐age children. The present study investigated whether the supplementation of soy‐derived phosphatidylserine (PS), a naturally occurring phospholipid, improves ADHD symptoms in children.

Methods

Thirty six children, aged 4–14 years, who had not previously received any drug treatment related to ADHD, received placebo (n = 17) or 200 mg day^–1 PS (n = 19) for 2 months in a randomised, double‐blind manner. Main outcome measures included: (i) ADHD symptoms based on DSM‐IV‐TR; (ii) short‐term auditory memory and working memory using the Digit Span Test of the Wechsler Intelligence Scale for Children; and (iii) mental performance to visual stimuli (GO/NO GO task).

Results

PS supplementation resulted in significant improvements in: (i) ADHD (P < 0.01), AD (P < 0.01) and HD (P < 0.01); (ii) short‐term auditory memory (P < 0.05); and (iii) inattention (differentiation and reverse differentiation, P < 0.05) and inattention and impulsivity (P < 0.05). No significant differences were observed in other measurements and in the placebo group. PS was well‐tolerated and showed no adverse effects.

Conclusions

PS significantly improved ADHD symptoms and short‐term auditory memory in children. PS supplementation might be a safe and natural nutritional strategy for improving mental performance in young children suffering from ADHD.     

Validation of the PAGI-SYM and PAGI-QOL among healing and maintenance of erosive esophagitis clinical trial participants

Background and aims  

Valid instruments are needed to assess important patient-reported outcomes (PROs) in erosive esophagitis (EE).     

Race and gender associations between obesity and nine health-related quality-of-life measures

Purpose  

To assess how health-related quality of life (HRQoL) varies by body mass index (BMI) category among gender and racial subgroups using nine HRQoL measures.     

A field study on clinical signs and symptoms in cleaners at floor polish removal and application in a Swedish hospital

Aim  

To study health effects in hospital cleaners (N = 21) at floor polish removal and application.     

The use of haematopoietic stem cell transplantation in Fanconi anaemia patients: a survey of decision making among families in the US and Canada

Background

Fanconi anaemia (FA) is a rare genetic disorder associated with bone marrow failure (BMF), congenital anomalies and cancer susceptibility. Stem cell transplantation (SCT) offers a potential cure for BMF or leukaemia, but incurs substantial risks. Little is known about factors influencing SCT decision making.

Objective

The study objective was to explore factors influencing patients' with FA and family members' decision making about SCT.

Design

Using a mixed‐methods exploratory design, we surveyed US and Canadian patients with FA and family members who were offered SCT.

Main variables studied

Closed‐ended survey items measured respondents' beliefs about the necessity, risks and concerns regarding SCT; multivariable logistic regression was used to examine the association between these factors and the decision to undergo SCT. Open‐ended survey items measured respondents' perceptions of factors important to the SCT decision; qualitative analysis was used to identify emergent themes.

Results

The decision to undergo SCT was significantly associated with greater perceived necessity (OR = 2.81, P = 0.004) and lower concern about harms of SCT (OR = 0.31, P = 0.03). Qualitative analysis revealed a perceived lack of choice among respondents regarding the use of SCT, which was related to physician influence and respondent concerns about patients' quality of life.

Conclusions

Overall, study results emphasize the importance of the delicate interplay between provider recommendation of a medical procedure and patient/parental perceptions and decision making. Findings can help providers understand the need to acknowledge family members' perceptions of SCT decision making and offer a comprehensive discussion of the necessity, risks, benefits and potential outcomes.     

Utility values for symptomatic non-severe hypoglycaemia elicited from persons with and without diabetes in Canada and the United Kingdom

Objective  

To elicit societal and patient utilities associated with diabetic symptomatic non-severe hypoglycaemia for three health states: 1) rare (quarterly), 2) intermittent (monthly), 3) and frequent (weekly) hypoglycaemia episodes.     

Anthropometric indexes of obesity and hypertension in elderly from Cuba and Barbados

Objective  

To investigate the association between various anthropometric indexes of obesity with arterial hypertension in elderly from Barbados (Bridgetown) and Cuba (Havana).     

The Pregnancy,Arsenic, and Immune Response (PAIR) Study in rural northern Bangladesh

Background

Arsenic exposure and micronutrient deficiencies may alter immune reactivity to influenza vaccination in pregnant women, transplacental transfer of maternal antibodies to the foetus, and maternal and infant acute morbidity.

Objectives

The Pregnancy, Arsenic, and Immune Response (PAIR) Study was designed to assess whether arsenic exposure and micronutrient deficiencies alter maternal and newborn immunity and acute morbidity following maternal seasonal influenza vaccination during pregnancy.

Population

The PAIR Study recruited pregnant women across a large rural study area in Gaibandha District, northern Bangladesh, 2018–2019.

Design

Prospective, longitudinal pregnancy and birth cohort.

Methods

We conducted home visits to enrol pregnant women in the late first or early second trimester (11–17 weeks of gestational age). Women received a quadrivalent seasonal inactivated influenza vaccine at enrolment. Follow-up included up to 13 visits between enrolment and 3 months postpartum. Arsenic was measured in drinking water and maternal urine. Micronutrient deficiencies were assessed using plasma biomarkers. Vaccine-specific antibody titres were measured in maternal and infant serum. Weekly telephone surveillance ascertained acute morbidity symptoms in women and infants.

Preliminary Results

We enrolled 784 pregnant women between October 2018 and March 2019. Of 784 women who enrolled, 736 (93.9%) delivered live births and 551 (70.3%) completed follow-up visits to 3 months postpartum. Arsenic was detected (≥0.02 μg/L) in 99.7% of water specimens collected from participants at enrolment. The medians (interquartile ranges) of water and urinary arsenic at enrolment were 5.1 (0.5, 25.1) μg/L and 33.1 (19.6, 56.5) μg/L, respectively. Water and urinary arsenic were strongly correlated (Spearman's ⍴ = 0.72) among women with water arsenic ≥ median but weakly correlated (⍴ = 0.17) among women with water arsenic < median.

Conclusions

The PAIR Study is well positioned to examine the effects of low-moderate arsenic exposure and micronutrient deficiencies on immune outcomes in women and infants. Registration : NCT03930017.     

Prevalence and risk factors of anabolic-androgenic steroids (AAS) abuse among adolescents and young adults in Poland

Objective  

To estimate the prevalence of anabolic-androgenic steroids (AAS) abuse among adolescent and young adults in Poland.     

Health related quality of life measures by demographics and common health risks, Jordan 2004

Objective:  

To measure health-related quality of life (HRQOL) in Jordan     

Mapping adolescent health and lifestyles in a multi-state country: methodological aspects and first results

Objectives  

To explore the feasibility of a geographical analysis (mapping) of data from a national adolescent survey.     

The relation of cognitive load and pupillary unrest

Objective  

This study examines the relationship between pupillary unrest (PU) and cognitive load.     

Food derived carbonyl compounds affect basal and stimulated secretion of interleukin-6 and -8 in Caco-2 cells

Background  

The carbonyl compounds methylglyoxal (MG) and glyoxal (G) are reactive intermediates generated in a variety of foods and beverages during processing and prolonged storage.