METHODS: Integrated community participatory action research (CPAR) was employed using preparation, planning, implementation, and evaluation. Data was collected using quantitative and qualitative methods from high school students. Descriptive statistics such as frequency and percentage, chi-square and fisher's exact test were used to summarize and compare quantitative data before and after intervention. Similarly, qualitative data was collected through interviews and focus group discussion (FGD) and then analyzed through thematic analysis.
RESULTS: Two hundred and thirty-nine (96.3%, n = 239/248) and 232 (93.5, n = 232/248) participants were included in the interventions before and after, respectively. School-based dengue prevention was developed with input from a variety of stakeholders, including students, community leaders, health educators, district officials, and community health volunteers. As demonstrated by pre- to post-test results, students understanding of dengue and the larval indices surveillance system has increased. Students who received the training were not only inspired but created a sense of community responsibility with a high commitment to teaching and sharing information in their circle to enhance overall community wellbeing. Being female and higher educational attainment was associated with students understanding of dengue and larval indices surveillance.
CONCLUSION: This participatory action research not only improved students' understanding of dengue but also empowered them to be proactive in various community health initiatives. The positive correlation between educational attainment and students understanding of dengue solution and larval indices surveillance underscores the need for tailored educational interventions that address diverse learning needs within the community. Collaborative efforts to establish dengue health information center based at primary schools and above can better improve reduction of dengue incidence.
METHODS: Fifty selected CRC cases of deficient mismatch repair (dMMR) and proficient mismatch repair (pMMR) which were identified immunohistochemically in the previous study were subjected to MSI analysis. MSI Analysis System 1.2 (Promega) was utilized.
RESULTS: The results of MSI analysis method showed MSI-High: 26% (13/50), MSI-Low: 6% (3/50), and Microsatellite Stable: 68% (34/50). The concordance was perfect (0.896, Kappa value) between MSI analysis and IHC methods for the assessment of MMR/MSI status in CRC patients. The discordance was only 4% (2/50). MSI analysis identified all dMMR cases determined by IHC except one case. The obtained frequency of dMMR and pMMR patients was 11.4% (14/123) and 88.6% (109/123) by IHC method, respectively.
CONCLUSION: Our findings support the universal practice of evaluating the MMR/MSI status in all newly diagnosed CRC patients. Based on the perfect concordance of two methods, the method of choice is based on the availability of expertise and equipments. IHC is highly appreciable method due to its feasibility and reproducibility.
METHODS: The datasets were analysed using SPSS (version 26) and ChatGPT-4. Statistical tests included the independent t-test, paired t-test, ANOVA, chi-square test, Wilcoxon signed-rank test, Mann-Whitney U test, Pearson and Spearman correlation, regression analysis, kappa statistic, intraclass correlation coefficient (ICC), Bland-Altman analysis, and sensitivity and specificity analysis. Descriptive statistics were used to report results, and differences between the two tools were noted.
RESULTS: SPSS and ChatGPT-4 produced identical results for the independent sample t-test, paired t-test, and simple linear regression. In one-way ANOVA, both tools provided consistent F-values, but post-hoc analysis revealed discrepancies in mean differences and confidence intervals. Pearson chi-square and Wilcoxon signed-rank tests showed variations in p-values and Z-values. Mann-Whitney U test had differences in interquartile range (IQR), U, and Z-values. Pearson and Spearman's correlations were consistent, with IQR differences in Spearman. Sensitivity, specificity, and area under the curve (AUC) analyses were consistent, though differences in standard errors and confidence intervals were observed.
CONCLUSION: ChatGPT-4 produced accurate results for several statistical tests, matching SPSS in simpler analyses. However, discrepancies in post-hoc analyses, confidence intervals, and more complex tests indicate that careful validation is required when using ChatGPT-4 for detailed statistical work. Researchers should exercise caution and cross-validate results with established tools such as SPSS.
METHODS: We conducted cognitive interviews (n = 645) in three iterative waves of data collection across 19 countries during March 2022-March 2023, with participants of diverse sex, gender, age and geography. Interviewers used a semi-structured field guide to elicit narratives from participants about their questionnaire item interpretation and response processes. Local study teams completed data analysis frameworks, and we conducted joint analysis meetings between data collection waves to identify question failures.
FINDINGS: Overall, we observed that participants were willing to respond to even the most sensitive questionnaire items on sexual biography and practices. We identified issues with the original questionnaire that (i) affected the willingness (acceptability) and ability (knowledge barriers) of participants to respond fully; and/or (ii) prevented participants from interpreting the questions as intended, including poor wording (source question error), cultural portability and very rarely translation error. Our revisions included adjusting item order and wording, adding preambles and implementation guidance, and removing items with limited cultural portability.
CONCLUSION: We have demonstrated that a questionnaire exploring sexual practices, experiences and health-related outcomes can be comprehensible and acceptable by the general population in diverse global contexts, and have highlighted the importance of rigorous processes for the translation and cognitive testing of such a questionnaire.
OBJECTIVE: To investigate clinical laboratory markers of SARS-CoV-2 and PASC.
DESIGN: Propensity score-weighted linear regression models were fitted to evaluate differences in mean laboratory measures by prior infection and PASC index (≥12 vs. 0). (ClinicalTrials.gov: NCT05172024).
SETTING: 83 enrolling sites.
PARTICIPANTS: RECOVER-Adult cohort participants with or without SARS-CoV-2 infection with a study visit and laboratory measures 6 months after the index date (or at enrollment if >6 months after the index date). Participants were excluded if the 6-month visit occurred within 30 days of reinfection.
MEASUREMENTS: Participants completed questionnaires and standard clinical laboratory tests.
RESULTS: Among 10 094 participants, 8746 had prior SARS-CoV-2 infection, 1348 were uninfected, 1880 had a PASC index of 12 or higher, and 3351 had a PASC index of zero. After propensity score adjustment, participants with prior infection had a lower mean platelet count (265.9 × 109 cells/L [95% CI, 264.5 to 267.4 × 109 cells/L]) than participants without known prior infection (275.2 × 109 cells/L [CI, 268.5 to 282.0 × 109 cells/L]), as well as higher mean hemoglobin A1c (HbA1c) level (5.58% [CI, 5.56% to 5.60%] vs. 5.46% [CI, 5.40% to 5.51%]) and urinary albumin-creatinine ratio (81.9 mg/g [CI, 67.5 to 96.2 mg/g] vs. 43.0 mg/g [CI, 25.4 to 60.6 mg/g]), although differences were of modest clinical significance. The difference in HbA1c levels was attenuated after participants with preexisting diabetes were excluded. Among participants with prior infection, no meaningful differences in mean laboratory values were found between those with a PASC index of 12 or higher and those with a PASC index of zero.
LIMITATION: Whether differences in laboratory markers represent consequences of or risk factors for SARS-CoV-2 infection could not be determined.
CONCLUSION: Overall, no evidence was found that any of the 25 routine clinical laboratory values assessed in this study could serve as a clinically useful biomarker of PASC.
PRIMARY FUNDING SOURCE: National Institutes of Health.
METHODS: A total of 103 patients (15-40 yrs.; 67 females, 36 males) undergoing orthodontic treatment with a 0.022-inch slot (MBT prescription) in both arches were recruited. Information on pain perception, knowledge, attitude, and diet diversity scores was collected through validated questionnaires using visual analogue scale and close-ended questions at one time point. The correlation between variables was analyzed using the Pearson's correlation coefficient.
RESULTS: Of the patients, 48.5% were aged 15 to 19 years old, with 65% females and 73.8% of Chinese ethnicity. Approximately 90% of the orthodontic patients perceived low levels of pain from orthodontic treatment, and 98% had a positive attitude toward orthodontic treatment. The patients had a good level of knowledge (Mean: 6±0.65). Approximately 49.5% of patients reported having moderate diet diversity. No significant correlation was found between pain perception and knowledge, or pain perception and diet diversity (r=0.062, p=0.534). However, a significant weak negative correlation (r=-0.289, p<0.05) between pain perception and attitude was observed.
CONCLUSION: Patients undergoing fixed orthodontic treatment presented with overall low pain perception, a positive attitude, and good knowledge about their treatment with moderate diet diversity. Informing the patient in advance about different orthodontic procedures encourages a positive attitude and facilitates patient cooperation. An interprofessional approach involving nutritionists can provide a holistic patient approach during orthodontic treatment.
STUDY DESIGN: Retrospective cohort study.
METHODS: We included 548,830 women from six countries in Asia. The data were sourced from 20 cohorts participating in the Asia Cohort Consortium (ACC) and two additional cohort studies: Japan Multi-institutional Collaborative Cohorts (J-MICC), and Japan Nurse Health Study (JNHS) with data on age at menarche. Joinpoint regression was used to evaluate changes in age at menarche by birth year and by country.
RESULTS: The study includes data from cohorts in six Asian countries namely, China, Iran, Japan, Korea, Malaysia and Singapore. Birth cohorts ranged from 1873 to 1995. The mean age of menarche was 14.0 years with a standard deviation (SD) of 1.4 years, ranged from 12.6 to 15.5 years. Over 100 years age at menarche showed an overall decrease in all six countries. China showed a mixed pattern of decrease, increase, and subsequent decrease from 1926 to 1960. Iran and Malaysia experienced a sharp decline between about 1985 and 1990, with APC values of -4.48 and -1.24, respectively, while Japan, South Korea, and Singapore exhibited a nearly linear decline since the 1980s, notably with an APC of -3.41 in Singapore from 1993 to 1995.
CONCLUSIONS: Overall, we observed a declining age at menarche, while the pace of the change differed by country. Additional long-term observation is needed to examine the contributing factors of differences in trend across Asian countries. The study could serve as a tool to strengthen global health campaigns.
STUDY DESIGN: To assess the attributable burden of injury risk factors, the data of interest on data sources were retrieved from the Global Health Data Exchange (GHDx) and analyzed.
METHODS: Cause-specific death from injuries was estimated using the Cause of Death Ensemble model in the GBD 2019. The burden attributable to each injury risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life years. The Socio-demographic Index (SDI) was used to evaluate countries' developmental status.
RESULTS: Globally, there were 713.9 million (95% uncertainty interval [UI]: 663.8 to 766.9) injuries incidence and 4.3 million (UI: 3.9 to 4.6) deaths caused by injuries in 2019. There was an inverse relationship between age-standardized disability-adjusted life year rate and SDI quintiles in 2019. Overall, low bone mineral density was the leading risk factor of injury deaths in 2019, with a contribution of 10.5% (UI: 9.0 to 11.6) of total injuries and age-standardized deaths, followed by occupational risks (7.0% [UI: 6.3-7.9]) and alcohol use (6.8% [UI: 5.2 to 8.5]).
CONCLUSION: Various risks were responsible for the imposed burden of injuries. This study highlighted the small but persistent share of injuries in the global burden of diseases and injuries to provide beneficial data to produce proper policies to reach an effective global injury prevention plan.
METHODS: We systematically searched MEDLINE, Embase, and Cochrane databases until November 2022 for randomized controlled PEP prophylaxis trials. We invited authors to share individual patient data, including PEP risk profile and prophylaxes used. PEP incidence rates for different prophylaxis were calculated. Efficacy was compared using multilevel logistic regression and expressed as relative risk (RR). Subgroup analysis evaluated the role of patient and ERCP-related risk factors in developing PEP.
RESULTS: Data from 11 studies, including 6430 patients, were analyzed. After adjusting for risk factors, rectal NSAIDs (RR 0.69, 95%CI 0.54-0.88) and peri-procedural high-volume intravenous fluid (IVF) (RR 0.40, 95%CI 0.21-0.79) were effective in reducing PEP incidence, while no benefit was noted with pancreatic duct (PD) stents (RR 1.25, 95%CI 0.91-1.73). In patients receiving rectal NSAIDs (n = 2617), difficult cannulation (RR 1.99, 1.45-2.73), contrast injection into the pancreatic duct (PD) (RR2.37, 1.68-3.32), and prior history of PEP (RR 1.90, 1.06-3.41) were associated with increased PEP risk.
CONCLUSION: This IPDMA confirms that rectal NSAIDs and peri-procedural IVF are effective PEP prophylactic strategies. Further studies focusing on combination therapy or the development of personalized PEP risk calculators are needed to improve prophylactic strategies.
METHODS: A survey was distributed through the friends of United European Gastroenterology (UEG) Young Talent Group network to physicians working in a UEG member or associated states who regularly performed ERCPs.
RESULTS: Of 1035 respondents from 35 countries, 649 were eligible for analysis: 228 trainees, 225 trainers, and 196 individuals who regularly performed ERCP but were neither trainees nor trainers. The mean age was 43 years, with 72.1% identifying as male, 27.6% as female, and 0.3% as non-binary. The majority (80.1%) agreed that a structured training regimen is desirable. However, only 13.7% of trainees and 28.4% of trainers reported having such a structured program in their institutions. Most respondents (79.7%) supported the concept of concentrating training in centers meeting specific quality metrics, with 64.1% suggesting a threshold of 200 annual ERCPs as a prerequisite. This threshold revealed that 36.4% of trainees pursued training in lower-volume centers performing <200 ERCPs annually. As many as 70.1% of trainees performed <50 annual ERCPs, whereas only 5.0% of trainers performed <50 ERCPs annually. A low individual trainee caseload (<50 ERCPs annually) was more common in lower-volume centers than in higher-volume centers (82.9% vs. 63.4%).
CONCLUSIONS: The first pan-European survey investigating ERCP training conditions reveals strong support for structured training and the concentration of training efforts within centers meeting specific quality metrics. Furthermore, this survey exposes the low availability of structured training programs with many trainees practicing at lower-volume centers and 71% of all trainees having little hands-on exposure. These data should motivate to standardize ERCP training conditions further and ultimately improve patient care throughout Europe.
OBJECTIVES: This study aimed to assess the feasibility and acceptability of integrating clinical pharmacists into the multidisciplinary team (MDT) to manage cancer pain and assess preliminary outcomes in cancer patients receiving pain treatment. This pilot study was undertaken to inform a future definitive randomized controlled trial (RCT).
METHODS: The protocol was registered with ClinicalTrials.gov (NCT05021393). The PharmaCAP trial was conducted in two oncology centers in Nepal, where patients were randomly enrolled into usual care (UC) or an intervention group (PharmaCAP). The latter received a clinical pharmacist-led medication review, which involved a comprehensive assessment of the patient's current medications, identification of potential drug-related problems, and personalized recommendations for optimizing pain management. This was accompanied by pain assessment, education and counseling on pain management strategies. Baseline and 4-weeks post-intervention assessments measured primary outcomes, i.e., feasibility metrics (recruitment of the patients, retention of patients, patient satisfaction). Secondary outcomes included pain intensity, health-related QoL, anxiety, depression, barriers to pain management, and medication adherence at 4 weeks.
RESULTS: Out of 140 screened patients, 108 were evaluated for eligibility, with 16 opting out primarily due to lack of interest (n = 11) and communication barriers (n = 5). A total of ninety-two participants with cancer pain were randomized into two groups, with 91 patients successfully recruited and 85 (93.4%) completing 4 weeks post-intervention assessment). Completion rates for the UC and PharmaCAP groups were 91.3% and 93.4%, respectively. The primary feasibility outcomes were positive: 100% of patients found random allocation acceptable. Retention rates were high, with 91.3% in the UC group and 93.4% in the PharmaCAP group, despite a few dropouts due to being unreachable, COVID-related issues, and changes in treatment centers. No evidence of contamination between groups was found, as participants did not discuss interventions or influence each other's attitudes, ensuring effective isolation of interventions The PharmaCAP intervention showed significant improvement in QoL (P