METHODS: This was a retrospective study of children with CMT who had at least one pelvic radiograph between 2000 and 2020. Reimer's migration percentage, acetabular index and lateral center edge angle were used to identify hip dysplasia.
RESULTS: A total of 178 children were included with a median age of 6.4 (IQR 3.4-11.3) years at CMT diagnosis. First pelvic radiographs were performed at a median age of 8.0 (IQR 4.6-12.2) years and 64 (35.8%) had hip dysplasia, of which 20 normalized over time. Repeat radiographs were done in 96/178 children (53.9%), and six children with originally normal radiographs developed later radiographic hip dysplasia. At the time of last follow up, 50/178 children (28.1%) had hip dysplasia and 17/178 children (9.6%) required surgical intervention. The frequency of hip dysplasia in specific CMT subtypes was: 28/100 in CMT1A, 5/7 in Dejerine-Sottas disease, 3/10 in CMT2A, and 4/4 in TRPV4-related CMT.
INTERPRETATION: The prevalence of hip dysplasia in children with CMT in this cohort was estimated to be between 9.6% and 28.1%. Serial imaging is important to monitor outcomes into adulthood. Specific CMT subtypes were more likely to be associated with hip dysplasia.
METHODS: A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process.
RESULTS: There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes.
CONCLUSION: The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.
METHODS: MEDLINE and Embase (inception to 2023) were systematically searched for observational studies of adults with CKD conducted in Asia that reported the prevalence of anaemia or its treatment. Additional relevant unpublished data were obtained from national experts. Summary estimates of the prevalence of anaemia and its treatment were determined using a random-effects meta-analysis according to country and study-specific CKD inclusion criteria.
RESULTS: Eighty-six studies from 10 Asian countries reported data on 1 342 121 participants. The overall prevalence of anaemia in individuals with CKD was 42% (95% CI 33%-52%), with wide variation (12%-57% in studies including all CKD stages; 21%-96% in studies limited to individuals with kidney failure). Anaemia prevalence progressively increased with more advanced CKD (80% in Stage 5). Studies reporting data on anaemia treatment, particularly in early CKD, were limited. The prevalence of erythropoietin-stimulating agents (ESAs) and iron therapy was 40% (95% CI 24%-58%) and 21% (95% CI 14%-31%), respectively (ESA: 7%-29% in CKD, 63%-95% in kidney failure; iron: 6%-26% in CKD, 15%-88% in kidney failure).
CONCLUSION: Our findings indicate a significant, but widely varying, prevalence of anaemia and its treatment in people with CKD in Asia. Substantial variability in data availability and collection highlights the need for standardised reporting to facilitate the development of regionally relevant strategies for anaemia management in CKD.
METHODS: The calcaneus, talus and patella from each hind limb were collected from 94 male and 77 female mature greyhound cadavers and grouped into four groups; right or left bones from greyhounds with a standard or fused sacrum. The measurements were recorded for the following parameters: body mass of the greyhound, mass, length, and width of the right and left calcanei, tali and patellae.
RESULTS: A fused sacrum (4 sacral vertebrae) was present in 41% of specimens. The right and left calcanei, tali and patellae in greyhounds with a standard or fused sacrum were anatomically similar. Overall, left to right asymmetry was found, in the width of calcaneus (P < 0.01) and the talus (P < 0.05) and the length of calcaneus (P < 0.001) all these being larger in bones from the left hind limbs. Comparing bones from dogs with a fused or unfused sacrum showed that the right calcaneus length (P < 0.05) was significantly less than the left in those greyhounds with standard sacrum; the right calcaneus width was significantly less (P < 0.01) than the left in those with a fused sacrum. There were no significant differences in the means of measurements of bones between greyhounds with a standard and those with a fused sacrum except for the mass of the right (95% CI 0.22 to 1.10, P < 0.01) and left (95% CI 0.18 to 1.04, P < 0.01) calcaneus which were heavier in greyhounds with a fused sacrum than those with a standard sacrum.
CONCLUSION: In a population of greyhounds that race on anticlockwise tracks, the left calcaneus was wider and longer than the right and the left talus was wider. This asymmetry was more significant in dogs with sacrocaudal fusion and those dogs had more massive calcanei than dogs with standard sacrums, suggesting a difference in the way these bones were loaded in dogs with sacrocaudal fusion compared to dogs with the standard sacral anatomy.
OBJECTIVES: To examine the associations among UPF intake, anthropometric adiposity indicators, and obesity status in Canadian children.
DESIGN, SETTING, AND PARTICIPANTS: In the CHILD Cohort Study, one of the largest prospective, multicenter, population-based pregnancy cohorts in Canada, diet was assessed during the 3-year visit (September 2011 to June 2016), and anthropometric measurements were assessed at the 5-year visit (December 2013 to April 2018). Data analysis was performed between July 1, 2023, and June 30, 2024.
EXPOSURE: Diet intake was assessed using a semiquantitative food frequency questionnaire at 3 years of age. UPFs were identified using the NOVA classification system.
MAIN OUTCOMES AND MEASURES: Anthropometric adiposity indicators were measured at 5 years of age and used to calculate age- and sex-standardized z scores for body mass index (BMI), waist to height ratio, and subscapular and triceps skinfold thicknesses, and obesity, which was defined using BMI z score cutoffs. Multivariable-adjusted regression analyses were used to examine the associations of UPF with adiposity and obesity development, accounting for parental, birth, and early-childhood factors.
RESULTS: Among 2217 participants included in this study, median age at the outcome assessment was 5.0 (IQR, 5.0-5.1) years, and 1175 (53.0%) were males. At 3 years of age, UPF contributed 45.0% of total daily energy intake. UPF energy contribution was higher in males vs females (46.0% vs 43.9%; P
OBJECTIVE: To develop an evidence-informed, consensus-guided, adaptable digital health competencies framework for the design and development of digital health curricula in medical institutions globally.
EVIDENCE REVIEW: A core group was assembled to oversee the development of the Digital Health Competencies in Medical Education (DECODE) framework. First, an initial list was created based on findings from a scoping review and expert consultations. A multidisciplinary and geographically diverse panel of 211 experts from 79 countries and territories was convened for a 2-round, modified Delphi survey conducted between December 2022 and July 2023, with an a priori consensus level of 70%. The framework structure, wordings, and learning outcomes with marginal percentage of agreement were discussed and determined in a consensus meeting organized on September 8, 2023, and subsequent postmeeting qualitative feedback. In total, 211 experts participated in round 1, 149 participated in round 2, 12 participated in the consensus meeting, and 58 participated in postmeeting feedback.
FINDINGS: The DECODE framework uses 3 main terminologies: domain, competency, and learning outcome. Competencies were grouped into 4 domains: professionalism in digital health, patient and population digital health, health information systems, and health data science. Each competency is accompanied by a set of learning outcomes that are either mandatory or discretionary. The final framework comprises 4 domains, 19 competencies, and 33 mandatory and 145 discretionary learning outcomes, with descriptions for each domain and competency. Six highlighted areas of considerations for medical educators are the variations in nomenclature, the distinctiveness of digital health, the concept of digital health literacy, curriculum space and implementation, the inclusion of discretionary learning outcomes, and socioeconomic inequities in digital health education.
CONCLUSIONS AND RELEVANCE: This evidence-informed and consensus-guided framework will play an important role in enabling medical institutions to better prepare future physicians for the ongoing digital transformation in health care. Medical schools are encouraged to adopt and adapt this framework to align with their needs, resources, and circumstances.
METHODS: A cross-sectional study was conducted from December 2022 to April 2023, using a valid and reliable self-administered six sections questionnaire consisting of; (i) sociodemographic, (ii) work-related factors, (iii) MHSU, (iv) perception of stigmatisation by others, (v) enabling factors, and (vi) need factors. Respondents were selected through proportionate stratified random sampling based on job categories. Multiple Logistic Regression using SPSS version 26 was used to determine the predictors of MHSU.
RESULTS: A total of 294 respondents participated in this study, with a response rate of 83.5%. The 12-months MHSU prevalence was 45.6%. Mental health services were predominantly utilised for screening (96.3%) and treatment purposes (28.4%), primarily accessed through health clinics (85.1%), and interaction with paramedics (44.0%) and medical officers (38.8%). Significant drivers predicting MHSU were B40 household income (aOR = 3.426, 95% CI: 1.588, 7.393, p-value = 0.002) and M40 household income (aOR = 3.781, 95% CI: 1.916, 7.460, p-value<0.001), low supervisor support (aOR = 2.302, 95% CI: 1.206, 4.392, p-value = 0.011), received mental health training (aOR = 2.058, 95% CI: 1.221, 3.469, p-value = 0.007) and high co-worker support (aOR = 1.701, 95% CI: 1.034, 2.798, p-value = 0.036).
CONCLUSION: Almost half of respondents used mental health services, predicted by lower and middle household income, received mental health training and high co-worker support. Conversely, MHSU was also predicted by low supervisor support. To sustain high levels of MHSU, it is essential to implement regular mental health training targeted HCWs with lower to middle household incomes and those experiencing low supervisor support, while simultaneously enhancing co-worker support and screening program for early detection of mental health problems.
OBJECTIVE: This study aimed to determine the prevalence of inadequate toothbrushing practice among adolescents aged 13 to 17 years in Malaysia and its association with sociodemographic and other related risky lifestyles.
METHOD: This study was part of a national cross-sectional study, Global School Health Survey 2017. 27,497 students were agreed to participate in this study, with response of 89.2%. A validated self-administered bilingual, comprised of topics related to sociodemographic as well as adolescent health and risky lifestyles; substance use (alcohol, drug, smoking cigarettes), eating patterns, hygiene (inclusive of oral and hand hygiene), mental health status, lack of peer and parental/guardian support, truancy, physical activity, and body mass index (BMI). Analysis was performed using IBM SPSS for Windows version 26.0 involving complex sampling analysis and logistic regression.
RESULTS: A total of 12.7% (95% CI: 11.8-13.6) of in-school adolescents had inadequate toothbrushing practices. Higher prevalence of inadequate toothbrushing were found among male, Indian, had ever drug use, had three or more lack of protective factors and had inadequate hand hygiene practices. Adolescents who had inadequate toothbrushing were significantly higher odd among males, Indian ethnic, ever drug use, inadequate hand hygiene practices and adolescents who had three or more lack of peer and parental/guardian support.
CONCLUSION: Approximately 1 out of 10 adolescents had inadequate toothbrushing practices with several factors associated, such as male gender, Indian ethnicity, inadequate hand hygiene, ever drug use and lack of protective factors are identified to be associated. By emphasizing the significance of frequent brushing, we can encourage positive changes and reduce the burden of preventable dental problems on adolescents.