Building trust and increasing inclusion in public health research: co-produced strategies for engaging UK ethnic minority communities in research.

Patient and public involvement and engagement (PPIE) is essential for improved research outcomes and reduced research waste. To be effective, PPIE should provide opportunities for diverse groups to contribute to all research stages. However, UK ethnic minority communities remain underrepresented in research. This article describes strategies adopted in a public health research project that were effective in building trust and increasing inclusion of ethnic minority communities. The study team of researchers and PPIE partners reflects lessons learnt during the project and describe six main strategies that built meaningful levels of trust and inclusion: 1) early start to recruitment of PPIE partners; 2) relationship-focused engagement; 3) co-production and consultation activities; 4) open communication and iterative feedback; 5) co-production of project closure activities, and; 6) diverse research team. Meaningful outcomes for the community included the involvement of people from ethnic minorities as research participants and PPIE partners, community wellbeing, co-production of public health recommendations co-presented at the UK Houses of Parliament, and consortium-wide impact evidenced by the enrolment of 51 active PPIE partners. PPIE partners reflect on their research involvement, offering advice to researchers and encouraging people from ethnic minority communities to take part in research. An important message from PPIE partners is that involvement should not be restricted to projects specific to ethnic minorities but become a routine part of general population research, recognising ethnic minorities as an integral part of UK society. In conclusion, this article demonstrates that with appropriate strategies, inclusion and diversity can be achieved in public health research. We recommend researchers, practitioners and policy makers adopt these strategies when planning their public health projects.

EVALUATION OF INTERFACIAL ADAPTATION BETWEEN VARIOUS TYPES OF FIBER POSTS AND RESIN CEMENTS USING MICRO CT: AN IN VITRO COMPARATIVE STUDY.

The aim of this study was to evaluate the interfacial adaptation between different types of prefabricated fiber posts and different types of resin cement using Micro Computed Tomography. Twenty-seven (n=27) removed premolars with same single root lengths were divided into (three) groups each of (n=9) according to type of fiber posts. Teeth were decorated, and placed in poly vinyl silicone frame, showing 2 mm of the crown. Teeth were exposed to endodontic restoration, and preparation of post space. Then, in accordance with the type of resin cement, the three groups were further separated into three subgroups (n=3). After post cementation, the specimens were subjected to Micro Computed Tomography and 3D reconstruction to evaluate and estimate the gaps at the line between the post and cement. Statistical analyses were be done using IBM SPSS Statistics version 20, and Two-Way ANOVA and Duncan's Multiple Range test were used to compare the results at 5% significant level. Results: The study outlined a statistically significant difference at (P≤0.05) among groups regarding to gap formation in µm at the interface between fiber post and resin cement and group (F1C3: glass fiber post+TOTAL C-RAM) represent the highest gap volume formation (575.00±32.71), while group (F3C1: everStick post+RelyX U200) represent the lowest gap volume formation (85.50±21.09). The interfacial adaptation between fiber post and resin cement can be affected by various kinds of resin cements and fiber posts used.

Presence of Escherichia coli O157:H7 in Dairy Farms located in Najaf, Baghdad, Kirkuk, and Erbil, Iraq.

It has been approved that one of the most dangerous foodborne pathogenic bacteria is E. coli O157:H7, which is responsible for several infection and death cases worldwide. It is well documented that in the developing countries E. coli O157:H7 is considered the main causative pathogen of human gastrointestinal infections. Therefore, the current research was aimed to evaluate the prevalence of E. coli O157:H7 in dairy cattle's milk using a rapid method, in Iraq (Najaf, Baghdad, Kirkuk, and Erbil). Over a period of 6 months (During hot months) samples were obtained and investigated by culturing on selective media (CT-SMAC). The multiplex PCR (m-PCR) also used for milk sample direct investigation. Using biochemical tests the recorded data showed that, 2 recognized isolates were E. coli, while the recorded data obtained from m-PCR assay revealed that none of the isolated E. coli was toxigenic E.coli O157:H7. The results of m-PCR on the milk samples revealed that 45 milk samples contained at least one of the following genes: O157, H7, stx1, stx2 genes. Also the results of the m-PCR revealed that 2 samples (raw milk) were toxigenic O157:H7 positive. In conclusion, to the best of authors' knowledge, this investigation was the first report on the prevalence of E. coli O157:H7 in the raw milk samples in Iraq. The results showed that the proportion of contaminated milk samples contaminated with E. coli O157:H7 identified in the current survey were similar to that the results of the previously published research from different dairy products across different countries in the Middle East region.

Investigation of in vitro Cytotoxicity of Chelidonium majus against Leishmania major.

One of the public health issues in the endemic areas, especially in the Middle East region would be the Leishmaniasis. The suggested cure for leishmaniasis is pentavalent antimonials. These medications have drastic side effects and the risk of relapse. On the other hand, nowadays use of herbal remedies as safe and cost-effective treatments have been increased. Therefore this study was designed to determine in vitro anti-leishmanial activity of methanol extracts of greater celandine (Chelidonium majus) against Leishmania major. Greater celandine extract was added to L. major promastigotes and intra-macrophagic amastigotes. After 24, 48 and 72 h in vitro culture the percentage of promastigotes viability was calculated by direct counting method and MTT assay. Cytotoxicity in intra-macrophagic amastigotes was evaluated by direct counting method. Viability in minimum dose and maximum dose-treated groups (1.5 and 90 µg/ml) after 24 h, was 55.52% and 36.34%, respectively. After 48 h, it was 40% and 25.26% and after 72 h, it was 62.18% and 38.45%, respectively. The half maximal inhibitory concentration (IC50) was 0.92 µg/ml, after 24 h. Cytotoxicity in intra-macrophagic amastigotes treated by 3 µg/ml dose after 24 and 48 h, was 33.23% and 50.34%, respectively. It could be concluded that greater celandine methanolic extract has in vitro cytotoxic effect on the L. major in time and dose-dependent pattern.

The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: Systematic review and meta-analysis.

OBJECTIVES: To determine the effectiveness of influenza vaccination during pregnancy on child health outcomes. DESIGN: Systematic review/meta-analysis. DATA SOURCES: Clinical Trials.gov, Cochrane Library, EMBASE, Medline, Medline in process, PubMed and Web of Science, from 1st January 1996 to 29th June 2018. An updated Medline search was performed 30th June 2018 to 31st October 2019. METHODS: Randomised controlled trials (RCTs) and observational studies reporting health outcomes of infants and children born to women who received inactivated influenza vaccine during pregnancy. The primary outcome was infant laboratory confirmed influenza (LCI). Secondary outcomes included influenza-like illness (ILI), other respiratory illnesses, primary care, clinic visit or hospitalisations due to influenza illness and long-term respiratory childhood outcomes. RESULTS: 19 studies were included; 15 observational studies and 4 primary RCTs with an additional 3 papers reporting secondary outcomes of these RCTs. In a random effects meta-analysis of 2 RCTs including 5742 participants, maternal influenza vaccination was associated with an overall reduction of LCI in infants of 34% (95% confidence interval 15-50%). However, there was no effect of maternal influenza vaccination on ILI in infants ≤6 months old. Two RCTs were excluded from the meta-analysis for the outcome of LCI in infants (different controls used). Both of these studies showed a protective effect for infants from LCI, with a vaccine efficacy of up to 70%. Overall observational studies showed an inverse (protective) association between maternal influenza vaccination and infant LCI, hospitalisation and clinic visits due to LCI or ILI in infants and other respiratory illness in infants ≤6 months old. CONCLUSIONS: This systematic review supports maternal influenza vaccination as a strategy to reduce LCI and influenza-related hospitalisations in young infants. Communicating these benefits to pregnant women may support their decision to accept influenza vaccination in pregnancy and increase vaccine coverage in pregnant women. REGISTRATION: PROSPERO CRD42018102776.

Predicting childhood overweight and obesity using maternal and early life risk factors: a systematic review.

BACKGROUND: Childhood obesity is a serious public health challenge, and identification of high-risk populations with early intervention to prevent its development is a priority. We aimed to systematically review prediction models for childhood overweight/obesity and critically assess the methodology of their development, validation and reporting. METHODS: Medline and Embase were searched systematically for studies describing the development and/or validation of a prediction model/score for overweight and obesity between 1 to 13 years of age. Data were extracted using the Cochrane CHARMS checklist for Prognosis Methods. RESULTS: Ten studies were identified that developed (one), developed and validated (seven) or externally validated an existing (two) prediction model. Six out of eight models were developed using automated variable selection methods. Two studies used multiple imputation to handle missing data. From all studies, 30,475 participants were included. Of 25 predictors, only seven were included in more than one model with maternal body mass index, birthweight and gender the most common. CONCLUSION: Several prediction models exist, but most have not been externally validated or compared with existing models to improve predictive performance. Methodological limitations in model development and validation combined with non-standard reporting restrict the implementation of existing models for the prevention of childhood obesity.

Detection and genotyping of human papillomavirus in breast cancer tissues from Iraqi patients.

Studies have suggested a possible link between breast cancer pathogenesis and human papillomavirus (HPV) infection. This study in Iraq used in situ hybridization to detect the frequency and genotyping of HPV in tissue specimens from 129 patients diagnosed with malignant breast cancer, 24 with benign breast tumours and 20 healthy controls. In the breast cancer group, cocktail HPV genotypes were detected in 60 (46.5%) archived tissue blocks. Of these, genotypes 16 (55.5%), 18 (58.4%), 31 (65.0%) and 33 (26.6%) were detected. Mixed HPV genotypes 16 + 18, 16 + 18 + 31, 16 + 18 + 33, 18 + 33, 16 + 31 and 18 + 31 were found in 5.0%, 25.0%, 8.3%, 7.7%, 10.0% and 13.3% of cancer cases respectively. Only 3 benign breast tumour tissues (12.5%) and none of the healthy breast tissue specimens were HPV-DNA-positive. The detection of high-oncogenic HPV genotypes in patients with breast cancer supports the hypothesis of an etiologic role for the virus in breast cancer development.

Does nausea and vomiting of pregnancy play a role in the association found between maternal caffeine intake and fetal growth restriction?

The aim of this study was to explore the relationships between nausea and vomiting in pregnancy and (a) fetal growth restriction; and (b) maternal caffeine metabolism and fetal growth restriction. A cohort of 2,643 pregnant women, aged 18-45 years, attending two UK maternity units between 8 and 12 weeks gestation, was recruited. A validated tool assessed caffeine intake at different stages of pregnancy and caffeine metabolism was assessed from a caffeine challenge test. Experience of nausea and vomiting of pregnancy was self-reported for each trimester. Adjustment was made for confounders, including salivary cotinine as a biomarker of current smoking status. There were no significant associations between fetal growth restriction and nausea and vomiting in pregnancy, even after adjustment for smoking and alcohol intake. There were no significant differences in the relationship between caffeine intake and fetal growth restriction between those experiencing symptoms of nausea and vomiting and those who did not, for either the first (p = 0.50) or second trimester (p = 0.61) after adjustment for smoking, alcohol intake and caffeine half-life. There were also no significant differences in the relationship between caffeine half-life and fetal growth restriction between those experiencing symptoms of nausea and vomiting and those who did not, for either the first trimester (p = 0.91) or the second trimester (p = 0.45) after adjusting for smoking, alcohol intake and caffeine intake. The results from this study show no evidence that the relationship between maternal caffeine intake and fetal growth restriction is modified by nausea and vomiting in pregnancy.

[Knowledge and practices of women in Iraqi universities on breast self examination].

This study evaluated the knowledge and practice of breast self-examination (BSE), among a sample of educated Iraqi women. The study sample comprised 858 women aged 18-62 years affiliated to 6 major Iraqi universities, categorized according to occupation as teaching staff (11.5%), administrative staff (18.0%) and students (70.5%). Data were collected by a self-completed questionnaire. In all, 93.9% of the women had heard about BSE, the main source of information was television (39.9%), doctors (18.4%) and the awareness campaign of the Iraqi National Breast Cancer Research Programme (11.6%). Only 53.9% of the women practised BSE; the most common excuses by those that did not were lack of knowledge of the significance of BSE (42.0%) and lack of confidence in their ability to perform BSE (39.5%). Just over 38% did not seek medical advice if they experienced signs/symptoms of breast disease, attributing that to reasons of timidity, lack of time or fear of discovering cancer. The majority (88%) of the women were willing to instruct others in BSE (aftertraining), 40% of whom were interested in collaborating with the National Breast Cancer Awareness Programme in Iraq.

Knowledge, attitude and practice regarding breast cancer and breast self-examination among a sample of the educated population in Iraq.

This cross-sectional, questionnaire-based study evaluated the knowledge, attitude and practice towards breast cancer and breast self-examination (BSE) among 387 (302 females and 85 males) educated Iraqis affiliated to 2 Iraqi universities. The participants were categorized into 3 occupations: student (71.3%), teaching staff (10.3%) and administrative staff (18.3%). About half of the participants had a low knowledge score (< 50%); only 14.3% were graded as "Good" and above. Almost 75% of the participants believed that the best way to control breast cancer was through early detection and other possible preventive measures. Most participants (90.9%) had heard of BSE, the main source of information being television. However, only 48.3% practised BSE; the most common reason for not doing so was lack of knowledge of how to perform the technique correctly. Almost 84% of the female participants were willing to instruct others in the technique of BSE.

Antimicrobial resistance of Staphylococcus species isolated from Lebanese dairy-based products.

The study evaluated the antimicrobial resistance of molecularly characterized strains of Staphylococcus aureus and S. saprophyticus isolated from 3 Lebanese dairy-based food products that are sometimes consumed raw: kishk, shanklish and baladi cheese. Suspected Staphylococcus isolates were identified initially using standard biochemical tests, then strains that were confirmed by polymerase chain reaction (29 S. aureus and 17 S. saprophyticus) were evaluated for their susceptibility to different antimicrobials. The highest levels of contamination with staphylococci were in baladi cheese. Resistance rates ranged from 67% to gentamicin to 94% to oxacillin and clindamycin. The results suggest that these locally made dairy-based foods may act as vehicles for the transmission of antimicrobial-resistant Staphylococcus spp.

The relationship between dietary supplement use in late pregnancy and birth outcomes: a cohort study in British women.

OBJECTIVE: To examine the relationship between dietary supplement use during pregnancy and birth outcomes. DESIGN: A prospective birth cohort. SETTING: Leeds, UK. SAMPLE: One thousand two hundred and seventy-four pregnant women aged 18-45 years. METHODS: Dietary supplement intake was ascertained using three questionnaires for the first, second and third trimesters. Dietary intake was reported in a 24-hour dietary recall administered by a research midwife at 8-12 weeks of gestation. Information on delivery details and antenatal pregnancy complications was obtained from the hospital maternity records. MAIN OUTCOME MEASURES: Birthweight, birth centile and preterm birth. RESULTS: Reported dietary supplement use declined from 82% of women in the first trimester of pregnancy to 22% in the second trimester and 33% in the third trimester. Folic acid was the most commonly reported supplement taken. Taking any type of daily supplement during any trimester was not significantly associated with size at birth taking into account known relevant confounders. Women taking multivitamin-mineral supplements in the third trimester were more likely to experience preterm birth (adjusted OR = 3.4, 95% CI 1.2, 9.6, P = 0.02). CONCLUSIONS: Regular multivitamin-mineral supplement use during pregnancy, in a developed country setting, is not associated with size at birth. However, it appears to be associated with preterm birth if taken daily in the third trimester. The mechanism for this is unclear and our study's findings need confirming by other cohorts and/or trials in developed countries.

Breast cancer: demographic characteristics and clinico-pathological presentation of patients in Iraq.

Breast cancer is the commonest type of malignancy in Iraq. The study was carried out on 721 out of a total of 5044 patients (14.3%) presenting with palpable breast lumps that were diagnosed as cancer. Approximately one third of the breast cancer patients were diagnosed at age 40-49 years; 71.9% came from urban areas; and 75% were married. History of lactation was reported in 63.1% and hormonal therapy in 29%. Positive family history was recorded in 16.2%. Although the lump was detected by the patient herself in 90.6% of cases, only 32% sought medical advice within the first month. Accordingly, 47% of these patients presented in advanced stages (III and IV). The main histological type was invasive ductal carcinoma, in which pathological changes of grade II and III were observed in 56.6% and 39.9% respectively. DNA analysis showed that 80.3% of the carcinomas were aneuploid. The findings of this study justify increasing efforts for establishing comprehensive breast cancer control programmes in Iraq.

Antimicrobial resistance and pathogenicity of Escherichia coli isolated from common dairy products in the Lebanon.

In a recent study, bacteria have been isolated from popular Lebanese dairy products, which had been collected in the Beqaa Valley, in north-eastern Lebanon. The foods investigated were two cheeses (shankleesh and baladi) and a dried fermented mixture of yogurt and wheat grains (kishk). Bacterial colonies on McConkey and sorbitol-McConkey agar that showed the morphology of Escherichia coli were biochemically tested and then classified, using PCR-based assays, into the various strains of pathogenic and non-pathogenic E. coli. Some of the confirmed E. coli isolates were proven to be pathogenic, including two identified as E. coli O157:H7. When the pathogenic isolates were tested for their susceptibility to 10 different antibiotics (all commonly used, by clinicians and veterinarians, for the treatment of infections with Gram-negative bacteria), each tested isolate was found to be highly resistant to at least one antibiotic. It therefore appears that, in Lebanon, some popular dairy products pose a public-health hazard, acting as vehicles for the transmission of drug-resistant pathogens.

Length of hospitalisation for people with severe mental illness.

BACKGROUND: In high income countries, over the last three decades, the length of hospital stays for people with serious mental illness has reduced drastically. Some argue that this reduction has led to revolving door admissions and worsening mental health outcomes despite apparent cost savings, whilst others suggest longer stays may be more harmful by institutionalising people to hospital care. OBJECTIVES: To determine the clinical and service outcomes of planned short stay admission policies versus a long or standard stay for people with serious mental illnesses. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group's register of trials (July 2007). SELECTION CRITERIA: We included all randomised trials comparing planned short with long/standard hospital stays for people with serious mental illnesses. DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated fixed effects weighted mean differences (WMD). MAIN RESULTS: We included six relevant trials. We found no significant difference in hospital readmissions between planned short stays and standard care at one year (n=651, 4 RCTs, RR 1.26 CI 1.0 to 1.6). Short hospital stay did not confer any benefit in terms of 'loss to follow up compared with standard care (n=453, 3 RCTs, RR 0.87 CI 0.7 to 1.1). There were no significant differences for the outcome of 'leaving hospital prematurely' (n=229, 2 RCTs, RR 0.77 CI 0.3 to 1.8). More post-discharge day care was given to participants in the short stay group (n=247, 1 RCT, RR 4.52 CI 2.7 to 7.5, NNH 3 CI 2 to 6) and people from the short stay groups were more likely to be employed at two years (n=330, 2 RCTs, RR 0.61 CI 0.5 to 0.8, NNT 5 CI 4 to 8). Economic data were few but, once discharged, costs may be more for those allocated to an initial short stay. AUTHORS' CONCLUSIONS: The effects of hospital care and the length of stay is important for mental health policy. We found limited data, although outcomes do suggest that a planned short stay policy does not encourage a 'revolving door' pattern of admission and disjointed care for people with serious mental illness. More large, well-designed and reported trials are justified.

Surgeon's awareness of the synchronous liver metastases during colorectal cancer resection may affect outcome.

AIM: There is conflicting evidence about the importance of synchronous metastases upon tumor outcome. The aim of this study is to identify the effect of finding synchronous colorectal liver metastases on the performance of the surgeon whilst operating on primary colorectal cancer. METHODS: Patients with completed colorectal cancer data who underwent liver resection for colorectal metastases between 1993 and 2001 were included. Two hundred seventy patients were categorised according to the site of the primary tumour (colon or rectum) and knowledge of the presence of liver metastases by the colorectal surgeon (SA=surgeon aware, n=112, SNA=surgeon not aware, n=158). The number of retrieved lymph nodes and colorectal resection margin involvement were used as surgical performance indicators. Survival and local recurrence rate were monitored. RESULTS: The SA group had a higher rate of colorectal circumferential resection margin involvement, the local and intra-abdominal recurrence rate was also significantly higher in this group (p<0.001). CONCLUSIONS: Awareness of the presence of liver metastases by the operating surgeon is an independent predictor of intra abdominal extra hepatic recurrence of colorectal cancer following potentially curative hepatic resection. This is related to an increased rate of primary colorectal resection margin involvement.

Flow cytometric DNA analysis of oral squamous cell carcinoma in Iraqi patients.

We studied the DNA content, DNA index and cell cycle parameters that are reliable markers for assessing the proliferative activity and aggressiveness of malignancies. Cytometric DNA analysis was performed on formalin-fixed paraffin embedded sections from 36 Iraqi patients with oral squamous cell carcinoma. The results showed that 20 of 36 cases (55.5%) were diploid, while 15 cases (41.7%) were aneuploid. Significantly higher S-phase fractions and higher DNA indices characterized aneuploid tumours. Nuclear DNA analysis as part of the evaluation of oral squamous cell carcinoma will influence the selection of appropriate treatment strategies.

Colposcopy, cervical cytology and human papillomavirus detection as screening tools for cervical cancer.

A cohort of 77 women referred for routine screening or investigation of Pap test abnormality underwent colposcopic examination. Pap-stained liquid-based preparations were diagnosed and categorized according to the Bethesda system. Residual material on the sampling device was used to detect high-risk oncogenic human papillomavirus DNA. Although the colposcopic failure rate was higher than that of cytology, no lesion was missed when both methods were used together. High-risk types were recorded in 24% of patients with atypical squamous cells of undetermined significance, 45% with low-grade squamous intraepithelial lesions and 79% with high-grade squamous intraepithelial lesions--indicating that the efficacy of cytological screening can be improved by papillomavirus detection.

DNA proliferative index as a marker in Iraqi aneuploid mammary carcinoma.

This study estimated nuclear DNA ploidy and DNA proliferative indices (PI) in mammary ductal carcinomas from 120 Iraqi female patients. Of the examined specimens, 82.7% were aneuploid. DNA ploidy correlated significantly with histological grade and estrogen receptor content of the primary neoplasm. In aneuploid carcinomas, high PI showed a clearer association than aneuploidy with menopausal status and progesterone receptor content of the tumour. PI and percentage aneuploidy were higher in larger tumours; nodal status showed no association with these cytometric findings. Using PI, patients classified as having Auer aneuploid carcinomas can be divided into subsets with different tumour characteristics, thus improving the selection of those whose high risk, node-negative presentation makes them candidates for adjuvant systemic therapy.