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BACKGROUND: Nearly 40% of unplanned pregnancies in the USA are the result of inconsistent or incorrect contraceptive use. Finding ways to increase women's comfort and satisfaction with contraceptive use is therefore critical to public health. One promising pathway for improving patient outcomes is through the use of digital decision aids that assist women and their physicians in choosing a contraceptive option that women are comfortable with. Testing the ability of these aids to improve patient outcomes is therefore a necessary first step toward incorporating this technology into traditional physician appointments. PURPOSE: To evaluate the effectiveness of a novel contraceptive decision aid at minimizing decisional conflict and increasing comfort with contraception among adult women. METHODS: In total, 310 adult women were assigned to use either the Tuune contraceptive decision aid or a control aid modeled after a leading online contraceptive prescriber's patient intake form. Participants then completed self-report measures of decisional conflict, contraceptive expectations, satisfaction, and contraceptive use intentions. Individual between-subjects analysis of variance (ANOVA) models were used to examine these outcomes. RESULTS: Women using the Tuune decision aid (vs. those using the control aid) reported lower decisional conflict, more positive contraceptive expectations, greater satisfaction with the decision aid and recommendation, and more positive contraceptive use intentions. CONCLUSIONS: Use of Tuune improved each of the predicted patient outcomes relative to a control decision aid. Online decision aids, particularly when used alongside physician consultations, may be an effective tool for increasing comfort with contraceptive use. CLINICAL TRIALS REGISTRATION #: NCT05177783, ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT05177783.
Digital decision aids that help women and their physicians choose contraceptive options that women are most comfortable with present one promising way to improve contraceptive use outcomes, such as avoiding unplanned pregnancies. However, current decision aids have been found to struggle in helping improve women's satisfaction with and confidence in their contraceptive choices. The aim of this study was to test the effectiveness of a new digital decision aid, named Tuune, at helping improve women's confidence and comfort with contraception. Three hundred and ten adult women were randomly assigned to use and then receive a contraceptive recommendation from either the Tuune decision aid or a control aid designed after leading traditional health intake forms. Women's confidence and satisfaction with the aids, as well as their contraceptive recommendation, were then compared between groups. We found good evidence to suggest that women using the Tuune contraceptive decision aid were more satisfied and positive about their contraceptive choices and reported greater intentions to use contraception with increased confidence compared to women who used the control decision aid. New online decision aids, like Tuune, may be an effective tool for increasing women's comfort and experiences using contraception.
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Conducta Anticonceptiva , Técnicas de Apoyo para la Decisión , Satisfacción del Paciente , Humanos , Femenino , Adulto , Conducta Anticonceptiva/psicología , Adulto Joven , Anticoncepción/métodos , Adolescente , Toma de DecisionesRESUMEN
BACKGROUND/OBJECTIVES: Diagnostic criteria for atopic dermatitis (AD) are limited in their performance and/or usability. The American Academy of Dermatology (AAD) consensus criteria include hierarchical categories of disease features to improve these metrics but have not been validated. Our objective was to create and validate a checkbox form of the AAD consensus criteria in the pediatric population. METHODS: We performed a cross-sectional study of 100 pediatric patients with AD (n = 58) and diseases in the differential diagnosis of AD (n = 42). RESULTS: Having three or more "Essential," ≥2 "Important," ≥1 "Associated" features of the AAD criteria was optimal for the diagnosis of AD in children. This combination was 91.4% (95% CI, 84.2%-98.6%) sensitive and 95.2% (88.8%-100%) specific. The UK working party criteria and the Hanifin-Rajka criteria had sensitivities of 96.6% (95% CI 91.9%-100%) and 98.3% (95% CI 94.9%-100%) and specificities of 83.3% (95% CI 72.1%-94.6%) and 71.4% (95% CI 57.8%-85.1%), respectively. The AAD criteria had significantly greater specificity than the Hanifin-Rajka criteria (p = .002). CONCLUSIONS: This study represents an important step in validating the AAD consensus criteria and formulating a useable checkbox form for diagnosing AD in the pediatric population.
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Dermatitis Atópica , Dermatología , Niño , Humanos , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/epidemiología , Estudios Transversales , Diagnóstico Diferencial , ConsensoRESUMEN
BACKGROUND: Neurodegenerative disorders have been reported in elite athletes who participated in contact sports. The incidence of neurodegenerative disease among former professional soccer players has not been well characterized. METHODS: We conducted a retrospective cohort study to compare mortality from neurodegenerative disease among 7676 former professional soccer players (identified from databases of Scottish players) with that among 23,028 controls from the general population who were matched to the players on the basis of sex, age, and degree of social deprivation. Causes of death were determined from death certificates. Data on medications dispensed for the treatment of dementia in the two cohorts were also compared. Prescription information was obtained from the national Prescribing Information System. RESULTS: Over a median of 18 years, 1180 former soccer players (15.4%) and 3807 controls (16.5%) died. All-cause mortality was lower among former players than among controls up to the age of 70 years and was higher thereafter. Mortality from ischemic heart disease was lower among former players than among controls (hazard ratio, 0.80; 95% confidence interval [CI], 0.66 to 0.97; P = 0.02), as was mortality from lung cancer (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.001). Mortality with neurodegenerative disease listed as the primary cause was 1.7% among former soccer players and 0.5% among controls (subhazard ratio [the hazard ratio adjusted for competing risks of death from ischemic heart disease and death from any cancer], 3.45; 95% CI, 2.11 to 5.62; P<0.001). Among former players, mortality with neurodegenerative disease listed as the primary or a contributory cause on the death certificate varied according to disease subtype and was highest among those with Alzheimer's disease (hazard ratio [former players vs. controls], 5.07; 95% CI, 2.92 to 8.82; P<0.001) and lowest among those with Parkinson's disease (hazard ratio, 2.15; 95% CI, 1.17 to 3.96; P = 0.01). Dementia-related medications were prescribed more frequently to former players than to controls (odds ratio, 4.90; 95% CI, 3.81 to 6.31; P<0.001). Mortality with neurodegenerative disease listed as the primary or a contributory cause did not differ significantly between goalkeepers and outfield players (hazard ratio, 0.73; 95% CI, 0.43 to 1.24; P = 0.24), but dementia-related medications were prescribed less frequently to goalkeepers (odds ratio, 0.41; 95% CI, 0.19 to 0.89; P = 0.02). CONCLUSIONS: In this retrospective epidemiologic analysis, mortality from neurodegenerative disease was higher and mortality from other common diseases lower among former Scottish professional soccer players than among matched controls. Dementia-related medications were prescribed more frequently to former players than to controls. These observations need to be confirmed in prospective matched-cohort studies. (Funded by the Football Association and Professional Footballers' Association.).
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Atletas , Enfermedades Neurodegenerativas/mortalidad , Fútbol , Adulto , Anciano , Anciano de 80 o más Años , Lesiones Encefálicas , Estudios de Casos y Controles , Causas de Muerte , Femenino , Cardiopatías/mortalidad , Humanos , Incidencia , Modelos Logísticos , Longevidad , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Nootrópicos/uso terapéutico , Estudios Retrospectivos , Escocia/epidemiologíaRESUMEN
BACKGROUND: Autopsy studies of former contact sports athletes, including soccer and rugby players, frequently report chronic traumatic encephalopathy, a neurodegenerative pathology associated with traumatic brain injury. Nevertheless, little is known about the risk of neurodegenerative disease in these populations. We hypothesised that neurodegenerative disease risk would be higher among former elite rugby union players than the general population. METHODS: We conducted a retrospective cohort study accessing national electronic records on death certification, hospital admissions and dispensed prescriptions for a cohort of 412 male Scottish former international rugby union players and 1236 members of the general population, matched to former players by age, sex and area socioeconomic status. Mortality and incident neurodegenerative disease diagnoses among former rugby players were then compared with the matched comparison group. RESULTS: Over a median 32 years follow-up from study entry at age 30 years, 121 (29.4%) former rugby players and 381 (30.8%) of the matched comparison group died. All-cause mortality was lower among former rugby players until 70 years of age with no difference thereafter. During follow-up, 47 (11.4%) former rugby players and 67 (5.4%) of the comparison group were diagnosed with incident neurodegenerative disease (HR 2.67, 95% CI 1.67 to 4.27, p<0.001). CONCLUSIONS: This study adds to our understanding of the association between contact sports participation and the risk of neurodegenerative disease. While further research exploring this interaction is required, in the meantime strategies to reduce exposure to head impacts and head injuries in sport should be promoted.
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Traumatismos en Atletas , Conmoción Encefálica , Fútbol Americano , Enfermedades Neurodegenerativas , Humanos , Masculino , Adulto , Fútbol Americano/lesiones , Traumatismos en Atletas/epidemiología , Enfermedades Neurodegenerativas/epidemiología , Estudios Retrospectivos , Rugby , Conmoción Encefálica/diagnósticoRESUMEN
BACKGROUND: Although basal cell carcinoma (BCC) tends to follow an indolent course, some tumors can exhibit locally aggressive behavior and invade into bone. OBJECTIVE: To analyze all published demographic, clinical, and treatment data on recurrence patterns, disease progression, disease-specific death, and overall mortality of BCC with bone invasion. METHODS: A systematic review and pooled-survival analysis was performed, including case reports and case series of BCC with bone invasion. RESULTS: The study included 101 patients from 70 publications. BCC tumors invading into bone were most often large, neglected tumors located in high-risk face areas. At 5 years, patients had a 30% risk probability of disease recurrence (after negative margins), a 72.1% risk of disease progression or death (with ambiguous margin status), an 18.2% risk of BCC-related death, and a 20.7% overall probability of death. LIMITATIONS: Limitations include the reliance on case reports and series for individual patient data, which has the potential to introduce selection bias. CONCLUSION: The high rate of disease progression and suboptimal 5-year survival rate highlights the poor prognosis of BCC with bone invasion and further underscores the importance of early detection and treatment.
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Carcinoma Basocelular , Neoplasias Cutáneas , Carcinoma Basocelular/patología , Progresión de la Enfermedad , Humanos , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Neoplasias Cutáneas/patología , Análisis de SupervivenciaRESUMEN
BACKGROUND: Bone invasion has long been recognized as a poor prognostic indicator for cutaneous squamous cell carcinoma (SCC). Survival analyses of factors associated with SCC with bone invasion have not been published. OBJECTIVE: To analyze all published demographic, clinical, and treatment data for SCC with bone invasion and assess the impact of prognostic variables on disease progression, disease-specific death, and overall mortality. MATERIALS AND METHODS: A systematic review and pooled-survival analysis was performed using individual patient data from case reports. Progression-free survival (PFS), disease-specific survival (DSS), and overall survival (OS) were estimated by Kaplan-Meier analysis. RESULTS: The study included 76 cases of SCC with bone invasion from 49 publications. Recurrent tumors and nonsurgical treatment modality were predictors of disease progression in univariable analysis and tumors of the trunk, head, and neck were predictors of disease progression in multivariable analysis. At 5 years from bone invasion diagnosis, patients had a PFS, DSS, and OS rate of 66.7%, 71.7%, and 66.2%, respectively. CONCLUSION: Cases of SCC with bone invasion had poor DFS, DSS, and OS rates, with worse outcomes imparted to tumors of the trunk, head, and neck.
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Carcinoma de Células Escamosas , Neoplasias Cutáneas , Carcinoma de Células Escamosas/patología , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Humanos , Recurrencia Local de Neoplasia , Pronóstico , Estudios Retrospectivos , Neoplasias Cutáneas/terapia , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
In March 2020, with lockdown due to the coronavirus pandemic underway, the Francis Crick Institute (the Crick) regeared its research laboratories into clinical testing facilities. Two pipelines were established, one for polymerase chain reaction and the other for Serology. This article discusses the Cricks Flow Cytometry Science Technology Platform (Flow STP) role in setting up the Serology pipeline. Pipeline here referring to the overarching processes in place to facilitate the receipt of human sera through to a SARs-CoV-2 enzyme-linked immunosorbent assay result. We examine the challenges that had to be overcome by a research laboratory to incorporate clinical diagnostics and the processes by which this was achieved. It describes the governance required to run the service, the design of the standard operating procedures (SOPs) and pipeline, the setting up of the assay, the validation required to show the robustness of the pipeline and reporting the results of the assay. Finally, as the lockdown started to ease in June 2020, it examines how this new service affects the daily running of the Flow STP. © 2020 The Authors. Cytometry Part A published by Wiley Periodicals LLC on behalf of International Society for Advancement of Cytometry.
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Adaptación Psicológica , COVID-19/diagnóstico , Citometría de Flujo/normas , Laboratorios/normas , SARS-CoV-2/aislamiento & purificación , COVID-19/sangre , COVID-19/epidemiología , Ensayo de Inmunoadsorción Enzimática/normas , Ensayo de Inmunoadsorción Enzimática/tendencias , Citometría de Flujo/tendencias , Humanos , Laboratorios/tendencias , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Despite the large burden of impetigo in childhood and high frequency of pediatric emergency department (ED) visits for skin conditions, limited information exists on the use of EDs for impetigo among US children. OBJECTIVE: Our study aimed to generate national estimates of ED utilization and to identify sociodemographic predictors of impetigo-related ED visits. METHODS: This was a retrospective, cross-sectional study of children ages 1-17 presenting to EDs with a primary diagnosis of impetigo using years 2013-2015 of the Nationwide Emergency Department Sample. RESULTS: Impetigo accounted for 163 909 of the 71 488, 511 pediatric ED visits and was the fourth most common presenting skin diagnosis. Controlling for sociodemographic factors, patients presenting to the ED with impetigo were most likely to be 6-11 years old, male, and from lower-income quartiles. Patients were most likely to be uninsured and most likely to present on weekends in the summer. CONCLUSION: This study provided national-level estimates of ED use for impetigo among US children. Ultimately, the identification of factors associated with increased ED utilization may help in developing targeted interventions to reduce the use of emergency care for impetigo.
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Impétigo , Adolescente , Niño , Preescolar , Estudios Transversales , Servicio de Urgencia en Hospital , Humanos , Impétigo/diagnóstico , Impétigo/tratamiento farmacológico , Impétigo/epidemiología , Lactante , Masculino , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Recent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a 'Head Injury Discharge At Triage' tool (HIDAT). We sought to implement this into clinical practice. METHODS: Paediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED. RESULTS: Of the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018. CONCLUSION: We have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources.
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Lesiones Traumáticas del Encéfalo/diagnóstico , COVID-19/prevención & control , Traumatismos Cerrados de la Cabeza/diagnóstico , Traumatismos Penetrantes de la Cabeza/diagnóstico , Triaje/métodos , Lesiones Traumáticas del Encéfalo/etiología , Lesiones Traumáticas del Encéfalo/prevención & control , COVID-19/epidemiología , COVID-19/transmisión , Niño , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Traumatismos Cerrados de la Cabeza/complicaciones , Traumatismos Penetrantes de la Cabeza/complicaciones , Implementación de Plan de Salud , Hospitales Pediátricos/organización & administración , Humanos , Enfermeras Pediátricas/organización & administración , Pandemias/prevención & control , Alta del Paciente , Rol Profesional , Triaje/organización & administración , Triaje/normasRESUMEN
INTRODUCTION: There is growing recognition of an association between contact sports participation and increased risk of neurodegenerative disease, including Alzheimer's disease and chronic traumatic encephalopathy. In addition to cognitive impairment, a range of mental health disorders and suicidality are proposed as diagnostic features of traumatic encephalopathy syndrome, the putative clinical syndrome associated with chronic traumatic encephalopathy. However, to date, epidemiological data on contact sport participation and mental health outcomes are limited. METHODS: For a cohort of former professional soccer players (n=7676) with known high neurodegenerative mortality and their matched general population controls (n=23 028), data on mental health outcomes were obtained by individual-level record linkage to national electronic records of hospital admissions and death certification. RESULTS: Compared with matched population controls, former professional soccer players showed lower risk of hospital admission for anxiety and stress related disorders, depression, drug use disorders, alcohol use disorders and bipolar and affective mood disorders. Among soccer players, there was no significant difference in risk of hospitalisation for mental health disorders between outfield players and goalkeepers. There was no significant difference in rate of death by suicide between soccer players and controls. CONCLUSIONS: Among a population of former professional soccer players with known high neurodegenerative disease mortality, hospital admissions for common mental health disorders were lower than population controls, with no difference in suicide. Our data provide support for the reappraisal of currently proposed diagnostic clinical criteria for traumatic encephalopathy syndrome, in particular the inclusion of mental health outcomes.
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Atletas/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Trastornos Mentales/epidemiología , Fútbol , Suicidio/estadística & datos numéricos , Adulto , Anciano , Alcoholismo/epidemiología , Trastornos de Ansiedad/epidemiología , Atletas/psicología , Trastorno Bipolar/epidemiología , Estudios de Cohortes , Trastorno Depresivo/epidemiología , Humanos , Masculino , Trastornos Mentales/psicología , Salud Mental , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
OBJECTIVES: To assess if a nurse-led application of a paediatric head injury clinical decision tool would be safe compared with current practice. METHODS: All paediatric (<17 years) patients with head injuries presenting to Frimley Park Emergency Department (ED), England from 1 May to 31 October 2018 were prospectively screened by a nurse using a mandated electronic 'Head Injury Discharge At Triage' questionnaire (HIDATq). We determined which patients underwent CT of brain and whether there was a clinically important intracranial injury or re-presentation to the ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using this tool. RESULTS: Of the 1739 patients screened, 61 had CTs performed due to head injury (six abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative, 349 (33%)/1052 had 'no other injuries' and 543 (52%)/1052 had 'abrasions or lacerations'. HIDATq's negative predictive value for CT was 99.9% (95% CI 99.4% to 99.9%) and 100% (95% CI 99.0% to 100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72 hours but did not require CT imaging. CONCLUSION: A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739), if patients with lacerations or abrasions were given advice and discharged at triage. A large multicentre study is required to validate the tool.
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Traumatismos Craneocerebrales/diagnóstico por imagen , Técnicas de Apoyo para la Decisión , Servicio de Urgencia en Hospital , Evaluación en Enfermería , Tomografía Computarizada por Rayos X , Adolescente , Niño , Preescolar , Inglaterra , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , TriajeRESUMEN
Measuring affective well-being in organizational studies has become increasingly widespread, given its association with key work-performance and other markers of organizational functioning. As such, researchers and policy-makers need to be confident that well-being measures are valid, reliable and robust. To reduce the burden on participants in applied settings, short-form measures of affective well-being are proving popular. However, these scales are seldom validated as standalone, comprehensive measures in their own right. In this article, we used a short-form measure of affective well-being with 10 items: the Daniels five-factor measure of affective well-being (D-FAW). In Study 1, across six applied sample groups (N = 2624), we found that the factor structure of the short-form D-FAW is robust when issued as a standalone measure, and that it should be scored differently depending on the participant instruction used. When participant instructions focus on now or today, then affect is best represented by five discrete emotion factors. When participant instructions focus on the past week, then affect is best represented by two or three mood-based factors. In Study 2 (N = 39), we found good construct convergent validity of short-form D-FAW with another widely used scale (PANAS). Implications for the measurement and structure of affect are discussed.
RESUMEN
Within the context of the conservation of resources model, when a resource is deployed, it is depleted - albeit temporarily. However, when a 'key', stable resource, such as Conscientiousness, is activated (e.g., using a self-control strategy, such as resisting an email interruption), we predicted that (1) another, more volatile resource (affective well-being) would be impacted and that (2) this strategy would be deployed as a trade-off, allowing one to satisfy task goals, at the expense of well-being goals. We conducted an experience-sampling field study with 52 email-users dealing with their normal email as it interrupted them over the course of a half-day period. This amounted to a total of 376 email reported across the sample. Results were analysed using random coefficient hierarchical linear modelling and included cross-level interactions for Conscientiousness with strategy and well-being. Our first prediction was supported - deploying the stable, key resource of Conscientiousness depletes the volatile, fluctuating resource of affective well-being. However, our second prediction was not fully realized. Although resisting or avoiding an email interruption was perceived to hinder well-being goal achievement by Conscientious people, it had neither a positive nor negative impact on task goal achievement. Implications for theory and practice are discussed. Practitioner points: It may be necessary for highly Conscientious people to turn off their email interruption alerts at work, in order to avoid the strain that results from an activation-resistance mechanism afforded by the arrival of a new email.Deploying key resources means that volatile resources may be differentially spent, depending on one's natural tendencies and how these interact with the work task and context. This suggests that the relationship between demands and resources is not always direct and predictable.Practitioners may wish to appraise the strategies they use to deal with demands such as email at work, to identify if these strategies are assisting with task or well-being goal achievement, or whether they have become defunct through automation.