Motivations for and outcomes of graduate education amongst dental hygienists: A pan-Canadian study.

OBJECTIVES: Motivations and career outcomes of dental hygienists with baccalaureate degrees have been recently reported; however, few studies have explored Canadian dental hygienists pursuing graduate education. There is limited evidence to inform career outcomes and motivating factors for advanced education, limiting knowledge of how professional outcomes have evolved alongside advancements in graduate program offerings. This study focused on understanding motivating factors to pursue graduate education and the professional outcomes of dental hygienists with graduate degrees. METHODS: This nested online anonymous survey was conducted between November and December 2021 with dental hygienists who graduated from one of four Canadian baccalaureate-level dental hygiene degree programs and had further indicated that they were pursuing or had obtained additional graduate-level education (n = 60). Participants were asked to report on any advanced graduate-level education. Open-ended questions on graduate degree education were analysed through thematic analysis. RESULTS: Motivations for pursuing graduate degrees were influenced by personal and professional preferences. Master's degree recipients cited expanded career opportunities, alternate interests, convenience, and dissatisfaction with/desire to leave clinical practice as major motivators. Doctoral degree holding dental hygienists identified expanded/alternate career opportunities as major motivation but also cited program convenience as an influencer. The availability of distance and flexible programming is a novel finding that positively influences the pursuit of advanced education. CONCLUSION: Dental hygienists are pursuing graduate education to expand their scope of knowledge and create new career opportunities. Graduate degree programs that accommodate work-life balance through flexible and online offerings are very attractive to dental hygienists.

Facilitators for increasing dental attendance of people from vulnerable groups: a rapid review of evidence relevant to the UK.

Objective To rapidly review facilitators of access for vulnerable groups and to evaluate their effectiveness.Methods Data sources: MEDLINE via Ovid. Publications in English from 2000. DATA SELECTION: Research involving 'vulnerable groups' relevant to UK health systems, with a primary outcome of increasing attendance. DATA EXTRACTION: One author extracted and tabulated data. These were audited by a second author. DATA SYNTHESIS: A narrative synthesis was produced.Results Data from 31 studies were available for ten vulnerable groups: people with learning, physical or sensory disabilities (n = 8); people experiencing homelessness (n = 6); prisoners (n = 4); asylum-seekers and refugees (n = 3); people living in socioeconomically deprived areas (n = 3); people with severe mental health conditions (n = 2); vulnerable children (n = 2); dependent older people (n = 1); Gypsy, Roma or Traveller groups (n = 1); and people with drug dependency (n = 1). Many facilitators involved organisational reform and more integration of health, social and other services. Other facilitators included: modification of premises; team development and skill-mix use; and awareness of needs and flexible services to meet them. Few studies evaluated effectiveness.Conclusion Although facilitators for access for vulnerable groups have been proposed, there is little evidence to support or refute their effectiveness. Efforts are needed to promote access for vulnerable groups in the UK with evaluation plans embedded.

Mismatch negativity predicts initial auditory-based targeted cognitive training performance in a heterogeneous population across psychiatric disorders.

Auditory-based targeted cognitive training (ATCT) programs are emerging pro-cognitive therapeutic interventions which aim to improve auditory processing to attenuate cognitive impairment in a "bottom up" manner. Biomarkers of early auditory information processing (EAIP) like mismatch negativity (MMN) and P3a have been used successfully to predict gains from a full 40 h course of ATCT in schizophrenia (SZ). Here we investigated the ability of EAIP biomarkers to predict ATCT performance in a group of subjects (n = 26) across SZ, MDD, PTSD and GAD diagnoses. Cognition was assessed via the MATRICS Consensus Cognitive Battery (MCCB) and MMN/P3a were collected prior to completing 1 h of "Sound Sweeps," a representative ATCT exercise. Baseline and final performance over the first two levels of cognitive training served as the primary dependent variables. Groups had similar MMN, but the SZ group had attenuated P3a. MMN and MCCB cognitive domain t-scores, but not P3a, were strongly correlated with most ATCT performance measures, and explained up to 61% of variance in ATCT performance. Diagnosis was not a significant predictor for ATCT performance. These data suggest that MMN can predict ATCT performance in heterogeneous neuropsychiatric populations and should be considered in ATCT studies across diagnostically diverse cohorts.

Impact of built environment change on all-cause and cause-specific mortality: a novel longitudinal method and study.

BACKGROUND: Public health research increasingly acknowledges the influence of built environments (BE) on health; however, it is uncertain how BE change is associated with better population health and whether BE change can help narrow health inequalities. This knowledge gap is partly due to a lack of suitable longitudinal BE data in most countries. We devised a method to quantify BE change longitudinally and explored associations with mortality. The method is replicable in any nation that captures BE vector map data. METHODS: Ordnance Survey data were used to categorise small areas as having no change, loss or gain, in buildings, roads, and woodland between 2015 and 2019. We examined individual mortality records for 2012-2015 and 2016-2019, using negative binomial regression to explore associations between BE change and all-cause and cause-specific mortality, adjusting for income deprivation. RESULTS: BE change varied significantly by deprivation and urbanicity. Change in the BE and change in mortality were not related, however, areas that went on to experience BE change had different baseline mortality rates compared with those that did not. For example, areas that gained infrastructure already had lower mortality rates. CONCLUSION: We provide new methodology to quantify BE change over time across a nation. Findings provide insight into the health of areas that do/do not experience change, prompting critical perspectives on cross-sectional studies of associations between BE and health. Methods and findings applied internationally could explore the context of BE change and its potential to improve health in areas most in need beyond the UK.

Motivating influences and career outcomes of baccalaureate-educated dental hygienists: a pan-Canadian study.

Background: As discussions about baccalaureate education for dental hygiene continue at national and international levels, examining outcomes of earning a baccalaureate degree in a Canadian context is essential. This study aimed to explore the motivating reasons for pursuing a dental hygiene baccalaureate degree in Canada and the career outcomes of Canadian dental hygiene baccalaureate degree graduates. Methods: Graduates from all 4 Canadian dental hygiene degree programs (N = 262) participated in a cross-sectional online survey between November and December 2021. Survey questions explored motivating reasons for pursuing dental hygiene degree education, educational experiences, employment outcomes, and career satisfaction. A descriptive analysis was performed to report absolute and relative frequencies of responses to each question. Differences between participant characteristics, motivating reasons for pursing a degree, and practice outcomes were assessed. Where applicable, results were compared to the results of the Canadian Dental Hygienists Association's 2019 Job Market and Employment Survey. A thematic analysis was applied to open-ended descriptive responses. Results: Primary motivators included personal satisfaction (77%), status of a degree (75%), increase in employment opportunities (71%), and increase in knowledge base (69%). Respondents (87%) reported that they were satisfied with their educational experiences, and the majority (65%) agreed that a degree should be the minimum entry-level credential for dental hygiene practice in Canada. Primary practice settings were reported as clinical dental hygiene care (80%), educational institutions (9%), community and public health (4%), and other practice settings (7%). A larger proportion reported working in non-clinical settings than those in the national survey (20% and 8%, respectively; p < 0.001). Conclusion: These findings underscore the impact of baccalaureate education on dental hygiene practice in Canada.

Contexte: Étant donné que les discussions sur les études menant à un baccalauréat en hygiène dentaire se poursuivent aux échelles nationales et internationales, il est essentiel d'examiner les résultats de l'obtention d'un baccalauréat dans un contexte canadien. Cette étude visait à explorer les raisons qui motivent la poursuite d'un baccalauréat en hygiène dentaire au Canada et les possibilités de carrière des diplômés canadiens d'un programme de baccalauréat en hygiène dentaire. Méthodologie: Des diplômés des 4 programmes canadiens de baccalauréat en hygiène dentaire (N = 262) ont participé à une enquête ponctuelle en ligne entre novembre et décembre 2021. Les questions de l'enquête ont exploré les raisons motivant la poursuite d'études en hygiène dentaire menant à un baccalauréat, les expériences éducatives, les possibilités d'emploi et la satisfaction par rapport à la carrière. Une analyse descriptive a permis d'établir les fréquences absolues et relatives des réponses à chaque question. Les différences entre les caractéristiques des participants, les raisons motivant l'obtention d'un baccalauréat et les possibilités de la pratique professionnelle ont été évaluées. Le cas échéant, les résultats ont été comparés aux résultats du Sondage sur le marché du travail et de l'emploi de 2019 de l'Association canadienne des hygiénistes dentaires. Une analyse thématique a été appliquée aux réponses descriptives ouvertes. Résultats: Les principaux facteurs de motivation comprenaient la satisfaction personnelle (77 %), le statut d'un baccalauréat (75 %), l'augmentation des possibilités d'emploi (71 %) et l'augmentation de la base de connaissances (69 %). Les répondants (87 %) ont déclaré être satisfaits de leurs expériences éducatives et la majorité (65 %) était d'accord pour dire qu'un baccalauréat devrait être le titre de compétence minimal pour l'admission à la pratique de l'hygiène dentaire au Canada. Les milieux de pratique primaires ont été déclarés comme étant les suivants : soins cliniques en hygiène dentaire (80 %), établissements d'enseignement (9 %), santé communautaire et publique (4 %), et autres milieux de pratique (7 %). Un plus grand nombre de répondants ont déclaré travailler dans des milieux non cliniques que ceux de l'enquête nationale (20 % et 8 %, respectivement; p < 0,001). Conclusion: Ces résultats soulignent l'impact des études menant à un baccalauréat sur la pratique de l'hygiène dentaire au Canada.

Is spatial exposure to heritage associated with visits to heritage and to mental health? A cross-sectional study using data from the UK Household Longitudinal Study (UKHLS).

OBJECTIVES: Existing research highlights the beneficial nature of heritage engagement for mental health, but engagement varies geographically and socially, and few studies explore spatial exposure (ie, geographic availability) to heritage and heritage visits. Our research questions were 'does spatial exposure to heritage vary by area income deprivation?', 'is spatial exposure to heritage linked to visiting heritage?' and 'is spatial exposure to heritage linked to mental health?'. Additionally, we explored whether local heritage is associated with mental health regardless of the presence of green space. DESIGN: Data were collected from January 2014 to June 2015 via the UK Household Longitudinal Study (UKHLS) wave 5. Our study is cross-sectional. SETTING: UKHLS data were either collected via face-to-face interview or online questionnaire. PARTICIPANTS: 30 431 adults (16+ years) (13 676 males, 16 755 females). Participants geocoded to Lower Super Output Area (LSOA) 'neighbourhood' and 'English Index of Multiple Deprivation' 2015 income score. MAIN EXPOSURES/OUTCOME MEASURES: LSOA-level heritage exposure and green space exposure (ie, population and area densities); heritage site visit in the past year (outcome, binary: no, yes); mental distress (outcome, General Health Questionnaire-12, binary: less distressed 0-3, more distressed 4+). RESULTS: Heritage varied by deprivation, the most deprived areas (income quintile (Q)1: 1.8) had fewer sites per 1000 population than the least deprived (Q5: 11.1) (p<0.01). Compared with those with no LSOA-level heritage, those with heritage exposure were more likely to have visited a heritage site in the past year (OR: 1.12 (95% CI 1.03 to 1.22)) (p<0.01). Among those with heritage exposure, visitors to heritage had a lower predicted probability of distress (0.171 (95% CI 0.162 to 0.179)) than non-visitors (0.238 (95% CI 0.225 to 0.252)) (p<0.001). CONCLUSIONS: Our research contributes to evidence for the well-being benefits of heritage and is highly relevant to the government's levelling-up heritage strategy. Our findings can feed into schemes to tackle inequality in heritage exposure to improve both heritage engagement and mental health.

Mixed methods study design, pre-analysis plan, process evaluation and baseline results of trailbridges in rural Rwanda.

We present a study design, pre-analysis plan, process evaluation and baseline results designed to establish the impact of trailbridges on health, education, agricultural and economic outcomes of households in rural Rwanda. This intervention and study is being implemented in communities that face barriers to socioeconomic development through periodic isolation caused by flooding. We describe a mixed methods approach to measure the impacts of these trailbridges on outcomes at the village level. The study is anchored on a stepped-wedge randomized controlled trial (RCT) implemented in 147 sites: 97 phased-in intervention sites and 50 long-term control sites. These sites are being monitored in four annual waves comprising of a baseline period and three subsequent follow-up waves. We will supplement the RCT with three sub-studies. First, we are investigating the role of weather events and streamflow variability on temporal and spatial bridge use patterns among intervention sites. We will then find the relationship between the weather events, streamflow and bridge use from motion-activated cameras installed in intervention sites. Secondly, we are following 42 markets serving study sites to investigate the impact of the trailbridges on the market prices of key goods including crops, livestock and agricultural inputs. Lastly, we are following 30 villages that are more distant from the river crossings to determine the spatial extent of the trailbridge impacts. Our study will advance knowledge by generating new data on the impact of rural infrastructure and providing the opportunity to explore a range of outcomes for future evaluation of infrastructure in low- and middle-income countries. We will enable an outcomes-based funding model that ties implementer payments to demonstrated positive impacts of these trailbridges. Furthermore, we will identify cost-effective, easily assessed measures that are highly correlated to the economic and health benefits of the intervention. These measures may then be used by a portfolio of interventions across multiple geographies without always requiring complex trials.

Effectiveness of 10 and 13-valent pneumococcal conjugate vaccines against invasive pneumococcal disease in European children: SpIDnet observational multicentre study.

BACKGROUND: Pneumococcal conjugate vaccines covering 10 (PCV10) and 13 (PCV13) serotypes have been introduced in the infant immunization schedule of most European countries in 2010-11. To provide additional real-life data, we measured the effectiveness of PCV10 and PCV13 against invasive pneumococcal disease (IPD) in children of 12 European sites (SpIDnet). METHODS: We compared the vaccination status of PCV10 and PCV13 serotype IPD (cases) to that of nonPCV13 serotype IPD (controls) reported in 2012-2018. We calculated pooled effectiveness as (1-vaccination odds ratio)*100, and measured effectiveness over time since booster dose. RESULTS: The PCV13 and PCV10 studies included 2522 IPD cases from ten sites and 486 cases from four sites, respectively. The effectiveness of ≥ 1 PCV13 dose was 84.2% (95 %CI: 79.0-88.1) against PCV13 serotypes (n = 2353) and decreased from 93.1% (87.8-96.1) < 12 months to 85.1% (72.0-92.1) ≥ 24 months after booster dose. PCV13 effectiveness of ≥ 1 dose was 84.7% (55.7-94.7) against fatal PCV13 IPD, 64.5% (43.7-77.6), 83.2% (73.7-89.3) and 85.1% (67.6-93.1) against top serotypes 3, 19A and 1, respectively, and 85.4% (62.3-94.4) against 6C. Serotype 3 and 19A effectiveness declined more rapidly. PCV10 effectiveness of ≥ 1 dose was 84.8% (69.4-92.5) against PCV10 serotypes (n = 370), 27.2% (-187.6 to 81.6) and 85.3% (35.2-96.7) against top serotypes 1 and 7F, 32.5% (-28.3 to 64.5) and -14.4% (-526.5 to 79.1) against vaccine-related serotypes 19A and 6C, respectively. CONCLUSIONS: PCV10 and PCV13 provide similar protection against IPD due to the respective vaccine serotype groups but serotype-specific effectiveness varies by serotype and vaccine. PCV13 provided individual protection against serotype 3 and vaccine-related serotype 6C IPD. PCV10 effectiveness was not significant against vaccine-related serotypes 19A and 6C. PCV13 effectiveness declined with time after booster vaccination. This multinational study enabled measuring serotype-specific vaccine effectiveness with a precision rarely possible at the national level. Such large networks are crucial for the post-licensure evaluation of vaccines.

Treatment of periodontitis for glycaemic control in people with diabetes mellitus.

BACKGROUND: Glycaemic control is a key component in diabetes mellitus (diabetes) management. Periodontitis is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontitis.  Treatment for periodontitis involves subgingival instrumentation, which is the professional removal of plaque, calculus, and debris from below the gumline using hand or ultrasonic instruments. This is known variously as scaling and root planing, mechanical debridement, or non-surgical periodontal treatment. Subgingival instrumentation is sometimes accompanied by local or systemic antimicrobials, and occasionally by surgical intervention to cut away gum tissue when periodontitis is severe. This review is part one of an update of a review published in 2010 and first updated in 2015, and evaluates periodontal treatment versus no intervention or usual care.  OBJECTIVES: To investigate the effects of periodontal treatment on glycaemic control in people with diabetes mellitus and periodontitis. SEARCH METHODS: An information specialist searched six bibliographic databases up to 7 September 2021 and additional search methods were used to identify published, unpublished, and ongoing studies.  SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 diabetes mellitus and a diagnosis of periodontitis that compared subgingival instrumentation (sometimes with surgical treatment or adjunctive antimicrobial therapy or both) to no active intervention or 'usual care' (oral hygiene instruction, education or support interventions, and/or supragingival scaling (also known as PMPR, professional mechanical plaque removal)). To be included, the RCTs had to have lasted at least 3 months and have measured HbA1c (glycated haemoglobin). DATA COLLECTION AND ANALYSIS: At least two review authors independently examined the titles and abstracts retrieved by the search, selected the included trials, extracted data from included trials, and assessed included trials for risk of bias. Where necessary and possible, we attempted to contact study authors. Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c), which can be reported as a percentage of total haemoglobin or as millimoles per mole (mmol/mol). Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing, clinical attachment level, gingival index, plaque index, and probing pocket depth), quality of life, cost implications, and diabetic complications. MAIN RESULTS: We included 35 studies, which randomised 3249 participants to periodontal treatment or control. All studies used a parallel-RCT design and followed up participants for between 3 and 12 months. The studies focused on people with type 2 diabetes, other than one study that included participants with type 1 or type 2 diabetes. Most studies were mixed in terms of whether metabolic control of participants at baseline was good, fair, or poor. Most studies were carried out in secondary care.  We assessed two studies as being at low risk of bias, 14 studies at high risk of bias, and the risk of bias in 19 studies was unclear. We undertook a sensitivity analysis for our primary outcome based on studies at low risk of bias and this supported the main findings. Moderate-certainty evidence from 30 studies (2443 analysed participants) showed an absolute reduction in HbA1c of 0.43% (4.7 mmol/mol) 3 to 4 months after treatment of periodontitis (95% confidence interval (CI) -0.59% to -0.28%; -6.4 mmol/mol to -3.0 mmol/mol). Similarly, after 6 months, we found an absolute reduction in HbA1c of 0.30% (3.3 mmol/mol) (95% CI -0.52% to -0.08%; -5.7 mmol/mol to -0.9 mmol/mol; 12 studies, 1457 participants), and after 12 months, an absolute reduction of 0.50% (5.4 mmol/mol) (95% CI -0.55% to -0.45%; -6.0 mmol/mol to -4.9 mmol/mol; 1 study, 264 participants). Studies that measured adverse effects generally reported that no or only mild harms occurred, and any serious adverse events were similar in intervention and control arms. However, adverse effects of periodontal treatments were not evaluated in most studies. AUTHORS' CONCLUSIONS: Our 2022 update of this review has doubled the number of included studies and participants, which has led to a change in our conclusions about the primary outcome of glycaemic control and in our level of certainty in this conclusion. We now have moderate-certainty evidence that periodontal treatment using subgingival instrumentation improves glycaemic control in people with both periodontitis and diabetes by a clinically significant amount when compared to no treatment or usual care. Further trials evaluating periodontal treatment versus no treatment/usual care are unlikely to change the overall conclusion reached in this review.

"This program should come with a warning sign!": Mental wellness in occupational therapy and physical therapy students.

Objectives: To measure and compare distress in entry-level masters occupational therapy (OT) and physical therapy (PT) students; to evaluate distress levels relative to existing data; and to explore factors that cause stress, effects of stress, and coping strategies. Participants: Ninety-eight OT and PT students (75 females, 23 males) from two cohorts at a Canadian university. Methods: Sequential mixed-methods including questionnaires and inductive analysis of focus group discussions. Results: OT and PT students from one cohort reported higher levels of stress, anxiety and/or depression compared to the following academic year and compared to undergraduate and general population samples. The overall theme was the unrelenting tug of war between school and other aspects of students' lives. Factors related to academic workload negatively affected mental health. Coping strategies included physical activity, strategic selection of peers, and modifying expectations. Conclusions: Wellness in OT and PT students is an important concern that deserves attention.

Serotype Replacement after Introduction of 10-Valent and 13-Valent Pneumococcal Conjugate Vaccines in 10 Countries, Europe.

We evaluated invasive pneumococcal disease (IPD) during 8 years of infant pneumococcal conjugate vaccine (PCV) programs using 10-valent (PCV10) and 13-valent (PCV13) vaccines in 10 countries in Europe. IPD incidence declined during 2011-2014 but increased during 2015-2018 in all age groups. From the 7-valent PCV period to 2018, IPD incidence declined by 42% in children <5 years of age, 32% in persons 5-64 years of age, and 7% in persons >65 years of age; non-PCV13 serotype incidence increased by 111%, 63%, and 84%, respectively, for these groups. Trends were similar in countries using PCV13 or PCV10, despite different serotype distribution. In 2018, serotypes in the 15-valent and 20-valent PCVs represented one third of cases in children <5 years of age and two thirds of cases in persons >65 years of age. Non-PCV13 serotype increases reduced the overall effect of childhood PCV10/PCV13 programs on IPD. New vaccines providing broader serotype protection are needed.

Gender and Regionalization in North America: From NAFTA to CUSMA and Beyond?

The literature on world regions is largely gender-blind. This article suggests ways in which the study of regionalism can incorporate gender analysis, based on the case of North America. It argues that this can be done in three ways: through an examination of the gendered impact of regional integration; through an examination of how gender concerns are, or can be, mainstreamed into regional policies; and through research on new forms of feminist-inspired activism that may shape regional outcomes. After applying these perspectives to the case of North America and the new Canada-United States-Mexico Agreement, it argues that despite the failure of the Canadian government to achieve the inclusion of a gender chapter, the inclusion of language around gender discrimination in the labour chapter makes the new agreement a more effective (if still limited) tool for promotion of some forms of gender equality.

Efficacy and safety of different interventions to accelerate maxillary canine retraction following premolar extraction: A systematic review and network meta-analysis.

Decreasing orthodontic treatment duration is at the forefront of innovation for clinical orthodontics. This network meta-analysis aimed to determine the relative efficacy and safety of treatments for accelerated orthodontic tooth movement (OTM) in patients undergoing extraction of maxillary first premolars followed by canine retraction in any orthodontic setting. MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL and SCOPUS were searched (from inception to 20 April 2020). Study selection and data extraction were performed in duplicate. Eligible randomized controlled trials (RCTs) were meta-analysed to estimate the rate of tooth movement, 95% credible interval and surface under the cumulative ranking curve (SUCRA) in the first 3 months following the application of the adjunctive accelerative method. Eligible RCTs were assessed by Cochrane risk of bias tool, and quality of evidence was assessed by GRADE approach, obtained from CINeMA web application. Interventions were ranked for efficacy and reviewed for safety. Nineteen studies pertaining to eight interventions, with data from 415 patients were included. Quality of evidence was very low to moderate. Very low-to low-quality evidence suggests that corticotomy is an efficacious and safe adjunctive treatment to accelerate OTM in comparison with conventional treatment in the first 2 months of treatment. Low-quality evidence suggests that piezocision and micro-osteoperforations (MOP) are efficacious and safe adjunctive treatments only in the first month of treatment. Frequent MOP in conjunction with low-level laser therapy appeared to be an efficacious and safe adjunctive treatment only in the first month following its initial application but not thereafter.

Anticholinergic Medication Burden-Associated Cognitive Impairment in Schizophrenia.

OBJECTIVE: Many psychotropic medications used to treat schizophrenia have significant anticholinergic properties, which are linked to cognitive impairment and dementia risk in healthy subjects. Clarifying the impact of cognitive impairment attributable to anticholinergic medication burden may help optimize cognitive outcomes in schizophrenia. The aim of this study was to comprehensively characterize how this burden affects functioning across multiple cognitive domains in schizophrenia outpatients. METHODS: Cross-sectional data were analyzed using inferential statistics and exploratory structural equation modeling to determine the relationship between anticholinergic medication burden and cognition. Patients with a diagnosis of schizophrenia or schizoaffective disorder (N=1,120) were recruited from the community at five U.S. universities as part of the Consortium on the Genetics of Schizophrenia-2. For each participant, prescribed medications were rated and summed according to a modified Anticholinergic Cognitive Burden (ACB) scale. Cognitive functioning was assessed by performance on domains of the Penn Computerized Neurocognitive Battery (PCNB). RESULTS: ACB score was significantly associated with cognitive performance, with higher ACB groups scoring worse than lower ACB groups on all domains tested on the PCNB. Similar effects were seen on other cognitive tests. Effects remained significant after controlling for demographic characteristics and potential proxies of illness severity, including clinical symptoms and chlorpromazine-equivalent antipsychotic dosage. CONCLUSIONS: Anticholinergic medication burden in schizophrenia is substantial, common, conferred by multiple medication classes, and associated with cognitive impairments across all cognitive domains. Anticholinergic medication burden from all medication classes-including psychotropics used in usual care-should be considered in treatment decisions and accounted for in studies of cognitive functioning in schizophrenia.

Changes in Invasive Pneumococcal Disease Caused by Streptococcus pneumoniae Serotype 1 Following Introduction of PCV10 and PCV13: Findings from the PSERENADE Project.

Streptococcus pneumoniae serotype 1 (ST1) was an important cause of invasive pneumococcal disease (IPD) globally before the introduction of pneumococcal conjugate vaccines (PCVs) containing ST1 antigen. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project gathered ST1 IPD surveillance data from sites globally and aimed to estimate PCV10/13 impact on ST1 IPD incidence. We estimated ST1 IPD incidence rate ratios (IRRs) comparing the pre-PCV10/13 period to each post-PCV10/13 year by site using a Bayesian multi-level, mixed-effects Poisson regression and all-site IRRs using a linear mixed-effects regression (N = 45 sites). Following PCV10/13 introduction, the incidence rate (IR) of ST1 IPD declined among all ages. After six years of PCV10/13 use, the all-site IRR was 0.05 (95% credibility interval 0.04-0.06) for all ages, 0.05 (0.04-0.05) for <5 years of age, 0.08 (0.06-0.09) for 5-17 years, 0.06 (0.05-0.08) for 18-49 years, 0.06 (0.05-0.07) for 50-64 years, and 0.05 (0.04-0.06) for ≥65 years. PCV10/13 use in infant immunization programs was followed by a 95% reduction in ST1 IPD in all ages after approximately 6 years. Limited data availability from the highest ST1 disease burden countries using a 3+0 schedule constrains generalizability and data from these settings are needed.

Engineering environmental resilience: A matched cohort study of the community benefits of trailbridges in rural Rwanda.

Rural isolation can limit access to basic services and income-generating opportunities. Among some communities, rainfall induced flooding can cause increased uncertainty where first-mile transportation infrastructure is limited. In Rwanda, this challenge is apparent, where 90% of the population below the poverty line live in rural areas that are typically mountainous with frequent flooding - events that may be increasing in frequency and severity as the climate changes. To reduce these transportation barriers, the non-profit organization Bridges to Prosperity (B2P) plans to construct hundreds of trailbridges in Rwanda between 2018 and 2023. This scale of rural infrastructure services presents an opportunity for experimental investigation of the effects of these new trailbridges on economic, health, agricultural and education outcomes in rural communities. In this paper, we present a cohort study evaluating the potential community benefits of rural trailbridges - including economic, health and social outcomes for Rwandan communities experiencing environmental change. We examined households living near 12 trailbridge sites and 12 comparison sites over February 2019-March 2020. We found that labor market income increased by 25% attributable to the trailbridges. We did not observe any significant effects on agricultural income, education or health outcomes, however given the small sample and short duration of this study we anticipate observing additional outcomes within the recently started 200 site, 4 year trial.

The Thyroid Tumor Microenvironment: Potential Targets for Therapeutic Intervention and Prognostication.

Thyroid cancer is the most common endocrine malignancy and incidences are rising rapidly, in both pediatric and adult populations. Many thyroid tumors are successfully treated which results in low mortality rates, but there is often a significant morbidity associated with thyroid cancer treatments. For patients with tumors that are not successfully treated with surgical resection or radioactive iodine treatment, prognosis is dramatically reduced. Patients diagnosed with anaplastic thyroid cancer face a very grim prognosis with a median survival of 6 months post-diagnosis. There is a critical need to identify patients who are at greatest risk of developing persistent disease and progressing to poorly differentiated or anaplastic disease. Furthermore, development of treatments associated with less morbidity would represent a significant improvement for thyroid cancer survivors. It is well established the stromal cells and components of the tumor microenvironment can drive tumor progression and resistance to therapy. Here we review the current state of what is known regarding the thyroid tumor microenvironment and how these factors may contribute to thyroid tumor pathogenesis. Study of the tumor microenvironment within thyroid cancer is a relatively new field, and more studies are needed to dissect the complex and dynamic crosstalk between thyroid tumor cells and its tumor niche.

The relationship between living in urban and rural areas of Scotland and children's physical activity and sedentary levels: a country-wide cross-sectional analysis.

BACKGROUND: Living in urban or rural environments may influence children's levels of physical activity and sedentary behaviours. We know little about variations in device-measured physical activity and sedentary levels of urban and rural children using nationally representative samples, or if these differences are moderated by socioeconomic factors or seasonal variation. Moreover, little is known about the influence of 'walkability' in the UK context. A greater understanding of these can better inform intervention strategies or policy initiatives at the population level. METHODS: Country-wide cross-sectional study in Scotland in which 774 children (427 girls, 357 boys), aged 10/11 years, wore an accelerometer on one occasion for at least four weekdays and one weekend day. Mean total physical activity, time spent in sedentary, light, and moderate-to-vigorous physical activity (MVPA), per day were extracted for weekdays, weekend days, and all days combined. Regression analyses explored associations between physical activity outcomes, urban/rural residence, and a modified walkability index (dwelling density and intersection density); with interactions fitted for household equivalised income and season of data collection. Sensitivity analyses assessed variation in findings by socioeconomic factors and urbanicity. RESULTS: Rural children spent an average of 14 min less sedentary (95% CI of difference: 2.23, 26.32) and 13 min more in light intensity activity (95% CI of difference, 2.81, 24.09) per day than those from urban settlements. No urban-rural differences were found for time spent in MVPA or in total levels of activity. Our walkability index was not associated with any outcome measure. We found no interactions with household equivalised income, but there were urban/rural differences in seasonal variation; urban children engaged in higher levels of MVPA in the spring months (difference: 10 mins, p = 0.06, n.s) and significantly lower levels in winter (difference: 8.7 mins, p = 0.036). CONCLUSIONS: Extrapolated across one-year, rural children would accumulate approximately 79 h (or just over 3 days) less sedentary time than urban children, replacing this for light intensity activity. With both outcomes having known implications for health, this finding is particularly important. Future work should prioritise exploring the patterns and context in which these differences occur to allow for more targeted intervention/policy strategies.