Effects of psychosocial work factors on preterm birth: systematic review and meta-analysis.

OBJECTIVES: Preterm birth is one of the global public health issues that result in high rates of infant mortality and long-term health complications. We sought to explore the association between psychosocial work factors and preterm birth. STUDY DESIGN: Systematic review and meta-analysis. METHODS: This systematic review and meta-analysis searched relevant literature from electronic databases to explore the association between psychosocial work factors and preterm birth. The methodological quality of the included studies was evaluated through the Joanna Briggs Institute's critical appraisal method. We performed a meta-analysis using a random-effects model to combine odds ratios (ORs) from studies with similar definitions of exposure and outcome. The quality of the evidence was evaluated using the GRADE (Grade of recommendation, Assessment, development, and Evaluation) method to assess. RESULTS: Ten studies were included, with a total of 92,815 participants. Moderate evidence indicated a positive association between high psychosocial job strain and preterm birth. The result from the meta-analysis supported the statistical significance of this relationship (OR 1.32 [95% CI (1.22-1.44)]). CONCLUSIONS: Pregnant women who experience high levels of psychosocial job strain are more likely to give birth prematurely. In order to decrease this risk, employers should prioritise creating supportive work environments, government bodies should enact protective policies and regulations, and clinicians should give advice to pregnant working women. Pregnant women should be aware of the risk of preterm birth from psychosocial work factors.

Management of encounters related to subfertility and infertility in Australian general practice: a focus on Aboriginal and Torres Strait Islander females.

OBJECTIVE: To investigate the management of subfertility and infertility among Aboriginal and Torres Strait Islander females attending Australian general practice. METHODS: Cross-sectional study of 1,258,581 women (18-49 years) attending general practice between January 2011 and June 2019, utilising data from NPS MedicineWise MedicineInsight, a national general practice database in Australia. RESULTS: The prevalence of subfertility/infertility encounters was lower for Aboriginal and Torres Strait Islander females (12.37 per 1,000) than for non-Indigenous females (16.62 per 1,000). Aboriginal and Torres Strait Islander females with a subfertility/infertility encounter were younger and more likely to live outside Major cities and in areas of socioeconomic disadvantage than non-Indigenous females. Rates of prescribed infertility medications were not different between groups, however Aboriginal and Torres Strait Islander females were more likely to receive a pelvic ultrasound (24.30% vs. 19.90%); tests for luteinizing hormone (31.89% vs. 25.65%); testosterone (14.93% vs. 9.96%) and; glycated haemoglobin (HbA1c) (6.32% vs. 3.41%),but less likely to receive an anti-müllerian hormone test (2.78% vs. 7.04%). CONCLUSIONS: Lower encounter rates for infertility/subfertility among Aboriginal and Torres Strait Islander peoples may indicate access issues, preferred use of Aboriginal community-controlled health centres or younger average age at first birth and thus less age-related infertility. IMPLICATIONS FOR PUBLIC HEALTH: Future efforts should focus on maximising the inclusiveness of infertility surveillance. There is also a need for further research into the experiences of and preferences for infertility care and associated barriers among Aboriginal and Torres Strait Islander people.

Menopause care delivery in the time of COVID-19: evaluating the acceptability of telehealth services for women with early and usual age menopause.

OBJECTIVES: This study aimed to explore women's and clinician's experiences and acceptability of telehealth use within a specialized multidisciplinary menopause service during the COVID-19 pandemic. METHODS: In-depth qualitative semi-structured interviews were analyzed via thematic inductive approaches. Telehealth acceptability was guided by the Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (NASSS) framework. RESULTS: A heterogeneous group of 18 women who had attended the menopause service and six clinicians (gynecologists and endocrinologists) were interviewed. The majority of women and clinicians perceived telehealth as an acceptable way to deliver menopause care. Benefits of telehealth delivery were identified; themes centered around convenience, greater access to care and improved safety. Telehealth challenges included perceived impacts on personalized quality of care, patient-related logistical issues and system/organizational-related issues. A hybrid flexible delivery model combining telehealth and face-to-face care was recommended, following the easing of COVID-19 restrictions. Improvements to support embedding and adaptation of telehealth into routine care were described. CONCLUSION: In this study, telehealth was viewed as acceptable, supporting the ongoing delivery of a hybrid service model of telehealth and face-to-face menopause care. The findings provide valuable information to improve the menopause service to meet the needs of women during the ongoing current pandemic and beyond.

Severity of Dementia and Survival in Patients Diagnosed with Colorectal Cancer: A National Cohort Study in England and Wales.

AIMS: There is little evidence about the survival of patients with colorectal cancer (CRC) also diagnosed with dementia. We quantified dementia severity and estimated how it is associated with 2-year overall survival. MATERIALS AND METHODS: Records of patients aged 65 years or older diagnosed with CRC in England and Wales were identified. A novel proxy for dementia severity combined dementia diagnosis in administrative hospital data with Eastern Cooperative Oncology Group performance status. Cox regression was used to estimate hazard ratios with and without risk adjustment. RESULTS: In total, 4033 of 105 250 CRC patients (3.8%) had dementia recorded. Two-year survival decreased with increasing dementia severity from 65.4% without dementia, 53.5% with mild dementia, 33.0% with moderate dementia to 16.5% with severe dementia (hazard ratio comparing severe with no dementia: 2.97; 95% confidence interval 2.79, 3.16). Risk adjustment for comorbidity and cancer stage reduced this association slightly (hazard ratio 2.52; 95% confidence interval 2.37, 2.68) and additional adjustment for treatment factors reduced it further (hazard ratio 1.60; 95% confidence interval 1.50, 1.70). CONCLUSIONS: Survival of CRC patients varied strongly according to dementia severity, suggesting that a 'one-size-fits-all' policy for the care of CRC patients with dementia is not appropriate. Comprehensive assessment of cancer patients with dementia that considers dementia severity is essential in a shared decision-making process that ensures patients receive the most appropriate treatment for their individual needs and preferences.

Autonomous control for miniaturized mobile robots in unknown pipe networks.

Despite recent advances in robotic technology, sewer pipe inspection is still limited to conventional approaches that use cable-tethered robots. Such commercially available tethered robots lack autonomy, and their operation must be manually controlled via their tethered cables. Consequently, they can only travel to a certain distance in pipe, cannot access small-diameter pipes, and their deployment incurs high costs for highly skilled operators. In this paper, we introduce a miniaturised mobile robot for pipe inspection. We present an autonomous control strategy for this robot that is effective, stable, and requires only low-computational resources. The robots used here can access pipes as small as 75 mm in diameter. Due to their small size, low carrying capacity, and limited battery supply, our robots can only carry simple sensors, a small processor, and miniature wheel-legs for locomotion. Yet, our control method is able to compensate for these limitations. We demonstrate fully autonomous robot mobility in a sewer pipe network, without any visual aid or power-hungry image processing. The control algorithm allows the robot to correctly recognise each local network configuration, and to make appropriate decisions accordingly. The control strategy was tested using the physical micro robot in a laboratory pipe network. In both simulation and experiment, the robot autonomously and exhaustively explored an unknown pipe network without missing any pipe section while avoiding obstacles. This is a significant advance towards fully autonomous inspection robot systems for sewer pipe networks.

Exploring the acceptability and experience of receiving diabetes and pregnancy care via telehealth during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The COVID-19 pandemic has significantly impacted the delivery of diabetes in pregnancy care and general maternity care. This study aimed to explore the experiences and acceptability of telehealth use in diabetes in pregnancy care during the COVID-19 pandemic, from the perspectives of pregnant women and their clinicians. The secondary aim was to explore the experiences of pregnant women receiving general maternity care via telehealth during the COVID-19 pandemic. METHODS: In-depth qualitative semi-structured interviews were undertaken and analysed via thematic inductive approaches. The Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies Framework (NASSS) was applied. RESULTS: Eigthteen interviews were conducted with culturally and linguistically diverse pregnant women and 4 clinicians (endocrinologists and dietitians). All interviewees were satisfied with telehealth as a positive alternative to face-to-face consultations for diabetes care during the COVID-19 pandemic. Numerous benefits of delivering diabetes care via telehealth were discussed and themes centred around greater access to care, economic benefits and improved safety. Most barriers concerned the adopters (clinicians), yet, feasible and realistic suggestions to overcome barriers were voiced. The scope for technology adaptation and ongoing embedment into routine diabetes care was described. Overall, a hybrid flexible delivery model, predominantly consisting of telephone consultations, with some face-to-face consultations for initial diabetes appointments was recommended for future care. The use of telehealth in replacement of face-to-face appointments for general maternity care was perceived as reducing care quality. CONCLUSION: In this study, telehealth was viewed as acceptable to women and clinicians for diabetes in pregnancy care, supporting the ongoing delivery of a hybrid service model of telehealth and face-to-face care. These findings provide valuable information to improve diabetes in pregnancy services to meet the needs of women during the COVID-19 pandemic and beyond.

Radiant Exitance of Old, New, and Damaged LED Light Curing Units.

PURPOSE: This study aimed to determine the radiant exitance of new, damaged, and 16-year-old light-curing units (LCUs) with and without infection control barriers, and before and after removal of any debris. METHODS AND MATERIALS: Old LCUs consisted of 62 SmartLite iQ2 lights (Dentsply Sirona, York, PA). New LCUs consisted of 58 SmartLite Focus (Dentsply Sirona) and 58 Valo Grand (Ultradent, South Jordan, UT, USA) LCUs. Each LCU was examined for damage and debris on its tip. A handheld radiometer (CheckUp with BlueLight Analytics app, Halifax, Nova Scotia, Canada ) was used to measure the radiant exitance using a 10-second exposure time. Measurements were made with and without infection control barriers. If debris was present, the radiant exitance was measured before and after removal of debris with and without the barriers. All measurements were repeated three times. The means of the measurements were used for statistical analyses, which consisted of paired t-tests, analysis of variance (ANOVA), and Tukey post-hoc analyses conducted with a 0.05 level of significance. RESULTS: Infection control barriers significantly reduced the radiant exitance of all LCUs, ranging from 4.35% to 6.91% depending upon the LCU and the presence of debris or damage. Clean undamaged SmartLite Focus (907 mW/cm2) and Valo Grand (Ultradent) LCUs (883 mW/cm2) with barriers had statistically higher radiant exitance than older clean undamaged SmartLite iQ2 (Dentsply Sirona) LCUs (719 mW/cm2) with barriers. All LCUs exceeded the recommended 400 mW/cm2 radiant power to cure 2 mm of Filtek Supreme Ultra shade A2 composite resin (3M ESPE, St Paul MN, USA). CONCLUSION: Infection control barriers, debris, damage, and age all significantly reduced radiant exitance of the lights.

The 3-D Skills Model: a Randomised Controlled Pilot Study Comparing a Novel 1-1 Near-Peer Teaching Model to a Formative OSCE with Self-regulated Practice.

INTRODUCTION: Near-peer teaching is a popular pedagogical teaching tool, with well-recognised benefits for students and tutors. There are multiple existing models to structure these interventions, but it is often unclear how they translate to academic attainment. We designed a novel near-peer teaching model that expands on previous research. METHODS: Our model was piloted in a formative Objective Structured Clinical Examination (OSCE) setting, trialled on 22 pre-clinical medical students to establish feasibility, acceptability and descriptive outcomes that could inform the design of a larger study. Students were randomly assigned to intervention or control cohorts. Each cohort undertook 5 min formative OSCE assessments with either 3 additional minutes of structured teaching or 3 min of self-regulated practice before reattempting the first OSCE station. Checklist marking sheets for 1st and 2nd sittings were collected by independent external markers, in addition to a global assessment rating in which we used the Borderline Regression Method to establish the station pass mark. RESULTS: A quantitative and qualitative result analysis was performed, demonstrating that students gained on average 3 additional marks after teaching with this model. Students and student-tutors reported increased confidence, high course satisfaction and evidence of reflective practice. DISCUSSION: We established acceptability and feasibility outcomes. The descriptive outcomes will support the design of a larger, adequately powered study required to demonstrate translation to summative exam performance. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01369-w.

Evaluation of a lateral-flow nanoparticle fluorescence assay for TB infection diagnosis.

BACKGROUND: Programmatic management of TB infection is a critical component of the WHO End TB Strategy. Interferon-gamma release assays (IGRAs) overcome some limitations of the tuberculin skin test, but implementation of IGRA testing in low-resource settings is challenging.METHODS: In this feasibility study, we evaluated performance of a novel digital lateral-flow assay, the QIAreach® QuantiFERON® TB (QIAreach-QFT) test, against the QuantiFERON®-TB Gold Plus (QFT-Plus) assay. A population with a mix of risk factors for TB infection (111 donors) were sampled over multiple days. A total of 207 individual blood samples were tested according to the manufacturer´s instructions.RESULTS: The overall percentage agreement was 95.6% (two-sided 95% CI 91.8-98), with a positive percentage agreement (i.e., sensitivity) of 100% (95% CI 94.7-100) and a negative percentage agreement (i.e., specificity) of 95.6% (95% CI 90.6-98.4). All QFT-Plus positive specimens with TB1-Nil and TB2-Nil values less than 1 IU/ml tested positive on QIAreach-QFT.CONCLUSIONS: QIAreach QFT is a deployable, accurate testing solution for decentralised testing. It has the potential to overcome key hurdles for TB infection screening in high-burden settings thus helping to achieve the WHO End TB programme goals.

What is the current practice for managing patients with chronic limb-threatening ischaemia in vascular surgery services? A survey of UK vascular surgeons.

INTRODUCTION: The Vascular Society of Great Britain and Ireland (VSGBI) Peripheral Arterial Disease Quality Improvement Framework (PAD QIF) stipulates targets for managing patients with chronic limb-threatening ischaemia (CLTI); however, it is unknown whether these are achievable. This survey aims to evaluate contemporary practice for managing CLTI in the UK. METHODS: A questionnaire was developed in conjunction with the VSGBI to survey the management of CLTI and canvass opinions on the PAD QIF. The survey was distributed to all consultant members of the VSGBI and through a targeted social media campaign. RESULTS: Forty-seven consultant vascular surgeons based at 36 arterial centres across the UK responded (response rate from arterial centres = 46%). Only 14.3% of centres provided outpatient consultation within the target of seven days from referral, with only one centre providing revascularisation within the target of seven days from consultation. For inpatient management, 31.6% provided surgical and 23.8% endovascular revascularisation within the target of three days from assessment. While 60% of participants believe the PAD QIF's 5-day 'admitted care' pathway is achievable, only 28.6% thought the 14-day 'non-admitted care' pathway was feasible. Challenges to meeting these targets include the availability of theatre space and angiography lists, and availability of outpatient appointments for patient assessment. CONCLUSIONS: The opinion of UK vascular surgeons indicates that achieving the targets of the PAD QIF represents a major challenge based upon current services. Adapting existing services with a greater focus on providing an 'urgent' model of care may help to potentially overcome these challenges.

Factors associated with delays in revascularization in patients with chronic limb-threatening ischaemia: population-based cohort study.

BACKGROUND: Prompt revascularization in patients with chronic limb-threatening ischaemia (CLTI) is important, and recent guidance has suggested that patients should undergo revascularization within 5 days of an emergency admission to hospital. The aim of this cohort study was to identify factors associated with the ability of UK vascular services to meet this standard of care. METHODS: Data on all patients admitted non-electively with CLTI who underwent open or endovascular revascularization between 2016 and 2019 were extracted from the National Vascular Registry. The primary outcome was interval between admission and procedure, analysed as a binary variable (5 days or less, over 5 days). Multivariable Poisson regression was used to examine the relationship between time to revascularization and patient and admission characteristics. RESULTS: The study analysed information on 11 398 patients (5973 open, 5425 endovascular), 50.6 per of whom underwent revascularization within 5 days. The median interval between admission and intervention was 5 (i.q.r. 2-9) days. Patient factors associated with increased risk of delayed revascularization were older age, greater burden of co-morbidity, non-smoking status, presentation with infection and tissue loss, and a Fontaine score of IV. Patients admitted later in the week were less likely undergo revascularization within 5 days than those admitted on Sundays and Mondays (P < 0.001). Delays were slightly worse among patients having open compared with endovascular procedures (P = 0.005) and in hospitals with lower procedure volumes (P < 0.001). CONCLUSION: Several factors were associated with delays in time to revascularization for patients with CLTI in the UK, most notably the weekday of admission, which reflects how services are organized. The results support arguments for vascular units providing revascularization to have the resources for a 7-day service.

Chronic limb-threatening ischaemia (CLTI) is a severe form of peripheral artery disease that reduces blood flow to the legs and can lead to amputation. Between 2016 and 2019, only 50.6 per cent of patients admitted to UK vascular units urgently with CLTI underwent revascularization within 5 days from admission. Several factors were associated with delays in time to revascularization, most notably the weekday of admission, which reflects how services are organized. The results support arguments for vascular units providing revascularization to have resources for a 7-day service.

'No sugar', 'no junk food', 'do more exercise' - moving beyond simple messages to improve the health of Aboriginal women with Hyperglycaemia in Pregnancy in the Northern Territory - A phenomenological study.

BACKGROUND: Globally, rates of hyperglycaemia in pregnancy are highest among Indigenous women. The highest prevalence has been documented among Aboriginal women in the Northern Territory of Australia. Despite knowledge of this for over two decades, there has been very limited examination of the specific needs and experiences of Aboriginal women regarding this condition. QUESTION: How do Aboriginal women with hyperglycaemia in pregnancy understand and experience this condition, and how can their care be improved? METHODS: A phenomenological methodology underpinned semi-structured in-depth interviews with 35 Aboriginal women and seven health professionals across the Northern Territory. Data were inductively analysed. FINDINGS: The findings revealed that in general, participants in this study could recite simple health messaging regarding diabetes (e.g. 'no sugar'), but many lacked in-depth knowledge and this affected the management of their condition. Nevertheless, many identified pregnancy as a powerful motivator for change, signalling scope to improve health messaging. Women consistently expressed the need for diabetes education that was culturally appropriate, a clear desire for maternity care that was family-centred, based on respectful relationships with the same care provider, and respected Aboriginal ways of knowing and being. CONCLUSION: Existing health messaging around hyperglycaemia in pregnancy has limited reach with Aboriginal women in the Northern Territory. Reducing the burden of hyperglycaemia in pregnancy among these women requires a sustained commitment to redesign of maternity and diabetes care to incorporate the cultural and social context of women's lives.

Viva la VOSCE?

BACKGROUND: The COVID-19 pandemic lockdown precluded face-to-face final Objective Structured Clinical Examinations (OSCE) in the UK. RESULTS: In response, we rapidly developed and then successfully implemented a novel Virtual Objective Structured Clinical Examination (VOSCE). CONCLUSIONS: In this article we both describe and reflect on our experience as well as discuss the implications for future undergraduate assessment as the situation evolves.

Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention.

BACKGROUND: Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. METHODS: A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines. DISCUSSION: This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.

Is there a gender gap in chemical sciences scholarly communication?

The Royal Society of Chemistry is committed to investigating and addressing the barriers and biases which face women in the chemical sciences. The cornerstone of this is a thorough analysis of data regarding submissions, review and citations for Royal Society of Chemistry journals from January 2014 until July 2018, since the number and impact of publications and citations are an important factor when seeking research funding and for the progression of academic career. We have applied standard statistical techniques to multiple data sources to perform this analysis, and have investigated whether interactions between variables are significant in affecting various outcomes (author gender; reviewer gender; reviewer recommendations and submission outcome) in addition to considering variables individually. By considering several different data sources, we found that a baseline of approximately a third of chemistry researchers are female overall, although this differs considerably with Chemistry sub-discipline. Rather than one dominant bias effect, we observe complex interactions and a gradual trickle-down decrease in this female percentage through the publishing process and each of these female percentages is less than the last: authors of submissions; authors of RSC submissions which are not rejected without peer review; authors of accepted RSC publications; authors of cited articles. The success rate for female authors to progress through each of these publishing stages is lower than that for male authors. There is a decreasing female percentage when progressing through from first authors to corresponding authors to reviewers, reflecting the decreasing female percentage with seniority in Chemistry research observed in the "Diversity landscape of the chemical sciences" report. Highlights and actions from this analysis form the basis of an accompanying report to be released from the Royal Society of Chemistry.

Women's perspectives of early menopause: development of a word cloud.

Objective: Early menopause (EM), menopause aged <45 years, occurs spontaneously or secondary to medical treatments and is associated with multiple health impacts. A word cloud is an image where the word size reflects the frequency of use. We aimed to assess the perspectives of women with EM using a word cloud.Methods: Women diagnosed with EM, recruited from clinics/community, completed a survey including the open-ended question 'What words do you associate with EM?'. Demographics and medical history were collected. Data analysis included descriptive statistics, identification of word themes/stems/synonyms, word frequency, and chi-square test. A word cloud was constructed from words used by two or more women using 'Wordle' (www.wordle.net).Results: Responses were obtained from 190/263 participants. The mean age was 54 ± 11 years, with EM diagnosed at age 38 ± 5 years. The cause of EM was unknown (30% of women), bilateral oophorectomy (27%), cancer therapy (25%), or autoimmune/genetic/metabolic (17%). The commonest words reported were hot flushes (36.8% of women), mood swings (20.5%), and infertility (16.8%), which varied with age and cause of EM. Few women reported neutral/positive words.Conclusion: Most words that women associate with EM have negative connotations and refer to symptoms. A word cloud is a novel way to illustrate women's perspectives.