Diversity competence training for health professionals in Europe: a modified delphi study investigating relevant content for short or online courses.

BACKGROUND: Diversity is a reality in our societies, requiring health professionals to adapt to the unique needs of all patients, including migrants and ethnic minorities. In order to enable health professionals to meet related challenges and reduce health disparities, long and demanding training courses have been developed. But due to busy schedules of professionals and often scarce resources, a need for shorter training courses exists. This study aims to investigate which topics and methods should be prioritised in designing basic diversity training courses that provide health professionals the opportunity to foster this competence. METHODS: The study provided an expert panel of 31 academic and clinical migrant health experts with the content and methods of an existing diversity training course. The panel was asked to prioritise training topics and teaching methods in a two-stage process, using an adapted Delphi method. In the first stage, experts rated 96 predefined items, commented on those items, provided answers to eight open-ended questions and suggested additional content for a short course. In the second stage, they commented on the ratings from Round 1, and rated new suggested content. Consensus for training topics was set to 80% and for teaching methods 70%. RESULTS: The entire panel deemed 'health effects of migration (pre-, during- and post-migration risk factors)' to be important or very important to include in a short/online, basic diversity training (100% consensus). Other high-scoring items and therefore topics to be included in trainings were 'social determinants of health' (97%) and 'discrimination within the healthcare sector' (also 97%). A general trend was to focus on reflective practice since almost all items regarding reflection reached consensus. 'Reflection on own stereotypes and prejudices' (97%) was the highest-rated reflection item. 'Opportunities and best practices in working with interpreters' was the highest-scoring skills item, both on consensus (96%) and mean value (5.77). CONCLUSIONS: Experts' prioritizations of teaching content and methods for diversity training can help the design of short (online) trainings for health professionals and reduce unnecessary course content, thereby fostering professional development and enabling diversity competence trainings to be implemented also when time and/or financial resources are limited.

Low back pain patterns over one year among 842 workers in the DPhacto study and predictors for chronicity based on repetitive measurements.

BACKGROUND: Low back pain (LBP) occurrence and intensity are considered to fluctuate over time, requiring frequent repetitive assessments to capture its true time pattern. Text messages makes frequent reporting of LBP feasible, which enables investigation of 1) the time pattern of LBP, and 2) predictors for having a continued high (chronic) level of LBP over longer periods of time. However, this has not previously been investigated in a larger working population. The aim of this study was to examine these two aspects in a working population of 842 workers with repetitive measurements of LBP over one year. METHODS: There were 842 workers from 15 companies in the DPhacto study participating in this study. Demographic, work- and health-related factors, and back endurance were measured at baseline, while 14 monthly repeated text message assessments of LBP intensity were prospectively collected. A factor analysis was used to cluster different time-patterns of LBP, and defining the group of participants with chronic LBP. A multi-adjusted logistic regression analysis was performed to investigate baseline predictors for chronic LBP. RESULTS: The factor analysis revealed two dimensions of the time pattern of LBP, defined as the LBP intensity and LBP variation, respectively. A Visual Pain Mapping was formed based on the combination of the two pain dimensions, classifying the time-patterns of LBP into four categories: (1) low intensity and low variation, (2) low intensity and high variation, (3) high intensity and high variation, (4) high intensity and low variation (defined as chronic LBP). Significant baseline predictors for chronic LBP in the fully adjusted model were high baseline LBP (p < 0.01), low workability (p < 0.01), low BMI (p < 0.05), and being a blue-collar worker (vs. white-collar worker) (p < 0.05). CONCLUSION: This study presents a novel classification of the course of LBP based on repetitive measurements over a year, and revealed the predicting factors for chronic LBP based on repetitive measurements in a working population.

Physical activities at work and risk of musculoskeletal pain and its consequences: protocol for a study with objective field measures among blue-collar workers.

BACKGROUND: Among blue-collar workers, high physical work demands are generally considered to be the main cause of musculoskeletal pain and work disability. However, current available research on this topic has been criticised for using self-reported data, cross-sectional design, insufficient adjustment for potential confounders, and inadequate follow-up on the recurrent and fluctuating pattern of musculoskeletal pain. Recent technological advances have provided possibilities for objective diurnal field measurements of physical activities and frequent follow-up on musculoskeletal pain.The main aim of this paper is to describe the background, design, methods, limitations and perspectives of the Danish Physical Activity cohort with Objective measurements (DPhacto) investigating the association between objectively measured physical activities capturing work and leisure time and frequent measurements of musculoskeletal pain among blue-collar workers. METHODS/DESIGN: Approximately 2000 blue-collar workers are invited for the study and asked to respond to a baseline questionnaire, participate in physical tests (i.e. muscle strength, aerobic fitness, back muscle endurance and flexibility), to wear accelerometers and a heart rate monitor for four consecutive days, and finally respond to monthly text messages regarding musculoskeletal pain and quarterly questionnaires regarding the consequences of musculoskeletal pain on work activities, social activities and work ability for a one-year follow-up period. DISCUSSION: This study will provide novel information on the association between physical activities at work and musculoskeletal pain. The study will provide valid and precise documentation about the relation between physical work activities and musculoskeletal pain and its consequences among blue-collar workers.

Preferences for CT colonography and colonoscopy as diagnostic tests for colorectal cancer: a discrete choice experiment.

OBJECTIVE: Computed tomography colonography (CTC) is an alternative diagnostic test to colonoscopy for colorectal cancer and polyps. The aim of this study was to determine test characteristics important to patients and to examine trade-offs in attributes that patients are willing to accept in the context of the diagnosis of colorectal cancer. METHODS: A discrete choice study was used to assess preferences of patients with clinical indications suspicious of colorectal cancer who experienced both CTC and colonoscopy as part of a diagnostic accuracy study in South Australia. Results were analyzed by using a mixed logit model and presented as odds ratios (ORs) for preferring CTC over colonoscopy. RESULTS: Colonoscopy was preferred over CTC as the need for a second procedure after CTC increased (OR of preferring CTC to colonoscopy = 0.013), as the likelihood of missing cancers or polyps increased (OR of preferring CTC to colonoscopy = 0.62), and as CTC test cost increased (OR of preferring CTC to colonoscopy = 0.65-0.80). CTC would be preferred to colonoscopy if a minimal bowel preparation was available (OR = 1.7). Some patients were prepared to trade off the diagnostic and therapeutic advantage of colonoscopy for a CTC study with a less intensive bowel preparation. Preferences also varied significantly with sociodemographic characteristics. CONCLUSIONS: Despite CTC's often being perceived as a preferred test, this may not always be the case. Informed decision making for diagnostic tests for colorectal cancer should include discussion of the benefits, downsides, and uncertainties associated with alternative tests, as patients are willing and able to make trade-offs between what they perceive as the advantages and disadvantages of these diagnostic tests.

The DPhacto cohort: An overview of technically measured physical activity at work and leisure in blue-collar sectors for practitioners and researchers.

For improved prevention of health issues among blue-collar workers, there is a need for an overview of the physical activity at work and leisure using technical long-term measurements in blue-collar sectors investigation of differences between the sectors. Thus, the objective of this paper was to provide an overview and investigate differences in physical activities and body postures at work and leisure among blue-collar sectors. The Dphacto cohort consists of 1087 workers from manufacturing, transportation and cleaning sectors (901 blue-collar and 186 white-collar workers) in Denmark. Eligible workers provided physical activity and heart rate measurements over several days with follow-up on health-related outcomes by self-report and registers. Considerable differences in sitting, standing, time on feet (walking, shuffling and standing combined) and forward bending of the back were found between work and leisure, and between the sectors. This overview of physical activity at work and leisure can be useful for better prevention of work-related health issues among blue-collar workers.

Prolonged sitting at work is associated with a favorable time course of low-back pain among blue-collar workers: a prospective study in the DPhacto cohort.

Objective Low-back pain (LBP) is a massive health problem. Sitting at work has been suggested to be both a risk and protective factor for LBP. Thus, the objective of this study was to investigate the association between total and temporal patterns of objectively measured sitting duration and individual time course of LBP. Methods The analysis was performed among 665 participants from the DPhacto cohort of mainly blue-collar workers. Sitting at work was measured by accelerometry at baseline, expressed in total duration and temporal pattern [% of working time spent in brief bursts (≤5 minutes), moderate (>5 - ≤20 minutes) and prolonged periods (>20 minutes)] of sitting. Time course of LBP (0-10 scale) were collected by monthly text messages across one year. Linear mixed models were applied to investigate the association, adjusting for potential confounders. Results Significant negative associations between sitting duration at work and adjusted time course of LBP were found; total sitting (B -0.01, 95% CI -0.01- -0.004), brief bursts (B -0.01, 95% CI -0.02- -0.01), moderate (B -0.01, 95% CI -0.01- -0.008) and prolonged periods (B -0.01, 95% CI -0.02- -0.01). Meaning, a 5-minute increase of sitting at work will correspond to a decrease in one year time course of LBP by -0.05 points. Conclusion Longer duration of total and temporal sitting periods at work was significantly associated with a favorable time course of LBP. This finding shows sitting at work to be beneficial for LBP, among populations of mainly blue-collar workers, by protecting from LBP aggravation.

Does objectively measured daily duration of forward bending predict development and aggravation of low-back pain? A prospective study.

OBJECTIVES: The aim of this paper was to investigate if objectively measured daily duration of forward bending of the trunk increases the risk of the development or aggravation of low-back pain (LBP) over one year in a working blue-collar population by examining (i) the incidence rate of LBP among workers reporting no LBP at baseline, and (ii) the aggravation of LBP among workers reporting LBP at baseline. METHODS: Using data from the Danish Physical Activity Cohort with Objective Measurements (DPhacto), the study measured forward bending of the trunk (>60˚) at work (FBW) and during leisure time (FBL), diurnally with accelerometers, and LBP with one-year monthly self-reports among 682 blue-collar workers from 15 workplaces. The development of LBP was investigated with Cox's proportional hazards model (N=200), and the aggravation of LBP was investigated with mixed model for repeated measurements (N=482). RESULTS: Workers with no LBP at baseline had a FBW median of 7.9 minutes/day. Workers with LBP at baseline had a FBW median of 7.3 minutes/day. No significant associations were found between daily duration of forward bending of the trunk and development or aggravation of LBP. Similar results were found in the secondary analyses, in which FBL, different degrees of forward bending (>30˚ and >90˚), and varying follow-up time since measurement were considered. CONCLUSION: Using objective measurements of forward bending and monthly follow-up of LBP over one year, this study did not confirm the hypothesis of a positive association between daily duration of forward bending and LBP.

Generation of new peptide-Fc fusion proteins that mediate antibody-dependent cellular cytotoxicity against different types of cancer cells.

Antibody-dependent cellular cytotoxicity (ADCC), a key effector function for the clinical effectiveness of monoclonal antibodies, is triggered by the engagement of the antibody Fc domain with the Fcγ receptors expressed by innate immune cells such as natural killer (NK) cells and macrophages. Here, we fused cancer cell-binding peptides to the Fc domain of human IgG1 to engineer novel peptide-Fc fusion proteins with ADCC activity. The designed fusion proteins were expressed in human embryonic kidney 293T cells, followed by purification and characterization by western blots. One of the engineered variants (WN-Fc), bound with high affinity to a wide range of solid tumor cell lines (e.g., colon, lung, prostate, skin, ovarian, and mammary tumors). Treatment of cancer cells with the engineered peptide-Fc fusions in the presence of effector NK cells potentially enhanced cytotoxicity, degranulation, and interferon-γ production by NK cells when compared to cells treated with the Fc control. The presence of competing peptides inhibited NK cell activation. Furthermore, a bispecific peptide-Fc fusion protein activated NK cells against HER-1- and/or HER-2-expressing cancer cells. Collectively, the engineered peptide-Fc fusions constitute a new promising strategy to recruit and activate NK cells against tumor cells, a primary goal of cancer immunotherapy.