Contextualising evidence based medicine in determining the key root for translational effectiveness for chronic disease self-management and heart failure.

BACKGROUND: Congestive heart failure (CHF) management has proven devastating on morbidity, mortality, quality of life and also costly to health systems. Therapeutics for CHF have advanced and benefited greatly due to large multicentre randomised controlled trials and the evidence obtained from them. Management for chronic diseases and nonpharmaceutical therapies such as chronic disease self-management has lagged, and for CHF the evidence base has even been questioned. METHODS: Perspective and non systematic mini review. CONCLUSIONS: Advancing translational research standards is important to achieve optimal cost effectiveness. Importantly is understanding evidence generation in medicine, identifying the primary roots for management and its translation.

Impact of social and cultural factors on incidence, transmission and control of Coronavirus disease in Iran: a qualitative study.

INTRODUCTION: COVID-19 pandemic has had mixed reactions from nations, people and governments about ways to cope with, prevent and control the disease. The current study identifies social, cultural and policy factors affecting the incidence and control of Coronavirus disease in Iran. METHODS: A qualitative study consists of content analysis as well as the views of 20 experienced and knowledgeable subjects specialized in social and cultural health management. The data were gathered using three semi-structured interviews and then continued by 17 semi-structured interviews. Data analysis was done using Graneheim approach. After each interview, the recorded audio files transcript and reviewed. Then codes extracted and divided to categories and sub-categories. RESULTS: There are distinct social and cultural factors in coping with Coronavirus disease. These consisted of three categories of governance, individual and community related factors. A total of 17 subcategories and 215 primary codes that were extracted from the text of interviews as variables of the study and in relation to the research question. Ten subdomains of governance including vaccination, political issues, knowledge, support services, administrative services, transportation, health and treatment, culturalization, legislation and, managerial and financial policies impacted the spread and mitigation of the pandemic at various levels. CONCLUSION: The management of pandemics requires a comprehensive capacity for identifying and determining social and cultural criteria. A healthy partnership between governments and the community may be required to remove unnecessary obstacles that hinder public health attempt to alleviate the risk. The obtained criteria and indicators from this study may be utilized by policy makers in an attempt to strengthen protocols for mitigating pandemics. Further studies may be warranted to confirm these findings.

Factors associated with magnetic resonance imaging defined patellar tendinopathy in community-based middle-aged women: a prospective cohort study.

BACKGROUND: Patellar tendinopathy identified by imaging modalities has been reported in asymptomatic athletes and associated with tendon-related symptoms. However there is little data in community-based populations. The aim of this cohort study was to examine the prevalence of magnetic resonance imaging (MRI) defined patellar tendinopathy, the factors associated with this condition, and whether it was associated with knee pain in community-based middle-aged women. METHODS: One hundred seventy six women, aged 40-67 years, with no significant knee pain or injury underwent knee MRI. Patellar tendinopathy was defined on both T1- and T2-weighted fat-saturated MRIs. The cross-sectional area of vastus medialis was measured from MRI. Height and weight were measured to calculate body mass index (BMI). Physical activity was assessed using a questionnaire. Knee pain was assessed using the Western Ontario and McMaster University Osteoarthritis Index. RESULTS: The prevalence of MRI defined patellar tendinopathy was 30.1%. Higher levels of physical activity (odds ratio 1.65, 95% CI 1.09-2.51) and greater vastus medialis cross-sectional area (odds ratio 1.22, 95% CI 1.04-1.43) were associated with increased prevalence of patellar tendinopathy, independent of age and BMI. The persistence of patellar tendinopathy was associated with the worsening of knee pain over 2 years (odds ratio 10.65, 95% CI 1.14-99.77). CONCLUSION: In community-based middle-aged women MRI-diagnosed patellar tendinopathy is common, with higher levels of physical activity and greater vastus medialis size being risk factors suggesting a biomechanical effect. Persistent patellar tendinopathy is associated with worsening of knee pain. These findings suggest that further work is needed to determine the contribution of patellar tendinopathy on knee pain and function in older people.

Exploring Progesterone Deficiency in First-Trimester Miscarriage and the Impact of Hormone Therapy on Foetal Development: A Scoping Review.

Background and Objectives: Progesterone deficiency during pregnancy may lead to various complications, including first-trimester miscarriage, which is the most common pregnancy complication. However, progesterone therapy may play a role in pregnancy maintenance and foetal development. The aim of this scoping review is to present evidence on the link between progesterone deficiency and first-trimester miscarriage among pregnant women and assess the impact of progesterone therapy on foetal development. Methods: A comprehensive global systematic search of mainly primary research studies was conducted using several databases. Peer-reviewed studies published between 2010 and 2023 were included. The scoping review was conducted using the framework outlined by the Joanna Briggs Institute (JBI) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) statement. Results: Twenty-three articles (which included 35,862 participants) were included in the analysis. Most studies were conducted in mid- to high-income countries. All 23 articles reported a significant positive relationship between progesterone deficiency and first-trimester miscarriage. Furthermore, the majority of studies reported a higher risk of miscarriage when lower levels of progesterone are combined with other declined hormones. While most studies reported that progesterone therapy may reduce the rate of first-trimester miscarriage among pregnant women, no evidence of health-related harm to offspring development was reported. Conclusions: The findings from this systematic-scoping review indicate possible benefits of progesterone replacement therapy in maintaining a healthy pregnancy and foetal development. Rigorous studies that include large sample sizes and systematic reviews are required to confirm these findings further.

Impact of Gluten-Free and Casein-Free Diet on Behavioural Outcomes and Quality of Life of Autistic Children and Adolescents: A Scoping Review.

BACKGROUND: Gluten- and casein-containing foods could aggravate the symptoms of children and adolescents with autism spectrum disorder (ASD), and subsequently impact their quality of life. However, there is a mixed opinion among researchers concerning the impact of alternative diet on reducing ASD symptoms. OBJECTIVE: This scoping review aimed at examining the impact of the "gluten-free, casein-free" (GFCF) diet on health outcomes and the quality of life among autistic children and adolescents. METHODS: A scoping review of the literature was performed following the Joanna Briggs Institute (JBI) guidelines. Four databases, including EbscoHost, Medline, CINAHL, and ProQuest, were used to obtain subject-specific studies relevant to the research question and published between July 2013 and March 2024. A comprehensive search using keywords such as "autism spectrum disorder", "gluten-free diet", and "casein-free diet" was conducted to obtain articles related to the research focus area. Only full-text, peer-reviewed, written in English articles were selected. Data extraction and data analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension to Scoping Review (PRISMA-ScR) protocol. RESULTS: From the initial 586 studies, a total of 27 articles were included in the final analysis of the review. The thematic analysis included "GFCF diet and improvement of the core autistic symptoms", "the gut-brain link", "dietary interventions and autism", "possible side effects due to the GCFC diet", and "inconclusive studies and mixed opinions". A majority of the studies showed a positive effect of the GFCF diet on a variety of autistic symptoms, including positive changes in cognitive skills, behaviour, and gastrointestinal symptoms, while some showed conflicting evidence. CONCLUSIONS: The currently available evidence on the impact of the "GFCF" diet on the quality of life of autistic children and adolescents may warrant potentially effective interventions for alleviating symptoms of autism spectrum disorders. However, this scoping review highlights the need for more research to provide more reliable evidence on the health outcomes and quality of life of ASD sufferers to guide practice.

Cannabis Use and Its Impact on Mental Health in Youth in Australia and the United States: A Scoping Review.

Cannabis is a widely used substance among the youth population, with an estimated 2.8% currently smoking cannabis. Its popularity is growing due to the perception of its harmless nature and lack of dependence. However, this increase in use has been linked to mental health issues, especially since its partial decriminalisation in some part of the United States and Australia. The objective of this scoping review was to investigate the mental health impact of cannabis use among young people in Australia and the United States. A scoping review was conducted according to the Joanna Briggs Institute (JBI) protocol, and articles were searched from ProQuest Central and EBSCO Host (MEDLINE and CINAHL databases). A total of 24 articles were analysed, including systematic reviews, meta-analyses, and cohort, longitudinal, and cross-sectional studies. The findings indicate that cannabis use is associated with depression, psychosis, suicide, cannabis use disorder, dependence, decline in cognitive function, and the development of externalising behaviour, particularly attention deficit hyperactivity disorder. However, the relationship between cannabis use and anxiety is equivocal. Mental health issues were more prevalent with increased frequency, duration, intensity, and type of use. Female, minority, LGBTQI, African American, Aboriginal, and Torres Strait Islander youth and the age of onset of cannabis use were significant factors for the development of mental health problems. The increasing prevalence of cannabis use among high school and college students suggests the need for intervention by teachers, parents, and community health professionals to make them aware of its potential negative mental health outcomes. Moreover, policy-level interventions by the government are required to discourage young people from using cannabis.

Burden from Study Questionnaire on Patient Fatigue in Qualitative Congestive Heart Failure Research.

Mixed methods research forms the backbone of translational research methodologies. Qualitative research and subjective data lead to hypothesis generation and ideas that are then proven via quantitative methodologies and gathering objective data. In this vein, clinical trials that generate subjective data may have limitations, when they are not followed through with quantitative data, in terms of their ability to be considered gold standard evidence and inform guidelines and clinical management. However, since many research methods utilise qualitative tools, an initial factor is that such tools can create a burden on patients and researchers. In addition, the quantity of data and its storage contributes to noise and quality issues for its primary and post hoc use. This paper discusses the issue of the burden of subjective data collected and fatigue in the context of congestive heart failure (CHF) research. The CHF population has a high baseline morbidity, so no doubt the focus should be on the content; however, the lengths of the instruments are a product of their vigorous validation processes. Nonetheless, as an important source of hypothesis generation, if a choice of follow-up qualitative assessment is required for a clinical trial, shorter versions of the questionnaire should be used, without compromising the data collection requirements; otherwise, we need to invest in this area and find suitable solutions.

Effectiveness of self-management programmes for heart failure with reduced ejection fraction: a systematic review protocol.

INTRODUCTION: Chronic disease self-management (CDSM) is a vital component of congestive heart failure (CHF) programmes. Recent CHF guidelines have downgraded CDSM programmes citing a lack of gold-standard evidence. This protocol describes the aims and methods of a systematic review to collate and synthesise the published research evidence to determine the effectiveness of CDSM programmes and interventions for patients treated for CHF. METHODS: Medline, PubMed, Embase, CENTRAL, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO, SCOPUS, Web of Science, the Science Citation Index and registers of clinical trials will be searched from 1966 to 2024. In addition, the reference lists of shortlisted articles will be reviewed. Randomised controlled trials, with case management interventions of CDSM and CHF with reported major adverse cardiovascular events (MACEs), will be extracted and analysed. There is no restriction on language. Study protocol template developed from Cochrane Collaboration and Reporting adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines for systematic review and meta-analyses 2020. Two independent authors will apply inclusions and exclusion criteria to limit article search and assess bias and certainty of evidence rating. Data extraction and study description of included studies will include quality appraisal of studies and quantitative synthesis of data will then be undertaken to ascertain evidence for the study aims. Subgroup analyses will be conducted for different CDSM programmes. The primary outcome will be a significant change in MACE parameters between intervention and control arms. Meta-analysis will be conducted using statistical software, if feasible. ETHICS AND DISSEMINATION: Ethics approval is not sought as the study is not collecting primary patient data. The results of this study will be disseminated through peer-reviewed scientific journals and also presented to audiences through meetings and scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42023431539.

Can oral health care be a gateway to improve cardiovascular disease? A scoping review.

Background: Cardiovascular diseases (CVDs) are a significant cause of morbidity and mortality worldwide, resulting in a high socioeconomic burden. Growing evidence has shown a link between oral diseases and several chronic conditions including CVDs. The focus of this review is to investigate and summaries the evidence surrounding oral health interventions and their potential impact on reducing both the risk and/or severity of CVDs. Methods: A scoping review was conducted to examine oral health interventions for managing CVD outcomes and risks. The review adhered to the Joanna Briggs Institute (JBI) framework for evidence synthesis and followed the reporting standards outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis- extension to Scoping Review (PRISMA-ScR). A systematic search across EBSCOhost, PubMed, and Scopus databases from 2012 to 2024 was utilized to identify relevant studies. Inclusion criteria focused on English language articles with a sample size of at least 50, evaluating the impact of oral health interventions on CVD outcomes. Results: Out of the initial 2,154 studies identified in the search, 12 studies met the inclusion and exclusion criteria and were included in the final analysis. Overall, the studies revealed that along with surgical and non-surgical periodontal therapy, regular oral hygiene care practices, including toothbrushing, tongue brushing, and flossing, significantly reduced the risk of cardiovascular events and mortality. These interventions in patients with or without CVD baseline have shown a decrease in CVD risk markers as well as a reduction in bacterial colonization. Similarly, consistent oral hygiene routines, combined with regular dental visits, were associated with a lower risk of heart failure and CVD risk mortality. Conclusion: The evidence extracted from this review suggests that periodontal therapy, regular dental cleaning, and re-enforcing of oral health regimes can stabilize oral health conditions and subsequently improve CVD progression/risks. However, limited to no evidence exists regarding the therapeutic effects of oral health promotion in managing CVD markers and its direct impact on disease outcomes, warranting further investigation.

The Impact of Regular Physical Activity on the Mental Health and Well-Being of Dementia Patients in High-Income Countries-A Systematic Scoping Review.

Background: Dementia is a term used to describe a group of symptoms impacting memory, thinking, and social abilities. Evidence suggests a positive role of physical activity in physical and mental well-being in general. This systematic scoping review aimed to gather, summarise, and analyse evidence of the impact of physical activity on the mental health and well-being of dementia patients. Methods: A comprehensive systematic search of mainly primary research was conducted using several databases. Peer-reviewed studies in high-income countries published between 2005 and 2023 were included. The systematic scoping review was performed using the framework outlined by the Joanna Briggs Institute (JBI) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement. Results: Twenty-four articles (including 93,984 participants) were included in the analysis. Most articles (21) reported that physical activity (particularly regular physical activity) is associated with decreased depression score, decreased cognition impairment, and fewer falls, all of which contributed to improved well-being among dementia patients. These studies showed that there is a significant positive relationship between the level of physical activity and the level of improvement in the mental health and well-being of dementia patients. Conclusions: Findings from this systematic scoping review provide relatively reliable evidence that regular physical activity may improve the mental health and well-being of dementia patients. Systematic reviews and meta-analyses may be required to further confirm these findings.

Barriers to Cardiac Rehabilitation among Patients Diagnosed with Cardiovascular Diseases-A Scoping Review.

BACKGROUND: Cardiovascular diseases (CVDs) are a rising global burden. Preventative strategies such as cardiac rehabilitation (CR) have shown a marked reduction in disease burden. Despite this, CR is underutilized worldwide. This study aims to identify the barriers to CR among patients diagnosed with CVD. METHODS: A scoping review of the literature was conducted following the Joanna Briggs Institute (JBI) guidelines. Four major databases, including CINAHL, PubMed, EBSCOhost, and Scopus, were used to obtain studies published between 2010 and 2023. Search terms such as "Cardiac rehab*", "Barrier*", "Cardiovascular", "Disease", and "diagnosis*" were utilized in order to obtain subject-specific studies relevant to the research question. RESULTS: From the initial 2098 studies, only 14 were included in the final analysis, consisting of both qualitative and quantitative designs. The thematic analysis included "healthcare system-related factors", "Socioeconomic factors", and "individual characteristics". Healthcare system-related factors were mostly related to the poor availability of CR programs, lack of proper referral strategies, inadequate knowledge of CR provider and inter-provider communication issues, and lack of alternative methods of CR delivery. The socioeconomic barriers were lack of education, longer distance to CR facilities, high cost of care, unemployment, and poor income status. The identified individual characteristics were female gender, older age, and comorbidities. CONCLUSIONS: Lack of resources, poor access, educational attainment, and high cost of care were some of the barriers to CR, particularly in low- and middle-income countries (LMICs). Health policymakers and healthcare providers should implement strategies incorporating the issues identified in this scoping review. Systematic reviews may be required to confirm these findings.

The relationship between patellofemoral and tibiofemoral morphology and gait biomechanics following arthroscopic partial medial meniscectomy.

PURPOSE: To examine the relationship between tibiofemoral and patellofemoral joint articular cartilage and subchondral bone in the medial and gait biomechanics following partial medial meniscectomy. METHODS: For this cross-sectional study, 122 patients aged 30-55 years, without evidence of knee osteoarthritis at arthroscopic partial medial meniscectomy, underwent gait analysis and MRI on the operated knee once for each sub-cohort of 3 months, 2 years, or 4 years post-surgery. Cartilage volume, cartilage defects, and bone size were assessed from the MRI using validated methods. The 1st peak in the knee adduction moment, knee adduction moment impulse, 1st peak in the knee flexion moment, knee extension range of motion, and the heel strike transient from the vertical ground reaction force trace were identified from the gait data. RESULTS: Increased knee stance phase range of motion was associated with decreased patella cartilage volume (B = -17.9 (95% CI -35.4, -0.4) p = 0.045) while knee adduction moment impulse was associated with increased medial tibial plateau area (B = 7.7 (95% CI 0.9, 13.3) p = 0.025). A number of other variables approached significance. CONCLUSIONS: Knee joint biomechanics exhibited by persons who had undergone arthroscopic partial meniscectomy gait may go some way to explaining the morphological degeneration observed at the patellofemoral and tibiofemoral compartments of the knee as patients progress from surgery. LEVEL OF EVIDENCE: III.

The Impact of Prenatal Environmental Tobacco Smoking (ETS) and Exposure on Chinese Children: A Systematic Review.

Background: There is considerable evidence to support the association between exposure to environmental tobacco smoke (ETS) and children's burden of disease. However, the literature on the health outcomes of prenatal ETS exposure among Chinese children has not yet been comprehensively reviewed. Objective: This systematic review examines the currently available evidence and identifies gaps for further research on the health consequences of prenatal ETS exposure on Chinese children. Methods: Following the JBI systematic-scoping review methodological framework, we conducted a computer-aided search of three electronic databases-PubMed, EBSCOhost, and ProQuest to include studies from January 2011 to May 2023 that addressed the health outcomes of Chinese children whose mothers were exposed to ETS at any stage of pregnancy. Furthermore, a methodological quality assessment of the selected articles was conducted using JBI critical appraisal checklists. Results: A total of 30 articles were reviewed, including eleven high-quality studies and nineteen moderate-quality studies. Five main themes, including hypertension, fetal and children's development, behavioural disorders, respiratory outcomes, and "other health outcomes", were encompassed. The majority of the studies showed a positive link between prenatal ETS exposure and an increased risk of preterm birth, and moderate risk of fetal growth restriction. A few studies explored other potential adverse outcomes of ETS, including hypertension, respiratory morbidity, lung function, and asthma in children. Conclusions: The currently available evidence on prenatal ETS exposure in Chinese children has unveiled a wide range of health outcomes, including preterm birth, fetal development, behavioural disorders, and much more. However, Chinese studies in this area are still lacking and a gap still exists in relation to the strength of association between prenatal ETS exposure and some health risks. Efficient anti-smoking policies and smoking cessation programs should be developed to promote maternal and child health. Further research is also needed to provide better evidence in this field.

A perspective on mental health literacy and mental health issues among Australian youth: Cultural, social, and environmental evidence!

Mental health literacy (MHL) helps improve mental health outcomes and reduce the impacts of mental illness. This study aims to reflect on scientific evidence on MHL levels, barriers to MHL, their impacts on mental health among Australian youth and interventions to overcome these barriers. The factors explored in the Perspective included; influence of social determinants, culturally and linguistically diverse (CALD) communities, help-seeking attitudes and behaviors. MHL intervention programs and MHL for improving mental health outcomes due to the recent COVID-19 pandemic were also explored. Adequate levels of youth MHL significantly improved one's ability to recognize own mental health status as well as provide peer support. Practical considerations such as designing more gender and culturally specific youth MHL programs are proposed.

Challenges of Health Data Use in Multidisciplinary Chronic Disease Care: Perspective from Heart Failure Care.

The healthcare sector generates approximately 30% of all the world's data volume, mostly for record keeping, compliance and regulatory requirements, and patient care. Healthcare data often exist in silos or on different systems and platforms due to decentralised storage and data protection laws, limiting accessibility for health service research. Thus, both the lack of access to data and more importantly the inability to control data quality and explore post-trial (phase IV) data or data with translational relevance have an impact on optimising care and research of congestive heart failure (CHF). We highlight that for some diseases, such as CHF, generating non-traditional data has significant importance, but is hindered by the logistics of accessing chronic disease data from separate health silos and by various levels of data quality. Modern multidisciplinary healthcare management of cardiovascular diseases-especially when spanning across community hubs to tertiary healthcare centres-increases the complexities involved between data privacy and access to data for healthcare and health service research. We call for an increased ability to leverage health data across systems, devices, and countries.

Comparison of short and long forms of the Flinders program of chronic disease SELF-management for participants starting SGLT-2 inhibitors for congestive heart failure (SELFMAN-HF): protocol for a prospective, observational study.

Introduction: Congestive heart failure (CHF) causes significant morbidity and mortality. It is an epidemic, and costs are escalating. CHF is a chronic disease whose trajectory includes stable phases, periods of decompensation, and finally palliation. Health services and medical therapies must match the various patient needs. Chronic disease self-management (CDSM) programmes that are patient-focused, identify problems and set actionable goals that appear as a logical, cost-friendly method to navigate patient journeys. There have been challenges in standardising and implementing CHF programmes. Methods and analysis: SELFMAN-HF is a prospective, observational study to evaluate the feasibility and validity of the SCRinHF tool, a one-page self-management and readmission risk prediction tool for CHF, with an established, comprehensive CDSM tool. Eligible patients will have CHF with left ventricular ejection fraction <40% and commenced sodium glucose co-transporter-2 inhibitors (SGLT2-i) within 6 months of recruitment. The primary endpoint is the 80% concordance in readmission risk predicted by the SCRinHF tool. The study will recruit >40 patients and is expected to last 18 months. Ethics and dissemination: This study has been approved by the St Vincent's ethics committee (approval no. LRR 177/21). All participants will complete a written informed consent prior to enrolment in the study. The study results will be disseminated widely via local and international health conferences and peer-reviewed publications.

The Wider Considerations in Closing Chronic Disease Gaps - Focus on Heart Failure and Implementation.

BACKGROUND: Heart failure (HF) is predominately a chronic disease. There are overlaps in HF and chronic disease research and care. Chronic disease and HF research are conducted with multiple goals. The overarching goal is "optimized patient outcomes at maximum costeffectiveness". However, observations on patients can come with many variables; thus, we see differences in clinical translation. This document discusses an argument for three important gaps common to HF and chronic disease, i.e., screening, self-management, and patient-reported outcomes (PRO), and provides a glance of how it could fit into the evidence tree. Pertinent arguments for a framework for health services and models of care are provided as a prelude to future consensus. METHODOLOGY: 1) A preliminary literature review to identify a taxonomy for cardiovascular research, and 2) a review of the published literature describing the translation of research studies into clinical practice for cardiovascular disorders. A spectrum from observational to large randomized controlled trials to post-marketing studies were identified. DISCUSSION: A brief discussion on traditional research and differences focusing on screening, mixed methods research concepts, and chronic diseases models of care. Six steps to facilitate this: 1) Research design; 2) Research application (translation) i. routine ii. challenges; 3. Transforming research to translational level; 4. Funding and infrastructure; 5. Clinical Centres of Research Excellence (CCRE) and collaboration; 6. Governance and cost-effectiveness. CONCLUSION: Implementation research that aims to link research findings to improved patient outcomes in an efficient and effective way is a neglected area. Skills required to perform implementation research are complex. Ways to maximize translational impacts for chronic disease research to clinical practice are described in a HF context.

Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy.

PURPOSE: To examine articular cartilage and subchondral bone changes in tibiofemoral and patellofemoral joints following partial medial meniscectomy. METHODS: For this cross-sectional study, 158 patients aged 30-55 years, without evidence of knee osteoarthritis at arthroscopic partial medial meniscectomy (APMM), and 38 controls were recruited. MRI was performed once on the operated knee for each subcohort of 3 months, 2 or 4 years post-surgery, and the randomly assigned knee of the controls. Cartilage volume, cartilage defects, and bone size were assessed using validated methods. RESULTS: Compared with controls, APMM patients had more prevalent cartilage defects in medial tibiofemoral (OR = 3.17, 95%CI 1.24-8.11) and patellofemoral (OR = 13.76, 95%CI 1.52-124.80) compartments, and increased medial tibial plateau bone area (B = 143.8, 95%CI 57.4-230.2). Time from APMM was positively associated with cartilage defect prevalence in medial tibiofemoral (OR = 1.02, 95%CI 1.00-1.03) and patellofemoral (OR = 1.04, 95%CI 1.01-1.07) compartments, and medial tibial plateau area (B = 2.5, 95%CI 0.8-4.3), but negatively associated with lateral tibial cartilage volume (B = -4.9, 95%CI -8.4 to -1.5). The association of APMM and time from APMM with patellar cartilage defects was independent of tibial cartilage volume. CONCLUSIONS: Partial medial meniscectomy is associated with adverse effects on articular cartilage and subchondral bone, which are associated with subsequent osteoarthritis, in both tibiofemoral and patellofemoral compartments. LEVEL OF EVIDENCE: III.

Digital Interventions to Save Lives From the Opioid Crisis Prior and During the SARS COVID-19 Pandemic: A Scoping Review of Australian and Canadian Experiences.

Background: The potential for digital initiatives for opioid harm reduction is boundless. Synthesized evidence on current interventions and their efficacy are emerging. This scoping review is an effort to aggregate Canadian and Australian digital health initiatives used to prevent opioid-related deaths and minimize harm, prior to and particularly during the pandemic of SARs-COVID-19, when the crisis escalated. Methods: The Joanna Briggs Institute's methodological framework for conducting scoping reviews was used. Peer reviewed and gray literature published between January 2016 to October 2021 were included. Search translation was performed across CINAHL, Cochrane, SCOPUS, MEDLINE Complete, and ProQuest Public Health with consistent use of key search terms. Citation checks were also conducted. Studies included were written in English and reported on digital technologies to prevent opioid-related harm and/or mortality in participants aged 18 years or older in Australia and Canada. Results: A total of 16 publications were included in the final analysis (Australia = 5; Canada = 11). The most frequently reported digital technologies were telehealth to support access to treatment (n = 3) and mobile applications for overdose monitoring and prevention (n = 3). Telehealth-delivered opioid replacement therapy demonstrated equal outcomes and treatment retention rates compared to in-person and mobile applications for overdose monitoring demonstrated lifesaving capability through direct linkages with emergency response services. Conclusions: Digital interventions to minimize opioid crisis related harm and overdose prevention are fast emerging in Australia and Canada. During the pandemic, the crisis escalated in both countries as a public health emergency, and different initiatives were trialed. Digital harm reduction solutions via mobile apps (or SaaS solutions) were found to have the potential to prevent accidental overdose deaths and save lives, if rendered through privacy preserved, secure and trust enabled methods that empower users. Knowledge sharing between the two countries, relating to suitable interventions, may add significant value in combatting the escalating opioid crisis in the post pandemic era.

Predictors of regular physical activity behavior and quality of life in post-menopausal Iranian women based on the multi-theory model.

This research aims to identify the predictive factors related to the initiation and sustaining of regular physical activity behaviors and their influence in adapting to menopausal symptoms. The study uses the multi-theory model (MTM) as the conceptual framework. The descriptive cross-sectional research was conducted on 200 post-menopausal women aged 45-55 years. All participants were referred to health centers, where they completed a three-part questionnaire involving: demographic information, a questionnaire on the influence of regular physical activity on the onset and sustaining of menopause using the MTM, and a standard questionnaire of menopausal quality of life. Data were collected, managed, and analyzed using SPSS 20 and AMOS 23 software. This study reveals that behavioral confidence and changes in the physical environment with coefficients of 0.55 and 0.14 respectively had a direct and significant impact on the initiation of regular physical activity-related behaviors during menopause. The construct of participatory dialogue had no significant impact on the initiation of regular physical activity-related behaviors and menopause. Regarding the sustainability of regular physical activity, the emotional transformation construct with a coefficient of 0.73 and change in social environment construct with a coefficient of 0.11 directly and significantly impact keeping regular physical activity behaviors due to menopause. Therefore, interventions based on the MTM can prove very useful for this specific population. In addition, the use of constructs validated by this study will especially be useful in producing evidence-based intervention for the target population.