Comorbid depression among adults with heart failure in Ethiopia: a hospital-based cross-sectional study.

BACKGROUND: Depression is a common comorbidity in adults with heart failure. It is associated with poor clinical outcomes, including decreased health-related quality of life and increased morbidity and mortality. There is a lack of data concerning the extent of this issue in Ethiopia. Consequently, this study aimed to assess the prevalence of comorbid depression and associated factors among adults living with heart failure in Ethiopia. METHODS: A hospital-based cross-sectional study was conducted at the cardiac outpatient clinics of two selected specialist public hospitals in Addis Ababa, Ethiopia: St. Paul's Hospital Millennium Medical College and St. Peter Specialized Hospital. An interviewer-administered questionnaire was used to collect data from 383 adults with heart failure who attended the clinics and met the inclusion criteria. Depression was measured using the Patient Health Questionnaire (PHQ-9). A binary logistic regression model was fitted to identify factors associated with depression. All statistical analyses were conducted using STATA version 17 software. RESULTS: The mean age of the participants was 55 years. On average, participants had moderate depression, as indicated by the mean PHQ-9 score of 11.02 ± 6.14, and 217 (56.6%, 95%CI 51.53-61.68) had comorbid depression. Significant associations with depression were observed among participants who were female (AOR: 2.31, 95%CI:1.30-4.08), had comorbid diabetes mellitus (AOR: 3.16, 95%CI: 1.47-6.82), were classified as New York Heart Association (NYHA) class IV (AOR: 3.59, 95%CI: 1.05-12.30), reported poor levels of social support (AOR: 6.04, 95%CI: 2.97-12.32), and took more than five medications per day (AOR: 5.26, 95%CI: 2.72-10.18). CONCLUSIONS: This study indicates that over half of all adults with heart failure in Ethiopia have comorbid depression, influenced by several factors. The findings have significant implications in terms of treatment outcomes and quality of life. More research in the area, including interventional and qualitative studies, and consideration of multifaceted approaches, such as psychosocial interventions, are needed to reduce the burden of comorbid depression in this population.

Health-related quality of life of people with heart failure in low- and middle-income countries: a systematic review and meta-analysis.

PURPOSE: Heart failure is a global health concern and associated with poor health-related quality of life and increased mortality. There is a disproportionate burden on patients and health systems in low- and middle-income countries. This systematic review and meta-analysis estimates the health-related quality of life of people with heart failure in low- and middle-income countries. METHODS: A systematic literature search was conducted to identify relevant studies from January 2012 to November 2022 using the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Scopus and JBI EBP database. Study screening, quality appraisal and data extraction were conducted using JBI methodology. A random-effects model was used to perform the meta-analysis. Heterogeneity was assessed using the I2 statistic. All statistical analyses were done in STATA version 17. RESULTS: A total of 33 studies with 5612 participants were included in this review. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short-Form-36 questionnaire (SF-36) were the most used instruments across 19 and 8 studies, respectively. The pooled mean MLHFQ and SF-36 scores using the random-effects model were 46.08 (95% CI 35.06, 57.10) and 41.23 (95% CI 36.63, 45.83), respectively. In a subgroup analysis using both instruments, the highest health-related quality-of-life scores occurred in studies with inpatient participants. CONCLUSION: The overall health-related quality of life of people with heart failure in low- and middle-income countries is poor. Strategies should be strategically developed to improve the health-related quality of life of people with heart failure in these countries. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022377781.

Development of a video analysis protocol and assessment of fall characteristics in equestrian cross-country eventing.

Cross-country eventing is one of the highest-risk sporting activities for serious injury outcomes. This study investigated relationships between fall characteristics and high-risk falls at jumps in cross-country eventing. A video analysis protocol was systematically developed to analyze 87 video recordings of high-risk rider falls; defined as when the rider's head impacted the ground and/or where there was potential horse impact with the rider. Falls were classified according to competition type, jump type, horse-related, and rider-related factors. At least one high-risk fall characteristic was observed in 45 of 87 examined falls. Multivariable best subsets regression identified five independent variables explaining 38.4% of the variance in the number of high-risk falls. Increased likelihood of high-risk falls was associated with continuation of horse direction or speed upon rider ground impact, higher jump approach speed, changes in rider body posture upon landing, rider air jacket usage, and reduced rider fall time. The Eventing Fall Assessment Instrument (EFAI) video analysis protocol (attached as supplementary material) facilitated systematic examination of multiple characteristics associated with high-risk falls and identified likely influential characteristics. Based on EFAI and subsequent data analyses, findings suggest optimized approach speed for correct striding and take-off; jump design to enable run-out; and rider training could help reduce the occurrence of high-risk falls. Air jacket usage and their design characteristics warrant further investigation.

The kinematic differences between skill levels in the squash forehand drive, volley and drop strokes.

Knowledge of the kinematic differences that separate highly skilled and less-skilled squash players could assist the progression of talent development. This study compared trunk, upper-limb and racket kinematics between two groups of nine highly skilled and less-skilled male athletes for forehand drive, volley and drop strokes. A 15-camera motion analysis system recorded three-dimensional trajectories, with five shots analysed per participant per stroke. The highly skilled group had significantly (p < 0.05) larger forearm pronation/supination range-of-motion and wrist extension angles at impact than the less-skilled. The less-skilled group had a significantly more "open" racket face and slower racket velocities at impact than the highly skilled. Rates of shoulder internal rotation, forearm pronation, elbow extension and wrist flexion at impact were greater in the drive stroke than in the other strokes. The position of the racket at impact in the volley was significantly more anterior to the shoulder than in the other strokes, with a smaller trunk rotation angular velocity. Players used less shoulder internal/external rotation, forearm pronation/supination, elbow and wrist flexion/extension ranges-of-motions and angular velocities at impact in the drop stroke than in the other strokes. These findings provide useful insights into the technical differences that separate highly skilled from less-skilled players and provide a kinematic distinction between stroke types.

The kinematic differences between accurate and inaccurate squash forehand drives for athletes of different skill levels.

To maintain the accuracy of squash shots under varying conditions, such as the oncoming ball's velocity and trajectory, players must adjust their technique. Although differences in technique between skilled and less-skilled players have been studied, it is not yet understood how players vary their technique in a functional manner to maintain accuracy under varying conditions. This study compared 3-dimensional joint and racket kinematics and their variability between accurate and inaccurate squash forehand drives of 9 highly skilled and 9 less-skilled male athletes. During inaccurate shots, less-skilled players hit the ball with a more open racket, demonstrating a difference in this task-relevant parameter. No joint kinematic differences were found for accuracy for either group. Coordinated joint rotations at the elbow and wrist both displayed a "zeroing-in" effect, whereby movement variability was reduced from the initiation of propulsive joint rotation to a higher consistency at ball-impact; potentially highlighting the "functionality" of the variability prior to the impact that enabled consistent task-relevant parameters (racket orientation and velocity) under varying conditions. Further, highly skilled players demonstrated greater consistency of task-relevant parameters at impact than less-skilled players. These findings highlight the superior ability of highly skilled players to adjust their technique to achieve consistent task-relevant parameters and a successful shot.

Kinematic Differences in Shoulder Roll and Hip Roll at Different Front Crawl Speeds in National Level Swimmers.

Andersen, JT, Sinclair, PJ, McCabe, CB, and Sanders, RH. Kinematic differences in shoulder roll and hip roll at different front crawl speeds in National Level Swimmers. J Strength Cond Res 34(1): 20-25, 2020-Dry-land strength training is a common component of swimming programs; however, its efficacy is contentious. A common criticism of dry-land strength training for swimming is a lack of specificity. An understanding of movement patterns in swimming can enable dry-land strength training programs to be developed to elicit adaptations that transfer to improvements in swimming performance. This study aimed to quantify the range and velocity of hip roll, shoulder roll, and torso twist (produced by differences in the relative angle between shoulder roll and hip roll) in front crawl at different swimming speeds. Longitudinal torso kinematics was compared between sprint and 400-m pace front crawl using 3D kinematics of 13 elite Scottish front crawl specialists. The range (sprint: 78.1°; 400 m: 61.3°) and velocity of torso twist (sprint: 166.3°·s; 400 m: 96.9°·s) were greater at sprint than 400-m pace. These differences were attributed to reductions in hip roll (sprint: 36.8°; 400 m: 49.9°) without corresponding reductions in shoulder roll (sprint: 97.7°; 400 m: 101.6°) when subjects swam faster. Shoulder roll velocity (sprint: 190.9°·s; 400 m: 139.2°·s) and hip roll velocity (sprint: 75.5°·s; 400 m: 69.1°·s) were greater at sprint than 400-m pace due to a higher stroke frequency at sprint pace (sprint: 0.95 strokes·s; 400 m: 0.70 strokes·s). These findings imply that torques acting to rotate the upper torso and the lower torso are greater at sprint than 400-m pace. Dry-land strength training specificity can be improved by designing exercises that challenge the torso muscles to reproduce the torques required to generate the longitudinal kinematics in front crawl.

The CKD-DETECT study: An RCT aimed at improving intention to initiate a kidney health check in Australian practice nurses.

BACKGROUND: The burden of Chronic Kidney Disease (CKD) on the Australian health system is growing. Efforts to reverse this trend have not been successful. This paper evaluates the effectiveness of a targeted asynchronous web based e-learning module on general practice nurses' behavioural intentions in relation to opportunistic screening practices for people at risk of CKD. DESIGN: Double blinded pre-post interventional randomised control design. METHODS: Participants were nurses working in general practice settings in Australia. Participants were randomised to a knowledge based active control or targeted behavioural based intervention which were delivered using asynchronous e-learning modules. The intervention was designed to influence the behavioural constructs of the theory of planned behaviour (TPB): attitude, subjective norm and perceived behavioural control (PBC). RESULTS: Of the 420 participants, we analysed the primary and secondary outcomes for 212 (50.47%) who had complete follow up data. There were no significant differences (p 0.424, [d] 0.04) in behavioural intention between the intervention and control groups at follow-up, when controlling for baseline values. However, regression models assessing the relationship between the change in the TPB constructs and behavioural intention at follow-up for all participants, regardless of study arm, demonstrated a significant change in intention to initiate a kidney health check. Although these changes could not be attributed to the effect of the intervention. Attitude (r2 = 0.3525, p 0.0004) and PBC (r2 = 0.3510, p 0.0005) models accounted for approximately 35% of the explained variance in behavioural intentions and social norm (r2 = 0.3297, p 0.0171) accounted for approximately 33% of the variance. When all TPB constructs were included in the model, 37% of the variance in intention was explained. CONCLUSION: A targeted behavioural online intervention was no more effective than a knowledge based online program to improve primary health care nurses' intention to initiate a kidney health check in people at risk of chronic kidney disease. RELEVANCE TO CLINICAL PRACTICE: Collaborative efforts are required by all staff working in general practice to develop models of care to improve screening practices for chronic kidney disease. Future research should focus on interventions that improve collaboration between health care professionals in the primary care setting and public health campaigns to increase awareness of risks of CKD and the importance of screening in the primary care setting.

Outcomes of early versus late treatment of severe Class II high-angle patients.

INTRODUCTION: The aim of this work was to compare the skeletal and dental outcomes of 1- versus 2-phase treatment in Class II subjects with difficult-to-treat high-angle severe Class II malocclusions. METHODS: The sample of 120 cases was collected from the private offices of 3 experienced clinicians. The following selection criteria were used: (1) ANB ≥6°, (2) SN-GoGn ≥37° or mandibular plane to Frankfort horizontal plane ≥30°; and (3) overjet ≥6 mm. Patients were classified into either the early or the late treatment group according to dental age (early Tx: ≥5 primary teeth; late Tx: otherwise). Thirty-four angular, linear, and proportional measurements were determined for each patient. Statistical significance was assessed with the use of a 2-tailed t test, analysis of covariance test, and chi-square test. RESULTS: The results showed that early 2-phase treatment for severe Class II high-angle patients offered no skeletal anteroposterior advantages over late 1-phase treatment. Severe high-angle Class II patients also showed similar dental anteroposterior outcomes with the use of both approaches. Vertically there was a higher frequency of increased mandibular plane angles and extrusion of upper incisors and lower molars in the late treatment group. CONCLUSIONS: Early 2-phase treatment for severe Class II high-angle patients offered no skeletal or dental advantage over late 1-phase treatment.

The effectiveness of bench press training with or without throws on strength and shot put distance of competitive university athletes.

PURPOSE: Maximum force exertion against various resistance levels (heavy-light) is commonly implemented to improve both strength- and speed-oriented components of power. Medium-light resistances allow rapid accelerations, yet incur significant decelerations in the later concentric phase to bring the bar to a halt, which may limit the concentric effort and, therefore, the effectiveness of training. Accordingly, ballistic actions have been recommended. This study evaluated the effectiveness of power bench press training, with the bar thrown on a Smith machine (BPthrow) or without throwing (BPnon-throw), for developing strength and shot put distance. METHODS: Nine university shot-putters performed BPthrow and BPnon-throw at 50, 40 and 30% 1RM, as well as seated and standing shot put trials. Peak angular velocities at the elbow were measured in these tasks using a wireless electro-goniometer. Participants underwent 24 sessions of training (12 weeks) with either BPthrow (n = 5) or BPnon-throw (n = 4) at the three intensities (20 s × 2 sets at 50, 40 and 30% 1RM). RESULTS: The peak elbow velocity during BPthrow was 1.7 times greater than BPnon-throw for all intensities. The velocity of BPthrow at 30% 1RM (854.7°/s), however, was still slower than seated (1121.3°/s) and standing (1539.1°/s) shot puts. BPthrow training significantly improved 1RM (+ 10.0%) and the distances of seated (+ 11.7%) and standing (+ 3.8%) shot puts, while no performance changes occurred after BPnon-throw training. CONCLUSION: When undergoing power bench press against medium-light resistances, maximum ballistic actions are important strategies for improving 1RM and shot put performance of university shot-putters.

The relationship between segmental kinematics and ball spin in Type-2 cricket spin bowling.

The techniques of spin bowling in cricket have been largely formulated from the collective intuitions of past players. A standard model of bowling technique has been generally prescribed for both off-spin and leg-spin bowlers, but there has been no biomechanics research to validate this approach. This study measured 20 Type-2 off-spin and 15 Type-2 leg-spin bowlers using a 3D Cortex motion analysis system. Correlation coefficients between segmental kinematic variables and spin rate in the off-spin and leg-spin bowlers revealed that off-spin bowling was associated with an earlier movement time of the thorax, whereas leg-spin bowling was associated with a greater magnitude and earlier movement time of pelvis rotation, as well as a greater magnitude of pelvis-shoulder separation movement. The maximum velocity of rear hip flexion differentiated between both groups of bowlers. The GLM suggested that for off-spinners, rear hip flexion velocity significantly explained the variance in spin rate (subject to sequential timing constraints), while for leg-spinners, the time of maximum rear hip flexion and maximum arm circumduction velocity significantly explained variance in spin rate. This study supports the notion that off-spinners and leg-spinners have significant differences in their joint kinematics, and should not be coached under a one-size-fits-all technical model.

Contribution of uncertainty in estimation of active drag using assisted towing method in front crawl swimming.

Active drag force in swimming can be calculated from a function of five different variables: swim velocity, tow velocity, belt force, power output and exponent of velocity. The accuracy of the drag force value is dependent on the accuracy of each variable, and on the contribution of each variable to drag estimation. To calculate uncertainty in drag value, first the derivatives of the active drag equation with respect to each variable were obtained. Second, these were multiplied by the uncertainty of that variable. Twelve national age and open level swimmers were recruited to complete four free swimming and five active drag trials. The uncertainties for the free and the tow swim velocities, and for the belt force, contributed approximately 5-6% and 2-3% error, respectively, in calculation of drag. The result of the uncertainty of the velocity exponent (1.8-2.6) indicated a contribution of about 6% error in active drag. The contribution of unequal power output showed that if a power changed 7.5% between conditions, it would lead to about 30% error in calculated drag. Consequently, if a swimmer did not maintain constant power output between conditions, there would be substantial errors in the calculation of active drag.

Mothers' experience of caring for a child with early onset scoliosis: A qualitative descriptive study.

AIMS AND OBJECTIVES: This study aimed to identify and describe the experience of parents of children diagnosed with early onset scoliosis living in Australia. BACKGROUND: Chronic childhood disease has a major impact on health-related quality of life. Caring for a child with a chronic illness is well documented but the specific experiences of parents who care for children with early onset scoliosis, a rare but devastating illness, has not been explored. Numerous studies have described the interrelated psychological, financial, social, physical and logistical factors that impact the experience of the caregiver role with various diseases, but in the case of early onset scoliosis, limited studies have been conducted about the parental experience. METHODS: A qualitative descriptive design was used. A snowball sampling technique assisted in the recruitment. Parents invited to the study included mothers, fathers and guardians. Data were collected through semistructured interviews and transcribed verbatim. Transcripts were analysed thematically. Data collection complied with the Consolidated criteria for reporting qualitative research guidelines. FINDINGS: Twelve mothers of children with early onset scoliosis were interviewed, as only mothers consented to participate. Four major themes emerged: emotional rollercoaster ride, a lack of resources, money talks and pervasive burden. Factors that impacted on the participants' ability to confront, manage and endure caring for a child with early onset scoliosis emerged from the data. CONCLUSION: The findings suggest there are multiple factors that influence the experience of mothers' caring for a child with early onset scoliosis. The recognition and appropriate management of these factors by healthcare professionals have the potential to improve the quality of life of parents who care for a child with early onset scoliosis. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals have first-line contact with parents of children with early onset scoliosis and are well placed to provide parents with evidence-based education and increased support.

Barriers and facilitators to opportunistic chronic kidney disease screening by general practice nurses.

AIM: Opportunistic screening in general practice (GP) is a cost-effective and viable approach to the early identification of chronic kidney disease (CKD). This study sought to identify the barriers and facilitators to CKD screening practices of GP nurses working in a regional area of New South Wales, Australia. METHODS: An eight-item elicitation questionnaire informed by the Theory of Planned Behaviour was administered to a convenience sample of 26 GP nurses. RESULTS: Participants identified that the advantages of CKD screening were its early detection and treatment, the reduction of disease burden, and the opportunity to increase awareness and provide disease prevention education. These positive attitudinal beliefs were offset by negative beliefs about the impost of opportunistic screening on nursing time, particularly when there were other competing clinical priorities. Participants reported that practice doctors were wary of the financial costs associated with additional non-claimable services and believed that unfunded services, regardless of patient benefit, were difficult to justify in a private business environment. Screening was enabled in GP settings with existing screening protocols or initiatives, and when patients presented with known risk factors. Barriers to screening were more frequently described and illustrated a strong focus on financial aspects of GP. Without reimbursement through the Medicare Benefits Scheme, screening was not considered an economical use of nursing time. Other competing and billable clinical services took precedence. CONCLUSION: The findings of this study can be used to inform the development and evaluation of interventions that target opportunistic CKD screening in the GP setting.

Sixteen-week analysis of unaltered elastomeric chain relating in-vitro force degradation with in-vivo extraction space tooth movement.

INTRODUCTION: The purposes of this study were to evaluate whether unaltered elastomeric chain can continue to move teeth for 16 weeks and to relate it to the amount of force remaining for the same batch of elastomeric chains. METHODS: The in-vivo portion of the study had a sample of 30 paired extraction space sites from 22 subjects who were measured for closure of the space every 28 days. The altered side elastomeric chain served as the control and was replaced at 28-day intervals whereas the experimental side remained unaltered. In the in-vitro portion of the study, 100 each of 2-unit and 3-unit segments of the same batch of elastomeric chains were placed in a water bath, and the force was measured for 20 of each segment length at the 28-day measurement points. RESULTS: Statistically significant amounts of space closure occurred at both the altered and unaltered sites at all measurement time points. The mean space closure at the altered sites was minimally greater than that observed at the paired unaltered sites. The mean differences of space closure between the altered and unaltered sites ranged from a minimum of -0.05 mm at 4 weeks to a maximum of -0.14 mm at 8 weeks. The elastomeric chain force degraded rapidly by 4 weeks but continued a gradual diminution of force to 86 g at 16 weeks. CONCLUSIONS: Unaltered elastomeric chain continued to move teeth into extraction spaces for 16 weeks in this sample from both statistically and clinically significant standpoints. There were minimal and statistically insignificant differences in the mean space closure measurements between the paired altered and unaltered sites. The elastomeric chain force at 16 weeks was less than 100 g, yet at the same time point, teeth continued to move clinically.

High engagement, high quality: A guiding framework for developing empirically informed asynchronous e-learning programs for health professional educators.

E-learning involves the transfer of skills and knowledge via technology so that learners can access meaningful and authentic educational materials. While learner engagement is important, in the context of healthcare education, pedagogy must not be sacrificed for edu-tainment style instructional design. Consequently, health professional educators need to be competent in the use of current web-based educational technologies so that learners are able to access relevant and engaging e-learning materials without restriction. The increasing popularity of asynchronous e-learning programs developed for use outside of formal education institutions has made this need more relevant. In these contexts, educators must balance design and functionality to deliver relevant, cost-effective, sustainable, and accessible programs that overcome scheduling and geographic barriers for learners. This paper presents 10 guiding design principles and their application in the development of an e-learning program for general practice nurses focused on behavior change. Consideration of these principles will assist educators to develop high quality, pedagogically sound, engaging, and interactive e-learning resources.

Moral courage in undergraduate nursing students: A literature review.

Aim: The aim of this review was to explore factors which facilitate or inhibit undergraduate nursing students' willingness to demonstrate moral courage when confronted by poor patient care. Methods: Included papers were those that met the criteria of being qualitative research that explored undergraduate nursing students' depictions of situations where moral courage was or was not demonstrated during clinical placements, with a particular focus on situations that impacted or had the potential to impact the quality of patient care.Papers were reviewed using the Critical Appraisal Skills Programme Qualitative Research Checklist. The 15 papers included in the review were then thematically analysed. Findings: The literature reports, despite feeling a moral obligation to act, most nursing students lack the moral courage to intervene or speak up when faced with poor practice. While students may subsequently report the behaviour, at the time of the event, they often remain passive spectators and sometimes even active participants. The major themes identified in the literature were: just a student, don't rock the boat, fear of consequences, mentor­student relationship, and patient advocate identity. The literature also identified that nursing students suffer ongoing moral distress when they do not have the courage to confront poor practice. Conclusion: There is a need for further research to explore positive examples of how nursing students demonstrate moral courage when undertaking clinical placements. These narratives have the potential to influence future students' attitudes, values and behaviours by providing stimulus materials for teaching.

Discovery of novel non-steroidal reverse indole mineralocorticoid receptor antagonists.

Reported herein are a series of reverse indoles that represent novel non-steroidal mineralocorticoid receptor (MR) antagonists. The key structure-activity relationships (SAR) are presented below. This reverse indole series is exemplified by a compound that demonstrated efficacy in an acute natriuresis rodent model comparable to marketed MR antagonists, spironolactone and eplerenone.

Mineralocorticoid receptor antagonists: identification of heterocyclic amide replacements in the oxazolidinedione series.

Novel potent and selective mineralocorticoid receptor antagonists were identified, utilizing heterocyclic amide replacements in the oxazolidinedione series. Structure-activity relationship (SAR) efforts focused on improving lipophilic ligand efficiency (LLE) while maintaining nuclear hormone receptor selectivity and reasonable pharmacokinetic profiles.