Quality of stroke guidelines in low- and middle-income countries: a systematic review.

OBJECTIVE: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. METHODS: We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. FINDINGS: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. CONCLUSION: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions

The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I 2 of > 75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licens

Lexical grammatical structure of dentistry research article titles written in spanish

Este artículo persigue analizar la estructura sintáctica y la función retórica de 250 títulos de artículos de investigación odontológicos en español. Se examinó cualitativa y cuantitativamente la longitud, la puntuación, la estructura léxico-gramatical y los tipos de títulos. Se encontró un promedio de 15,5 palabras por título. Se identificaron tres tipos de títulos: nominales (78%), compuestos (21,2%) y oraciones completas (0,8%). Predominan los títulos sin puntuación. El 21,2% usa los dos puntos y el punto y seguido para formar títulos compuestos. Se observaron dos combinaciones retóricas en los títulos compuestos: tema-método y tema-descripción. Predominan las construcciones nominales de un núcleo (nombres no disciplinares) con frases preposicionales (100%), adjetivos (29%), frases verbales no personales (28%) y cláusulas relativas (4,4%) como posmodificadores.This paper aims to analyze the syntactic structure and rhetorical function of 250 dentistry research articles titles in Spanish. Length, punctuation, lexical-grammatical structure, and styles of titles were examined qualitatively and quantitatively. It was found an average of 15.5 words per title; three types of titles: nominal (78%), compound (21.2%) and full-sentence titles (0.8%). Titles without punctuation predominated. 21.2% used colon and period to form compound titles predominated. It was observed that compound titles combine two rhetorical components: topic-method and topic-description. Uni-head nominal constructions (using mainly non-discipline-specific nouns) using prepositional phrases (100%), adjectives (29%), non-personal verbal phrases (28%) and relative clauses (4.4%) as postmodifiers predominated

Estructura lingüística de títulos de casos clínicos odontológicos en español

El estudio de los géneros discursivos de las ciencias biomédicas ha priorizado el artículo de investigación en inglés, mientras que otros géneros relevantes, como las revisiones sistemáticas o el caso clínico, han merecido menos interés. Tampoco abundan los estudios discursivos en español sobre la estructura del título que orienten a lectores y autores y faciliten la indexación de esos documentos en bases de datos. Por ello, se propone identificar las estructuras léxico-gramaticales y las funciones retóricas que desempeñan los títulos de casos clínicos en español, además de compararlos con algunas investigaciones previas sobre el mismo componente en géneros odontológicos afines en inglés y español. Para ello, se recopilaron y analizaron 248 títulos de casos clínicos publicados en español en revistas especializadas, con métodos de análisis discursivo, complementados con entrevistas semiestructuradas a informantes expertos del campo. Se encontró: un promedio 12,7 palabras por título; una alta presencia de títulos compuestos por dos (94%) y tres elementos (4%), seguidos de títulos nominales (2%); dos combinaciones retóricas primordiales (1/enfermedad o tratamiento y método, 2/tema, descripción o método); alta presencia de construcciones nominales, modificadas con frases preposicionales (100%) y frases verbales no personales (10%); una mayoría de títulos identifica el género discursivo (‘caso clínico’, ‘reporte de caso’ o ‘caso clínico’) e incluye tanto nombres disciplinares como no disciplinares (‘miasis maxilar’, ‘reporte’). Estos resultados tienen implicaciones pedagógicas para la enseñanza de la escritura académica a estudiantes de odontología y odontólogos en proceso de formación, pues los datos empíricos y ejemplos reales aportados pueden fundamentar el diseño de los programas y la práctica

Application of the Theoretical Framework of Acceptability to assess a telephone-facilitated health coaching intervention for the prevention and management of type 2 diabetes

Background: Lifestyle interventions focusing on diet and physical activity for the prevention and management of type 2 diabetes have been found effective. Acceptance of the intervention is crucial. The Theoretical Framework of Acceptability (TFA) developed by Sekhon et al. (2017) describes the multiple facets of acceptance: Affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs and self-efficacy. The aims of this study were to develop and assess the psychometric properties of a measurement scale for acceptance of a telephone-facilitated health coaching intervention, based on the TFA; and to determine the acceptability of the intervention among participants living with diabetes or having a high risk of diabetes in socioeconomically disadvantaged areas in Stockholm. Methods: This study was nested in the implementation trial SMART2D (Self-management approach and reciprocal learning for type 2 diabetes). The intervention consisted of nine telephone-facilitated health coaching sessions delivered individually over a 6-month period. The acceptability of the intervention was assessed using a questionnaire consisting of 19 Likert scale questions developed using Sekhon's TFA. Exploratory factor analysis (EFA) was performed. Results: Ratings from 49 participants (19 with type 2 diabetes and 30 at high risk of developing diabetes) in ages 38-65 were analyzed. The EFA on the acceptability scale revealed three factors with acceptable reliabilities: affective attitude (alpha 0.90), coherence and understanding (alpha 0.77), perceived burden (alpha 0.85), explaining 82% of the variance. Positive affect and coherence had high median scores and small variance. Median score for perceived burden was low, but with significant variance due to younger individuals and those at high risk reporting higher burden. Conclusions: The telephone-facilitated health coaching intervention was perceived as acceptable by the study population using a questionnaire based on Sekhon's TFA, with a wider variation in perceived burden seen among high risk and younger participants

SMART2D intervention guide _points of contact and SOPs ENGLISH.

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Overview of session structure in the telephone-facilitated health coaching intervention.

Overview of session structure in the telephone-facilitated health coaching intervention.</p

Duration per session.

Duration per session.</p

Participant characteristics.

Participant characteristics.</p

Reported responses.

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