A systematic review of grandparents’ influence on grandchildren’s cancer risk factors

Many lifestyle patterns are established when children are young. Research has focused on the potential role of parents as a risk factor for non communicable disease in children, but there is limited investigation of the role of other caregivers, such as grandparents. The aim of this review was to identify and synthesise evidence for any influence grandparents’ care practices may have on their grandchildren’s long term cancer risk factors. A systematic review was carried out with searches across four databases (MEDLINE, Embase, Web of Science, PsycINFO) as well as searches of reference lists and citing articles, and Google Scholar. Search terms were based on six areas of risk that family care could potentially influence–weight, diet, physical activity, tobacco, alcohol and sun exposure. All study designs were included, as were studies that provided an indication of the interaction of grandparents with their grandchildren. Studies were excluded if grandparents were primary caregivers and if children had serious health conditions. Study quality was assessed using National Institute for Health and Care Excellence checklists. Grandparent impact was categorised as beneficial, adverse, mixed or as having no impact. Due to study heterogeneity a meta-analysis was not possible. Qualitative studies underwent a thematic synthesis of their results. Results from all included studies indicated that there was a sufficient evidence base for weight, diet, physical activity and tobacco studies to draw conclusions about grandparents’ influence. One study examined alcohol and no studies examined sun exposure. Evidence indicated that, overall, grandparents had an adverse impact on their grandchildren’s cancer risk factors. The theoretical work in the included studies was limited. Theoretically underpinned interventions designed to reduce these risk factors must consider grandparents’ role, as well as parents’, and be evaluated robustly to inform the evidence base further

Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model

BACKGROUND: E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. METHODS: We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. RESULTS: Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. CONCLUSION: This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

eHealth cognitieve gedragstherapie voor patiënten met chronische somatische aandoeningen

-based cognitive behavioral therapy for patients with chronic somatic conditions Many patients with chronic somatic conditions regularly experience impairments in physical and psychological functioning in their daily life. A way to support these patients is to offer online programs based on cognitive behavioral therapy (Internet-based cognitive behavioral therapy; ICBT). Although a substantial evidence base already exists regarding the effectiveness of ICBT in treating, for example, depressive symptoms, research on ICBT for chronic somatic conditions is still upcoming. In recent years, a growing number of randomized controlled trials were published that examined the effectiveness of ICBT in various chronic somatic conditions. To systematically and quantitatively evaluate the results of these studies, a metaanalysis was conducted, the results of which are discussed in this article. Results indicated that ICBT is also overall effective for chronic somatic conditions, with small to moderate effect sizes. Larger effects were occasionally found for disease-specific outcomes such as disease symptoms and disease-specific quality of life. A longer treatment duration was found to be marginally related to a larger decrease in depressive symptoms. In addition to the results of the meta-analysis, this article provides an overview of the recent literature regarding several clinically relevant ICBT topics: cost-effectiveness, guided ICBT interventions versus self-help, the role of treatment duration, and optimal design and implementation of eHealth interventions.FSW - Self-regulation models for health behavior and psychopathology - ou

Assessment of Exposure to Chlorinated Organics through the Ingestion of Moose Meat for a Canadian First Nation Community

Moose is an important traditional food for members of the Swan River First Nation (SRFN), located in northern Alberta, Canada. As industrial development is encroaching on First Nations’ traditional territories in northern Alberta, community members are growing increasingly concerned for the sustainability and safety of their traditional foods. The Alberta Special Waste Treatment Centre (ASWTC) is an industrial incineration facility located in the core of SRFN’s traditional territory. An accidental release at the ASWTC in 1996 resulted in a significant discharge of polychlorinated biphenyls (PCBs) to the environment. In addition to this accident, the ongoing operation of the ASWTC is linked to routine low-level emissions of PCBs, polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs). Since the 1996 release, levels of PCBs and PCDD/Fs have been measured in wild game tissues and the provincial government has issued consumption advisories. This study was undertaken to provide answers to the community regarding food safety and was designed to address concerns regarding PCB and PCDD/F concentrations in moose tissues. Samples of moose muscle (n=15), liver (n=13) and kidney (n=14) were collected as part of regular food harvesting activities of the SRFN in the summer and fall of 2015 and generously shared by the SRFN hunters and harvesters to allow for their inclusion into the study. A risk assessment approach was used to evaluate the potential risks to human health using hazard quotients (HQ). All HQs were below the benchmark level of 0.2 for a single pathway exposure. The results show that PCB and PCDD/F concentrations in moose tissues were low and comparable to those of meats available in Canadian supermarkets. Based on results from this study, community exposure to PCBs and PCDD/Fs from the consumption of moose tissue is low and consumption may continue at quantities documented in regional studies

Assessment of On-Site Treatment Process of Institutional Building’s Wastewater

This study is conducted to investigate the characteristics of outflow wastewater of the 1 m3 on-site wastewater treatment unit on the basis of the testing and measurement data of the samples that were taken during the study monitored period (August 2017 to January 2018). For this purpose, samples were taken on a weekly basis from the treated wastewater effluent and five quality parameters (biochemical oxygen demand (BOD), chemical oxygen demand (COD), total suspended solids (TSS), pH, E-coli counts) were monitored and measured. The average values of the five parameters were compared with the Jordanian standard maximum values, and water reuse in irrigation of plants classifications have been assessed and investigated. Average values of BOD, COD, TSS, pH, and E-coli in treated wastewater were 11 mg/L, 104 mg/L, 15 mg/L, 7.51, and 387 counts, respectively. The installation of in-line ultraviolet (UV) unit in recirculating delivery system played a vital role in the reduction of counts far below the permissible maximum level (1000 counts). Based on national and international standards and criteria, results showed that the treated wastewater is suitable for the irrigation of two classifications of plants: (i) Fruit trees, road-green sides outside cities, and green landscape; (ii) Crops, commercial crops, and forest trees. Hence, such very low water flow rate treatment system can be utilized in refugees’ camps and water scarce residential areas in Jordan

Light-Stimulated Permanent Shape Reconfiguration in Cross-Linked Polymer Microparticles

Reconfiguring the permanent shape of elastomeric microparticles has been impossible due to the incapability of plastic deformation in these materials. To address this limitation, we synthesize the first instance of microparticles comprising a covalent adaptable network (CAN). CANs are cross-linked polymer networks capable of reconfiguring their network topology, enabling stress relaxation and shape changing behaviors, and reversible addition–fragmentation chain transfer (RAFT) is the corresponding dynamic chemistry used in this work to enable CAN-based microparticles. Using nanoimprint lithography to apply controllable deformations we demonstrate that upon light stimulation microparticles are able to reconfigure their shape to permanently fix large aspect ratios and nanoscale surface topographies