Home built environment interventions and inflammation biomarkers: a systematic review and meta-analysis protocol

BACKGROUND: Inflammation control is a fundamental part of chronic care in patients with a history of cancer and comorbidity. As the risk-benefit profile of anti-inflammatory drugs in cancer survivors (CS) is unclear, GPs and patients could benefit from alternative non-pharmacological treatment options for dysregulated inflammation. There is a potential for home built environment (H-BE) interventions to modulate inflammation, however, discrepancies exist between studies. AIM: To evaluate the effectiveness of H-BE interventions on cancer-associated inflammation biomarkers. DESIGN & SETTING: A systematic review and meta-analysis of randomised and non-randomised trials in community-dwelling adults. METHOD: PubMed-Medline, Embase, Web of Science, and Google Scholar will be searched for clinical trials published in January 2000 onwards. We will include H-BE interventions modifying air quality, thermal comfort, non-ionising radiation, noise, nature and water. No restrictions to study population will be applied to allow deriving expectations for effects of the interventions in CS from available source populations. Outcome measures will be inflammatory biomarkers clinically and physiologically relevant to cancer. The first reviewer will independently screen articles together with GPs and extract data that will be verified by a second reviewer. The quality of studies will be assessed using the Cochrane Risk-of-Bias tools. Depending on the clinical and methodological homogeneity of populations, interventions, and outcomes, we will conduct a meta-analysis using random-effects models. CONCLUSIONS: Findings will determine the effectiveness of H-BE interventions on inflammatory parameters, guide future directions for its provision in community-dwelling CS and support GPs with safer anti-inflammatory treatment options in high-risk patients for clinical complications

Processus cognitifs associés au trouble d'acquisition de la coordination

Background: Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. Objectives: To evaluate the effect of telephone support to help smokers quit, including proactive or reactive counselling, or the provision of other information to smokers calling a helpline. Search methods: We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2018. Selection criteria: Randomised or quasi‐randomised controlled trials which offered proactive or reactive telephone counselling to smokers to assist smoking cessation. Data collection and analysis: We used standard methodological procedures expected by Cochrane. We pooled studies using a random‐effects model and assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I2 statistic. In trials including smokers who did not call a quitline, we used meta‐regression to investigate moderation of the effect of telephone counselling by the planned number of calls in the intervention, trial selection of participants that were motivated to quit, and the baseline support provided together with telephone counselling (either self‐help only, brief face‐to‐face intervention, pharmacotherapy, or financial incentives). Main results: We identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long‐term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms. Among trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self‐help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate. In studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate. In subgroup analysis, we found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta‐regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self‐help written support (P Authors' conclusions: There is moderate‐certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate‐certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. There is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. Evidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention.</br

Frequencies and patterns of microbiology test requests from primary care in Oxfordshire, UK, 2008-2018: a retrospective cohort study of electronic health records to inform point of care testing

Objectives: To inform point-of-care test (POCT) development, we quantified the primary care demand for laboratory microbiology tests by describing their frequencies overall, frequencies of positives, most common organisms identified, temporal trends in testing and patterns of cotesting on the same and subsequent dates. Design: Retrospective cohort study. Setting: Primary care practices in Oxfordshire. Participants :393 905 patients (65% female; 49% aged 18–49). Primary and secondary outcome measures The frequencies of all microbiology tests requested between 2008 and 2018 were quantified. Patterns of cotesting were investigated with heat maps. All analyses were done overall, by sex and age categories. Results: 1 596 752 microbiology tests were requested. Urine culture±microscopy was the most common of all tests (n=673 612, 42%), was mainly requested without other tests and was the most common test requested in follow-up within 7 and 14 days. Of all urine cultures, 180 047 (27%) were positive and 172 651 (26%) showed mixed growth, and Escherichia coli was the most prevalent organism (132 277, 73% of positive urine cultures). Antenatal urine cultures and blood tests in pregnancy (hepatitis B, HIV and syphilis) formed a common test combination, consistent with their use in antenatal screening. Conclusions: The greatest burden of microbiology testing in primary care is attributable to urine culture ± microscopy; genital and routine antenatal urine and blood testing are also significant contributors. Further research should focus on the feasibility and impact of POCTs for these specimen types

Uso de las aplicaciones de internet durante el primer año de la pandemia del COVID 19

This article studies the use of the Internet and the applications that have been most used during the first year of the COVID 19 pandemic in Ecuador. For this purpose, the public database of the National Institute of Statistics and Census of the National Multipurpose Household Survey 2020 was employed, using the section on information and communication technologies. The multivariate methods of factor analysis and principal component analysis (PCA) were applied. The identified components explain 83.3% of the total variance and the KMO test gave a value of 0.925 which means that the study is very good, Bartlett's test reported a significant value less than 0.05. It was obtained that the principal components that most influence the use of technology in times of pandemic are Social Networks, Wi-Fi, Bluetooth, Email, GPS and Downloads.En este artículo se realiza el estudio del uso de internet y de las aplicaciones que más se han utilizado durante el primer año de la pandemia del COVID 19 en Ecuador. Para el efecto, se utilizó la base de datos pública del Instituto Nacional de Estadística y Censos sobre la encuesta nacional multipropósito de hogares 2020, usando la sección de tecnologías de la información y comunicación. Se aplicaron los métodos multivariantes del análisis factorial y el análisis de componentes principales (PCA). Los componentes identificados explican un 83,3% de la varianza total y el test de KMO dio un valor de 0,925 que significa que el estudio es muy bueno, la prueba de Bartlett reportó un valor significativo menor a 0,05. Se obtuvo que los componentes principales que más influyen en el uso de la tecnología en tiempos de pandemia son Redes Sociales, Wifi, Bluetooth, Correo Electrónico, GPS y Descarga

Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis

Objective: Possible childhood appendicitis is a common emergency presentation. The exact value of blood tests is debated. This study sought to determine the diagnostic accuracy of four blood tests (white cell count (WCC), neutrophil(count or percentage), C reactive protein (CRP) and/or procalcitonin) for childhood appendicitis. Design: A systematic review and diagnostic meta-analysis. Data sources included MEDLINE, EMBASE, Central, Web of Science searched from inception-March 2022 with reference searching and authors contacted for missing/unclear data. Eligibility criteria was studies reporting the diagnostic accuracy of the four blood tests compared to the reference standard (histology or follow-up). Risk of bias was assessed (QUADAS-2), pooled sensitivity and specificity were generated for each test and commonly presented cut-offs. To provide insight into clinical impact, we present strategies using a hypothetical cohort. Results: 67 studies were included (34 839 children, 13 342 with appendicitis), all in the hospital setting. The most sensitive tests were WCC (≥10 000 cells/µL, 53 studies sensitivity 0.85 (95% CI 0.80 to 0.89)) and absolute neutrophil count (ANC) (≥7500 cells/µL, five studies sensitivity 0.90 (95% CI 0.85 to 0.94)). Combination of WCC or CRP increased sensitivity further(≥10 000 cells/µL or ≥10 mg/L, individual patient data (IPD) of 6 studies, 0.97 (95% CI 0.93 to 0.99)). Applying results to a hypothetical cohort(1000 children with appendicitis symptoms, of whom 400 have appendicitis) 60 and 40 children would be wrongly discharged based solely on WCC and ANC, respectively, 12 with combination of WCC or CRP. The most specific tests were CRP alone (≥50 mg/L, 38 studies, specificity 0.87 (95% CI 0.80 to 0.91)) or combined with WCC (≥10 000 cells/µL and ≥50 mg/L, IPD of six studies, 0.93 (95% CI 0.91 to 0.95)). Conclusions: The best performing single blood tests for ruling-out paediatric appendicitis are WCC or ANC; with accuracy improved combining WCC and CRP. These tests could be used at the point of care in combination with clinical prediction rules. We provide insight into the best cut-offs for clinical application. PROSPERO registration number: CRD4201708003

C-reactive protein and neutrophil count laboratory test requests from primary care:what is the demand and would substitution by point of care technology be viable?

Aims: C-reactive protein (CRP) and neutrophil count (NC) are important diagnostic indicators of inflammation. Point-of-care (POC) technologies for these markers are available but rarely used in community settings in the UK. To inform the potential for POC tests, it is necessary to understand the demand for testing. We aimed to describe the frequency of CRP and NC test requests from primary care to central laboratory services, describe variability between practices and assess the relationship between the tests.Methods: We described the number of patients with either or both laboratory tests, and the volume of testing per individual and per practice, in a retrospective cohort of all adults in general practices in Oxfordshire, 2014–2016.Results: 372 017 CRP and 776 581 NC tests in 160 883 and 275 093 patients, respectively, were requested from 69 practices. CRP was tested mainly in combination with NC, while the latter was more often tested alone. The median (IQR) of CRP and NC tests/person tested was 1 (1–2) and 2 (1–3), respectively. The median (IQR) tests/ practice/week was 36 (22–52) and 72 (50–108), and per 1000 persons registered/practice/week was 4 (3–5) and 8 (7–9), respectively. The median (IQR) CRP and NC concentrations were 2.7 (0.9–7.9)mg/dL and 4.1 (3.1–5.5)×109/L, respectively.Conclusions: The high demand for CRP and NC testing in the community, and the range of results falling within the reportable range for current POC technologies highlight the opportunity for laboratory testing to be supplemented by POC testing in general practice

National trends in heart failure mortality in men and women, United Kingdom, 2000–2017

Aims: To understand gender differences in the prognosis of women and men with heart failure, we compared mortality, cause of death and survival trends over time. Methods and results: We analysed UK primary care data for 26 725 women and 29 234 men over age 45 years with a new diagnosis of heart failure between 1 January 2000 and 31 December 2017 using the Clinical Practice Research Datalink, inpatient Hospital Episode Statistics and the Office for National Statistics death registry. Age-specific overall survival and cause-specific mortality rates were calculated by gender and year. During the study period 15 084 women and 15 822 men with heart failure died. Women were on average 5 years older at diagnosis (79.6 vs. 74.8 years). Median survival was lower in women compared to men (3.99 vs. 4.47 years), but women had a 14% age-adjusted lower risk of all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84–0.88]. Heart failure was equally likely to be cause of death in women and men (HR 1.03, 95% CI 0.96–1.12). There were modest improvements in survival for both genders, but these were greater in men. The reduction in mortality risk in women was greatest for those diagnosed in the community (HR 0.83, 95% CI 0.80–0.85). Conclusions: Women are diagnosed with heart failure older than men but have a better age-adjusted prognosis. Survival gains were less in women over the last two decades. Addressing gender differences in heart failure diagnostic and treatment pathways should be a clinical and research priority.</p

Impact of program characteristics on weight loss in adult behavioral weight management interventions: systematic review and component network meta-analysis

Objective: Behavioral weight management programs (BWMPs) for adults lead to greater weight loss at 12 months than minimal-intervention control treatments. However, there is considerable heterogeneity in the content of BWMPs and outcomes of treatment. This study assessed the contribution of individual components of BWMPs, using Bayesian component network meta-analysis. Methods: Randomized controlled trials of BWMPs in adults were identified (latest search: December 2019) and arms coded for presence or absence of 29 intervention components grouped by type, content, provider, mode of delivery, and intensity. Results: A total of 169 studies (41 judged at high risk of bias) were included in the main analysis. Six components had effect estimates indicating clinically significant benefit and credible intervals (CrIs) excluding no difference: change in diet (mean difference [MD] = −1.84 kg, 95% CrI: −2.91 to −0.80); offering partial (MD = −2.12 kg, 95% CrI: −3.39 to −0.89) or total meal replacements (MD = −2.63 kg, 95% CrI: −4.58 to −0.73); delivery by a psychologist/counselor (MD = −1.45 kg, 95% CrI: −2.81 to −0.06) or dietitian (MD = −1.31 kg, 95% CrI: −2.40 to −0.24); and home setting (MD = −1.05 kg, 95% CrI: −2.02 to −0.09). Conclusions: Future program development should consider including these components; other approaches continue to warrant evaluation of effectiveness

Description of an experimental set up for the culture of benthic foraminifera in controlled pH conditions

10 páginas, 4 figuras, 1 tabla[EN] Acidification of the oceans is one of the consequences of ongoing increasing atmospheric CO2 concentrations. The effects on organisms that build their shells of calcium carbonate are not sufficiently studied and might be detrimental. Simulating ocean acidification scenarios in the laboratory is a reasonable way to study their response to decreased pH and carbonate ion concentrations. In this study we describe in detail an experimental system to carry out ocean acidification experiments with non-symbiotic benthic foraminifera. We test the performance of the designed experimental set up by running a long-term experiment (90 days) using a potentially suitable benthic foraminiferal species for culturing (Miliolinella spp.). Although foraminifera did not survive the experimental period likely due to ciliates infestation, seawater pH measurement results indicate that the design is suitable for carrying out ocean acidification experiments[ES] La acidificación oceánica es una de las consecuencias del aumento progresivo de la concentración de CO2 en la atmósfera. Los efectos en los organismos que construyen sus conchas con carbonato cálcico no están suficientemente estudiados, pero podrían ser perjudiciales. La simulación en laboratorio de diferentes escenarios de acidificación oceánica es una forma de estudiar la respuesta de esos organismos al descenso de pH y de la concentración del ion carbonato. En este estudio se describe minuciosamente un sistema experimental diseñado para realizar experimentos de acidificación oceánica con foraminíferos bentónicos sin simbiontes. La viabilidad del diseño experimental se ha probado con un experimento de larga duración (90 días) utilizando una especie de foraminífero bentónico potencialmente apta para ser cultivada (Miliolinella spp.). Aunque los foraminíferos no sobrevivieron durante todo el experimento debido a contaminación por ciliados, los resultados de las medidas del pH marino ponen de manifiesto que el diseño es adecuado para llevar a cabo experimentos de acidificación oceánicaThis research leading to these results was supported by the Spanish Ministry of Sciences and Innovation and co-founded by the Fondo Europeo de Desarrollo Regional 2007-2012 (FEDER) through the CATARINA Project (CTM2010-17141/MAR) and GRACCIEPeer reviewe