Efficacy of postural awareness by booklet on back pain among the sweet makers

Background: The purpose of the study was to identify the efficacy of postural awareness by a booklet on back pain among sweet makers. Objective was to explore socio-demographic (age, gender, educational status, occupation) characteristics of sweet-makers with back pain. To compare the rating of pain intensity before and after postural awareness by a booklet with the back pain of sweet-makers. Methods: This study was conducted by pre-test post-test experimental study in which a total of 25 sweet-makers were selected with back pain from January 2021 to December 2022. Data were collected by using the functional rating index questionnaire to evaluate the activity of daily living and pain measured by the visual analogue scale questionnaire. Statistical package for the social sciences (SPSS) was used for data analysis. Results: In this study, the results showed significant improvement in the reduction of back pain and increase functional activities of daily living by postural awareness with an educational booklet among sweet-makers. The NPRS score in pair sample t-test before and after 15 days of postural awareness by booklet was the level of significant 0.000123, the mean of 0.640±0.700. The pattern of pain before and after 15 days of postural awareness by booklet was the level significant 0.042896 when the mean difference was -0.160±0.374. The referred pain before and after 15 days of postural awareness by booklet was 0.000032 level significant where the mean difference was -0.520±0.510. Conclusions: The result of this study suggests that postural awareness through a booklet on back pain was effective and it also improves activities of daily living among sweet-makers.

Low-dose spironolactone and cardiovascular outcomes in moderate stage Chronic Kidney Disease:a randomised controlled trial

Chronic kidney disease (CKD) is associated with substantial risk of progression to end stage renal disease and vascular events. The non-steroidal mineralocorticoid receptor antagonist (MRA), finerenone, offers cardio-renal protection for people with CKD and diabetes, but there is uncertainty if the steroidal MRA, spironolactone, provides the same protection. In this prospective, randomised, open, blinded endpoint (PROBE) trial we assessed the effectiveness of 25mg spironolactone in addition to usual care or usual care alone for reducing cardiovascular outcomes in stage 3b CKD among an older community cohort (mean age 74.8 years, standard deviation 8.1). We recruited 1,434 adults from English primary care, of whom 1,372 (96%) were included in the primary analysis. The primary outcome was time from randomisation until the first occurrence of; death, hospitalisation for heart disease, stroke, heart failure, transient ischaemic attack or peripheral arterial disease, or first onset of any condition listed not present at baseline. Across three years of follow-up, the primary endpoint occurred in 113/677 participants randomised to spironolactone (16.7%) and 111/695 randomised to usual care (16.0%) with no significant difference between groups (hazard ratio 1.05, 95%CI:0.81-1.37). Two-thirds of participants randomised to spironolactone stopped treatment within six months, predominantly because they met pre-specified safety stop criteria. The most common reason for stopping spironolactone was a decrease in the estimated glomerular filtration rate that met pre-specified stop criteria (n=239, 35.4%), followed by participants being withdrawn due to treatment side-effects (n=128, 18.9%) and hyperkalaemia (n=54, 8.0%). In conclusion, we found that spironolactone was frequently discontinued due to safety concerns, with no evidence that it reduced cardiovascular outcomes in people with stage 3b CKD. Spironolactone should not be used for people with stage 3b CKD without another explicit treatment indication. ClinicalTrials.gov registration: ISRCTN44522369.<br/

Low-dose spironolactone and cardiovascular outcomes in moderate stage Chronic Kidney Disease:a randomised controlled trial

Chronic kidney disease (CKD) is associated with substantial risk of progression to end stage renal disease and vascular events. The non-steroidal mineralocorticoid receptor antagonist (MRA), finerenone, offers cardio-renal protection for people with CKD and diabetes, but there is uncertainty if the steroidal MRA, spironolactone, provides the same protection. In this prospective, randomised, open, blinded endpoint (PROBE) trial we assessed the effectiveness of 25mg spironolactone in addition to usual care or usual care alone for reducing cardiovascular outcomes in stage 3b CKD among an older community cohort (mean age 74.8 years, standard deviation 8.1). We recruited 1,434 adults from English primary care, of whom 1,372 (96%) were included in the primary analysis. The primary outcome was time from randomisation until the first occurrence of; death, hospitalisation for heart disease, stroke, heart failure, transient ischaemic attack or peripheral arterial disease, or first onset of any condition listed not present at baseline. Across three years of follow-up, the primary endpoint occurred in 113/677 participants randomised to spironolactone (16.7%) and 111/695 randomised to usual care (16.0%) with no significant difference between groups (hazard ratio 1.05, 95%CI:0.81-1.37). Two-thirds of participants randomised to spironolactone stopped treatment within six months, predominantly because they met pre-specified safety stop criteria. The most common reason for stopping spironolactone was a decrease in the estimated glomerular filtration rate that met pre-specified stop criteria (n=239, 35.4%), followed by participants being withdrawn due to treatment side-effects (n=128, 18.9%) and hyperkalaemia (n=54, 8.0%). In conclusion, we found that spironolactone was frequently discontinued due to safety concerns, with no evidence that it reduced cardiovascular outcomes in people with stage 3b CKD. Spironolactone should not be used for people with stage 3b CKD without another explicit treatment indication. ClinicalTrials.gov registration: ISRCTN44522369.<br/

Sources of Community Health Worker Motivation: A Qualitative Study in Morogoro Region, Tanzania.

There is a renewed interest in community health workers (CHWs) in Tanzania, but also a concern that low motivation of CHWs may decrease the benefits of investments in CHW programs. This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts. We conducted semi-structured interviews with 20 CHWs in Morogoro Region, Tanzania. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results. Sources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks. Resistance to CHW work exhibited by families and community members is limited. The organizational level (the government and its development partners) provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance. Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. In addition, CHWs' intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial incentives and in-kind alternatives would allow already-motivated CHWs to increase their commitment to their work

PET-CT Surveillance versus Neck Dissection in Advanced Head and Neck Cancer

BACKGROUND: The role of image-guided surveillance as compared with planned neck dissection in the treatment of patients with squamous-cell carcinoma of the head and neck who have advanced nodal disease (stage N2 or N3) and who have received chemoradiotherapy for primary treatment is a matter of debate. METHODS: In this prospective, randomized, controlled trial, we assessed the noninferiority of positron-emission tomography–computed tomography (PET-CT)–guided surveillance (performed 12 weeks after the end of chemoradiotherapy, with neck dissection performed only if PET-CT showed an incomplete or equivocal response) to planned neck dissection in patients with stage N2 or N3 disease. The primary end point was overall survival. RESULTS: From 2007 through 2012, we recruited 564 patients (282 patients in the planned-surgery group and 282 patients in the surveillance group) from 37 centers in the United Kingdom. Among these patients, 17% had nodal stage N2a disease and 61% had stage N2b disease. A total of 84% of the patients had oropharyngeal cancer, and 75% had tumor specimens that stained positive for the p16 protein, an indicator that human papillomavirus had a role in the causation of the cancer. The median follow-up was 36 months. PET-CT–guided surveillance resulted in fewer neck dissections than did planned dissection surgery (54 vs. 221); rates of surgical complications were similar in the two groups (42% and 38%, respectively). The 2-year overall survival rate was 84.9% (95% confidence interval [CI], 80.7 to 89.1) in the surveillance group and 81.5% (95% CI, 76.9 to 86.3) in the planned-surgery group. The hazard ratio for death slightly favored PET-CT–guided surveillance and indicated noninferiority (upper boundary of the 95% CI for the hazard ratio, <1.50; P=0.004). There was no significant difference between the groups with respect to p16 expression. Quality of life was similar in the two groups. PET-CT–guided surveillance, as compared with neck dissection, resulted in savings of £1,492 (approximately $2,190 in U.S. dollars) per person over the duration of the trial. CONCLUSIONS: Survival was similar among patients who underwent PET-CT–guided surveillance and those who underwent planned neck dissection, but surveillance resulted in considerably fewer operations and it was more cost-effective. (Funded by the National Institute for Health Research Health Technology Assessment Programme and Cancer Research UK; PET-NECK Current Controlled Trials number, ISRCTN13735240.

Birthweight: EN-BIRTH multi-country validation study.

BACKGROUND: Accurate birthweight is critical to inform clinical care at the individual level and tracking progress towards national/global targets at the population level. Low birthweight (LBW)  98% for four hospitals) and legible > 99.9%. Weighing of stillbirths varied by hospital, ranging from 12.5-89.0%. Observed LBW rate was 15.6%; survey-reported rate 14.3% (8.9-20.9%), sensitivity 82.9% (75.1-89.4%), specificity 96.1% (93.5-98.5%); register-recorded rate 14.9%, sensitivity 90.8% (85.9-94.8%), specificity 98.5% (98-99.0%). In surveys, "don't know" responses for birthweight measured were 4.7%, and 2.9% for knowing the actual weight. 95.9% of observed babies were weighed within 1 h of birth, only 14.7% with a digital scale. Weight heaping indices were around two-fold lower using digital scales compared to analogue. Observed heaping was almost 5% higher for births during the night than day. Survey-report further increased observed birthweight heaping, especially for LBW babies. Enablers to register birthweight measurement in qualitative interviews included digital scale availability and adequate staffing. CONCLUSIONS: Hospital registers captured birthweight and LBW prevalence more accurately than women's survey report. Even in large hospitals, digital scales were not always available and stillborn babies not always weighed. Birthweight data are being captured in hospitals and investment is required to further improve data quality, researching of data flow in routine systems and use of data at every level

The Milky Way Project First Data Release: A Bubblier Galactic Disk

We present a new catalogue of 5,106 infrared bubbles created through visual classification via the online citizen science website 'The Milky Way Project'. Bubbles in the new catalogue have been independently measured by at least 5 individuals, producing consensus parameters for their position, radius, thickness, eccentricity and position angle. Citizen scientists - volunteers recruited online and taking part in this research - have independently rediscovered the locations of at least 86% of three widely-used catalogues of bubbles and H ii regions whilst finding an order of magnitude more objects. 29% of the Milky Way Project catalogue bubbles lie on the rim of a larger bubble, or have smaller bubbles located within them, opening up the possibility of better statistical studies of triggered star formation. Also outlined is the creation of a 'heat map' of star-formation activity in the Galactic plane. This online resource provides a crowd-sourced map of bubbles and arcs in the Milky Way, and will enable better statistical analysis of Galactic star-formation sites.Comment: 19 pages, 20 figures, submitted to MNRA

Recognition and diagnosis of sleep disorders in Parkinson's disease

Contains fulltext : 109296.pdf (publisher's version ) (Open Access)Sleep disturbances are among the most frequent and incapacitating non-motor symptoms of Parkinson's disease (PD), and are increasingly recognized as an important determinant of impaired quality of life. Here we review several recent developments regarding the recognition and diagnosis of sleep disorders in PD. In addition, we provide a practical and easily applicable approach to the diagnostic process as a basis for tailored therapeutic interventions. This includes a stepwise scheme that guides the clinical interview and subsequent ancillary investigations. In this scheme, the various possible sleep disorders are arranged not in order of prevalence, but in a 'differential diagnostic' order. We also provide recommendations for the use of sleep registrations such as polysomnography. Furthermore, we point out when a sleep specialist could be consulted to provide additional diagnostic and therapeutic input. This structured approach facilitates early detection of sleep disturbances in PD, so treatment can be initiated promptly