Objective assessment of functional and motor-cognitive outcomes among asymptomatic primary hyperparathyroidism patients undergoing parathyroidectomy using wearable technologies: a pilot study towards better informed clinical decision-making

For the past 40 years, most patients with Primary Hyperparathyroidism (PHPT) have presented with the asymptomatic form of PHPT. Despite the dominance of the asymptomatic PHPT phenotype, current National Institutes of Health (NIH) indications for parathyroidectomy fail to identify as many as 80% of patients afflicted with asymptomatic PHPT. To date, studies of the therapeutic benefits of parathyroidectomy among asymptomatic PHPT patients have relied on general health questionnaires and patient reports of their satisfaction with the surgery. The purpose of the present study was to implement objective, quantifiable metrics in assessing whether or not asymptomatic PHPT patients experience improvements in domains salient to them such as mobility and cognitive function following parathyroidectomy. This information may help set the foundation for more accurately identifying patients who would benefit from parathyroidectomy. We hypothesized that asymptomatic patients would exhibit improvement in motor-cognitive outcomes following successful parathyroidectomy. We performed a single-center prospective assessment of gait, frailty, and motor-cognitive function among patients diagnosed with PHPT. Demographics, medical history, and perioperative labs were recorded. Pre- and post-surgical measures included the Fried frailty criteria, the PROMIS 10 Global Health Scale, and gait analysis under habitual (ST), walking while performing working memory test (dual-task: DT), and fast-walking conditions, an upper extremity frailty (UEF) test, and an interactive trail-making task (iTMT) . Descriptive statistics, Chi-squared, 2-sample t tests, and repeated measures analysis of variance were applied where appropriate. 22 parathyroidectomy patients (male 7; 31.8%); median age of 54.9 (standard deviation=15.5) years participated. The prevalence of frailty/pre-frailty was 60% at baseline and reduced to 33% at 3 weeks post-op. PROMIS 10 physical health improved significantly by 3 months post-op (d=0.93, p=0.010). DT and fast walk velocities were significantly increased by 3 weeks post-op (p<0.050) with highest effect size observed during DT conditions (24%, Cohen's effect size d=1.30 , p=0.017). ST velocity increased but not significantly (17.5%, d=0.46, p=0.422). Results from UEF tests and iTMT did not achieve statistical significance at any visit date. Asymptomatic PHPT patients experience significant resolution of motor-cognitive symptoms as measured by DT gait and PROMIS 10 Global Health Scale following parathyroidectomy performed by a skilled surgeon

Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASSII): a combined evidence and theory-based plus partnership intervention development approach.

Introduction: Deaths from second-hand smoke (SHS) exposure are increasing but there is not sufficient evidence to recommend a particular SHS intervention or intervention development approach. Despite the available guidance on intervention reporting, and on the role and nature of pilot and feasibility studies, partial reporting of SHS interventions is common. The decision-making while developing such interventions is often under-reported. This paper describes the processes and decisions employed during transitioning from the aim of adapting an existing mosque-based intervention focused on public health messages, to the development of the content of novel community-based Smoke-Free Home (SFH) intervention. The intervention aims to promote smoke-free homes to reduce non-smokers’ exposure to SHS in the home via faith-based messages. Methods: The development of the SFH intervention had four sequential phases: in-depth interviews with adults in households in Dhaka; identification of an intervention programme theory and content with Islamic scholars from the Bangladesh Islamic Foundation (BIF); user testing of candidate intervention content with adults, and iterative intervention development workshops with Imams and khatibs who trained at the BIF. Results: It was judged inappropriate to take an intervention adaptation approach. Following the identification of an intervention programme theory and collaborating with stakeholders in an iterative and collaborative process to identify barriers, six potentially modifiable constructs were identified. These were targeted with a series of behaviour change techniques operationalised as Quranic verses with associated health messages to be used as the basis for Khutbahs. Following iterative user testing, acceptable intervention content was generated. Conclusion: The potential of this community-based intervention to reduce SHS exposure at home and improve lung health among non-smokers in Bangladesh is the result of an iterative and collaborative process. It is the result of the integration of behaviour change evidence and theory, and community stakeholder contributions to the production of the intervention content. This novel combination of intervention development frameworks demonstrates a flexible approach that could provide insights for intervention development in related contexts

Tobacco smoking and associated factors among people living with HIV in Uganda

Introduction: This study aimed to assess smoking patterns, behaviours and associated factors among people living with HIV (PLWH) in Uganda. Methods: A cross-sectional survey was conducted among adults in HIV care in Uganda. Descriptive statistics were used to describe smoking patterns and behaviours. Logistic regression was used to identify factors associated with current smoking status. Results: We recruited 777 participants between October and November 2019: 387 (49.8%) current smokers and 390 (50.2%) non-smokers. 60.9% were males, and the mean age was 40.5 (SD 10.7) years. In multivariate logistic regression, the following increased the odds of being a current smoker: being male (OR 6.60 (95%CI= 4.34 to 10.04)), having at least two smokers among five closest friends (OR 3.97 (95%CI=2.08 to 7.59)), living in smoking-permitted households (OR 5.83 (95%CI= 3.32 to 10.23)), alcohol use (OR 3.96 (95%CI= 2.34 to 6.71)), a higher perceived stress score (OR 2.23 (95%CI= 1.50 to 3.34)), and higher health-related quality of life (OR 5.25 (95%CI= 1.18 to 23.35)). Among smokers, the mean Fagerstrom Test for Nicotine Dependence score was 3.0 (SD 1.9), and 52.5% were making plans to quit. Self-efficacy to resist smoking and knowledge of the impact of smoking on PLWH’s health were low. Conclusions: Being male, having at least two smokers among five closest friends, living in smoking-permitted households, alcohol use, higher perceived stress scores and higher health-related quality of life were associated with being a current smoker. Smokers had low to moderate nicotine dependence, high willingness to quit, and low self-efficacy

Building capacity for applied research to reduce tobacco- related harm in low- and middle-income countries : the Tobacco Control Capacity Programme (TCCP)

Background: Tobacco use is the leading cause of preventable deaths in the world. By 2030, more than 80% of these tobacco-related deaths will occur in low- and mid- dle-income countries (LMICs). The aim of the Tobacco Control Capacity Programme (TCCP) therefore, is to reduce tobacco-related mortality and morbidity by building research capacity in LMICs. Methods: A consortium of fifteen partner organisations across eight countries (Ban- gladesh, Ethiopia, Ghana, India, South Africa, the Gambia, Uganda and the UK) will offer extensive research methods and leadership training opportunities to conduct high quality research projects on policy and practice and establish strong research partnerships. An example of one such study using a mixed method design to inves- tigate tobacco industry interference in Uganda is presented. Results: The TCCP programme will produce research that can inform policies and practice within countries to prevent or reduce tobacco use. By conducting research in three key areas (tobacco taxation, reducing illicit trade, and addressing tobacco industry interference, as well as other local priorities) the programme will help to reduce tobacco disease and death and also generate revenue for governments through taxation which aids other development priorities. While conducting research in LMICs on these themes TCCP will provide evidence to support better implementation of the Framework Convention for Tobacco Controls (FCTC), which will result in re- ductions in tobacco-related mortality and morbidity and also help generate revenue for governments through taxation which aids other development priorities. Conclusion: The TCCP programme will create a cohort of skilled early-career re- searchers and research leaders who will build cohesive and successful research teams in LMICs. It will also create several collaborative networks of researchers, policy- makers and advocates to co-produce context-specific research on tobacco control and its translation into policy. This will advance implementation science in LMICs and improve population health. By generating context-specific evidence, the TCCP will support advocacy efforts to shift attitudes within communities and governments towards a stronger tobacco control. Policy makers will be assisted by the evidence generated in this programme to challenge aggressive tobacco industry tactics and implement effective tobacco control

ImPROving TB outcomes by modifying LIFE-style behaviours through a brief motivational intervention followed by short text messages (ProLife): study protocol for a randomised controlled trial

Background: South Africa is among the 7 highest tuberculosis (TB) burden countries. Harmful lifestyle behaviours, such as smoking and alcohol, and poor medication adherence can affect clinical outcomes. Modification of these behaviours is likely to improve TB treatment outcomes and has proven possible using motivational interviewing (MI) techniques or use of short message service (SMS) text messaging. There have been no studies assessing the effect of combined MI and SMS interventions on multiple lifestyle factors and TB treatment outcomes. Methods: This is a prospective, multi-centre, two-arm individual randomised controlled trial looking at the effectiveness and cost-effectiveness of a complex behavioural intervention (the ProLife programme) on improving TB and lifestyle-related outcomes in 3 provinces of South Africa. The ProLife programme consists of an MI counselling strategy, delivered by lay health workers, augmented with subsequent SMS. We aim to recruit 696 adult participants (aged 18 years and over) with drug-sensitive pulmonary TB who are current smokers and/or report harmful or hazardous alcohol use. Patients will be consecutively enrolled at 27 clinics in 3 different health districts in South Africa. Participants randomised individually to the intervention arm will receive 3 MI counselling sessions 1 month apart. Each MI session will be followed by twice-weekly SMS messages targeting treatment adherence, alcohol use and tobacco smoking, as appropriate. We will assess the effect on TB treatment success, using standard World Health Organization (WHO) treatment outcome definitions (primary outcome), as well as on a range of secondary outcomes including smoking cessation, reduction in alcohol use and TB medication and anti-retroviral therapy adherence. Secondary outcomes will be measured at 3 and 6 months follow-up. Discussion: This trial aligns with the WHO agenda of integrating TB care with the care for chronic diseases of life-style, such as provision of smoking cessation treatments, and with the use of digital technologies. If the ProLife programme is found to be effective and cost- effective, the programme could have significant implications for TB treatment globally and could be successfully implemented in a wide range of TB treatment settings

Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use, and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis : A multicentre, randomised controlled trial of the ProLife programme in South Africa

Objectives: To investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking. Design: Multicentre, individual, randomised controlled trial where participants were assigned (1:1) to the ProLife intervention or usual care. Setting: 27 primary care clinics in South Africa. Participants: 574 adults starting treatment for drug-sensitive pulmonary TB who smoked tobacco or reported harmful/hazardous alcohol use. Interventions: The intervention, delivered by lay health workers (LHWs), consisted of 3 brief motivational interviewing (MI) sessions, augmented with Short Message Service (SMS) messages, targeting medication adherence, alcohol use and tobacco smoking. Outcome measures: The primary outcome was successful versus unsuccessful TB treatment at 6 to 9 months, from TB records. Secondary outcomes were biochemically confirmed sustained smoking cessation, reduction in the Alcohol Use Disorder Identification Test (AUDIT) score, improved TB and antiretroviral treatment (ART) adherence and ART initiation, each measured at 3 and 6 months by questionnaires; and cure rates in patients who had bacteriology-confirmed TB at baseline, from TB records. Results: Between 15 November 2018 and 31 August 2019, 574 participants were randomised to receive either the intervention (n=283) or usual care (n=291). TB treatment success rates did not differ significantly between intervention (67.8%) and control (70.1%; OR=0.9 (95% CI: 0.64,1.27)). There was no evidence of an effect at 3- and 6-months respectively on continuous smoking abstinence (OR=0.65 (95% CI: 0.37,1.14); OR=0.76 (95% CI: 0.35,1.63)), TB medication adherence (OR=1.22 (95%CI: 0.52,2.87); OR=0.89 (95%CI: 0.26,3.07)), taking ART (OR=0.79 (0.38,1.65), OR=2.05 (0.80,5.27)) or AUDIT scores (mean score difference 0.55 (95% CI: -1.01,2.11); -0.04 (95% CI: -2,1.91); and adjusting for baseline values. Cure rates were not significantly higher (OR=1.16 (0.83,1.63)). Conclusions: Simultaneous targeting of multiple health risk behaviours with MI and SMS using LHWs may not be an effective approach to improve TB outcomes

Muslim Communities learning about second-hand smoke in Bangladesh (MCLASS II): study protocol for a cluster randomised controlled trial of a community-based smoke-free homes intervention, with or without Indoor Air Quality feedback

Background Second-hand smoke (SHS) is a serious health hazard costing 890,000 lives a year globally. Women and children in many economically developing countries are worst affected as smoke-free laws are only partially implemented and homes remain a major source of SHS exposure. There is limited evidence on interventions designed to reduce SHS exposure in homes, especially in community settings. Following a successful pilot, a community-based approach to promote smoke-free homes in Bangladesh, a country with a strong commitment to smoke-free environments but with high levels of SHS exposure, will be evaluated. The study aims to assess the effectiveness and cost-effectiveness of a community-based intervention, Muslims for better Health (M4bH), with or without Indoor Air Quality (IAQ) feedback, in reducing non-smokers’ exposure to SHS in the home. Methods/design Based on behaviour-change theories, M4bH and IAQ feedback are designed to discourage people from smoking indoors. M4bH consists of a set of messages couched within mainstream Islamic discourse, delivered weekly by faith leaders (imams and khatibs) in mosques over 12 weeks (one message each week). The messages address key determinants of current smoking behaviours including lack of knowledge and misconceptions on specific harms associated with SHS exposure. IAQ feedback consists of personalised information on IAQ measured by a particulate matter (PM2.5) monitor within the home. Following adaptation of M4bH and IAQ feedback for the Bangladeshi context, a three-arm cluster randomised controlled trial will be conducted in Dhaka. Forty-five mosques and 1800 households, with at least one smoker and one non-smoker, will be recruited. Mosques will be randomised to: M4bH and IAQ feedback; M4bH alone; or usual services only. The primary outcome is 24-h mean household concentration of indoor fine particulate matter (PM2.5) at 12 months post randomisation. Secondary outcomes are 24-h mean household PM2.5 at 3 months post randomisation, frequency and severity of respiratory symptoms, health care service use and quality of life. A cost-effectiveness analysis and process evaluation will also be conducted. Discussion The MCLASS II trial will test the potential of a community-based intervention to reduce second-hand smoke exposure at home and improve lung health among non-smokers in Bangladesh and beyond