| 1041. |
- Nahhas, M. A., et al.
(author)
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Epidemiology of overweight and obesity in early childhood in the Gulf Cooperation Council countries: a systematic review and meta analysis protocol
- 2018
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In: Bmj Open. - : BMJ. - 2044-6055. ; 8:6
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Journal article (peer-reviewed)abstract
- Introduction There has been a notable increase in the prevalence of overweight and obesity in school-aged children in many industrialised regions. The worldwide prevalence of childhood overweight and obesity increased from 4.2% in 1990 to 6.7% in 2010. Although many studies have been published, the epidemiological burden of overweight and obesity in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) is unclear. There is a need to bring together and appraise relevant studies in order to estimate the epidemiological burden (including incidence, prevalence, risk factors, trend over time) of overweight and obesity in this region and thus help to inform national and regional policies. Methods and analysis We will conduct a systematic review and meta-analysis on the epidemiology of overweight and obesity in early childhood including incidence, prevalence, risk factors and trends over time in the GCC countries. We will search international electronic databases including MEDLINE, EMBASE, Cochrane Library, ISI Web of Science, CINAHL, Google Scholar, AMED, Psych INFO, CAB International and WHO Global Health Library for published, unpublished and in-progress epidemiological studies of interest published from inception to 2017. In addition, we will contact an international panel of experts on the topic. There will be no restriction on the language of publication of studies. We will use the Effective Public Health Practice Project (EPHPP) to appraise the methodological quality of included studies. Meta-analysis will be undertaken using random effects models. Ethics and dissemination Ethical approval is riot required. The outcome of the review will he disseminated through conference presentations and peer-reviewed journal publication.
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| 1042. |
- Nakabe, T, et al.
(author)
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Classification tree model of the personal economic burden of dementia care by related factors of both people with dementia and caregivers in Japan: a cross-sectional online survey
- 2019
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In: BMJ open. - : BMJ. - 2044-6055. ; 9:7, s. e026733-
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Journal article (peer-reviewed)abstract
- The purpose of this study was to clarify the microlevel determinants of the economic burden of dementia care at home in Japanese community settings by classifying them into subgroups of factors related to people with dementia and their caregivers.DesignA cross-sectional online survey.Participants4313 panels of Japanese research company who fulfilled the following criteria: (1) aged 30 years or older, (2) non-professional caregiver of someone with dementia, (3) caring for only one person with dementia and (4) having no conflicts of interest with advertising or marketing research entities.Primary outcome measuresInformal care costs and out-of-pocket payments for long-term care (LTC) services.ResultsFrom 4313 respondents, only 1383 caregivers in community-settings were included in this analysis. We conducted a χ² automatic interaction detection analysis to identify the factors related to each cost (informal care costs and out-of-pocket payments for LTC services) divided into subcategories. In the resultant classifications, informal care cost was mainly related to caregivers’ employment status. When caregivers acquired family care leave, informal care costs were the highest. On the other hand, out-of-pocket payments for LTC were related to care-need levels and family economic status. Activities of Daily Living and Instrumental Activities of Daily Living functions such as bathing, toileting and cleaning were related to all costs.ConclusionThis study clarified the difference in dementia care costs between classified subgroups by considering the combination of the situations of both people with dementia and their caregivers. Informal care costs were related to caregivers’ employment and cohabitation status rather to the situations of people with dementia. On the other hand, out-of-pocket payments for LTC services were related to care-need levels and family economic status. These classifications will be useful in understanding which situation represents a greater economic burden and helpful in improving the sustainability of the dementia care system in Japan.
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| 1043. |
- Nakiganda, Lydia Jacenta, et al.
(author)
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Cross-sectional comparative study of risky sexual behaviours among HIV-infected persons initiated and waiting to start antiretroviral therapy in rural Rakai, Uganda
- 2017
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In: BMJ Open. - : BMJ. - 2044-6055. ; 7:9
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Journal article (peer-reviewed)abstract
- Objectives To compare risky sexual behaviours between HIV-positive persons initiated on antiretroviral therapy (ART) (ART-experienced) and persons waiting to start on ART (ART-naive) and assess predictors of risky sexual behaviours among HIV-infected patients in rural Rakai district, Uganda. Study design This is a cross-sectional study that used data from the Rakai Community Cohort Study (RCCS) database between 2013 and 2014. A structured questionnaire was used for data collection. We used stepwise logistic regression as an index to estimate the adjusted ORs for the association between risky sexual behaviours and ART treatment status. Study setting This study was conducted in Rakai district, located in south-western Uganda. The data for this study were extracted from the RCCS. RCCS is an open prospective cohort of approximately 15 000 consenting participants aged 15-49 years. Participants HIV-positive participants aged 18-49 years who had sex at least once a month with any partner prior to the start of the study. Main outcome measures Inconsistent/no condom use in the last 12 months, alcohol use at last sexual encounter, and two or more sexual partners. Results ART-naive participants were more likely to report inconsistent condom use (OR=1.74, 95% CI 1.11 to 2.73) and more likely to drink alcohol at last sexual encounter (OR=1.65, 95% CI 1.11 to 2.46), compared with ART-experienced patients. ART treatment status (p<0.001) was a significant predictor of risky sexual behaviours. Both marital status (p=0.016) and occupation level (p=0.009) were positively associated with inconsistent condom use, while sex (p<0.001) correlated with alcohol use at last sexual encounter. Conclusion ART-naive participants were more likely to exhibit risky sexual behaviours than the ART-experienced participants. The intensity of risk reduction counselling should be increased for HIV-positive persons waiting to start ART but already in HIV care.
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| 1044. |
- Nakiganda, Lydia Jacenta, et al.
(author)
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Cross-sectional study on the prevalence and predictors of pregnancy among women living in HIV discordant relationships in a rural Rakai cohort, Uganda
- 2018
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In: BMJ Open. - : BMJ. - 2044-6055. ; 8:4
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Journal article (peer-reviewed)abstract
- Objectives: This study examines the prevalence of pregnancy in serodiscordant couples and identifies predictors associated with pregnancy in rural Rakai, Uganda. Study design A population-based cross-sectional study that used data from the Rakai Community Cohort Study (RCCS). Setting and participants: We used data from the RCCS survey round 17 (2015-2016), which included 488 women in serodiscordant relationships. This study was conducted in Rakai district, located in south-western Uganda. Primary outcomes: Pregnancy status. Statistical analysis Multivariable modified Poisson regression using stepwise selection was used to determine characteristics and behaviours associated with pregnancy status. Results: The prevalence of pregnancy was 12% in women among serodiscordant couples. HIV-negative women in serodiscordant couples had a slightly higher pregnancy prevalence rate (13.6%) compared with HIV-positive women in serodiscordant couples (11%). Factors significantly associated with higher prevalence of pregnancy were; younger age 15-24 years (prevalence risk ratio (PRR)=4.04; 95% CI 1.72 to 9.50), middle age 25-34 years (PRR=2.49; 95% CI 1.05 to 5.89), Christian religion (PRR=2.26; 95% CI 1.41 to 3.63) and inconsistent condom use in the last 12 months (PRR=4.38, 95% CI 1.09 to 17.53). Neither HIV status nor HIV status disclosure was significantly associated with risk of getting pregnant. Conclusion: Nearly 12% of women in serodiscordant relationships were pregnant, highlighting the need for integrated services to prevent unintended pregnancies and reduce conceptional related risks for those choosing to conceive. Association with younger age and inconsistent condom use suggests a role for early and continued couple-based conception counselling.
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| 1045. |
- Naseer, Mahwish, et al.
(author)
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Individual and contextual predictors of emergency department visits among community-living older adults : a register-based prospective cohort study
- 2022
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In: BMJ Open. - : BMJ. - 2044-6055. ; 12:2
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors.DESIGN: A register-based prospective cohort study.SETTING: Swedish region of Dalarna.PARTICIPANTS: Participants were 16 543 community-living adults aged 80 or older who were residents of the Dalarna region of Sweden, excluding older adults who moved out of Dalarna or into residential care during the study period.OUTCOME MEASURES: Dependent variables were initial ED visit, and at least one ED revisit within 30 days of an initial ED visit.RESULTS: Approximately 36% of the participants visited the ED during the study period with 18.9% returning to the ED within 30 days. For both initial ED visits and ED revisits, the addition of contextual factors to models containing individual factors significantly improved model fit (p<0.001; p<0.022) and the amount of variance explained in the outcome. In the final models, initial ED visit was significantly associated with older age, number of chronic diseases, receipt of home help, number of primary care visits, proportion of 80+ in the population and shorter distance to the ED; while an ED revisit was significantly associated with greater use of social care, number of hospital admissions and disposition (discharged; admitted to hospital) at initial ED visit.CONCLUSION: Contextual factors explain variance in initial ED visit, additional to that explained by individual factors alone, which indicates inequitable access to ED care. These findings suggest considering local variations in contextual factors in order to improve health-related outcomes among older adults.
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| 1046. |
- Natarajan Gavriilidou, Nivetha, et al.
(author)
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Does mandibular bone structure predict subsequent height loss? A longitudinal cohort study of women in Gothenburg, Sweden.
- 2023
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In: BMJ open. - : BMJ Publishing Group. - 2044-6055. ; 13:7
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Journal article (peer-reviewed)abstract
- Several risk factors for loss of height with increasing age have been identified.To investigate if mandibular bone structure predicts future height loss in middle-aged and elderly Swedish women.Prospective cohort study with longitudinally measured heights, radiographical assessments of the cortical bone using Klemetti's Index (normal, moderate or severely eroded cortex) and classification of the trabecular bone using an index proposed by Lindh et al (sparse, mixed or dense trabeculation). No intervention was performed.Gothenburg, Sweden.A population-based sample of 937 Swedish women born in 1914, 1922 and 1930 was recruited. At the baseline examination, the ages were 38, 46 and 54 years. All had undergone a dental examination with panoramic radiographs of the mandible, and a general examination including height measurements on at least two occasions.Height loss was calculated over three periods 12-13years (1968-1980, 1980-1992, 1992-2005).Mean annual height loss measures were 0.075cm/year, 0.08cm/year and 0.18cm/year over the three observation intervals, corresponding to absolute decreases of 0.9cm, 1.0cm and 2.4cm. Cortical erosion in 1968, 1980 and 1992 significantly predicted height loss 12 years later. Sparse trabeculation in 1968, 1980 and 1992 also predicted significant shrinkage over 12 or 13 years. Multivariable regression analyses adjusting for baseline covariates such as height, birth year, physical activity, smoking, body mass index and education yielded consistent findings except for cortical erosion 1968-1980.Mandibular bone structure characteristics such as severe cortical erosion and sparse trabeculation may serve as early risk factors for height loss. Since most individuals visit their dentist at least every 2years and radiographs are taken, a collaboration between dentists and physicians may open opportunities for predicting future risk of height loss.
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| 1047. |
- Nava, Chiara, et al.
(author)
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Accuracy of continuous glucose monitoring in preterm infants : A systematic review and meta-analysis
- 2020
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In: BMJ Open. - : BMJ. - 2044-6055. ; 10:12
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Research review (peer-reviewed)abstract
- Background and objectives Continuous glucose monitoring (CGM) could be a valuable instrument for measurement of glucose concentration in preterm neonate. We undertook a systematic review and meta-analysis to compare the diagnostic accuracy of CGM devices to intermittent blood glucose evaluation methods for the detection of hypoglycaemic or hypoglycaemic events in preterm infants. Data sources A structured electronic database search was performed for studies that assessed the accuracy of CGM against any intermittent blood glucose testing methods in detecting episodes of altered glycaemia in preterm infants. No restrictions were used. Three review authors screened records and included studies. Data extraction Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. From individual patient data (IPD), sensitivity and specificity were determined using predefined thresholds. The mean absolute relative difference (MARD) of the studied CGM devices was assessed and if those satisfied the accuracy requirements (EN ISO 15197). IPD datasets were meta-analysed using a logistic mixed-effects model. A bivariate model was used to estimate the summary receiver operating characteristic curve (ROC) curve and extract the area under the curve (AUC). The overall level of certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. Results Among 4481 records, 11 were included. IPD datasets were obtained for five studies. Only two of the studies showed an MARD lower than 10%, with none of the five CGM devices studied satisfying the European Union (EU) ISO 15197 requirements. Pooled sensitivity and specificity of CGM devices for hypoglycaemia were 0.39 and 0.99, whereas for hyperglycaemia were 0.87 and 0.99, respectively. The AUC was 0.70 and 0.86, respectively. The certainty of the evidence was considered as low to moderate. Limitations primarily related to the lack of representative population, reference standard and CGM device. Conclusions CGM devices demonstrated low sensitivity for detecting hypoglycaemia in preterm infants, however, provided high accuracy for detection of hyperglycaemia. PROSPERO registration number CRD42020152248.
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| 1048. |
- Neerland, B. E., et al.
(author)
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Alpha-2-adrenergic receptor agonists for the prevention of delirium and cognitive decline after open heart surgery (ALPHA2PREVENT): protocol for a multicentre randomised controlled trial
- 2022
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In: Bmj Open. - : BMJ. - 2044-6055. ; 12:6
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Journal article (peer-reviewed)abstract
- Introduction Postoperative delirium is common in older cardiac surgery patients and associated with negative short-term and long-term outcomes. The alpha-2-adrenergic receptor agonist dexmedetomidine shows promise as prophylaxis and treatment for delirium in intensive care units (ICU) and postoperative settings. Clonidine has similar pharmacological properties and can be administered both parenterally and orally. We aim to study whether repurposing of clonidine can represent a novel treatment option for delirium, and the possible effects of dexmedetomidine and clonidine on long-term cognitive trajectories, motor activity patterns and biomarkers of neuronal injury, and whether these effects are associated with frailty status. Methods and analysis This five-centre, double-blind randomised controlled trial will include 900 cardiac surgery patients aged 70+ years. Participants will be randomised 1:1:1 to dexmedetomidine or clonidine or placebo. The study drug will be given as a continuous intravenous infusion from the start of cardiopulmonary bypass, at a rate of 0.4 mu g/kg/hour. The infusion rate will be decreased to 0.2 mu g/kg/hour postoperatively and be continued until discharge from the ICU or 24 hours postoperatively, whichever happens first. Primary end point is the 7-day cumulative incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). Secondary end points include the composite end point of coma, delirium or death, in addition to delirium severity and motor activity patterns, levels of circulating biomarkers of neuronal injury, cognitive function and frailty status 1 and 6 months after surgery. Ethics and dissemination This trial is approved by the Regional Committee for Ethics in Medical Research in Norway (South-East Norway) and by the Norwegian Medicines Agency. Dissemination plans include publication in peer-reviewed medical journals and presentation at scientific meetings.
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| 1049. |
- Nelander, Maria, et al.
(author)
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Pregnancy hypertensive disease and risk of dementia and cardiovascular disease in women aged 65 years or older : a cohort study
- 2016
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In: BMJ Open. - : BMJ. - 2044-6055. ; 6:1
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The primary aim was to study pregnancy hypertensive disease and subsequent risk of dementia. The second aim was to study if the increased risks of cardiovascular disease (CVD) and stroke after pregnancy hypertensive disease persist in an elderly population.DESIGN: Cohort study.SETTING: Sweden.POPULATION OR SAMPLE: 3232 women 65 years or older (mean 71 years) at inclusion.METHODS: Cox proportional hazards regression analyses were used to calculate risks of dementia, CVD and/or stroke for women exposed to pregnancy hypertensive disease. Exposure data were collected from an interview at inclusion during the years 1998-2002. Outcome data were collected from the National Patient Register and Cause of Death Register from the year of inclusion until the end of 2010. Age at inclusion was set as a time-dependent variable, and adjustments were made for body mass index, education and smoking.MAIN OUTCOME MEASURES: Dementia, CVD, stroke.RESULTS: During the years of follow-up, 7.6% of the women exposed to pregnancy hypertensive disease received a diagnosis of dementia, compared with 7.4% among unexposed women (HR 1.19; 95% CI 0.79 to 1.73). The corresponding rates for CVD were 22.9% for exposed women and 19.0% for unexposed women (HR 1.29; 95% CI 1.02 to 1.61), and for stroke 13.4% for exposed women and 10.7% for unexposed women (HR 1.36; 95% CI 1.00 to 1.81).CONCLUSIONS: There was no increased risk of dementia after self-reported pregnancy hypertensive disease in our cohort. We found that the previously reported increased risk of CVD and stroke after pregnancy hypertensive disease persists in an older population.
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| 1050. |
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