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Validation in China of the Quality Maternal and Newborn Care Framework index
No full textProblem: Despite progress in maternal and newborn health, China still lacks a validated and multidimensional tool to monitor care quality and guide improvements.Background: The Quality Maternal and Newborn Care Framework index (QMNCFi) is a novel but comprehensive and globally developed tool for assessing maternity care quality from the service user’s perspective, offering huge potential for assessing care quality in China.Aim: This study aimed to validate the Chinese version of the QMNCFi and report initial findings from economically diverse settings.Methods: An online survey was conducted in five hospitals in five provinces in China among women between 6 weeks to 1 year postpartum. Construct validity was assessed using confirmatory factor analysis. Reliability was evaluated through internal consistency and test–retest reliability. Inferential statistics were used to analyze score differences across sub-groups.Findings: 547 mothers completed the survey. Confirmatory factor analysis indicated that the construct of the Chinese version aligned with the original version. The Cronbach’s α for the survey’s 13 sections ranged from 0.629 to 0.975, and the Intraclass Correlation Coefficient of test-retest ranged from 0.620 to 0.926. There is a modest correlation between regional economic level and QMNCFi scores at all time periods (p < 0.05). Pregnancy sub-index scores were slightly higher among women in rural areas compared to urban areas (p < 0.05).Conclusion: The Chinese version of the QMNCFi is feasible to obtain service user perceptions of the quality of care at scale in China
Validation of an algorithm for selection of SGLT2 and DPP4 inhibitor therapies in people with type 2 diabetes across major UK ethnicity groups:a retrospective cohort study
Get PDFBackground Routine clinical features of individual patients can potentially be used to guide selection of type 2 diabetes treatments. We aimed to evaluate a recently proposed treatment selection model predicting differences in glycaemic responses to SGLT2-inhibitors and DPP4-inhibitors across major UK ethnicity groups. Methods We externally validated the SGLT2i-DPP4i model in UK primary care cohort (CPRD Aurum, 2013-2020) independent of the original model development cohort. Non-insulin treated individuals with type 2 diabetes were identified and categorised by major UK self-reported ethnicity groups: White, Black, South Asian and Mixed/Other. For each ethnicity group, we applied a closed testing procedure to assess whether model recalibration was required. After model updates, we assessed the calibration accuracy of predicted differences in glycaemic response (6-month change in HbA1c) between SGLT2i and DPP4i for each ethnicity group. FindingsSGLT2i (n=57,749) and DPP4i (n=87,807) initiations were identified amongst people of White (n=114,287; 78.5%), Black (n=6,663; 4.6%), South Asian (n=20,969; 14.4%) and Mixed/Other (n=3,637; 2.5%) ethnicities. Minor model adjustment was required to adjust for greater observed than predicted glycaemic responses to DPP4i (White -1.6 mmol/mol; Black -3.0 mmol/mol; South Asian -2.6 mmol/mol; Mixed/Other -2.6 mmol/mol). SGLT2i predictions did not require adjustment for non-White ethnicity groups. After model updates, average predicted HbA1c reduction was 3.7 mmol/mol (95%CI 3.5-3.9) greater with SGLT2i than DPP4i for those of White ethnicity; this was greater than for those of South Asian (2.1 mmol/mol (95%CI 1.6-2.6)), Black (0.6 mmol/mol (95%CI 0.5-1.7)) and Mixed/Other (2.6 mmol/mol (95%CI 1.4-3.8)) ethnicity groups. For all ethnicity groups, predicted differential glycaemic treatment effects were well-calibrated. Interpretation Our model for selection of SGLT2-inhibitor and DPP4-inhibitor therapies was accurate for all major self-reported ethnicity groups in a UK primary care cohort. Simple recalibration is beneficial to optimise performance and this is recommended prior to deployment of the model in new populations and settings
Feasibility of integrating depression care into tuberculosis services in India
Get PDFBackground Depression is three times more common in Tuberculosis (TB) patients than in the general population and worsens TB outcomes, often goes undetected or untreated. Integrating depression care into existing TB services is essential. Objectives To develop and assess the feasibility of a tailored care pathway that integrates depression screening and management into existing TB services in India. Methods The study was conducted in three TB care facilities in Bengaluru, Karnataka, India, in two phases: (i)Co-design of tailored depression in the TB care pathway through a series of workshops. (ii)Testing the feasibility of the pathway A training manual was developed and used to train TB health workers. The feasibility of the care pathway was assessed by evaluating the proportion of persons with TB attending each facility during the study period who were screened for depression, as well as through a series of feedback workshops to assess acceptability. Results A total of 114/164 (69.51 %) TB patients underwent screening over a six month period, with seven reporting scores of over 2 on the PHQ-2. The feedback workshops identified the acceptability and appropriateness of the tools, as well as areas for improvement in knowledge and understanding. Addressing complex health issues such as suicidality, alcohol and tobacco use and the burden on existing staff due to a higher volume of cases reported as challenges. Conclusions This care pathway warrants further testing to establish its feasibility in a larger context and to understand how to optimise its wider implementation, scale-up and sustainability.</p
GLP-1RA precision medicine in people with type 2 diabetes:current insights and future prospects
Get PDFGlucagon-like peptide-1 receptor agonists (GLP-1RAs) have become an essential drug class for treating type 2 diabetes, offering proven benefits in glycemic control, weight reduction, and cardiovascular and renal protection. However, growing evidence of heterogeneity in GLP-1RA treatment effects highlights the potential for developing precision medicine approaches to more accurately allocate GLP-1RAs to maximize patient benefit. In this Review, we explore the evidence for treatment effect heterogeneity with GLP-1RAs, focusing on clinical and genetic factors that robustly influence established therapeutic outcomes. We also highlight the potential of recent predictive models that integrate routine clinical data with personalize treatment decisions, comparing GLP-1RA to other major type 2 diabetes drug classes. While such models have shown considerable promise in identifying optimal type 2 diabetes treatment based on glycemic response, their utility for informing treatment choice for other clinical outcomes remains largely unexplored
Mapping multisystemic protective resources supporting resilience among street youth:A systematic scoping review of qualitative studies
Get PDFStreet youth face and overcome multiple challenges. While these challenges are well-documented, also in systematic reviews, the resources facilitating street youth resilience to these challenges have not been synthesized. To close this gap, we conducted a systematic scoping review of studies reporting street youth experiences of resources that enabled them to effectively cope with street-related challenges. Scoping the literature involved a systematic search of 10 databases for qualitative or mixed methods studies that investigated the resilience of street youth aged 10 to 35. Twenty-five articles (from 3464 original records) were included, and we used a narrative approach (basic content analysis) to identify the systemic resources that street youth experienced as resilience-supporting. Guided by a multisystemic resilience approach, we found that personal resources (primarily agency and psychological ruggedness) and informal social resources (mostly other street peers) dominated accounts of street youth resilience. In contrast, very few studies reported cultural, institutional or physical environment resources, or combinations of resources, that went beyond psychosocial ones. In the absence of enabling institutional and physical environment supports, the narrow focus on psychosocial resources is unlikely to advance interventions and policy decisions that can optimize street youth resilience
Wave-current-floating body interactions:Experiments and modelling
Get PDFThe interaction of combined waves and current with floating bodies is studiedby conducting laboratory experiments and by developing theoretical models.The laboratory experiments are conducted in a wave-current tank usingtwo floating cylinders with circular and square waterplane areas. Bothfreely floating and moored conditions are considered. Two theoretical modelsare developed to study wave-body and wave-current-body interactions: onebased on the computational fluid dynamics and the other following the linearwave-current diffraction theory using the Green function method. Resultsfrom these models are compared with laboratory measurements for a range ofwave and wave-current conditions. The study analyses the effect of ambientcurrent on the wave-induced motions of floating bodies and evaluates howwell the models capture the wave-current-body interactions. Additionally,the effect of the square cylinder’s sharp edges on wave-current-body interactionsis analysed in comparison to the circular cylinder, along with themodels’ capability to capture these effects. It is observed that the presenceof the current not only causes significant drift of the freely floating cylinders,but also affects their surge and pitch oscillations, while having no notable effecton heave motion. For the conditions considered, the linear theory basedon the Green function method provides overall good predictions of the floatingbodies’ responses at a significantly lower computational cost comparedto the computational fluid dynamics model
Progression to decompensation of severe fibrosis compared to cirrhosis in MASLD:A Systematic Review and Meta-analysis
Get PDFBackground & Aims Metabolic associated steatotic liver disease (MASLD) is increasing in prevalence worldwide. Clinical practice is focused on identifying those with cirrhosis and monitoring for complications such as varices and hepatocellular carcinoma (HCC). Non-invasive tests of fibrosis differentiate between F3 and F4 fibrosis poorly. People with F3 fibrosis, may progress and develop decompensated liver disease. The aim of this review is to examine the progression to decompensated liver disease in patients with F3 fibrosis compared to those with F4 fibrosis. Methods Searches were carried out in four databases; articles were screened by two independent reviewers against pre-specified inclusion and exclusion criteria. Results29 studies were included in the review: 12 with paired liver biopsies, 2 progression to cirrhosis, 13 progression to decompensation, 2 portal hypertension in F3 fibrosis and 13 on HCC in F3 fibrosis. Rates of progression on paired biopsies were 16-30% over varied follow-up. Varices were found in 16% of patients with F3 fibrosis and rates of non-cirrhotic HCC varied from 37-75%. Pooled univariate HR for F3 progression and F4 progression to major adverse liver outcomes (MALO) were 8.15 (95%CI 3.42-19.43) and 38.16 (95%CI 11.58-125.76) respectively. Conclusions Progression to cirrhosis and decompensation events occurs in a significant proportion of patients with F3 fibrosis in MASLD. There is evidence of portal hypertension and HCC developing in F3 MASLD. Further work to identify risk groups, including those at risk of rapid progression to guide future clinical management are urgently required given the prognostic inflection of decompensated disease
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