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Validation and cultural adaptation of the Attitude Toward Hypnosis Questionnaire (ATHQ) for a Malaysian cohort with Major Depressive Disorder
No full textThe primary goal was to culturally adapt the ATHQ to fit Malaysia’s unique cultural and linguistic landscape. The validation process involved a sample of 200 participants with clinical diagnosis of Major Depressive Disorder (MDD). This study employed exploratory factor analysis to evaluate the validity of the Attitude Toward Hypnosis Questionnaire-Malay (ATHQ-Malay). Results confirmed that the ATHQ-Malay maintains its original three-factor structure, i.e. Positive Beliefs, Mental Stability, and Fearlessness, establishing it as a reliable and valid tool for assessing attitudes toward hypnosis among this clinical cohort. While the findings affirm the questionnaire’s effectiveness in the studied clinical population, their applicability to broader or non-clinical groups remains limited. This underscores the significance of cultural adaptations in psychological assessments and the necessity for extended research to verify its utility across various demographic groups.</p
Genetic Links Between Common Lung Diseases and Lung Cancer Progression: Bioinformatics and Machine Learning Insights
Get PDFLung cancer (LC) is one of the most frequently diagnosed cancers and remains the leading cause of cancer-related mortality worldwide, representing a significant global health challenge. While numerous common lung diseases (CLDs) are implicated in LC development, the underlying causes of LC originating from CLDs remain inadequately elucidated. A thorough exploration of LC’s progression from CLDs is essential; our approach integrated bioinformatics and machine learning, utilizing data from GEO and TCGA databases. We began by identifying differentially expressed genes (DEGs) in LC and CLDs, and our gene-disease network revealed for the first time shared DEGs (LC shares significant genes with TB (36), asthma (10), pneumonia (17), COPD (18), and Idiopathic Pulmonary Fibrosis (IPF) (78)), providing insights into potential connections of LC with CLDs. This analysis not only broadened our understanding of their associations but also identified significant pathways and hub proteins (SPTBN1, KCNA4, SCN7A, KCNQ3, GRIA1, and SDC1) through a protein-protein interaction network (PPI). Furthermore, RNA-seq and clinical data were obtained from the cBioPortal portal for shared DEGs of LC and CLDs, assessing their impact on LC patient survival. Integrated mRNA-Seq and clinical data were analyzed via univariate and multivariate Cox Proportional Hazard models to elucidate the influence of significant genes on survival. Furthermore, we developed and deployed a predictive model leveraging the identified hub genes, which demonstrated high accuracy in predicting LC progression. The identified biomarkers and pathways hold promise for further translational research and potential therapeutic targets, advancing understanding of LC development from CLDs. Additionally, co-expression networks among common genes were explored using the Weighted Gene Co-expression Network Analysis (WGCNA). Finally, the hub genes were validated using the Human Protein Atlas (HPA) database and evaluated through various classification algorithms to ascertain their predictive power and diagnostic potential.</p
Effectiveness of clinician-directed default nudges on reducing overuse of tests and treatments in healthcare: a systematic review of randomised controlled trials
No full textObjective:To evaluate the effectiveness of clinician-directed default nudges for reducing overuse of tests and treatments.Design:A systematic review was conducted to synthesise evidence from randomised controlled trials examining the effect of clinician-directed default nudges on overuse of tests or treatments, measured as a proportion of encounters or patients. Four databases and three clinical trial registries were searched up to 13 January 2025. Two reviewers screened, extracted data, assessed risk of bias and certainty of evidence using Cochrane guidance. Because there was high clinical heterogeneity, we used the Synthesis Without Meta-analysis guidelines for our overall analysis. A secondary exploratory meta-analysis was performed on a subgroup of default nudge interventions targeting opioid prescriptions.Results:We included six trials (five cluster randomised trials and one patient randomised trial, n=767 to 21 331). Trials targeted overuse of opioids, antibiotics, high-risk medicines for older patients and imaging during palliative radiotherapy. Lowering default quantities of opioids may cause reductions in opioid overuse, but on one occasion increased overuse. It is unclear if opt-out defaults reduce antibiotic overuse in patients with sepsis eligible for de-escalation or if lowering default doses reduce overuse of high-risk medications in older patients. Reducing the default frequency of imaging probably causes large reductions in unnecessary imaging in people receiving palliative radiotherapy. A subgroup meta-analysis was only possible on one type of default for opioids. A 10-tablet default may reduce overuse of large packs of opioids (risk difference=−14.3%, 95% CI −51.4% to +22.9%, 3 trials, 18 186 encounters, very low certainty evidence).Conclusions:Clinician-directed default nudges had inconsistent effects on overuse of healthcare, with limited and mostly low certainty evidence. High-quality trials are essential to determine whether default nudges reduce overuse or improve patient outcomes
Primary Health Care Costs Associated With Trajectories of Physical Activity Over 10 Years
No full textBackground: The aim of this study was to investigate whether health care costs were influenced by trajectories of physical activity (PA) over a 10-year period. Methods: Five hundred and forty-one users of primary health care services in Brazil were followed from 2010 to 2020. PA (questionnaire) was assessed every 2 years. The score of PA was used in latent class trajectory models, and 4 trajectories were chosen: (1) low (participants who started and finished the follow-up with the lowest PA values), (2) moderate (participants who started with moderate PA levels and had a slight decrease), (3) decreasing (participants who showed a marked decrease), and (4) high (participants who started and finished with the highest PA levels). Health care costs were retrieved from medical records. Quantile regression was performed to compare costs according to trajectories of PA. Results: Median values of PA scores decreased over time in all groups, but this was more evident in the Decreasing group (54% decline). Costs in each year became more highly skewed over time, with very high maximum costs (approximately US$ 200) noted in the Low and Decreasing groups. Moderate and High groups had lower costs than the Low group in both the median and 90th percentile analyses. Using the median data, compared with costs in the Low group, costs were reduced by 26% and 43% in the Moderate and High groups, respectively. In the 90th percentile, these reductions were 48% and 55%, respectively. Conclusion: The achieving and maintaining of moderate or high PA levels over 10 years was associated with significant cost savings
Frankenstein, thematic analysis and generative artificial intelligence: Quality appraisal methods and considerations for qualitative research
Get PDFObjective:To determine accuracy and efficiency of using generative artificial intelligence (GenAI) to undertake thematic analysis.Introduction:With the increasing use of GenAI in data analysis, testing the reliability and suitability of using GenAI to conduct qualitative data analysis is needed. We propose a method for researchers to assess reliability of GenAI outputs using deidentified qualitative datasets.Methods:We searched three databases (United Kingdom Data Service, Figshare, and Google Scholar) and five journals (PlosOne, Social Science and Medicine, Qualitative Inquiry, Qualitative Research, Sociology Health Review) to identify studies on health-related topics, published prior to whereby: humans undertook thematic analysis and published both their analysis in a peer-reviewed journal and the associated dataset. We prompted a closed system GenAI (Microsoft Copilot) to undertake thematic analysis of these datasets and analysed the GenAI outputs in comparison with human outputs. Measures include time (GenAI only), accuracy, overlap with human analysis, and reliability of selected data and quotes.Results:Five studies were identified that met our inclusion criteria. The themes identified by human researchers and Copilot showed minimal overlap, with human researchers often using discursive thematic analyses (40%) and Copilot focusing on thematic analysis (100%). Copilot’s outputs often included fabricated quotes (58% SD = 45%) and none of the Copilot outputs provided participant spread by theme. Additionally, Copilot’s outputs primarily drew themes and quotes from the first 2-3 pages of textual data, rather than from the entire dataset. Human researchers provided broader representation and accurate quotes (79% quotes were correct, SD = 27%).Conclusions:Based on these results, we cannot recommend the current version of Copilot for undertaking thematic analyses. This study raises concerns about the validity of both human-generated and GenAI-generated qualitative data analysis and reporting
National Aged Care Reforms and Trends in Psychotropic Medication Use in 428 Residential Age Care Facilities, 2018-2022
No full textObjectives:To assess changes in the prevalence of psychotropic medication administration in Australian residential aged care (RAC) during a period of national reforms, including the introduction of mandatory reporting of antipsychotic use.Design: A retrospective cohort study using routinely collected electronic medication administration data.Setting and Participants:Daily medication administration data for 52,201 residents of 428 RAC facilities in 7 Australian states and territories between January 2018 and December 2022.Methods:We estimated the percentage of residents administered psychotropic medications from 4 classes (antipsychotics, sedatives and anxiolytics, antiseizure medication, antidepressants) at least once in each calendar month. The relative monthly average percentage change (RAPC) in prevalence by dementia status was the primary outcome.Results: Significant reductions occurred in the administration of antipsychotic, sedative and anxiolytic, and antiseizure medication to residents with and without dementia between 2018 and 2022. Residents with dementia experienced an RAPC of -45.6% (95% CI: 48.3, -36.9; P < .001) for antipsychotics, -40.9% (95% CI: 50.4, -31.4; P < .001) for sedatives and anxiolytics, and -41.0% (95% CI: 49.0, -33.0; P < .001) for antiseizure medication. Residents without dementia experienced an RAPC of -43.8% (95% CI: 50.9, -36.7) for antipsychotics, -36.1% (95% CI: 43.4, -28.9) for sedatives and anxiolytics, and -25.0% (95% CI: 34.4, -18.5) for antiseizure medication. Antidepressant use overall, and for both dementia and nondementia groups, did not significantly change. However, from May 2019, antidepressant administration for residents with dementia rose higher than that for residents without dementia.Conclusions and Implications: Between 2018 and 2022, use of 3 psychotropic medication classes declined in Australian RAC. However, antidepressant use may be increasing in people with dementia as a form of chemical restraint. Ongoing monitoring of the national Quality Indicator program and other initiatives is crucial to ensure there are no unintended consequences such as switching between psychotropic medication classes
Electrification, Clean Cooking Technologies and Gender Inequality: Policy Insight from Sub-Saharan Africa
No full textOne of the key recommendations from the International Energy Agency Global Commission on People-Centred Clean Energy Transitions meeting is to integrate gender, equality, and social considerations into energy transition policies. The majority of the population in Sub-Saharan Africa (SSA) currently lacks access to clean, modern and reliable energy, prompting numerous policies aimed at improving universal energy access in the region. SSA's energy access deficit disproportionately impacts women, many of whom spend substantial productive hours on unpaid tasks like searching for and collecting firewood. This study investigates whether universal access to clean, modern, and reliable energy fosters gender equality in SSA. In particular, the analysis focuses on electrification and clean cooking technologies' impact on gender inequality, using data from 41 SSA countries spanning 2000 to 2022. The findings based on the Panel Corrected Standard Error model reveal that electrification and clean cooking technologies contribute significantly to decreasing gender inequality in SSA. These results remain consistent across income groups and are robust when addressing endogeneity with Lewbel's two-stage least squares estimator and accounting for distributional heterogeneity via the method of moment quantile regression. The policy implication of our findings is that energy policies that support universal energy accessibility could effectively promote gender equality in SSA
Exploring mental health approaches and curriculum in physiotherapy: an Australasian perspective
Get PDFBackground:Exposure to mental health problems are becoming increasingly more frequent within physiotherapy. Physiotherapists recognize the need for a biopsychosocial approach, how-ever their knowledge, assessment, and treatment skills specific to mental health problems requires further research.Purpose:To profile the level of education and perception of education that physiotherapists have acquired specific to mental health problems; and to profile an understanding of the current practice of physiotherapists specific to mental health problems.Methods:An online survey addressed the aims of the study and collected data from physiothera-pists in Australia and New Zealand (open between 20th of October 2022 to the 20th of March 2023).Results: 139 respondents were included in the analysis. Physiotherapists had a perception that a significantly greater amount of coursework related to mental health needed to be included within their initial degree compared to what they received (mean difference of 20.0%, 95% CI: 17.5 to 22.5). This trend was evident irrespective of the degree level or the year of graduation. Higher perceived knowledge of anxiety (MD of 11.4, p = 0.001, ES: 0.5) and depression (MD of 11.8, p = 0.001, ES: 0.5) was evident in outpatient care physiotherapists. Lack of perceived knowledge is a reason for whether an assessment or treatment strategy is used with patients experiencing a mental health problem. Motivational interviewing and mindfulness were the most frequently used psychologically based techniques.Conclusion:This study reveals the need to increase the amount of mental health and psycholo-gically based techniques within Physiotherapy curriculum
Targeted exonic sequencing identifies novel variants in a cerebral small vessel disease cohort
Get PDFBackground and aims: Cerebral small vessel diseases (CSVDs) are a set of conditions that affect the small blood vessels in the brain and can cause severe neurological pathologies such as stroke and vascular dementia. The most common monogenic CSVD is cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) which is caused by mutations in NOTCH3. However, only 15–20% of CADASIL cases referred for genetic testing have pathogenic mutations in NOTCH3. We hypothesise that other monogenic causes of CSVD may be causing a CADASIL-like CSVD phenotype. Methods:To test this, we performed whole exome sequencing for 50 individuals suspected of having CADASIL, but did not exhibit a disease-causing mutation in NOTCH3, and applied targeted analysis of all monogenic forms of CSVD. Results: This analysis identified three mutations affecting the Collagen type IV genes in three individuals likely to be causative of CSVD. Conclusions: This suggests that screening for all monogenic forms of CSVD when one monogenic form is clinically suspected may improve diagnosis in clinically suspected monogenic CSVD. However, despite these findings, the majority of NOTCH3 negative CSVD cases did not have candidate mutations in known CSVD genes, suggesting that additional genetic factors contributing to the disease are yet to be identified.</p
The Prevalence and Determinants of Undernutrition Among Infants and Children Aged 6 Months to 5 Years in Sub-Saharan African Countries: A Systematic Scoping Review
Get PDFObjective: To explore the prevalence and determinants of undernutrition among infants and children aged six months to five years in Sub-Saharan African countries. Background: Despite substantial progress over the last 20 years, undernutrition has remained an alarming global challenge. Sub-Saharan Africa is the only region where the prevalence of stunting in children under five has significantly increased. This study seeks to update the evidence on the prevalence and determinants of childhood undernutrition in this vulnerable region. Methods: This systematic scoping review was conducted following the 2018 PRISMA extension for scoping reviews. Five electronic databases were searched on December 14, 2022, with no date or language restrictions. Primary studies presenting evidence on the prevalence and determinants of infants and children aged six months to five years were included. Data on the prevalence (stunting, wasting and underweight) and determinants of undernutrition were extracted, described, and compared to national survey data. Results: Fifty-nine publications from 11 countries were included, with most studies conducted in Ethiopia (n=38) and Tanzania (n=7). Stunting prevalence ranged from 8% to 64%, wasting prevalence ranged from 1% to 58%, and the prevalence of underweight ranged from 2% to 63%. The most frequently reported determinants of undernutrition were the child’s age (>24 months), male sex, maternal illiteracy, diarrhoea or illness in the past two weeks, low household socioeconomic status or living in a larger household (>4 members). Overall, 56% of the included studies reported higher stunting prevalence, 60% reported higher wasting prevalence, and 57% reported a higher prevalence of underweight than reported by relevant national surveys. Conclusion: The prevalence of childhood undernutrition reported by primary studies is often higher than reported by national surveys. Several immediate and underlying determinants influence childhood undernutrition. Future research should incorporate the findings from primary research to develop holistic, multi-strategy approaches to address childhood undernutrition in Sub-Saharan African countries. Keywords Under-fives; Stunting; Sub-Saharan Africa; Underweight; Wastin