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Older adults' attitudes toward deprescribing in 14 countries
Get PDFImportance: Better understanding of patients’ attitudes toward deprescribing specific medications will inform future deprescribing interventions.
Objective: To investigate older adults’ attitudes toward deprescribing by investigating which medications they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing.
Design, Setting, and Participants: This survey study was conducted from May 2022 to December 2023 in primary care settings in 14 countries. Patients aged 65 years or older taking 5 or more medications were consecutively recruited by their general practitioner (GP) and completed the questionnaire.
Exposures: Patient characteristics, including gender, number of medications, GP gender, education level, financial status, confidence in completing medical forms, self-rated health, satisfaction with medications, trust in the GP, and country.
Main Outcomes and Measures: The primary outcomes were patient attitudes toward deprescribing specific medications, as measured by responses to the question, “Thinking about your current medication list, are there any medications that you would like to stop taking or reduce the dose of?” Multilevel multivariable logistic regression analysis was used, adjusted for clustering effect at the country level, to investigate the association between patient characteristics and interest in deprescribing.
Results: Of 1340 patients (mean [SD], 96 [47] patients per country), 736 (55%) were women, 580 (44%) had secondary school as their highest level of education, 1089 (82%) were satisfied with their medications, and 589 (44%) expressed they would like to deprescribe 1 or more of their medications. Patients expressed interest in deprescribing specific medications at varying levels, from 79% (86 of 109 patients) in Poland to 23% (21 of 96 patients) in Bulgaria. The 3 most reported medications patients would like to have deprescribed were diuretics (111 of 1002 medications [11%]), lipid-modifying agents (109 of 1002 medications [11%]), and agents acting on the renin-angiotensin system (83 of 1002 medications [8%]). The odds of naming at least 1 specific medication for deprescribing were lower for patients with higher medication satisfaction (odds ratio, 0.31; 95% CI, 0.21-0.47) and for patients with higher trust in their GP (odds ratio, 0.960; 95% CI, 0.930-0.998).
Conclusions and Relevance: In this survey study with primary care patients aged 65 years and older, patient attitudes toward deprescribing specific medications varied across countries, demonstrating that deprescribing interventions could be more impactful when adapted to specific settings and contexts. These findings highlight the importance of patient-practitioner communication in ensuring appropriate medication use
Physiological regulation of oral saliva ion composition and flow rate are not coupled in healthy humans : partial revision of our current knowledge required
Get PDFAppropriate composition of oral saliva is essential for a healthy milieu that protects mucosa and teeth. Only few studies, with small sample numbers, investigated physiological saliva ion composition in humans. We determined saliva ion composition in a sufficiently large cohort of healthy adults and analyzed the effect of physiological stimulation. We collected saliva from 102 adults under non-stimulated and physiologically stimulated conditions (chewing). Individual flow rates, pH, osmolality, Na+, K+, Cl−, and HCO3− concentrations under both conditions as well as the individual changes due to stimulation (Δvalues) were determined. Non-stimulated saliva was hypoosmolal and acidic. Na+, Cl−, and HCO3− concentrations remained well below physiological plasma values, whereas K+ concentrations exceeded plasma values more than twofold. Stimulation resulted in a doubling of flow rates and substantial increases in pH, HCO3−, and Na+ concentrations. Overall, stimulation did not considerably affect osmolality nor K+ or Cl− concentrations of saliva. An in-depth analysis of stimulation effects, using individual Δvalues, showed no correlation of Δflow rate with Δion concentrations, indicating independent regulation of acinar volume and ductal ion transport. Stimulation-induced Δ[Na+] correlated with Δ[HCO3−] and Δ[Cl−] but not with Δ[K+], indicating common regulation of ductal Na+, Cl−, and HCO3− transport. We present a robust data set of human oral saliva ion composition in healthy adults and functional insights into physiological stimulation. Our data show (i) that flow-dependence exists for Na+ and HCO3− but not for K+ and Cl− concentrations, (ii) osmolality is flow-independent, (iii) regulation of Na+, Cl−, and HCO3− transport is coupled, (iv) regulation of flow rate and ion concentrations are independent and (v) spatially separated between acini and ducts, respectively
Study protocol for key interventions to improve the follow-up adherence postcervical precancerous lesion treatment in Ethiopia : a pragmatic randomised controlled trial
Get PDFIntroduction: The follow-up adherence after treatment for a positive screening test is critical for preventing the development of screen‐detected abnormalities in cervical cancer. Yet, this poses a major challenge in developing countries like Ethiopia, emphasising the urgency for intervention strategies. Our trial aims to assess which strategies would be effective in improving adherence to follow-up after suspicious cervical lesion treatment in Ethiopia. Thus, the objective of this study is to evaluate key interventions to improve the follow-up adherence rate among women treated for suspicious cervical lesions in primary healthcare settings in Ethiopia.
Method and analysis: We will employ a pragmatic randomised control trial study design, using Consolidated Standards of Reporting Trials guidelines for reporting and a Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist for developing the protocol, to evaluate intervention effectiveness. These interventions are: (a) structured nurses-led telephone call reminders, (b) home-visit reminders led by health extension workers and (c) application-based automated short message service text reminders. The standard care involves only receiving oral follow-up advice and a baseline follow-up card. The planned start date is 1 November 2024, with an anticipated end date of 1 November 2025. Our study will include women aged 30–49 who are HIV-negative and those over 25 who are HIV-positive, and who have been treated for suspicious cervical lesions after a positive visual inspection with acetic acid (VIA) screening, as per Ethiopian Ministry of Health guidelines for cervical cancer screening eligibility. The required sample size is 460, with 115 participants per arm. Study participants in the intervention group will receive the stated interventions plus the standard care, while the control group will receive only the standard care. The interventions will be delivered three times annually: 4 months from baseline, then at 8 months and finally at 12 months before the appointment due date. The primary outcome of our study is the proportion of adherence to follow-up recommendations, which will be measured by rescreening (VIA) after 1 year (11–13 months after the first screening). Descriptive statistics, χ2 test (Fisher’s exact test), binary logistic regression analysis and intention-to-treat will be used to describe and interpret the results.
Ethics and dissemination: The trial protocol has been approved by the institutional review board of Addis Ababa University with protocol number (008/24/SPH). Trial results will be disseminated to study participants, national and international audiences through workshops, conferences and publications in reputable journals
The Role of High Water Temperature in the Context of Low-Flow Risk Analysis
Get PDFLow-flow events significantly impact water users and ecosystems due to reduced flow rates and deteriorating water quality. Elevated water temperatures during these periods have led to economic and ecological consequences. Therefore, water temperature is a key aspect in the context of low-flow risk analysis, and it is essential to model it accurately. This study introduces a one-dimensional water temperature model optimized for integration into low-flow risk analysis frameworks. Results demonstrate good performance in simulating water temperatures for both rivers, with Nash–Sutcliffe efficiency values of 0.85–0.98 and root mean square errors of 0.96–1.96 K. The model was evaluated on two contrasting river systems: the small Selke River and the large Elbe River. The model effectively captures anthropogenic influences and altered environmental conditions. Key factors influencing water temperature varied by river size, with tributaries and shading having more impact on smaller rivers, while air temperature was the primary driver for larger rivers. The model’s computational efficiency enables the practical implementation of long-term risk assessments. This temperature model fulfills the requirements for integration into low-flow risk management frameworks, providing a valuable tool for assessing temperature-related impacts and evaluating mitigation strategies across diverse river systems.MDPI IOA
Declining academic freedom in the Maghreb
Get PDFKeywords: academic freedom, university autonomy, higher education, autocratisationSchlagworte: akademische Freiheit, Hochschulautonomie, Hochschulbildung, Autokratisierun
Reliability and validity of a self-developed virtual reality-based test battery for assessing motor skills in sports performance
Get PDFAthletes must master various motor skills for success in their sports. To assess performance and identify areas of improvement, effective sports-motoric tests are essential. Key abilities such as reaction time, jumping, and complex movement coordination are critical. Virtual reality (VR) offers a practical, traditional equipment-free tool for assessment, though new VR-based tests must be evaluated first. We evaluated a self-developed test battery to measure reaction time (drop-bar test), jumping ability (jump and reach test), and parkour execution involving multiple complex motor tasks (with/without a virtual opponent). 32 participants completed these tests twice in real environment (RE) and VR (pre- and post-test). Intraclass correlation coefficients showed high reliability for reaction time in RE (0.858) and VR (0.888), with moderate significant correlations between them (r = .445), suggesting validity. The jump and reach test showed even better reliability (RE: 0.944, VR: 0.886) with strong correlations between RE and VR (r = .838). The parkour test showed lower reliability (x̄ 0.770), particularly for one task, with significant differences between the conditions indicating different behavior in VR. However, the addition of a virtual opponent eliminated these differences. VR appears to be a promising alternative to traditional testing methods, revealing comparable values across conditions
The intensity of the transcriptional response varies across infection with distinct viral strains in an insect host
Get PDFOrganisms respond to infectious agents through diverse immune strategies, and may need to cater a specific response to distinct pathogen challenges, such as various strains of a virus, to maximize fitness. Deformed wing virus (DWV) is one of the most damaging viruses of honey bees (Apis mellifera) across the globe, with variant DWV-B currently expanding at the expense of variant DWV-A. While previous research has characterized general host transcriptomic responses to viral exposure, host responses to different DWV strains have not been fully explored. Here, we performed experimental infections with the two dominant strains of DWV, A and B, as well as a mixed infection, and conducted transcriptomic analyses to compare differences in host molecular response to infection. We confirmed canonical anti-viral response to DWV infection, including upregulation of Toll pathway genes and the antimicrobial peptides abaecin and hymenoptaecin. Furthermore, our results suggest a potential role of aerobic glycolysis during viral infection in honey bees. DWV-A and mixed infections were associated with differential expression of a much larger number of host genes than infection with DWV-B. That DWV-B potentially elicits a reduced host immune response may provide a mechanistic explanation for its higher virulence and global emergence. Overall, this study provides the first evidence for strain-specific immune responses to DWV infection, and integrates these findings into the broader domain of insect immunity and host-pathogen dynamics
Screening attendance of breast or cervical cancers and its associated factors among 30-49 year old women in Gedeo zone, South Ethiopia : cross-sectional study
Get PDFIntroduction:
Breast and cervical cancers are the most frequent and fatal cancers among women. Thus, early detection is necessary to improve the prognosis of affected women. However, in Ethiopia, the rates of screening remain alarmingly low.
Objective:
To assess the magnitude of screening attendance for breast or cervical cancer, as well as the factors that predict it, among women aged 30–49 years old in Gedeo Zone, South Ethiopia, in 2023.
Method:
A community-based cross-sectional study was conducted using a multi-stage cluster sampling technique. Data were collected using pretested, structured questionnaires by trained interviewers. Univariate and multivariate logistic regression models were employed to identify factors associated with screening attendance.
Results:
A total of 554 women participated in the study. Of them, 132 (23.8%) were screened for breast or cervical cancer. Higher age of 40–44 versus 45–49 years (adjusted odds ratio [AOR] 4.18 [95% CI 1.59, 10.9]), higher education status ([AOR] 5.49 [95% CI 2.01, 13.1]), having family or a friend with history of breast or cervical cancer ([AOR] 5.55 [95% CI 2.47, 12.5]), short anticipated time to seek help ([AOR] 4.66 [1.31, 11.7]), adequate health literacy ([AOR] 6.98 [95% CI 2.82,13.3]) and high self-efficacy ([AOR] 2.32 [95% CI 1.08, 4.96]) were positive factors with higher screening attendance. High response cost ([AOR] 0.19 95% CI [0.08, 0.50]) was a negative factor and associated with lower screening attendance.
Conclusion and recommendation:
The study found that only one in four women attended breast or cervical cancer screening. Screening uptake was better in women with higher education, health literacy, self-efficacy, and older age–similar to factors associated with other health seeking behavior. Interestingly, history of breast or cervical cancer in a friend or relative was also associated with higher uptake. This indicates that in addition to awareness campaigns, personal testimonials of survivors could encourage women to visit screening facilities
Einfluss kardialer Risikofaktoren und Vorerkrankungen auf die Schwere und den Krankheitsverlauf von SARS-CoV-2-Infektionen bei Patienten im südlichen Sachsen-Anhalt
No full textIn Sachsen-Anhalt lassen sich im Vergleich zur Bundesrepublik kardiovaskuläre Risiko-faktoren (CVRF) in überdurchschnittlichem Ausmaß erkennen. Die monozentrische Registerstudie (COHORT) wurde vom 27. Januar 2020 bis 30. Mai 2021 am Universi-tätsklinikum Halle initiiert. Risikofaktoren von Covid-19 sollen aufgegriffen und ein mög-licher Zusammenhang zwischen CVRF und Vorerkrankungen im Hinblick auf den Ver-lauf und das Outcome von hospitalisierten Patienten mit einer SARS-CoV-2-Infektion identifiziert werden. Es zeigt sich ein erhöhtes Risiko für Patienten mit CVRF im Rah-men einer SARS-CoV-2-Infektion intensivmedizinisch behandelt und invasiv beatmet werden zu müssen, sowie ein erhöhtes Mortalitätsrisiko. Darüber hinaus gelten ein er-höhtes Patientenalter und das männliche Geschlecht als unabhängige Risikofaktoren. Patienten mit häufig auftretenden CVRF in Sachsen-Anhalt, wie Adipositas oder Vor-hofflimmern, wurden ebenfalls vermehrt intensivmedizinisch behandelt und verstarben häufiger