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ns to seek help when suffering from mental disorders. Local primary prevention actions since the beginning of their training period and having access to a well-known highly reliable programme may partly explain these findings.

To establish a hospital-based platform to explore the epidemiological and clinical characteristics of patients screened for COVID-19.

Hospital-based surveillance.

This study was conducted in four selected hospitals in Bangladesh during 10 June-31 August 2020.

In total, 2345 patients of all age (68% male) attending the outpatient and inpatient departments of surveillance hospitals with any one or more of the following symptoms within last 7 days fever, cough, sore throat and respiratory distress.

The outcome measures were COVID-19 positivity and mortality rate among enrolled patients. Pearson's χ

test was used to compare the categorical variables (sign/symptoms, comorbidities, admission status and COVID-19 test results). Regression analysis was performed to determine the association between potential risk factors and death.

COVID-19 was detected among 922 (39%) enrolled patients. It was more common in outpatients with a peak positivity in second week of July (112, 54%). The median age of the confhird of patients with suspected COVID-19 attending selected hospitals. While managing such patients, the risk factors identified for higher death rates should be considered.

ACOSOG-Z0011(Z11) trial showed that axillary node clearance (ANC) may be omitted in women with ≤2 positive nodes undergoing breast conserving surgery (BCS) and whole breast radiotherapy (RT). A confirmatory study is needed to clarify the role of axillary treatment in women with ≤2 macrometastases undergoing BCS and groups that were not included in Z11 for example, mastectomy and those with microscopic extranodal invasion. The primary objective of POsitive Sentinel NOde adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy (POSNOC) is to evaluate whether for women with breast cancer and 1 or 2 macrometastases, adjuvant therapy alone is non-inferior to adjuvant therapy plus axillary treatment, in terms of 5-year axillary recurrence.

POSNOC is a pragmatic, multicentre, non-inferiority, international trial with participants randomised in a 11 ratio. Women are eligible if they have T1/T2, unifocal or multifocal invasive breast cancer, and 1 or 2 macrometastases at sentinel nodeittee East Midlands-Nottingham 2 (REC reference 13/EM/0459). Results will be submitted for publication in peer-reviewed journals.

ISRCTN54765244; NCT0240168Cite Now.

ISRCTN54765244; NCT0240168Cite Now.

To evaluate the association between the urinary 8-hydroxy-2'-deoxyguanosine (U8-OHdG) levels and the incidence of small-for-gestational age (SGA) infants and to assess the utility of U8-OHdG as a biomarker to predict the incidence of SGA infants.

Prospective cohort study.

The Japan Environment and Children's Study.

Data of participants enrolled in the Japan Environment and Children's Study, a nationwide birth cohort study, between 2011 and 2014 were analysed; 104 062 fetal records were analysed. Data of women with singleton pregnancies ≥22 weeks of gestation were analysed.

U8-OHdG levels were assessed using liquid chromatography-tandem mass spectrometry. Participants were categorised into the following three groups according to the quartile of the distribution of U8-OHdG low U8-OHdG (<1.95 ng/mgCre), moderate U8-OHdG (the combined second and third quartiles; 1.95-2.95 ng/mgCre) and high U8-OHdG (>2.95 ng/mgCre) groups. Additionally, participants in the 90th percentile for U8-OHdG levels were aHowever, this parameter would not be a useful screening tool for predicting SGA infants owing to its low sensitivity and specificity.

Patient e-services are increasingly launched globally to make healthcare more efficient and digitalised. One area that is digitalised is medical advice, where patients asynchronously chat with nurses and physicians, with patients having filled in a form with predefined questions before the chat. This study aimed to explore how occupational professionalism and the possibility of professional judgement are affected when clinical patient contact is digitalised. The study's overall question concerns whether and how the scope of the healthcare staff's professional judgement and occupational professionalism are affected by digitalisation.

A qualitative study of healthcare professionals working in a pilot project with a chat programme for patients in a medical advice setting in Sweden.

Contextual inquiries and 17 interviews with nurses (n=9) and physicians (n=8). The interviews were thematically analysed. The analysis was inductive and based on theories of decision making.

Three themes emerged (1) Predefined questions to patients not tailored for healthcare professionals' work, (2) reduced trust in written communication and (3) reduced opportunity to obtain information through chat communication.

The results indicate that asynchronous chat with patients might reduce the opportunity for nurses and physicians to obtain and use professional knowledge and discretionary decision making. Furthermore, the system's design increases uncertainty in assessments and decision making, which reduces the range of occupational professionalism.

The results indicate that asynchronous chat with patients might reduce the opportunity for nurses and physicians to obtain and use professional knowledge and discretionary decision making. Furthermore, the system's design increases uncertainty in assessments and decision making, which reduces the range of occupational professionalism.

Assess differences in movement behaviours within the 24-hour cycle, including light intensity physical activity (LPA), moderate-to-vigorous physical activity (MVPA), sedentary time and sleep, before and during the COVID-19 pandemic and assess these differences stratified by several relevant factors in a subcohort of the Cancer Prevention Study-3.

US-based longitudinal cohort study (2018-August 2020).

N=1992 participants, of which 1304 (65.5%) are women, and 1512 (75.9%) are non-Latino white, with a mean age 57.0 (9.8) years.

Age, sex, race/ethnicity, education; self-reported LPA, MVPA, sedentary time and sleep duration collected before and during the pandemic; pandemic-related changes in work, childcare and living arrangement; COVID-19 health history.

Compared to 2018, participants spent an additional 104 min/day sedentary, 61 fewer min/day in LPA and 43 fewer min/day in MVPA during the pandemic. Time spent sleeping was similar at the two time points. Differences in movement behaviours were more pronounced among men, those with a higher level of education, and those who were more active before the pandemic.

From 2018 to Summer 2020, during the COVID-19 pandemic, US adults have made significant shifts in daily time spent in LPA, MVPA and sedentary. There is an urgent need to promote more physical activity and less sedentary time during this public health crisis to avoid sustaining these patterns long-term.

From 2018 to Summer 2020, during the COVID-19 pandemic, US adults have made significant shifts in daily time spent in LPA, MVPA and sedentary. There is an urgent need to promote more physical activity and less sedentary time during this public health crisis to avoid sustaining these patterns long-term.

This study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks.

A qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants' views and experiences about adaptation process.

Nine guideline development organisations from seven countries.

Guideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees' list.

We conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing

clinical guidelines, implementing source clinical guidelop rigorous international standards for adapting clinical guidelines.

Adaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines.

We aimed to ascertain the prevalence of perceived loneliness among older adults following the onset of the COVID-19 pandemic and to examine factors contributing to the perception of loneliness.

Cross-sectional and longitudinal data from the Atherosclerosis Risk in Communities (ARIC) Study cohort.

The ARIC Study cohort, a prospective cohort that recruited (1987-1989) participants from four distinct communities in the USA.

2984 ARIC cohort members.

Perceived loneliness assessed using the University of California at Los Angeles (UCLA) UCLA three-item Loneliness Scale telephone interviews conducted May-October 2020 and prior to March 2020.

Of the total 5037 participants alive in 2020, 2984 (56.2%) responded to the UCLA three-item questionnaire (mean age 82.6 (SD 4.6) years, 586 (19.6%) black participants, 1081 (36.2%) men), of which 66 (2.2%) reported having had a COVID-19 infection during the observation period. The proportion of participants reporting feeling lonely was 56.3% (n=1680). selleck compound Among participants with repeat measures of loneliness (n=516), 35.2% (n=182) reported feeling more lonely following pandemic onset. Self-rated health and emotional resilience were strongly associated with self-perceived loneliness. The burden of COVID-19 infections, concern about the pandemic and decreased self-reported physical activity were greater among black as compared with white participants and among those with an educational attainment of less than high school as compared with high school or more.

Findings from this study document the increase in perceived loneliness among older adults during the COVID-19 pandemic in the USA.

Findings from this study document the increase in perceived loneliness among older adults during the COVID-19 pandemic in the USA.

To understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services.

Realist review.

PubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020.

Criteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible).

Inductive and deductive coding was used to generate context-mechanism-outcome configurations.

73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one's behaviour or actions).