Josephsenlyon5223

s will provide written informed consent. Results will be disseminated via publications.

NCT03569072; Pre-results.

NCT03569072; Pre-results.

We aimed to understand the prevalence of reduced kidney function in China by sociodemographics and geographical region, and to examine health correlates of reduced kidney function.

Cross-sectional study.

Participants were 6706 adults ≥60 years from the 2015-2016 wave of the China Health and Retirement Longitudinal Study.

Reduced kidney function was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m². The estimated glomerular filtration rate was calculated with the creatinine-cystatin C equation developed by the Chronic Kidney Disease Epidemiology Collaboration in 2012. The associations between reduced kidney function and potential risk factors were analysed using multivariable regression models.

The prevalence of reduced kidney function was 10.3% (95% CI 9.3% to 11.2%), corresponding to approximately 20 million older adults. Multivariable analysis showed that older adults with hypertension (β=-3.61, 95% CI -4.42 to 2.79), cardiac disease (β=-1.90, 95% CI -2.93 to 0.86), who had a stroke (β=-3.75, 95% CI -6.35 to 1.15), kidney disease (β=-3.88, 95% CI -5.62 to 2.13), slow gait speed (β=-2.23, 95% CI -3.27 to 1.20), and living in the South (β=-4.38, 95% CI -5.95 to 2.80) and South Central (β=-1.85, 95% CI -3.15 to 0.56) were more significantly likely to have reduced kidney function.

Kidney function screening should be performed, especially in patients with hypertension, cardiac disease and who had a stroke. More efforts should be paid to improve the kidney function of older adults living in the South and South Central parts of China.

Kidney function screening should be performed, especially in patients with hypertension, cardiac disease and who had a stroke. More efforts should be paid to improve the kidney function of older adults living in the South and South Central parts of China.

Periprosthetic fractures have considerable clinical implications for patients and financial implications for healthcare systems. This study aims to determine the burden of periprosthetic fractures of the lower and upper limbs in England and identify any factors associated with differences in treatment and outcome.

A national, observational study.

England.

All individuals admitted to hospital with periprosthetic fractures between 1 April 2015 and 31 December 2018.

Mortality, length of stay, change in rate of admissions.

We analysed Hospital Episode Statistics data using the International Classification of Diseases 10th Revision code M96.6 (Fracture of bone following insertion of orthopaedic implant, joint prosthesis, or bone plate) to identify periprosthetic fractures recorded between April 2013 and December 2018. We determined the demographics, procedures performed, mortality rates and discharge destinations. Patient characteristics associated with having a procedure during the index admission wertor and improve performance.

The clinical and operational burden of periprosthetic fractures is considerable and increasing rapidly. We suggest that the management of people with periprosthetic fractures should be undertaken and funded in a similar manner to that successfully employed for people sustaining hip fractures, using national standards and data collection to monitor and improve performance.

Programmes to ensure doctors' maintenance of professional competence (MPC) have been established in many countries. Since 2011, doctors in Ireland have been legally required to participate in MPC. A significant minority has been slow to engage with MPC, mirroring the contested nature of such programmes internationally. This study aimed to describe doctors' attitudes and experiences of MPC in Ireland with a view to enhancing engagement.

All registered medical practitioners in Ireland required to undertake MPC in 2018 were surveyed using a 33-item cross-sectional mixed-methods survey designed to elicit attitudes, experiences and suggestions for improvement.

There were 5368 responses (response rate 42%). Attitudes to MPC were generally positive, but the time, effort and expense involved outweighed the benefit for half of doctors. Thirty-eight per cent agreed that MPC is a tick-box exercise. Heavy workload, travel, requirement to record continuing professional development activities and demands placed on pehould be established to continually evaluate doctors' perspectives.

Doctors need to be convinced of the benefits of MPC to them and their patients. A combination of clear communication and improved relevance to practice would help. Addition of a facilitated element, for example, appraisal, and varied ways to meet requirements, would support participation. MPC should be adequately resourced, including provision of high-quality free educational activities. Systems should be established to continually evaluate doctors' perspectives.

The oncological safety of diagnostic hysteroscopy in patients with stage Ⅰ endometrial cancer remains uncertain and conflicting. The aim of the proposed systematic review and meta-analysis is to summarise the available evidence examining the association between diagnostic hysteroscopy and the prognosis of stage Ⅰ endometrial cancer and to statistically synthesise the results of relevant studies.

Systematic searches of PubMed/MEDLINE, Embase, Cochrane Library and Web of Science will be undertaken using prespecified search strategies. Two authors will independently conduct eligible studies selection process, perform data extraction and appraise the quality of included studies. Original case-control studies, cohort studies and randomised controlled trails published in English will be considered for inclusion. The outcomes of interest will be 5-year recurrence-free survival, disease-specific survival and overall survival. Meta-analyses will be performed to calculate pooled estimates.

Our study will be based on published data, and thus there is no requirement for ethics approval. The results will be shared through publication in a peer-reviewed journal and presentations at academic conferences.

CRD42020193696.

CRD42020193696.

Loneliness is a significant and independent risk factor for depression in later life. Particularly in Asian culture, older people may find it less stigmatising to express loneliness than depression. This study aimed to adapt a simple loneliness screen for use in older Chinese, and to ascertain its relevance in detecting depressive symptoms as a community screening tool.

This cross-sectional study was conducted among 1653 older adults aged 60 years or above living in the community in Hong Kong. This was a convenient sample recruited from four local non-governmental organisations providing community eldercare or mental healthcare services. All data was collected by trained social workers through face-to-face interviews.

Loneliness was measured using an adapted Chinese version of UCLA 3-item Loneliness Scale, depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and social support with emotional and instrumental support proxies (number of people who can offer help). Basic demographics including age, gender, education and living arrangement were also recorded.

The average loneliness score was 3.9±3.0, and it had a moderate correlation with depressive symptoms (r=0.41, p<0.01). A loneliness score of 3 can distinguish those without depression from those with mild or more significant depressive symptoms, defined as a PHQ-9 score of ≥5 (sensitivity 76%, specificity 62%, area under the curve=0.73±0.01). Binimetinib cell line Loneliness explained 18% unique variance of depressive symptoms, adding to age, living arrangement and emotional support as significant predictors.

A 3-item loneliness scale can reasonably identify older Chinese who are experiencing depressive symptoms as a quick community screening tool. Its wider use may facilitate early detection of depression, especially in cultures with strong mental health stigma.

ClinicalTrials.gov NCT03593889.

ClinicalTrials.gov NCT03593889.

To evaluate the effect of four-phase national lockdown from March 25 to May 31 in response to the COVID-19 pandemic in India and unmask the state-wise variations in terms of multiple public health metrics.

Cohort study (daily time series of case counts).

Observational and population based.

Confirmed COVID-19 cases nationally and across 20 states that accounted for >99% of the current cumulative case counts in India until 31 May 2020.

Lockdown (non-medical intervention).

We illustrate the masking of state-level trends and highlight the variations across states by presenting evaluative evidence on some aspects of the COVID-19 outbreak case fatality rates, doubling times of cases, effective reproduction numbers and the scale of testing.

The estimated effective reproduction number R for India was 3.36 (95% CI 3.03 to 3.71) on 24 March, whereas the average of estimates from 25 May to 31 May stands at 1.27 (95% CI 1.26 to 1.28). Similarly, the estimated doubling time across India was at 3.56 days oe-level variations and identifying these variations can help in both understanding the dynamics of the pandemic and formulating effective public health interventions. Our framework offers a holistic assessment of the pandemic across Indian states and union territories along with a set of interactive visualisation tools that are daily updated at covind19.org.

In the absence of robust direct data on ethnic inequalities in COVID-19-related mortality in the UK, we examine the relationship between ethnic composition of an area and rate of mortality in the area.

Ecological analysis of COVID-19-related mortality rates occurring by 24 April 2020 and ethnic composition of the population. Account is taken of age, population density, area deprivation and pollution.

Local authorities in England.

For every 1% rise in proportion of the population who are ethnic minority, COVID-19-related deaths increased by 5·12, 95% CI (4·00 to 6·24), per million. This rise is present for each ethnic minority category examined, including the white minority group. The size of this increase is a little reduced in an adjusted model to 4·42, 95% CI (2·24 to 6·60), suggesting that some of the association results from ethnic minority people living in more densely populated, more polluted and more deprived areas.This estimate suggests that the average England COVID-19-related death rate would rise by 25% in a local authority with two times the average number of ethnic minority people.

We find clear evidence that rates of COVID-19-related mortality within a local authority increases as the proportion of the population who are ethnic minority increases. We suggest that this is a consequence of social and economic inequalities driven by entrenched structural and institutional racism and racial discrimination. We argue that these factors should be central to any investigation of ethnic inequalities in COVID-19 outcomes.

We find clear evidence that rates of COVID-19-related mortality within a local authority increases as the proportion of the population who are ethnic minority increases. We suggest that this is a consequence of social and economic inequalities driven by entrenched structural and institutional racism and racial discrimination. We argue that these factors should be central to any investigation of ethnic inequalities in COVID-19 outcomes.