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Behavioural change science assumes that (i) morbidity and mortality are due in part to certain behaviours and (ii) these behaviours are modifiable. The aim of this debate article is to discuss reasons why clinicians must include long term behavioural change into their management plan and methods they may use to facilitate the change ensuring recipients are empowered to act and make today the day their 'lives will surely change'.
The objective of the study was to provide echocardiographic reference intervals for English bulldogs (EBs) and to assess if age, sex, body weight (BW), and heart rate have an influence on echocardiographic variables.
We prospectively enrolled client-owned EBs that were considered healthy based on unremarkable history, normal physical examination, six-lead electrocardiography, and transthoracic echocardiography.
Breed-related reference intervals were provided, and associations between age, sex, BW, and heart rate and echocardiographic variables were tested using a multivariate analysis. Allometric scales were generated for echocardiographic variables showing correlation with BW. Moreover, echocardiographic variables obtained in our population of EBs and previous published reference ranges were compared.
Echocardiographic reference intervals were generated from 50 healthy adult EBs. As per the multivariate analysis, left atrial diameter (p=0.015), left ventricular internal end diastolic diameter (p=0.002), aortic valve annulus (p=0.032), and pulmonary valve annulus (p=0.017) resulted influenced by BW, and reference intervals were generated using allometric scales. Our study suggests that EBs tend to have a smaller aortic root and sphericity index than other breeds. In addition, EBs seem to have smaller indexed left ventricular volumes and higher left ventricular ejection fraction than boxers and Doberman.
Preliminary reference intervals in the EBs are reported, which might be helpful for accurate echocardiographic interpretation and screening purposes in this breed.
Preliminary reference intervals in the EBs are reported, which might be helpful for accurate echocardiographic interpretation and screening purposes in this breed.
to assess the effect of implementation of the extended placement option available to midwifery students during the first wave of the COVID-19 pandemic.
Online survey open from 2nd June 2020 to 15th July 2020.
United Kingdom.
Lead Midwives for Education (LMEs).
A total of 38 of 55 LMEs responded (response rate 69%). The majority of Approved Education Institutions (AEIs) offered an extended placement to students, but with some variation in the choices offered, unrelated to geographical location or size of student cohort. AEIs appeared to provide the majority of decisional support for students. Many practice learning environments became unavailable, particularly community, gynaecology/medical wards and neonatal units. LMEs experienced both internal and external pressures to instigate rapid change.
The impact of COVID-19 on midwifery education is significant and will need continual scrutiny to minimise future detriment. The pressures of providing midwifery education throughout the early phase of COVID-19 were substantial, but it is important that we learn from the immediate changes made, value and pursue the changes that have been beneficial, and learn from those that were not.
Student learning experiences have undergone significant change during the pandemic. It is essential to assess what effect the extended placement has had on student readiness for practice, their confidence, resilience, mental health, and attrition and retention. Educators transitioned to remote working, and rapidly assimilated new skills for online education; exploration of the impact of this is recommended.
Student learning experiences have undergone significant change during the pandemic. It is essential to assess what effect the extended placement has had on student readiness for practice, their confidence, resilience, mental health, and attrition and retention. Educators transitioned to remote working, and rapidly assimilated new skills for online education; exploration of the impact of this is recommended.
Little information is available about the association of obstructive sleep apnea (OSA) with atherogenic dyslipidemia and the contribution of sleep characteristics to lipid alterations. We compare dyslipidemia prevalence among non-apneic subjects and mild-severe OSA patients to identify the sleep characteristics that are independently associated with dyslipidemia and serum lipid levels in OSA patients.
We recruited 809 consecutive patients who had been referred for polysomnography study by OSA suspicion. Anthropometric characteristics, body composition and comorbidities were recorded. Spirometry and 24-h ambulatory blood pressure monitoring were performed the same day of the sleep study. The day after attended polysomnography, fasting blood samples were drawn to measure the lipid profile.
Dyslipidemia prevalence increased with the presence of OSA, from non-OSA subjects to mild, moderate and severe OSA patients (31%, 33%, 42% and 51%, respectively; p<0.001). After adjusting for sex, age, body mass index and smoking habit, only severe OSA had an independent association with dyslipidemia when compared to non-OSA subjects (adjusted odds ratio 1.71, 95%CI 1.09 to 2.69, p=0.019). In OSA patients, multivariate logistic regression identified active smoking, apnea-hypopnea index (AHI) and mean nocturnal saturation as variables independently associated with dyslipidemia. However, in these patients, arousal index, slow wave sleep duration and REM latency were also independently associated with cholesterol and low-density lipoprotein levels.
The association between dyslipidemia and OSA is limited to severe patients, with high AHI and nocturnal hypoxemia. However, sleep fragmentation and increased sympathetic activity could also contribute to OSA-related lipid dysregulation.
The association between dyslipidemia and OSA is limited to severe patients, with high AHI and nocturnal hypoxemia. However, sleep fragmentation and increased sympathetic activity could also contribute to OSA-related lipid dysregulation.
This study examines the validity and reliability of the Sleep Disturbance Scale for Children (SDSC) in the Turkish language.
This scale was translated into the Turkish language by applying the translation-back translation method and content validity analysis. A total of 1903 participants aged 5-15 years were included in the study. A sociodemographic data form, SDSC, and the Children's Sleep Habits Questionnaire (CSHQ) were filled by the parents. Internal consistency analysis, correlation analysis, test-retest analysis, and confirmatory factor analysis were applied to evaluate the reliability and validity of the applied scale.
The internal consistency of the scale was high (Cronbach α=0.84). Test-retest reliability was found to be high as well. According to the confirmatory factor analysis, the Turkish version of the scale was compatible with the model of the original scale. According to the T-score evaluation, the frequency of sleep disorders was determined to be 4.15%, and the most common sleep disorder was sleep hyperhidrosis. Correlations between the scores of the SDSC and CSHQ were at a satisfactory level.
These results revealed that the SDSC is a valid and reliable scale that can be used in children aged 5-14 years in Turkey to question sleep disorder symptoms.
These results revealed that the SDSC is a valid and reliable scale that can be used in children aged 5-14 years in Turkey to question sleep disorder symptoms.
This study examined the prevalence and factors associated with paid sick leave benefits among direct service providers who work with people experiencing homelessness.
Cross-sectional study using an online survey disseminated during the second wave of the COVID-19 pandemic in Canada.
Survey data from 572 direct service providers working in the homeless, supportive housing, and harm reduction service sectors were analyzed for this study. Univariate and multivariate logistic regression models were used to examine predictors of paid sick leave benefits.
One hundred one (17.7%) participants did not have any paid sick leave benefits. In the univariate models, paid sick leave was associated with older age, greater family income, full-time work, specific employment settings (supportive housing and not emergency shelters or harm reduction programs), having a regular medical doctor, and fewer occupational impacts of the COVID-19 pandemic. Savolitinib solubility dmso Older age, full-time work, and non-receipt of emergency financial benefits remained statistically significant predictors in the multivariate model.
Although the majority of service providers working with people experiencing homelessness have some amount of paid sick leave benefits, there is a precariously employed subset of individuals who are younger and working part-time in the sector. Temporary expansion of paid sick leave and removal of waiting periods for new employees to qualify for benefits are recommended.
Although the majority of service providers working with people experiencing homelessness have some amount of paid sick leave benefits, there is a precariously employed subset of individuals who are younger and working part-time in the sector. Temporary expansion of paid sick leave and removal of waiting periods for new employees to qualify for benefits are recommended.
The aim of this study was to trace contacts of coronavirus disease 2019 (COVID-19) hospitalised patients and determine the risk factors of infection in urban areas.
Longitudinal analysis of contacts identified from index cases.
A contact tracing study was carried out in the Northern Metropolitan area of Barcelona, Spain, during the inter-epidemic lapse of May to July 2020, a period of low SARS-CoV-2 incidence. Index cases were notified from the referral hospital. Contacts were traced and followed up for 14 days. Reverse transcription polymerase chain reaction was performed on day 0 and day 14 for contacts.
In total, 368 contacts were identified from 81 index cases (median of seven contacts per index case), from which 308 were traced successfully. The median age of contacts was 28 years, 62% (223 of 368) were men. During the follow-up period, 100 contacts tested positive for COVID-19 (32.5% [95% confidence interval CI=27.3-38.0]), with a secondary infection rate of 48.3% (95% CI=40.8-55.9) among housemates. Clusters of index and respective contacts tended to aggregate within disadvantaged neighbourhoods (P<0.001), and non-national index cases (N = 28, 34.1%) resulted in higher secondary infection rates compared with nationals (51.0% [95% CI=41.0-60.9] vs 22.3% [95% CI=16.8-28.8]; P<0.001).
Disadvantaged communities experience a disproportionate burden of COVID-19 and may act as infection reservoirs. Contact tracing with a cross-cutting approach among these communities is required, especially during inter-epidemic periods.
Disadvantaged communities experience a disproportionate burden of COVID-19 and may act as infection reservoirs. Contact tracing with a cross-cutting approach among these communities is required, especially during inter-epidemic periods.
