Notes

Higher Extremity Task-Specific Training: Guide book Development and also Rendering Investigation inside of Inpatient Rehab.
To assess the extent and type of data redaction in all active technology appraisals (TA) and highly specialised technology (HST) evaluations issued by the National Institute for Health and Care Excellence (NICE) from its conception of the institute to September 2019. To propose policy recommendations for transparency.

Structured audit to establish extent of data redaction-proportion of appraisals and specific data categories and assess redaction by indication, appraisal process, manufacturer, type of data-price, adverse events (AEs), clinical (excluding AEs), incremental quality-adjusted life-years. Longitudinal analysis over 20 years.

All TAs with available documentation and active recommendations (n=408) and HSTs (n=10) published from March 2000 to 11 September 2019 have been assessed for data redaction. Overall, 333 TAs (81.6%) have data redaction, 86 (25.8%) of them are heavily redacted. Clinical data (excluding AEs) are redacted in 268 (65.7%) appraisals, AE data in 128 (31.4%), price in 238 (58.3%l and economic data of importance to patients, clinicians and researchers. Documents remain redacted on the NICE website for years. Policy change is required to ensure transparency of data underpinning NICE's decisions.
This study aimed to evaluate the level of medical students' self-directed learning (SDL) ability in mainland China and to identify its modifiable influencing factors for medical educators to take measures to improve medical professionals' ability in SDL.

This was a cross-sectional study conducted between January and June 2019.

This study involved students from five medical colleges located in the cities of Shenyang, Binzhou, Xuzhou, Shanghai and Guangzhou of mainland China.

Participants included 365 medical students and residents sampled by the stratified clustered random method from five medical colleges.

The t-test, F-test and multiple linear regression analyses were performed to test the association between personal and contextual factors of medical students and SDL.

The mean total SDL score was 76.12 (SD=10.96), implying that Chinese mainland medical students had moderate SDL ability. A univariate analysis found that the personal characteristics of confidence, students' enjoyment of their specr study indicated that the contextual factors of learning resources, family income and age as well as the personal factors of academic performance, learning goals, confidence and utilisation of library resources were associated with medical students' SDL ability in mainland China. It may be advisable to implement appropriate teaching strategies to improve students' confidence and assist them establish learning goals, as well as to amplify school learning resources and encourage students to use them fully.
This study aims to determine the prevalence of joint pain and its association with demographic, socioeconomic and behavioural factors in Nepal.

The study was a national cross-sectional population-based study.

We used the most recent nationally representative population-based cross-sectional health survey, The WHO STEPwise approach to surveillance (STEPS) survey, 2019 from all seven provinces of Nepal including both urban and rural areas.

The participants were men and women aged 15-69 years, who were usual residents of the households for at least 6 months and have stayed the night before the survey.

Primary outcome in this study was prevalence of joint pain. The secondary outcome measure was factors associated with joint pain in Nepal. Joint pain in our study was based on any self-reported symptoms of joint pain, stiffness and swelling lasting for more than 1 month in the past 12 months. Data were weighted to generate national estimates.

The prevalence of self-reported joint pain in Nepal was 17% (he need for health policies directed to prevention, treatment and rehabilitation for people affected by chronic musculoskeletal conditions addressing related disabilities and loss of work in Nepal.
To examine whether urinary excretion of cysteine-rich protein 61 (Cyr61), an acknowledged proinflammatory factor in kidney pathologies, increases in chronic kidney disease (CKD) and is associated with subsequent rapid kidney function decline.

An observational cohort study.

In the nephrology outpatient clinics of a tertiary hospital in Taiwan.

We enrolled 138 adult CKD outpatients (n=12, 32, 18, 18, 29 and 29 in stages 1, 2, 3a, 3b, 4 and 5 CKD, respectively) between February and October 2014 and followed them for 1 year. Their mean age was 60.46±13.16 years, and 51 (37%) of them were women.

Urinary Cyr61 levels were measured by ELISA. Rapid kidney function decline was defined as an estimated glomerular filtration rate (eGFR) decline rate ≥ 4 mL/min/1.73 m
/year or developing end-stage renal disease during subsequent 3-month or 1-year follow-up period. Models were adjusted for demographic and clinical variables.

The urine Cyr61-to-creatinine ratio (UCyr61CR) increased significantly in patients witng.
Elevated urinary Cyr61 excretion is associated with rapid short-term kidney function deterioration in patients with CKD. Measuring urinary Cyr61 excretion is clinically valuable for monitoring disease trajectory and may guide treatment planning.
Cancer survival rates have improved over the past few decades, yet socioeconomic disparities persist. Social determinants of health (SDOH) have consistently been shown to correlate with health outcomes. The objective of this study was to characterise oncologists' perceptions of the impact of SDOH on their patients, and their opinions on how these effects could be remediated.

Cross-sectional survey of physicians.

Web-based survey completed prior to live meetings held between February and April 2020.

Oncologists/haematologists from across the USA.

Clinical practice in a community-based or hospital-based setting.

Physician responses regarding how SDOH affected their patients, which factors represented the most significant barriers to optimal health outcomes and how the impact of SDOH could be mitigated through assistance programmes.

Of the 165 physicians who completed the survey, 93% agreed that SDOH had a significant impact on their patients' health outcomes. Financial security/lack of insurance agists were aware of the impact of SDOH on their patients but were constrained in their time to assist patients with social needs. The physicians in our study identified a need for more accessible assistance programmes and greater involvement from all stakeholders in addressing SDOH to improve health outcomes.
To review prevalence studies of multimorbidity in South Africa to identify prevalence estimates, common disease clusters and factors associated with multimorbidity.

Systematic review.

South Africa (general community and healthcare facilities).

Articles were retrieved from electronic databases (PubMed, Web of Science, Scopus, CINAHL, Science Direct and JSTOR).

Studies addressing the prevalence of multimorbidity in South Africa were eligible for inclusion. A systematic search was done in various databases up to December 2020. A risk of bias assessment was conducted for each article using a modified checklist.

Two researchers independently screened titles and abstracts; assessed the risk of bias of each study and extracted data. Included studies were described using a narrative synthesis.

In total, 1407 titles were retrieved; of which 10 articles were included in the narrative synthesis. Saracatinib manufacturer Six studies had a low risk of bias and three had a moderate risk of bias. One study was not assessed for risk of bias, because there was no criteria that apply to routine health information systems. Three of the included studies were population-based surveys, four were community-based cohorts and three cross-sectional studies of health facility data. The prevalence of multimorbidity was low to moderate (3%-23%) in studies that included younger people or had a wide range of selected age groups; and moderate to high (30%-87%) in studies of older adults. The common disease clusters were hypertension and diabetes, hypertension and HIV, and TB and HIV.

All studies indicated that multimorbidity is a norm in South Africa, especially among older adults. Hypertension is the main driver of multimorbidity. Research on multimorbidity in South Africa needs to be strengthened with high-quality study designs.

CRD42020196895.
CRD42020196895.
To synthesise the available scientific evidence on the effects of combined exercise on glycaemic control, weight loss, insulin sensitivity, blood pressure and serum lipids among patients with type 2 diabetes (T2D) and concurrent overweight/obesity.

PubMed, EMBASE, Web of Science, the Cochrane library, WANFANG, CNKI, SinoMed, OpenGrey and ClinicalTrials.gov were searched from inception through April 2020 to identify randomised controlled trials (RCTs) that reported the effects of combined exercise in individuals with T2D and concurrent overweight/obesity.

Quality assessment was performed using the Cochrane Collaboration's risk of bias tool. The mean difference (MD) with its corresponding 95% CI was used to estimate the effect size. Meta-analysis was performed using Review Manager V.5.3.

A total of 10 RCTs with 978 participants were included in the meta-analysis. Pooled results demonstrated that combined exercise significantly reduced haemoglobin A1c (MD=-0.16%, 95% CI -0.28 to -0.05, p=0.006); body mass index (MD=-0.98 kg/m
, 95% CI -1.41 to -0.56, p<0.001); homeostasis model assessment of insulin resistance (MD=-1.19, 95% CI -1.93 to -0.46, p=0.001); serum insulin (MD=-2.18 μIU/mL, 95% CI -2.99 to -1.37, p<0.001) and diastolic blood pressure (MD=-3.24 mm Hg, 95% CI -5.32 to -1.16, p=0.002).

Combined exercise exerted significant effects in improving glycaemic control, influencing weight loss and enhancing insulin sensitivity among patients with T2D and concurrent overweight/obesity.
Combined exercise exerted significant effects in improving glycaemic control, influencing weight loss and enhancing insulin sensitivity among patients with T2D and concurrent overweight/obesity.
Rates of age-associated severe maternal morbidity (SMM) have increased in Canada, and an association with neighbourhood income is well established. Our aim was to examine SMM trends according to neighbourhood material deprivation quintile, and to assess whether neighbourhood deprivation effects are moderated by maternal age.

A population-based retrospective cohort study using linked administrative databases in Ontario, Canada. We included primiparous women with a live birth or stillbirth at ≥20 weeks' gestational age.

SMM from pregnancy onset to 42 days postpartum. We calculated SMM rate differences (RD) and rate ratios (RR) by neighbourhood material deprivation quintile for each of four 4-year cohorts from 1 April 2002 to 31 March 2018. Log-binomial multivariable regression adjusted for maternal age, demographic and pregnancy-related variables.

There were 1 048 845 primiparous births during the study period. The overall rate of SMM was 18.0 per 1000 births. SMM rates were elevated for women living ining in low deprivation areas. This raises concerns of a widening social gap in maternal health disparities and highlights an opportunity to focus risk reduction efforts toward disadvantaged women during pregnancy and postpartum.
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