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Fracture table vs. lateral positioning for intramedullary fixation of femur fractures (The FLiP Trial): the feasibility of a cluster randomized crossover trial
(2026-03-13) Axelrod, Daniel E.; Sprague, Sheila; Guerra-Farfan, Ernesto; Garcia-Sanchez, Yaiza; Meulenkamp, Brad; Dodd-Moher, Melanie; Bzovsky, Sofia; Shibu, Christy; Del Fabbro, Gina; Gallant, Jodi L.; Mammen, Thomas; Johal, Herman
Abstract Background Femoral shaft fractures are common severe injuries that carry an elevated risk of operative complications, including femoral malrotation, neurologic, and vascular injuries. There is no definitive research comparing two commonly used surgical tables and patient positions in aiding with both reduction and fixation of femoral shaft fractures. The objective of this pilot trial was to test the feasibility of a cluster randomized crossover trial that assesses the comparative effectiveness of supine positioning on a fracture table versus lateral positioning on a radiolucent table for antegrade intramedullary fixation of femoral shaft fractures. Methods Three orthopaedic trauma centres participated in this pilot trial. Each clinical site was randomized to a starting position, crossed over to the other treatment after 2 months, and alternated treatments in this fashion for the length of the trial. During the enrolment phase, we assessed compliance, enrolment rates, participant follow-up, and accurate documentation of the primary clinical outcome. The feasibility success criteria were: (1) 90% enrolment of eligible participants during enrolment phases; (2) 90% compliance with the trial interventions as per the cluster randomization crossover scheme; (3) timely collection of primary outcome data (i.e., within 6 weeks of fracture) in 95% of participants, (4) 90% completion of participant follow-up data; and (5) definition of the primary outcome as a categorical variable with an appropriate threshold value. Feasibility outcomes were summarized using descriptive statistics reported as means (standard deviation) or medians (first quartile, third quartile) for continuous variables depending on their distribution and counts (percentage) for categorical variables. Results All five of the criteria for feasibility were met. Of the 110 eligible patients identified at the three clinical sites, 101 (91.8%) were enroled over a 2.5-year period and 95/101 (94.1%) received the correct cluster-assigned treatment. The primary outcome (malrotation measured on the CT) was accurately documented within 6 weeks of fracture for 98% of participants (99/101) with 93 participants completing the final follow-up (92.0%). Lastly, the trial data informed an appropriate threshold, a malrotation cut off of 15°, for the primary outcome in the definitive trial. Conclusions These results confirm the feasibility of a definitive trial comparing patient positioning during intramedullary fixation of femoral shaft fractures using a cluster randomized crossover trial design. However, due to funding limitations, a slower than anticipated enrolment, and concerns with surgical equipoise, this trial did not proceed to the definitive phase. Trial registration ClincialTrials.gov NCT03868280.
TaIlored ManagEment of Sleep (TIMES) for people with dementia and mild cognitive impairment in primary care in England: protocol for a feasibility cluster-randomised controlled trial
(2026-03-07) van Horik, Jayden; Allan, Louise; Aryankhesal, Aidin; Broomfield, Niall; Greenstreet, Peter; Hilton, Andrea; Killett, Anne; Khondoker, Mizanur; Livingston, Gill; Loke, Yoon; Maidment, Ian; Medina-Lara, Antonieta; Palmer-Welsh, Adam; Reeve, Joanne; Scott, Sion; Shepstone, Lee; Warren, Fiona C.; Wong, Geoff; Fox, Chris
Abstract Background People living with dementia (PLWD) and mild cognitive impairment (MCI), and their family carers, often experience sleep disturbance which can impair daily living and care. There are limited options for effective long-term pharmacological management of sleep disturbance, yet recent advances in non-pharmacological approaches offer promising alternatives. TIMES is a novel, complex intervention, which aims to improve wellbeing for PLWD/MCI and their carers in primary care, by developing whole-person, tailored care plans that optimise management of sleep disturbance in context. Methods Two-arm cluster-randomised (1:1), single-blinded, feasibility trial in 10 general practice sites in England, recruiting 64 patient–carer dyad participants (32 intervention + 32 treatment as usual). Co-primary objectives are to assess the feasibility and acceptability of conducting a subsequent definitive cluster-randomised controlled trial (cRCT) of the TIMES intervention. Secondary objectives include assessing the ability to collect data to address putative primary and secondary outcomes of a definitive cRCT. We will collect participant demographics at screening, and the following outcome measures at baseline, 9 and 15 week follow-ups: Sleep Disorders Inventory (SDI); Epworth Sleepiness Scale (ESS); Activities of Daily Living assessed with the Disability Assessment for Dementia (ADL DAD); Dementia Quality of Life Measure (DEMQOL); EQ-5D 5 level (EQ-5D-5L); ICEpop Capability measure for older people aged ≥ 65 (ICECAP-O); Neuropsychiatric Inventory Questionnaire (NPI-Q); Client Service Receipt Inventory (CSRI); Telephone Montreal Cognitive Assessment (T-MoCA); patient medical records review; patient serious adverse events (SAEs). We will conduct Process Evaluation interviews and Discrete Choice Experiments to inform refinement of the intervention content and delivery. Discussion Our findings will inform the refinement and delivery of a subsequent definitive cRCT that tests the clinical and cost-effectiveness of the TIMES intervention compared with usual care. Trial registration This study received approval from the Health Research Authority (HRA) and London–Harrow Research Ethics Committee (Reference: 24/LO/0123), and is sponsored by the University of Exeter (Reference: 2021–22-38). Trial registration: ISRCTN, ISRCTN54051676, registered 20 March 2024, https://www.isrctn.com/ISRCTN54051676 .
Risk of adverse maternal outcomes among pregnancies with gestational diabetes mellitus in Ontario, Canada, 2012–2020: a retrospective cohort study
(2026-03-07) Luo, Rong; Fell, Deshayne B.; Corsi, Daniel J.; Taljaard, Monica; Wen, Shi W.; Walker, Mark C.
Abstract Background The rate of gestational diabetes mellitus (GDM) has increased over the past decades, but it’s unclear whether associations with maternal outcomes have changed. We aimed to describe rates of adverse maternal outcomes following deliveries with and without GDM over time and assess risks in these outcomes for GDM by delivery period. Methods This population-based retrospective cohort study was conducted using provincial birth registry linked with health administrative databases in Ontario, Canada. All singleton hospital deliveries between April 1, 2012 and March 31, 2020 were included. We assessed the trends of adverse maternal outcomes among GDM and non-GDM pregnancies and used modified Poisson regression to estimate associations between GDM and adverse maternal outcomes, using crude and adjusted relative risk (aRR) and risk difference (aRD) with 95% confidence intervals (CIs). Outcome measures included labour induction, caesarean section (CS), assisted vaginal delivery, gestational hypertension/preeclampsia, and maternal morbidity or mortality. Results Among 1 044 258 deliveries, 82 896 (7.9%) had GDM. The age-adjusted rate of GDM increased from 6.2 (95% CI 6.1–6.4) to 10.2 (95% CI 10.0-10.4) per 100 deliveries from fiscal year 2012/13 to 2019/20. Overall, GDM were at a higher risk (aRR [95% CI]) of induction (1.61 [1.59, 1.62]), CS (1.08 [1.06, 1.09]) and gestational hypertension/preeclampsia (1.35 [1.32, 1.38]). The risk of gestational hypertension/preeclampsia for GDM, compared to no GDM, attenuated from an aRR of 1.45 (1.41, 1.49) in 2012/13-2015/16 to an aRR of 1.29 (1.25, 1.32) in 2016/17-2019/20. The strength of the association between GDM and induction (1.62 [1.60, 1.64] vs. 1.60 [1.59, 1.62]), CS (1.10 [1.08, 1,12] vs. 1.07 [1.05, 1.08]), assisted vaginal delivery (0.96 [0.92, 1.00] vs. 0.94 [0.90, 0.98]), and maternal morbidity and mortality (0.93 [0.78, 1.08] vs. 1.09 [0.97, 1.20]) remained stable over time. Conclusions In this large population-based study of singleton hospital deliveries in Ontario, Canada, GDM was associated with higher risks of certain maternal adverse outcomes; however, these risks did not increase despite the increasing rate of GDM over the 8-year period, except for postpartum hemorrhage with interventions. Future large prospective studies should prioritize investigation into the risks of maternal outcomes across different glycemic diagnostic thresholds to inform cost-effective health care resource allocation for GDM pregnancies.
A scoping review of statistical methods for the analysis of method comparison studies with repeated measurements of clinical data
(2026-03-11) Brousseau, Karine; Ivankovic, Victoria; Lenet, Tori; McIsaac, Daniel I.; Ramsay, Tim; Fergusson, Dean A.; Martel, Guillaume
Abstract Background Method comparison studies are conducted to examine the level of agreement between two instruments measuring physiological continuous parameters. The inclusion of repeated measurements in such studies poses additional challenges. The Bland & Altman limits of agreement (LOA) approach has been adapted to account for the correlation between repeated measurements and is widely used in method comparison studies. Alternate statistical methods are not always appropriate for the analysis of such data, and there is a paucity of evidence and guidelines pertaining to statistical methods that inform the analysis of method comparison studies that include repeated measurements. This scoping review aimed to identify methodological publications that propose statistical methods to inform the analysis of method comparison studies that include repeated measurements of continuous clinical data and that may be compared with the LOA method. Methods Six online databases were searched from inception to November 2022 using a peer-reviewed search strategy. Searching of grey literature and books, as well as backward citation searching were performed to identify additional sources of evidence. Screening and data abstraction were done by two independent reviewers. Results were synthesized narratively. Results Twenty-nine publications were included in this review. Thirty-two independent statistical methods were identified from the included publications, including variants of the LOA method. Four included publications compared findings from different versions of the LOA method. Four different approaches to handling repeated measurements in the context of method comparison studies were identified and were used to group findings from the included publications. Reported strengths and limitations of the LOA method were summarized. Conclusion This scoping review provides a synthesis of existing statistical approaches to inform the analysis of method comparison studies with repeated measurements of clinical data, as well as how the various statistical methods perform when compared with various version of the LOA method. Based on the findings, it is generally advisable to consider using adjusted LOAs or modified mixed-effect LOAs in analyzing method comparison studies with repeated measurements. Trial registration The protocol was registered on Open Science Framework ( https://osf.io/4p8ut ).
Making room for patients in economic evaluation: a commentary on current capacity and future directions
(2026-04-13) Thompson, Emily R.; Wilson, Mackenzie; Nicholls, Stuart G.; Fergusson, Dean A.; Lalu, Manoj; Smith, Maureen; Hawrysh, Terry; Bede, Sharon; Halas, Michael; Riches, Linda; Walsh, Deirdre; Presseau, Justin; Thavorn, Kednapa
Abstract Patient engagement, in which patients and their caregivers work together with research teams, can enhance the relevance, quality, and applicability of health research findings. While patient engagement has been successfully integrated into many areas of health research, its application within health economic evaluations remains limited. This commentary explores interest and strategies for patient engagement in economic evaluation, based on our work with 5 patient partners and 12 research centres affiliated with the Ontario Strategy for Patient-Oriented Research SUPPORT Unit (OSSU). We also piloted a co-production approach to develop practical tools and strategies for meaningful engagement. Both patient partners and OSSU centre representatives emphasized the need for clear guidance, targeted training, and sustained investment to enable scalable and equitable engagement in this complex area of research. Key barriers identified included a lack of plain-language resources, limited institutional capacity for facilitating patient partnerships, and the absence of centralized supports across OSSU research centres. Through a series of virtual meetings between patient partners, we co-created a visual flow diagram and a patient activity matrix to support engagement across key stages of economic evaluation. The engagement process was grounded in shared learning, respect for lived experience, and responsiveness to evolving priorities. Our work supports the growing literature on patient engagement in health economics and offers early evidence that co-developed tools can support inclusive, patient-informed economic evaluations. Our findings lay the groundwork for future efforts to create targeted and practical guidance on when and how to embed patient perspectives throughout the economic evaluation process, thereby contributing to more transparent, collaborative, and equitable health policy decision-making.
The influence of human population movement on mass drug administration for neglected tropical diseases: a scoping review
(2026-04-07) Sangare, Moussa; Coulibaly, Oumar; Duguay, Claudia; Diabate, Abdoul F.; Nazaire, Dukharmel; Hailu, Kiflom; Coulibaly, Yaya I.; Vlassoff, Carol; Kulkarni, Manisha A.; Krentel, Alison
Abstract Background Neglected tropical diseases (NTDs), including but not limited to lymphatic filariasis, onchocerciasis, trachoma, schistosomiasis, and soil-transmitted helminths, remain a major public health challenge in Africa. Mass drug administration (MDA) is a key strategy for NTD control and elimination. However, mobile populations such as internally displaced persons (IDPs), nomadic groups, and seasonal workers often face major constraints that reduce MDA effectiveness defined by coverage. Understanding how mobility and its underlying drivers affect MDA implementation is therefore critical to designing inclusive, effective, and equitable intervention strategies. In this review, we aim to map existing evidence on how human population movement influences the outcomes of MDA programs in Africa. Methods Following PRISMA-ScR guidelines, we searched using electronic databases Medline (Ovid), Embase, Web of Science, and manually screened additional sources for studies published in English or French between January 2000 and February 19, 2025. Two authors independently extracted data, resolving discrepancies through discussion, or with a third reviewer. We included studies reporting on MDA interventions and mobile or migrant populations in Africa. Data were extracted using a standardized template and synthesized thematically to describe mobility patterns, barriers to access, implementation gaps, and strategies used to improve MDA reach among mobile groups. The thematic synthesis consisted of organizing the extracted data into recurring themes, comparing trends across studies, and grouping similar observations to develop broader themes that reflect common challenges and approaches related to mobile populations. Results From 6814 studies identified, twenty (20) met the inclusion criteria. The review identified multiple challenges likely to affect MDA equity and effectiveness. Mobility, particularly among nomad pastoralists, seasonal workers, IDPs, and cross-border populations leads to systematic exclusion from MDA campaigns. Barriers included geographic inaccessibility, limited tailored communication, lack of cross-border collaboration/coordination, and rigid campaign schedules. Promising strategies documented were mobility-informed microplanning, cross-border collaboration/coordination, flexible delivery models, enhanced community engagement and integration with other health interventions. The evidence emphasizes the need for adaptive, equity-focused MDA approaches to effectively reach mobile populations. Conclusions Population mobility has a significant impact on equitable MDA delivery and can hinder progress toward NTD elimination targets in Africa. Tailored, flexible, and inclusive strategies are urgently needed to ensure mobile populations are reached. Future efforts should focus on developing mobility indicators, pilot-testing adaptive MDA delivery models aligned with movement patterns and strengthening partnerships with neighboring countries and humanitarian organizations.
Efficacy and Safety of Glecaprevir/Pibrentasvir in Participants with Chronic HCV Infection and Comorbidities or Multiple Concomitant Medications: An Integrated Analysis
(2026-04-08) Cooper, Curtis; Raina, Shweta A.; Johnson, Lisa; Feld, Jordan J.; Brown, Ashley; Martinez, Anthony; Conway, Brian; Gordon, Stuart C.; Asselah, Tarik; Uribe, Liz; Li, Moming; Iacob, Alexandru; Marcinak, John; Semizarov, Dimitri; Pol, Stanislas
Abstract Introduction Glecaprevir/pibrentasvir (G/P) is globally approved for the treatment of chronic hepatitis C virus (HCV) infection and for acute HCV infection in the USA. The efficacy and safety of G/P has been clinically demonstrated in participants with chronic HCV. We used clinical trial data to assess the efficacy, safety, and tolerability of G/P in participants with comorbidities or on multiple concomitant medications with potential for drug–drug interaction with G/P. Methods An integrated pooled analysis across 21 randomized, controlled phase 2 and 3 trials of participants who received G/P for 8, 12, or 16 weeks was performed. Participants were stratified by comorbidity or population of interest and by number of concomitant medications received. Results This analysis included 6547 participants with chronic HCV infection. Overall, 2068 (31.6%) had cardiovascular disorders, 2031 (31.0%) reported illicit drug use, 1373/4617 (29.7%) reported injection drug use, 1810 (27.6%) had psychiatric disorders, 1169 (17.9%) had compensated cirrhosis, and 291 (4.4%) had human immunodeficiency virus (HIV)–HCV coinfection. Additionally, 4524 (69.1%) were receiving ≥ 1 concomitant medication. According to the Liverpool HEP Drug Interactions checker, 1357 (20.7%) were receiving a concomitant medication with mechanistic potential or weak potential drug–drug interaction with G/P. Overall, 94.3% (6174/6547) achieved sustained virologic response at 12 weeks post-treatment (SVR12: 98.7% [6174/6257] when excluding non-virologic treatment failure), with consistent rates between subgroups. In total, 3140 (48.0%) of participants experienced an adverse event (AE) and 1638 (25.0%) experienced a treatment-related AE. Serious AEs and treatment-related serious AEs were observed in 165 (2.5%) and 6 (0.1%) participants, respectively. In subgroup analyses, the highest rate of treatment-related serious AEs was observed in participants with HIV–HCV coinfection (0.7%). Mean compliance was 99.6%, which was consistent across subgroups and by number of concomitant medications received. Conclusions These pooled data support the efficacy, safety, and tolerability of G/P in participants with chronic HCV infection and comorbidities or who are on multiple concomitant medications.
Barriers and facilitators to implementing strategies for reducing inappropriate antipsychotic use in long-term care: a scoping review
(2026-03-04) Wong, Karen L. Y.; Hung, Lillian; Wong, Joey O. Y.; Zhao, Yong; Adekoya, Adebusola; Chan, Ian; Wong, Jason; Berndt, Annette; Mann, Jim; Yuen, Katrina; Fong, Arwen; Van, Mary; Santaella, Paulina; Zhang, Enhui; Javanbakht, Sanaz; Vasarhelyi, Krisztina
Abstract Background Inappropriate use of antipsychotics negatively affects the quality of life of residents in long-term care (LTC). Despite efforts to reduce inappropriate antipsychotic use, understanding of how to implement antipsychotic reduction strategies remains limited. Objective This scoping review explores: (1) the types of effective non-pharmacological strategies used to reduce antipsychotic use in LTC, (2) barriers to their implementation, and (3) facilitators supporting their implementation. Methodology Following the guidelines of the Joanna Briggs Institute, we synthesize existing evidence. A three-step search strategy was conducted across databases for publications from January 2014 to September 2024. Data extraction was thematically analyzed and subsequently compared with the Consolidated Framework for Implementation Research (CFIR) for further insights. The review team comprised diverse stakeholders, including patient and family partners, and healthcare providers. Findings The review identified three main types of strategies with positive outcomes: person-centred care and environmental adaptation, medication review and monitoring, and regulatory measures, with education and training cutting across these strategies. Key implementation barriers included staff and family resistance, poor team coordination and communication, and challenges with staffing and training, which could be addressed by related facilitators: cultural shifts, a cohesive team approach, and improvements to staffing and training. Beyond those addressing specific barriers, additional facilitators included increased accountability and the use of multifaceted approaches. Conclusion and Implications Findings underscore the need for comprehensive, integrated approaches that combine clinical, organizational, and educational strategies to overcome implementation challenges. Future initiatives should prioritize team-based coordination and engagement from staff, families, and leadership.
Parental willingness and influencing factors for school-based mental health screening in Eastern China
(2026-03-03) Dong, Xiaolian; Pang, Xinyue; Chen, Yingfeng; Li, Jiangnan; Xie, Yuyang; Zhao, Qi; Zhu, Zhenguo; Fu, Chaowei; Chen, Yue; Wang, Na
Abstract Background Adolescent mental health issues are increasingly prominent, making early screening essential for intervention. Schools, as the primary environment for adolescents, serve as ideal settings for screening programs. Parents, as key decision-makers, directly influence participation through their willingness. This study aimed to assess parents’ acceptance of school-based mental health screening among Chinese middle school students, identified relevant factors and concerns, with the goal of providing valuable insights for future programs. Methods A cross-sectional survey was conducted in Deqing County, Zhejiang Province, involving parents from three junior high schools. A total of 2,872 valid questionnaires were collected. A self-administered questionnaire assessed sociodemographic characteristics, mental health awareness, screening-related concerns, and willingness. Logistic regression analysis identified associated factors. Results 89.4% of parents expressed willingness for children to participate in screening. Parents of girls (OR = 0.68, 95% CI: 0.53–0.87) and older parents (age group 45 + vs. < 40 years: OR = 0.71, 95% CI: 0.51–0.99) were less willing, whereas those with high school education (high school/vocational school vs. junior high school or below: OR = 1.54, 95% CI: 1.11–2.13) and higher household income (5000–9999 vs. < 5000 RMB/month: OR = 1.77, 95% CI: 1.29–2.43; 10000 + vs. < 5000 RMB/month: OR = 1.71, 95% CI: 1.20–2.44) showed greater willingness. Parents whose children had a history of mental illness (OR = 0.46, 95% CI: 0.22–0.97) or no prior screening (OR = 0.25, 95% CI: 0.18–0.34) were less willing. Cognitive factors were significant: perceiving mental health issues as unimportant (OR = 0.13, 95% CI: 0.07–0.23), not severe (OR = 0.49, 95% CI: 0.35–0.71) or lacking knowledge (OR = 0.37, 95% CI: 0.24–0.57) was associated with lower willingness, whereas awareness of school-based services was associated with higher willingness (1–2 types: OR = 2.75, 95% CI: 1.86–4.05; ≥3 types: OR = 6.88, 95% CI: 3.29–14.41). Key concerns included children’s comprehension of questions, tool validity, and result reliability. Worries that screening content could negatively influence children were associated with lower willingness (OR = 0.66, 95% CI: 0.45–0.96). Conclusions Parents of Chinese junior high school students generally support screening. Willingness is associated with child’s gender, parental age, economic status, mental health awareness and concerns. Enhancing parents’ mental health knowledge and improving tool credibility may be associated with greater parental willingness of children’s mental health screening.
The challenges and opportunities for equitable global access to medications for paediatric rheumatology in low-to middle-income countries: a review on behalf of the Paediatric Global Task Force for Musculoskeletal Health
(2026-02-27) Scott, Christiaan; Slamang, Waheba; Dushnicky, Molly; Hause, Emily; Faleye, Ayodele; Furia, Francis; Cuevas, Octavio A.; Hadef, Djohra; Munro, Jane; Nzabonimpa, Clarisse; Foster, Helen; Migowa, Angela
Abstract Advances in medications to treat paediatric rheumatic conditions including juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) have transformed outcomes in well-resourced settings. Access to therapeutic agents that are an accepted standard of care in many regions of the world remains unequal. Here we review access to medications through a global paediatric rheumatology lens, examining challenges from drug development to delivery. The high cost of novel medications, combined with complex research and regulatory environments, market forces, the rarity of conditions and policy gaps, drive disparities in low- and middle-income countries (LMICs) where outcomes in children with JIA and SLE are closely linked to socioeconomic status and geography. Data concerning the prevalence of rheumatic conditions in LMICs are sparse, contributing to the under-recognition of disease burden. Clinical trials are disproportionately conducted in high-income countries, limiting global representation and knowledge of safety and efficacy across diverse populations. Additionally, medicines may technically be available, but with barriers that undermine true access. Global and regional organizations, including the Paediatric Task Force for Global Musculoskeletal Health, have advanced education, advocacy, and alignment of medicines with the WHO Essential Medicines List for children (EMLc). However, implementation at the country level remains inconsistent, and essential medicines for treating rheumatic diseases are often absent from national formularies. Addressing these inequities requires coordinated strategies: expanding and harmonizing EMLs, accelerating biosimilar approval and uptake, building a workforce and research capacity in LMICs, and embedding paediatric rheumatology within broader noncommunicable disease and universal health coverage frameworks. We summarize some strategic directions and aspirations within these 5 described arenas, that may help to address the global inequity of drug access.
Levels of immunoglobulin isotypes in serum and respiratory samples of patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis
(2026-02-25) Unninayar, Dana; Segun-Ige, Oluwafemi; Porto, Luana L. T. N.; Shea, Beverley; Cameron, Donald W.; Cowan, Juthaporn
Abstract COPD is a disease of progressive and irreversible airflow obstruction, with exacerbations (AECOPD) often triggered by infection. Immunoglobulins play an important role in immune defense and immune regulation, however their role in COPD is poorly understood. Therefore, the purpose of our systematic review and meta-analysis was to assess serum, sputum, and bronchoalveolar lavage (BAL) levels of IgG, IgG subclasses, IgA, and IgM in COPD, and the association between immunoglobulins and key clinical outcomes. EMBASE and Ovid MEDLINE were searched from inception to April 2024. Study screening and extraction were completed by two independent reviewers. Non-randomized studies assessing immunoglobulin levels were included. Data was analyzed using RevMan 5. Our search identified 1897 studies; 36 were included in meta-analysis. Compared with healthy controls, individuals with COPD showed elevated secretory IgA levels (Standard Mean Difference (SMD) 1.68 [95% Confidence Interval (CI), 0.78, 2.59], N = 2). IgG2 was significantly lower in COPD compared to controls [SMD − 0.91 (-1.24, -0.58)]. There was no significant SMD in other IgG subclasses, serum IgG, IgM, or BAL IgA. Serum IgG and subclass levels did not differ between stable and AECOPD (SMD 0.10 [-0.61, 0.81]). Compared to COPD with normal IgG, the COPD-low IgG group had increased risk of COPD admissions (OR 1.32 [95% CI, 1.11, 1.56]), lower FEV1/FVC % (SMD − 2.26[-3.3, -1.14] and FVC (SMD − 0.31[-0.58, -0.05]). Systemic steroid use trended higher in COPD-low IgG (OR 2.32[0.94, 5.72]). There was no difference in 1-year mortality. In conclusion, serum IgG2 was lower in COPD and low IgG was associated with increased COPD-related admissions. These findings support further investigation of IgG as a potential biomarker and therapeutic target in COPD.
Effects of non-pharmacological interventions on sleep quality in older adults: a systematic review and network meta-analysis of randomized controlled trials
(2026-02-25) Song, Jia; Dong, Heng; Wang, Chunying; Zheng, Yanxi; Huang, Yangzhen; Wei, Yilin; Zhang, Kangkang; Qing, Hua; Xiong, Zhongbao; Pan, Yangyang; Chen, Manwei; Kang, Ruizhe; Ghose, Bishwajit; Tang, Dongfeng; Wang, Ruoxi; Long, Chengxu; Li, Yunfei; Tang, Shangfeng
Abstract Background Sleep problems are common among older adults and are associated with a wide range of adverse health outcomes. Concerns about pharmacological treatments have increased interest in non-pharmacological interventions; however, evidence comparing their relative effectiveness remains limited. Methods A systematic search was conducted in PubMed, Scopus, Embase, Web of Science, Cochrane Library, and CINAHL. Randomized controlled trials (RCTs) evaluating non-pharmacological interventions in adults aged ≥ 60 years published between 2000 and 2024 were included. Network meta-analyses were conducted using random-effects models to estimate standardized mean differences (SMDs) with 95% confidence intervals (CIs). P-scores were used to rank the efficacy of interventions. The protocol was registered in PROSPERO (CRD42024521492). Results Thirty-four RCTs involving 3078 participants and 21 interventions were included. Eleven interventions significantly improved sleep quality. Cognitive behavioral therapy for insomnia plus positive mood strategies (CBT-I+) showed the largest effect (P-score = 0.99, SMD = − 3.32, 95% CI − 4.59 to − 2.06), followed by cognitive behavioral therapy for insomnia (CBT-I) (P-score = 0.92, SMD = − 2.18, 95% CI − 3.04 to − 1.31). Subgroup analyses indicated that music therapy (MUS) was more effective among participants with PSQI < 10 (SMD = − 1.25, 95% CI − 1.85 to − 0.65), whereas CBT-I+ showed greater effects for those with PSQI ≥ 10 (SMD = − 5.48, 95% CI − 6.80 to − 4.16). By intervention setting, traditional Chinese health-promotion exercise (TCHPE) was more effective in home-based settings (SMD = − 1.55, 95% CI − 2.60 to − 0.50), whereas CBT-I+ showed greater effects in non-home settings (SMD = − 3.31, 95% CI − 4.57 to − 2.06). Conclusions CBT-I+ was associated with the greatest improvements in sleep quality among older adults, particularly those with baseline PSQI ≥ 10 and in non-home settings. MUS showed greater benefits among older adults with baseline PSQI < 10, and TCHPE showed greater benefits in home-based settings. These findings support stratified, context-specific intervention selection. Given the low GRADE certainty, these results should be interpreted with caution.
Barriers and enablers to using evidence-based antibiotic prescription guidelines in primary care: a qualitative systematic review and synthesis using the theoretical domains framework
(2026-02-16) Bursey, Krystal; Patey, Andrea M.; Etchegary, Holly; Aubrey-Bassler, Kris; Kavanagh, Victoria; Pike, Andrea; Romme, Kristen; Grimshaw, Jeremy M.; Hall, Amanda
Abstract Background Antibiotics are commonly overprescribed for upper respiratory tract infections (URTIs) in primary care against widely known guideline recommendations. To design an effective intervention to improve adherence to URTI guideline-based care, it is important to understand why the behaviour persists. This review aimed to conduct a qualitative systematic review of the barriers and enablers to URTI guideline-based prescribing for FPs in primary care using a Theoretical Domains Framework (TDF)-based analysis. Methods The following databases were searched with no date or language restrictions from inception to December 2024: MEDLINE, Web of Science, CINAHL, Embase, The Cochrane Library, and APA PsycInfo. Qualitative studies that explored FP’s experiences with following antibiotic prescription guidelines for URTIs were included. Data on the barriers and enablers for URTI guideline adherence were extracted and analyzed using the TDF approach and categorized into the 14 TDF domains. Barriers and enablers were assessed for confidence using the Grading of Recommendations Assessment, Development and Evaluation—Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. Results A total of 2837 articles were screened, and 23 studies were included. The included studies had moderate to high methodological rigour and included a total of 516 FPs. A total of 61 barriers across 13 TDF domains were identified but only 17 barriers across 8 TDF domains were determined to have high confidence. These barriers with high confidence largely centered on (1) lack of support for guideline-based prescribing and physician fatigue, (2) perception of patient demand for antibiotics and the doctor-patient relationship, and (3) poor physician understanding of antibiotic resistance and antibiotics and their role in patient care. A total of 40 enablers across 13 TDF domains were identified but only 10 enablers across 8 TDF domains were judged to have high confidence. The enablers with high confidence were related to (1) knowledge of the impact of antibiotic use on antibiotic resistance and prioritizing evidence-based care, and (2) antibiotic reduction strategies for both physician and patient. Conclusion This review found 17 barriers to adhering to URTI antibiotic prescribing guidelines for FPs in primary care across 8 TDF domains. This is important because many interventions do not target all the TDF domains we identified as barriers. Future intervention design should consider adopting strategies to target these domains to ensure its efficacy in improving guidelines adherence.
Estimation of short-course systemic corticosteroid risks on adverse outcomes in childhood asthma
(2026-02-24) Earl, Brian R.; Sucha, Ewa; Webster, Richard; Ahmet, Alexandra; Radhakrishnan, Dhenuka
Abstract Background and objectives Short-course systemic corticosteroids (SCS) are recommended for moderate-to-severe pediatric asthma exacerbations, though frequent courses may cause adverse outcomes. We examined the risk of adverse outcomes in asthmatic children who received multiple SCS courses for exacerbation management. Methods We conducted a retrospective study of children aged 1–16 years with an asthma emergency department presentation/hospitalization between October 1, 2017, and February 28, 2021. Using a Prentice-Williams-Peterson total time model, we compared steroid-associated adverse outcomes among children who received or did not receive short courses of SCS for asthma exacerbations over ≥ 24-months. Results Among 2009 eligible children, 1468 received ≥ 1 SCS course for asthma exacerbations and 541 did not receive SCS. Overall, there was no increase in the risk of recurrent SCS-associated adverse outcomes in those exposed to SCS (aHR = 0.95, 95% CI 0.74–1.23, p = 0.7), however, the number of SCS courses received significantly affected the risk of recurrent adverse outcomes (p = 0.029). Children receiving 2 SCS courses had a reduced risk of adverse outcomes (aHR = 0.49, 95% CI: 0.28–0.88), while those receiving ≥ 4 SCS courses experienced a non-significant, yet clinically meaningful elevated risk of adverse outcomes (aHR = 2.30, 95% CI 0.92–5.80). Conclusion This study shows that SCS administered for pediatric asthma exacerbations are generally safe; however, complication risk may be increased when receiving 4 + SCS courses and synergistic with higher-dose inhaled corticosteroids.
WHO launches global network of institutes to strengthen capacity for health inequality monitoring
(2026-03-30)
Abstract This article introduces the global WHO-managed Health Inequality Monitoring Network, which is dedicated to strengthening and expanding health inequality monitoring practices at global, regional and country levels. Launched in 2025, the Health Inequality Monitoring Network consists of 12 inaugural institutional members, represented by over 140 affiliated individuals spanning all world regions. The Network aims to: strengthen capacities for health inequality monitoring; generate and disseminate evidence on health inequalities; and develop health inequality monitoring tools, resources and best practices. This article details the rationale for establishing the Network, as well as its current activities, anticipated impacts and future development.
Publisher Correction: Age‑specific transmission dynamics under suppression control measures during SARS‑CoV‑2 Omicron BA.2 epidemic
(2026-03-24) Zhu, Wenlong; Wen, Zexuan; Chen, Yue; Gong, Xiaohuan; Zheng, Bo; Liang, Xueyao; Xu, Ao; Yao, Ye; Wang, Weibing
Mapping policies, regulations, and practice supports for medical office assistants in primary care: a scoping review
(2026-02-20) Shuldiner, Jennifer; Ragunathan, Apira; Mohammed, Jawairia; Katz, Alan; Andiappan, Meena; Barber, David; Condon, Amanda; Garber, Gary; Kiran, Tara; Hysong, Sylvia; Schoon, Jill; Martin, Danielle; Wong, Sabrina T.; Ivers, Noah
Abstract Importance Medical Office Assistants (MOAs) are non-clinicians who carry out critical tasks in primary care settings. Despite their central roles as the first point of contact for patients or at the front desk, there are no reviews of policies, supports or interventions that could help support MOAs within complex primary care clinics. Objective We systematically scoped the literature to identify interventions, regulations, policies, practice supports, or resources targeting MOAs in primary care. Evidence review Searches were conducted in Pubmed, EMBASE, Web of Science, and grey literature sources (Google, Google Scholar, and Duckduckgo), for items set in high-income countries and reported in English or French, from January 2000 to December 2024. We additionally searched for references for all articles through Scopus. Articles, reports, papers, or other online materials or articles were included if they reported anything about supporting MOAs in primary care clinics. Data analysis involved descriptive numerical summaries and content analysis. Findings Sixty articles were included, covering team building or reconfiguration of the team (18/60; 30%), education/counselling/health coaching (15/60; 25%), navigator or care management of patients (10/60; 17%), training or credentials for MOAs (8/60; 13%), screening activities (6/60; 10%), and advanced rooming (3/60; 5%). Articles were primarily set in the United States (47/60; 78%). Workforce well-being was the most common positive outcome (26/60; 43%). Equity outcomes were rarely reported (5/60; 8%). Commonly identified barriers to implementing interventions included time and resource constraints, staffing challenges, inadequate training, and lack of provider buy-in. Involving MOAs in planning, offering role flexibility, and fostering leadership support were important for success. Furthermore, strong leadership, collaborative relationships, and fair compensation were key components of an environment conducive to change. Conclusion and relevance This review reveals gaps in supporting MOAs as members of the primary care team. Most of the literature focuses on clinic-level changes, with limited evidence on MOA training and/or career growth. Given their strong impact on primary care access and experience for patients, more focus on MOAs in health system reform is warranted.
Reliability and criterion validity of a wearable IMU for ankle joint position sense: agreement with isokinetic dynamometry and discrimination of chronic ankle instability
(2026-01-19) Wang, Shitao; Wu, Chou; Niu, Yuxuan; Zhao, Xiong; Chen, Wensi; Wang, Qiuyue; He, Guangyan; Li, Haolin; Lu, Jianing; Mei, Nan
Abstract Background Chronic ankle instability (CAI) impairs joint position sense (JPS) and increase the risk of reinjury. Inertial measurement units (IMUs) are cost-effective and portable, but their reliability and validity for ankle JPS assessment remain uncertain. This study aimed to evaluate the reliability and concurrent validity of IMU-based ankle JPS assessment against an isokinetic dynamometer and to compare JPS errors between individuals with CAI and healthy controls. Methods In a prospective, assessor-blinded, cross-sectional study, adults with CAI (Cumberland Ankle Instability Tool ≤ 24) and matched controls performed active joint position reproduction tasks in plantarflexion, dorsiflexion, inversion, and eversion with vision occluded. Two IMU sensors recorded joint angles concurrently with a Contrex isokinetic dynamometer (reference standard). Absolute error (AE, °) was the primary outcome. Reliability was quantified using intraclass correlation coefficients (ICC) of intra-session reliability, standard error of measurement, and minimal detectable change; concurrent validity was examined with Bland–Altman analyses. Between-group differences and diagnostic utility were evaluated using group comparisons and receiver operating characteristic (ROC) analyses. Results Both the isokinetic dynamometer and the IMU demonstrated good-to-excellent intra-session reliability (dynamometer ICC 0.91–0.96; IMU 0.83–0.90), with larger SEM and MDC₉₅ values for the IMU. Bland–Altman analyses showed small negative biases (approximately − 0.4° to − 2.6°) and 95% limits of agreement generally within about ± 5° for plantarflexion, dorsiflexion, and inversion, with somewhat wider limits in eversion. Compared with controls, participants with chronic ankle instability exhibited significantly greater absolute JPS errors in plantarflexion, dorsiflexion, and inversion on both devices, and in eversion when assessed by the IMU. ROC analyses showed excellent discrimination for plantarflexion (AUC 0.93 for the dynamometer, 0.91 for the IMU), good discrimination for dorsiflexion and inversion, and limited, non-significant discrimination for eversion. Conclusion IMU-based ankle JPS testing demonstrates good reliability and clinically acceptable agreement with isokinetic dynamometry while detecting proprioceptive deficits in CAI, particularly in plantarflexion, dorsiflexion, and inversion. It appears to be a practical tool for clinical and sports settings, although eversion measurements were more variable and future studies should confirm these findings in larger samples and dynamic, multi-planar tasks.
The politics of breastfeeding: a feminist analysis of breastfeeding policies and promotion in Nigeria
(2026-03-11) Oko, Vera
Abstract Background Since the 1990s, global health policies have prescribed breastfeeding as an ideal and primarily positive practice essential to child survival and maternal health. In Nigeria, infant feeding policies have largely drawn on these global frameworks in promoting exclusive breastfeeding as a strategy against infant mortality. A feminist analysis of breastfeeding policies and promotion in Nigeria Grounded in feminist ethics of care and the Ubuntu philosophy, this critique examines the contradictions between breastfeeding policies and maternal realities in Nigeria. The analysis identified the following: (1) a universalist approach in global and Nigerian breastfeeding policies that assumes breastfeeding is ideal and positively experienced by most mothers. (2) policies place breastfeeding at the top of the invisible hierarchy of infant feeding and pathologize quotidian maternal experiences by framing exclusive breastfeeding as ideal, and positive in most cases thereby marginalizing the challenges and costs many mothers face. (3) unaddressed gaps between policy directives and structural conditions in Nigeria such as underdeveloped social amenities, insufficient maternity leave laws and cultural realities, reinforce gender inequalities, erode maternal autonomy and influence breastfeeding practices. Conclusion The gaps between breastfeeding policies and maternal realities in Nigeria highlight the need for policies discourse that are grounded in considering the challenges mothers face in breastfeeding. The review suggests ways to move beyond frameworks that treat infant care as solely a mother’s responsibility by emphasizing the essential role of support in infant care. Clinical trial number Not applicable N/A.
Profile of anatomy teachers of students in healthcare professions: a scoping review
(2026-02-12) Fevry, Joanne; Fotsing, Salomon; Merghem, Meriem; Roberge, Anne; Ramdani, Rayan; Filion, Isabelle; Domecq, Marie-Cécile; Jalali, Alireza
Abstract Background/objective Health education programs present a wide variety of anatomy educators’ profiles in human anatomy. Anatomy is an essential component of healthcare professional training. However, few studies have examined the professional profile of anatomy teachers and its links to the content taught, the teaching strategies employed, and the assessment methods used. This study aimed to explore the academic backgrounds of these teachers, the health professions in which they teach, the content delivered, and the teaching strategies employed. Methods This work followed the steps outlined by Arksey and O’Malley, as well as the PRISMA-ScR guidelines. Data were sourced from major academic databases, such as Embase, MEDLINE, CINAHL, etc. Five reviewers used Covidence to analyze the articles. Data on teachers and their strategies were extracted and then narratively synthesized. Results Of the 6,779 studies analyzed, 42 were selected. Teachers held a variety of degrees, including PhDs in anatomy and medicine. Most were full-time faculty members, including professors, lecturers and assistant professors with over twenty years of experience. Teaching strategies combined traditional and modern approaches, and assessments included written, practical, and continuous examinations. Discussion/conclusion This study demonstrated that anatomy teachers do not share a single profile. Teaching strategies need to be adapted to regional and institutional contexts. It is therefore necessary to support these teachers to better meet the contemporary demands of anatomy education.

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