Moving From Evidence To Decisions in Guidelines: An Analysis of Guidance Documents

Background The process of moving from evidence to decisions (EtD) represents a cornerstone within guideline development methods. Little is known about the processes used by organizations in charge of guideline development and what criteria they consider when formulating recommendations. Objective To identify and describe the processes suggested for the formulation of healthcare recommendations in health care guidelines available in guidance documents. Methods We searched in spring 2020 the Guidelines International Network (G-I-N) website, MEDLINE, and The Cochrane Methodology Register to retrieve guidance documents published in the last decade by organizations dedicated to guideline development. Pairs of researchers independently selected and extracted data about the characteristics of the guidance document, including explicit or implicit recommendation-related criteria and processes considered, as well as the use of frameworks. We conducted both descriptive and bivariate analyses. Results We included 68 guidance documents, published mostly by scientific societies (58%). Most of the organizations reported a system for grading the strength of recommendations (88%), half of them being the GRADE approach. Two out of three guidance documents (66%) proposed the use of a framework to guide the EtD process. We identified 14 recommendation-related criteria. The GRADE Evidence to Decision (GRADE-EtD) framework was the most often reported framework (19 organizations, 42%), whereas 20 organizations (44%) proposed their own multi-criteria frameworks. Using any EtD framework was related with a more comprehensive set of recommendation-related criteria compared to no framework, especially for criteria like values, equity, and acceptability. A similar association was observed between the GRADE-EtD framework and either no framework or another EtD frameworks. Conclusion The use of systematic and structured processes for moving from evidence to decisions is still limited among international organizations. The use of EtD frameworks facilitates the inclusion of relevant recommendation criteria. Among the structured frameworks, the GRADE-EtD framework offers the most comprehensive perspective for evidence-informed decision-making processes. More complete and detailed reporting in the guidance documents is warranted.

Social and economic inequality in coronavirus disease 2019 vaccination coverage across Illinois counties

Prior research has well established the association of ethno-racial and economic inequality with COVID-19 incidence and mortality rates across counties in the US. In this ecological study, a similar association was found between ethno-racial and economic inequality and COVID-19 full vaccination rates across the 102 counties in the American state of Illinois in the early months of vaccination. Among the counties with income inequality below the median, a county’s poverty rate had a negative association with the proportion of population fully vaccinated. However, among the counties with income inequality above the median, a higher percentage of Black or Hispanic population was persistently associated with a lower proportion of fully vaccinated population over the two-month period from early February to early April of 2021.

Analysis of associations between pharmacodynamic genetic factors and antipsychotics’ effectiveness and safety in adolescents with acute psychotic episodes taking antipsychotics during a 28-day follow-up

Introduction. Antipsychotics are the main drugs for treatment of schizophrenia spectrum disorders. Pharmacodynamic genetic factors are being actively studied to improve the accuracy of antipsychotic selection based on pharmacogenetic testing. Purpose of this study: to establish associations of genetic polymorphisms of the DRD2, DRD3, DRD4, HTR2A, COMT, ZNF804A, and ANKS1B genes with the efficacy and safety of antipsychotics in adolescents with an acute psychotic episode during a 28-day follow-up. Materials and methods. The study included 68 adolescents with an established diagnosis of acute polymorphic psychotic disorder at the time of admission (F23.0-9 according to ICD-10). All patients received an antipsychotic as their main therapy. Patients were monitored for 28 days. The effectiveness of antipsychotics was assessed using the Children’s Global Assessment Scale (CGAS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression Severity (CGI-S) and Improvement (CGI-I). The safety of pharmacotherapy was assessed using the UKU Side Effects Rating Scale (UKU SERS), Sympson-Angus Scale (SAS), Barnes Akathisia rating scale (BARS). From each patient we obtained a buccal scraped epithelium, extracted DNA from it by sorbent method and detected carriage of genetic polymorphisms DRD2 rs1800497 (C>T), DRD3 rs6280 (C>T), DRD3 rs324026 (C>T), DRD4 rs1800955 (C>T), HTR2A rs6313 (T>C), COMT rs4680 (Val158Met, G>A), ZNF804A rs1344706 (A>C), ANKS1B rs7968606 (C>T) by real-time PCR. Results. DRD2 rs1800497 T allele carriers had a stronger reduction in the PANSS subscore «Productive Symptomatics» on day 14 (Me=-7.0 [-9.0;-5.0] vs Me=-7.0 [-8.0;-2.0]; p=0.018) and day 28 of follow-up (Me=-11.0 [-9.0;-5.5] vs Me=-8.0 [-8.0;-2.0]; p=0.019). Also, greater improvement on the CGAS scale on day 14 of follow-up was seen in TC+CC HTR2A rs6313 carriers (Me=2.0 [1.0;3.0] vs. Me=2.0 [1.0;2.0]; p=0.029). DRD3 rs324026 homozygous carriers (TT) had a significantly lower SAS score (Me=0.5 [0.0; 1.0] vs. Me=1.0 [0.0; 5.0]; p=0.016) and UKU subscore «Neurological Disorders» on 28 days of antipsychotic therapy (Me=0.0 [0.0; 0.0] vs. Me=1.0 [0.0; 3.8]; p=0.005). DRD3 rs324026 TT carriers also had lower severity of akathisia according to the BARS scale. Carriers of the T DRD4 rs1800955 allele had a higher SAS scale score on day 28 of therapy compared with CC homozygotes (Me=1.0 [0.0;4.0] vs Me=0.0 [0.0;1.0]; p=0.036). Conclusion. The DRD2 rs1800497 was a predictor of better reduction of productive symptoms; HTR2A rs6313 demonstrated a similar association. The DRD2 rs1800497 polymorphic variant was a predictor of better reduction of productive symptomatology; HTR2A rs6313 demonstrated a similar association. DRD3 rs324026 and HTR2A rs6313 were associated with a lower frequency of neurological adverse reactions and akathisia. In contrast, carriers of the DRD4 rs1800955 were more prone to adverse reactions on pharmacotherapy.

Supercompensation in Elite Water Polo: Heart Rate Variability and Perceived Recovery

We examined the association of heart rate variability assessed with the logarithm of the root mean square of successive differences (LnRMSSD) and perceived recovery status of nine elite water polo players with the fluctuations of the internal training load (ITL). ITL, post-wakening LnRMSSD, and measures of perceived recovery were obtained across one regeneration week, during two mesocycles of intensified preseason training (PR1, PR2) and during two mesocycles of in-season training (IN1, IN2). ITL at PR1 and PR2 was increased by 60–70% compared to regeneration week (p<0.01) and was reduced by 30% at IN1 and IN2 compared to PR1 and PR2 (p<0.01). Weekly averaged LnRMSSD (LnRMSSDmean) was higher in IN2 compared to regeneration week and PR2 (p<0.01 and p<0.05, respectively). Perceived recovery was higher at IN1 and IN2 compared to PR2 (p=0.01 and p<0.001, respectively). ITL correlated with LnRMSSD in the preseason (r=–0.26, p=0.03). Nonetheless, similar association was not apparent during the in-season period (r=0.02, p=0.88). Cardiac autonomic perturbations may not occur when an increment of internal training load is less than 60–70%. However, the reduction of training load in season by 30% improves both LnRMSSDmean and perceived recovery status, implying that training periodization may lead players in supercompensation.

Neighbourhoods and Workplaces: Are They Related to the Fertility of Immigrants and Their Descendants? A Register-Based Study of Finland, 1999–2014

An increasing number of studies point to the existence of fertility differences between immigrants and those who are native to the receiving countries. However, despite a large body of literature covering a wide range of settings, there is a lack of research into the factors that may underlie the observed differentials. In this article, we focus on the role of population composition in residential neighbourhoods and workplaces, which are assumed to influence the convergence of the fertility patterns of immigrants with those of the host country. The study is based on individual-based register data for the residential population of Finland from 1999 to 2014. We use discrete-time event history models to analyse transitions to first, second, and third births among immigrant women and their descendants of African and Middle Eastern origin whose fertility patterns are markedly different from those of the host society. We investigate whether the proportion of co-ethnic immigrants in residential neighbourhoods and workplaces is related with the fertility adaptation among that high-fertility group. Our results suggest that among them, a higher concentration of co-ethnic immigrants in the neighbourhood is associated with an elevated propensity of having a second and third child. The association persists among child migrants and the second generation. However, a similar association is not observed between fertility and the workplace context.

Comparison of Various Methods to Determine Added Sugars Intake to Assess the Association of Added Sugars Intake and Micronutrient Adequacy

Different methods for determining the effect of added sugars intake among children and adults on meeting recommended nutrient intakes were compared using 24 h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014. Four methods were used to determine deciles of added sugars intake (as the percentage of total calories): 1 day intake, 2 day average intake, and individual usual intake (UI) determined with the National Cancer Institute (NCI) and the multivariate Markov Chain Monte Carlo methods. Percentages of the population below the Estimated Average Requirement (EAR) for calcium and vitamin D/above the Adequate Intake (AI) for potassium and dietary fiber for each decile of added sugars intake were assessed with the NCI method. Using regression analyses, added sugars intake deciles (by any method) in children were inversely associated (p < 0.001) with percentages below the EAR/above the AI of vitamin D, calcium, potassium, and fiber. In adults, added sugars intake deciles were inversely associated with meeting recommendations for vitamin D, potassium, and fiber. There were no significant between-method differences for regression coefficients for any nutrients investigated. Overall, these methods showed a similar association of added sugars intake with nutrient inadequacy/adequacy; therefore, method preference may depend more on practical reasons.

Perceptions on Blended Learning in Higher Education among Academics and Learners in SEGI College Penang, Malaysia

This paper serves as an exploration into finding the perceptions of students and academics on blended learning approach over a course, also to identify the perceived benefits, challenges and limitations in teaching and learning among students and academics. To examine the students’ and academics’ perceptions, this paper has used mixed methodology of questionnaire to the students and structured interview survey to the academics. Both data was analysed at the end of the course after all the content, assessment strategies and learning processes taken place with blended approach. Results indicated that the students’ perceptions are more likely to show positive association towards blended learning approach with some concerns on the format of blended learning approach. Likewise, the academics who have carried blended learning approach into their teaching have shown similar association. Besides that, the academics also shared their insights on the benefits, challenges and limitations respectively towards blended learning approach.

Coexisting systemic and organ-specific autoimmunity in MOG-IgG1-associated disorders versus AQP4-IgG+ NMOSD

Aquaporin-4 (AQP4) neuromyelitis optica spectrum disorder (NMOSD) has been demonstrated to be associated with non-organ and organ-specific autoantibodies (antinuclear antibody, extractable nuclear antibody, double-stranded DNA, muscle acetylcholine receptor antibody) and systemic autoimmune diseases. In this study, we evaluated whether a similar association with non-organ and organ-specifc autoantibodies occurs in patients with MOG-IgG1-associated disorders. We determined that MOG-IgG1 was not strongly associated with these organ and non-organ-specific autoantibodies. Systemic lupus erythematous (SLE) was significantly associated with AQP4-IgG+ NMOSD and not with MOGAD ( p = 0.037). These findings suggest differences in co-existing systemic and organ-specific autoimmunity between MOGAD and AQP4-IgG+ NMOSD.

Analysis of SCN9A Gene Variants for Acute and Chronic Postoperative Pain and Morphine Consumption After Total Hysterectomy

Background Single nucleotide polymorphisms (SNPs) of the voltage-gated sodium channel alpha subunit gene (SCN9A) have been associated with pain in various settings. The aim of this study was to investigate the association of the SNPs to evaluate the influence of common gene variants on chronic postoperative pain (CPSP) and other related pain variables in a cohort of patients who underwent a scheduled hysterectomy. Methods DNA samples from a cohort of 1,075 patients who underwent a scheduled total hysterectomy in our hospital were genotyped for three common SCN9A SNPs using TaqMan assays. Multivariate logistic regression models were used to quantify the association between independent covariates such as pain threshold, pain endurance, pain scores, morphine use, and the presence of chronic pain. Results Frequencies of the minor alleles were different between the different ethnic groups. There was a statistically significant association of rs16851799 with morphine consumption and self-reported postoperative pain for the 1,038 subjects genotyped, with the TT genotype reporting higher pain and using more morphine. For the subpopulation of 446 subjects with chronic pain data, there was a similar association with self-reported postoperative pain and tolerance of pressure pain. Univariate analysis also showed a statistically significant association of rs16851799 with CPSP, whereas multivariable analysis revealed a similar association of rs4387806 with this outcome. There were three haplotypes with different relative frequencies for the CPSP and non-CPSP groups. Conclusions Our results showed that SCN9A polymorphisms could play a role in acute pain perception and the susceptibility to chronic pain.

Anaerobic and Agility Parameters of Salonists in Laboratory and Field Tests

This study aimed to investigate the relationship between mechanical parameters from the Running-based Anaerobic Sprint Test (RAST2×17.5), agility performance from the Illinois Agility Test (IAT) and all-out 30-second tethered running (AO30) in college futsal athletes. It also investigates whether these protocols are capable of identifying differences between sexes. Twenty subjects were evaluated. The IAT was applied on a specific course and performance was considered as the total time (T.T). The RAST2×17.5 consisted of six maximum efforts in a shuttle exercise of 2x17.5 m per bout. The AO30 was conducted under maximal effort on a non-motorized treadmill. Maximum, mean and minimum power were determined for RAST2×17.5 and AO30. Mean power from RAST2×17.5 was inversely and significantly correlated to T.T regardless of sex (male: r=–0.76; p=0.010; female: r=–0.89; p=0.010). A similar association was noticed for maximum power for females (r=–0.94; p=0.001). The AO30 maximum and mean power were significantly correlated with T.T (male: r=–0.67; p=0.031 and r=–0.66; p=0.035, respectively; female: r=–0.64; p=0.046 and r=0.66; p=0.035, respectively). Maximum power from RAST2×17.5 and AO30 were significantly correlated (male: r=0.68; p=0.030; female: r=0.72; p=0.019). Our results reinforce the adoption of field-based tests like RAST2×17.5 and IAT for futsal, since significant relationships among these parameters and AO30 results were obtained. Moreover, these protocols differentiated male and female athletes by mechanical and agility parameters, proving their application under specific field evaluation.