Factors influencing physical distancing compliance among young adults during COVID-19 pandemic in Indonesia: A photovoice mixed methods study

The spreading of the coronavirus disease (COVID-19) is growing out of control in Indonesia since the first two confirmed cases were announced in March 2020. Physical distancing measures are key to slowing down COVID-19 transmission. This study investigated factors associated with physical distancing compliance among young adults in the Jakarta Metropolitan Area, Indonesia. A convergent photovoice mixed methods design was used. Quantitatively, using data from 330 young adults in Jakarta Metropolitan Area, Indonesia, physical distancing compliance scores and its associated factors were analyzed with hierarchical linear regression. Responses from 18 young adults in online focus group discussions and 29 young adults in photovoice were analyzed with thematic analysis. Then, the findings were integrated using joint displays. The mean compliance score of young adults was 23.2 out of 27.0. The physical distancing compliance score was higher among those who worked or studied from home (β = 0.14, p <0.05), compared with those who resumed work at an office or study at school. Celebrating religious days (β = −0.15, p <0.05) and having hometown in the Jakarta Metropolitan Area (β = −0.12, p <0.05) were negatively associated with higher physical distancing compliance scores. Joint displays expanded the reasons for workplace policy, awareness, and social pressure as facilitators and barriers to compliance. Young adults’ physical distancing compliance scores were high, but they are at risk of not complying due to religious events and changes in workplace policies. Beyond individual efforts, external factors, such as workplace policies and social pressure, play a major role to influence their physical distancing compliance.

Promelaxin Microenemas Are Non-inferior to Oral Polyethylene Glycol for the Treatment of Functional Constipation in Young Children: A Randomized Clinical Trial

Background: Polyethylene glycol (PEG) is recommended as first-line treatment of pediatric functional constipation. However, the oral route of administration is often poorly feasible in children mostly due to poor palatability. Promelaxin microenemas exert a topical evacuative action and may offer a valuable option in pediatric FC.Aim: To assess whether Promelaxin microenemas would be non-inferior to PEG 4000 in young children with FC.Methods: This is a randomized, open-label, multi-centric, non-inferiority trial enrolling infants and young children aged 6–48 months, with FC according to Rome III criteria. After 1 week of run in, children were randomized to 2 weeks of Promelaxin or PEG, followed by a 6-week on-demand treatment period. Primary endpoint was response rate to randomized treatment, with “response” defined as at least 3 evacuations per week and an average increase of at least one evacuation per week as compared to baseline. Safety, stool consistency and the analysis of fecal microbiota were secondary endpoints.Results: Out of the 158 patients who entered the trial, 153 patients were treated (77 and 76, PEG and Promelaxin arm, respectively). In the primary analysis, the 95% confidence interval (CI) for the treatment's effect lay entirely above the non-inferiority margin in both Full Set (FAS) and Per Protocol (PP) analyses, providing evidence of the non-inferiority of Promelaxin vs. PEG 4000 [response rate difference: 16.5% (CI 1.55–31.49%) and 11.03% (CI −5.58 to 27.64%), FAS and PP analyses, respectively]. Mean compliance to the randomized treatment was &gt;80% in both arms. Secondary endpoints did not significantly differ between the two arms, except for the average number of total days of on-demand treatment that was significantly lower in the Promelaxin arm [14.6 (12.7) vs. 9.8 (9.1), mean (SD); primary endpoint responders in PEG and Promelaxin arm, respectively; p = 0.027]. Microbiota evenness significantly increased in the PEG 4000 arm at V4 as compared to the Promelaxin arm (p &lt; 0.05). In addition, at V5, patients treated with PEG showed a significantly decreased microbiota density as compared to patients treated with Promelaxin (p = 0.036).Conclusions: Promelaxin microenemas are non-inferior to oral PEG in children with FC.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02751411.

The Impact of Fish Oil Supplementation on Self-Perception of the Voice in Vocal Performers: A Randomized, Single-Blind, Placebo-Controlled Study

Purpose Physically active adults have experienced training benefits from fish oil–derived omega-3 fatty acid (FO n3), which may also be of benefit to singers. The purpose of this research study was to determine if self-reported vocal adaptations and body composition changes occur in singers following FO n3 supplementation in conjunction with a singer's normal training regimen. Method Twenty college students, currently enrolled in vocal lessons at a university, were randomized to receive either 3.0 g of FO n3 or placebo, which they took during a 10-week study period. Participants were blinded to group assignment. Participants completed the Reflux Symptom Index (RSI), Singing Voice Handicap Index-10 (SVHI-10), and the Evaluation of Ability to Sing Easily (EASE) and submitted to body composition measures (weight, skeletal mass, and body fat mass) before and after the study period. Results Sixteen participants completed all parts of the study protocol. Mean compliance for the placebo group (83.9%) and the supplement group (75.2%) was similar. There were no significant differences in body composition measures, RSI scores, and EASE scores between groups. Scores on the SVHI-10 decreased significantly over time for all participants. Conclusions Improvements seen in the SVHI-10 were not meaningfully different between the supplement and placebo group, pointing to the benefit of weekly lessons. The lack of changes in the questionnaire scores in the supplement group are partially attributed to the low compliance rate and low sample size, which is supported by the lack of change in the body composition measures.

Dietary Patterns, Adherence to the Food-Based Dietary Guidelines, and Ultra-Processed Consumption During the COVID-19 Lockdown in a Sample of Spanish Young Population

Purpose: The aim of this study was to explore the dietary patterns, adherence to Food-Based Dietary Guidelines, and the ultra-processed consumption during the COVID-19 lockdown among a Spanish young population aged 3–17 years.Methods: Parents/legal guardians of preschoolers, children, and adolescents aged 3–17 years were enrolled through social networks. The eating habits were assessed by a Food Propensity Questionnaire applied in the ENALIA (Encuesta Nacional de Alimentación en la población Infantil y Adolescente) Spanish survey, which aims to collect food intake information and other data about eating habits on children and adolescents (0–18 years old). Participants were dichotomized following the Food-Based Dietary Guidelines for the Spanish young population offered by the Spanish Society of Community Nutrition. The ultra-processed food score was determined following the principles established in the NOVA classification.Results: Data from 604 children and adolescents were included. An association between age group and the recommendations of snacks (p = 0.002), fruits (p = 0.010), and diaries (p &lt; 0.001) was found. Adolescents showed a lower mean compliance with these guidelines than children (p = 0.004) and preschoolers (p &lt; 0.001). Similarly, children reported lower Food-Based Dietary Guidelines than preschoolers (p = 0.015). Regarding ultra-processed consumption, it was also observed a higher intake in adolescents than in children (p = 0.037), as well as in preschoolers (p &lt; 0.001).Conclusions: The associations that were found highlight the low proportion of the young population (especially adolescents) meeting the Food-Based Dietary Guidelines and the high consumption of ultra-processed foods during COVID-19 lockdown.

BJS.04PreciSSIon: A collaborative initiative to reduce incidence of SSI after elective colorectal surgery

Aims Surgical Site Infection (SSI) is common after colorectal surgery where rates are reported as high as 30%. The aim of this project was to assess whether a collaborative approach to implement a 4-point care bundle could reduce SSI rates across a group of hospitals. Methods PreciSSIon is a Quality Improvement Project (QIP) involving 7 NHS hospitals, with a design based on the Institute for Healthcare Improvement’s Breakthrough Series collaborative model. The Public Health England SSI surveillance questionnaire was used to measure patient-reported SSI at 30 days post-op. An evidence based bundle of care was introduced including: 2% chlorhexidine skin preparation; dual ring wound protectors; triclosan-coated sutures for wound closure; and a second dose of antibiotics after 4 hours. Results All hospitals had implemented the care bundle by February 2020. By December 2020 6/7 hospitals had reduced SSI. Mean patient questionnaire response rate = 84.8%. Mean compliance with each of the above bundle components are as follows: 91%; 72%; 85%; and 92% respectively. Conclusions Implementing an evidence based care bundle, using a collaborative approach to QIP, was effective in reducing the rates of patient-reported SSI following colorectal surgery. The success of this project in the West of England suggests that similar methodology could be used to improve patient outcomes in other regions.

EP.WE.467A Snapshot Audit on the Compliance of Postoperative ERAS Protocol Following the Resumption of Elective Colorectal Surgical Operations in the COVID-19 era

Aim The COVID-19 pandemic has put a pause on most elective surgical procedures nationally. Although the efficacy of ERAS protocol has been well established, its compliance following the resumption of elective services is unknown. Our study aims to assess the level of adherence in the postoperative arm of ERAS in a large district general hospital (DGH). Methods Patients who underwent elective colorectal surgery were audited prospectively between 1st September 2020 and 15th October 2020. Results The mean age (SD) of the 23 patients audited [11(48%) male] was 65 (16) years. Of the cases audited, 17 (74%) had malignant pathology and 6 (26%) were benign. The overall mean compliance score was 4.91 out of 7 (70%). Nasogastric tube was not used in most patients [22(96%)]. However, compliance was poor with regards to opioid avoidance [2(8%)]. Majority of cases complied with early discontinuation of intravenous fluids administration and catheter removal, 14 (61%) and 13 (57%) respectively. 18 patients (78%) resumed oral intake by the first day after surgery and 21 patients (91%) mobilised by the third postoperative day. Higher compliance was significantly associated with decreased length of stay (p = 0.01) but did not reveal significant association with 30-day morbidity. Conclusion Although the compliance to postoperative ERAS protocol is generally good, our study highlighted a strong need to improve the postoperative practice of opioid avoidance. Stricter adherence should be aimed for as it is associated with shorter hospital stay which is particularly important in the COVID-19 pandemic era.

1476Assessment of Compliance to Indian Tobacco Control Legislation in Northern Hilly State of India

Background Parliament of India enacted an act to prohibit advertisement of, and to provide for the regulation of trade and commerce in, and production, supply and distribution of cigarettes and other tobacco products – COTPA. It has been now more than 15 years of this act is in place and there is need to evaluated compliance of COTPA throughout India, this will help stakeholders and policy makers to understand current implementation status. Aim & Objective: To assess the compliance to COTPA across all districts of a Northern Hilly State of India, Uttarakhand. Methodology Study Setting: All 13 districts of a Northern Hilly State of India, Uttarakhand. Study Design: Sequential mixed methods study design. Study Period: 06 months (March – August 2019). Geographical Scope (Venues of visit) and Study Population: For Section 4: All the potential public places in each district were divided into 5 broad categories: Eateries; Offices/banks; Educational Institutions; Health Care Facilities; Transit Stations For Section 5, 6 (a), 7, 8 &9: All the points of sale; For Section 6 (b): all educational institutions Quantitative - School going adolescent's students aged 14 – 16 years (class 8th to 10th) enrolled in educational institutions and tobacco product point of sale and its vendors near the educational institution. Survey Tools: Total six survey checklist were used in the survey along with a semi structured questionnaire for students in educational institutions regarding their tobacco use status. A Global Positioning System (GPS) tool to geolocate educational institute and POS within 500 meters of educational institution. All the study tools from 1-6 were created using Open Data Kit (University of Washington) software or EpiCollect5 software and data collection was done using tablets. Ethical Consideration: This survey was an unobtrusive observational study. Hence no prior informed consent from the vendors was taken for making the observation. Along-with, the prior permission was taken from the concerned health authorities (in this case State Tobacco Control Society) for conduction of this survey. Result The overall compliance to all Sections of COTPA (based upon mean of major compliance indicators) - 75.1. The mean compliance to major indicators of Section 4 of COTPA – 59.4%; Section 5 of COTPA -93.8%; Section6(a) of COTPA -83.2%; Section6(b) of COTPA -66.6%; Section 7,8,9 of COTPA -72.3%. Compliance to health warning present on packs were recognized in most of the packs in rural areas (82.2%) and urban areas (81.4%). Compliance with display of no promotional messages was 15.4% in rural. Among different type of tobacco products (PoS), Foreign Made Cigarettes were found to be more compliant (87.0%) while Foreign Made Cigars of tobacco was least compliant (45.8%) to major compliance indicators of Section 6 (a) of COTPA. Conclusions Overall compliance to COPTA was above 80%. Keywords Prevention and Care - Policy and Community Interventions This survey has been funded by State Tobacco Control Cell, Government of Uttarakhand.

NODAL COSINE SINE MATERIAL INTERPOLATION IN MULTI OBJECTIVE TOPOLOGY OPTIMIZATION WITH THE GLOBAL CRITERIA METHOD FOR LINEAR ELASTO STATIC, HEAT TRANSFER, POTENTIAL FLOW AND BINARY CROSS ENTROPY SHARPENING

Topology optimization is typically used for suitable design suggestions for objectives like mean compliance, mean temperature, or model analysis. Some modern modeling technics in topology optimization require a nodal based material interpolation. Therefore this article is referred to a continuous material interpolation in topology optimization. To cover a smooth and differentiable density field, we address trigonometric shape functions which are infinitely differentiable. Furthermore, we extend a so-known global criteria method with a sharpening function based on binary cross-entropy, so that sharper solutions results. The proposed material interpolation is applied to different applications such as heat transfer, elasto static, and potential flow. Furthermore, these different objectives are together optimized using a multi-objective criterion.

Feasibility of Repeated Assessment of Cognitive Function in Older Adults Using a Wireless, Mobile, Dry-EEG Headset and Tablet-Based Games

Access to affordable, objective and scalable biomarkers of brain function is needed to transform the healthcare burden of neuropsychiatric and neurodegenerative disease. Electroencephalography (EEG) recordings, both resting and in combination with targeted cognitive tasks, have demonstrated utility in tracking disease state and therapy response in a range of conditions from schizophrenia to Alzheimer's disease. But conventional methods of recording this data involve burdensome clinic visits, and behavioural tasks that are not effective in frequent repeated use. This paper aims to evaluate the technical and human-factors feasibility of gathering large-scale EEG using novel technology in the home environment with healthy adult users. In a large field study, 89 healthy adults aged 40–79 years volunteered to use the system at home for 12 weeks, 5 times/week, for 30 min/session. A 16-channel, dry-sensor, portable wireless headset recorded EEG while users played gamified cognitive and passive tasks through a tablet application, including tests of decision making, executive function and memory. Data was uploaded to cloud servers and remotely monitored via web-based dashboards. Seventy-eight participants completed the study, and high levels of adherence were maintained throughout across all age groups, with mean compliance over the 12-week period of 82% (4.1 sessions per week). Reported ease of use was also high with mean System Usability Scale scores of 78.7. Behavioural response measures (reaction time and accuracy) and EEG components elicited by gamified stimuli (P300, ERN, Pe and changes in power spectral density) were extracted from the data collected in home, across a wide range of ages, including older adult participants. Findings replicated well-known patterns of age-related change and demonstrated the feasibility of using low-burden, large-scale, longitudinal EEG measurement in community-based cohorts. This technology enables clinically relevant data to be recorded outside the lab/clinic, from which metrics underlying cognitive ageing could be extracted, opening the door to potential new ways of developing digital cognitive biomarkers for disorders affecting the brain.

Ways to increase compliance in patients with acute otitis externa

Topicality: The problem of diagnosis and treatment of otitis externa (OE) has been posed to doctors for a long time, and until the discovery of antibiotics (AB) and antifungal drugs (AFD) remained unresolved. OE can affect up to 10% of people at different periods of their lives, manifesting itself in the form of acute OE (AOE) in 95% of cases after the age of 2 years. There is a reduction in the number of patients admittance to the ENT specialist with the onset of the COVID-19 pandemic while maintaining the structure of the pathology, where AOE - in the top three of frequency. At the same time, there are a reports of an increasing amount of AOE cases in patients with COVID-19. Aim: To evaluate the dynamics of pain, the need for additional analgesia, systemic antibacterial therapy (ABT) or topical antifungal therapy (TAT), the level of compliance in patients with AOE in empirical treatment with a complex drug «Candibiotic» in comparison with protocol treatment. Material and methods: The study included adults and children from 2 years of age with a diagnosis of AOE: 30 patients in the main (17 adults, 13 children) and 25 patients in the control (15 adults, 10 children) groups. Patients in the main group as a basic treatment received topical ear drops «Candibiotic». Patients in the control group received protocol treatment. If necessary, patients were additionally prescribed analgesic therapy (ibuprofen in the appropriate dose), systemic ABT or TAT. For subjective pain asses, a visual analog scale (VAS) was used. Compliance was assessed using the Morisky-Green questionnaire. The obtained results were processed by common statistical methods. Results and discussion: In the main group of patients receiving «Candibiotic», there were fewer needs for additional systemic analgesia, systemic ABT, no one needed additional TAT. Comparison of the obtained results (percentage) in the form of arbitrary tables using the chi-squared test established that the relationship between factor and performance traits is not statistically significant (p>0.05). The mean compliance score between the two study groups differed significantly as a whole and separately between the groups of adults and children (p<0.05). Conclusion: In patients of adult and pediatric age with a diagnosis of AOE at the initial empirical appointment of the drug «Candibiotic» there was less need for additional analgesia, the appointment of systemic ABT and AFT. Such results did not differ statistically significantly from the results in adult and pediatric patients who were prescribed protocol treatment of AOE. Patients with «Candibiotic» monotherapy had a significantly higher average compliance score compared with the control group, especially among parents of children with AOE. The complex composition of ear drops «Candibiotic» contributes to a high adherence to treatment in patients, and the lack of an absolute analogue makes it the means of choice for the initial empirical treatment of AOE in adults and children over 2 years.