Background: Health risk behaviours such as smoking, physical inactivity and poor diet are independently associated with depression. However, there is a paucity of data examining associations between combined healthy behaviours and mental distress and depression. Methods: Using cross-sectional data from a nationwide population-based sample of adults in Germany [German Health Update (GEDA) 2009 and 2010 telephone surveys; n = 21 940 women, n = 17 061 men], we examined associations between five healthy behaviours and frequent mental distress (FMD) and self-reported diagnosed depression in the past 12 months. Healthy behaviours included non-smoking, low-risk alcohol drinking, regular sport, maintaining normal weight and healthy fruit and vegetable consumption. Multiple logistic regression analyses adjusted for potential confounders examined associations between the combined number of healthy behaviours and FMD and self-reported diagnosed depression. Results: FMD was reported by 13.6 and 8.0% and diagnosed depression in the last 12 months by 8.3 and 4.7% of women and men, respectively. At least four of five assessed healthy behaviours were reported by 29.1% of women and 17.8% of men. Compared with those with less than two healthy behaviours, women and men with at least four behaviours were about half as likely to report FMD [odds ratio (OR) 0.53, 95% confidence interval (CI) 0.44–0.64, and OR 0.52, 95% CI 0.41–0.66, respectively) and women with at least four behaviours were less likely to report diagnosed depression (OR 0.76, 95% CI 0.61–0.95). Conclusion: A higher number of healthy behaviours are associated with a lower prevalence of FMD for both women and men and of self-reported diagnosed depression in women.
Deceased donation occurs at times of significant family distress and it is usually not possible to 'train' during these periods. Therefore, learning occurs either in a piecemeal fashion on the job or in classrooms, based on theory and quite removed from the real world of the intensive care environment. Simulation allows staff training and development in a safe environment while enacting real-time events. Nottingham University Hospitals Trust Donation Committee felt that simulation may be an appropriate tool for staff to develop skills in the deceased donation process. A one-day simulation pilot was planned collaboratively with the Trent Simulation and Clinical Skills Centre. This successful pilot demonstrated that simulation was an effective environment to train staff in deceased donation and had the ability to benefit both participants and faculty. A second deceased donation simulation day, unchanged in format, was delivered and the combined outline and results for both days are reported. The intention in future is to support all regional intensive care, emergency medicine and neurosurgery trainees to attend a deceased donation simulation day during their training and to package the course so that it is freely available to other interested centres.
Objective: To provide normative data for the Digit Symbol Substitution Test (DSST) of the Wechsler Adult Intelligence Scale, 3rd edition (WAIS-III) in a population-based sample of community-dwelling older adults in Germany according to age, sex, and level of education. Method: The sample comprised 1385 participants aged 65–79 years from the nationwide representative ‘German Health Interview and Examination Survey for Adults’ (DEGS1, 2008–2011). Participants with known cognitive impairment or dementia, other medical conditions affecting cognition, or currently using psychotropic drugs were excluded. Educational level was categorized as low, medium, and high according to the Comparative Analyses of Social Mobility in Industrial Nations (CASMIN) scale. Normative values for the DSST according to age, sex, and level of education were estimated by multiple linear regression using population weights. Results: Mean age was 71.1 years, 48.6% were men and low, medium, and high education levels were 62.8, 24.6, and 12.6%, respectively. Younger age, female sex, and higher level of education were significantly associated with higher DSST scores. Regression-based normative data for the DSST is provided according to age, sex, and level of education. In addition, a normative score calculator is provided. Conclusions: These are the first age-, sex-, and education-specific normative data for older individuals for the DSST of the WAIS-III in Germany. These normative data will enable future population-level analyses on impaired cognitive function according to DSST.
Reports of sex-specific differences in mortality after coronary artery bypass graft surgery (CABGS) are contradictory. The review aim was to determine whether CABGS is differentially efficacious than alternative procedures by sex, on short- and longer-term mortality.EMBASE, CINAHL, Medline, and the Cochrane Library were searched. Inclusion criteria: English language, randomized controlled trials from 2010, comparing isolated CABGS to alternative revascularization. Analyses were included Mantel-Haenszel fixed-effects modelling, risk of bias (Cochrane RoB2), and quality assessment (CONSORT). PROSPERO Registration ID: CRD42020181673. The search yielded 4459 citations, and full-text review of 29 articles revealed nine studies for inclusion with variable time to follow-up. Risk of mortality for women was similar in pooled analyses [risk ratio (RR) 0.94, 95% confidence interval (CI) 0.84-1.05, P = 0.26] but higher in sensitivity analyses excluding 'high risk' patients (RR 1.22, 95% CI 1.01-1.48, P = 0.04). At 30 days and 10 years, in contrast to men, women had an 18% (RR 0.82, 95% CI 0.66-1.02, P = 0.08) and 19% (RR 0.81, 95% CI 0.69-0.95, P = 0.01) mortality risk reduction. At 1-2 years women had a 7% (RR 1.07, 95% CI 0.69-1.64, P = 0.77), and at 2-5 years a 25% increase in risk of mortality compared with men (RR 1.25, 95% CI 1.03-1.53, P = 0.03). Women were increasingly under-represented over time comprising 41% (30 days) to 16.7% (10 years) of the pooled population.Meta-analysis revealed inconsistent sex-specific differences in mortality after CABGS. Trials with sex-specific stratification are required to ensure appropriate sex-differentiated treatments for revascularization.
Releasing timely and relevant clinical guidelines is challenging for organizations globally. Priority-setting is crucial, as guideline development is resource-intensive. Our aim, as a national organization responsible for developing cardiovascular clinical guidelines, was to develop a method for generating and prioritizing topics for future clinical guideline development in areas where guidance was most needed.Several novel processes were developed, adopted and evaluated, including (1) initial public consultation for health professionals and the general public to generate topics; (2) thematic and qualitative analysis, according to the International Classification of Diseases (ICD-11), to aggregate topics; (3) adapting a criteria-based matrix tool to prioritize topics; (4) achieving consensus through a modified-nominal group technique and voting on priorities; and (5) process evaluation via survey of end-users. The latter comprised the organization's Expert Committee of 12 members with expertise across cardiology and public health, including two citizen representatives.Topics (n = 405; reduced to n = 278 when duplicates removed) were identified from public consultation responses (n = 107 respondents). Thematic analysis synthesized 127 topics that were then categorized into 37 themes using ICD-11 codes. Exclusion criteria were applied (n = 32 themes omitted), resulting in five short-listed topics: (1) congenital heart disease, (2) valvular heart disease, (3) hypercholesterolaemia, (4) hypertension and (5) ischaemic heart diseases and diseases of the coronary artery. The Expert Committee applied the prioritization matrix to all five short-listed topics during a consensus meeting and voted to prioritize topics. Unanimous consensus was reached for the topic voted the highest priority: ischaemic heart disease and diseases of the coronary arteries, resulting in the decision to update the organization's 2016 clinical guidelines for acute coronary syndromes. Evaluation indicated that initial public consultation was highly valued by the Expert Committee, and the matrix tool was easy to use and improved transparency in priority-setting.Developing a multistage, systematic process, incorporating public consultation and an international classification system led to improved transparency in our clinical guideline priority-setting processes and that topics chosen would have the greatest impact on health outcomes. These methods are potentially applicable to other national and international organizations responsible for developing clinical guidelines.
Abstract BackgroundReleasing timely and relevant clinical guidelines is challenging for organisations globally. Priority setting is crucial as guideline development is resource intensive. Our aim, as a national organisation responsible for developing cardiovascular clinical guidelines, was to develop a method of generating and prioritising topics for future clinical guideline development in areas where guidance was most needed.MethodsSeveral novel processes were developed, adopted and evaluated including: 1) initial public consultation for health professionals and the general public to generate topics; 2) thematic and qualitative analysis, according to the International Classification of Diseases (ICD-11), to aggregate topics; 3) adapting a criteria-based matrix tool to prioritise topics; 4) achieving consensus through modified-nominal group technique and voting on priorities; and 5) process evaluation via survey of end-users. The latter was comprised of the organisation’s Expert Committee of 12 members with expertise across cardiology and public health, including two citizen representatives.ResultsTopics (n=405; reduced to n=278 when duplicates removed) were identified from public consultation responses (n=107 respondents). Thematic analysis synthesised 127 topics that were then categorised into 37 themes using ICD-11 codes. Exclusion criteria were applied (n=32 themes omitted), resulting in 5 short-listed topics: 1) congenital heart disease; 2) valvular heart disease; 3) hypercholesterolaemia, 4) hypertension and 5) ischaemic heart diseases and diseases of the coronary artery. The Expert Committee applied the prioritisation matrix to all five short-listed topics during a consensus meeting and voted to prioritise topics. Unanimous consensus was reached for the topic voted the highest priority: ischaemic heart disease and diseases of the coronary arteries, resulting in the decision to update the organisation’s 2016 clinical guidelines for acute coronary syndromes. Evaluation indicated that initial public consultation was highly valued by the Expert Committee, the matrix tool was easy to use and improved transparency in priority setting.ConclusionDeveloping a multistage, systematic process, incorporating public consultation, and an international classification system led to improved transparency in our clinical guideline priority setting processes and that topics chosen would have the greatest impact on health outcomes These methods are potentially applicable to other national and international organisations responsible for developing clinical guidelines.
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