Vaping in Youth

This JAMA Insights reviews the health effects of vaping among youth in the US and current recommendations for screening and treatment.

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Randomized Invitation to Systematic NT-proBNP and ECG Screening in 75-Year Olds to Detect Atrial Fibrillation -STROKESTOP II

Circulation, Ahead of Print. Background:Guidelines have suggested screening for atrial fibrillation to enable early treatment and avoid downstream negative clinical events. We aimed to determine if atrial fibrillation screening potentially enhanced by NT-proBNP would reduce stroke or systemic embolism incidence as compared to in a control group and to determine if it was safe for those with low NT-proBNP concentrations to forfeit prolonged screening.Methods:In this randomized controlled trial all 75/76-year-old individuals in Stockholm Region, Sweden were randomized 1:1 to be invited to screening or serve as a control group. NT-proBNP concentration were measured and a single-lead-ECG registered only once if NT-proBNP

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Contralateral Breast Cancer Remains a Complex Biological Conundrum

Although contralateral breast cancer (CBC) is the most frequent second malignant tumor among women who have experienced a diagnosis of primary breast cancer, it is less frequent, and less ominous than recurrence of the initial cancer. Nevertheless, for many patients with newly diagnosed unilateral breast cancer, it can be a prominent source of worry as they navigate their treatment decisions. This worry is accentuated among young patients and those with early-stage disease. The most effective preventive solution for CBC is contralateral mastectomy, which was rarely used in the 20th century but has been increasingly used during the past 20 years, first in the US, and now in other countries with comparable resources. For women with a unilateral breast cancer, the consideration of contralateral mastectomy has many drivers, some undoubtedly patient-related, but others stemming from misconceptions among the medical community regarding the risks and benefits of contralateral mastectomy. To date, studies addressing the question of survival following contralateral phylactic mastectomy (CPM) have failed to provide evidence for improved survival. Although lack of survival benefit may seem counter-intuitive, a tenable explanation is that the dominant hazard to survival derives from the index primary tumor rather than the CBC. Because patients with breast cancer are diagnosed with the index primary tumor at a younger age (which increases the hazard of death) and are treated with older, less effective regimens, it is possible that the risk of death from CBC is subsumed by the risk from the index cancer, particularly if second cancers are diagnosed at earlier stages in survivors who tend to be more adherent to posttreatment screening. Consequently, surgical measures to prevent a second primary tumor do not extend survival.

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Screening ECGs for Cardiovascular Risk Assessment

In their article on routine electrocardiogram (ECG) screening and cardiovascular disease (CVD) events Yagi and colleagues report findings from a nationwide cohort study on screening electrocardiography in Japan between January 2015 and December 2021. Since 1989, an annual screening ECG has been mandatory for working-age people in Japan aged 35 years and older. The authors assessed claims and annual health screening data from the Japan Health Insurance Association that included 3 698 429 individuals registered in the database and who had a screening ECG in 2016. Electrocardiograms were classified as having 1 minor abnormality, 2 or more minor abnormalities, or major abnormalities. Using multivariable Cox proportional hazards models and adjusting for multiple clinical covariates, the authors found a greater risk of the composite outcome of overall death or hospital admission for CVD in people with 1 minor abnormality (hazard ratio [HR], 1.19; 95% CI, 1.18-1.20), 2 or more minor abnormalities (HR, 1.37; 95% CI, 1.34-1.39), and major ECG abnormalities (HR, 1.96; 95% CI, 1.92-2.02) compared with people with a normal ECG result. Cardiovascular events were observed across subgroups by age, sex, and low vs moderate to high CVD risk groups. The authors concluded that “further studies are needed to elucidate the role of routine ECG screening for early prevention of CVD events, along with optimal follow-up strategies for both major and minor ECG abnormalities.”

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Associations Between Prenatal Cannabis Use and Maternal Health Outcomes

With the legalization of cannabis in many states, the question of what effect it has on pregnant individuals has become more pressing. In this issue of JAMA Internal Medicine, Young-Wolff and colleagues examine the association between prenatal cannabis use and maternal health outcomes. Data were drawn from the Kaiser Permanente Northern California system, with prenatal cannabis use defined as any self-reported use during early pregnancy or a positive toxicology test result based on universal screening when establishing prenatal care. Using a population-based cohort design, they examined outcomes of gestational hypertension, preeclampsia, eclampsia, gestational diabetes, gestational weight gain greater and less than guidelines, placenta previa, placental abruption, placenta accreta, and severe maternal morbidity during an 8-year period (2011-2019).

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AI and Big Data approaches to addressing the opioid crisis: a scoping review protocol

Introduction
This paper outlines the steps necessary to assess the latest developments in artificial intelligence (AI) as well as Big Data technologies and their relevance to the opioid crisis. Fatal opioid overdoses have risen to over 82 998 annually in the USA. This highlights the need for urgent and effective data-driven solutions. AI approaches, such as machine learning, deep learning and natural language processing, have been employed to analyse patterns and trends in overdose data and facilitate timely interventions. However, a comprehensive scoping review on the effectiveness of AI-driven technologies to detect, treat, prevent or respond to the opioid crisis remains absent. Thus, it is important to identify recent advancements in AI and Big Data technologies in addressing the opioid crisis.

Methods and analysis
We will electronically search four scientific databases (PubMed, Web of Science, Engineering Village and PsycInfo), including finding reference lists and grey literature from 2013 to 2023. Covidence will be used for screening and selecting papers. We will extract information such as citation details, study context, data used, AI/Big Data technologies, features, algorithms and evaluation metrics. This data will be synthesised, analysed and summarised to draw meaningful conclusions and identify future directions to tackle the opioid crisis.

Ethics and dissemination
Ethics approval is not required. Results will be disseminated via conference presentations and peer-reviewed publication.

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Opportunities for nurses aspiring to or undertaking clinical academic development globally: protocol for a scoping review

Introduction
Nurse researchers often lack awareness of how to start a clinical academic research career and often lack clear entry routes. This scoping review aims to identify the range and nature of clinical academic opportunities available for nurses. This will also identify the knowledge gaps and provide the basis for future research.

Methods and analysis
The review will be conducted using scoping review methodology and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses with the Extension for Scoping Reviews guidelines. We will search CINAHL (EBSCO), MEDLINE (Ovid), AMED (Ovid) and ProQuest using a search based on the facet’s ‘nurse’, ‘research’ and ‘clinical academic’. Grey literature and a hand search of the reference lists will be conducted for additional publications meeting the inclusion and exclusion criteria. We will include articles published in English, with a focus on registered nurses interested in undertaking clinical academic development within any healthcare system, with no restrictions regarding the date of publication. Following initial screening of titles and abstracts, relevant full-text papers will be screened for inclusion. Two independent reviewers will participate in an iterative process of screening the literature, paper selection and data extraction. We will use a prespecified form to extract data which will be charted and presented in a tabular form. Samples of data extraction and charting will be checked by a second reviewer. This will support a narrative summary structured around key identified variables agreed on iteratively by the review team.

Ethics and dissemination
No ethical or Health Research Authority approval is required to undertake this scoping review. The findings will inform future research exploring the opportunities supporting nurses aspiring to undertake clinical academic development and be disseminated via presentations at national conferences and publications in peer-reviewed journals.

Study registration
Open Science Framework, DOI:10.17605/OSF.IO/WVDXH.

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Psychological and pharmacological treatments of intermittent explosive disorder: a meta-analysis protocol

Introduction
Intermittent explosive disorder (IED) is characterised by recurrent, sudden episodes of impulsive aggression that are disproportionate to the provocation. The condition’s management remains challenging due to the variability in treatment efficacy and the absence of Food and Drug Administration-approved interventions specifically for IED. This meta-analysis aims to evaluate the effectiveness of existing treatments for IED.

Methods and analysis
Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was conducted in November 2023, yielding 17 randomised controlled trials after screening and eligibility assessments. Studies were included based on participants’ confirmed diagnosis of IED, sufficient statistical power and provision of data for effect size calculation. Interventions analysed included pharmacological treatments, psychotherapies and combination therapies, with an emphasis on cognitive–behavioural therapy and selective serotonin reuptake inhibitors. Quality assessment was performed using the Cochrane Risk of Bias Tool.

Ethics and dissemination
Given that our study is a synthesis of published data, ethical approval from a research ethics committee is not required. Nevertheless, the methodology of this review was designed to ensure full transparency and accountability. All efforts have been made to respect the confidentiality and intellectual property rights of the original data sources. Any ethical issues encountered during the data collection process were addressed in accordance with the guidelines of the Declaration of Helsinki. As this research involves the analysis of existing published data, there are no direct safety concerns related to patient interactions. Our primary focus has been on ensuring the secure handling and processing of data to uphold the ethical standards set by previous original studies. To ensure the findings of our meta-analysis reach both the academic community and the public effectively, we aim to submit our findings to peer-reviewed journals within the fields of psychology to ensure rigorous review and broad academic dissemination.

PROSPEO registration number
CRD42024497587.

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Comparison of outcomes of open, laparoscopic and robot-assisted laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: protocol for a systematic review and meta-analysis

Introduction
The treatment of children with pelviureteric junction obstruction (PUJO) has naturally progressed from open, to minimally invasive approaches, including laparoscopic pyeloplasty and robot-assisted laparoscopic pyeloplasty (RALP). The RALP is now considered to be the gold standard for paediatric patients with PUJO, except for smaller infants due to size limitations. Our systematic review aims to synthesise all the available evidence regarding key postoperative outcomes for the three surgical approaches to pyeloplasties in children. Our outcomes of interest include, but are not limited to, the reoperation rate, length of hospital stay and postoperative complications as classified by the Clavien-Dindo grading system. A comprehensive assessment of all three methods in paediatric patients has yet to be conducted in the literature to date.

Methods and analysis
A systematic search of the MEDLINE, PubMed, EMBASE and Cochrane databases will be conducted. Screening, data extraction, statistical analysis and reporting will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included papers will be full-text manuscripts written between 1947 and March 2024, comparing the outcomes and complications of open, laparoscopic and RALP. Quality and study bias will be assessed using the Newcastle-Ottawa score and, if relevant, the Cochrane risk of bias tool for randomised trials. This present protocol is written in accordance with the PRISMA Protocol 2015 checklist, ensuring that the highest methodological standards are adhered to.

Ethics and dissemination
No ethical approval shall be required, as this is a review of already published literature. Findings will be disseminated through publications in peer-reviewed journals and presentations at international and national conferences.

PROSPERO registration number
CRD42023456779.

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Machine learning-derived phenotypic trajectories of asthma and allergy in children and adolescents: protocol for a systematic review

Introduction
Development of asthma and allergies in childhood/adolescence commonly follows a sequential progression termed the ‘atopic march’. Recent reports indicate, however, that these diseases are composed of multiple distinct phenotypes, with possibly differential trajectories. We aim to synthesise the current literature in the field of machine learning-based trajectory studies of asthma/allergies in children and adolescents, summarising the frequency, characteristics and associated risk factors and outcomes of identified trajectories and indicating potential directions for subsequent research in replicability, pathophysiology, risk stratification and personalised management. Furthermore, methodological approaches and quality will be critically appraised, highlighting trends, limitations and future perspectives.

Methods and analyses
10 databases (CAB Direct, CINAHL, Embase, Google Scholar, PsycInfo, PubMed, Scopus, Web of Science, WHO Global Index Medicus and WorldCat Dissertations and Theses) will be searched for observational studies (including conference abstracts and grey literature) from the last 10 years (2013–2023) without restriction by language. Screening, data extraction and assessment of quality and risk of bias (using a custom-developed tool) will be performed independently in pairs. The characteristics of the derived trajectories will be narratively synthesised, tabulated and visualised in figures. Risk factors and outcomes associated with the trajectories will be summarised and pooled estimates from comparable numerical data produced through random-effects meta-analysis. Methodological approaches will be narratively synthesised and presented in tabulated form and figure to visualise trends.

Ethics and dissemination
Ethical approval is not warranted as no patient-level data will be used. The findings will be published in an international peer-reviewed journal.

PROSPERO registration number
CRD42023441691.

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Protocol of health screening related to occupational diseases in 100 000 workers in critical sectors: a cross-sectional study with worksite risk assessment

Background
Occupational diseases are one of the most important health problems related to employment However, in Malaysia, there are few epidemiological studies discussing these issues, especially among workers in the industry. For that, this study aimed to screen workers from high-risk industrial sectors, identify hazards in the workplace and recommend improvement measures in the workplace to prevent occupational diseases.

Methods and analysis
This is a 3-year project in which a survey of 100 000 workers from all 13 states in Malaysia will be conducted using a web-based screening tool that is comprised of two parts: occupational disease screening tool and hazard identification, risk assessment and risk control method. Data will be collected using a multistage stratified sampling method from 500 companies, including seven critical industrial sectors. The independent variables will be sociodemographic characteristics, comorbidities, previous medical history, high-risk behaviour and workplace profile. The dependent variable will be the types of occupational diseases (noise-induced hearing loss, respiratory, musculoskeletal, neurotoxic, skin and mental disorders). Subsequently, suggestions of referral for medium and high-risk workers to occupational health clinics will be attained. The approved occupational health service clinics/providers will make a confirmatory diagnosis of each case as deemed necessary. Subsequently, a walk-through survey to identify workplace hazards and recommend workplace improvement measures to prevent these occupational diseases will be achieved. Both descriptive and inferential statistics will be used in this study. Simple and adjusted binary regression will be used to find the determinants of occupational diseases.

Ethics and dissemination
This study has been approved by the MARA University of Technology Research Ethics Board. Informed, written consent will be obtained from all study participants. Findings will be disseminated to the Department of Occupational Health and Safety, involved industries, and through peer-reviewed publications.

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Physiotherapy interventions in post- and long-COVID-19: a scoping review protocol

Introduction
Post- or long-COVID-19 conditions manifest with a spectrum of symptoms reminiscent of pulmonary, musculoskeletal, psychological and neurological disorders. Individuals with post- or long-COVID-19 syndrome often present with myalgia, pulmonary problems and fatigue, which significantly impact their daily functioning. Physiotherapy interventions are an accepted medical remedy for these symptoms. This scoping review aims to outline the evidence of physiotherapy interventions documented in the scientific literature, specifically focusing on hands-on therapy.

Methods and analysis
This scoping review conforms to the methodological framework established by the Joanna Briggs Institute (JBI). The procedure for drafting a scoping review involves several steps, starting with defining the research question and the inclusion and exclusion criteria. Eligible studies are those analysing physiotherapy treatment parameters for direct patient interaction in post- and long-COVID-19 patients. Telemedicine and entirely home-based workouts will be excluded aligning with the context of outpatient physiotherapy in Germany. The literature search will be conducted in PubMed, EBSCO research, Scopus, Web of Science, Embase, PEDRO, Cochrane and WISO databases by two independent researchers. Screening, data extraction and a critical appraisal will be performed by these researchers using assessment tools provided by the JBI. Extracted data will encompass demographic characteristics, definitions of post- or long-COVID-19 conditions, descriptions of interventions, their treatment parameters and treatment outcome. Subsequently, findings will be disseminated through a scoping review article or conference presentation.

Ethics and dissemination
Given that this review does not involve human participants, ethical committee approval is deemed unnecessary. The results will be published in peer-reviewed journals and presented at academic and physiotherapeutic conferences.

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Development and implementation determinants of competency frameworks for mental health clinicians and service providers working with youth: a scoping review protocol

Introduction
Despite high prevalence, access to mental healthcare for Canadian youth is limited, with less than 20% receiving adequate treatment. Marginalised and at-risk youth face particular challenges, including cultural misunderstandings, long wait times and negative care experiences. A competency framework for mental health clinicians working with youth can be a tool to increase the capacity of the health workforce to deliver culturally responsive care. This scoping review aims to comprehensively summarise the existing literature on competency frameworks for mental health clinicians and youth service providers, assessing how these frameworks align with culturally responsive care and examining their development, evaluation and implementation methods.

Methods and analysis
This review protocol is guided by the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines and registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/EY7NF). The search strategy, developed with an Information Specialist, comprises a three-step process: preliminary searches in two databases, expansion of the search across Medline, CINAHL, EMBASE, PsycInfo, CENTRAL and dissertations and theses databases and examination of reference lists and hand-searching for additional sources. The search strategy was reviewed using the Peer Review of Electronic Search Strategies checklist. Eligible English language articles will be selected through title and abstract screening (level 1) and full-text review (level 2). The search dates are 18 July and 21 August 2023, as well as 19 January 2024. Data from eligible articles will be extracted in duplicate and independently using a data extraction form. The data will then be summarised descriptively and qualitatively using content analysis mapped to the four evidence-based conceptual frameworks and presented in a table.

Ethics and dissemination
As the scoping review involves gathering and describing existing literature, it is exempt from ethical approval requirements. The findings of this scoping review will be presented at relevant local and international conferences and published in a peer-reviewed journal. The findings will also be disseminated and shared with professional organisations to enhance healthcare workforce capacity and drive systemic change. Furthermore, the findings will be used to inform doctoral work and future mental health and health education research related to underserved youth.

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