Collaborating to plan efficient public health guideline evidence reviews

The National Institute for Health and Care Excellence (NICE) produces public health guidelines. Information specialists collaborate with technical analysts to perform systematic searches for evidence reviews (ERs). Public health ERs require searches from multiple disciplines across a range of sources leading to high volumes of results. The purpose of the project was to provide evidence to support the choice of sources for new topics. It aimed to retrospectively analyse a sample of NICE public health ERs by examining which sources retrieved publications. Medical databases found the highest proportion of publications, but smaller subject focussed databases and search techniques also contributed. These findings justify use of a range of sources for public health reviews and help the planning of ERs.

Habitual Physical Exercise and Osteoarthritis of the Knee in Female

The study aimed to evaluate the association of recreational (habitual) physical activities with the osteoarthritis (OA) of the knee in the female. The case-control study was carried out at the Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka in the year 2016 and 2017. The total participants were 174 female selected purposively with the age range of 40 – 70 years, among them 87 were the cases with OA of the knee, and the same number of the same age group were included as the control without OA of the knee. A structured interviewer-administered questionnaire was used to collect data. High level of physical activities (20 or more miles per week) was associated with OA of the knee, whereas moderate level of physical activities (10-20 miles/per week) and low level of physical activities (<10miles/per week) had no significant association with the OA of the knee. This study reveled the relationship of the physical activity and OA of the knee. Continue physical activity according to the public health guideline, may eliminate this such physical problem for the general health promotion and particularly to prevent the OA of the knee. Bangladesh Med J. 2019 Sep; 48 (3): 39-42

The importance of pregnancy planning in lupus pregnancies

Objective In seeking new approaches to improve lupus pregnancy outcomes, we study the association between pregnancy planning, behaviors recommended by American College of Rheumatology’s Reproductive Health Guideline 2020, and pregnancy and infant outcomes. Methods Lupus pregnancies in a prospective registry (1/1/2018 to 4/1/2020) were classified as planned or not-planned using the patient-reported London Measure of Unplanned Pregnancy. These groups were compared for demographics, pre-pregnancy disease activity, pregnancy planning behaviors, and delivery outcomes. Results Among 43 women with 43 singleton pregnancies the average age was 29.4 years and 42% were Black. Overall, 60% were planned pregnancies and 40% were not-planned (16 ambivalent, 1 unplanned). Women with not-planned pregnancies had lower age, income, and education, and more required Medicaid. Women with not-planned pregnancies were more likely to conceive when lupus activity was higher (p = 0.001), less likely to receive pre-pregnancy counseling with a rheumatologist (p = 0.02), and less likely to continue pregnancy-compatible medications (p = 0.03). Severe PROMISSE adverse pregnancy outcomes (APOs) and severe neonatal outcomes were higher among women with not-planned than planned pregnancies (43% vs 0% p = 0.003; 70% vs 30% p = 0.06). Conclusion This study identifies pregnancy intention as a potentially modifiable risk factor for poor outcomes in women with lupus. It highlights a unique population of women with lupus at high risk for pregnancy and infant complications: those ambivalent about pregnancy. These women may not be effectively engaging in health behaviors that prevent pregnancy nor those that will prepare for a safe pregnancy. With effective pregnancy planning and contraception guidance, we may decrease their risk for maternal-fetal morbidity and mortality.

"It’s Not Smooth Sailing": Bridging the Gap Between Methods and Content Expertise in Public Health Guideline Development

Background: The development of reliable, high quality health-related guidelines depends on explicit and transparent processes, methods aimed at minimising risks of bias and the inclusion of all relevant expertise and perspectives. While the methodological aspects of guidelines have been a focus to improve their quality, less is known about the social processes involved, for example, how guideline group members interact and communicate with one another, and how the evidence is considered in informing recommendations. With this in in mind, we aimed to empirically examine the perspectives and experiences of the key participants involved in developing public health guidelines for the Australian National Health and Medical Research Council (NHMRC). Design: This study was conducted using constructivist grounded theory as described by Charmaz, which informed our sampling, data collection, coding and analysis of interviews with key participants involved in developing public health guidelines. Setting: Australian public health guidelines commissioned by the NHMRC. Participants: Twenty experts that were involved in Australian NHMRC public health guideline development, including working committee members with content topic expertise (n=16) and members of evidence review groups responsible for evaluating the evidence (n=4). Results: Public health guideline development in Australia is a divided process. The division is driven by 3 related factors: the divergent disciplinary background and expertise that each group brings to the process; the methodological limitations of the framework, inherited from clinical medicine, that is used to assess the evidence; and barriers to communication between content experts and evidence reviewers around respective roles and methodological limitations. Conclusion: Our findings suggest several improvements for a more functional and unified guideline development process: greater education of the working committee on the methodological process employed to evaluate evidence, improved communication on the role of the evidence review groups and better facilitation of the process so that the evidence review groups feel their contribution is valued.

Exposures and Health Risks from Volatile Organic Compounds in Communities Located near Oil and Gas Exploration and Production Activities in Colorado (U.S.A.)

The study objective was to use a preliminary risk based framework to evaluate the sufficiency of existing air data to answer an important public health question in Colorado: Do volatile organic compounds (VOCs) emitted into the air from oil and gas (OG) operations result in exposures to Coloradoans living at or greater than current state setback distances (500 feet) from OG operations at levels that may be harmful to their health? We identified 56 VOCs emitted from OG operations in Colorado and compiled 47 existing air monitoring datasets that measured these VOCs in 34 locations across OG regions. From these data, we estimated acute and chronic exposures and compared these exposures to health guideline levels using maximum and mean air concentrations. Acute and chronic non-cancer hazard quotients were below one for all individual VOCs. Hazard indices combining exposures for all VOCs were slightly above one. Lifetime excess cancer risk estimates for benzene were between 1.0 × 10−5–3.6 × 10−5 and ethylbenzene was 7.3 × 10−6. This evaluation identified a small sub-set of VOCs, including benzene and n-nonane, which should be prioritized for additional exposure characterization in site-specific studies that collect comprehensive time-series measurements of community scale exposures to better assess community exposures.