bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Flow Within Hospitals: A Conceptual Model
Authors: Leviner Sherry
Published: December 2019

Optimal patient flow minimizes waiting and is associated with quality healthcare. Emergency Department crowding is an indicator of poor patient flow and has been the focus of patient flow interventions. These interventions have failed to address interactions among components of the hospital. This has led to an incomplete understanding of why poor patient flow occurs and what is the best strategy for improving patient flow. The purpose of this article is to review the literature on the importance of good patient flow within hospitals and present a conceptual model of patient flow to guide research in this area.
α-Lipoic acid modulates liver fibrosis: A cross talk between TGF-β1, autophagy, and apoptosis
Authors: El-Maadawy WH , Hammam OA , Seif el-Din SH , El-Lakkany NM
Published: December 2019

Autophagy and apoptosis are important players in the progression of hepatic fibrosis via activation of hepatic stellate cells (HSCs). Despite the recently depicted antifibrotic effects of alpha-lipoic acid (ALA), however, its modulatory effects on HSCs autophagy remain unverified. Our study aimed to elucidate the underlying antifibrotic mechanisms through which ALA mediates HSC autophagy and apoptosis. Liver fibrosis was induced via thioacetamide (TAA) intoxication in rats; TAA-intoxicated rats were treated with either silymarin or ALA. Effect of ALA on biochemical parameters and immunohistopathological examinations was measured and compared to silymarin. ALA restored normal hepatic architecture (S1 vs. S4), liver functions, hepatic glutathione, and transforming growth factor-β1 levels. ALA ameliorated hepatic levels of malondialdehyde, platelet-derived growth factor, tissue inhibitor metalloproteinases-1, hydroxyproline, and expression of alpha-smooth muscle actin. Moreover, ALA significantly reduced messenger RNA expression of LC3-II genes and triggered caspase-3 expression. Interestingly, ALA exhibited superior activities over silymarin regarding suppression of proliferation, activation and autophagy of HSCs, collagen deposition, and induction of HSCs apoptosis. In conclusion, treatment of TAA-intoxicated rats with ALA inhibited autophagy and induced apoptotic clearance of activated HSCs. Accordingly, this study provides mechanistic insights into the possible applicability of ALA in the treatment of hepatic fibrosis.
What Do Nursing Students Tell Us About Their Communication With People With Mental Illness? A Qualitative Study
Authors: Yıldız Erman
Published: December 2019

Background:

Communication with individuals with mental disorder (IMDs) may often be a nonlinear, complex, and variable situation. In general, the first contact of nurses with IMDs occurs during training rotations at a psychiatric clinic. Psychiatric nursing students’ initial communication experiences with IMDs may be critical to their thinking of psychiatric nursing as a career.

Aim:

To determine the communication experiences of psychiatric nursing students with IMDs.

Method:

A qualitative interview study was conducted with psychiatric nursing students studying at a nursing faculty in the east of Turkey in 2019 who completed the clinical practice. Semistructured interviews were conducted by an independent researcher. The data were analyzed using content analysis with an inductive approach.

Results:

In this study, maximum effort was made for data saturation criteria, and data saturation was achieved with 26 students. As a result of the data analysis, four main themes and 11 categories were developed. The main themes were as follows: (1) restrictions caused by psychological barriers, (2) restrictions caused by thinking and perceptions, (3) restrictions caused by personal and behavioral barriers, and (4) effective communication and therapeutic environment.

Conclusions:

In this study, although it is seen that nursing students encounter many communication barriers with IMDs, it is an important development that they implement approaches to provide effective therapeutic communication. The results show the importance of effective nurse–patient communication skills as the first step in improving the clinical practice of nurses in psychiatry clinics.
Improving Kiribati educational outcomes: Capacity-building of school leaders and teachers using sustainable approaches and donor support
Authors: Owen Susanne M
Published: December 2019

Using effective models for continuing teacher and school leader education in developing countries is essential for long-term improvement of the education system and student outcomes. Instructional leadership approaches have been used to capacity-build school leaders, improving leader skills in working with teachers on classroom practices and also focusing on ongoing monitoring of student academic progress. Foreign aid frequently supports such initiatives concerned with turning around school systems in developing countries, with local ownership and integration within national frameworks being essential to ensure sustainability. This paper outlines a leadership programme and processes for Kiribati. Early findings and challenges are outlined within the context of instructional leadership models, as well as strategies used to address issues. The programme has relevance for other continuing education programmes in developing countries, especially within foreign aid situations.
Walking Refrains for Storied Movement
Authors: Powell Kimberly
Published: December 2019

In this article, I describe my narrative walking project, StoryWalks, as a methodology that underscores the concept of movement in relation to place-based narratives. I describe several community member’s walking narratives, theorizing movement through Deleuze and Guattari’s concept of the refrain and through Donna Haraway’s concept of storytelling as open signification and materialization in order to think about the various ways in which walking with stories is an entanglement of memories, place-based inquiry, history, future goals, and imaginings that matter for an ethnic and racial politics of place, identity, and belonging. I highlight storytelling through walking as an affective production of political, social, and cultural formations within communities.
Knowledge and perception differences towards generic medicines consumption among consumers
Authors: Dzulkipli Mohd Redhuan , Maon Siti Noorsuriani , Hassali Mohamed Azmi
Published: December 2019

The objective of this study was to evaluate the population behavioural influence towards generic medicines use in a Klang Valley. A self-administered questionnaire in the Klang Valley, Malaysia, was distributed conveniently. A total of 222 respondents have participated in the study (response rate 57.8%). The majority of the respondents (87.7%) have reported considerable amount of knowledge on the generic medicine availability in the market. In comparison of sociodemographic influence, only household size was found to influence the respondent’s knowledge and curiosity. For the perception, there was a statistically significant difference in attitude scores for respondents who had good level of knowledge (M = 3.322, SD = 0.516) and poor level of knowledge (M = 3.011, SD = 0.591) towards generic medicines; t(220) = –4.180, p < 0.05. In terms of subjective norms, data findings indicate a statistically significant difference in scores for respondents who had good level of knowledge (M = 3.456, SD = 0.704) and poor level of knowledge (M = 3.057, SD = 0.616) towards generic medicines; t(220) = –4.393, p < 0.05. Similarly, this study found a statistically significant difference in perceived behavioural control scores for respondents who had good level of knowledge (M = 3.605, SD = 0.548) and poor level of knowledge (M = 3.121, SD = 0.577) towards generic medicines; t(220) = –6.350, p < 0.05. Therefore, these results reveal that good level of knowledge really influence the level of perceptions among consumers of generic medicines. It is imperative that more initiatives to be introduced by the government to promote the practice to prescribe generic drugs to the population. The need to educate both health professionals and patients on the availability of the cheaper and bioequivalence medicine should be put into formality, thus increasing the awareness of the patient of the generic medicine and next reduce the dependency of the costlier innovator brand medicine in the prescription at both public and private healthcare settings.
Psychology Cannot Afford to Ignore the Many Harms Caused by Microaggressions
Authors: Williams Monnica T.
Published: December 2019

In an ongoing debate, Scott Lilienfeld (2019) continues to question the merits and meaning of microaggressions research. Key issues include how to define microaggressions, whether microaggressions cause measurable harm, whether microaggression education is helpful, and defining the most important next steps in the microaggressions research agenda. I discuss the importance of understanding microaggressions in context and as they relate to pathological stereotypes about groups, given that this is critical to identifying them. I summarize some of the many longitudinal studies linking psychological and medical problems to experiences of everyday discrimination. In addition, the literature indicates that victims of microaggressions experience further harms when trying to respond to offenders, but there is little research to support any specific interventions, including those advanced by Lilienfeld. I discuss the importance of believing and supporting those reporting experiences of microaggressions. I conclude that there is a need for more research examining (a) how to reduce the commission of microaggressions, (b) how to best respond to offenders in the moment in a way that mitigates harm for all persons involved, and (c) how clinicians can best help those who are suffering as a result of microaggressions as the next frontier in this important work.
Intersections of ISIS media leader loss and media campaign strategy: A visual framing analysis
Authors: Winkler Carol , El-Damanhoury Kareem , Saleh Zainab , Hendry John , El-Karhili Nagham
Published: December 2019

The decision to target leaders of groups like ISIS to hamper their effectiveness has served as a longstanding principle of counterterrorism efforts. Yet, previous research suggests that any results may simply be temporary. Using insights from confiscated ISIS documents from Afghanistan to define the media leader roles that qualified for each level of the cascade, CTC (Combating Terrorism Center) records to identify media leaders who died, and a content analysis of all ISIS images displayed in the group’s Arabic weekly newsletter to identify the group’s visual framing strategies, this study assesses whether and how leader loss helps explain changes in the level and nature of the group’s visual output over time. ISIS’s quantity of output and visual framing strategies displayed significant changes before, during, and after media leader losses. The level of the killed leader within the group’s organizational hierarchy also corresponded to different changes in ISIS’s media framing.
The Risk of Stroke and Stroke Type in Patients With Atrial Fibrillation and Chronic Kidney Disease
Authors: Mace-Brickman Trevor , Eddeen Anan Bader , Carrero Juan-Jesus , Mark Patrick B. , Molnar Amber O. , Lam Ngan N. , Zimmerman Deborah , Harel Ziv , Sood Manish M.
Published: December 2019

Background:

Atrial fibrillation (AF) and chronic kidney disease (CKD) are known to increase the risk of stroke.

Objectives:

We set out to examine the risk of stroke by kidney function and albuminuria in patients with and without AF.

Design:

Retrospective cohort study.

Settings:

Ontario, Canada.

Participants:

A total of 736 666 individuals (>40 years) from 2002 to 2015.

Measurements:

New-onset AF, albumin-to-creatinine ratio (ACR), and an estimated glomerular filtration rate (eGFR).

Methods:

A total of 39 120 matched patients were examined for the risk of ischemic, hemorrhagic, or any stroke event, accounting for the competing risk of all-cause mortality. Interaction terms for combinations of ACR/eGFR and the outcome of stroke with and without AF were examined.

Results:

In a total of 4086 (5.2%) strokes (86% ischemic), the presence of AF was associated with a 2-fold higher risk for any stroke event and its subtypes of ischemic and hemorrhagic stroke. Across eGFR levels, the risk of stroke was 2-fold higher with the presence of AF except for low levels of eGFR (eGFR < 30 mL/min/1.73 m2, hazard ratio [HR]: 1.38, 95% confidence interval [CI]: 0.99-1.92). Similarly across ACR levels, the risk of stroke was 2-fold higher except for high levels of albuminuria (ACR > 30 mg/g, HR: 1.61, 95% CI: 1.31-1.99). The adjusted risk of stroke with AF differed by combinations of ACR and eGFR categories (interaction P value = .04) compared with those without AF. Both stroke types were more common in patients with AF, and ischemic stroke rates differed significantly by eGFR and ACR categories.

Limitations:

Medication information was not included.

Conclusions:

Patients with CKD and AF are at a high risk of total, ischemic, and hemorrhagic strokes; the risk is highest with lower eGFR and higher ACR and differs based on eGFR and the degree of ACR.
The organizational social context in public healthcare as viewed by first-line nursing managers: A cross-sectional study
Authors: Viinikainen Sari , Rostila Ilmari , Green Philip , Asikainen Paula , Helminen Mika , Suominen Tarja
Published: December 2019

Different organizational climates and cultures appear within healthcare organizations and vary within their associated subgroups. The healthcare and nursing work environments have been studied from the individualistic perspectives rather than from organizational or nurse managers’ group perspectives. The aim of this cross-sectional study was to examine the differentiation of organizational social contexts in hospitals. The organizational social context (OSC) measurement system was used to assess characteristics of culture, climate and morale. The data have been statistically analyzed using within-group consistency (rwg), ANOVA-based eta-squared values and interclass correlation coefficient (ICC). The results revealed that at the divisional level, the organization’s social context is different.
Worsening of Self-Reported Symptoms Through Suggestive Feedback
Authors: van Helvoort Daniël , Otgaar Henry , Merckelbach Harald
Published: December 2019

Previous studies found that misleading feedback may increase self-reported symptoms. Does this reflect social demand or internalized misinformation? We investigated whether suggestive misinformation may escalate symptoms when it is provided in a context that minimizes social demand. Eighty participants completed the Checklist for Symptoms in Daily Life twice. Between test and retest, participants were given standardized symptom feedback through a bogus computer program that allegedly produced an analysis of their symptom ratings. The feedback pertained to randomly selected symptom ratings of participants: accurate feedback on four ratings (controls) and manipulated feedback (i.e., misinformation) on two other ratings (i.e., targets), which we increased by two full-scale points. Forty-nine (66%) participants accepted both target manipulations, of whom 35 (71%) confabulated explanations for the inflated ratings. Critically, at retest, participants who accepted the misinformation increased their ratings for target symptoms dramatically, whereas ratings for control symptoms and relevant ratings by participants who rejected the misinformation increased moderately. Our findings may help to understand iatrogenic effects of psychotherapy.
Harmonizing technological advances in phenomics and genomics for enhanced salt tolerance in rice from a practical perspective
Authors: Jaiswal Sarika , Gautam R. K. , Singh R. K. , Krishnamurthy S. L. , Ali S. , Sakthivel K. , Iquebal M. A. , Rai Anil , Kumar Dinesh
Published: December 2019

Half of the global human population is dependent on rice as a staple food crop and more than 25% increase in rice productivity is required to feed the global population by 2030. With increase in irrigation, global warming and rising sea level, rising salinity has become one of the major challenges to enhance the rice productivity. Since the loss on this account is to the tune of US$12 billion per annum, it necessitates the global attention. In the era of technological advancement, substantial progress has been made on phenomics and genomics data generation but reaping benefit of this in rice salinity variety development in terms of cost, time and precision requires their harmonization. There is hardly any comprehensive holistic review for such combined approach. Present review describes classical salinity phenotyping approaches having morphological, physiological and biochemical components. It also gives a detailed account of invasive and non-invasive approaches of phenomic data generation and utilization. Classical work of rice salinity QLTs mapping in the form of chromosomal atlas has been updated. This review describes how QTLs can be further dissected into QTN by GWAS and transcriptomic approaches. Opportunities and progress made by transgenic, genome editing, metagenomics approaches in combating rice salinity problems are discussed. Major aim of this review is to provide a comprehensive over-view of hitherto progress made in rice salinity tolerance research which is required to understand bridging of phenotype based breeding with molecular breeding. This review is expected to assist rice breeders in their endeavours by fetching greater harmonization of technological advances in phenomics and genomics for better pragmatic approach having practical perspective.
A T-DNA mutant screen that combines high-throughput phenotyping with the efficient identification of mutated genes by targeted genome sequencing
Authors: Frank Ulrike , Kublik Susanne , Mayer Dörte , Engel Marion , Schloter Michael , Durner Jörg , Gaupels Frank
Published: December 2019

Background

Nitrogen dioxide (NO2) triggers hypersensitive response (HR)-like cell death in Arabidopsis thaliana. A high-throughput mutant screen was established to identify genes involved in this type of programmed cell death.

Results

Altogether 14,282 lines of SALK T-DNA insertion mutants were screened. Growing 1000 pooled mutant lines per tray and simultaneous NO2 fumigation of 4 trays in parallel facilitated high-throughput screening. Candidate mutants were selected based on visible symptoms. Sensitive mutants showed lesions already after fumigation for 1 h with 10 ppm (ppm) NO2 whereas tolerant mutants were hardly damaged even after treatment with 30 ppm NO2. Identification of T-DNA insertion sites by adapter ligation-mediated PCR turned out to be successful but rather time consuming. Therefore, next generation sequencing after T-DNA-specific target enrichment was tested as an alternative screening method. The targeted genome sequencing was highly efficient due to (1.) combination of the pooled DNA from 124 candidate mutants in only two libraries, (2.) successful target enrichment using T-DNA border-specific 70mer probes, and (3.) stringent filtering of the sequencing reads. Seventy mutated genes were identified by at least 3 sequencing reads. Ten corresponding mutants were re-screened of which 8 mutants exhibited NO2-sensitivity or -tolerance confirming that the screen yielded reliable results. Identified candidate genes had published functions in HR, pathogen resistance, and stomata regulation.

Conclusions

The presented NO2 dead-or-alive screen combined with next-generation sequencing after T-DNA-specific target enrichment was highly efficient. Two researchers finished the screen within 3 months. Moreover, the target enrichment approach was cost-saving because of the limited number of DNA libraries and sequencing runs required. The experimental design can be easily adapted to other screening approaches e.g. involving high-throughput treatments with abiotic stressors or phytohormones.
Inhibition of type I interferon signaling abrogates early Mycobacterium bovis infection
Authors: Wang Jie , Hussain Tariq , Zhang Kai , Liao Yi , Yao Jiao , Song Yinjuan , Sabir Naveed , Cheng Guangyu , Dong Haodi , Li Miaoxuan , Ni Jiamin , Mangi Mazhar Hussain , Zhao Deming , Zhou Xiangmei
Published: December 2019

Background

Mycobacterium bovis(M. bovis) is the principal causative agent of bovine tuberculosis; however, it may also cause serious infection in human being. Type I IFN is a key factor in reducing viral multiplication and modulating host immune response against viral infection. However, the regulatory pathways of Type I IFN signaling duringM. bovisinfection are not yet fully explored. Here, we investigate the role of Type I IFN signaling in the pathogenesis ofM. bovisinfection in mice.

Methods

C57BL/6 mice were treated with IFNAR1-blocking antibody or Isotype control 24 h beforeM. bovisinfection. After 21 and 84 days of infection, mice were sacrificed and the role of Type I IFN signaling in the pathogenesis ofM. boviswas investigated. ELISA and qRT-PCR were performed to detect the expression of Type I IFNs and related genes. Lung lesions induced byM. boviswere assessed by histopathological examination. Viable bacterial count was determined by CFU assay.

Results

We observed an abundant expression of Type I IFNs in the serum and lung tissues ofM. bovisinfected mice. In vivo blockade of Type I IFN signaling reduced the recruitment of neutrophils to the lung tissue, mediated the activation of macrophages leading to an increased pro-inflammatory profile and regulated the inflammatory cytokine production. However, no impact was observed on T cell activation and recruitment in the early acute phase of infection. Additionally, blocking of type I IFN signaling reduced bacterial burden in the infected mice as compared to untreated infected mice.

Conclusions

Altogether, our results reveal that Type I IFN mediates a balance betweenM. bovis-mediated inflammatory reaction and host defense mechanism. Thus, modulating Type I IFN signaling could be exploited as a therapeutic strategy against a large repertoire of inflammatory disorders including tuberculosis.
Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication – an observational study in general practice
Authors: Faber Suzanne J. , Scherpbier Nynke D. , Peters Hans J. G. , Uijen Annemarie A.
Published: December 2019

Background

Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation.

Methods

We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1 and 6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥ 70 years, CKD, or heart failure. From this population, we selected patients with a ‘dehydration-risk’ episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in 3 months after the ‘dehydration-risk’ episode.

Results

We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 ‘dehydration-risk’ episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred.

Conclusions

Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during ‘dehydration-risk’ episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.
Assessment of β-human-derived chorionic gonadotrophic hormone (βhCG) and pregnancy-associated plasma protein A (PAPP-A) levels as predictive factors of preeclampsia in the first trimester among Iranian women: a cohort study
Authors: Honarjoo Maryam , Kohan Shahnaz , Zarean Elahe , Tarrahi Mohammad Javad
Published: December 2019

Background

Preeclampsia (PE) is a leading cause of maternal and perinatal mortality. There are controversial findings regarding the prediction of PE through the assessment of the Pregnancy-Associated Plasma Protein A (PAPP-A) and β-Human-Derived Chorionic Gonadotrophic hormone (βhCG) levels in the first trimester of pregnancy. Therefore, this cohort study was conducted to evaluate of PAPP-A and βhCG levels as predictive factors for PE development in the first trimester among Iranian women.

Methods

In this cohort study, a total of 4605 volunteer Primigravida and Multigravida women were selected by the census from 16 randomly selected Health Centers in Isfahan, Iran, from July 2016 to June 2018. Eligible pregnant women participated in the study had already undergone fetal anomalies screening tests between 11 + 0 and 13 + 6 weeks of pregnancy and their PAPP-A and βhCG biomarkers were adjusted to the Multiples of the Median (MOM). MOM PAPP-A <  0.4 and MOM βhCG > 3 were considered abnormal. The samples were followed up until delivery. The biomarkers’ levels were compared in the two groups of women with and without PE and Relative risk (RR) and odds ratio (OR) of PE calculated.

Results

In the PE group, the mean MOM PAPP-A was significantly lower (1 vs. 1.09 with P = 0.006) and MOM βhCG was significantly higher (1.51 vs. 1.14 with P = 0.001) than the group without PE. RR and OR for PE in subjects with MOM PAPP-A <  0.4 were reported as follows: RR = 2.49, (p = 0.001) and OR = 2.09, (p = 0.001). RR and OR for PE in subjects with MOM βhCG > 3 were also reported as follows: RR = 4.02, (p = 0.001) and OR = 5.65, (p = 0.001). Adjusted OR for MOM PAPP-A <  0.4 and MOM βhCG > 3 was obtained as follows: OR = 2.09 (P = 0.001) and OR = 5.65 (P = 0.001), respectively.

Conclusion

The results of the study showed that the high levels of βhCG would cause 5.65 times increase and the low levels of PAPP-A would cause 2.09 times increase in the chance of developing PE.
Maternal and perinatal outcomes of hypertensive disorders of pregnancy in Ethiopia: systematic review and meta-analysis
Authors: Mersha Amanual Getnet , Abegaz Tadesse Melaku , Seid Mohammed Assen
Published: December 2019

Background

Hypertensive disorders of pregnancy complicate around 6% of pregnancies and accounts for 19% of maternal death in Ethiopia. The current review aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Ethiopia.

Methods

A systematic review and meta-analysis was done on the outcome of hypertensive disorder among pregnant women in Ethiopia. Literature search was made in five databases and Statistical analyses were carried out by using Stata 14 software. The pooled prevalence of maternal death, HELLP syndrome, perinatal death, and low birth weight was calculated using a random-effects model. Egger’s test and funnel plot were used to evaluate publication bias. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies.

Result

Thirteen studies included in the review, with an overall sample size of 5894 women diagnosed to have hypertensive disorder of pregnancy. The pooled prevalence of maternal death was estimated to be 4% (95% CI: 2, 6%). The pooled prevalence of HELLP syndrome was 13% (95% CI: 10, 16%). Other complications such as pulmonary edema, kidney injury, hepatic injury, placental abruption, and aspiration pneumonia were also reported. Perinatal death was observed in one-fourth of women with HDP 25% (95% CI: 18, 32%). The pooled prevalence of low birth weight neonate in a woman with HDP is 37% (95% CI, 27, 48%).

Conclusions

In Ethiopia, the prevalence of perinatal and maternal mortality among pregnant women with one of the hypertensive disorders were found to be higher than rates reported from high income as well as most of the low and middle income countries. For instance, one in four of pregnancies complicated by hypertensive disorder end up in perinatal death in Ethiopia. HELLP syndrome, placental abruption, pulmonary edema, renal damage, prematurity, perinatal asphyxia, and low birth weight were also commonly reported. To improve the health outcomes of hypertensive disorders of pregnancy, it is recommended to improve utilization of maternal health service; early detection and early referral of pregnant women with hypertensive disorder; advocating policies and strategies that improves the quality of health care that a pregnant woman and her newborn receive.
Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis
Authors: Berta Marta , Lindgren Helena , Christensson Kyllike , Mekonnen Sollomon , Adefris Mulat
Published: December 2019

Background

It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor.

Method

The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis.

Results

We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2–34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839–30.396) minutes, with the same significant heterogeneity between the studies (I2 = 96.8%,p < 000).

Conclusion

The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position.

Prospero registration number

[CRD42019120618]
EGFR mutation: novel prognostic factor associated with immune infiltration in lower-grade glioma; an exploratory study
Authors: Hao Zhaonian , Guo Dongsheng
Published: December 2019

Background

Glioma is one of the most common type of primary central nervous system tumors. EGFR mutation, a common alteration occurs in various tumors, is not brought to the forefront in understanding and treating glioma at present.

Methods

In the present study, we demonstrated an immune infiltration related pattern of EGFR mutation in lower-grade glioma. In silico analyses were performed to investigate EGFR mutation and its biological effects and clinical values. GO and GSEA process were used as enrichment analysis. Infiltration levels of specific types of immune cells were estimated at TIMER database. Clinical data of patients were obtained from TCGA and were employed for survival analyses.

Results

Here we revealed that EGFR mutation leads to an up-regulation of immune response related pathways and dismal prognosis in lower-grade glioma. Infiltration of CD4+ T cells, neutrophils, macrophages, and dendritic cells were significantly increased in EGFR-mutant cases. Infiltration of specific types of immune cells were correlated with shorter survival time. PD-L1 was elevated in EGFR-mutant cases and correlated with infiltration level of CD4+ T cells, neutrophils and dendritic cells.

Conclusion

EGFR mutation indicates increasing infiltration of specific types of immune cells and poor prognosis in lower-grade glioma. Alteration of immune microenvironment since the EGFR mutation might influence the survival of glioma. We also provided a novel evidence and indicator of PD-1 inhibitor application in glioma.
Delays to diagnosis among people with severe mental illness in rural Vietnam, a population-based cross-sectional survey
Authors: Nguyen Trang , Tran Thach , Green Sally , Hsueh Arthur , Tran Tuan , Tran Ha , Fisher Jane
Published: December 2019

Background

People with severe mental illness (SMI) living in low and middle-income countries can experience extended delays to diagnosis, which hinder access to medical treatment. The aims of this study were to describe the interval to diagnosis among these people in rural Vietnam and its associated factors.

Methods

A population-based cross-sectional study was conducted among people with SMI in two provinces in Vietnam. The delay to diagnosis was defined as the time between the first abnormal behaviour being observed by family members and the formal diagnosis of psychosis. A multilevel linear regression was used to examine the factors associated with the delay to diagnosis.

Results

Among 404 people with SMI from 370 households, the median delay to diagnosis was 11.5 months (IQR 0–168.0). Overall, 53.7% had a delay to diagnosis of less than one year (95% CI: 48.81–58.54). The financial burden of these people on their families was nearly USD 470/year. After adjusting for other factors at individual and household levels, living in a Northern province; older age, and having psychotic diagnosis before the implementation of the National Community Mental Health program (2003) were associated with a delay of more than twelve months to diagnosis.

Conclusions

These data indicate that the implementation of a national policy for community-based care has been effective in reducing the delay to diagnosis in rural Vietnam. Therefore, there is a need for strengthening the program and mental health policies, focusing on public communication to improve mental health literacy and reduce stigma against SMI.
Dietary patterns of adults and their associations with Sami ethnicity, sociodemographic factors, and lifestyle factors in a rural multiethnic population of northern Norway - the SAMINOR 2 clinical survey
Authors: Petrenya Natalia , Rylander Charlotta , Brustad Magritt
Published: December 2019

Background

Few population-based studies have assessed dietary behaviors in the rural multiethnic population of Northern Norway. The present study determined dietary patterns and investigated their association with Sami ethnicity, sociodemographic factors, and lifestyle factors in a multiethnic population in rural Northern Norway.

Methods

This cross-sectional study included 4504 participants of the SAMINOR 2 Clinical Survey (2012–2014) aged 40–69 years. All participants completed a lifestyle and food frequency questionnaire. Dietary patterns were determined using principal component analysis. Associations between food patterns and ethnicity, sociodemographic factors, and lifestyle factors were examined by multiple linear regression.

Results

Six dietary patterns were identified that accounted for 28% of the variability in food intake in the study sample: ‘processed meat/westernized’, ‘fish/traditional’, ‘fruit/vegetables’, ‘reindeer/traditional’, ‘bread and sandwich spreads’, and ‘sweets and bakery goods’. The ‘reindeer/traditional’ pattern was most common among the inland Sami population. The ‘fish/traditional’ pattern was most common among costal multiethnic Sami and least common among inland Sami and among women independent of ethnicity. The ‘fish/traditional’ pattern was also positively associated with older age, high education level, small household size, and smoking. Adherence to the ‘processed meat/westernized’ pattern was lower among inland Sami than inland/coastal non-Sami; no ethnic differences in adherence to this pattern were found between costal multiethnic Sami and inland/coastal non-Sami. Unhealthy lifestyle factors, like low physical activity level and smoking, and younger age were mainly associated with the ‘processed meat/westernized’ pattern, whereas socioeconomic factors like low education, low gross annual household income, and large household size were related to the ‘sweets and bakery goods’ pattern. Male gender, low education level, and smoking were associated with the ‘bread and sandwich spreads’ pattern. The ‘fruit/vegetables’ pattern was characterized by healthy dietary choices and a health-conscious lifestyle, and was more common in women with a high education level and income.

Conclusions

Adherence to the six identified dietary patterns was characterized by different sociodemographic and lifestyle factors. Ethnicity, in combination with geographical region of residence, was associated with dietary behaviors. This study provides knowledge that will be useful in future studies on dietary patterns related to chronic diseases in the rural population of Northern Norway.
How does bridging social capital relate to health-behavior, overweight and obesity among low and high educated groups? A cross-sectional analysis of GLOBE-2014
Authors: Kamphuis Carlijn B. M. , Oude Groeniger Joost , Poelman Maartje P. , Beenackers Mariëlle A. , van Lenthe Frank J.
Published: December 2019

Background

Social capital is an important determinant of health, but how specific sub-dimensions of social capital affect health and health-related behaviors is still unknown. To better understand its role for health inequalities, it is important to distinguish between bonding social capital (connections between homogenous network members; e.g. similar educational level) and bridging social capital (connections between heterogeneous network members). In this study, we test the hypotheses that, 1) among low educational groups, bridging social capital is positively associated with health-behavior, and negatively associated with overweight and obesity, and 2) among high educational groups, bridging social capital is negatively associated with health-behavior, and positively with overweight and obesity.

Methods

Cross-sectional data on educational level, health-behavior, overweight and obesity from participants (25–75 years; Eindhoven, the Netherlands) of the 2014-survey of the GLOBE study were used (N = 2702). Social capital (“How many of your close friends have the same educational level as you have?”) was dichotomized as: bridging (‘about half’, ‘some’, or ‘none of my friends’), or bonding (‘all’ or ‘most of my friends’). Logistic regression models were used to study whether bridging social capital was related to health-related behaviors (e.g. smoking, food intake, physical activity), overweight and obesity, and whether these associations differed between low and high educational groups.

Results

Among low educated, having bridging social capital (i.e. friends with a higher educational level) reduced the likelihood to report overweight (OR 0.73, 95% CI 0.52–1.03) and obesity (OR 0.58, 95% CI 0.38–0.88), compared to low educated with bonding social capital. In contrast, among high educated, having bridging social capital (i.e. friends with a lower educational level) increased the likelihood to report daily smoking (OR 2.11, 95% CI 1.37–3.27), no leisure time cycling (OR 1.55, 95% CI 1.17–2.04), not meeting recommendations for vegetable intake (OR 2.09, 95% CI 1.50–2.91), and high meat intake (OR 1.39, 95% CI 1.05–1.83), compared to high educated with bonding social capital.

Conclusions

Bridging social capital had differential relations with health-behavior among low and high educational groups. Policies aimed at reducing segregation between educational groups may reduce inequalities in overweight, obesity and unhealthy behaviors.
Correction to: Circadian rhythm of COPD symptoms in clinically based phenotypes. Results from the STORICO Italian observational study
Authors:   on behalf of STORICO study group, Scichilone Nicola , Antonelli Incalzi Raffaele , Blasi Francesco , Schino Pietro , Cuttitta Giuseppina , Zullo Alessandro , Ori Alessandra , Canonica Giorgio Walter
Published: December 2019

Following publication of the original article [1], the authors flagged that the article had been provided with the names of the authors (not including the STORICO study group) in the wrong order: the ‘Given Names’ and Family Names’ were erroneously swapped around.
Immunomodulatory and anti-inflammatory effects of hydro-ethanolic extract of Ocimum basilicum leaves and its effect on lung pathological changes in an ovalbumin-induced rat model of asthma
Authors: Eftekhar Naima , Moghimi Ali , Mohammadian Roshan Nema , Saadat Saeideh , Boskabady Mohammad Hossein
Published: December 2019

Background

Ocimum species (Lamiaceae) has been traditionally used for treatment of upper respiratory tract infections, bronchitis, coughs, sore throat, and wound healing. The Immunomodulatory and anti-inflammatory effects of hydro-ethanolic extract of Ocimum basilicum (O. basilicum) leaves was examined in ovalbumin sensitized animals.

Methods

Wistar rats were divided to six groups; non-sensitized, sensitized to ovalbumin, sensitized and treated with dexamethasone (1.25 μg/mL), and O. basilicum extract (0.75, 1.50 and 3.00 mg/mL) in drinking water for 21 days. The levels of interleukin 4 (IL-4), interferon gamma (IFN-γ), IFN-γ/IL-4 ratio, immunoglobulin E (IgE), phospholipase A2 (PLA2) and total protein (TP) in BALF, and lung pathological changes were examined.

Results

A significant increase in IL-4, IgE, PLA2 and TP levels, all lung pathological indices as well as significant decrease in IFN-γ/IL-4 ratio was seen in the asthmatic compared to the control rats (P < 0.05 to P < 0.001). Treatment with O. basilicum extract resulted in decreased IL-4, IgE, PLA2 and TP levels, but increased IFN-γ/IL-4 ratio compared to untreated sensitized rats (P < 0.01 to P < 0.001). The plant significantly improved the pathological changes of sensitized rats (P < 0.05 to P < 0.01). The improvement effects of higher concentrations of the O. basilicum extract were significantly more than those of dexamethasone (P < 0.05 to P < 0.001).

Conclusion

The improvement effects of O. basilicum on pathological changes, immunological and inflammatory markers in sensitized rats comparable or even more potent than dexamethasone suggests the therapeutic potential of the plant in asthma.
Are physicians on the same page about do-not-resuscitate? To examine individual physicians’ influence on do-not-resuscitate decision-making: a retrospective and observational study
Authors: Chen Yen-Yuan , Su Melany , Huang Shu-Chien , Chu Tzong-Shinn , Lin Ming-Tsan , Chiu Yu-Chun , Lin Kuan-Han
Published: December 2019

Background

Individual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, thus influencing the practice of do-not-resuscitate (DNR) orders. The objective of this study was to examine the influence of individual attending physicians on signing a DNR order.

Methods

This study was conducted in closed model, surgical intensive care units in a university-affiliated teaching hospital located in Northern Taiwan. The medical records of patients, admitted to the surgical intensive care units for the first time between June 1, 2011 and December 31, 2013 were reviewed and data collected. We used Kaplan–Meier survival curves with log-rank test and multivariate Cox proportional hazards models to compare the time from surgical intensive care unit admission to do-not-resuscitate orders written for patients for each individual physician. The outcome variable was the time from surgical ICU admission to signing a DNR order.

Results

We found that each individual attending physician’s likelihood of signing do-not-resuscitate orders for their patients was significantly different from each other. Some attending physicians were more likely to write do-not-resuscitate orders for their patients, and other attending physicians were less likely to do so.

Conclusion

Our study reported that individual attending physicians had influence on patients’/surrogates’ do-not-resuscitate decision-making. Future studies may be focused on examining the reasons associated with the difference of each individual physician in the likelihood of signing a do-not-resuscitate order.
Impact evaluation of contracting primary health care services in urban Bangladesh
Authors: Albis Manuel Leonard F. , Bhadra Subrata K. , Chin Brian
Published: December 2019

Background

The Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership. The first phase of the project started in 1998 and the project is currently in its fourth phase covering more urban areas than the first three phases. This study evaluates the impact of the second phase project (UPHCP-II) on health outcomes, mainly child diarrhea, acute respiratory infection, antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections, and HIV/AIDS awareness.

Methods

The effect of the project was estimated through propensity score matching between project and non-project areas comparing baseline and endline surveys over a six-year period from 2006 to 2012. An innovation of this study is the recalibration of the sampling weights that allows the use of these two independent surveys in impact evaluation.

Results

Over the six-year period, UPHCP-II improved the health status of the population in project areas compared to non-project areas. The study found significant improvement in health outcomes in terms of reduced diarrhea and acute respiratory infection in children, which explains the downward trend in child mortality rate. Moreover, the project also improved antenatal care and skilled birth attendance. Contraceptive prevalence and HIV/AIDS awareness and avoidance increased, and sexually transmitted infections decreased.

Conclusions

UPHCP-II was effective in achieving its health outcome targets, while previous studies show that it was efficient in the delivery of health care and clients were highly satisfied because health facilities were in close proximity, and doctors and staff were perceived as responsive in delivering high quality of care. The results of this study could help inform future design and implementation of urban health interventions that involve contracting primary health care service delivery in Bangladesh and other similar settings.