bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of women, infant, and children (WIC) services on birth weight before and during the 2007–2009 great recession in Washington state and Florida: a pooled cross-sectional time series analysis
Authors: Blakeney Erin L. , Herting Jerald R. , Zierler Brenda Kaye , Bekemeier Betty
Published: April 2020

Background

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to have positive effects in promoting healthy birth outcomes in the United States. We explored whether such effects held prior to and during the most recent Great Recession to improve birth outcomes and reduce differences among key socio-demographic groups.

Methods

We used a pooled cross-sectional time series design to study pregnant women and their infants with birth certificate data. We included Medicaid and uninsured births from Washington State and Florida (n = 226,835) before (01/2005–03/2007) and during (12/2007–06/2009) the Great Recession. Interactions between WIC enrollment and key socio-demographic groupings were analyzed for binary and continuous birth weight outcomes.

Results

Our study found beneficial WIC interaction effects on birth weight. For race, prenatal care, and maternal age we found significantly better birth weight outcomes in the presence of WIC compared to those without WIC. For example, being Black with WIC was associated with an increase in infant birth weight of 53.5 g (baseline) (95% CI = 32.4, 74.5) and 58.0 g (recession) (95% CI = 27.8, 88.3). For most groups this beneficial relationship was stable over time.

Conclusions

This paper supports previous research linking maternal utilization of WIC services during pregnancy to improved birth weight (both reducing LBW and increasing infant birth weight in grams) among some high-disadvantage groups. WIC appears to have been beneficial at decreasing disparity gaps in infant birth weight among the very young, Black, and late/no prenatal care enrollees in this high-need population, both before and during the Great Recession. Gaps are still present among other social and demographic characteristic groups (e.g., for unmarried mothers) for whom we did not find WIC to be associated with any detectable value in promoting better birth weight outcomes. Future research needs to examine how WIC (and/or other maternal and child health programs) could be made to work better and reach farther to address persistent disparities in birth weight outcomes. Additionally, in preparation for future economic downturns it will be important to determine how to preserve and, if possible, expand WIC services during times of increased need.

Trial registration

Not applicable, this article reports only on secondary retrospective data (no health interventions with human participants were carried out).
Enhanced antitumor efficacy in colon cancer using EGF functionalized PLGA nanoparticles loaded with 5-Fluorouracil and perfluorocarbon
Authors: Wu Pingping , Zhou Qing , Zhu Huayun , Zhuang Yan , Bao Jun
Published: April 2020

Background

Tumor recurrence and metastasis occur at a high rate in patients with colon cancer. Identification of effective strategies for the treatment of colon cancer is critical. Recently, poly (lactic-co-glycolic acid) (PLGA) has been shown to have potential as a broad therapeutic drug delivery system. We designed a dual-loaded nanoparticle drug delivery system to overcome the limitations of chemotherapeutic drugs used to treat colon cancer.

Methods

We developed epidermal growth factor (EGF) functionalized PLGA nanoparticles (NPs) co-loaded with 5-fluorouracil (5Fu) and perfluorocarbon (PFC) (EGF-PLGA@5Fu/PFC) for targeted treatment of colon cancer. CCK-8 assay, Hoechst33342 staining and flow cytometry were performed to investigate the functions of EGF-PLGA@5Fu/PFC NPs in SW620 cells. Beside, animal experiment, histological analysis and immunofluorescence staining were adopted to further confirm the role of EGF-PLGA@5Fu/PFC NPs in vivo.

Results

The findings showed that EGF-PLGA@5Fu /PFC NPs had an average size 200 nm and a 5Fu-loading efficiency of 7.29%. Furthermore, in vitro release was pH-sensitive. Targeted EGF-PLGA@5Fu/PFC NPs exhibited higher cellular uptake than non-targeted NPs into colon cancer cells. In addition, EGF-PLGA@5Fu/PFC NPs suppressed cell viability and induced apoptosis in SW620 cells to a greater extent than non-targeted NPs. In tumor xenografted mice, EGF-PLGA@5Fu/PFC NPs suppressed tumor growth more effectively than 5Fu, PLGA@5Fu or PLGA@5Fu/PFC NPs. Histopathological analysis further demonstrated that EGF-targeted NPs inhibited tumor growth to a greater extent than non-targeted or non-NP treatments. The improved therapeutic outcomes observed in this study were due to relief of tumor hypoxia by transport of oxygen by PFC to the tumors.

Conclusion

We constructed a biocompatible nanodrug delivery system based on functionalized nanoparticles that provided a novel strategy for selective delivery of chemotherapy drugs to tumors.
Outcomes after traffic injury: mental health comorbidity and relationship with pain interference
Authors: Pozzato I. , Craig A. , Gopinath B. , Kifley A. , Tran Y. , Jagnoor J. , Cameron I. D.
Published: April 2020

Background

Mental health symptoms, like depressive mood (DM) and post-traumatic stress (PTS), and pain interference (PI) with daily functioning often co-occur following traffic injury and their comorbidity can complicate recovery. This study aimed to map the course and overlapping trajectories of mental health symptoms, and associations with PI in a traffic injury population.

Methods

In total, 2019 adults sustaining minor-to-moderate traffic injury were recruited within 28 days post-injury and assessed using phone interviews at 1, 6 and 12-months post-injury. Trajectories of DM, PTS and PI were established and relationships between DM, PTS and PI trajectories were explored using dual trajectory modelling. Bio-psychosocial predictors (e.g. pre-injury health, catastrophizing, acute distress, quality of life, social support) of mental health trajectories were investigated.

Results

Up to five typical post-trauma trajectories were identified for DM, PTS and PI. Most people were in a resilient mental health trajectory (over 60%, DM or PTS), or in a chronic PI trajectory (almost 60%) 12 months post-injury. While recovery/resilient mental health trajectories were strongly interrelated (73.4% joint probability and > 94% conditional probabilities), DM/PTS comorbidity in chronic trajectories was not straightforward, suggesting a possibly asymmetric relationship. That is, persistent DM was more likely associated with persistent PTS (90.4%), than vice versa (31.9%), with a 22.5% probability that persistent PTS was associated with none or milder depression (i.e. following a recovery/resilient DM trajectory). An asymmetrical relationship was also found between mental health and PI. The majority of those with persistent PI were likely to be in a recovery/resilient DM/PTS trajectory (almost 70%), but those in a non-resilient DM/PTS trajectory showed a high risk of persistent PI. Predictors of non-resilient mental health trajectories included poorer pre-injury health and social support, and shared factors like acute psychological distress and pain catastrophizing.

Conclusions

Strong interrelations were confirmed between mental health symptoms and PI following traffic injury. However, persistent DM was more strongly linked to persistent PTS, than vice versa. Persistent PI was only linked with persistent DM/PTS in vulnerable subgroups. Early psychiatric/psychological interventions should target elevated psychological distress and negative appraisals in vulnerable individuals, to reduce long-term mental health morbidity/comorbidity and PI.

Trial registration

ACTRN12613000889752.
Reliability, validity and measurement invariance of the Simplified Medication Adherence Questionnaire (SMAQ) among HIV-positive women in Ethiopia: a quasi-experimental study
Authors: Agala Chris B. , Fried Bruce J. , Thomas James C. , Reynolds Heidi W. , Lich Kristen Hassmiller , Whetten Kathryn , Zimmer Catherine , Morrissey Joseph P.
Published: April 2020

Background

Adherence to antiretroviral therapy is critical to the achievement of the third target of the UNAIDS Fast-Track Initiative goals of 2020–2030. Reliable, valid and accurate measurement of adherence are important for correct assessment of adherence and in predicting the efficacy of ART. The Simplified Medication Adherence Questionnaire is a six-item scale which assesses the perception of persons living with HIV about their adherence to ART. Despite recent widespread use, its measurement properties have yet to be carefully documented beyond the original study in Spain. The objective of this paper was to conduct internal consistency reliability, concurrent validity and measurement invariance tests for the SMAQ.

Methods

HIV-positive women who were receiving ART services from 51 service providers in two sub-cities of Addis Ababa, Ethiopia completed the SMAQ in a HIV treatment referral network study between 2011 and 2012. Two cross-sections of 402 and 524 female patients of reproductive age, respectively, from the two sub-cities were randomly selected and interviewed at baseline and follow-up. We used Cronbach’s coefficient alpha (α) to assess internal consistency reliability, Pearson product-moment correlation (r) to assess concurrent validity and multiple-group confirmatory factor analysis to analyze factorial structure and measurement invariance of the SMAQ.

Results

All participants were female with a mean age of 33; median: 34 years; range 18–45 years. Cronbach’s alphas for the six items of the SMAQ were 0.66, 0.68, 0.75 and 0.75 for T1 control, T1 intervention, T2 control, and T2 intervention groups, respectively. Pearson correlation coefficients were 0.78, 0.49, 0.52, 0.48, 0.76 and 0.80 for items 1 to 6, respectively, between T1 compared to T2. We found invariance for factor loadings, observed item intercepts and factor variances, also known as strong measurement invariance, when we compared latent adherence levels between and across patient-groups.

Conclusions

Our results show that the six-item SMAQ scale has adequate reliability and validity indices for this sample, in addition to being invariant across comparison groups. The findings of this study strengthen the evidence in support of the increasing use of SMAQ by interventionists and researchers to examine, pool and compare adherence scores across groups and time periods.
The characteristics of influenza-like illness management in Japan
Authors: Tsuzuki Shinya , Yoshihara Keisuke
Published: April 2020

Background

This study aimed to make a quantitative assessment of the management of influenza-like illnesses (ILI) in Japanese healthcare settings.

Methods

We analysed participants’ healthcare-seeking behaviour and physicians’ practice in January 2019 using an online survey of 200 households in Japan. Quality of life score, quality-adjusted life years lost, the duration of symptoms, and the duration of absence from work were compared between the influenza ILI group and the non-influenza ILI group with one-to-one propensity score matching. Missing data were imputed using multiple imputation.

Results

In total, 261 of the 600 (43.5%) participants had at least one episode of influenza-like illness during January 2019. Of these, 194 (75.5%) visited healthcare facilities, 167 (86.1%) within 2 days of onset of symptoms. A total of 169 out of 191 (88.5%) received a rapid influenza diagnostic test and 101 were diagnosed with influenza, of whom 95.0% were treated with antivirals. The median quality-adjusted life-years (QALYs) lost was 0.0055 (interquartile range, IQR 0.0040–0.0072) and median absence from work for a single episode of influenza-like illness was 2 days (IQR 1–5 days). Albeit QALYs lost per episode was not different between two groups, the influenza ILI group showed longer duration of absence from work (5 days, IQR 4–6 days) than the non-influenza ILI group (2 days, IQR 1–3 days).

Conclusions

In Japan, most people with influenza-like illnesses visit healthcare facilities soon after symptoms first occur and receive a diagnostic test. Those with influenza are usually treated with antivirals. Absence from work was longer for influenza than other similar illnesses.
Exploring food insecurity and obesity in Dutch disadvantaged neighborhoods: a cross-sectional mediation analysis
Authors: van der Velde Laura A. , Nyns Claire J. , Engel Marije D. , Neter Judith E. , van der Meer Irene M. , Numans Mattijs E. , Kiefte-de Jong Jessica C.
Published: April 2020

Background

Food insecurity is related to risk of adverse health outcomes such as obesity, but the explanatory factors underlying this association are still unclear. This study aimed to assess the association between food insecurity and obesity, and to explore potential mediation by sociodemographic and lifestyle factors.

Methods

This cross-sectional study was conducted among 250 participants in a deprived urban area in the Netherlands. Data on sociodemographic and lifestyle factors, food insecurity status and diet quality were collected using questionnaires. Diet quality was determined based on current national dietary guidelines. BMI was calculated from self-reported height and weight. Regression analyses were performed to explore the association between food insecurity and BMI status. Mediation analyses were performed to estimate the total-, direct-, and indirect effect and proportion of total effect mediated of the food insecurity-obesity association.

Results

The overall prevalence of food insecurity was 26%. Food insecurity was associated with obesity (OR = 2.49, 95%CI = 1.16, 5.33), but not with overweight (OR = 1.15, 95%CI = 0.54, 2.45) in the unadjusted model. The food insecurity-obesity association was partially mediated by living situation (proportion mediated: 15.4%), diet quality (− 18.6%), and smoking status (− 15.8%) after adjustment for other covariates.

Conclusions

The findings of this study suggest an association between food insecurity and obesity. Living situation, diet quality and smoking status explained part, but not all, of the total association between food insecurity and obesity. Future longitudinal studies are warranted to examine the temporal order of the food insecurity-obesity association and potential mediators in this relationship. In addition, food insecurity and its potential consequences need to be taken into account in obesity prevention programs and policies.
Diverting blame to stay sane - young people’s strategies for dealing with the mental health effects of precarious employment: a grounded theory study
Authors: Toivanen Susanna , Tarantino Anna Olofsson , Emmelin Maria , Östergren Per-Olof
Published: April 2020

Background

Precarious employment is a risk factor for poor mental health, particularly among young adults. Knowledge about how young people maintain their mental health while in a precarious employment situation is scarce. The aim of the study was to explore the meaning of precarious employment for young adults in Sweden and their strategies for maintaining good mental health.

Methods

In-depth interviews were conducted with 15 individuals (9 men and 6 women) aged 20–39 years in a precarious employment situation. Contact persons at union offices and at specific job-coaching organizations collaborating with the Swedish public employment agency in the city of Malmö were gate openers to reach informants. Analysis was based on constructivist grounded theory, implying an emergent design where data collection and analysis go hand in hand.

Results

All informants had completed secondary school in Sweden, and one third had studied at the university level. A majority currently had jobs; however, they were mostly employed on an hourly basis and only a few had temporary full-time jobs. The analysis resulted in a core category “Diverting blame to stay sane,” which summarized an emergent coping process involving individual resources and resources represented by the individuals’ social capital. The developed theoretical model contained four main categories, “Facing reality,” “Losing control,” “Adapting,” and “Fighting back,” related to the core category.

Conclusions

The results implied a process where the challenges created by loss of employment-based rights required a coping process where the individual’s social capital plays an important role. However, social capital is to a large extent determined by contextual factors, underlining the strong health equity aspect of precarious employment.
The dynamics of decision-making in weight loss and maintenance: a qualitative enquiry
Authors: Poltawski Leon , van Beurden Samantha Barbara , Morgan-Trimmer Sarah , Greaves Colin
Published: April 2020

Background

Behavioural approaches to weight loss are often initially successful but less so in the longer term, as some people maintain the necessary behaviour changes while others do not. This study aimed to derive possible explanations for this using a qualitative approach with a view to improving intervention effectiveness.

Methods

Thirty-six participants in a development and feasibility study for a weight loss and maintenance intervention (called SkiM) were interviewed three times over 18 months regarding their experiences before, during and after the intervention. Data were analysed thematically. The accounts of those who were more and less successful in terms of longer term weight loss were compared, and a conceptual model linking the main analytic themes was developed.

Results

Five interpretative themes were generated: encountering and managing key situations; the impact of emotion; the source of control; personal values; and acquiring knowledge and skills. These themes were linked through a model of decision-making during key situations. In this model, behavioural decisions emerge from a dynamic interplay between several drivers: emotional state and needs, perceived control, personal values, the individual’s knowledge and skills, and their existing habits. The individual’s response in key situations generates experiential learning that can influence decisional dynamics in similar situations in future. These dynamics appeared to differ between participants, and between those who were more and less successful in weight management.

Conclusions

Our analysis and model of decision-making during weight-management have implications for the development and delivery of behavioural weight management interventions. By helping individuals to identify the drivers of their decision-making in key situations, and equipping them to manage these drivers, programmes may enhance their capacity to sustain the behaviour changes needed for long-term weight loss.
Association between social capital and mental health among older people living with HIV: the Sichuan Older HIV-Infected Cohort Study (SOHICS)
Authors: Han Jiayu , Jia Peng , Huang Yuling , Gao Bo , Yu Bin , Yang Shifan , Yu Jun , Xiong Jun , Liu Chang , Xie Tian , Dong Peijie , Yang Chao , Wang Zixin , Yang Shujuan
Published: April 2020

Background

Mental health problems are common among older people living with HIV and associated with poorer health outcomes. Social capital is an important determinant of mental health problems but under-studied in this population. This study investigated the association between social capital and mental health problems among older people living with HIV in China.

Methods

The study was based on the baseline data of a cohort study investigating mental health among older people living with HIV in Sichuan, China during November 2018 to February 2019. Participants were people living with HIV aged ≥50 years living in Sichuan province. Stratified multi-stage cluster sampling was used to recruit participants from 30 communities/towns; 529 out of 556 participants being approached completed the face-to-face interview. Social capital was measured by two validated health-related social capital scales: the Individual and Family scale and the Community and Society scale. Presence of probable depression (CES-D-10 score ≥ 10) and probable anxiety (GAD-7 score ≥ 5) were used as dependent variables. Two-level logistic regression models were applied to examine the association between social capital and probable depression/anxiety.

Results

The prevalence of probable depression and probable anxiety was 25.9% (137/529) and 36.3% (192/529), respectively. After adjusting for significant covariates, the individual/family level of social capital was inversely associated with both probable depression (odds ratios (OR): 0.89, 95% CI: 0.84–0.93, p < 0.001) and probable anxiety (OR: 0.90, 95% CI: 0.86–0.95, p < 0.001). The community/society level social capital was associated with probable depression (OR: 0.91, 95% CI: 0.84–0.99, p < 0.001) but not probable anxiety (p > 0.05).

Conclusions

Interventions building up social capital should be considered to improve mental health of older people living with HIV. Some useful strategies include cognitive processing therapy, improving community networking and engagement, and promoting social bonding with neighborhood.
Diagnosis of avulsion fractures of the distal fibula after lateral ankle sprain in children: a diagnostic accuracy study comparing ultrasonography with radiography
Authors: Takakura Yoshiyuki , Yamaguchi Satoshi , Akagi Ryuichiro , Kamegaya Makoto , Kimura Seiji , Tanaka Hirofumi , Yasui Tetsuro
Published: April 2020

Background

The purpose of this study was to determine the diagnostic accuracy of ultrasonography for the diagnosis of avulsion fractures of the distal fibula for lateral ankle sprain in children and compare it to that of radiography.

Methods

Children who sustained lateral ankle sprain were prospectively surveyed. They underwent both ultrasonography and radiography at the first clinic visit to diagnose any concomitant avulsion fractures of the distal fibula. The patients underwent follow-up radiography 4 weeks later to obtain the reference standard diagnosis. The measures of diagnostic accuracy (i.e., sensitivity, specificity, positive predictive value, and negative predictive value) of the initial ultrasonography and radiography were calculated; they were then compared using the McNemar test. Totally, 52 patients (with a median age of 9 years) were analyzed.

Results

On the reference standard (follow-up) radiographs, 32 patients (62%) were found to have avulsion fractures of the distal fibula. The sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 94, 85, 91, and 89% respectively; and 81, 100, 100, and 77% respectively for radiography at the first visit. There were no significant differences in sensitivity and specificity between the two diagnostic methods (P = 0.22, 0.25).

Conclusions

Ultrasonography has a high diagnostic accuracy, which is comparable to that of radiography, for the diagnosis of avulsion fracture of the distal fibula. Ultrasonography may be used as an option of imaging modality for lateral ankle sprain in children.
Management of complex renal cysts in Canada: results of a survey study
Authors: Couture Félix , Finelli Antonio , Tétu Amélie , Bhindi Bimal , Breau Rodney H. , Kapoor Anil , Kassouf Wassim , Lavallée Luke , Tanguay Simon , Violette Philippe D. , Richard Patrick O.
Published: April 2020

Background

Bosniak III and IV cysts have a high risk of malignancy and have traditionally been managed surgically. However, growing evidence suggests that many can be managed by active surveillance. The main objective of this study was to characterize the use of surveillance in the management of complex renal cysts.

Methods

A web-based survey was sent to all registered, active members of the Canadian Urological Association (N = 583) in October 2018.

Results

The survey response rate was 24.7%. Management of Bosniak III cysts varied considerably. A large proportion of respondents (33.1%) offered active surveillance in > 50% of cases. Only 13.7% of respondents reported never or rarely (< 5% of cases) offering surveillance. In contrast, for Bosniak IV cysts, 60.1% of urologists never or rarely offered surveillance, while only 10.1% offer it in > 50% of cases. A significantly greater proportion of academic urologists, compared to non-academic urologists, viewed surveillance as a management option for patients with a Bosniak III or IV cyst. The most commonly reported barriers to a greater adoption of surveillance were concerns regarding its oncologic safety, the lack of data to support surveillance in this population, and the lack of triggers for discontinuation of active surveillance and intervention.

Conclusions

Despite active surveillance being included as a management option in guidelines, many Canadian urologists are reluctant to offer surveillance to patients with Bosniak III or IV cysts. Practice patterns are heterogeneous among those offering surveillance. High-quality studies are required to better define the benefits and risks of cystic renal mass surveillance.
Comparison of three-dimensional printing guides and double-layer guide plates in accurate bracket placement
Authors: Zhang Yue , Yang Chunhao , Li Yanfeng , Xia Dong , Shi Tingting , Li Changjian
Published: April 2020

Background

In the current study, we aimed to evaluate the accuracy of indirect bonding by either three-dimensional (3D) printing guides or double-layer guide plates. The results may serve as a clinical reference for bracket placements.

Methods

In total, 140 teeth were collected and arranged into five pairs of full dentition. The marking points were labeled on the buccal/labial surface of the crown in these orthodontic study models. (1) 3D printing guide: A digital profile was generated using an intraoral scanner. Two types of indirect bonding guide, namely the whole denture type and the single tooth type, were designed with the 3Shape TRIOS® Standard intraoral scanner and fabricated using 3D printing technology. (2) Double-layer guide plate: A working model was obtained by replicating the experimental models, and the double-layer guide plate was then made of the inner layer soft film (1.0 mm thickness) and the outer layer hard film (0.6 mm or 0.8 mm thickness). Brackets were transferred from working models to study models by the indirect bonding trays. We measured and analyzed the distance between marking points and bracket placement. Statistical analysis was done using SPSS 20.0 software. The accuracy of indirect bonding between 3D printing guide and double-layer guide plate was compared using paired t-test.

Results

According to our data, there was a significant difference between the 0.6 mm group and 0.8 mm group when the brackets were indirectly adhered using double-layer guide plates (p = 0.036). However, no statistical significance in bracket positioning accuracy was revealed between two types of 3D printing guide (p = 0.078), as well as between the 3D printing guide group and the 0.6 mm double-layer guide plate group (p = 0.069).

Conclusions

When applying double-layer guide plates for indirect bonding, the 0.6 mm group is more accurate than the 0.8 mm group. When utilizing 3D printing guides for indirect bonding, whole denture type is more accessible than single tooth type but with no significant difference in accuracy. The accuracy of indirect bonding is comparable when using 3D printing guides (whole denture type) and double-layer guide plates (0.6 mm).
Belief in and use of traditional Chinese medicine in Shanghai older adults: a cross-sectional study
Authors: Xin Benlu , Mu Siyu , Tan Teckkiang , Yeung Anne , Gu Danan , Feng Qiushi
Published: April 2020

Background

Traditional medicine is broadly used across Asian societies for various medical conditions and health concerns. However, there remains a wide disparity between users and non-use, which makes it imperative to understand the factors affecting the lay perception and utilization of traditional medicine. This study systematically examined the demographic, medical, and socioeconomic factors affecting belief in and use of traditional medicine among older adults of Shanghai, China.

Methods

We used the data from Survey of Life and Opinion on Shanghai Older Adults in 2013 with a sample of 3418 older adults aged 50 years or older. The multilevel logistic models were applied to examine the associations between faith and utilization of traditional medicine and a set of factors of the respondents, including demographics (gender, age, rural/urban residence), socioeconomic status (educational attainment, income, primary occupation), social support (marital status, social network), and disease/conditions. The associations between individual use of traditional medicine and the profile of socioeconomic development and the medical services conditions of local communities were also modelled.

Results

We found that cardiovascular diseases, lung diseases, cancer, prostatitis, arthritis, and nervous system diseases were positive correlates for using traditional medicine. Older adults who had a cancer, a prostatitis, or a fracture had more faith in traditional treatment. Rural living, higher educational attainment, and white-collar occupation promoted the use of traditional medicine. A higher number of strong social ties and a tie connected with medical staff were positive factors of use as well.

Conclusion

The belief in and use of traditional medicine were prevalent among older adults in Shanghai, China. Though not conclusive, our study suggested that traditional medicine in China appears to serve two distinct functions, namely complementary medicine for those socioeconomically advantaged whereas alternative medicine for those socioeconomically disadvantaged.
Preparing undergraduate students for clinical work in a complex environment: evaluation of an e-learning module on physiotherapy in the intensive care unit
Authors: Major Mel E. , Ramaekers Stephan P. J. , Engelbert Raoul H. H. , Van der Schaaf Marike
Published: April 2020

Background

Intensive Care Units (ICUs) are daunting environments for physiotherapy (PT) students performing clinical rotations. To prepare students for this environment, a newly developed, evidence-based e-learning module was designed and implemented in the undergraduate curriculum. The aim of this study was to investigate whether e-learning is a feasible method in preparing PT students for clinical work in complex ICU environments, as perceived by students and experts.

Methods

A mixed methods proof of concept study was undertaken. Participants were final-year students of an international curriculum, and experts from didactic and clinical fields. An e-learning module consisting of 7 separate chapters based on the latest scientific evidence and clinical expertise was developed, piloted and incorporated into the undergraduate curriculum as a compulsory course to be completed prior to clinical ICU rotations. Data were collected through 3 focus group meetings and 5 semi-structured interviews; these meetings and interviews were audio recorded, transcribed verbatim and analyzed.

Results

The study sample comprised of 14 students and 5 experts. Thematic analysis revealed three themes: expected competencies of PT students in ICU, feeling prepared for ICU clinical work and dealing with local variety. The e-learning module enabled students to anticipate clinical situations and PT tasks in the ICU. Higher level clinical reasoning skills, handling of lines and wires and dealing with out-of-textbook situations could not be achieved with the e-learning module alone.

Conclusions

An e-learning module can sufficiently prepare PT students for their clinical tasks in the ICU, as long as it is integrated with, or closely connected to, the students’ clinical placement.
Effect of guided counseling on nutritional status of pregnant women in West Gojjam zone, Ethiopia: a cluster-randomized controlled trial
Authors: Demilew Yeshalem Mulugeta , Alene Getu Degu , Belachew Tefera
Published: April 2020

Background

Undernutrition during pregnancy affects birth outcomes adversely. In Ethiopia, despite nutrition counseling on the maternal diet being given by the health workers during pregnancy, maternal undernutrition is still high in the country. Hence, this study aimed to assess the effect of guided counseling using the health belief model and the theory of planned behavior on the nutritional status of pregnant women.

Methods

A two-arm parallel cluster randomized controlled community trial was conducted in West Gojjam Zone, Ethiopia, from May 1, 2018, to April 30, 2019. The nutritional status of the women was assessed using mid-upper arm circumference. A total of 694 pregnant women were recruited from the intervention (n=346 ) and control (n=348) clusters. Of which endline data were collected from 313 and 332 pregnant women in the intervention and control clusters, respectively. The intervention was started before 16 weeks of gestation and pregnant women in the intervention group attended 4 counseling sessions. Counseling was given at the participants’ homes using a counseling guide with the core contents of the intervention. Leaflets with appropriate pictures and the core messages were given for women in the intervention arm.

Women in the control group got the routine nutrition education given by the health care system. Data were collected using interviewer administered structured questionnaires and mid-upper arm circumference was measured using an adult MUAC tape. Descriptive statistics  and linear mixed-effects model were used to assess the intervention effect after adjusting for potential confounders.

Results

After the intervention, the prevalence of undernutrition was 16.7% lower in the intervention group compared with the control arm (30.6% Vs 47.3%,P = < 0.001). Women in the intervention group showed significant improvement in nutritional status at the end of the trial than the control group (β = 0.615,p = < 0.001).

Conclusion

This study demonstrated that guided counseling using the health belief model and the theory of planned behavior was effective in improving the nutritional status of pregnant women. The results imply the need for the design of model and theory based nutrition counseling guidelines. The trial was registered in Clinical Trials.gov (NCT03627156).
NEK10 interactome and depletion reveal new roles in mitochondria
Authors: Peres de Oliveira Andressa , Basei Fernanda Luisa , Slepicka Priscila Ferreira , de Castro Ferezin Camila , Melo-Hanchuk Talita D. , de Souza Edmarcia Elisa , Lima Tanes I. , dos Santos Valquiria Tiago , Mendes Davi , Silveira Leonardo Reis , Menck Carlos Frederico Martins , Kobarg Jörg
Published: April 2020

Background

Members of the family of NEK protein kinases (NIMA-related kinases) were described to have crucial roles in regulating different aspects of the cell cycle. NEK10 was reported to take part in the maintenance of the G2/M checkpoint after exposure to ultraviolet light. NEK1, NEK5, NEK2 and NEK4 proteins on the other hand have been linked to mitochondrial functions.

Methods

HEK293T cells were transfected with FLAG empty vector or FLAG-NEK10 and treated or not with Zeocin. For proteomic analysis, proteins co-precipitated with the FLAG constructs were digested by trypsin, and then analyzed via LC-MS/MS. Proteomic data retrieved were next submitted to Integrated Interactome System analysis and differentially expressed proteins were attributed to Gene Ontology biological processes and assembled in protein networks by Cytoscape. For functional, cellular and molecular analyses two stable Nek10 silenced HeLa cell clones were established.

Results

Here, we discovered the following possible new NEK10 protein interactors, related to mitochondrial functions: SIRT3, ATAD3A, ATAD3B, and OAT. After zeocin treatment, the spectrum of mitochondrial interactors increased by the proteins: FKBP4, TXN, PFDN2, ATAD3B, MRPL12, ATP5J, DUT, YWHAE, CS, SIRT3, HSPA9, PDHB, GLUD1, DDX3X, and APEX1. We confirmed the interaction of NEK10 and GLUD1 by proximity ligation assay and confocal microscopy. Furthermore, we demonstrated that NEK10-depleted cells showed more fragmented mitochondria compared to the control cells. The knock down of NEK10 resulted further in changes in mitochondrial reactive oxygen species (ROS) levels, decreased citrate synthase activity, and culminated in inhibition of mitochondrial respiration, affecting particularly ATP-linked oxygen consumption rate and spare capacity. NEK10 depletion also decreased the ratio of mtDNA amplification, possibly due to DNA damage. However, the total mtDNA content increased, suggesting that NEK10 may be involved in the control of mtDNA content.

Conclusions

Taken together these data place NEK10 as a novel regulatory player in mitochondrial homeostasis and energy metabolism.
Association between social health status and health-related quality of life among community-dwelling elderly in Zhejiang
Authors: Lu Jieming , Yu Zhebin , Zhang Xiaocong , Wu Mengyin , Lin Shujuan , Zhu Yao , Xu Zenghao , You Liuqing , Wei Fang , Tang Mengling , Jin Mingjuan , Wang Jianbing , Chen Kun
Published: April 2020

Background

Population aging is an inevitable trend and previous studies have showed the relationship between social health related factors and health-related quality of life (HR-QOL) in the elderly. The objective of this study is to investigate the association of social health status with HR-QOL among community-dwelling elderly in Zhejiang.

Methods

This cross-sectional study was based on community-dwelling elderly individuals from July 2018 to September 2018 in Zhejiang, China. HR-QOL was measured by the 12-item Short-Form Health Survey (SF-12). Social health status was estimated by the long-form of the Social Health Scale for the Elderly (SHSE-L) and classified into three categories (poor, moderate and good). Multivariable linear regression models were conducted to evaluate the association between social health status and HR-QOL (PCS, MCS and SF-12 total score).

Results

A total of 2952 elderly participants were included in this study. The mean age was 70.68 ± 7.75 years (mean ± SD); of the eligible participants, more than half (50.4%) were females; the mean scores were 48.10 ± 8.49, 47.70 ± 7.09 and 47.90 ± 5.86 for PCS, MCS and SF-12 total score, separately. Results from the multivariable models showed that social health status was positively related to HR-QOL after adjusting for covariates. Compared with individuals with a poor social health status, those who had a moderate or good social health status were more likely to report better HR-QOL (for moderate social health status: β = 1.90(95%CI: 1.09, 2.71) for PCS, β = 1.78(1.08, 2.48) for MCS, β = 1.84(1.29, 2.39) for SF-12 total score; for good social health status: β = 3.29(2.24, 4.34) for PCS, β = 3.10(2.12, 4.01) for MCS, β = 3.20(2.48, 3.91) for SF-12 total score).

Conclusion

In our study, we found that social health status was positively associated with HR-QOL among the elderly in Zhejiang. Our findings could provide valuable information for decision-makers to develop interventions to improve the HR-QOL of the elderly.
Clinical, hormonal and genetic characteristics of androgen insensitivity syndrome in 39 Chinese patients
Authors: Liu Qingxu , Yin Xiaoqin , Li Pin
Published: April 2020

Background

Abnormal androgen receptor (AR) genes can cause androgen insensitivity syndrome (AIS), and AIS can be classified into complete androgen insensitivity syndrome (CAIS), partial androgen insensitivity syndrome (PAIS) and mild AIS. We investigated the characteristics of clinical manifestations, serum sex hormone levels and AR gene mutations of 39 AIS patients, which provided deeper insight into this disease.

Methods

We prospectively evaluated 39 patients with 46, XY disorders of sex development (46, XY DSD) who were diagnosed with AIS at the Department of Endocrinology of Shanghai Children’s Hospital from 2014 to 2019. We analysed clinical data from the patients including hormone levels and AR gene sequences. Furthermore, we screened the AR gene sequences of the 39 AIS patients to identify probable mutations.

Results

The 39 AIS patients came from 37 different families; 19 of the patients presented CAIS, and 20 of them presented PAIS. The CAIS patients exhibited a higher cryptorchidism rate than the PAIS (100 and 55%, P = 0.001). There were no significant difference between the CAIS and PAIS groups regarding the levels of inhibin B (INHB), sex hormone-binding globulin (SHBG), basal luteinizing hormone (LH), testosterone (T), or basal dihydrotestosterone (DHT), the T:DHT ratio, DHT levels after human chorionic gonadotropin (HCG) stimulation or T levels after HCG stimulation. However, the hormone levels of AMH (P = 0.010), peak LH (P = 0.033), basal FSH (P = 0.009) and peak FSH (P = 0.033) showed significant differences between the CAIS group and the PAIS group. Twenty-one reported pathogenic and 9 novel AR mutations were identified. Spontaneous AR mutations were found in 5 AIS patients, and 21 patients inherited mutations from their mothers, who carried heterozygous mutations.

Conclusions

Forty-six XY DSD patients with cryptorchidism and female phenotypes were highly suspected of having AIS. We demonstrated that CAIS patients could not be distinguished by their hormone levels alone. Compared with PAIS patients, CAIS patients exhibited higher basal FSH, peak FSH, and peak LH hormone levels but lower AMH expression. We identified 21 reported pathogenic AR mutations and 9 novel AR mutations that led to different types of AIS. Missense mutations were the major cause of AIS and mostly occurred in exon 7 of the AR gene. These findings provided deeper insight into the diagnosis and classification of AIS and will even contributed to its clinical assessment.
What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana
Authors: Hollingworth Samantha A. , Downey Laura , Ruiz Francis J. , Odame Emmanuel , Dsane-Selby Lydia , Gyansa-Lutterodt Martha , Nonvignon Justice , Chalkidou Kalipso
Published: April 2020

Background

Evidence-based decision-making for prioritising health is assisted by health technology assessment (HTA) to integrate data on effectiveness, costs and equity to support transparent decisions. Ghana is moving towards universal health coverage, facilitated mainly by the National Health Insurance Scheme (NHIS) established in 2003. The Government of Ghana is committed to institutionalising HTA for priority-setting. We aimed to identify and describe the sources of accessible data to support HTA in Ghana.

Methods

We identified and described data sources encompassing six main domains using an existing framework. The domains were epidemiology, clinical efficacy, costs, health service use and consumption, quality of life, and equity. We used existing knowledge, views of stakeholders, and searches of the literature and internet.

Results

The data sources for each of the six domains vary in extent and quality. Ghana has several large data sources to support HTA (e.g. Demographic Health Surveys) that have rigorous quality assurance processes. Few accessible data sources were available for costs and resource utilisation. The NHIS is a potentially rich source of data on resource use and costs but there are some limits on access. There are some data on equity but data on quality of life are limited.

Conclusions

A small number of quality data sources are available in Ghana but there are some gaps with respect to HTA based on greater use of local and contextualised information. Although more data are becoming available for monitoring, challenges remain in terms of their usefulness for HTA, and some information may not be available in disaggregated form to enable specific analyses. We support recent initiatives for the routine collection of comprehensive and reliable data that is easily accessible for HTA users. A commitment to HTA will require concerted efforts to leverage existing data sources, for example, from the NHIS, and develop and maintain new data (e.g. local health utility estimates). It will be critical that an overarching strategic and mandatory approach to the collection and use of health information is developed for Ghana in parallel to, and informed by, the development of HTA approaches to support resource allocation decisions. The key to HTA is to use the best available data while being open about its limitations and the impact on uncertainty.
Microglia knockdown reduces inflammation and preserves cognition in diabetic animals after experimental stroke
Authors: Jackson Ladonya , Dumanli Selin , Johnson Maribeth H. , Fagan Susan C. , Ergul Adviye
Published: April 2020

Introduction

Unfortunately, over 40% of stroke victims have pre-existing diabetes which not only increases their risk of stroke up to 2–6 fold, but also worsens both functional recovery and the severity of cognitive impairment. Our lab has recently linked the chronic inflammation in diabetes to poor functional outcomes and exacerbated cognitive impairment, also known as post-stroke cognitive impairment (PSCI). Although we have shown that the development of PSCI in diabetes is associated with the upregulation and the activation of pro-inflammatory microglia, we have not established direct causation between the two. To this end, we evaluated the role of microglia in the development of PSCI.

Methods

At 13 weeks of age, diabetic animals received bilateral intracerebroventricular (ICV) injections of short hairpin RNA (shRNA) lentiviral particles targeting the colony stimulating factor 1 receptor (CSF1R). After 14 days, animals were subjected to 60 min middle cerebral artery occlusion (MCAO) or sham surgery. Adhesive removal task (ART), novel object recognition (NOR), and 2-trial Y-maze were utilized to evaluate sensorimotor and cognitive function. Tissue from freshly harvested brains was analyzed by flow cytometry and immunohistochemistry.

Results

CSF1R silencing resulted in a 94% knockdown of residential microglia to relieve inflammation and improve myelination of white matter in the brain. This prevented cognitive decline in diabetic animals.

Conclusion

Microglial activation after stroke in diabetes may be causally related to the development of delayed neurodegeneration and PSCI.
Evaluation of the relationship between malar projection and lower facial convexity in terms of perceived attractiveness in 3-dimensional reconstructed images
Authors: Woo Hon Kwan , Ajmera Deepal Haresh , Singh Pradeep , Li Kar Yan , Bornstein Michael Marc , Tse Kwan Lok , Yang Yanqi , Gu Min
Published: April 2020

Background

This study aimed to investigate dental student’s perception of facial attractiveness with regard to different combinations of anteroposterior malar-jaw positions using 3-dimensional (3-D) reconstructed images of subjects.

Methods

Two Chinese young adults (1 male and 1 female) with straight profiles and average malar projections were selected for the study. 3-D facial images and cone-beam computed tomography images of these two subjects were superimposed using 3-D imaging software. Lateral and oblique views of nine different images were created by moving the maxillomandibular complex and/or zygomatic bone by 4 mm either forward or backward along the sagittal plane. One hundred three undergraduate dental students (n = 24, 33, and 46 students from the Year 3, 4, and 5, respectively) then scored lateral and 45° oblique view images of the newly reconstructed faces.

Results

In the present study, images with a neutral malar and retruded jaws were found to be the most attractive in both male and female subjects. In addition, the Protruded malar (PM) group (p < 0.001), and the Retruded Jaws (RJ) group were rated more attractive (p < 0.001). Furthermore, the Relatively Prominent malar (RP) group was rated more attractive (p < 0.001) when malar-jaw relative positions were compared.

Conclusion

This study shows that a neutral or a protruded malar favours facial attractiveness in both Chinese male and female subjects. Therefore, an appropriate relationship between malar projection and lower facial convexity should be taken into consideration while designing the orthodontic/orthognathic treatment plans for enhanced aesthetic outcomes.