bluuebunny/crossref_metadata_2025 huggingface dataset:
The diagnostic and prognostic value of H2AFY in hepatocellular carcinoma
Authors: Ma Xuyang , Ding Ying , Zeng Li
Published: April 2021

Background

The potential correlation between H2AFY (also known as MacroH2A1) and the clinical characteristics of hepatocellular carcinoma (HCC) patients was analysed through gene expression profiles and clinical data in The Cancer Genome Atlas (TCGA) database, and the diagnostic and prognostic value of H2AFY in HCC was discussed.

Methods

The gene expression data of HCC and the corresponding clinical characteristics of HCC patients were downloaded from the TCGA database. The differences in H2AFY in normal liver tissues and HCC were analysed. The relationship between H2AFY and clinical characteristics was analysed by Wilcoxon signed-rank test, logistic regression and Kruskal-Wallis test. The Kaplan-Meier method and the Cox regression method were used to analyse the relationship between overall survival and clinical characteristics of the patients. An ROC curve was used to predict the diagnostic value of H2AFY in HCC. Gene set enrichment analysis (GSEA) was used to analyse the pathway enrichment of H2AFY.

Result

Compared with normal liver tissues, H2AFY was significantly highly expressed in HCC. H2AFY was positively correlated with the age, clinical stage, G stage (grade) and T stage (tumor stage) of liver cancer patients. Higher H2AFY expression predicted a poor prognosis in HCC patients. Cox regression analysis suggested that H2AFY was an independent risk factor for the prognosis of HCC patients. The ROC curve suggested that H2AFY had certain diagnostic value in HCC. GSEA suggested that H2AFY was correlated with lipid metabolism and a variety of tumour pathways.

Conclusion

Our study showed that H2AFY was significantly overexpressed in HCC. H2AFY may be a potential diagnostic and prognostic marker for HCC, and high expression of H2AFY predicts a poor prognosis in patients with HCC.
Novel mutations in the PHKB gene in an iranian girl with severe liver involvement and glycogen storage disease type IX: a case report and review of literature
Authors: Beyzaei Zahra , Ezgu Fatih , Geramizadeh Bita , Alborzi Alireza , Shojazadeh Alireza
Published: April 2021

Background

Glycogen storage disease (GSD) type IXb is one of the rare variants of GSDs. It is a genetically heterogeneous metabolic disorder due to deficient hepatic phosphorylase kinase activity. Diagnosis of GSD can be difficult because of overlapping manifestations. Mutation analysis of the genes related to each type of GSD is supposed to be problem-solving, however, the presence of novel mutations can be confusing. In this case report, we will describe our experience with a young girl with the diagnosis of GSD and two novel mutations related to GSD type IXb.

Case presentation

A 3-year- old girl presented with short stature, hepatomegaly, and liver cirrhosis. No specific diagnosis was made based on laboratory data, so liver biopsy and targeted-gene sequencing (TGS) were performed to find out the specific molecular basis of her disease. It was confirmed that the patient carries two novel variants in the PHKB gene. The variant in the PHKB gene was classified as pathogenic.

Conclusions

This is the first reported case of a dual molecular mutation of glycogen storage disease type IXb in the same patient. Two novel variants in PHKB were identified and one of them was a pathogenic split-site mutation. In conclusion, for the first time, identification of the novel variants in this patient expands the molecular and the phenotype basis of dual variants in GSD-IXb.
Caffeine-clozapine interaction associated with severe toxicity and multiorgan system failure: a case report
Authors: Yartsev Alex , Peisah Carmelle
Published: April 2021

Background

Caffeine is a known inhibitor of Clozapine metabolism mediated by inhibition of CYP1A2. Hitherto, the effects of caffeine on Clozapine levels have always been modest, as have the clinical manifestations of toxicity resulting from their interaction. We present a case of severe toxicity associated with the co-consumption of caffeine and Clozapine culminating in life-threatening complications requiring management in Intensive Care.

Case presentation

A 34 year old male with a history of chronic schizophrenia, who had been managed stably on 400 mg Clozapine for the previous 5 years, changed his dietary behaviour and began consuming caffeine-containing energy drinks over the course of 3 weeks. The total daily dose of caffeine was estimated as 600 mg/day (four cans of Red Bull). He subsequently presented to the Emergency Department with life-threatening Clozapine toxicity, resulting in a decreased level of consciousness, severe metabolic acidosis, acute respiratory failure, raised inflammatory markers and acute renal failure attributed to interstitial nephritis. Maximum recorded Clozapine level was 1796 ng/ml.

Conclusions

This case describes the interaction between a common caffeine-containing beverage and a commonly prescribed antipsychotic medication, associated with severe adverse effects. We call for clinical and scientific attention to the possible interaction between these substances and draw attention to the implications for prescribing practices and patient counselling.
Developing and testing of an interactive internet-based intervention to reduce sexual harm of sexualised drug use (‘chemsex’) among men who have sex with men in Hong Kong: a study protocol for a randomised controlled trial
Authors: Choi Edmond P. H. , Chau Pui Hing , Wong William C. W. , Kowk Jojo Y. Y. , Choi Kitty W. Y. , Chow Eric P. F.
Published: April 2021

Background

Sexualised drug use, known as ‘chemsex’ or ‘chemfun,’ is the practice of intentionally using illicit drugs before or during sexual activates to enhance sexual arousal and pleasure. International and local data have both suggested that chemsex is common among men who have sex with men (MSM). Chemsex is generally seen with the engagement of risky sexual activities and therefore poses a threat regarding the potentially increased spread of human immunodeficiency virus and other sexually transmitted infections. However, little work has been done on the primary prevention of chemsex among MSM. Therefore, the aim of this study is to develop and evaluate an interactive internet-based intervention in reducing the sexual harms of chemsex among MSM in Hong Kong,

Methods

A two-armed, randomised, parallel-group trial with a three-month follow-up period will be conducted. 250 MSM aged 18 years or the above will be recruited through local non-governmental organisations, social media and by snowballing in Hong Kong. Participants will be randomly allocated into either the intervention (n = 125) or control group (n = 125). The interactive internet-based intervention will be developed based on the theory of planned behaviours. Participants in the control group will receive a web-based intervention without any sexual health information and without any interactive components. The primary outcomes will be self-efficacy in refusing risky sexual behaviours and chemsex, as measured by the Drug Avoidance Self-Efficacy Scale, the Self-Efficacy for Sexual Safety and the Condom Self-Efficacy Scale. Subjects in both groups will be evaluated at baseline and 3 months after baseline.

Discussion

To the best of our knowledge, this will be the first interactive internet-based intervention to specifically target chemsex among MSM. This project can help in the development and testing of culturally relevant health promotion programmes that reduce chemsex among MSM. Using an online delivery mode, the intervention is capable of reaching a large population of targets at a relatively low cost and thus has the potential to reduce the public health burden of chemsex and other risky sexual behaviours among MSM in a cost-effective manner.

Trial registration

International standard randomized controlled trial number (ISRCTN) registry: ISRCTN20134522 registered on 17 March 2021.
Revisiting the continuum of resistance model in the digital age: a comparison of early and delayed respondents to the Norwegian counties public health survey
Authors: Clarsen Benjamin , Skogen Jens Christoffer , Nilsen Thomas Sevenius , Aarø Leif Edvard
Published: April 2021

Background

The continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has only been assessed in one large online population health survey.

Methods

Respondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n = 4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension.

Results

The overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%).

Conclusions

There appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.
The epidemiological trends in the burden of lung cancer attributable to PM2.5 exposure in China
Authors: Wu Xiaomei , Zhu Bo , Zhou Jin , Bi Yifei , Xu Shuang , Zhou Baosen
Published: April 2021

Objective

PM2.5, which is a major contributor to air pollution, has large effects on lung cancer mortality. We want to analyse the long-term trends in lung cancer burden attributable to PM2.5 exposure and provide evidence that can be used for preventive measures and health resource planning.

Methods

Mortality data related to lung cancer were obtained from the Global Burden of Disease (GBD) 2019 project. A joinpoint regression analysis was used to assess the magnitude and direction of the trends in mortality from 1990 to 2019, and the age-period-cohort method was used to analyse the temporal trends in the mortality rate of lung cancer attributable to PM2.5 exposure by age, period, and cohort.

Results

From 1990 to 2019, the age-standardized mortality rate (ASMR) attributable to PM2.5 exposure trended slowly upwards, and the ASMR due to ambient PM2.5 exposure (APE) increased significantly, that due to household PM2.5 exposure (HPE) decreased. The longitudinal age curves show that the mortality rates due to PM2.5 exposure among younger individuals were low, and they significantly increased from their levels among those in the 45–49 age group to their levels among those in the over-85 age group. From 1990 to 2019, the period RRs due to APE increased, but those due to HPE decreased. Similar trends were observed in the cohort RRs. The overall net drift per year attributable to PM2.5 exposure was below 0. The local drift values increased with age and were above 0 for the over-80 age groups. The overall net drifts per year were above zero for APE and below zero for HPE. The corresponding results among males were higher than those among females.

Conclusions

In China, the type of air pollution responsible for lung cancer has changed from household air pollution to ambient air pollution. PM2.5 exposure is more harmful among males and older people. Ambient air pollution should be emphasized, and China should strengthen its implementation of effective public policies and other interventions.
The understanding, acceptability, and relevance of personalised multidimensional physical activity feedback among urban adults: evidence from a qualitative feasibility study in Sri Lanka
Authors: Arambepola Carukshi , Perera Madhawa , Gillison Fiona , Peacock Oliver , Thompson Dylan
Published: April 2021

Background

Wearable technologies are being used to provide personalised feedback across multiple physical activity dimensions in countries such as the UK, but their feasibility has not been tested in South Asia, where physical inactivity is increasing. This study assessed the understanding, acceptability, and relevance of personalised multidimensional physical activity feedback in urban dwellers in Colombo, Sri Lanka.

Methods

A qualitative feasibility study was conducted among 35 adults to assess a community-based approach to provide multidimensional physical activity feedback. Healthy adults, adults at risk of non-communicable diseases and community-based primary healthcare professionals wore a physical activity monitor for 7 days and were then guided through their personalised multidimensional physical activity feedback. One-to-one interviews were conducted, transcribed verbatim and analysed using framework analysis.

Results

Four themes were generated: understanding of personalised physical activity feedback, perceived novelty of the feedback, motivation, and consideration of the multidimensional nature of physical activity. A majority of participants required guidance initially to understand the feedback, following which most were quickly able to interpret the data shown, and were willing to use the feedback as a basis for identifying goals to improve physical activity. Participants perceived the feedback and its delivery as novel because it provided new knowledge about physical activity guidelines and awareness on their own behaviour through graphics. Comparisons of personal performance against recommended physical activity levels and information on sedentary time were the most commonly motivating aspects of the feedback, prompting talk about behaviour change. All three groups showed poor planning on goal achievement, with some noticeable differences between those with and without health risk of non-communicable diseases. Following the feedback, most participants understood that physical activity is composed of several dimensions, while around half could recognise more suitable options to change behaviour. Of the physical activity dimensions, calorie burn received more attention than others.

Conclusions

Multidimensional physical activity feedback was considered understandable and acceptable and has the potential to support behaviour change among urban Sri Lankans with or without identified health risk. These findings highlight the feasibility of this technology-enabled approach as a personalised intervention to improve knowledge and motivation for physical activity behaviour.
Workplace flexibility important for part-time sick leave selection—an exploratory cross-sectional study of long-term sick listed in Norway
Authors: Standal Martin Inge , Hjemdal Odin , Aasdahl Lene , Foldal Vegard Stolsmo , Johnsen Roar , Fors Egil Andreas , Hagen Roger
Published: April 2021

Background

Part-time sick leave (PTSL) where sick-listed individuals work a percentage corresponding to their remaining work capabilities is often used to promote return to work. The effects of PTSL are uncertain due to participant selection on personal and social factors, which are not easily captured by evaluations that primarily rely on register-data. More knowledge of health-related, workplace and personal characteristics that influence the propensity to utilize PTSL is needed.

The objective of the present study was to explore whether individuals on PTSL and full-time sick leave (FTSL) differ in terms of self-reported health, workplace resources and psychological resilience while also considering known sociodemographic factors that influence PTSL selection.

Methods

The study utilized a cross-sectional sample of 661 workers sick listed for 8 weeks with a 50–100% sick-listing degree. Differences between those on PTSL and FTSL with regard to current self-reported health, previous long-term sick leave, workplace adjustment latitude, psychosocial work environment, work autonomy, coping with work demands, and psychological resilience were examined and adjusted for known selection factors (age, education, gender, sector, diagnosis, and physical work) using logistic regression.

Results

An inverse U-shaped curvilinear association between self-reported health and PTSL was identified. Those on PTSL also reported greater workplace adjustment latitude and better psychosocial work environment than those on FTSL. These differences persisted after adjusting for previously known selection factors. Furthermore, the PTSL group reported more work autonomy and poorer coping with work demands, but these differences were more uncertain after adjustment. The groups did not differ in terms of previous long-term sick leave or psychological resilience.

Conclusion

The present study found differences between those on PTSL and FTSL with regards to self-reported health, workplace adjustment latitude and psychosocial work environment that were independent of differences identified in previous research. These results are important for future evaluations of the effect of PTSL on RTW, suggesting more attention should be paid to self-reported health status and workplace characteristics that are not captured using register data.
Determinants of work capacity (predicted VO2max) in non-pregnant women of reproductive age living in rural India
Authors: DiPietro Loretta , Bingenheimer Jeffrey , Talegawkar Sameera A. , Sedlander Erica , Yilma Hagere , Pradhan Pratima , Rimal Rajiv
Published: April 2021

Background

The negative impact of anemia on work capacity has been studied extensively in male and female workers; however, the simultaneous contributions of confounding variables such as physical activity, as well as other behavioral and sociodemographic characteristics have not been considered. The purpose of this study was to examine cross-sectionally the multivariable correlates of work capacity in non-pregnant women (n = 330) living in rural India.

Methods

The Reduction in Anemia through Normative Innovations (RANI) Project is a norms-based, clustered randomized controlled trial to reduce anemia among women (15–49 years) living in Odisha, India between 2018 and 2021. For the larger trial, 89 clusters of villages were randomized into treatment and control groups on a 1:1 basis. Women (2055/group) living in 15 selected clusters (40–41 villages) were then randomly selected for data collection. The sampling design also randomly-generated a subset (n = 375) of non-pregnant participants who performed a modified Queen’s College Step Test (QCST) and who wore an activity monitor for 3 days. Predicted work capacity (VO2max) was determined using the QCST. Levels (h/day) of daily reclining, sitting, standing, walking (steps/day), and energy expenditure (MET∙h/day) were determined using an ActivPAL accelerometer. Hemoglobin concentrations (g/dL) were determined using a HemoCue photometer. Predetermined hierarchical (non-multilevel) regression models tested the independent associations between the primary study variables of interest (physical activity, hemoglobin concentrations) and predicted VO2max, while adjusting for age, body mass index (BMI: kg/m2), education, parity, and dietary diversity score.

Results

Approximately 61% of the participants had anemia (Hb < 12 g/dL). Age2(β = − 0.01; 95% CI: − 0.01, 0.00), BMI (β = − 0.19; 95% CI:-0.28, − 0.09), educational attainment (β = − 1.35; 95% CI: − 2.34, − 0.36), and MET∙h/day (β = 0.19; 95% CI: 0.00, 0.38) were significant and independent determinants of work capacity. Hemoglobin concentration was marginally associated with work capacity in the presence of the other covariables (β = 0.22; 95% CI:-0.02, 0.47).

Conclusions

Our data indicate that factors other than anemia are important correlates of work capacity and should be considered when promoting the health and economic capacity of rural Indian women.

Trial registration

Clinical Trial Registry- India (CTRI)http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=26285&EncHid=&userName=CTRI/2018/10/016186on 29 October 2018.
Dorsal approach with tailored partial sacrectomy and gluteal V–Y fasciocutaneous advancement flap for the management of recurrent pelvic sepsis; case report
Authors: Sparenberg Sebastian , Sharabiany Sarah , Musters Gijsbert D. , Castano Borrero Brenda M. , Hompes Roel , Lapid Oren , Tanis Pieter J.
Published: April 2021

Background

Pelvic sepsis after surgery for rectal cancer is a severe complication, mostly originating from anastomotic leakage. Complex salvage surgery, during which an omentoplasty is often used for filling of the pelvic cavity, is seldomly required. If this fails, a symptomatic recurrent presacral abscess with a risk of progressive inflammation can develop. Such patients have often undergone multiple surgeries and have disturbed abdominal wall integrity, adhesion formation, and presence of one or two stoma(s). Subsequent salvage surgery via the conventional anterior abdominal approach is therefore less suitable. We describe three cases with a chronic presacral sinus and failure of first salvage surgery. All three patients underwent a prone only approach with tailored sacrectomy. This novel approach provided direct access to the pelvic abscess with optimal exposure for complete and safe debridement. A unilateral or bilateral gluteal V–Y fasciocutaneous advancement flap was created to completely fill the cavity with well vascularized tissue.

Case presentations

Three male patients of 80, 66 and 51 years of age initially underwent low anterior resection with neo-adjuvant radiotherapy for rectal cancer. The first patients underwent intersphincteric resection of the anastomosis with omentoplasty 128 months after index surgery, and second salvage surgery 2 months later. The second patient underwent abdominoperineal resection with omentoplasty for locally recurrent rectal cancer, cystoprostatectomy with revision of the omentoplasty for pelvic sepsis 100 months after index surgery, and second salvage surgery 16 months later. In the third patient, the anastomosis was dismantled with subsequent intersphincteric proctectomy and omentoplasty 20 months after index surgery, and second salvage surgery was performed 93 months later. Second salvage surgery in all three patients was indicated because of symptomatic recurrent pelvic sepsis. Second salvage surgery consisted of sacrectomy, complete debridement of the presacral area, and filling with a gluteal advancement flap. This resulted in favorable postoperative recovery with ultimate healing of the pelvic cavity.

Conclusion

The dorsal approach with tailored sacrectomy and gluteal V–Y advancement flap is a valuable option in highly selected patients to treat recurrent pelvic sepsis after multiple prior transabdominal interventions for chronic presacral sinus.
Association of IL-10 (− 1082 A/G) and IL-6 (− 174 G/C) gene polymorphism with type 2 diabetes mellitus in Ethiopia population
Authors: Ayelign Birhanu , Negash Markos , Andualem Henok , Wondemagegn Tadelo , Kassa Eyuel , Shibabaw Tewodros , Akalu Yonas , Molla Meseret Derbew
Published: April 2021

Background

Interleukin (IL)-6 and IL-10 are the most important cytokine with pro and anti-inflammatory activities, respectively. Dysregulation of IL-6 and IL-10 are associated with increased risk of developing Type 2 Diabetes Mellitus (T2DM). Despite this, a fundamental understanding of both cytokine gene polymorphisms with its expression is critical in understanding of cellular mechanism of insulin resistance as well as T2DM intervention. Therefore, this study aimed to assess IL-6 (− 174 G/C) and IL-10 (− 1082 A/G) gene polymorphism, and its association with T2DM, North West Ethiopia.

Methods

A comparative cross-sectional study from January to May 2018 was conducted on study participants with T2DM and apparently healthy controls. Deoxyribonucleic acid (DNA) extraction and genotyping was carried out by using amplification refractory mutation system polymerase chain reaction to detect polymorphism of IL-6 and IL-10 gene at the position − 174 and − 1082, respectively. The logistic regression model was fitted to assess the association of between cytokine gene polymorphisms and T2DM. Odds ratio with 95% CI was determined to assess the presence and strength of association between the explanatory variables and outcome variable. A P-value < 0.05 was considered as statistically significant.

Result

Participants carrying the GG genotype of IL-6 (− 174) (OR (95% CI) = 4.61 (2.07–10.54) was a high likelihood of having T2DM compared to those carrying the CC and AA genotypes. AA and AG genotypes of IL-10 (− 1082) were at lower odd of developing T2DM compared to those carrying the GG genotype. In addition, individuals carrying the G allele of IL-6 (− 174) have 2.82-fold odds of developing T2DM compared to individuals carrying the C allele (OR (95% CI) =2.81 (1.78–4.50)).

Conclusion

Our study revealed that genetic polymorphisms of IL-6 (− 174) GG genotype is the potential host genetic risk factors to T2DM. While, IL-10 (− 1082) AA genotype is negatively associated with T2DM. Therefore, IL-6 (− 174) and IL-10 (− 1082) genetic variation may be considered as a biomarker for early screening and diagnosis of T2DM.
A meta-analysis of the association between physical demands of domestic labor and back pain among women
Authors: Osinuga Abisola , Hicks Chelsea , Ibitoye Segun E. , Schweizer Marin , Fethke Nathan B. , Baker Kelly K.
Published: April 2021

Background

Back pain (BP) is among the most common musculoskeletal problems globally and is a leading contributor to disability among adults. Millions of women especially those in low-income settings, engage in strenuous domestic activities that may increase their risk of BP. The purpose of this meta-analysis was to estimate the association between physically demanding domestic labor (PDDL) which is characterized as intensity, frequency, duration of work and biomechanical risk factors of work and BP among women.

Methods

Five databases were searched for records published from January 1991 to March 2020; and results from 11studies were included in the meta-analysis. A random effects model and the generic inverse-variance method was used to estimate the pooled odds ratio (OR), 95% confidence interval (CI), and the degree of heterogeneity among studies (I2). Stratified and sensitivity analyses were conducted to identify the influence of outliers and identify the sources of heterogeneity.

Results

Exposure to high PDDL was significantly associated with BP (OR = 1.63; 95% CI 1.30, 2.04; I2 = 70%). The odds of back pain were highest among the following groups: women performing domestic labor in non-neutral postures (OR = 2.30; 95% CI = 1.75–3.04; I2 = 0%; N = 4 studies) and among women from low- and middle-income countries (OR = 1.98; 95% CI = 1.58–2.49; I2 = 29%; N = 5 studies). We found no evidence of publication bias (Egger’s test p-value = 0.15).

Conclusions

PDDL may significantly increase a woman’s risk of experiencing BP, but larger prospective studies are needed to further investigate the association. Presenting data on how domestic work affects the musculoskeletal health of women will be important in designing future interventions (behavioral, infrastructural, and ergonomic) that can reduce the burdens from domestic labor.
The effect of a mindfulness-based stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study
Authors: Cohen Zsofia P. , Cosgrove Kelly T. , Akeman Elisabeth , Coffey Sara , Teague Kent , Hays-Grudo Jennifer , Paulus Martin P. , Aupperle Robin L. , Kirlic Namik
Published: April 2021

Background

Early life stress (ELS) has been linked to poor mental and physical health outcomes in adolescence and adulthood. Mindfulness reduces symptoms of depression and anxiety and improves cognitive and social outcomes in both youth and adults. However, little is known whether mindfulness can mitigate against the adverse neurobiological and psychological effects of ELS. This study aimed to examine the feasibility of conducting a group mindfulness intervention in adolescents with ELS and provide preliminary indication of potential effects on stress-related biomarkers and mental health symptoms.

Methods

Forty adolescents were randomized to receive either eight sessions of Mindfulness-Based Stress Reduction for Teens in group format (MBSR-T;n = 21) or Treatment as Usual Control group (CTRL;n = 17). Outcomes were assessed at baseline and follow-up and included measures associated with neurobiological functioning (immune and endocrine biomarkers) and self-reported mental health (depressive) symptoms. Linear mixed effects models were used to assess the effects of group and time on these outcome measures.

Results

Sixteen of the 21 adolescents completed the intervention, attending an average of 6.5 sessions. The model examining cortisol responses to stress induction revealed medium effects trending toward significance (Cohen’sd = .56) for anticipatory cortisol levels in the MBSR-T relative to CTRL groups. No significant effects were found in models examining C-reactive protein or interleukin 6 inflammatory markers. The model examining depressive symptoms revealed a medium effect for symptom reduction (Cohen’sd = .69) in the MBSR-T relative to CTRL groups.

Conclusions

This study demonstrated feasibility of conducting a group-based MBSR-T intervention for adolescents with ELS. There was some evidence for efficacy on a symptom level with potential subtle changes on a biological level. Future larger studies are needed to determine the efficacy of group-based mindfulness interventions in this population.

Trial registration

Identifier #NCT03633903, registered 16/08/2018.
Experiences of Inuit in Canada who travel from remote settings for cancer care and impacts on decision making
Authors:   Inuit Medical Interpreter Team, Jull Janet ,   Mamisarvik Healing Centre Team, Sheppard Amanda J. , Hizaka Alex , Barton Gwen , Doering Paula , Dorschner Danielle , Edgecombe Nancy , Ellis Megan , Graham Ian D. , Habash Mara , Jodouin Gabrielle , Kilabuk Lynn , Koonoo Theresa , Roberts Carolyn
Published: April 2021

Background

Inuit experience the highest cancer mortality rates from lung cancer in the world with increasing rates of other cancers in addition to other significant health burdens. Inuit who live in remote areas must often travel thousands of kilometers to large urban centres in southern Canada and negotiate complex and sometimes unwelcoming health care systems. There is an urgent need to improve Inuit access to and use of health care. Our study objective was to understand the experiences of Inuit in Canada who travel from a remote to an urban setting for cancer care, and the impacts on their opportunities to participate in decisions during their journey to receive cancer care.

Methods

We are an interdisciplinary team of Steering Committee and researcher partners (“the team”) from Inuit-led and/or -specific organizations that span Nunavut and the Ontario cancer health systems. Guided by Inuit societal values, we used an integrated knowledge translation (KT) approach with qualitative methods. We conducted semi-structured interviews with Inuit participants and used process mapping and thematic analysis.

Results

We mapped the journey to receive cancer care and related the findings of client (n = 8) and medical escort (n = 6) (“participant”) interviews in four themes: 1) It is hard to take part in decisions about getting health care; 2) No one explains the decisions you will need to make; 3) There is a duty to make decisions that support family and community; 4) The lack of knowledge impacts opportunities to engage in decision making. Participants described themselves as directed, with little or no support, and seeking opportunities to collaborate with others on the journey to receive cancer care.

Conclusions

We describe the journey to receive cancer care as a “decision chain” which can be described as a series of events that lead to receiving cancer care. We identify points in the decision chain that could better prepare Inuit to participate in decisions related to their cancer care. We propose that there are opportunities to build further health care system capacity to support Inuit and enable their participation in decisions related to their cancer care while upholding and incorporating Inuit knowledge.
Development and application of tools to cost the delivery of environmental health services in healthcare facilities: a financial analysis in urban Malawi
Authors: Anderson Darcy M. , Cronk Ryan , Pak Emily , Malima Precious , Fuente David , Tracy J. Wren , Mofolo Innocent , Kafanikhale Holystone , Hoffman Irving , Bartram Jamie
Published: April 2021

Background

Environmental health services (EHS) in healthcare facilities (HCFs) are critical for providing a safe, functional healthcare environment, but little is known about their costs. Poor understanding of costs impedes progress towards universal access of EHS in HCFs. We developed frameworks of essential expenses required to provide EHS and conducted an ex-post financial analysis of EHS in a network of medical research and training facilities in Lilongwe, Malawi, serving an estimated 42,000 patients annually through seven outpatient buildings.

Methods

We estimated the cost of providing the following EHS: water, sanitation, hygiene, personal protective equipment use at the point of care, waste management, cleaning, laundry, and vector control. We developed frameworks of essential outputs and inputs for each EHS through review of international guidelines and standards, which we used to identify expenses required for EHS delivery and evaluate the completeness of costs data in our case study. For costing, we use a mixed-methods approach, applying qualitative interviews to understand facility context and review of electronic records to determine costs. We calculated initial costs to establish EHS and annual operations and maintenance.

Results

Available records contained little information on the upfront, capital costs associated with establishing EHS. Annual operations and maintenance totaled USD 220,427 for all EHS across all facilities (USD 5.21 per patient encounter), although costs of many essential inputs were missing from records. Annual operations and maintenance costs were highest for cleaning (USD 69,372) and waste management (USD 46,752).

Discussion

Missing expenses suggests that documented costs are substantial underestimates. Costs to establish services were missing predominantly because purchases pre-dated electronic records. Annual operations and maintenance costs were incomplete primarily because administrative records did not record sufficient detail to disaggregate and attribute expenses.

Conclusions

Electronic health information systems have potential to support efficient data collection. However, we found that existing records systems were decentralized and poorly suited to identify EHS costs. Our research suggests a need to better code and disaggregate EHS expenses to properly leverage records for costing. Frameworks developed in this study are a potential tool to develop more accurate estimates of the cost of providing EHS in HCFs.
Rural and urban differences in patient experience in China: a coarsened exact matching study from the perspective of residents
Authors: Zhao Dantong , Zhou Zhongliang , Shen Chi , Nawaz Rashed , Li Dan , Ren Yangling , Zhao Yaxin , Cao Dan , Zhai Xiaohui
Published: April 2021

Background

Patient experience is a key measure widely used to evaluate quality of healthcare, yet there is little discussion about it in China using national survey data. This study aimed to explore rural and urban differences in patient experience in China.

Methods

Data regarding this study were drawn from Chinese General Social Survey (CGSS) 2015, with a sample size of 9604. Patient experience was measured by the evaluation on healthcare services. Coarsened exact matching (CEM) method was used to balance covariates between the rural and urban respondents. Three thousand three hundred seventy-two participants finally comprised the matched cohort, including 1592 rural residents and 1780 urban residents. Rural and urban differences in patient experience were tested by ordinary least-squares regression and ordered logistic regression.

Results

The mean (SD) score of patient experience for rural and urban residents was 72.35(17.32) and 69.45(17.00), respectively. Urban residents reported worse patient experience than rural counterparts (Crude analysis: Coef. = − 2.897, 95%CI: − 4.434, − 1.361; OR = 0.706, 95%CI: 0.595, 0.838; Multivariate analysis: Coef. = − 3.040, 95%CI: − 4.473, − 1.607; OR = 0.675, 95%CI: 0.569, 0.801). Older (Coef. = 2.029, 95%CI: 0.338, 3.719) and healthier (Coef. = 2.287, 95%CI: 0.729, 3.845; OR = 1.217, 95%CI: 1.008, 1.469) rural residents living in western area (Coef. = 2.098, 95%CI: 0.464, 3.732; OR = 1.276, 95%CI: 1.044, 1.560) with higher social status (Coef. = 1.158, 95%CI: 0.756, 1.561; OR = 1.145, 95%CI: 1.090, 1.204), evaluation on adequacy (Coef. = 7.018, 95%CI: 5.045, 8.992; OR = 2.163, 95%CI: 1.719, 2.721), distribution (Coef. = 4.464, 95%CI: 2.471, 6.456; OR = 1.658, 95%CI: 1.312, 2.096) and accessibility (Coef. = 2.995, 95%CI: 0.963, 5.026; OR = 1.525, 95%CI: 1.217, 1.911) of healthcare resources had better patient experience. In addition, urban peers with lower education (OR = 0.763, 95%CI: 0.625, 0.931) and higher family economic status (Coef. = 2.990, 95%CI: 0.959, 5.021; OR = 1.371, 95%CI: 1.090,1.723) reported better patient experience.

Conclusions

Differences in patient experience for rural and urban residents were observed in this study. It is necessary to not only encourage residents to form a habit of seeking healthcare services in local primary healthcare institutions first and then go to large hospitals in urban areas when necessary, but also endeavor to reduce the disparity of healthcare resources between rural and urban areas by improving quality and capacity of rural healthcare institutions and primary healthcare system of China.
Involving clinicians in management: assessing views of doctors and nurses on hybrid professionalism in clinical directorates
Authors: Prenestini Anna , Sartirana Marco , Lega Federico
Published: April 2021

Background

Hybrid professionalism is one of the most effective ways to involve clinicians in management practices and responsibilities. With this study we investigated the perceptions of doctors and nurses on hybridization in clinical directorates (CDs) in hospitals.

Methods

We investigated the attitudes of healthcare professionals (doctors and nurses) towards eight hospital CDs in the Local Health Authority (LHA) of Bologna (Emilia Romagna, Italy) 6 years after their implementation. We used a validated questionnaire by Braithwaite and Westbrook (2004). Drawing on Palmer et al. (2007), we added a section about the characteristics of department heads. In all, 123 healthcare professionals in managerial roles completed and returned the questionnaire. The return rate was 47.4% for doctors and 31.6% for nurses.

Results

Doctors reported an increase in clinical governance, interdisciplinarity collaboration, and standardization of clinical work. Hybridization of practices was noted to have taken place. While doctors did not see these changes as a threat to professional values, they felt that hospital managers had taken greater control. There was a large overlap of attitudes between doctors and nurses: inter-professional integration in CDs fostered alignment of values and aims. The polarity index was higher for responses from the doctors than from the nurses.

Conclusion

The study findings have implications for policy makers and managers: mission and strategic mandate of CDs; governance of CDs, leadership issues; opportunities for engaging healthcare professionals; changes in managerial involvement during the COVID-19 pandemic. We also discuss the limitations of the present study and future areas for research into hybrid structures.
Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis
Authors: Su Qing , Sun Xiaohui , Zhu Liwen , Yan Qin , Zheng Peiwen , Mao Yingying , Ye Ding
Published: April 2021

Background

The aim of this study was to quantitatively summarize the available evidence on the association of breastfeeding with the risk of childhood cancer.

Methods

A literature search of PubMed and Embase databases was performed to identify eligible observational studies published from inception to July 17, 2020. The categorical and dose-response meta-analysis was conducted by pooling relative risk (RR) or odds ratio (OR) estimates with 95% confidence intervals (CIs). Potential sources of heterogeneity were detected by meta-regression and stratification analysis. Sensitivity analysis and publication bias test were also carried out.

Results

Forty-five articles involving 475,579 individuals were included in the meta-analysis. Among the thirty-three studies on the association between breastfeeding and risk of childhood leukemia, the pooled risk estimates were 0.77 (95% CI, 0.65–0.91) and 0.77 (95% CI 0.63–0.94) for ever versus non/occasional breastfeeding and longest versus shortest breastfeeding duration group, respectively. There was clear indication for non-linear dose-response relationship between breastfeeding duration and the risk of childhood leukemia (Pnon-linear < 0.001). The most protective effect (OR, 0.66, 95% CI 0.62–0.70) was observed at a breastfeeding duration of 9.6 months. Four studies examined, the association between breastfeeding and risk of childhood neuroblastoma, and significant inverse associations were consistently observed in both the comparisons of ever breastfeeding versus non/occasional breastfeeding (OR = 0.59, 95% CI 0.44–0.81) and longest versus shortest breastfeeding (OR = 0.61, 95% CI 0.44–0.83). However, no associations of breastfeeding with risk of other cancers were found.

Conclusions

Our study supports a protective role of breastfeeding on the risk of childhood leukemia, also suggesting a non-linear dose-response relationship. Further studies are warranted to confirm the association between breastfeeding and risk of childhood neuroblastoma.
Identification and genetic characterization of equine infectious anemia virus in Western Balkans
Authors: Lupulovic Diana , Savić Sara , Gaudaire Delphine , Berthet Nicolas , Grgić Živoslav , Matović Kazimir , Deshiere Alexandre , Hans Aymeric
Published: April 2021

Background

Equine infectious anemia (EIA) is a viral disease, caused by the Equine Infectious Anemia virus (EIAV) belonging to the Retroviridae family, genus Lentivirus. Horses (or equids) infected with EIAV are lifelong carriers and they remain contagious for other horses even in the absence of clinical signs. So far, EIAV infection has been reported among horses in North and South America, France, Germany, Italy, Hungary and Romania, with no publication regarding the presence of EIAV in horses in Serbia. To determine the circulation of EIAV among, approximately, the 5000 horses of the Vojvodina region, northern part of Serbia, 316 serum undergone serological testing for EIA. Then, identification and full genome sequencing using next generation sequencing was performed from one EIA positive horse.

Results

the 316 sera were tested with 3 different commercial agar gel immunodiffusion (AGID) tests and two different commercial enzyme-linked immunosorbent assay (ELISA). With the three AGID kits, 311 (98.4%) among the 316 tested sera were negative and only five (1.6%) sera were positive for EIA. Some discrepancies were seen for the two ELISA kits tested since one exhibited the same results as AGID test and the second gave 295 sera with negative results, five with a positive result and 16 with doubtful outcome. Phylogenetic analysis performed using the full genome sequence showed that EIAV characterized from a horse in Serbia is different from those identify so fare around the world and form a distinct and separate group together with another EIAV strain.

Conclusions

This study demonstrate for the first time that EIAV is circulating at a low level in the horse population from the Northern part of Serbia. Interestingly, phylogenetic data indicates that this EIAV from the western Balkan region of Europe belongs to a new cluster.
Serological evidence of Rift Valley fever virus infection among domestic ruminant herds in Uganda
Authors: Ndumu Deo B. , Bakamutumaho Barnabas , Miller Edward , Nakayima Jesca , Downing Robert , Balinandi Stephen , Monje Fred , Tumusiime Dan , Nanfuka Mary , Meunier Natascha , Arinaitwe Eugene , Rutebarika Chris , Kidega Eugene , Kyondo Jackson , Ademun Rose , Njenga Kariuki M. , Veas Francisco , Gonzalez Jean-Paul
Published: April 2021

Background

Prior to the first recorded outbreak of Rift Valley fever (RVF) in Uganda, in March 2016, earlier studies done until the 1970’s indicated the presence of the RVF virus (RVFV) in the country, without any recorded outbreaks in either man or animals. While severe outbreaks of RVF occurred in the neighboring countries, none were reported in Uganda despite forecasts that placed some parts of Uganda at similar risk.

The Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) undertook studies to determine the RVF sero-prevalence in risk prone areas.

Three datasets from cattle sheep and goats were obtained; one from retrospective samples collected in 2010–2011 from the northern region; the second from the western region in 2013 while the third was from a cross-sectional survey done in 2016 in the south-western region. Laboratory analysis involved the use of the Enzyme Linked Immunosorbent Assays (ELISA). Data were subjected to descriptive statistical analyses, including non-parametric chi-square tests for comparisons between districts and species in the regions.

Results

During the Yellow Fever outbreak investigation of 2010–2011 in the northern region, a total sero-prevalence of 6.7% was obtained for anti RVFV reacting antibodies (IgG and IgM) among the domestic ruminant population. The 2013 sero-survey in the western region showed a prevalence of 18.6% in cattle and 2.3% in small ruminants. The 2016 sero-survey in the districts of Kabale, Kanungu, Kasese, Kisoro and Rubirizi, in the south-western region, had the respective district RVF sero-prevalence of 16.0, 2.1, 0.8, 15.1and 2.7% among the domestic ruminants combined for this region; bovines exhibited the highest cumulative sero-prevalence of 15.2%, compared to 5.3 and 4.0% respectively for sheep and goats per species for the region.

Conclusions

The absence of apparent outbreaks in Uganda, despite neighboring enzootic areas, having minimal restrictions to the exchange of livestock and their products across borders, suggest an unexpected RVF activity in the study areas that needs to be unraveled. Therefore, more in-depth studies are planned to mitigate the risk of an overt RVF outbreak in humans and animals as has occurred in neighboring countries.