bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Insurance Information-Seeking Behaviors among Internet Users: An Exploratory Analysis to Inform Policies
Authors: Erlyana Erlyana , Acosta-Deprez Veronica , O'Lawrence Henry , Sinay Tony , Ramirez Jeremy , Jacot Emmanuel C. , Shim Kyuyoung
Published: May 2024

The purpose of this study was to explore characteristics of Internet users who seek health insurance information online, as well as factors affecting their behaviors in seeking health insurance information. Secondary data analysis was conducted using data from the 2012 Pew Internet Health Tracking Survey. Of 2,305 Internet user adults, only 29% were seeking health insurance information online. Bivariate analyses were conducted to test differences in characteristics of those who seek health insurance information online and those who do not. A logistic regression model was used to determine significant predictors of health insurance information-seeking behavior online. Findings suggested that factors such as being a single parent, having a high school education or less, and being uninsured were significant and those individuals were less likely to seek health insurance information online. Being a family caregiver of an adult and those who bought private health insurance or were entitled to Medicare were more likely to seek health insurance information online than non-caregivers and the uninsured. The findings suggested the need to provide quality health insurance information online is critical for both the insured and uninsured population.
Healthcare Forecasting in the United Arab Emirates (Uae)
Authors: Younies Hassan , Elzenaty Raed J.K. , Gantasala Swapna , Nwagwu Emeka
Published: May 2024

This study has been designed to address the issue of the forecasting of the healthcare needs of the United Arab Emirate (UAE) from 1974 to 2011. This includes predicting the health system's need for hospitals and hospital beds, as well as the public health manpower (example, physicians, nurses) requirements. The analysis was based on historical data: the number of hospitals, number of nurses, number of hospital beds, which have been posited as the measures of life expectancy in the Emirate. The study found that, although significant changes designed to enhance public health outcomes in the UAE have been made, beds to population ratio was the most significant factor in enhancing healthcare and the public health.
Factors Associated with the Uptake of Sodium Dichloroisocyanurate (NADCC) Tablets as Household Water-Treatment Product among Caregivers of Children under Five in Benin, West Africa
Authors: Inungu Joseph N. , Zinsou Cyprien E. , Mustafa Younis , Singbo Narcisse
Published: May 2024

Improving access to safe drinking water is a critical step in mitigating diarrheal diseases that affect millions of children under 5 years throughout the developing world each year. While the delivery of safe water is out of the reach of many countries, the utilization of Sodium dichloroisocyanurate (NaDCC) is a proven cost-effective alternative to prevent diarrhea caused by waterborne pathogens. However, its uptake remains low in many developing countries, such as the Republic of Benin. This study examines the trends and the determinants of NaDCC uptake in Benin.

Population Services International and its affiliate conducted two multistage household surveys among caregivers of children under five in Benin to examine the practices towards diarrheal disease in children under five and identify the factors associated with the use of NaDCC in this population. 2912 respondents/caregivers of children under five were interviewed in 2009 versus 3196 in 2011. The proportion of caregivers who reported ever treating water with NaDCC increased from 5.8% in 2009 to 11.5% in 2011, p<0.001. The logistic regression model showed that caregivers who knew places that sell NaDCC in the community; those who felt capable of utilizing NADCC correctly to treat drinking water as well as caregivers who reported to be Muslim were more likely than their counterparts to use NaDCC as water treatment product.

In order to increase the use of NADCC among caregivers, the Government of Benin and its development partners should focus not only on making NADCC available in the community and informing the community members about the different points of sale, but also in building up the capacity and confidence of caregivers in utilizing it.
The Prevalence of Community Benefit Participation in the Hospital Region and Its Relationship to Community Health Outcomes
Authors: Cronin Cory E.
Published: May 2024

The structure of the U.S. health care industry has long emphasized individual outcomes, but there is a growing recognition that hospitals may be able to provide more cost-effective care through community-focused initiatives. Few assessments have been established to measure outcomes of these increasing community benefit efforts. This study uses the rate of ambulatory care sensitive condition admissions in the Medicare population as a mechanism for understanding the effectiveness of a range of hospital community benefit practices. This study is based on national data collected through the American Hospital Association Annual Survey for the years 2004, 2006, 2008, and 2010 and supplemented by demographic, region, and policy information collected from other sources. The outcome measure and the region definition are established through the Dartmouth Atlas of Health Care. Multilevel mixed-effects linear regression modeling is used to analyze the relationship between community benefit participation levels within a region and the region's ambulatory care sensitive condition prevalence.

Community health education was found to be associated with a reduced prevalence of ambulatory care sensitive conditions (ACSCs). ACSC rates were also connected to several other factors, including health needs and demographic characteristics in a region. The finding that community education appears to have the greatest link to limiting ACSC admissions is in line with other studies showing community education initiatives to be effective in improving health outcomes. This may be particularly important for hospitals seeking to best direct their resources in a way that addresses broader community health outcomes.
Educating Paramedics for the Future: A Holistic Approach
Authors: O'Meara Peter F. , Furness Susan , Gleeson Ray
Published: May 2024

The education and training of paramedics largely remains focused on an emergency medicine dominated curricula with limited attempts made to expand paramedic education to include primary care and public health topics that might better address the contemporary needs of practicing paramedics. In developed countries, paramedic roles and scopes of practice are changing in response to aging populations and the attendant prevalence of chronic conditions, advances in technology, changes in community expectations and broader health system challenges. The emergence of paramedic practitioner roles in a number of countries illustrates the impact of these social, technological and economic factors, and how paramedics are being integrated into the health systems of their respective countries.

Countries such as the United Kingdom, Australia and New Zealand, have moved toward near-mandatory higher education models for paramedics. While three-year Baccalaureate degrees generally provide the scope and flexibility to introduce a wider range of studies in primary care and public health, they face the challenge of adding these topics to an already crowded curriculum. In countries without widespread access to Baccalaureate degrees in paramedicine the challenge of broadening the education of paramedics would appear to be near impossible within the constraints of relatively short entry-level programs.

This paper describes how an Australian university is responding to this challenge through the development of a four-year Bachelor of Paramedic Practice with (Clinical) Honours program. The paramedic program was initially encompassed within a suite of allied health courses in 2009 and provided students with the qualification of Bachelor of Health Science / Master of Paramedic Practice. Shortly after its inception, the course was reviewed against the future needs of students, industry and the community. Practice trends and the educational requirements of future entry-level paramedics were critically examined in Australia and internationally through literature reviews, conference attendances, direct feedback from the field, and overseas visits. As a result, the program was modified, and after further review, a new four-year paramedic program will be offered to commencing students in 2018.

The structure of the program will provide opportunities for students to gain skills and knowledge beyond that delivered in traditional paramedicine programs, including knowledge specific to primary health care and extended community paramedicine. These components of the program will allow for enhanced and flexible roles within communities and professional settings, and are responsive to calls for a holistic model of education to meet future paramedic role demands.
Cultivating A Culture of Health in the Southwest: Linking Access and Social Determinants to Quality of Life Amongst Diverse Communities
Authors: Talmage Craig A. , Figueroa Holly L. , Wolfersteig Wendy L.
Published: May 2024

Even with advances in modern medicine and science, communities remain underprepared or unable to achieve positive health outcomes for all their residents. Such achievement requires a built and sustained culture of health that raises quality of life and improves the conditions in which people live, work, play, and learn. The Patient Protection and Affordable Care Act (ACA) has been influential on both individuals and communities, but its impact has not been comprehensively addressed regarding links to social determinants and quality of life with a special emphasis on access to care. This manuscript focuses on views expressed regarding individual, family, and organizational needs in building and sustaining a culture of health within communities of place, identity, status, and influence. Results are shared from a large-scale coordinated community health needs assessment conducted in Maricopa County, Arizona. Three hundred and sixty-seven persons ( n = 367) participated in the focus groups used for the assessment. Focusing on subgroups with the County, views of the cultural, social, and economic factors impacting the health care system emerge, as do specific insights on implementation impacts of the ACA. While being able to have insurance was now a positive factor for many, cost was still a large barrier in affording insurance and obtaining health care services. Location and cultural competence of providers, health literacy, distrust, and dissatisfaction were also discussed as factors impacting quality of health care. This discussion can help with developing health care services aimed at improving quality of life.
A Comparative Assessment of Maternal Health and Maternal Health Policies in India and the U.S.: Need to Transition from a Biomedical Model to a Biopsychosocial Model for Maternal Health Policies
Authors: Mali Nidhi Vij
Published: May 2024

More than 300,000 women died due to pregnancy related causes in 2015, a global maternal mortality ratio (MMR) of 216 per 100,000 live births (Alkema et al., 2016). Millennium Development Goals have led to a 44% decline in global MMR, but significant variations still remain across geographical regions (United Nations [UN], 2015). India accounts for the second highest maternal deaths in the world (World Health Organization [WHO], 2015). In contrast, the U.S. is the only developed country with an increasing MMR in recent years (“Maternal Mortality,” 2015). However, little attention has been given to maternal health in public policy research and practice in both countries. This paper compares and contrasts maternal health status and analyzes maternal health policies in India and the U.S. two health models. Based on comparative case analysis, the overall recommendation is to expand the scope of maternal health from a biomedical health model towards a biopsychosocial model and restructure the policy frameworks. This paper contributes to the maternal health discourse and hopes to garner attention of global and regional health policy scholars and policy makers.
A Stakeholder Analysis of Online Accountability Practices in Rural Hospitals
Authors: Cooley Asya
Published: May 2024

The purpose of this study was to assess online accountability practices in rural hospitals and to determine how these practices differ from those of urban hospitals. The online accountability practices instrument was used to quantitatively analyze website contents of 238 hospitals, sampled from the American Hospital Association database. The findings suggest that rural hospitals with higher revenues and affiliated with health systems were more likely to have robust online accountability practices, while privately-owned rural hospitals were less likely to disclose accountability information in an online environment. More importantly, rural hospitals were just as robust as urban hospitals as it relates to online accountability practices, positioning themselves favorably within the community environment. When looking deeper into dimensions of online accountability, rural hospitals were less likely to disclose their audited financial statements, include an option to instantly connect with an organization, provide search capability and include a link to online donations. In addition, rural hospitals were more likely to include an employee directory with contact information.
Building Cross-Sector Collaboration to Improve Community Health
Authors: Kritz Jessica , Batsa Peter
Published: May 2024

Urban slums present complex challenges. In 2015, the Old Fadama slum of Accra, Ghana, was home to over 100,000 people and had virtually no water or sanitation infrastructure, contributing to diminished quality of health and frequent cholera outbreaks. Beginning with three stakeholders, participatory action researchers (PAR) introduced the cross-sector collaboration evidence base and used interviews, focus groups, and a community survey to create priorities, strategies, and a latrine installation project. Latrine installation resulted in city sanitation policy change. The strategy was adopted by local businesses, creating a path to sustainability and freeing the stakeholders to develop a new strategy. This project responded to United Nations Sustainable Development Goal (SDG) 17, focusing on partnerships, in order to achieve SDG 3, good health and well-being, and SDG 6, clean water and sanitation. The PAR intervention created in this phase has been applied to new challenges in Accra's urban slums and underserved rural areas in northern Ghana, with expanded data collection from more than 4,000 stakeholders.
Are current rates of uncemented fixation in total hip arthroplasty supported by the literature? An update on the uncemented paradox
Authors: Scanlon Christopher M , Gemayel Anthony C , Buehring Weston , Slover James D , Malchau Henrik
Published: May 2024

The optimal fixation method in total hip arthroplasty (THA) remains controversial. Initial concerns related to the long-term performance of cement fixation as well as cement disease led to the development of cementless implants, and registry data has indicated that the use of this type of fixation has increased in recent years. However, data from these same registries has not shown any improvement in outcomes when compared to cement fixation. On the contrary, while similar outcomes are seen when comparing these fixation types in younger patients (<70 years of age), cementless fixation has shown increased implant failure and revision rates in elderly patients (>70 years of age). Given the increased projected volume of THA in the United States over the next decade, it is important to utilise available data to make clinical decisions that minimise not only individual patient harm, but also the burden on the healthcare system itself. This review provides an overview of currently available outcomes data comparing cement and cementless fixation, as well as an updated analysis of current trends in fixation use in THA. We furthermore provide a comprehensive technique guide to help surgeons optimise cement fixation of the femoral component for THA and hemiarthroplasty.
Feasibility of outrigger structural system for tall timber buildings: A numerical study
Authors: Hegeir Osama Abdelfattah , Stamatopoulos Haris
Published: May 2024

Tall timber buildings are prone to serviceability problems (e.g. lateral displacements and wind-induced accelerations). This article investigates the feasibility of timber outrigger system to build up to 20 storeys using linear elastic finite element analysis and relevant European and international standards such as EN 1990, EN 1991-1-1, EN 1991-1-4, EN 1995-1-1 and ISO 10137. The location of up to two outriggers was optimised based on different serviceability criteria. Various outrigger layouts were investigated, and their stiffness demands were discussed. The efficiency of outrigger structures in reducing lateral displacements and wind-induced accelerations is highlighted. A feasibility study considering serviceability requirements was performed using different basic wind velocities, number of storeys and gravity loads. Although the focus of the article is on serviceability requirements, some ultimate limit state considerations (forces and stresses) were briefly discussed. The results demonstrate the feasibility of building up to 16 storeys under medium to high wind velocities.
Who supports energy citizenship? / ¿Quién apoya la ciudadanía energética?
Authors: Röderer Kathrin , Corcoran Katja , Held Johanna
Published: May 2024

Energy citizenship (EC) is a concept that has received little attention in psychological research. However, citizen participation and engagement in the energy system play an important part in the EU’s vision of a low-carbon economy. The expectation is that EU citizens take an active role in a decentralized energy market and become ‘energy citizens’. Psychologically, it remains unclear who is likely to support this transition. In this paper, we investigate which psychological factors predict support for EC and might motivate individuals to become active in the energy transition using an online questionnaire. Results from Austria ( n = 272) show that personal norms predict support for an EC scenario in a multiple linear regression, whereas biospheric values, ecological attitudes, awareness of adverse consequences, as well as ascription of responsibility do not. Further unique variance is explained by right-wing authoritarianism, a concept understudied but important for the massive societal changes involved in the energy transition. We highlight the importance of feeling personally responsible and obliged and being open to overcome conventions for the transition towards EC.
Determinants of Counterproductive Work Behavior: A Moderation and Mediation Analysis
Authors: Patre Smruti , Chakraborty Debarun
Published: May 2024

The purpose of the article is to investigate the impact of employment stressors, specifically job insecurity (JI), interpersonal conflicts at work (ICW), and leader–member exchange (LMX), on counterproductive work behaviors (CWB). The stressor-emotion theory of CWB suggests that the connections between these factors could be influenced by emotional exhaustion (EE) and regulated by emotional intelligence (EI). A cross-sectional survey was undertaken online to gather data from 431 IT personnel in India. The model proposed, postulating relationships among the variables, underwent testing through structural equation modeling (SEM) utilizing the process macro in SPSS. The moderation analysis was conducted using Hayes’ PROCESS macro in SPSS. The findings confirmed that all three job stressors have a significant impact on CWB. Additionally, EE partially mediated all three relationships. Similarly, EI moderated only the association between ICW and CWB, but not those of JI and LMX with CWB. It is highly imperative for organizations to comprehend the concept deeply and research further to determine the antecedents that impact CWB, to realize their goals.
Musculoskeletal Knowledge on the in-Training Examination Improves in Family Medicine Residents Participating in a Longitudinal Sports Medicine Clinical Track
Authors: Furr Micah , Tumin Dmitry , Ferderber Megan L
Published: May 2024

Objectives

The study aims to assess the impacts of a sports medicine (SM) track on musculoskeletal (MSK) knowledge of family medicine (FM) residents. In-training examination (ITE) results were used to compare the MSK knowledge of FM residents with and without SM track participation.

Methods

A single-center, retrospective study was completed on 85 FM residents from the 2018 to 2024 graduating classes who completed the ITE from 2017 to 2021. Residents were categorized by participation in the SM track, where half a day of FM continuity clinic per week is replaced with an SM clinic, supervised by a fellowship-trained SM physician. ITE scores throughout training were compared between the 2 groups using mixed-effects regression.

Results

The ITE MSK scores increased among both SM track participants (+77 points/year, p = .001) and nonparticipants (+39 points/year, p = .001) throughout their training. By postgraduate year 3, SM track participants performed significantly better on the MSK portion of the ITE (+87 points compared to non-participants, p = .045). No significant difference in total ITE scores was seen between groups.

Conclusions

Our data demonstrates that participation in an SM track is associated with an increase in MSK knowledge of ITE, suggesting that an SM track may provide FM residents with a better understanding of MSK conditions.
Creating Value Through Leveraging Gender Norms
Authors: DeTienne Kristen , Alessandri Alice , Evans Whitney
Published: May 2024

This article examines how blending both traditionally masculine and feminine traits in an organizational culture might create value for a company. The article examines workplace defaults and compares and contrasts masculine and feminine traits. Then, the results of an analysis of the research on how masculine defaults create and destroy value in organizations are examined. Next, the article presents the findings from research examining how masculine and feminine traits and behaviours can create and destroy value. Finally, the article examines the impact of hybrid or androgynous traits and behaviours and presents directions for future research.
Persoz hardness: A useful property to study performance of exterior wood coatings
Authors: Malassenet L. , George B. , Merlin A. , Podgorski L.
Published: May 2024

Improving the durability of exterior coatings is essential for the use and development of wood as a building material. In Europe, performances of wood coatings are mainly estimated through visual assessments of panels exposed to weathering. The aim of this work was to investigate the Persoz pendulum as a simple tool to gain information on hardness and mechanical properties of exterior wood coatings. The influence of the substrate and the coating thickness has been studied to figure out the limits of the test method. Through a comparison with tensile tests performed on free films, Persoz pendulum was found to be relevant as a simple tool to estimate mechanical properties of the coating film. Finally, Persoz hardness was assessed on several coatings exposed to 4032 h of artificial weathering. Results have shown that the pendulum hardness test is a useful method to study wood coatings performances for outdoors.
Vitamin D supplement for patients with early-stage chronic lymphocytic leukemia is associated with a longer time to first treatment
Authors: Tadmor Tamar , Melamed Guy , Alapi Hilel , Gazit Sivan , Patalon Tal , Rokach Lior
Published: May 2024

Low levels of vitamin D are associated with a shorter time to first treatment (TTFT) and inferior overall survival in patients with chronic lymphocytic leukemia (CLL). But whether vitamin D supplement affects the clinical course of patients with CLL, remains an open question. In this study, we aimed to retrospectively explore the clinical benefit of vitamin D supplement or one of its analogs, on TTFT and treatment-free survival (TFS) in a large cohort of patients with asymptomatic CLL, who were under watch-and-wait approach. Among the 3474 patients included in the study, 931 patients (26.8%) received either vitamin D supplement or its analog, for a minimum of 6 months. We found that vitamin D supplement was statistically significant for longer TTFT in the young cohort (age ≤65) and was associated with a longer TFS for all ages (P = .004). Among non–vitamin-D users, the median TFS was found to be 84 months, whereas among vitamin D supplement users the median TFS extended to 169 months. In conclusion, our long-term retrospective study demonstrates that the administration of vitamin D to patients with CLL in a watch-and-wait active surveillance is significantly associated with a longer TFS (in any age) and a longer TTFT among young patients (age ≤65). A prospective clinical trial is needed to validate results.
Fluocinolone intravitreal implant (Iluvien) for macular edema secondary to immune recovery uveitis in patient with acute myeloid leukemia
Authors: Cachero Rodríguez JM , Artaraz J. , Imaz Nora , Fonollosa A.
Published: May 2024

Purpose

To report the use of Fluocinolone intravitreal implant (Iluvien) for the treatment of persistent cystoid macular edema (CME) due to immune recovery uveitis syndrome in a patient with previous cytomegalovirus retinitis and acute myeloid leukemia.

Design

Case report.

Methods

The clinical history of a patient who received an Iluvien implant in one eye for the treatment of cystoid macular edema due to immune recovery uveitis syndrome, previously treated with peribulbar Triamcinolone and intravitreal Dexamethasone injections, was reviewed.

Results

A 48-year-old woman presented with cystoid macular edema due to immune recovery uveitis syndrome. The patient had a history of cytomegalovirus retinitis 3.5 years prior, secondary to immunosuppressive treatment for an acute myeloid leukemia. Three periocular triamcinolone injections and two dexamethasone intravitreal implants were performed, but the edema recurred, so fluocinolone intravitreal implant was used, achieving a sustained control of the condition at one year of follow-up.

Conclusion

The Fluocinolone intravitreal implant may be an effective treatment for persistent CME in patients with immune recovery uveitis syndrome.
Propensity score analysis for health care disparities: a deweighting approach
Authors: Choi Byeong Yeob
Published: May 2024

Background

Propensity score weighting is a useful tool to make causal or unconfounded comparisons between groups. According to the definition by the Institute of Medicine (IOM), estimates of health care disparities should be adjusted for health-status factors but not for socioeconomic status (SES) variables. There have been attempts to use propensity score weighting to generate estimates that are concordant with IOM’s definition. However, the existing propensity score methods do not preserve SES distributions in minority and majority groups unless SES variables are independent of health status variables.

Methods

The present study introduces a deweighting method that uses two types of propensity scores. One is a function of all covariates of health status and SES variables and is used to weight study subjects to adjust for them. The other is a function of only the SES variables and is used to deweight the subjects to preserve the original SES distributions.

Results

The procedure of deweighting is illustrated using a dataset from a right heart catheterization (RHC) study, where it was used to examine whether there was a disparity between black and white patients in receiving RHC. The empirical example provided promising evidence that the deweighting method successfully preserved the marginal SES distributions for both racial groups but balanced the conditional distributions of health status given SES.

Conclusions

Deweighting is a promising tool for implementing the IOM-definition of health care disparities. The method is expected to be broadly applied to quantitative research on health care disparities.
Mortality and its predictors among human immunodeficiency virus-infected children younger than 15 years receiving antiretroviral therapy in Ethiopia: a systematic review and meta-analysis
Authors: Woldegeorgis Beshada Zerfu , Asgedom Yordanos sisay , Gebrekidan Amanuel Yosef , Kassie Gizachew Ambaw , Borko Ushula Deboch , Obsa Mohammed Suleiman
Published: May 2024

Background

Despite antiretroviral treatment (ART), the human immunodeficiency virus (HIV) continues to pose a considerable health burden in resource-poor countries. This systematic review and meta-analysis aimed to determine the pooled incidence density of mortality and identify potential predictors among HIV-infected children receiving ART, from studies conducted in various parts of Ethiopia.

Methods

A comprehensive database search was made in Excerpta Medica, PubMed, Web of Science, African Journals Online, Google Scholar, and Scopus. We reported results following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. Excel Spreadsheet and STATA Version 14 software were used for data abstraction and meta-analysis, respectively. Statistical heterogeneity among studies was assessed using I2 statistics. Meta-regression and subgroup analysis were performed to further explore the sources of statistical heterogeneity. Moreover, publication bias and a leave-out-one sensitivity analysis were performed.

Results

Twenty-two articles involving 8,731 participants met inclusion criteria and were included. The pooled incidence density of mortality was 3.08 (95% confidence interval (CI), 2.52 to 3.64) per 100 child years. Predictors of mortality were living in rural areas (hazard ratio (HR), 2.18 [95% CI, 1.20 to 3.98]), poor adherence to ART (HR, 2.85 [ 95% CI, 1.39 to 5.88]), failure to initiate co-trimoxazole preventive therapy (HR, 2.16 [95% CI, 1.52 to 3.07]), anemia (HR, 2.28 [95% CI, 1.51 to 3.45]), opportunistic infections (HR, 1.52 [ 95% CI, 1.15 to 2.00]), underweight (HR, 1.74 [95% CI, 1.26 to 2.41]), wasting (HR, 2.54 [95% CI, 1.56 to 4.16]), stunting (HR, 2.02 [95% CI, 1.63 to 2.51]), World Health Organization classified HIV clinical stages III and IV (HR, 1.71 [95% CI, 1.42 to 2.05]), and Nevirapine-based regimens (HR, 3.91 [95% CI, 3.09 to 4.95]).

Conclusions

This study found that the overall mortality rate among HIV-infected children after ART initiation was high. Therefore, high-level commitment and involvement of responsible caregivers, healthcare providers, social workers, and program managers are of paramount importance to identify these risk factors and thus enhance the survival of HIV-infected children receiving ART.
Predictive performance of two types of urinary biomarkers for renal non-recovery in sepsis-associated acute kidney injury: a prospective observational study
Authors: Licheng  , Jia Huimiao , Jiang Yijia , Li Wenxiong
Published: May 2024

Background and purpose

Renal non-recovery is known to have negative prognostic implications in patients suffering from acute kidney injury (AKI). Nevertheless, the identification of biomarkers for predicting renal non-recovery in sepsis-associated AKI (SA-AKI) within clinical settings remains unresolved. This study aims to evaluate and compare the predictive ability for renal non-recovery, use of kidney replacement therapy (KRT) in the Intensive Care Unit (ICU), and 30-day mortality after SA-AKI by two urinary biomarkers, namely C-C motif chemokine ligand 14 (CCL14) and [TIMP-2]•[IGFBP7].

Methods

We prospectively screened adult patients who met the criteria for AKI stage 2–3 and Sepsis-3.0 in two ICUs from January 2019 to May 2022. Patients who developed new-onset SA-AKI after ICU admission were enrolled and urinary biomarkers including [TIMP-2]•[IGFBP7] and CCL14 were detected at the time of SA-AKI diagnosis. The primary endpoint was non-recovery from SA-AKI within 7 days. The secondary endpoints were the use of KRT in the ICU and 30-day mortality after SA-AKI. The individual discriminative ability of [TIMP-2]•[IGFBP7] and CCL14 to predict renal non-recovery were evaluated by the area under receiver operating characteristics curve (AUC).

Results

141 patients with stage 2–3 SA-AKI were finally included, among whom 54 (38.3%) experienced renal non-recovery. Urinary CCL14 exhibited a higher predictive capability for renal non-recovery compared to [TIMP-2]•[IGFBP7], with CCL14 showing an AUC of 0.901, versus an AUC of 0.730 for [TIMP-2]•[IGFBP7] (P = 0.001). Urinary CCL14 and [TIMP-2]•[IGFBP7] demonstrated a moderate predictive value for the need for KRT in ICU, with AUC values of 0.794 and 0.725, respectively; The AUC of [TIMP-2]•[IGFBP7] combined with CCL14 reached up to 0.816. Urinary CCL14 and [TIMP-2]•[IGFBP7] exhibited poor predictive power for 30-day mortality, with respective AUC values of 0.623 and 0.593.

Conclusion

Urinary CCL14 had excellent predictive value for renal non-recovery in SA-AKI patients. For predicting the use of KRT in the ICU, the predictive capability of urinary [TIMP-2]•[IGFBP7] or CCL14 was fair. However, a combination of [TIMP-2]•[IGFBP7] and CCL14 showed good predictive ability for the use of KRT.
Sleep initiation patterns and sleep quality among toddlers in the southeast of China: initial study results
Authors: Lin Xiaoxia , Chen Xianrui , Chen Yanhui , Xu Ping , Chen Shan
Published: May 2024

Background

A large number of psychological consequences including sleep health emerged during the 2019 Coronavirus disease (COVID-19) pandemic. Sleep patterns in toddlers are vulnerable to negative environmental exposures, however, very few studies on this topic have been published so far.

Objectives

In this paper, we aimed to investigate the sleep patterns and associated factors in toddlers from China confined at home in the context of COVID-19 pandemic.

Methods

From April to November 2021, a convenience sample of 493 parents of young children aged (12–35 months) were surveyed from Fuzhou, Sanming, Quanzhou, Nanping, and Longyan cities in the Fujian Province, China. A cross-sectional survey was conducted via Electronic questionnaires to collect parent and child social-demographic characteristics. The Brief Infant Sleep Questionnaire (BISQ) was used to collect data on sleep practices, sleep duration and patterns, as well as the number of nocturnal awaking .

Results

The mean age of toddlers was 2.11 years old, and 52.54% (259/493) were males. Among the 493 toddlers’ sleep patterns, 331(67.1%) initiated sleep accompanied by parents, 67(13.6%) slept independently, 59 (12.0%) were breast fed/bottle fed to initiate sleep, 27 (5.5%) were held and 9 (1.8%) rocked. The clear longitudinal association between the duration of night-time sleep, the frequency of nighttime awakenings, and various sleep patterns remains clear (p < 0.05). Multiple linear regression analysis indicated that sleep initiation with bottle-feeding/breast-feeding and rocked significantly increased the frequency of nighttime awakenings and reduced the duration of nighttime sleep (p < 0.05), as held was dramatically only for increasing the number of nighttime awakenings (p < 0.05). Multi-variate logistic regression analysis demonstrated that toddlers with severe sleep difficulties had a higher probability of being rocked to initiate sleep (p < 0.05). Conversely, young children with minor sleep problems were more apt to be in bed alone to initiate sleep (p < 0.05).

Conclusions

During the COVID-19 pandemic, most infants and toddlers initiated sleep accompanied by parents and tend to have electronic media exposure before bedtime. Increased waking at night may be associated with sleep initiation with breast-feeding/bottle-feeding. Therefore, pediatric practitioners in primary community hospitals should pay attention to the education and promotion of sleep hygiene and parenting knowledge of young children to avoid the formation of poor sleep hygiene habits.
Stapled versus hand-sewn anastomoses after bowel resection in patients with crohn disease
Authors: Lahes Saleh , Fischer Celine , Igna Dorian , Jacob Peter , Glanemann Matthias
Published: May 2024

Background

Anastomosis configuration is an essential step in treatment to restore continuity of the gastrointestinal tract following bowel resection in patients with Crohn’s disease (CD). However, the association between anastomotic type and surgical outcome remains controversial. This retrospective study aimed to compare early postoperative complications and surgical outcome between stapler and handsewn anastomosis after bowel resection in Crohn’s disease.

Methods

Between 2001 and 2018, a total of 339 CD patients underwent bowel resection with anastomosis. Patient characteristics, intraoperative data, early postoperative complications, and outcomes were analyzed and compared between two groups of patients. Group 1 consisted of patients with stapler anastomosis and group 2 with handsewn anastomosis.

Results

No significant difference was found in the incidence of postoperative surgical complications between the stapler and handsewn anastomosis groups (25% versus 24.4%, p = 1.000). Reoperation for complications and postoperative hospital stay were similar between the two groups.

Conclusion

Our analysis showed that there were no differences in anastomotic leak, nor postoperative complications, mortality, reoperation for operative complications, or postoperative hospital stay between the stapler anastomosis and handsewn anastomosis groups.
Factors influencing TSH suppression efficacy in postoperative papillary thyroid carcinoma patients: a retrospective cohort study
Authors: Zhang Qing , Zhong Zhen-Zhu , Wu Tian , He Yuan-Qiang
Published: May 2024

Objectives

While surgery plays a crucial role in treating papillary thyroid carcinoma (PTC), the potential effects of subsequent TSH suppression therapy on prognosis should not be overlooked. This study aims to investigate the factors that influence postoperative TSH suppression therapy in patients with PTC.

Methods

This study was a retrospective cohort study conducted at our hospital. It included 268 patients who underwent surgery and were pathologically diagnosed with PTC between February 2019 and February 2021. The selected patients received postoperative TSH suppression therapy. Based on the TSH level measured 12 months after surgery, the patients were divided into two groups: TSH level conforming group (n = 80) and non-conforming group (n = 188). We then compared the general clinical data, clinicopathological characteristics, preoperative laboratory test indicators, postoperative levothyroxine sodium tablet dosage, follow-up frequency, and thyroid function-related indicators between the two groups of patients. The correlation between the observed indicators and the success of TSH suppression therapy was further analyzed, leading to the identification of influencing factors for TSH suppression therapy.

Results

There were no statistically significant differences in general clinical data and clinicopathological characteristics between the two groups of patients (P > 0.05). The proportion of patients with preoperative TSH ≥ 2.0 mU/L was higher in the non-conforming group compared to the TSH level conforming group (P < 0.05), and the ROC curve analysis indicated that the area under the curve for the preoperative TSH index was 0.610 (P < 0.05). The proportion of patients in the TSH level conforming group who took oral levothyroxine sodium tablets at a dose of ≥ 1.4 µg/kg·d after surgery was higher (P < 0.05). The postoperative levels of FT3 and FT4 were higher in the TSH level conforming group (P < 0.05). The results of binary logistic regression analysis indicated that factors “Postoperative TSH level ≥ 2 mU/L”, “Levothyroxine sodium tablet dose<1.4 µg/kg·d”, and “Combined with Hashimoto thyroiditis” were significantly associated with an elevated risk of postoperative TSH levels failing to reach the target (P < 0.05).

Conclusion

Optimal thyroid function in patients with PTC post-surgery is best achieved when adjusting the dose of levothyroxine sodium in a timely manner to reach the target TSH level during follow-up visits.
The mylohyoid line is highly variable but does not affect the microarchitecture of the edentulous alveolar bone – an anatomical micro-CT study
Authors: Domic Danijel , Kappenberger Julia , Bertl Kristina , Hirtler Lena , Heimel Patrick , Ulm Christian
Published: May 2024

Objectives

To evaluate in the absence of teeth the variability of the mylohyoid line (ML), the microarchitecture of the adjacent bone, and whether the variable prominence/width of the ML is associated with the quality of the adjacent bone.

Methods

µCT scans of 28 human mandibles from anatomical specimens were analyzed. The following parameters were assessed in four edentulous areas (first and second premolar (PM), first, second, and third molar (M1/2/3)): ML width, cortical thickness (CtTh), average cortical- (Avg.Ct.BV/TV), and trabecular bone volume fraction (Avg.Tb.BV/TV).

Results

The ML width increased from the PM towards the M2 region, which also showed the highest variance (range: 0.4–10.2 mm). The CtTh showed a decrease in the M3 region, while Avg.Ct.BV/TV and Avg.Tb.BV/TV hardly differed among the regions. In the multivariable model on the effect of the various parameters on the ML width, only gender and tooth region were significant. Specifically, male specimens were associated with a wider ML width compared to female specimens and the M2 region was associated with a wider ML width compared to the other tooth regions.

Conclusion

The ML width was not associated with the cortical and trabecular bone quality in the adjacent bone, while gender and tooth region had a significant effect. Specifically, the ML width was lower in female, but peaked in the M2 region with a median width of 3–4 mm.

Clinical relevance

From a clinical point of view, it was confirmed that the ML is in general a highly variable structure, especially in the M2 region, but the ML width does not allow any conclusions on the bone quality. Altogether, this underlines the need for an individual and accurate diagnostic prior to any surgical intervention.
The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study
Authors: Gao Qiufeng , Zhang Bin , Zhou Qian , Lei Cuiyao , Wei Xiaofei , Shi Yaojiang
Published: May 2024

Objectives

In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.

Methods

Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction.

Results

The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.

Conclusion

This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.
Comparative genomics of Ascetosporea gives new insight into the evolutionary basis for animal parasitism in Rhizaria
Authors: Hiltunen Thorén Markus , Onuț-Brännström Ioana , Alfjorden Anders , Pecková Hana , Swords Fiona , Hooper Chantelle , Holzer Astrid S. , Bass David , Burki Fabien
Published: May 2024

Background

Ascetosporea (Endomyxa, Rhizaria) is a group of unicellular parasites infecting aquatic invertebrates. They are increasingly being recognized as widespread and important in marine environments, causing large annual losses in invertebrate aquaculture. Despite their importance, little molecular data of Ascetosporea exist, with only two genome assemblies published to date. Accordingly, the evolutionary origin of these parasites is unclear, including their phylogenetic position and the genomic adaptations that accompanied the transition from a free-living lifestyle to parasitism. Here, we sequenced and assembled three new ascetosporean genomes, as well as the genome of a closely related amphizoic species, to investigate the phylogeny, origin, and genomic adaptations to parasitism in Ascetosporea.

Results

Using a phylogenomic approach, we confirm the monophyly of Ascetosporea and show that Paramyxida group with Mikrocytida, with Haplosporida being sister to both groups. We report that the genomes of these parasites are relatively small (12–36 Mb) and gene-sparse (~ 2300–5200 genes), while containing surprisingly high amounts of non-coding sequence (~ 70–90% of the genomes). Performing gene-tree aware ancestral reconstruction of gene families, we demonstrate extensive gene losses at the origin of parasitism in Ascetosporea, primarily of metabolic functions, and little gene gain except on terminal branches. Finally, we highlight some functional gene classes that have undergone expansions during evolution of the group.

Conclusions

We present important new genomic information from a lineage of enigmatic but important parasites of invertebrates and illuminate some of the genomic innovations accompanying the evolutionary transition to parasitism in this lineage. Our results and data provide a genetic basis for the development of control measures against these parasites.