bluuebunny/crossref_metadata_2025 huggingface dataset:
Shared decision making for women with uncomplicated Cystitis in Primary Care in the Netherlands: a qualitative interview study
Authors: van Horrik Tessa M.Z.X.K. , Laan Bart J. , van Seben Rosanne , Rodenburg Gerda , Heeregrave Edwin J. , Geerlings Suzanne E.
Published: October 2022

Background

Urinary tract infections (UTIs) are common, especially among women. Antibiotics are commonly used to treat UTIs, but might not always be necessary, for example in the case of uncomplicated UTIs such as cystitis. Shared decision making (SDM) could reduce the risk of unnecessary antibiotic prescriptions for uncomplicated cystitis. We investigated the current management and the use of SDM for uncomplicated cystitis in primary care.

Methods

We performed a qualitative semi-structured interview study among 23 women with a history of cystitis, 12 general practitioner (GP) assistants, and 12 GPs in the Netherlands from July to October 2020. All interviews were individually performed by telephone. The data were analyzed through the use of using open and axial coding.

Results

The GP assistants managed the initial diagnostics and treatment of uncomplicated cystitis in all general practices. Usually, antibiotics were considered the standard treatment of cystitis. In most general practices, SDM was not used in the treatment of uncomplicated cystitis, mainly because of a lack of time. Women reported that they valued being involved in the treatment decision-making process, but they were not always involved. Further, both GP assistants and GPs indicated that SDM would improve the care pathway of uncomplicated UTIs.

Conclusion

In our study, SDM was infrequently used to help women with uncomplicated cystitis. To reduce the use of antibiotics for uncomplicated UTIs, a tailored intervention is needed to implement SDM for the treatment of uncomplicated cystitis in primary care.
Social and private activity after retirement—substitutes or complements
Authors: Kalbarczyk Małgorzata , Łopaciuk-Gonczaryk Beata
Published: October 2022

Background

Commonly observed low activity of older adults harms their well-being. We perceive the retirement as a new opening that could be utilized to fulfill previously neglected needs and involve in new activities. They can be a remedy for losing the sense of life while changing the social role and getting older. This study explores trends in activity over retirement. In particular, it verifies if different post-retirement activities: 1) formal social engagement; 2) informal help given outside the household; 3) solitary leisure or self-development activities, and 4) sociable leisure or self-development activities are mutually exclusive or supportive of each other.

Methods

We use the data from 4 and 6th wave of Survey of Health, Ageing and Retirement in Europe, taking into consideration 2757 respondents who participated in both waves. We analyze trends in activity over retirement and verify the hypotheses regarding the relationships between engaging into different types of activities and between the activity and development of personal social networks. We conduct the descriptive analysis and utilize the Generalized Structural Equation Model.

Results

Most people do not change their involvement in different activities after retirement. Among those who change, the average trend is upward. We find support that different types of activities undertaken after retirement do not crowd out each other. On the contrary, being active in one sphere goes hand in hand with activity in another. We give evidence for presence of social network mechanisms that enhance such understood complementarity. Maintaining social relationships correlates with engagement in socially-oriented activities and privately-oriented sociable pastimes. Being active, with exception of solitary forms of recreation, creates an opportunity to foster relations with other people and, thanks to their encouragement, to engage in new activities.

Conclusions

The small change in activity after retirement signifies the need to encourage non-work activity during earlier stages of life. As different types of post-retirement activities are complementary, the most active group of older adults would be the most open for social engagement and volunteering, however the least active group needs the biggest support to involve in any activities.
Real-world effectiveness of steroids in severe COVID-19: a retrospective cohort study
Authors: Wang Wenjuan , Snell Luke B , Ferrari Davide , Goodman Anna L , Price Nicholas M , Wolfe Charles D , Curcin Vasa , Edgeworth Jonathan D , Wang Yanzhong
Published: October 2022

Introduction

Randomised controlled trials have shown that steroids reduce the risk of dying in patients with severe Coronavirus disease 2019 (COVID-19), whilst many real-world studies have failed to replicate this result. We aim to investigate real-world effectiveness of steroids in severe COVID-19.

Methods

Clinical, demographic, and viral genome data extracted from electronic patient record (EPR) was analysed from all SARS-CoV-2 RNA positive patients admitted with severe COVID-19, defined by hypoxia at presentation, between March 13th 2020 and May 27th 2021. Steroid treatment was measured by the number of prescription-days with dexamethasone, hydrocortisone, prednisolone or methylprednisolone. The association between steroid > 3 days treatment and disease outcome was explored using multivariable cox proportional hazards models with adjustment for confounders (including age, gender, ethnicity, co-morbidities and SARS-CoV-2 variant). The outcome was in-hospital mortality.

Results

1100 severe COVID-19 cases were identified having crude hospital mortality of 15.3%. 793/1100 (72.1%) individuals were treated with steroids and 513/1100 (46.6%) received steroid ≤ 3 days. From the multivariate model, steroid > 3 days was associated with decreased hazard of in-hospital mortality (HR: 0.47 (95% CI: 0.31–0.72)).

Conclusion

The protective effect of steroid treatment for severe COVID-19 reported in randomised clinical trials was replicated in this retrospective study of a large real-world cohort.
The risk of inappropriate empiric treatment and its outcomes based on pathogens in non-ventilated (nvHABP), ventilated (vHABP) hospital-acquired and ventilator-associated (VABP) bacterial pneumonia in the US, 2012–2019
Authors: Zilberberg Marya D. , Nathanson Brian H. , Puzniak Laura A. , Dillon Ryan J. , Shorr Andrew F.
Published: October 2022

Background

Inappropriate empiric antimicrobial treatment (IET) contributes to worsened outcomes. While IET’s differential impact across types of nosocomial pneumonia (NP: non-ventilated [nvHABP], ventilated [vHABP] hospital-acquired and ventilator-associated [VABP] bacterial pneumonia) is established, its potential interaction with the bacterial etiology is less clear.

Methods

We conducted a multicenter retrospective cohort study in the Premier Healthcare Database using an administrative algorithm to identify NP. We paired respective pathogens with empiric treatments. Antimicrobial coverage was appropriate if a drug administered within 2 days of infection onset covered the recovered organism(s). All other treatment was IET.

Results

Among 17,819 patients with NP, 26.5% had nvHABP, 25.6% vHABP, and 47.9% VABP. Gram-negative (GN) organisms accounted for > 50% of all infections. GN pathogens were ~ 2 × as likely (7.4% vHABP to 10.7% nvHABP) to engender IET than Gram-positive (GP, 2.9% vHABP to 4.9% nvHABP) pathogens. Although rare (5.6% nvHABP to 8.3% VABP), GN + GP infections had the highest rates of IET (6.7% vHABP to 12.9% nvHABP). Carbapenem-resistant GNs were highly likely to receive IET (33.8% nvHABP to 40.2% VABP). Hospital mortality trended higher in the IET group, reaching statistical significance in GN + GP vHABP (47.8% IET vs. 29.3% non-IET, p = 0.016). 30-day readmission was more common with IET (16.0%) than non-IET (12.6%, p = 0.024) in GN VABP. Generally post-infection onset hospital length of stay and costs were higher with IET than non-IET.

Conclusions

IET is ~ 2 × more common in GN than GP infections. Although the magnitude of its impact varies by NP type, IET contributes to worsened clinical and economic outcomes.
Iranian women’s perception on the determinants of birth experience: a qualitative study
Authors: Mirghafourvand Mojgan , Meedya Shahla , Mohammadi Eesa , Mohammad-Alizadeh-Charandabi Sakineh , Jafarabadi Mohammad Asghari , Ghanbari-Homaie Solmaz
Published: October 2022

Background

The prevalence of cesarean birth in Iran is very high. Having a negative childbirth experience is one of the reasons that primiparous women provide to prefer caesarean birth over a vaginal birth. This study is aimed to understand women’s perspective on what determines a positive or negative birth experience for them.

Methods

This qualitative study is a part a mixed method study that was conducted among primiparous women with a previous vaginal birth experience. The purpose of the main study was to develop a guideline based on Iranian primiparous women’s birth experiences. The quantitative phase of the study was a cross-sectional study where women’s childbirth experiences was measured in a survey via the Childbirth Experience Questionnaire-2. In the qualitative part of the study, women were invited for an in-depth interview via a random stratified sampling method based on their childbirth mean score (women with 10% of the upper bound score which indicated a positive birth experience and 10% of the lower bound indicating negative birth experience, n = 17). Conventional content analysis was used for data analysis.

Results

We extracted three main themes: (a) “Internal control”, (b) “External control”, and (c) “Support”. Possessing internal control, having a balanced external control to feel cared and feeling supported were the main reasons for women to feel positive about their birth experiences. Whereas, loss of internal control, imbalanced external control and unsupportive environment were related to their negative childbirth experiences.

Conclusion

Considering that women’s sense of control, the care and support that they receive can influence their childbirth experiences, there is a need for changing maternity policies and practices to highlight the importance of a woman-centred care to create a pleasant, respectful and positive memory for primirparous women who experience normal vaginal births.
What predicts delayed first antenatal care contact among primiparous women? Findings from a cross-sectional study in Nigeria
Authors: Solanke Bola Lukman , Oyediran Olufemi O. , Opadere Ayodele Aderemi , Bankole Taofik Olatunji , Olupooye Olabusoye Olu , Boku Umar Idris
Published: October 2022

Background

Delayed first antenatal care contact refers to first antenatal care contact occurring above twelfth weeks of gestation. Studies in Nigeria and in other countries have examined the prevalence and predictors of delayed first antenatal care contact. Nevertheless, existing studies have rarely examined the predictors among primiparous women. In addition, the evidence of higher health risks associated with primigravida emphasizes the need to focus on primiparous women. This study, therefore, examined the predictors of delayed first antenatal care contact among primiparous women in Nigeria.

Methods

The study was a descriptive cross-sectional design that analyzed data extracted from the 2018 Nigeria Demographic and Health Survey. The study analyzed a weighted sample of 3,523 primiparous women. The outcome variable was delayed first antenatal care contact. explanatory variables were grouped into predisposing, enabling, and need factors. The predisposing factors were maternal age, education, media exposure, religion, household size, The knowledge of the fertile period, and women’s autonomy. The enabling factors were household wealth, employment status, health insurance, partner’s education, financial inclusion, and barriers to accessing healthcare. The need factors were pregnancy wantedness and spousal violence during pregnancy. Data were analyzed using Stata 14. Two multivariable logistic regression models were fitted. Statistical significance was set at p < 0.05.

Results

Nearly two-thirds (65.0%) of primiparous women delayed first antenatal care contact. Maternal age, maternal education, media exposure, religion, household membership, and knowledge of the fertile period were predisposing factors that significantly influenced the likelihood of delayed first antenatal care contact. Also, household wealth, employment status, health insurance, partner’s education, perception of distance to the health facility, and financial inclusion were enabling factors that had significant effects on delayed first antenatal care contact. Pregnancy wantedness was the only need factor that significantly influenced the likelihood of delayed first antenatal care contact.

Conclusion

The majority of primiparous women in Nigeria delayed first antenatal care contact and the delay was predicted by varied predisposing, enabling, and need factors. Therefore, a public health education program that targets women of reproductive age especially primiparous women is needed to enhance early antenatal care contact in the country.
Occupational stress is associated with job performance among pregnant women in Japan: comparison with similar age group of women
Authors: Nakamura Yasuka , Tsuno Yoko Sumikawa , Wada Aya , Nagasaka Keiko , Kawajiri Maiko , Takeishi Yoko , Yoshida Mikako , Yoshizawa Toyoko
Published: October 2022

Background

Pregnancy results in physical and psychological changes in women; however, pregnant women hesitate to take a break from work even when they feel the need. Since working while physically ill leads to decreased job performance, it is important to determine the factors that lead to this phenomenon.

Aim

To study the occupational stress associated with job performance and absenteeism of pregnant women compared with non-pregnant women.

Methods

In 2019, non-pregnant and pregnant employed women in their 20–40 s in Japan completed an online survey examining job performance (Work Limitation Questionnaire - Short Form), absenteeism, occupational stress (Brief Job Stress Questionnaire), and working situations.

Results

Of 918 respondents who met the inclusion criteria, 904 were included in the final analysis (454 non-pregnant and 450 pregnant women). Logistic regression analyses showed that absenteeism was significantly higher for pregnant women. However, for women who were absent, there was no significant difference between non-pregnant and pregnant women. After adjusting for attributes and working conditions, pregnant women had significantly higher (p < .001) work productivity losses than non-pregnant women, but only in the physical tasks domain; their physical stress response was also higher compared to non-pregnant women (p = .048). However, pregnant women reported significantly less interpersonal conflict stress (p < .001) and psychological stress (p = .026), as well as better workplace support as a buffering factor for stress (p = .021), than non-pregnant women.

Conclusion

Clarifying the physical burden associated with pregnancy and assisting women in coordinating their work duties while considering the physical demands of pregnancy may minimize work productivity losses among pregnant women.
“A person who does not have money does not enter”: a qualitative study on refugee women’s experiences of respectful maternity care
Authors: Kabakian-Khasholian Tamar , Makhoul Jihad , Ghusayni Aleni
Published: October 2022

Background

Women’s childbirth experiences in health facilities is at the core of quality of care. Their perceptions of poor-quality care, including disrespectful care at health facilities during childbirth, is recognized as a significant barrier to seeking care for subsequent births. Research that explores women’s perspectives of the dimensions of disrespect and mistreatment during childbirth in Arab countries is scarce, and there is none pertaining to refugee groups who carry the burden of multiple vulnerabilities and who suffer from discontinued care, especially in fragile health systems. This paper aims at presenting Palestinian, Iraqi and Syrian refugee women’s experiences, understanding and interpretation of disrespect and mistreatment during childbirth in hospitals in Lebanon.

Methods

This study employed phenomenology, a qualitative research design to generate data through in-depth interviews. Women who were 3 to 6 months postpartum were recruited through the non-governmental organizations (NGOs) that are actively engaged in providing welfare and healthcare services to different populations of refugee women in Lebanon. In total, 24 women were interviewed. All interviews were audio recorded, transcribed verbatim and subjected to thematic analysis.

Results

Of the 24 women who participated in this study, 9 were Palestinian, 12 were Syrian and 3 were Iraqi. The participants spoke of restricted choices to hospitals, care providers and to types of birth, while revealing adverse experiences during childbirth in healthcare facilities, including verbal and physical abuse, disrespectful verbal and non-verbal communication by healthcare providers. They also reported sub-standard care, denial of birth companions and breaches to their privacy. Our findings exemplify how the coverage of the cost of facility-based births by UN agencies and NGOs increase refugee women’s vulnerability to disrespect and mistreatment during childbirth.

Conclusion

This study shows how disrespect and mistreatment are intertwined in a complex system which is devised to ensure access to facility-based birth for displaced populations. Implications for programs and policies point to the need for strengthening capacity and for providing resources for the adaptation of global guidelines into context-specific strategies for the provision of quality maternity care during humanitarian crises and beyond.
High expression of syndecan-4 is related to clinicopathological features and poor prognosis of pancreatic adenocarcinoma
Authors: Zhu Yufei , Zheng Dijie , Lei Linhan , Cai Kun , Xie Huahua , Zheng Jian , Yu Chao
Published: October 2022

Objective

Pancreatic adenocarcinoma (PAAD) is a leading cause of cancer-related mortality in adults. Syndecan-4 (SDC4) is involved in cancer pathogenesis. Therefore, this study aimed to explore the expression and clinical significance of SDC4 in PAAD.

Methods

Differentially expressed genes (DEGs) between PAAD and normal pancreas were screened from the GTEx and TCGA databases, and the correlationship between the DEGs and prognosis were analyzed. The prognostic value of the screened SDC4, SERPINE1, and SLC2A1 was evaluated using the Kaplan–Meier curve and SDC4 was subsequently selected as the better candidate. Also, SDC4 expression was analyzed in PAAD tissues, the other risk factors affecting postoperative survival were analyzed using Cox regression analysis, and SDC4-mediated pathways enrichment was identified by GSVA and GSEA. SDC4 expression in PAAD tissues and adjacent normal tissues of selected PAAD patients was detected by RT-qPCR and immunohistochemistry. The correlation between SDC4 and clinical features was evaluated by the χ2 test.

Results

SDC4 was highly expressed in PAAD tissues. Elevated SDC4 was correlated with reduced overall survival. SDC4 enrichment pathways included spliceosome function, proteasome activity, pentose phosphate pathway, base excision repair, mismatch repair, DNA replication, oxidative phosphorylation, mitotic spindle formation, epithelial-mesenchymal transition, and G2M checkpoints. SDC4 was elevated in PAAD tissues of PAAD patients compared with adjacent normal tissues. High SDC4 expression was related to metastatic differentiation, TNM stage, lymphatic metastasis, and lower 3-year survival rate. SDC4 was an independent risk factor affecting postoperative survival.

Conclusion

SDC4 was highly expressed in PAAD and was related to clinicopathological features and poor prognosis, which might be an important index for PAAD early diagnosis and prognosis.
Underweight and its associated factors among pediatrics attending HIV Care in South Gondar Zone public health facilities, Northwest Ethiopia, 2021
Authors: Tiruneh Chalie Marew , Emiru Tigabu Desie , Tibebu Nigusie Selomon , Abate Moges Wubneh , Nigat Adane Birhanu , Bantie Berihun , Tigabu Agimasie , Belete Amsalu , Walle Belete Gelaw , Legas Getasew
Published: October 2022

Background

Malnutrition associated with HIV infection is a complex condition, with HIV-positive children having a higher mortality rate than HIV-negative children, resulting in significant morbidity and mortality in children. Data from a variety of situations are needed to counter this, but the evidence is limited, especially for the nutritional status of HIV-infected children. Therefore, this study aims to assess the magnitude of underweight and factors associated with it in children receiving antiretroviral therapy.

Methods

An institutional-based cross-sectional study was conducted among HIV-positive children in South Gondar, Northwest Ethiopia. Data were collected using an interviewer-administered questionnaire and anthropometry measurement. Data were coded and entered into Epi-Data Version 3.1 and analyzed using SPSS Version 25. Bivariable and multivariable binary logistic regression models were used to identify factors associated with nutritional status and variables with p-values ˂0.05 in multivariable logistic regression were considered as statistically significant factors.

Results

Of 406 participants, 379 participant were included in the study, which corresponds to a response rate of 93.3%. About one-third (36.4%) of the caregivers were not first relatives and 162 (42.7%) were unable to read and write. Of the study participants, 101 (26.6%) had a CD4 count below the normal threshold. Ninety (23.7%) of those questioned did not follow any nutritional advice from health care workers. In this study, the prevalence of underweight was 106 (28%). In the multivariable analysis being younger age, having low CD4 count, having recurrent diarrhea, and having poor adherence to dietary advice was significantly associated with being underweight.

Conclusion

This study found that the prevalence of underweight among HIV-positive children in south Gondar is significantly high. Therefore, HIV-positive pediatrics who are young, have low CD4 counts, have recurrent diarrhea, and do not adhere to dietary recommendations need to detect and monitor nutritional problems promptly.
Optimism and symptoms of anxiety and depression among Chinese women with breast cancer: the serial mediating effect of perceived social support and benefit finding
Authors: Mo Qingqian , Tan Chen , Wang Xiang , Soondrum Tamini , Zhang Jinqiang
Published: October 2022

Objective

This research examines the direct and indirect relationships between optimism, perceived social support (PSS), benefit finding (BF), and anxiety and depressive symptoms among Chinese women with breast cancer (BC).

Methods

We recruited 512 patients, aged averagely 47.46(SD = 8.51) years from two hospitals located in Hunan province, China. The variables were assessed using the Optimism–Pessimism Scale (OPS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Benefit Finding Scale (BFS), and the Hospital Anxiety and Depression Scale (HADS). Path analyses were conducted by Amos version 24.0 for Windows to test the hypothesized serial mediation model.

Results

Path analyses suggest a significant negative association between optimism and symptoms of anxiety and depression. The relationship was mediated by BF (β = -0.085, SE = 0.015, 95% CI [-0.126, -0.055]), and by BF together with PSS (β = -0.027, SE = 0.007, 95% CI [-0.047, -0.017]). The difference comparison between the two indirect effects was significant (β = 0.057, SE = 0.015, 95% CI [0.034,0.101]).

Conclusions

Our findings suggest that PSS, and BF are important mediators through which optimism may buffer symptoms of anxiety and depression among Chinese BC patients. Clinicians and healthcare practitioners should be aware of the importance of patients’ emotional health and endeavor to offer emotional support, facilitate their capacity to improve their quality of life.
Prevalence of mental disorders, associated co-morbidities, health care knowledge and service utilization in Rwanda – towards a blueprint for promoting mental health care services in low- and middle-income countries?
Authors: Kayiteshonga Yvonne , Sezibera Vincent , Mugabo Lambert , Iyamuremye Jean Damascène
Published: October 2022

Background

In order to respond to the dearth of mental health data in Rwanda where large-scale prevalence studies were not existing, Rwanda Mental Health Survey was conducted to measure the prevalence of mental disorders, associated co-morbidities and knowledge and utilization of mental health services nationwide within Rwanda.

Methods

This cross-sectional study was conducted between July and August 2018, among the general population, including survivors of the 1994 Genocide against the Tutsi. Participants (14–65 years) completed the Mini-International Neuropsychiatric Interview (Version 7.0.2), sociodemographic and epilepsy-related questionnaires. General population participants were selected first by random sampling of 240 clusters, followed by systematic sampling of 30 households per cluster. Genocide survivors within each cluster were identified using the 2007–2008 Genocide Survivors Census.

Results

Of 19,110 general survey participants, most were female (n = 11,233; 58.8%). Mental disorders were more prevalent among women (23.2%) than men (16.6%) (p < 0.05). The most prevalent mental disorders were major depressive episode (12.0%), panic disorder (8.1%) and post-traumatic stress disorder (PTSD) (3.6%). Overall, 61.7% had awareness of mental health services while only 5.3% reported to have used existing services. Of the 1271 genocide survivors interviewed, 74.7% (n = 949) were female; prevalence of any mental disorder was 53.3% for women and 48.8% for men. Most prevalent disorders were major depressive episode (35.0%), PTSD (27.9%) and panic disorder (26.8%). Among genocide survivors, 76.2% were aware of availability of mental health services, with 14.1% reported having used mental health services.

Conclusions

Despite high prevalence of mental disorders among the general population and genocide survivors, utilization of available mental health services was low. A comprehensive approach to mental health is needed for prevention of mental illness and to promote mental healthcare services.
Perceived mental health, work, and life stress in association with the amount of weekly alcohol consumption among Canadian adults who have ever drank
Authors: Geda Nigatu , Feng Cindy
Published: October 2022

Background

Excess alcohol consumption has multifaceted adverse impacts at individual, household, and community levels. The study primarily aims at assessing the role of perceived health and stress in alcohol consumption among adults in Canada who have ever drank.

Methods

The study was conducted based on a total of 35,928 Canadian adults aged 18 and above who have ever drank, extracted from the 2017–2018 Canadian Community Health Survey (CCHS) data. A mixed-effect Negative Binomial (NB) regression model was used to determine the effects of three key risk factors (perceived mental health, life stress, and work stress) in association with the self-reported number of weekly alcohol consumption, controlling for other variables in the model.

Results

The study found that regular alcohol consumption among ever drank Canadian adults is high, with the self-reported number of weekly alcohol consumption ranging from 0 to 210. The results of adjusted mixed-effect NB regression showed that the expected mean of alcohol consumption was significantly higher among those with a poorer perception of mental health, higher perceived work, and life stress. Nonsmokers have a much lower mean score of alcohol consumption compared to those who smoke daily. There was a significant interaction between racial background and the three key predictors (perceived mental health, life stress, and work stress).

Conclusion

Given the reported perceived health and stress significantly impacts alcohol consumption, the findings suggested improving individual/group counseling, and health education focusing on home and work environment to prevent and manage life stressors and drivers to make significant program impacts.
Investigating patients’ preferences for new anti-diabetic drugs to inform public health insurance coverage decisions: a discrete choice experiment in China
Authors: Geng Jinsong , Bao Haini , Feng Zhe , Meng Jingyi , Yu Xiaolan , Yu Hao
Published: October 2022

Background

Diabetes is a major public health concern with a considerable impact on healthcare expenditures. Deciding on health insurance coverage for new drugs that meet patient needs is a challenge facing policymakers. Our study aimed to assess patients’ preferences for public health insurance coverage of new anti-diabetic drugs in China.

Methods

We identified six attributes of new anti-diabetic drugs and used the Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). The DCE was conducted in consecutive samples of type 2 diabetes patients in Jiangsu Province. The mixed logit regression model was applied to estimate patient-reported preferences for each attribute. The interaction model was used to investigate preference heterogeneity.

Results

Data from 639 patients were available for analysis. On average, the most valued attribute was the improvement in health-related quality of life (HRQoL) (β = 1.383, p < 0.001), followed by positive effects on extending life years (β = 0.787, p < 0.001), and well-controlled glycated haemoglobin (β = 0.724, p < 0.001). The out-of-pocket cost was a negative predictor of their preferences (β = -0.138, p < 0.001). Elderly patients showed stronger preferences for drugs with a lower incidence of serious side effects (p < 0.01) and less out-of-pocket costs (p < 0.01). Patients with diabetes complications favored more in the length of extended life (p < 0.01), improvement in HRQoL (p < 0.05), and less out-of-pocket costs (p < 0.001).

Conclusion

The new anti-diabetic drugs with significant clinical effectiveness and long-term health benefits should become the priority for public health insurance. The findings also highlight the value of accounting for preference heterogeneity in insurance policy-making.
Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial
Authors: Bensalma Fatima , Hagemeister Nicola , Cagnin Alix , Ouakrim Youssef , Bureau Nathalie J. , Choinière Manon , Mezghani Neila
Published: October 2022

Background

Conventional radiography is commonly used to diagnose knee osteoarthritis (OA), but also to guide clinical decision-making, despite a well-established discordance between radiographic severity and patient symptoms. The incidence and progression of OA is driven, in part, by biomechanical markers. Therefore, these dynamic markers may be a good metric of functional status and actionable targets for clinicians when developing conservative treatment plans. The aim of this study was to assess the associations between biomechanical markers and self-reported knee function compared to radiographic severity.

Methods

This was a secondary analysis of data from a randomized controlled trial (RCT) conducted in primary care clinics with knee OA participants. Correlation coefficients (canonical (ρ) and structural (Corr)) were assessed between the Knee Injury and Osteoarthritis Outcome Score (KOOS) and both, radiographic OA severity using the Kellgren-Lawrence grade, and three-dimensional biomechanical markers quantified by a knee kinesiography exam. Significant differences between coefficients were assessed using Fischer’s z-transformation method to compare correlations from dependent samples.

Results

KOOS and biomechanical data were significantly more associated than KOOS and X-ray grading (ρ: 0.41 vs 0.20; p < 0.001). Structural correlation (Corr) between KOOS and X-ray grade was 0.202 (4% of variance explained), while individual biomechanical markers, such as the flexion during loading, explained up to 14% of KOOS variance (i.e., Corr2). Biomechanical markers showed the strongest associations with Pain and Activity of Daily Living KOOS subscales (both > 36% variance explained), while X-ray grading was most associated with Symptoms subscale (21% explained; all p ≤ 0.001).

Conclusions

Knee biomechanical markers are associated with patient-reported knee function to a greater extent than X-ray grading, but both provide complementary information in the assessment of OA patients. Understanding how dynamic markers relate to function compared to radiographic severity is a valuable step towards precision medicine, allowing clinicians to refine and tailor therapeutic measures by prioritizing and targeting modifiable biomechanical markers linked to pain and function.

Trial registration

Original RCT was approved by the Research Ethics Boards of École de technologie supérieure (H20150505) and Centre hospitalier de l’Université de Montréal (CHUM-CE.14.339), first registered at https://www.isrctn.com/ (ID-ISRCTN16152290) on May 27, 2015.
Barriers and facilitators to physical activity in people with an inflammatory joint disease: a mixed methods study
Authors: Bell Kirsty , Conde Monserrat , Hendry Gordon , Rafferty Danny , Steultjens Martijn
Published: October 2022

Background

Physical activity has been shown to be of great benefit to people with an inflammatory joint disease (IJD), however people with an IJD have been shown to be very inactive compared to the general population. The aims of this study were to explore 1) whether the transition from a National Health Service (NHS)-run exercise programme into exercising in the community could be achieved successfully; and 2) the barriers and facilitators during the transition period.

Methods

This study adopted a complementary mixed-methods study design including a qualitative approach using focus groups and a prospective cohort study. Descriptive statistics were used to summarise the cohort study data. All variables were assessed for normality of distribution using the Sharpiro-Wilk test. Paired t-tests or Wilcoxon tests were undertaken for two consecutive assessment timepoints; one-way repeated measures ANOVAs or Friedman’s tests for three consecutive assessment timepoints. Micro-interlocutor analysis was used to analyse the focus group data. Areas of congruence and incongruence were explored by confirming the statistical results against the qualitative results. The adapted ecological model of the determinants of physical activity was then used as a framework to describe the findings.

Results

A successful transition was defined as still exercising in the community 6-months post discharge from the NHS-run Inflammatory Arthritis Exercise Programme. This was self-reported to be 90% of the cohort. An individual barrier to physical activity in people with an IJD was found to be the unpredictable nature of their condition. Other barriers and facilitators found were similar to those found in the general population such as recreation facilities, locations, transportation and cost. Other facilitators were similar to those found in people living with other chronic long-term conditions such as the importance of peer support.

Conclusions

90% of the cohort data were defined as a successful transition. People with an IJD have similar barriers and facilitators to exercise as the general population and those living with other chronic long-term conditions. A barrier which appears to be unique to this population group is that of the unpredictable nature of their condition which needs to be considered whenever tailoring any intervention.
Magnitude of impaired fasting glucose and undiagnosed diabetic mellitus and associated risk factors among adults living in Woreta town, northwest Ethiopia: a community-based cross-sectional study, 2021
Authors: Teshome Assefa Agegnehu , Baih Shegaw Zeleke , Wolie Amare Kassaw , Mengstie Misganaw Asmamaw , Muche Zelalem Tilahun , Amare Shambel Nigussie , seid Mohammed Abdu , Yitbark Getachew Yideg , Molla Yalew Melkamu , Baye Nega Dagnaw , Ayehu Gashaw walle
Published: October 2022

Background

Impaired fasting glucose (IFG) is an early warning system that provides prior information to prevent the future development of DM and diabetes-related problems, but early detection of DM is not practically applicable in Ethiopia. This study was aimed to assess the magnitude of impaired fasting glucose and undiagnosed diabetes mellitus (DM) and associated factors.

Methods

A community-based, cross-sectional study was conducted from May to June 30, 2021. A structured interviewer-administered questionnaire was used to collect data. Anthropometric measurements were also recorded. A fasting blood sugar (FBS) test was assessed by samples taken early in the morning. Epi-Info 7.2.5.0 was used to enter data, which was then exported to SPSS 25 for analysis. To identify factors associated with IFG, logistics regression was used. The level of statistical significance was declared at p 0.05.

Result

Three hundred and twenty-four (324) participants with a mean age of 43.76 ± 17.29 years were enrolled. The overall magnitude of impaired fasting glucose (IFG) and undiagnosed diabetes mellitus (DM) were 43.2% and 10.0%, respectively. Waist circumference (AOR: 1.72, 95% CI 1.23–3.14), hypertension (AOR: 3.48, 95% CI 1.35–8.89), family history of Diabetic mellitus (AOR: 2.34, 95% CI 1.37–5.79) and hypertriglyceridemia (AOR: 2.35, 95% CI 1.41–5.43) were found to be independently associated with impaired fasting glucose.

Conclusion

Individuals who are overweight, hypertriglyceridemia, and are hypertensive should have regular checkups and community-based screening.
COVID-19 vaccine and menstrual conditions in female: data analysis of the Vaccine Adverse Event Reporting System (VAERS)
Authors: Zhang Bing , Yu Xiao , Liu Jinxing , Liu Jinbao , Liu Pengfei
Published: October 2022

Background

In reports of adverse reactions following vaccination with the coronavirus disease 2019(COVID-19) vaccines, there have been fewer reports of concern for menstrual disorders in female.

Objective

Our study employed Vaccine Adverse Event Reporting System (VAERS) to investigate and analyze the relationship between COVID-19 Vaccines and menstrual disorders in female.

Methods

We collected reports of menstrual disorders in VAERS from July 2, 1990 to November 12, 2021, and performed a stratified analysis. The potential relationship between COVID-19 vaccine and reports of menstrual disorders was evaluated using the Reporting Odds Ratio (ROR) method.

Results

A total of 14,431 reports of menstrual disorders were included in the study, and 13,118 were associated with COVID-19 vaccine. The ROR was 7.83 (95% confidence interval [95%CI]: 7.39–8.28). The most commonly reported event was Menstruation irregular (4998 reports), and a higher percentage of female aged 30–49 years reported menstrual disorders (42.55%) after exposure to COVID-19 Vaccines. Both for all reports of menstrual disorders (ROR = 5.82; 95%CI: 4.93–6.95) and excluding reports of unknown age (ROR = 13.02; 95%CI: 10.89–15.56),suggest that female age may be associated with menstrual disorders after vaccination with the COVID-19 Vaccines.

Conclusion

There is a potential safety signal when the COVID-19 vaccine is administered to young adult female (30–49 years old), resulting in menstrual disorders in. However, due to the well-known limitations of spontaneous reporting data, it is challenging to explicity classify menstrual disorders as an adverse event of the COVID-19 Vaccines, and reports of adverse reactions to COVID-19 Vaccines in this age group should continue to be tracked.
The relationship between aggressive behaviors of preschool children and the violence against Iranian women in the COVID-19 pandemic
Authors: Asadi Neda , Salmani Fatemeh , Salmani Mahin
Published: October 2022

Background

During epidemics, supports are limited and individual and collective vulnerabilities as well as domestic violence are increased. Therefore, various groups in society, especially children and their mothers, are extremely vulnerable. This study aimed to assess the relationship between aggressive behaviors of preschool children and the violence against Iranian women during the COVID-19 pandemic.

Methods

This descriptive-correlational study was conducted in October–November 2020. Stratified random sampling was performed among preschool children in Kerman. Data were collected using the Violence toward Women Inventory and the Aggression scale for preschoolers Scale. Data were analyzed using SPSS25, ANOVA, independent t-test, and Pearson correlation test.

Results

The results showed that the total mean scores of violence against women and preschoolers’ aggression were 54.43 ± 10.6 and 88.44 ± 6.5, respectively. The results showed a statistically significant difference in aggressive behaviors of preschool children, mother's job, number of children, mother's education, income, and age. A positive and significant relationship was also found between the subscales of violence against women and aggression in preschool children.

Conclusions

The results showed a positive and significant relationship between violence against women and aggression of preschool children. Therefore, it is recommended that parents identify and eliminate the risk factors for domestic violence during the COVID-19 in order to protect their children. Parents also must learn coping strategies for stress and resilience in the epidemic crises.
Coping with dysmenorrhea: a qualitative analysis of period pain management among students who menstruate
Authors: Ní Chéileachair Fódhla , McGuire Brian E. , Durand Hannah
Published: October 2022

Background

Dysmenorrhea, or period pain, affects up to 95% of menstruating individuals and is a common cause of educational absenteeism among students who menstruate worldwide. Evidence suggests that students may lack sufficient knowledge about their menstrual health, which may impede self-management. The aim of the current study was to explore pain management strategies used by students in Ireland with painful periods and to identify their unaddressed needs across physical, psychological, educational, and social domains.

Methods

This study used a qualitative, interpretive design and opportunity sampling approach to collect and interpret individual accounts of dysmenorrhea from third-level students in Ireland. Data from 21 students were collected using semi-structured online one-to-one interviews and analysed using reflexive thematic analysis.

Results

Analysis resulted in the construction of five themes: (1) Pain management is self-directed trial-and-error, (2) Home as safe haven, (3) Prioritising productivity over pain, (4) We’re missing an option between ‘normalise’ and ‘medicalise’, and (5) Cycle of censorship and concealment. Overall, limited formal education on dysmenorrhea and prevailing negative attitudes towards menstruation create an unsupportive environment for students to learn adequate coping skills. Beyond education, menstrual stigma may also restrict the availability of clear management guidance in domestic and medical spheres. Experiences of dysmenorrhea were also influenced by the COVID-19 pandemic, where work-from-home measures were viewed favourably by individuals with dysmenorrhea.

Conclusions

This study indicates that students in Ireland are inadequately prepared to cope with dysmenorrhea. The current findings have substantial implications for evaluating and reforming current menstrual education standards, in addition to clarifying the negative effects of social stigma on menstrual health literacy.
Understanding the multilevel determinants of clinicians’ imaging decision-making: setting the stage for de-implementation of low-value imaging
Authors: Hwang Soohyun , Birken Sarah A. , Nielsen Matthew E. , Elston-Lafata Jennifer , Wheeler Stephanie B. , Spees Lisa P.
Published: October 2022

Background

De-implementation requires understanding and targeting multilevel determinants of low-value care. The objective of this study was to identify multilevel determinants of imaging for prostate cancer (PCa) and asymptomatic microhematuria (AMH), two common urologic conditions that have contributed substantially to the annual spending on unnecessary imaging in the US.

Methods

We used a convergent mixed-methods approach involving survey and interview data. Using a survey, we asked 33 clinicians (55% response-rate) to indicate their imaging approach to 8 clinical vignettes designed to elicit responses that would demonstrate guideline-concordant/discordant imaging practices for patients with PCa or AMH. A subset of survey respondents (N = 7) participated in semi-structured interviews guided by a combination of two frameworks that offered a comprehensive understanding of multilevel determinants. We analyzed the interviews using a directed content analysis approach and identified subthemes to better understand the differences and similarities in the imaging determinants across two clinical conditions.

Results

Survey results showed that the majority of clinicians chose guideline-concordant imaging behaviors for PCa; guideline-concordant imaging intentions were more varied for AMH. Interview results informed what influenced imaging decisions and provided additional context to the varying intentions for AMH. Five subthemes touching on multiple levels were identified from the interviews: National Guidelines, Supporting Evidence and Information Exchange, Organization of the Imaging Pathways, Patients’ Clinical and Other Risk Factors, and Clinicians’ Beliefs and Experiences Regarding Imaging. Imaging decisions for both PCa and AMH were often driven by national guidelines from major professional societies. However, when clinicians felt guidelines were inadequate, they reported that their decision-making was influenced by their knowledge of recent scientific evidence, past clinical experiences, and the anticipated benefits of imaging (or not imaging) to both the patient and the clinician. In particular, clinicians referred to patients’ anxiety and uncertainty or patients’ clinical factors. For AMH patients, clinicians additionally expressed concerns regarding legal liability risk.

Conclusion

Our study identified comprehensive multilevel determinants of imaging to inform development of de-implementation interventions to reduce low-value imaging, which we found useful for identifying determinants of de-implementation. De-implementation interventions should be tailored to address the contextual determinants that are specific to each clinical condition.
Activation function 1 of progesterone receptor is required for progesterone antagonism of oestrogen action in the uterus
Authors: Lee Shi Hao , Lim Chew Leng , Shen Wei , Tan Samuel Ming Xuan , Woo Amanda Rui En , Yap Yeannie H. Y. , Sian Caitlyn Ang Su , Goh Wilson Wen Bin , Yu Wei-Ping , Li Li , Lin Valerie C. L.
Published: October 2022

Background

Progesterone receptor (PGR) is a master regulator of uterine function through antagonistic and synergistic interplays with oestrogen receptors. PGR action is primarily mediated by activation functions AF1 and AF2, but their physiological significance is unknown.

Results

We report the first study of AF1 function in mice. The AF1 mutant mice are infertile with impaired implantation and decidualization. This is associated with a delay in the cessation of epithelial proliferation and in the initiation of stromal proliferation at preimplantation. Despite tissue selective effect on PGR target genes, AF1 mutations caused global loss of the antioestrogenic activity of progesterone in both pregnant and ovariectomized models. Importantly, the study provides evidence that PGR can exert an antioestrogenic effect by genomic inhibition of Esr1 and Greb1 expression. ChIP-Seq data mining reveals intermingled PGR and ESR1 binding on Esr1 and Greb1 gene enhancers. Chromatin conformation analysis shows reduced interactions in these genes’ loci in the mutant, coinciding with their upregulations.

Conclusion

AF1 mediates genomic inhibition of ESR1 action globally whilst it also has tissue-selective effect on PGR target genes.