bluuebunny/crossref_metadata_2025 huggingface dataset:
Limits to the Productivity in Biobased Territorial SMEs
Authors: Gatica-Neira Francisco , Ramos-Maldonado Mario
Published: May 2022

In Latin América there are large exporting companies intensive in natural resources which do not connect with the SMEs in the territories. The aim of this study is to provide elements that explain the limits to the productivity of small and medium enterprises located in bio-based territories, providing inputs for a public policy that enhances local development. The case of sawmills located in the Province of Arauco, Bío-Bío Region, Chile, is studied. The results of a survey applied to 42 companies are analyzed, in the context of an initiative financed by the Regional Government of Biobío, which represent 84% of the total sawmills in the Province of Arauco. Different data science algorithms are used to generate clusters and decision trees. Based on the results, a heterogeneity within the group of companies is verified from the perception of the main problems, the processes that are internalized, the number of sectors it sells to and the cost of raw materials. Public policies recommendations are presented aimed at building support networks, improving quality standards through certifications, attracting, and retaining qualified human capital and promoting collaborative design among companies.
Worse Preoperative Disability is Predictive of Improvement in Disability After Complex Adult Spinal Deformity Surgery
Authors: Coury Josephine R. , Morrissette Cole R. , Lee Nathan J. , Cerpa Meghan , Sardar Zeeshan M. , Weidenbaum Mark , Lehman Ronald A. , Lombardi Joseph M. , Lenke Lawrence G.
Published: May 2022

Study Design

Retrospective Cohort Study.

Objectives

Few previous studies have examined the relationship between preoperative disability and patient outcomes after complex adult spinal deformity surgery. In this study, we hypothesized that patients with worse preoperative disability would be more likely achieve a clinically significant improvement in their symptoms after surgery.

Methods

Demographics, comorbidities, surgical data, and health related survey results were analyzed from a consecutive series of adults (≥18 years old) who underwent spinal deformity correction, instrumentation, and fusion. Patients included had 6 or more levels fused and their surgery performed at single institution between 2015 and 2018 with minimum 2 year follow up.

Results

A total of 108 patients met inclusion criteria. Bivariate analysis demonstrated the following as having a greater probability of reaching minimum clinically important difference (MCID) at 2 years postoperatively: >50th percentile Oswestry Disability Index (ODI) score (ODI >36), cardiac comorbidities, and use of pelvic fixation, pedicle subtraction osteotomy, and transforaminal lumbar interbody fusion. Conversely, baseline Scoliosis research society score (SRS) >50th percentile (SRS ≥62) and use of vertebral column resection (VCR) were significant predictors of not reaching MCID at 2 years. On logistic regression analysis, >50th percentile ODI score (ODI >36) was identified as the only independent predictor of achieving MCID.

Conclusions

Patients with greater disability, independent of other preoperative or surgical factors, are more likely to have clinically significant improvement in their daily functioning after complex deformity surgery. For patients who undergo surgical intervention for severe or progressive deformity, including VCR, MCID might be an ineffective outcome measure.
Illicit Financial Flows through Trade Mis-Invoicing in India: An Empirical Analysis of the Major Commodities Involved in Mis-Invoicing
Authors: Tiwari Praveen , Akhter Javaid , Chattopadhyay Saumen
Published: May 2022

This article identifies, based on reported trade data between India and its 19 trading partners, the major commodities exhibiting mis-invoicing during 2000–2018, the extent of mis-invoicing, major trade partners and the associated ports of trade in India. The computed differences in the trade values are too large to be explained by accounting or classification errors, presenting strong evidence of mis-invoicing; however, only a small percentage of commodities account for bulk of mis-invoicing consistently over the years. There is also evidence of the same commodities exhibiting under-invoicing (UI) in trade with some countries and over-invoicing (OI) in trade with others. The tariff rates seem to influence the type of import mis-invoicing—OI being mainly in commodities with higher tariff and UI in commodities with lower tariff. The article contributes to the existing literature by identifying the specific commodities with their 6-digit HS codes, and commodity groups prone to mis-invoicing, which can provide a robust framework for further investigation of transaction level data that may help pinpoint the parties involved in mis-invoicing and associated illicit flows. The findings of the article provide inputs for policies to mitigate the impact of illicit financial flows through trade mis-invoicing.

JEL Classifications: F13, F14, C32, H26
Shoulder and Elbow Injuries in Elite Taiwanese High School Baseball Pitchers From 2016 to 2017
Authors: Lu Yi , Chou Wen-Yi , Wu Kuan-Ting , Chen Alvin Chao-Yu , Chan Yi-Sheng , Chiu Chih-Hao
Published: May 2022

Background:

Numerous studies have discussed the risk factors for shoulder and elbow injuries in high school baseball players worldwide.

Purpose:

To determine the risk factors for pitching-related shoulder and elbow injuries in Taiwanese high school pitchers.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Included in the study were 144 pitchers from 11 top-ranked Taiwanese high school baseball teams between 2016 and 2017 high school baseball season. The participants answered a 55-item questionnaire concerning physical characteristics, pitching activities, injury history, and off-season activities. Univariate analyses were conducted separately for participants with and those without a pitching-related injury in the 12-month study period. The chi-square test or Fisher exact test was applied to categorical variables, and the F test or t test was applied to continuous variables. A stepwise multivariate logistic regression analysis was used to identify factors related to pitching-related injuries, and those results were calculated as odds ratios (ORs).

Results:

Having a pitching-related injury was significantly related to the number of pitches per week in the past 12 months (OR, 1.01; P = .006), pain over the shoulder and/or elbow in the past 12 months (OR, 3.56; P = .008), pitching competitive baseball for more than 8 of the past 12 months (OR, 2.53; P = .036), throwing sliders (OR, 2.97; P = .026), and lack of participating in other over-the-shoulder activities (0.03-0.11 fewer odds; P ≤ .010).

Conclusion:

For elite high school pitchers in Taiwan, pitching-related shoulder and elbow injuries were related to the number of pitches per week, pitching competitive baseball for more than 8 of the past 12 months, pain over the shoulder and/or elbow in the past 12 months, throwing sliders, and a lack of participation in other sports with over-the-shoulder activities.
Effect of Active and Passive Function of the Posterosuperior Rotator Cuff on Compensatory Muscle Loads in the Shoulder
Authors: Moroder Philipp , Chamberlain Aaron , Gabriel Stefan M. , Jacofsky Marc C. , Sengun Mehmet Z. , Spenciner David B. , Tokish John M. , Lacheta Lucca
Published: May 2022

Background:

Irreparable posterosuperior rotator cuff (PSRC) tears have been shown to result in shoulder pain and loss of function.

Purpose/Hypothesis:

The purpose of this study was to determine the effect of the loss of active or passive function of the PSRC on compensatory muscle loads in the deltoid and the remaining rotator cuff. It was hypothesized that both deactivation and resection of the PSRC would result in load increases in the remaining muscles and that resection of the PSRC would result in even higher required compensatory forces than would mere deactivation.

Study Design:

Controlled laboratory study.

Methods:

A total of 7 cadaveric shoulders were tested using a biomechanical shoulder simulator with 10 independently controlled actuators for various muscles (anterior, middle, and posterior deltoid; inferior and superior subscapularis; latissimus dorsi; pectoralis major; teres minor; supraspinatus; and infraspinatus) and 3-dimensional motion tracking. The muscle loads representing the latissimus dorsi and pectoralis major were each held constant, and the remaining muscle actuator forces required to abduct the arm in the scapular plane were determined. The actuator forces corresponding with arm elevation from 20° to 65° were compared at 5° increments for 3 testing conditions: (1) intact, active PSRC; (2) intact, deactivated PSRC; and (3) resected PSRC and shoulder capsule.

Results:

In both the deactivated and resected states, the teres minor showed a significant increase in required muscle forces through nearly the entire tested range of arm elevation compared to the active state. This was also the case for the subscapularis but only at higher elevation angles. The deltoid demonstrated increased muscle forces of at least 1 of its subunits between 25° and 55° of elevation when comparing the deactivated state or resected state to the active state. However, through nearly the entire range of elevation, no statistically significant differences were found between the deactivated and resected states for any of the actuator loads representing muscle forces.

Conclusion:

The loss of active function of the PSRC led to compensatory loads on the remaining rotator cuff and deltoid, regardless of the passive presence of the PSRC as a supposed subacromial spacer.

Clinical Relevance:

The findings encourage the exploration of treatment procedures that mimic the active function of the PSRC when the rotator cuff itself is irreparable.
Latour-Marliac, Since 1875
Authors: Sheldon Robert Charles
Published: May 2022

This case follows Charlie Zerzan as he tries to save Latour-Marliac, the cash-strapped but historically important company he owns in the south of France. Rather than devastate the company, the global pandemic of 2020 was a boon, leaving it with a stock of cash just as a handful of unique opportunities for growth arrived. Dumaurier must decide how far to go in pursuing these opportunities. On one hand, the company needs growth to break a decades-long period of stagnation, while on the other it cannot go back to the dangerously precarious cash position it had been in. How much debt is too much? How will revenue trend in the future? In order to seize the moment, Zerzan must project cash flows for the next 4 years, choose a growth strategy, and present his banker with corresponding pro forma income statements.
Giant Fibrous Polyp of the Gallbladder Showing a Periphery-Dominant Contrast Enhancement: How to Differentiate It From Early Carcinoma
Authors: Fujimoto Taketoshi , Kato Yo
Published: May 2022

Although polyp size and stalk diameter are significant for the differential diagnosis of a gallbladder polyp, it is necessary to catch genuine polyp characteristics to differentiate a giant fibrous polyp from gallbladder carcinoma (GBC). This case report analyses the images and their correlation with the pathology. Transabdominal sonography revealed gallstones and a giant pedunculated gallbladder polyp measuring 32 × 18 × 14 mm with a thick stalk. The polyp lacked a hyperechoic surface line and was not delineated by either a deep hypoechoic area or a conically thickened outermost hyperechoic layer. Contrast-enhanced ultrasonography (CEUS) depicted a periphery-dominant enhancement, during the post vascular phase. A noncontrast computed tomogram (CT) did not demonstrate a gallbladder mass; meanwhile, a dynamic study revealed an enhanced polyp showing a periphery-dominant enhancement. Hence, without diagnostic findings suggestive of an obvious advanced GBC or excluding an early GBC, a full-thickness laparoscopic cholecystectomy was performed. The histopathology demonstrated a fibrous polyp with a thick stalk. In conclusion, a giant gallbladder polyp with a thick stalk showing a periphery-dominant contrast enhancement could suggest a fibrous polyp.
Taking the Natural Exit: Opportunities for Treatment Rightsizing in Fetal Head and Neck Mass
Authors: Puricelli Michael D. , Danielsen Brodey Matthew , Van Beek-King Jessica , Wraight C. Lydia , Stewart Katharina S. , Beninati Michael , Lobeck Inna N. , Iruretagoyena J. Igor
Published: May 2022

Fetal head and neck masses, when present, may cause neonatal airway obstruction at birth and associated morbidity and mortality. Escalated maternal treatment intensity such as surgical laryngoscopist/airway surgeon attended delivery and ex utero intrapartum treatment can mitigate the neonatal risk, however, increase maternal risk for complications. Accordingly, accurate prediction of the potential neonatal benefit and maternal risk is essential. Serial third-trimester sonographic features suggestive of more severe airway obstruction may justify more aggressive intervention in the right patient. This case study presents a 23-year-old G1P0 with a fetus predicted to have reduced perinatal airway risk based upon serial third-trimester ultrasound findings. Treatment was de-escalated, and the patient was successfully managed. Collaborative data collection aimed at treatment rightsizing across neonatal, maternal, and systematic domains will support ideal allocation.
Cumulative corticosteroid-sparing effect of anti-interleukin-5/5Ra in eosinophilic asthma
Authors: Kroes Johannes A. , Zielhuis Sybrand W.J. , De Jong Kim , Hashimoto Simone , Sont Jacob K. , Zielhuis Sander W. , Van Roon Eric N. , Bel Elisabeth H. , Ten Brinke Anneke
Published: May 2022

Background

Anti-interleukin (IL)-5/IL-5 receptor α (IL-5Ra) therapy has been shown to reduce maintenance oral corticosteroid (OCS) dose in severe eosinophilic asthma. However, the effect on cumulative OCS exposure is currently unknown. Neither is it known how prior OCS exposure affects response to anti-IL-5/5Ra treatment. We aimed primarily to compare the cumulative OCS exposure over a 2-year period before and after anti-IL-5/5Ra initiation, and secondarily to investigate whether duration and cumulative OCS exposure prior to anti-IL-5/5Ra influence the ability to discontinue OCS within 2 years of anti-IL-5/5Ra therapy.

Methods

This real-world nationwide observational registry-based study evaluated all dispensed OCS from 389 adults with severe eosinophilic asthma included in the Dutch Severe Asthma Registry (RAPSODI) 2 years before and 2 years after initiating anti-IL-5/5Ra. The Wilcoxon signed-rank test and multivariable regression analyses were used.

Results

Median (interquartile range) cumulative OCS exposure in the 2 years before and after anti-IL-5/5Ra initiation decreased from 2.715 (1.150–5.539) to 1.050 (0.300–3.640) g (p<0.001). 52% of patients were able to discontinue OCS within 2 years after anti-IL-5/5Ra therapy, which was independently predicted by lower and shorter prior OCS exposure.

Conclusions

This real-world study showed that anti-IL-5/5Ra therapy leads to a significant reduction in cumulative OCS exposure over a 2-year period. Patients with lower and shorter OCS exposure were more likely to completely eliminate OCS. Since cumulative exposure increased progressively prior to anti-IL-5/5Ra initiation, our data suggest that early intervention leads to a better long-term prognosis in patients with severe eosinophilic asthma.
ERS International Congress 2021: highlights from the Respiratory Clinical Care and Physiology Assembly
Authors: Gille Thomas , Sivapalan Pradeesh , Kaltsakas Georgios , Kolekar Shailesh B. , Armstrong Matthew , Tuffnell Rachel , Evans Rachael A. , Vagheggini Guido , Degani-Costa Luiza Helena , Vicente Cláudia , Das Nilakash , Poberezhets Vitalii , Rolland-Debord Camille , Bayat Sam , Vogiatzis Ioannis , Franssen Frits M.E. , Pinnock Hilary , Vanfleteren Lowie E.G.W.
Published: May 2022

It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of laboratory-based science, randomised controlled trials and qualitative research that were presented during the 2021 European Respiratory Society International Congress within the sessions from the five groups of the Assembly 1 – Respiratory clinical care and physiology. Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, electronic/mobile health (e-health/m-health), clinical respiratory physiology, exercise and functional imaging.
Comprehensive analysis of complete chloroplast genome and phylogenetic aspects of ten Ficus species
Authors: Huang Yuying , Li Jing , Yang Zerui , An Wenli , Xie Chunzhu , Liu Shanshan , Zheng Xiasheng
Published: May 2022

Background

The large genus Ficus comprises approximately 800 species, most of which possess high ornamental and ecological values. However, its evolutionary history remains largely unknown. Plastome (chloroplast genome) analysis had become an essential tool for species identification and for unveiling evolutionary relationships between species, genus and other rank groups. In this work we present the plastomes of ten Ficus species.

Results

The complete chloroplast (CP) genomes of eleven Ficus specimens belonging to ten species were determined and analysed. The full length of the Ficus plastome was nearly 160 kbp with a similar overall GC content, ranging from 35.88 to 36.02%. A total of 114 unique genes, distributed in 80 protein-coding genes, 30 tRNAs, and 4 rRNAs, were annotated in each of the Ficus CP genome. In addition, these CP genomes showed variation in their inverted repeat regions (IR). Tandem repeats and mononucleotide simple sequence repeat (SSR) are widely distributed across the Ficus CP genome. Comparative genome analysis showed low sequence variability. In addition, eight variable regions to be used as potential molecular markers were proposed for future Ficus species identification. According to the phylogenetic analysis, these ten Ficus species were clustered together and further divided into three clades based on different subgenera. Simultaneously, it also showed the relatedness between Ficus and Morus.

Conclusion

The chloroplast genome structure of 10 Ficus species was similar to that of other angiosperms, with a typical four-part structure. Chloroplast genome sizes vary slightly due to expansion and contraction of the IR region. And the variation of noncoding regions of the chloroplast genome is larger than that of coding regions. Phylogenetic analysis showed that these eleven sampled CP genomes were divided into three clades, clustered with species from subgenus Urostigma, Sycomorus, and Ficus, respectively. These results support the Berg classification system, in which the subgenus Ficus was further decomposed into the subgenus Sycomorus. In general, the sequencing and analysis of Ficus plastomes, especially the ones of species with no or limited sequences available yet, contribute to the study of genetic diversity and species evolution of Ficus, while providing useful information for taxonomic and phylogenetic studies of Ficus.
The impact of public health interventions on the future prevalence of ESBL-producing Klebsiella pneumoniae: a population based mathematical modelling study
Authors: Salazar-Vizcaya Luisa , Atkinson Andrew , Kronenberg Andreas , Plüss-Suard Catherine , Kouyos Roger D. , Kachalov Viacheslav , Troillet Nicolas , Marschall Jonas , Sommerstein Rami
Published: May 2022

Background

Future prevalence of colonization with extended-spectrum betalactamase (ESBL-) producing K. pneumoniae in humans and the potential of public health interventions against the spread of these resistant bacteria remain uncertain.

Methods

Based on antimicrobial consumption and susceptibility data recorded during > 13 years in a Swiss region, we developed a mathematical model to assess the comparative effect of different interventions on the prevalence of colonization.

Results

Simulated prevalence stabilized in the near future when rates of antimicrobial consumption and in-hospital transmission were assumed to remain stable (2025 prevalence: 6.8% (95CI%:5.4–8.8%) in hospitals, 3.5% (2.5–5.0%) in the community versus 6.1% (5.0–7.5%) and 3.2% (2.3–4.2%) in 2019, respectively). When overall antimicrobial consumption was set to decrease by 50%, 2025 prevalence declined by 75% in hospitals and by 64% in the community. A 50% decline in in-hospital transmission rate led to a reduction in 2025 prevalence of 31% in hospitals and no reduction in the community. The best model fit estimated that 49% (6–100%) of observed colonizations could be attributable to sources other than human-to-human transmission within the geographical setting.

Conclusions

Projections suggests that overall antimicrobial consumption will be, by far, the most powerful driver of prevalence and that a large fraction of colonizations could be attributed to non-local transmissions.
A multivariate multi-step LSTM forecasting model for tuberculosis incidence with model explanation in Liaoning Province, China
Authors: Yang Enbin , Zhang Hao , Guo Xinsheng , Zang Zinan , Liu Zhen , Liu Yuanning
Published: May 2022

Background

Tuberculosis (TB) is the respiratory infectious disease with the highest incidence in China. We aim to design a series of forecasting models and find the factors that affect the incidence of TB, thereby improving the accuracy of the incidence prediction.

Results

In this paper, we developed a new interpretable prediction system based on the multivariate multi-step Long Short-Term Memory (LSTM) model and SHapley Additive exPlanation (SHAP) method. Four accuracy measures are introduced into the system: Root Mean Square Error, Mean Absolute Error, Mean Absolute Percentage Error, and symmetric Mean Absolute Percentage Error. The Autoregressive Integrated Moving Average (ARIMA) model and seasonal ARIMA model are established. The multi-step ARIMA–LSTM model is proposed for the first time to examine the performance of each model in the short, medium, and long term, respectively. Compared with the ARIMA model, each error of the multivariate 2-step LSTM model is reduced by 12.92%, 15.94%, 15.97%, and 14.81% in the short term. The 3-step ARIMA–LSTM model achieved excellent performance, with each error decreased to 15.19%, 33.14%, 36.79%, and 29.76% in the medium and long term. We provide the local and global explanation of the multivariate single-step LSTM model in the field of incidence prediction, pioneering.

Conclusions

The multivariate 2-step LSTM model is suitable for short-term prediction and obtained a similar performance as previous studies. The 3-step ARIMA–LSTM model is appropriate for medium-to-long-term prediction and outperforms these models. The SHAP results indicate that the five most crucial features are maximum temperature, average relative humidity, local financial budget, monthly sunshine percentage, and sunshine hours.
Survival and predictors of mortality among chronic kidney disease patients on hemodialysis in Amhara region, Ethiopia, 2021
Authors: Workie Sewnet Getaye , Zewale Taye Abuhay , Wassie Gizachew Tadesse , Belew Makda Abate , Abeje Eleni Dagnaw
Published: May 2022

Background

Despite the high economic and mortality burden of chronic kidney disease, studies on survival and predictors of mortality among patients on hemodialysis in Ethiopia especially in the Amhara region are scarce considering their importance to identify some modifiable risk factors for early mortality to improve the patient’s prognosis. So, this study was done to fill the identified gaps. The study aimed to assess survival and predictors of mortality among end-stage renal disease patients on hemodialysis in Amhara regional state, Ethiopia, 2020/2021.

Method

Institution-based retrospective record review was conducted in Felege Hiwot, Gonder, and Gambi hospitals from March 5 to April 5, 2021. A total of 436 medical records were selected using a simple random sampling technique. A life table was used to estimate probabilities of survival at different time intervals. Multivariable cox regression was used to identify risk factors for mortality.

Result

Out of the 436 patients 153 (35.1%) had died. The median survival time was 345 days with a mortality rate of 1.89 per 1000 person-days (95%CI (1.62, 2.22)). Patients live in rural residences (AHR = 1.48, 95%CI (1.04, 2.12)), patients whose cause of CKD was hypertension (AHR = 1.49, 95%CI (1.01, 2.23)) and human immune virus (AHR = 2.22, 95%CI (1.41, 3.51)), and patients who use a central venous catheter (AHR = 3.15, 95%CI (2.08, 4.77)) had increased risk of death while staying 4 h on hemodialysis (AHR = 0.43, 95%CI (0.23, 0.80)) decreases the risk of death among chronic kidney disease patients on hemodialysis.

Conclusions

The overall survival rate and median survival time of chronic kidney disease patients on hemodialysis were low in the Amhara region as compared with other developing Sub–Saharan African counties.
Efficacy and safety of maintenance immune checkpoint inhibitors with or without pemetrexed in advanced non-squamous non-small cell lung cancer: a retrospective study
Authors: Gu Xiaodong , Shi Zhiyong , Shao Lan , Zhang Yuxin , Zhang Yiping , Song Zhengbo , Wang Wenxian , Lou Guangyuan
Published: May 2022

Background

Advanced non-squamous non-small cell lung cancer (NS-NSCLC) patients without driver gene mutations are usually treated with immune checkpoint inhibitors (ICIs) plus pemetrexed as maintenance therapy after first-line ICIs plus 4–6 cycles of pemetrexed/platinum. Some patients in the real world receive ICIs monotherapy as maintenance therapy. No clinical study has compared the efficacy and safety of ICIs with or without pemetrexed as maintenance therapy.

Methods

We performed a retrospective study analyzing clinical data of patients with NS-NSCLC who were diagnosed in Zhejiang Cancer Hospital from September 2018 to May 2021 and received maintenance therapy after 4–6 cycles of ICIs plus pemetrexed/platinum. Patients were divided into ICIs plus pemetrexed group and ICIs monotherapy group. Progression Free Survival 1 (PFS1) and PFS2, defined as the interval from the date of initial treatment and maintenance therapy to the date of systemic progression/death or the last follow-up, respectively.

Results

A total of 120 patients received ICIs with or without pemetrexed as maintenance therapy. Eighty-two patients received ICIs plus pemetrexed as maintenance therapy, and 38 patients received ICIs monotherapy. There were no statistically significant difference in median PFS1 between the ICIs monotherapy group and ICIs plus pemetrexed group (12.00 months vs. 12.07 months,P = 0.979). Among patients with PD-L1 TPS < 1%, the median PFS1 was worse with ICIs monotherapy (9.50 months vs. 14.20 months,P = 0.039). Among patients with PD-L1 TPS ≥50% or 1–49%, the median PFS1 in both groups was not statistically significant (P = 0.866,P = 0.589, respectively). Results for median PFS2 were similar to median PFS1, with statistically significantly different only in patients with PD-L1 TPS < 1% (P = 0.008). The 2-year survival rates of the two groups were similar (66.7% vs. 69.5%,P = 0.812). The incidence of fatigue was significantly higher in the ICIs plus pemetrexed group (P = 0.023).

Conclusions

ICIs with or without pemetrexed can be used as maintenance therapy after first-line ICIs plus 4–6 cycles of pemetrexed/platinum in patients with advanced NS-NSCLC based on PD-L1 expression.
Prevalence of drinking or eating more than usual and associated factors during childhood diarrhea in East Africa: a multilevel analysis of recent demographic and health survey
Authors: Eshetu Habitu Birhan , Fetene Samrawit Mihret , Shewarega Ever Siyoum , Fentie Elsa Awoke , Asmamaw Desale Bihonegn , Teklu Rediet Eristu , Aragaw Fantu Mamo , Belay Daniel Gashaneh , Alemu Tewodros Getaneh , Negash Wubshet Debebe
Published: May 2022

Background

Diarrhea is the second most common cause of death in under-five children. Fluid and food replacement during diarrheal episodes have a paramount effect to avert morbidity and mortality. However, there is limited information about feeding practices. This study aimed to assess the prevalence of drinking or eating more and associated factors during diarrhea among under-five children in East Africa using demographic and health surveys (DHSs).

Methods

Secondary data analysis was done on DHSs 2008 to 2018 in 12 East African Countries. Total weighted samples of 20,559 mothers with their under-five children were included. Data cleaning, coding, and analysis were performed using Stata 16. Multilevel binary logistic regression were performed to identify factors associated with drinking or eating more during diarrheal episodes. Adjusted Odds Ratio (AOR) with a 95% CI, and p-value < 0.05 were used to declare statistical significance.

Results

Prevalence of drinking or eating more than usual during diarrhea disease in East Africa was 26.27%(95% CI: 25.68–26.88). Mothers age > 35 years (AOR: 1.14, 95% CI: (1.03, 1.26), mothers primary education (AOR: 1.17, 95% CI: 1.06,1.28), secondary education (AOR: 1.43,95% CI: 1.27,1.61), and higher education (AOR: 1.42,95% CI: 1.11,1.81), occupation of mothers (agriculture, AOR: 2.2, 95% CI: 1.3–3.6), sales and services, AOR = 1.20, CI:1.07,1.34), manual, AOR =1.28,95% CI: 1.11,1.44), children age 1–2 years (AOR =1.34,95% CI: 1.22,1.46) and 3–4 years (AOR =1.36,95% CI: 1.20,1.55), four and more antenatal visits (AOR: 1.14,95% CI: 1.03,1.27), rich wealth status (AOR:1.27,95% CI: 1.16,1.40), birth in health facility (AOR = 1.19, 95%CI: 1.10, 1.30) and visit health facility (AOR = 1.12, 95%CI: 1.03, 1.22) were associated with drinking or eating more.

Conclusion

The prevalence of drinking or eating more is low in East Africa. Maternal age, occupation, antenatal care visit, marital status, educational status, wealth status, place of delivery, visiting health facility, and child age were significantly associated with drinking or eating more during diarrheal episodes. Health policy and programs should focus on educating mothers, improving the household wealth status, encouraging women to contact health facilities for better feeding practices of children during diarrheal episodes.
Factors of body dissatisfaction among lebanese adolescents: the indirect effect of self-esteem between mental health and body dissatisfaction
Authors: Al-Musharaf Sara , Rogoza Radoslaw , Mhanna Mariam , Soufia Michel , Obeid Sahar , Hallit Souheil
Published: May 2022

Background

Body dissatisfaction (BD) rates are alarmingly high, especially among adolescents, thus. Having a better understanding of correlates associated with BD seems to be an important issue in this developmental context. Furthermore, as adolescence is an essential time in the development of self-perception and self-esteem the current study assesses factors associated with BD among Lebanese adolescents and evaluates the indirect effect of self-esteem between depression/anxiety/stress and BD.

Methods

This is a cross-sectional study among 555 Lebanese adolescents, ages 15–18, who completed an online survey incorporating BD, socioeconomic status, weight and height, physical activity index, Rosenberg Self Esteem Scale, Beirut Distress Scale, Hamilton Anxiety Rating Scale, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index and Global Physical Activity Questionnaire.

Results

The results of a stepwise linear regression, taking the body dissatisfaction score as the dependent variable, showed that higher BMI (B = 0.47), feeling pressured by media/TV to lose weight (Beta = 2.80), higher depression (Beta = 0.39), exercising to lose weight (Beta = 1.84) and following a diet to lose weight (Beta = 1.58) were significantly associated with more body dissatisfaction, whereas higher self-esteem (Beta=-0.11) and more psychological distress (Beta=-0.21) were significantly associated with less body dissatisfaction. Self-esteem played an indirect role in the associations between anxiety and body dissatisfaction and stress and body dissatisfaction.

Conclusions

BD is common among young Lebanese adolescents. Treating adolescents with low self-esteem and psychological issues is crucial in preventing anticipated BD and future eating disorders.
Angiotensin I converting enzyme gene polymorphisms and risk of psychiatric disorders
Authors: Akbari Mohammadarian , Eghtedarian Reyhane , Hussen Bashdar Mahmud , Eslami Solat , Taheri Mohammad , Ghafouri-Fard Soudeh
Published: May 2022

Angiotensin-converting enzyme (ACE) as an important enzyme in the renin-angiotensin system facilitates biogenesis of the functionally active product angiotensin II from angiotensin I. ACE gene contains a number of functional polymorphisms which modulate activity of the encoded protein. In the current case–control study, we appraised the association between the rs4359 and rs1799752 polymorphisms and risk of bipolar disorder (type I and type II; BPDI and BPDII), schizophrenia (SCZ) and obsessive–compulsive disorder (OCD). The rs4359 was associated with risk of OCD, BPDI and BPDII in co-dominant and dominant models. The rs1799752 was associated with all assessed psychiatric conditions in four inheritance models except for BPDII whose association was not significant in recessive model. The I allele of rs1799752 was associated with OCD (adjusted FDR q-Value = 4.04E-04), SCZ (adjusted FDR q-Value = 6.00E-06), BPDI (adjusted FDR q-Value = 8.40E-03) and BPDII (adjusted FDR q-Value = 6.00E-06). The effective T allele of rs4359 showed a significant association with disease risk for BPDII group. The estimated haplotypes of these polymorphisms have been distributed differently among patients and controls. Taken together, ACE polymorphisms can be regarded as risk factors for a variety of psychiatric disorders.
Age-related variations in position and morphology of the temporomandibular joint in individuals with anterior openbite and crossbite: a multi-cross-sectional comparative study
Authors: Chen Yanxi , Wang Jingxi , Li Ying , Li Lingfeng , Luo Nan , Wu Yan , Dai Hongwei , Zhou Jianping
Published: May 2022

Background

This study aimed to compare the age-related positional and morphological characteristics of the temporomandibular joint (TMJ) between individuals with anterior openbite or crossbite and controls.

Methods

This multi-cross-sectional comparative study analysed cone-beam computed tomography images of 750 participants, equally divided into the openbite, crossbite, and control groups (OBG, CBG, and CG, respectively). Each group was further divided into five subgroups (8–11 years, 12–15 years, 16–19 years, 20–24 years, and 25–30 years). Measurements of the TMJ included the position of the condyles in their respective fossae and morphology of the condyles and fossae. Data were submitted to statistical analysis. The study adhered to the STROBE Statement checklist for reporting of cross-sectional studies.

Results

Condyles were positioned more posteriorly with increasing age in all groups, and the condylar position was more posterior in the OBG than in the CBG. The articular eminence inclination increased with age in all the groups. There were significant differences in the articular eminence inclination among the three major groups at the age of > 15 years, and the condylar path was flatter in the CBG than in the OBG.

Conclusions

Age-related morphological and positional characteristics of the TMJ differed considerably among OBG, CBG and CG. Contrary to CBG, OBG was found to have relatively posterior condylar position and steeper condylar path.
Effectiveness of end-stage renal disease communication skills training for healthcare personnel: a single-center, single-blind, randomized study
Authors: Fang Ji-Tseng , Chen Shih-Ying , Tian Ya-Chung , Lee Chien-Hung , Wu I-Wen , Kao Chen-Yi , Lin Chung-Chih , Tang Woung-Ru
Published: May 2022

Background

Given that the consequences of treatment decisions for end-stage renal disease (ESRD) patients are long-term and significant, good communication skills are indispensable for health care personnel (HCP) working in nephrology. However, HCP have busy schedules that make participation in face-to-face courses difficult. Thus, online curricula are a rising trend in medical education. This study aims to examine the effectiveness of online ESRD communication skills training (CST) concerning the truth-telling confidence and shared decision-making (SDM) ability of HCP.

Methods

For this single-center, single-blind study, 91 participants (nephrologists and nephrology nurses) were randomly assigned to two groups, the intervention group (IG) (n = 45) or the control group (CG) (n = 46), with the IG participating in ESRD CST and the CG receiving regular in-service training. Truth-telling confidence and SDM ability were measured before (T0), 2 weeks after (T1), and 4 weeks after (T2) the intervention. Group differences over the study period were analyzed by generalized estimating equations.

Results

IG participants exhibited significantly higher truth-telling confidence at T1 than did CG participants (t = 2.833, P = .006, Cohen’s d = 0.59), while there were no significant intergroup differences in the confidence levels of participants in the two groups at T0 and T2. Concerning SDM ability, there were no significant intergroup differences at any of the three time points. However, IG participants had high levels of satisfaction (n = 43, 95%) and were willing to recommend ESRD CST to others (n = 41, 91.1%).

Conclusions

ESRD CST enhanced short-term truth-telling confidence, though it is unclear whether this was due to CST content or the online delivery. However, during pandemics, when face-to-face training is unsuitable, online CST is an indispensable tool. Future CST intervention studies should carefully design interactive modules and control for method of instruction.
Diversity-sensitive measures in German hospitals – attitudes, implementation, and barriers according to administration managers
Authors: Erdsiek Fabian , Aksakal Tuğba , Mader Maria , Idris Munzir , Yılmaz-Aslan Yüce , Razum Oliver , Brzoska Patrick
Published: May 2022

Background

Populations have varying needs and expectations concerning health care that result from diversity characteristics such as a migrant background, gender identity, disability, and age. These needs and expectations must be considered to ensure adequate utilization and quality of health services. Approaches to address diversity do exist, however, little is known about the extent to which they are implemented by health care facilities. The present study aims to examine, which measures and structures hospitals in Germany employ to address diversity, as well as which barriers they encounter in doing so.

Methods

A mixed-mode survey among administration managers of all registered German hospitals (excluding rehabilitation hospitals; n = 1125) was conducted between May and October 2019 using pen-and-paper and online questionnaires. Results were analyzed descriptively.

Results

Data from n = 112 hospitals were available. While 57.1% of hospitals addressed diversity in their mission statement and 59.9% included diversity considerations in quality management, dedicated working groups and diversity commissioners were less prevalent (15.2% each). The majority of hospitals offered multi-lingual admission and exit interviews (59.8%), treatments or therapies (57.1%), but only few had multi-lingual meal plans (12.5%) and seminars or presentations (11.6%). While 41.1% of the hospitals offered treatment and/or nursing exclusively by staff of the same sex, only 17.0% offered group therapies for both sexes separately. According to the managers, the main barriers were a lack of financial resources (54.5%), a lack of incentives from the funding providers (49.1%), and organizational difficulties (45.5%). Other reported barriers were a lack of conviction of the necessity among decision makers (28.6%) and a lack of motivation among staff members (19.6%).

Conclusions

Administration managers from only a small proportion of hospitals participated in our survey on diversity sensitivity. Even hospitals of those who did are currently not adequately addressing the diversity of staff members and patients. Most hospitals address diversity on an ideational level, practical measures are not widely implemented. Existing measures suggest that most hospitals have no overarching concept to address diversity in a broader sense. The main reported barriers relate to economic aspects, a lack of support in organizing and implementing corresponding measures and a lack of awareness or motivation.
Patient satisfaction with quality of care of a multidisciplinary thrombosis service – a cross sectional survey
Authors: Young Stephanie W. , Bonsu Kwadwo O. , Lee Tiffany , Nguyen Hai V. , Chitsike Rufaro S.
Published: May 2022

Background

In October 2017 we opened a multidisciplinary Adult Outpatient Thrombosis Service (Thrombosis Service) in a regional health authority servicing over 300 000 people. The Thrombosis Service is a comprehensive thrombosis and anticoagulation management program with unique, interrelated clinics providing a broad spectrum of care for this patient group. Evaluation of patient satisfaction with this new model of patient care is an important quality measurement.

Methods

We conducted a cross-sectional survey of patients who attended the Thrombosis Service between October 2017 and May 2019. We measured patient satisfaction with the seven-item Short Assessment of Patient Satisfaction (SAPS) which uses a 5 point scale (0–4) for responses. The continuous score range for SAPS is 0 to 28. Categorical responses for SAPS are defined as 0–10 very dissatisfied, 11–18 dissatisfied, 19–26 satisfied, and 27–28 very satisfied. We used linear regression analysis to examine the associations between patients’ characteristics and their satisfaction with the Thrombosis Service.

Results

Of the 1058 surveys distributed, 563 were returned. The mean score for the SAPS was 22.1 (SD 4.1, range 8 to 28). For the categorical response, 85% were satisfied or very satisfied with the Thrombosis Service. The multivariate analysis showed patients with post-secondary education were more satisfied with the Thrombosis Service (β-coefficient 1.6153, p = 0.024), and patients taking warfarin were less likely to be satisfied with the Thrombosis Service (β-coefficient -1.5832, p = 0.0390).

Conclusions

The majority of survey participants (85%) who attended an appointment in one of the Thrombosis Service clinics were satisfied or very satisfied with the care they received. This information may benefit other centres who are interested in developing a program to manage thrombosis and anticoagulation.
Food consumption patterns and nutrient intakes of infants and young children amidst the nutrition transition: the case of Lebanon
Authors: Jomaa Lamis , Hwalla Nahla , Chokor Fatima Al Zahraa , Naja Farah , O’Neill Lynda , Nasreddine Lara
Published: May 2022

Background

This is the first study on dietary intakes of infants and young children in the Eastern Mediterranean Region, a region that is currently witnessing the nutrition transition. It aims at characterizing food consumption patterns amongst 0–4 year old children in Lebanon, evaluating their macro- and micronutrient intakes and assessing adherence to dietary recommendations.

Methods

Based on a national cross-sectional survey in 2012 (n = 866), the study collected data on sociodemographic and anthropometric characteristics, and one 24-hour dietary recall was administered. Nutrient intakes were compared with reference values: Estimated Average Requirement (EAR), Adequate Intake (AI) and Acceptable Macronutrient Distribution Range (AMDR).

Results

Milk was the highest contributor to energy intake (EI) in infants (95.8 and 56.5% in 0–5.9 months and 6–11.9 months old infants, respectively), while its intake was lower among toddlers and preschoolers (35.4 and 15.1%, respectively). In contrast, intakes of sweets and sweetened beverages were the highest in preschoolers compared to younger children, contributing 18.5% EI in preschoolers. Compared to dietary guidelines, the lowest dietary adherence was found for vegetables (17.8–20.7%) and fruits (14.4–34.3%). Protein intake was within the recommendations for the vast majority of children. Although total fat intake was lower in toddlers and preschoolers compared to infants, more than 40% of toddlers and preschoolers exceeded the AMDR for fat and 87.3% of preschoolers exceeded the upper limit for saturated fat. Only 3.6% of toddlers and 11.5% of preschoolers exceeded the AI level for dietary fiber. Micronutrient intake assessment showed that mean intakes in infants exceeded the AI for all micronutrients, except for vitamin D and magnesium. In toddlers, vitamin D and calcium were below the EAR among 84.7, and 44.6%, respectively. In preschoolers, most of the children (91.9%) had inadequate intakes of vitamin D, and a third had inadequate intakes of folate, calcium and vitamin A.

Conclusions

This study identified priority issues for nutrition intervention in infants and young children in Lebanon. Concerted multi-stakeholder efforts are needed to instill heathier food consumption and nutrient intake patterns early in life.
Employers’ perceptions of breastfeeding practice of employed mothers in Addis Ababa, Ethiopia: a qualitative study
Authors: Wolde Firmaye Bogale , Haidar Jemal , Getnet Yalemwork
Published: May 2022

Background

The Ethiopian Demographic and Health Survey 2019 shows that 59% of children are exclusively breastfed for the first 6 months of life, then the rate decreases sharply with age. Nearly half of the Ethiopian labor force (46%) is comprised of women. This is encouraging since women’s employment is one way of ensuring women’s empowerment. However, various factors related to employment make it one of the commonly mentioned factors contributing for the low prevalence of breastfeeding. Hence, there needs to be a conducive work environment that accommodates maternal needs to not fall back from empowerment and to improve breastfeeding practice. There are not many studies in Ethiopia that focus on work environment in relation with employers’ experience and their perception of breastfeeding of employed mothers. Therefore, this study aims to explore employers’ experience and perception of employed mothers’ breastfeeding experience in different working environments in Addis Ababa, Ethiopia.

Methods

A qualitative study design using a descriptive phenomenology strategy was employed in this study and purposive sampling technique was used to recruit study participants. Data was collected between December 2016 and May 2017 in Addis Ababa city from 10 employers from private, governmental and non-governmental institutions through an in-depth interview. Thematic data analysis was performed where collected data was organized, coded and categorized into themes to give meaningful contributions to answering the research questions.

Results

Understanding breastfeeding, current maternity leave, perception of breastfeeding supporting the conditions and mother-friendly work environment were the themes generated after analysis. Almost all employers in this study recognized the importance of breastfeeding despite their different work environments and they also acknowledged the importance of making the working environment mother-friendly for stability and motivation of employed mothers.

Conclusions

Providing mothers with a friendly environment is understood as a positive thing by employers. The current maternity leave of 3 months has low acceptance and both onsite childcare center and six-month maternity leave are believed to help in creating a mother-friendly work environment despite their pros and cons.