bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study.
Authors: Haegdorens Filip , Bogaert Peter Van , De Meester Koen , Monsieurs Koen
Published: November 2019

BACKGROUND
Growing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality. Current research is limited to studies using hospital level data or without proper adjustment for confounders which makes the translation to practice difficult.
METHOD
In this observational study we analysed retrospectively the control group of a stepped wedge randomised controlled trial concerning 14 medical and 14 surgical wards in seven Belgian hospitals. All patients admitted to these wards during the control period were included in this study. Pregnant patients or children below 17 years of age were excluded. In all patients, we collected age, crude ward mortality, unexpected death, cardiac arrest with Cardiopulmonary Resuscitation (CPR), and unplanned admission to the Intensive Care Unit (ICU). A composite mortality measure was constructed including unexpected death and death up to 72 hours after cardiac arrest with CPR or unplanned ICU admission.
Every four months we obtained, from 30 consecutive patient admissions across all wards, the Charlson comorbidity index. The amount of nursing hours per patient days (NHPPD) were calculated every day for 15 days, once every four months. Data were aggregated to the ward level resulting in 68 estimates across wards and time. Linear mixed models were used since they are most appropriate in case of clustered and repeated measures data.
RESULTS
The unexpected death rate was 1.80 per 1000 patients. Up to 0.76 per 1000 patients died after CPR and 0.62 per 1000 patients died after unplanned admission to the ICU. The mean composite mortality was 3.18 per 1000 patients. The mean NHPPD and proportion of nurse Bachelor hours were respectively 2.48 and 0.59. We found a negative association between the nursing hours per patient day and the composite mortality rate adjusted for possible confounders (B= -2.771, p=0.002). The proportion of nurse Bachelor hours was negatively correlated with the composite mortality rate in the same analysis (B= -8.845, p=0.023). Using the regression equation, we calculated theoretically optimal NHPPDs.
CONCLUSIONS
This study confirms the association between higher nurse staffing levels and lower patient mortality controlled for relevant confounders.
Trend analysis and seasonality of tuberculosis among patients attending Hiwot Fana Specialized University Hospital, Eastern Ethiopia: A retrospective study
Authors: Bodena Dagne , Ataro Zerihun , Tesfa Tewodros
Published: November 2019

The authors have withdrawn this preprint from Research Square
Men’s grief following pregnancy loss and neonatal loss: A systematic review and emerging theoretical model
Authors: Obst Kate , Due Clemence , Oxlad Melissa , Middleton Philippa
Published: November 2019

Background: Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men’s grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men’s grief, this systematic review sought to summarise and appraise the literature focusing on men’s grief following pregnancy loss and neonatal loss.
Methods: A systematic review was undertaken with searches completed across four databases (PsycINFO, PubMed, Embase and CINAHL). These were guided by two research questions: 1) what are men’s experiences of grief following pregnancy/neonatal loss; and 2) what are the predictors of men’s grief following pregnancy/neonatal loss? Eligible articles were qualitative, quantitative or mixed methods empirical studies including primary data on men’s grief, published between 1998 and October 2018. Eligibility for loss type included any definition of miscarriage or stillbirth, termination of pregnancy for nonviable foetal anomaly, and neonatal death up to 28 days after a live birth.
Results: A final sample of 46 articles were identified, of which 26 were qualitative, 19 quantitative, and one mixed methods. Findings indicate that men’s grief experiences are highly varied, and current grief measures may not capture all of the complexities of grief for men. Qualitative studies identified that in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent needs. Men may face double-disenfranchised grief in relation to the pregnancy/neonatal loss experience.
Conclusion: There is a need to increase the accessibility of support services for men following pregnancy/neonatal loss, and to provide recognition and validation to their experiences of grief. To refine an emerging socio-ecological model of men’s grief, cohort studies are required among varied groups of bereaved men to confirm grief-predictor relationships.
The effect of the laparoscopic primary suture of the common bile duct in elderly patients: a retrospective study
Authors: Liu Jinheng , Wang Yanting , Liu Xubao , Yin Sineng
Published: November 2019

Background Traditional surgery treatment strategies for elderly patients who were diagnosed as choledocholithiasis combined with cholecystolithiasis include laparoscopic choledocholithotomy, cholecystectomy, and T-tube drainage. However, long-term indwelling T-tube drainage will cause pain and other complications. This study was designed to compare the primary suture of the common bile duct and the T-tube drainage after laparoscopic choledochotomy to study the merits and demerits between primary suture and T-tube drainage in elderly patients. Methods Eighty-five patients were screened from January 2017 to January 2018. All patients were performed laparoscopic surgery. Fifty-six cases were the primary suture group (n=56). Twenty-nine cases were the T-tube group (n=29). Preoperative baseline characteristics, intraoperative and postoperative characteristics of the two groups were compared. Results There were no differences of baseline characteristics in both groups (P>0.05). Compared with the T-tube group, the postoperative total drainage volume on the first day and patients of residual stones were fewer, and all drainage tube indwelling time was shorter in the primary suture group(P﹤0.05). And there were statistically significant differences in postoperative total drainage volume on the first day, all drainage tube indwelling time, postoperative total bilirubin and residual stones between the two groups (P<0.05). There were no statistically significant differences of the other intraoperative and postoperative characteristics(P>0.05). There were no pressure sores, hypostatic pneumonia, deep vein thrombosis, serious complications of heart, lung and brain and even death in both groups. Conclusions With accurate preoperative risk assessment and strict treatment of basic diseases in elderly patients, and the stones were removed in laparoscopic surgery, the primary suture in elderly patients is feasible, safe, and valid.
GINGIVAL THICKNESS ASSESSMENT AT MANDIBULAR INCISORS OF ORTHODONTIC PATIENTS WITH ULTRASOUND AND CONE-BEAM CT. A CROSS-SECTIONAL STUDY
Authors: Kloukos Dimitrios , Kakali Lydia , Koukos George , Sculean Anton , Stavropoulos Andreas , Katsaros Christos
Published: November 2019

Background Quantitative and qualitative analysis of several periodontal parameters plays an important role in several dental procedures. Aim of the current study was to assess gingival thickness (GT) at mandibular incisors of orthodontic patients with two methods and determine how these methods are compared to each other when assessing periodontal anatomy through soft tissue thickness.Methods The sample consisted of 40 consecutive adult orthodontic patients. GT was measured at both central mandibular incisors, mid-facially on the buccal aspect, 2mm apically to the free gingival margin with two methods: a) clinically with an Ultrasound device (USD) and b) radiographically with Cone Beam Computed Tomography (CBCT).Results CBCT measurements were consistently higher than USD measurements, with the difference ranging from 0.13 mm to 0.21 mm. No difference was noted between the repeated CBCT measurements at the right central incisor (Bias= 0.05 mm; 95% CI= -0.01, 0.11, p=0.104). Although the respective results for the left incisor indicated, statistically, that the measurements were not exactly replicated, the magnitude of the point estimate was small and not clinically significant (Bias= 0.06 mm; 95% CI= 0.01, 0.11, p=0.014). Small differences between CBCT measurements made by the 2 examiners at the left central incisor (bias= 0.06 mm, 95% CI= 0.01, 0.11, p=0.014) were detected. However, this difference was minor, and again, not clinically significant. The respective analysis on the right incisor showed no significant difference (bias= 0.05 mm, 95% CI= -0.01, 0.11, p=0.246).Conclusions Present data indicate that CBCT measurements were highly reproducible and yielded greater values compared to USD measurements.
Identifying risk factors of anemia among women of reproductive age in Rwanda to inform designing better interventions – a secondary data analysis, cross-sectional study using the Rwanda Demographic and Health Survey (RDHS) data
Authors: Hakizimana Dieudonne , Nisingizwe Marie Paul , Logan Jenae , Wong Rex
Published: November 2019

Background Anemia among Women of Reproductive Age (WRA) continues to be among the major public health problems in many developing countries including Rwanda where it was increased comparing 2015 to 2010 Rwanda Demographic and Health Survey (RDHS) reports. A thorough understanding of the its risk factors is necessary to design interventions. However, to the best of our knowledge, no study with national representation assessing anemia risk factors among WRA has been conducted in Rwanda. Therefore, this study aims to identify anemia risk factors among WRA in Rwanda. Methods This was a quantitative, cross-sectional study using secondary data from the 2014-2015 RDHS data. The study population consisted of 6680 WRA who were tested for anemia during the survey. Anemia was defined as having a hemoglobin level equal or below to 10.9 g/dl for a pregnant woman, and hemoglobin level equal or below to 11.9 g/dl for a non-pregnant woman. Pearson’s chi-squared test and multiple logistic regression were conducted for bivariate and multivariable analysis respectively. We reported Odds Ratio (OR), 95% Confidence Intervals (CI) and p-values. Results The overall prevalence of anemia among WRA was 19.2% (95% CI: 18.0 - 20.5). After controlling for other variables, four factors were found associated with lower odds of anemia, they are being obese (OR: 0.61, 95% CI: 0.40 - 0.91), being in rich category (OR: 0.74, 95% CI: 0.63 - 0.87), sleeping under a mosquito net (OR: 0.85, 95% CI: 0.74 - 0.98), and using hormonal contraceptives (OR: 0.61, 95% CI: 0.50 - 0.73). Four factors associated with higher odds of anemia were being underweight (OR: 1.39, 95% CI: 1.09 - 1.78), using an Intra Uterus Device (OR: 1.98, 95% CI: 1.05 - 3.75), and living in the Southern province (OR: 1.45, 95% CI: 1.11 - 1.89) or in the Eastern province (OR: 1.41, 95% CI: 1.06 - 1.88). Conclusion Anemia continues to pose public health challenges; novel public health interventions should consider geographic variations, improve women economic status, and strengthen iron supplementation especially for Intrauterine Device users. Additionally, given the association between anemia and malaria, interventions to prevent malaria should be enhanced.
Archaic mitochondrial DNA inserts in modern day nuclear genomes
Authors: Bücking Robert , Cox Murray P , Hudjashov Georgi , Saag Lauri , Sudoyo Herawati , Stoneking Mark
Published: November 2019

Background:
Traces of interbreeding of Neanderthals and Denisovans with modern humans in the form of archaic DNA have been detected in the genomes of present-day human populations outside sub-Sahara Africa. Up to now, only nuclear archaic DNA has been detected in modern humans; we therefore attempted to identify archaic mitochondrial DNA (mtDNA) residing in modern human nuclear genomes as nuclear inserts of mitochondrial DNA (NUMTs).
Results:
We analysed 221 high-coverage genomes from Oceania and Indonesia using an approach which identifies reads that map both to the nuclear and mitochondrial DNA. We then classified reads according to the source of the mtDNA, and found one NUMT of Denisovan mtDNA origin; analysis of the flanking region suggests that this insertion is more likely to have happened in a Denisovan individual and introgressed into modern humans with the Denisovan nuclear DNA, rather than in a descendant of a Denisovan female and a modern human male.
Conclusions:
Here we present our pipeline for detecting introgressed NUMTs in next generation sequencing data that can be used on genomes sequenced in the future. Further discovery of such archaic NUMTs in modern humans can be used to detect interbreeding between archaic and modern humans and can reveal new insights into the nature of such interbreeding events.
Mating precedes selective immune priming which is maintained throughout bumblebee queen diapause
Authors: Colgan Thomas J , Finlay Sive , Brown Mark JF , Carolan James C
Published: November 2019

Background: Understanding the mechanisms by which organisms adapt to unfavourable conditions is a fundamental question in ecology and evolutionary biology. One such mechanism is diapause, a period of dormancy typically found in nematodes, fish, crustaceans and insects. This state is a key life-history event characterised by arrested development, suppressed metabolism and increased stress tolerance and allows an organism to avoid prolonged periods of harsh and inhospitable environmental conditions. For some species, diapause is preceded by mating which can have a profound effect on female behaviour, physiology and key biological processes, including immunity. However, our understanding of how mating impacts long-term immunity and whether these effects persist throughout diapause is currently limited. To address this, we explored molecular changes in the haemolymph of the ecologically important pollinator, the buff-tailed bumblebee Bombus terrestris . B. terrestris queens mate prior to entering diapause, a non-feeding period of arrested development that can last 6-9 months. Using mass-spectrometry-based proteomics, we quantified changes in the pre-diapause queen haemolymph after mating, as well as the subsequent protein expression of mated queens during and post-diapause. Results: Our analysis identified distinct proteome profiles associated with diapause preparation, maintenance and termination. More specifically, mating pre-diapause was followed by an increase in the abundance of antimicrobial peptides, key effectors of the immune system. Furthermore, we identified the elevated abundance of these proteins to be maintained throughout diapause. This finding was in contrast to a general reduction in immune proteins during diapause suggestive of selective immune priming and expression during diapause. Diapause also affected the expression of proteins involved in cuticular maintenance, olfaction, as well as proteins of unknown function, which may have roles in diapause regulation. Conclusions: Our results provide clear molecular evidence for the consequences and benefits of mating at the immune level as it precedes the selective increased abundance of antimicrobial peptides that are sustained throughout diapause. In addition, our results provide novel insights into the molecular mechanisms by which bumblebees prepare for, survive, and recover from diapause, insights that may have implications for our general understanding of these processes in other insect groups.
Helicobacter pylori: A Cause of Community-Acquired Pediatric Septic Shock: A Cross Sectional Study
Authors: Algebaly HebatAllah , Elsherif Rasha , Ghaith Doaa , Saad Bassem , Mohsen Nabil
Published: November 2019

The authors have withdrawn this preprint from Research Square
Coping styles in myalgic university students: A case control study.
Authors: Soto-Goñi Xabier , Viñals Ana Cristina , Pérez-González Fabian , Sánchez-Labrador Luis , Domínguez-Gordillo Adelaida , Sánchez-Sánchez Teresa , Ardizone-García Ignacio , Jiménez-Ortega Laura
Published: November 2019

Background: Patients suffering pain related temporomandibular disorders (TMD) exhibit greater levels of psychological distress, environmental stress, somatic symptoms, anxiety, depression, somatic awareness, pain catastrophizing, and pain coping strategies compared to pain-free controls. However, little is known about psychological factors involved in the different TMD types fulfilling DC/TMD criteria. Furthermore, regardless of the severity, the role of general coping strategies and styles in TMD is not yet well understood. The main goal of this study was to investigate anxiety, personality traits, and coping behavior in a group of dentistry students suffering from temporomandibular disorder with myalgia.

Methods: A cohort of 102 university students was initially recruited for this study. Following clinical evaluation, a myalgia group (24 participants) and a control group (25 participants) were formed. Participants were later assessed in anxiety, stress coping strategies, and personality measures by using the State-trait anxiety inventory (STAI), coping response inventory (CRI), and Neo Five-Factor Inventory (NEO-FFI) questionnaires respectively.

Results: The myalgia group presented greater levels of trait anxiety and neuroticism in comparison to the control group. In addition, participants with myalgia showed higher levels of avoidance coping.

Conclusions: Avoidance coping strategies are generally considered maladaptive, as they seem to increase perceived stress, a robust predictor of TMD. Interventions to reduce stress levels and prevent maladaptive coping styles, might improve temporomandibular health and prevent the myalgia and its chronification.
Comparison of videolaryngoscopy and direct laryngoscopy by less experienced paramedics during out-of-hospital cardiopulmonary resuscitation. An observational prospective study.
Authors: Risse Joachim , Volberg Christian , Kratz Thomas , Plöger Birgit , Jerrentrup Andreas , Pabst Dirk , Kill Clemens
Published: November 2019

Introduction: Videolaryngoscopy (VL) has become a popular method of intubation (ETI). Although VL may facilitate ETI in less-experienced rescuers there are limited data available concerning ETI performed by paramedics during CPR. The goal was to show the benefit of VL during CPR performed by non-physicians in a single emergency department in Germany. We investigated in an observational prospective study the superiority of VL for less-experienced paramedics during CPR compared with direct laryngoscopy (DL).Methods: We instructed and equipped paramedics from four ambulances in endotracheal intubation (ETI) with GlideScope® (GVL). The primary endpoint was good visibility of the glottis (Cormack-Lehane grading 1/2), and the secondary endpoint was successful intubation.Results: In total n = 97 patients were included, n = 69 using DL (with n = 85 intubation attempts) and n = 28 using VL (with n = 37 intubation attempts). Videolaryngoscopy resulted in a significantly improved visualization of the larynx compared with DL. In the group using GVL, 82% rated visualization of the glottis as CL 1&2 versus 55% in the DL group (p = 0.02). Despite better visualization of the larynx, there was no statistically significant difference in successful ETI between GVL and DL (GVL 75% vs. DL 68.1%, p = 0.63).Conclusions: When used by paramedics during CPR, GVL led to better visibility of the glottis but did not increase the number of successful initial intubation attempts. Therefore, we conclude that education in VL should also focus on insertion of the endotracheal tube, considering the different procedures of GVL.
Active and latent tuberculosis among refugees and asylum seekers: a systematic review and meta-analysis
Authors: Proenca Raquel , Souza Fernanda Mattos , Bastos Mayara Lisboa , Caetano Rosangela , Braga Jose Ueleres , Faerstein Eduardo , Trajman Anete
Published: November 2019

Background: In 2017, there were 68.5 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Tuberculosis prevalence in the country of origin and adverse conditions endured during their journey may increase their risk for tuberculosis. Objective: We summarized the prevalence of active and latent tuberculosis infection among refugees and asylum seekers through a literature systematic review and meta-analysis by country of origin. Methods: Articles published in Medline, EMBASE, Web of Science and LILACS from 2000 to August 2017 were searched for, without language restriction. Two independent authors performed the study selection, data extraction and quality assessment. Random effect models were used to estimate pooled measures of active and latent tuberculosis prevalence. Sub-group analysis was performed according to country of origin and host continent. Results: Sixty-seven out of 767 identified papers were included, of which 16 entered the meta-analysis. Pooled prevalence of active and latent tuberculosis was 1% [95% confidence interval (CI)=1-2%] and 37% (95% CI=23-52%), respectively, both with high level of heterogeneity (I 2 =98.2% and 99.8%). Prevalence varied more according to countries of origin than host continent. Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Many studies failed to provide relevant information. Conclusion: Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention in any host continent. To protect this vulnerable population, ensuring access to healthcare for early detection for prevention and treatment of the disease is essential. Key words: Forced migration. Mycobacterium Tuberculosis. Latent tuberculosis infection. Prevalence. Global health.
Analysis of Causes of Death Among Brought-in-Dead Cases in a Third-Level Hospital in Lusaka, Republic of Zambia, Using the Tariff Method 2.0 for Verbal Autopsy: A Cross-Sectional Study
Authors: Yokobori Yuta , Matsuura Jun , Sugiura Yasuo , Mutemba Charles , Nyahoda Martin , Mwango Chomba , Kazhumbula Lloyd , Yuasa Motoyuki , Chiluba Clarence
Published: November 2019

Background Over one third of deaths in Zambian health facilities involve someone who has already died before arrival (i.e., brought in dead [BiD]), and in most BiD cases, the causes of death (CoD) have not been fully analyzed. Therefore, this study aimed to analyze the CoD of BiD cases using the Tariff Method 2.0 for automated verbal autopsy (VA), which is called SmartVA.Methods The target site was one third-level hospital in the Republic of Zambia’s capital city. All BiD cases aged 13 years and older at this facility from January to August 2017 were included. The deceased’s closest relatives were interviewed using a structured VA questionnaire (Population Health Metrics Research Consortium Shortened Questionnaire) and the data were analyzed using the SmartVA to determine the CoD at the individual and population level. The CoDs were compared with description on the death notification forms by using t-test and Cohen’s kappa coefficient.Results Approximately 1500 cases were included (average age = 47.2 years, 61.8% males). The top CoD were infectious diseases, including acquired immunodeficiency syndrome, tuberculosis, and malaria, followed by non-communicable diseases, such as stroke, cardiovascular diseases, and diabetes mellitus (DM). The comparison with the CoD distribution among hospital deaths showed that the trends were similar except for DM, which was greater among hospital deaths, and malaria and accident, which were less frequent in the main CoD. The proportion of cases with a determined CoD was significantly higher when using the SmartVA (75%) than the death notification form (61%). A proportion (42.7%) of the CoD-determined cases matched in both sources, with a low concordance rate (kappa coefficient = 0.1385).Conclusions The CoD of the BiD cases were successfully analyzed using the SmartVA for the first time in Zambia. While there many erroneous descriptions on the death notification form, the SmartVA could determine the CoD among more BiD cases. Since the information on the death notification form is reflected in the national vital statistics, more accurate and complete CoD data are required. In order to strengthen the death registration system with accurate CoD, it will be useful to embed the SmartVA in Zambia’s health information system.
Parent-Adolescent Communication about Sexual and Reproductive Health and Its Association with Gender and Pre-Marital Sex Among Secondary and Preparatory School Students in Woldia Town, North East Ethiopia, 2019
Authors: Masresha Seteamlak Adane , Alen Gedefaw Diress , Aberra Israel Abraham , Dender Dawit Koru , Mamo Zekarias Abuhay , Girma Asfaw Derib , Misgie Ebrahim Mussa
Published: November 2019

Background : Adolescent today faced different health threats which are predominantly behavioral. Parent-adolescent communication about sexual matters is one of the means that encourages adolescents to adopt responsible sexual behavior. Many children in Africa is uncomfortable to have a Communication about sexual and reproductive health issues with their parents because the subject is a taboo topic in most homes. So, this study aimed to assess magnitude of communication between adolescents and parents on SRH issues and its association with gender and premarital sexual practice among school adolescents of Woldia Town. Methods : School based cross-sectional study was conducted on 368 unmarried Secondary and preparatory school adolescents (15-19 years) in Woldia Town. Simple random sampling were employed to select study participants. Self-administered questionnaire were used. Data were entered by EPI-Data version 3.0.2 and analyzed by using SPSS version 20. Result : In this study 56.3% of school adolescents had parental communication on sexual and reproductive health issues. The result of this study showed that there was a significant negative association between pre-marital sexual practice and adolescent-parent communication on SRH issues where by adolescents who had history of sexual intercourse where 64% less likely to communicate with parents (AOR: 0.36 95% CI: 0.20, 0.65). Conclusion and recommendation : This study showed that adolescent-parent communication about sexual and reproductive health issues was low in Woldia Town. Therefore, programs focusing on meeting young people sexual and reproductive health needs in the area should focus on changing the social and cultural views of communicating sexual issues in addition to working on changing individual behaviors on contraceptive use.
Association between Dietary Selenium Intake and the Prevalence of Osteoporosis: A Cross-Sectional Study
Authors: Wang Yuqing , Xie Dongxing , Li Jiatian , Long Huizhong , Wu Jing , Wu Ziying , He Hongyi , Wang Haochen , Wang Yilun , Yang Tuo
Published: November 2019

Objective To examine the correlation between dietary selenium (Se) intake and the prevalence of osteoporosis (OP) in the general middle-aged and older population in China. Methods Data for analyses were collected from a population based cross-sectional study performed at the Xiangya Hospital Health Management Centre. Dietary Se intake was evaluated using a validated semi-quantitative food frequency questionnaire. OP was diagnosed on the basis of bone mineral density scans using a compact radiographic absorptiometry system. The correlation between dietary Se intake and the prevalence of OP was primarily examined by multivariable logistic regression. Results This cross-sectional study included a total of 6267 subjects (mean age: 52.2 ± 7.4 years; 42% women), and the prevalence of OP among the included subjects was 9.6% (2.3% in men and 19.7% in women). Compared with the lowest quartile, the energy intake, age, gender and body mass index (BMI)-adjusted odds ratios of OP were 0.72 (95% confidence interval [CI] 0.55-0.94), 0.72 (95% CI 0.51-1.01) and 0.47 (95% CI 0.31-0.73) for the second, third and fourth quartiles of dietary Se intake, respectively (P for trend = 0.001). The results remained consistent in male and female subjects. Adjustment for additional potential confounders (i.e., smoking status, drinking status, physical activity level, nutritional supplements, diabetes, hypertension, fibre intake, and calcium intake) did not cause substantial changes to the results. Conclusions In the middle-aged and older humans, participants with lower levels of dietary Se intake have a higher prevalence of OP in a dose-response manner.
Why is tobacco control progress in Indonesia stalled? - A qualitative analysis of interviews with tobacco control experts
Authors: Astuti Putu Ayu Swandewi , Assunta Mary , Freeman Becky
Published: November 2019

Introduction Indonesia shoulders a significant tobacco burden, with almost two million cases of tobacco-related illnesses and more than two hundred thousand tobacco-related deaths annually. Indonesian tobacco control is progressing but lags behind other countries. Our study evaluates factors that contribute to the slow progress of tobacco policy change in Indonesia from the perspective of tobacco control experts (TCEs).Method We conducted qualitative interviews with four international and ten national TCEs, who have been active in tobacco control for at least 5 years. Our interview guideline included questions on the current tobacco control situation in Indonesia and explored reasons why tobacco control is progressing so slowly. The interviews were conducted either in English or Bahasa Indonesia, recorded and then transcribed verbatim. We conducted a thematic analysis based on five core causal factors for policy adoption: institutions, networks, socio-economic factors, agendas and ideas.Results and Discussion The multistage delay of tobacco policy adoption is principally due to political structures and policy hierarchy, complex bureaucracy, unclear roles and responsibilities, and a high degree of corruption. The low bargaining position and lack of respect for the Ministry of Health also contributes. There are contrasting frames of tobacco as a strategic economic asset and tobacco control as a sovereignty threat. There is an imbalance of power and influence between well entrenched and resourced tobacco industry networks compared to relatively young and less established tobacco control networks. The policy agenda is likely influenced by the privileged position of tobacco in Indonesia as a socially acceptable product with high consumption. There are constraints on transferring ideas and evidence to successful policy adoption.Conclusion Tobacco companies have substantially influenced both policy decisions and public perceptions, signifying a power imbalance within the government system and broader networks. Acceding to and enforcing the WHO-FCTC would enable the Indonesian government to shift the power imbalance towards public health stakeholders. Tobacco control advocates must enhance their network cohesion and embrace other community groups to improve engagement and communication with policymakers.
Finding a novel tetramethylated hydroxydiethylene of resveratrol analogue for potential anticancer agent
Authors: Xin Zhen-Hui , Meng Ya-Li , Jiang Wen-Jing , Li Ya-Peng , Ge Li-Ping , Zhang Cun-Hui , Liu Lian-Na , Kang Yan-Fei
Published: November 2019

With the improvement and advance in cancer diagnosis and treatment, the cancer is still a major cause of morbidity and mortality throughout the world. Obviously, new breakthroughs in therapies remain be urgent needed. In this work, we designed and synthesized the compound 1-4, namely resveratrol analogues with methylation of hydroxy distyrene, to further explore its new anti-cancer potential. Encouragingly, compound 1 (( E )-4,4'-(ethene-1,2-diyl)bis(3,5-dimethylphenol)) exhibited cytotoxicity superior to resveratrol in MCF 7 cells. More importantly, the compound 1 showed greater toxicity to tumor cells than that to normal cells, which proved that it could selectively kill tumor cells. The favorable results encouraged us to explore the inhibitory mechanism of compound 1 on MCF 7 cells. The research finding indicated the compound 1 inhibited tumor cell proliferation by both arresting cell cycle in S phase and apoptosis via a prooxidant manner. In addition, the results further verified compound 1 caused cell cycle arrest in S phase and apoptosis by down-regulation of the cycling A1/cycling A2 expression and the rise of Bax/Bcl-2 ratio in a p21-dependant pathway in MCF 7 cells. Therefore, these results are helpful for the effective design of anticanceranticancer reagents and the better understanding of their mechanism of action.
Discrimination by parity is a prerequisite for assessing induction of labour outcome – observational study
Authors: Denona Branko , Foley Michael , Mahony Rhona , Robson Michael
Published: November 2019

Objective: To demonstrate that studies on induction of labour should be analyzed by parity as there is a significant difference in the labour outcome among induced nulliparous and multiparous women Methods: Obstetric outcome, specifically caesarean section rates, among induced term nulliparous and multiparous women without a previous caesarean section were analyzed using the Robson 10 group classification 2 for the year 2016. Results: The caesarean rates among nulliparous women in spontaneous and induced labour, Robson groups 1 and 2A, were 7.8% (151/1925) and 32.6% (437/1339) respectively and among multiparous (excluding those women with a previous caesarean section), Robson group 3 and 4A were 1%(24/2389) and 4.4% (44/1005), respectively. Pre labour caesarean rates for nulliparous and multiparous women, Robson groups 2B and 4B 2 were 3.9% (133/3397) and 2.8% (100/3494), of the respective single cephalic cohort at term. Conclusion: The data strongly suggests that studies on induction of labour should be analyzed by parity and should probably be confined to nulliparous women.
Intestinal microbes affect bile acid metabolism involved in gallstone formation
Authors: Wang Qiang , Hao Chenjun , Yao Wenchao , Zhu Defu , Lu Haifeng , Li Long , Ma Biao , Xue Dongbo , Zhang Weihui
Published: November 2019

Background: The gut microbiota participates in the metabolism of substances and energy, promotes the development and maturation of the immune system, forms the mucosal barrier, and protects the host from pathogen attacks. Although the pathogenesis of cholesterol gallstones is still not clear, studies have suggested that gut microbiota dysbiosis plays an important role in their formation. Methods: Microbial DNA from faeces of normal control patients and those of patients with calculi was subjected to 16S rRNA gene sequencing to detect gene expression changes in intestinal microbes. ELISA kits were used to measure free bile acids, secondary bile acids and coprostanol according to the manufacturer’s instructions. The relationship between flora and their metabolites was then analysed. Results: In the gallstone group, the diversity of intestinal bacteria and the abundances of certain phylogroups were significantly decreased (p<0.05), especially Firmicutes (p<0.05), the largest phylum represented by the gut microbiota. This study found an increase in free bile acids (p<0.001) and secondary bile acids (p<0.01) in the enterohepatic circulation. Bile salt hydrolase activity was not related to the abundances of BSH-active bacteria. 7a-dehydroxylating gut bacteria were significantly increased (p<0.01), whereas cholesterol-lowering bacteria were significantly reduced (p<0.05). The Ruminococcus gnavus group could be used as a biomarker to distinguish the gallstone group from the control group. Conclusion: Substantial changes in the intestinal flora of patients with gallstones were observed, which affect cholesterol and bile acid metabolism and can lead to gallstones. Keywords: Gut microbiota, Gallstone, Bile acid, BSH, 16S rRNA gene sequencing
Betaine ameliorates intestinal injury by targeting the LPS/TLR4/MyD88 pathway and microbial communities of intestinal tract in acute liver failure
Authors: Chen Qian , Wang Yao , Jiao Fang-Zhou , Shi Chun-Xia , Pei Mao-Hua , Wang Lu-Wen , Gong Zuo-Jiong
Published: November 2019

Background: A growing body of evidence revealed that the gut microbiome has a marked impact in acute liver failure (ALF). Microbes and their products will translocate into enterocoelia and enter into circulation system from the damaged intestinal lumen. It will further aggravate liver injury by enhancing the spread of inflammation, tissue damage and sepsis. Betaine is a hepatoprotective drug which has anti-inflammatory and anti-oxidant effects. Here, we evaluated the impact of betaine on gut microbiota composition in ALF animal experiment. The potential protective effect of betaine by inhibiting Toll-like receptor 4 (TLR4) responses was explored as well.Results: Eighteen mice were randomly divided into normal, model, and betaine groups. The ALF-induced intestinal epithelial barrier disruption internal models were induced by D-galactosamine（D-Gal）and lpopolysaccharide (LPS). Betaine was administered intragastrically 1 week before exposure of D-Gal/LPS. LPS were solely applied with a rat small intestinal cell line IEC-18 to establish ALF-induced intestinal epithelial barrier disruption external model. Mice in the model group developed severe intestinal epithelial tissue injury than normal group, increased significantly in the protein levels of TLR4, MyD88, TRAF6 and TNF-a and the mRNA levels of TLR4 and MyD88, and decreased significantly in the protein and mRNA levels of (ZO)-1 and occludin. Whereas, all above indicators were improved significantly by administration of betaine than that in model. The degree of liver tissue pathological damage, liver function and serum inflammatory cytokines in betaine group were significantly reduced than that in model group. The permeability of mice intestinal epithelial and IEC-18 cell in models was improved in betaine group than models. A total of 509 Operational Taxonomic Units (OTUs) were produced from mice fecal samples according to 16s rRNA gene sequence analysis. There were 156 core microbiomes in fecal samples. There existed a total of 24 species contained 11 species at the genus level which had a significant difference between groups. The increased relative abundance of g-Enterorhabdus in the model group was detected compared with normal group. Betaine down-regulated the relative abundance of g-Enterorhabdus in model. The relative abundance of g-Bacteroides was the highest in normal group and the least in model group. The relative abundance of g-Prevotella was almost identical in normal and betaine group, and it was decreased in model group.Conclusion: Betaine effectively improved the intestinal mucosal barrier in acute liver failure. The mechanism was probably related to inhibit the LPS/TLR4/MyD88 signaling pathways, improved the intestinal mucosal barrier and then maintained the gut microbiota composition.
Factors Influencing Palliative Care Utilization Among Patients With Cancer: A Cross-Sectional Study
Authors: Dlamini Minenhle S. , Hlongwana Khumbulani W. , Dlamini Siyabonga B. , Ginindza Themba G.
Published: November 2019

Background: Cancer remains a public health challenge in low-and-middle income countries (LMICs). Over 30% of those in need of palliative care (PC) worldwide suffer from cancer and 80% of patients with cancer in LMICs are diagnosed at advanced stages, by which time they can only benefit from PC services. The aim of this study was to determine factors influencing PC utilization among patients with cancer in KZN.Methods: A cross-sectional descriptive study was used among patients who had been diagnosed with different cancers and attending Inkosi Albert Luthuli Central Hospital (IALCH), Addington Hospital, Pietermaritzburg Grey’s hospital, Msunduzi and Chatsworth Hospices. A systematic random sampling technique was used to select participants. Structured questionnaires were administered to a total of 394 patients. The questionnaire included two open-ended questions and the generated data was analysed and presented into two formats; firstly, the textual data was entered into REDcap (v.8.11.7) and then exported to IBM SPSS Statistics (v.25) and recoded for emerging themes which were later presented in a graph format. Secondly, the thematic analysis was presented in textual format and supported with verbatims quotes. Results: The mean (+SD) age of the 394 participants was 51.89 (+14.67) years and about 22.9% were within the age-group 41–50 years. Majority of participants were females (77.7%) and were unmarried (60.6%). Most of the participants’ racial classification was black (81.5%) and 64.5% had primary education. More than four-fifths (82.7%) were unemployed, 55.8% lived in urban areas and 24.6% had cervical cancer. The analysis of the two open-ended questions incorporated into the questionnaire revealed five themes as major barriers preventing cancer patients from seeking PC services.Conclusion: Lack of knowledge and awareness about cancer symptoms and PC services could be addressed by better education of the public. Hence, utilization of PC could be maximized, thereby providing a better quality of life for the sufferers and their families until the end of life’s journey. The study also provides information that can be used to strengthen and/or to develop PC guidelines addressing PC issues. Keywords: Cancer, Palliative care, barriers, utilization, KwaZulu-Natal
Ubisol Coenzyme Q10 Promotes Mitochondrial Biogenesis in HT22 Cells Challenged by Glutamate
Authors: Zimmerman Mary , Hall Mia , Qi Qi , Mehta Suresh L , Chen Guisheng , Li P. Andy
Published: November 2019

Background: Glutamate-induced excitotoxicity is a well-recognized cause of neuronal cell death and nutritional supplementation with Coenzyme Q10 (CoQ10) has previously been shown to have neuro-protective actions against it. The objective of this study was to determine whether the protective effect of CoQ10 against glutamate could be attributed to stimulating mitochondrial biogenesis. Results: The mouse hippocampal neuronal HT22 cells were incubated with glutamate with or without ubisol Q10 treatment. Significant deterioration of cells after glutamate exposure was observed under a light microscope and cell viability assay, along with a significant drop in clonogenic ability. Glutamate significantly decreased the mitochondrial biogenesis related protein levels of Akt, CREB, PGC-1α, and NRF2, and reduced mitochondrial biogenesis assessed by a mitochondrial biogenesis kit. Pretreatment with CoQ10 prevented the decreases of Akt, CREB, PGC-1α, and NRF2 and increased mitochondrial biogenesis. Conclusions: Taken together, these results describe a new mechanism of CoQ10-conveyed neuro-protection and indicate a central role for mitochondrial biogenesis in protecting against glutamate-induced excitotoxicity.
Reducing neuronal apoptosis in pontine micturition center by nerve root transfer to reconstruct bladder function after spinal cord injury
Authors: Yu Ronghua , Yin Gang , Zhao Jianguo , Chen Huihao , Meng Depeng , Zhang Jiaqiang , Lin Yaofa , Xie Zheng , Hou Chunlin , Lin Haodong
Published: November 2019

Background: The neuronal apoptosis is increased after spinal cord injury (SCI), but anastomosing the normal nerve roots above SCI level to the injury sacral nerve roots can enhance functional recovery of neurons. Therefore, we evaluated the effect of sacral nerve root transfer after SCI on pontine neuronal survival and restoration of bladder function. Methods: Adult female Sprague Dawley rats (N = 90, 9–10 weeks old, 240-260 grams weight) were randomly divided into three groups (N = 30). We anastomosed the dorsal and ventral roots of proximal L4 and distal S2 to reconstruct the rat bladder–spinal cord–cerebral nerve afferent and efferent pathways in Sprague Dawley rats after spinal cord transection. We examined pontine neuronal morphology and apoptosis using hematoxylin and eosin (H&E) staining and transmission electron microscopy (TEM) at different time points (1 day, 1 week, and 1, 3, or 6 months) after SCI and nerve transfer. Bcl-2 and Bax protein expression changes in the pontine micturition center were quantified by immunohistochemistry. Results: After nerve roots reconstruction, Group A compared with Group B, Bcl-2 expression increased significantly, Bax expression decreased significantly, Bcl-2/Bax ratio increased, the number of apoptotic neurons decreased, and the number of apoptotic bodies within neurons decreased significantly as observed by TEM.Conclusion: These findings demonstrate that lumbosacral nerve transfer can reduce neuronal apoptosis in the pontine micturition center and enhance functional recovery of neurons. This method can be used as a new approach for reconstructing bladder function after spinal cord injury.
Comparative transcriptome analysis of roots at different development stages reveals the mechanism of root expansion of Callerya speciosa Champ.
Authors: Yao Shaochang , Lan Zuzai , Huang Rongshao , Tan Yong , Gu Jinyuan , Pan Chunliu
Published: November 2019

Background Callerya speciosa Champ., a perennial shrub medicinal plant of Fabaceae, is one of the most commonly used in traditional Chinese medicine and food that has been widely cultivated in South China. The tuberous roots of C. speciosa transferred from fibrous roots but few fibrous roots can transfer into tuberous roots. To date, the underlying mechanisms for tuberous root formation and development of C. speciosa have not yet been elucidated.
Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: A systematic review and meta-analysis of randomized controlled trials
Authors: Liu Xiancun , Song Tingting , Chen Xuejiao , Zhang Jingjing , Shan Conghui , Chang Liangying , Xu Haiyang
Published: November 2019

Background Abdominal surgery is common and associated with severe postoperative pain. Transverse abdominal plane (TAP) block is considered an effective means for pain control in such cases. Quadratus lumborum (QL) block is another option for the management of postoperative pain. The aim of this study was to conduct a meta-analysis and thereby evaluate the efficacy and safety of QL block and TAP block for pain management after abdominal surgery. Methods We comprehensively searched PubMed, Embase, EBSCO, the Cochrane Library, Web of Science and CNKI for randomized controlled trials (RCTs) that compared QL block and TAP block for pain management in patients undergoing abdominal surgery. All of the data were screened and evaluated by two researchers. RevMan5.3 was applied to perform the meta-analysis. Results A total of 8 RCTs involving564 patients were included. The meta-analysis showed statistically significant differences between the two groups with respect to postoperative pain scores at 2 hours (standardized mean difference [Std.MD]=-1.76; 95% confidence interval [CI]=-2.63 to -0.89; p<.001), 4 hours (Std.MD=-0.77; 95% CI=-1.36 to -0.18; p=.01),6 hours (Std.MD=-1.24; 95% CI=-2.31 to -0.17; p=.02),12 hours (Std.MD=-0.70; 95% CI=-1.27 to -0.13; p=.02) and 24hours (Std.MD=-0.65; 95% CI=-1.29 to -0.02; p=.04) ; postoperative opioid consumption at 24 h (Std.MD=-1.39; 95% CI=-1.83 to -0.95; p<.001); and duration of postoperative analgesia (Std.MD=2.30; 95% CI=1.85 to 2.75; p<.001). There was no statistically significant difference between the two groups regarding postoperative nausea and vomiting (PONV) incidence (RR=0.55; 95% CI=0.27 to 1.14; p=.11). Conclusion QL block provides better pain management with less opioid consumption than TAP block after abdominal surgery. In addition, there are no differences between TAP block and QL block with respect to PONV.