bluuebunny/crossref_metadata_2025 huggingface dataset:
Working conditions in primary care: a qualitative interview study with physicians in Sweden informed by the Effort-Reward-Imbalance model
Authors: Nilsen Per , Fernemark Hanna , Seing Ida , Schildmeijer Kristina , Ericsson Carin , Skagerström Janna
Published: July 2021

Background

Many problems with primary care physicians’ psychosocial working conditions have been documented. Many studies on working condition have used the Effort-Reward-Imbalance (ERI) model, which posits that poor health and well-being may result from imbalances between the level of effort employees perceive that they put into their work and the rewards they receive. The model has not been used in qualitative research or applied to investigate primary care physicians’ working conditions. The aim of this study was to apply the ERI model to explore the perceived efforts and rewards by primary care physicians in Sweden and approaches they take to cope with potential imbalances between these efforts and rewards.

Methods

The study has a qualitative design, using semi-structured interviews. A purposeful sampling strategy was used to achieve a heterogeneous sample of primary care physicians who represented a broad spectrum of experiences and perceptions. We recruited 21 physicians; 15 were employed in public health care and 6 by private health care companies.

Results

The analysis of the interviews yielded 11 sub-categories: 6 were mapped to the efforts category, 3 were attributed to the rewards category and 2 were approaches to coping with effort/reward imbalances. Many of the statements concerned efforts in the form of high workload, restricted autonomy and administrative work burden. They also perceived resource restrictions, unpredictability of work and high expectations in their role as physicians as efforts. Three types of rewards emerged; the physicians found their job to be stimulating and meaningful, and the work climate to be supportive. The physicians coped with imbalances by means of job enrichment and using decisional latitude.

Conclusions

Primary care physicians perceive numerous types of efforts in their job, which is consistent with research concerning work stress and associated consequences, such as poor subjective health and well-being. There are also rewards according to primary care physicians, but the findings suggest a lack of reciprocity in terms of efforts and rewards although firm conclusions cannot be drawn since the study did not investigate the magnitude of the various efforts and rewards or the effectiveness of the approaches the physicians use to cope with imbalances. The ERI model was found to be useful to explore physicians’ primary care work and working conditions but its applicability likely depends on the type of work or professions being studied.
Sex disparities in the prevalence of physical function disabilities: a population-based study in a low-income community
Authors: Orellano-Colón Elsa M. , Suárez-Pérez Erick L. , Rivero-Méndez Marta , Boneu-Meléndez Claudia X. , Varas-Díaz Nelson , Lizama-Troncoso Mauricio , Jiménez-Velázquez Ivonne Z. , León-Astor Arelí , Jutai Jeffrey W.
Published: July 2021

Background

Functional disability continues to be a significant public health problem that increases older adults’ vulnerability to experience a diminished quality of life, loss of independence, higher healthcare costs and health services utilization, and increased risks of mortality. Thus, we aimed to study the prevalence of functional disabilities by sex according to the types of daily living activities, controlling for specific sociodemographic variables among older Hispanics from low-income communities.

Methods

We used a cross-sectional epidemiological research design, considering a complex sampling design of households to interview adults ≥65 years living in low-income communities in Puerto Rico. Functional disability was measured by the PROMIS® Physical Function Short Form-20 T-score. The selected community was reported to have 5980 adult residents ≥65 years, according to the USA Census. The prevalence of functional disability was estimated using the logistic regression model, weighting by the effect of the sampling. Our estimated prevalence was compared between sexes using the prevalence ratio (PR), which was estimated with logistic regression models, controlling for age, income, number of chronic conditions, high and low impact of chronic conditions in functional disabilities, marital status, and sampling design.

Results

We recruited 211 older Hispanics from a randomly selected sample. Their mean age was 74.4 ± 7.1 years, with female predominance (57.3%). The overall estimated prevalence of physical function disability using T-score among females was 2.70 (95% CI: 1.4, 5.1) times the estimated prevalence of physical function disability among males. Women were more likely to report functional disabilities in instrumental activities of daily living, self-care activities, and functional mobility compared to males. However, sex differences were largely explained by the presence of musculoskeletal conditions of high impact in functional disability.

Conclusions

The females in our study bear the greater burden of physical function disability in their adult age. Health policies, as well as future studies, should be targeted at reducing the burden of physical function disabilities in different types of daily activities through gender-sensitive disability self-management programs.
Mortality of a postpartum woman presented with massive vulvar edema in association with Covid-19: a case report with clinical and radiological findings
Authors: Alirezaei Somayeh , Vatanchi Atiye , Pourali Leila , Aminzadeh Behzad , Latifnejad Roudsari Robab
Published: July 2021

Background

In this case report, we presented a rare case of maternal death with massive vulvar edema and Covid-19 diagnosis.

Case presentation

The case was a 20-year-old woman who was referred to with pain and massive vulvar edema by passing 7 days from her labor. The laboratory tests showed leukocytosis, lymphopenia, and elevated C-reactive protein levels. The high-resolution computed tomography was in favor of Covid-19 changes. Finally, she died because of respiratory distress, ON the 8th day postpartum.

Conclusion

Given the increasing prevalence of Covid-19, it is important and vital to be aware of its potential complications and then to try prevent and manage them, especially during high-risk periods such as pregnancy and postpartum.
Campylobacter fetus bacteremia and meningitis in an acute lymphoblastic leukemia patient undergoing maintenance therapy: a case report
Authors: Nakatani Ryo , Shimizu Koki , Matsuo Takahiro , Koyamada Ryosuke , Mori Nobuyoshi , Yamashita Takuya , Mori Shinichiro
Published: July 2021

Background

Campylobacter fetusis an uncommonCampylobacterspecies,and its infections mainly cause infective endocarditis, aortic aneurysm, and meningitis rather than enteritis. It is more likely to be detected in blood thanCampylobacter jejuniorCampylobacter coli, specifically reported in 53% of patients. In our case,C. fetuswas detected in both blood and cerebrospinal fluid (CSF) cultures.

Case presentation

A 33-year-old woman, who was on maintenance chemotherapy for acute lymphoblastic leukemia (ALL), presented to our clinic with chief complaints of severe headache and nausea. Blood and CSF cultures revealedC. fetus. We administrated meropenem 2 g intravenously (IV) every 8 h for 3 weeks, and she was discharged without neurological sequelae.

Conclusion

We encountered a case ofC. fetusmeningitis without gastrointestinal symptoms, neck stiffness or jolt accentuation in a patient with ALL. Undercooked beef was considered the source ofC. fetusinfection in this case, suggesting that the need for a neutropenic diet and safe food handling be considered.
Prospective correlation between the patient microbiome with response to and development of immune-mediated adverse effects to immunotherapy in lung cancer
Authors: Chau Justin , Yadav Meeta , Liu Ben , Furqan Muhammad , Dai Qun , Shahi Shailesh , Gupta Arnav , Mercer Keri Nace , Eastman Evan , Hejleh Taher Abu , Chan Carlos , Weiner George J. , Cherwin Catherine , Lee Sonny T. M. , Zhong Cuncong , Mangalam Ashutosh , Zhang Jun
Published: July 2021

Background

Though the gut microbiome has been associated with efficacy of immunotherapy (ICI) in certain cancers, similar findings have not been identified for microbiomes from other body sites and their correlation to treatment response and immune related adverse events (irAEs) in lung cancer (LC) patients receiving ICIs.

Methods

We designed a prospective cohort study conducted from 2018 to 2020 at a single-center academic institution to assess for correlations between the microbiome in various body sites with treatment response and development of irAEs in LC patients treated with ICIs. Patients must have had measurable disease, ECOG 0–2, and good organ function to be included. Data was collected for analysis from January 2019 to October 2020. Patients with histopathologically confirmed, advanced/metastatic LC planned to undergo immunotherapy-based treatment were enrolled between September 2018 and June 2019. Nasal, buccal and gut microbiome samples were obtained prior to initiation of immunotherapy +/− chemotherapy, at development of adverse events (irAEs), and at improvement of irAEs to grade 1 or less.

Results

Thirty-seven patients were enrolled, and 34 patients were evaluable for this report. 32 healthy controls (HC) from the same geographic region were included to compare baseline gut microbiota. Compared to HC, LC gut microbiota exhibited significantly lower α-diversity. The gut microbiome of patients who did not suffer irAEs were found to have relative enrichment of Bifidobacterium (p = 0.001) and Desulfovibrio (p = 0.0002). Responders to combined chemoimmunotherapy exhibited increased Clostridiales (p = 0.018) but reduced Rikenellaceae (p = 0.016). In responders to chemoimmunotherapy we also observed enrichment of Finegoldia in nasal microbiome, and increased Megasphaera but reduced Actinobacillus in buccal samples. Longitudinal samples exhibited a trend of α-diversity and certain microbial changes during the development and resolution of irAEs.

Conclusions

This pilot study identifies significant differences in the gut microbiome between HC and LC patients, and their correlation to treatment response and irAEs in LC. In addition, it suggests potential predictive utility in nasal and buccal microbiomes, warranting further validation with a larger cohort and mechanistic dissection using preclinical models.

Trial registration

ClinicalTrials.gov, NCT03688347. Retrospectively registered 09/28/2018.
Effects of Tamoxifen vs. Toremifene on fatty liver development and lipid profiles in breast Cancer
Authors: Song Dandan , Hu Yingying , Diao Biyu , Miao Rongrong , Zhang Baodan , Cai Yangjun , Zeng Hanqian , Zhang Yuru , Hu Xiaoqu
Published: July 2021

Background

Tamoxifen (TAM) and Toremifene (TOR), two kinds of selective estrogen receptor modulators (SERMs), have equal efficacy in breast cancer patients. However, TAM has been proved to affect serum lipid profiles and cause fatty liver disease. The study aimed to compare the effects of TAM and TOR on fatty liver development and lipid profiles.

Methods

This study performed a retrospective analysis of 308 SERMs-treated early breast cancer patients who were matched 1:1 based on propensity scores. The follow-up period was 3 years. The primary outcomes were fatty liver detected by ultrasonography or computed tomography (CT), variation in fibrosis indexes, and serum lipid profiles change.

Results

The cumulative incidence rate of new-onset fatty liver was higher in the TAM group than in the TOR group (113.2 vs. 67.2 per 1000 person-years, p < 0.001), and more severe fatty livers occurred in the TAM group (25.5 vs. 7.5 per 1000 person-years, p = 0.003). According to the Kaplan-Meier curves, TAM significantly increased the risk of new-onset fatty liver (25.97% vs. 17.53%, p = 0.0243) and the severe fatty liver (5.84% vs. 1.95%, p = 0.0429). TOR decreased the risk of new-onset fatty liver by 45% (hazard ratio = 0.55, p = 0.020) and showed lower fibrotic burden, independent of obesity, lipid, and liver enzyme levels. TOR increased triglycerides less than TAM, and TOR increased high-density lipoprotein cholesterol, while TAM did the opposite. No significant differences in total cholesterol and low-density lipoprotein cholesterol are observed between the two groups.

Conclusions

TAM treatment is significantly associated with more severe fatty liver disease and liver fibrosis, while TOR is associated with an overall improvement in lipid profiles, which supports continuous monitoring of liver imaging and serum lipid levels during SERM treatment.
Proning related bilateral anterior ischaemic optic neuropathy in a patient with COVID-19 related acute respiratory distress syndrome
Authors: Clarke Kirsty Michelle , Riga Vivi , Shirodkar Amy-lee , Meyer Joel
Published: July 2021

Background

Non-arteritic ischaemic optic neuropathy (NAION) is a rare but harmful complication of prone positioning. Prone mechanical ventilation is a therapeutic strategy which has been used extensively during the COVID-19 pandemic to treat acutely hypoxemic patients with COVID-19 related acute respiratory distress syndrome (ARDS). Though a small number of cases of unilateral NAION have been reported in patients testing positive for the SARS-CoV-2 virus, we describe what is to our knowledge, the first reported case of bilateral NAION occurring in a patient proned extensively for the treatment of COVID-19 related ARDS. We consider the potential aetiological factors leading to NAION after prone mechanical ventilation in patients with COVID-19 and suggest strategies to protect against its development.

Case presentation

: We report a case of severe, irreversible, visual impairment secondary to bilateral anterior ION in a fifty-five-year-old male who underwent eight episodes of prone mechanical ventilation to treat COVID-19 related ARDS. Once weaned from his sedation he reported bilateral painless vision loss, and bedside ophthalmological assessment identified a reduced visual acuity of 3/30 unaided in the left eye and counting fingers in the right. Dilated indirect ophthalmoscopy revealed inferotemporal optic disc oedema with splinter haemorrhages in the right eye and mild disc oedema, temporal pallor, and nerve fibre layer haemorrhages inferiorly in the left eye. Humphrey visual field 24 − 2 testing confirmed a severely constricted visual field with macular sparing on the right and depressed inferonasal vision with preserved peripheral vision on the left eye. OCT disc imaging shortly after diagnosis revealed bilateral disc swelling and flame haemorrhages in the right eye.

Conclusions

NAION is a devastating, but preventable complication of prone positioning, which may pose significant risk of vision loss in patients with COVID-19 related ARDS.
Self-reported psychological problems and coping strategies: a web-based study in Peruvian population during COVID-19 pandemic
Authors: Ames-Guerrero Rita J. , Barreda-Parra Victoria A. , Huamani-Cahua Julio C. , Banaszak-Holl Jane
Published: July 2021

Background

The Coronavirus pandemic has disrupted health systems across the world and led to major shifts in individual behavior by forcing people into isolation in home settings. Its rapid spread has overwhelmed populations in all corners of Latin-American countries resulting in individual psychological reactions that may aggravate the health crisis. This study reports on demographics, self-reported psychological disturbances and associated coping styles during the COVID-19 pandemic for the Peruvian population.

Methods

This cross-sectional study uses an online survey with snowball sampling that was conducted after the state of emergency was declared in Perú (on April 2nd). The General Health Questionnaire (GHQ-28) was used to identify somatic symptoms, incidence of anxiety/ insomnia, social dysfunction and depression and the Coping Strategy Questionnaire (COPE-28) mapped personal strategies to address recent stress.

Results

434 self-selected participants ranging in age from 18 to 68 years old (Mean age = 33.87) completed the survey. The majority of participants were women (61.30%), aged between 18 and 28 (41.70%), well-educated (> = 85.00%), Peruvian (94.20%), employed (57.40%) and single (71.20%). 40.8% reported psychological distress, expressing fear of coronavirus infection (71.43%). Regression analysis shows that men had lower somatic-related symptom (β = − 1.87, 95%, CI: − 2.75 to −.99) and anxiety/insomnia symptom (β = − 1.91, 95% CI: − 2.98 to 0.84) compared to women. The risk for depression and social dysfunction are less likely with increasing age. Educational status was protective against developing psychological conditions (p < 0.05). While active responses (acceptance and social support) are scarcely used by individuals with psychological distress; passive strategies (such as denial, self-distraction, self-blame, disconnection, and venting) are more commonly reported.

Conclusion

This study provides a better understanding of the psychological health impact occurring during the COVID-19 pandemic on the Peruvian population. About half of the respondents reported psychological distress and poor coping responses. This evidence informs the need for broader promotional health policies focused on strengthening individual’s active strategies aiming at improving emotional health and preventing psychiatric conditions, during and after the COVID-19 pandemic.
Temporal relationships between happiness and psychiatric disorders and their symptom severity in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA)
Authors: Spinhoven Philip , Elzinga Bernet M. , Penninx Brenda W. J. H. , Giltay Erik J.
Published: July 2021

Background

Notwithstanding the firmly established cross-sectional association of happiness with psychiatric disorders and their symptom severity, little is known about their temporal relationships. The goal of the present study was to investigate whether happiness is predictive of subsequent psychiatric disorders and symptom severity (and vice versa). Moreover, it was examined whether changes in happiness co-occur with changes in psychiatric disorder status and symptom severity.

Methods

In the Netherlands Study of Depression and Anxiety (NESDA), happiness (SRH: Self-Rated Happiness scale), depressive and social anxiety disorder (CIDI: Composite Interview Diagnostic Instrument) and depressive and anxiety symptom severity (IDS: Inventory of Depressive Symptomatology; BAI: Beck Anxiety Inventory; and FQ: Fear Questionnaire) were measured in 1816 adults over a three-year period. Moreover, we focused on occurrence and remittance of 6-month recency Major Depressive Disorder (MDD) and Social Anxiety Disorders (SAD) as the two disorders most intertwined with subjective happiness.

Results

Interindividual differences in happiness were quite stable (ICC of .64). Higher levels of happiness predicted recovery from depression (OR = 1.41; 95% CI = 1.10–1.80), but not social anxiety disorder (OR = 1.31; 95%CI = .94–1.81), as well as non-occurrence of depression (OR = 2.41; 95%CI = 1.98–2.94) and SAD (OR = 2.93; 95%CI = 2.29–3.77) in participants without MDD, respectively SAD at baseline. Higher levels of happiness also predicted a reduction of IDS depression (sr = − 0.08; 95%CI = -0.10 - -0.04), and BAI (sr = − 0.09; 95%CI = -0.12 - -0.05) and FQ (sr = − 0.06; 95%CI = -0.09 - -0.04) anxiety symptom scores. Conversely, presence of affective disorders, as well as higher depression and anxiety symptom severity at baseline predicted a subsequent reduction of self-reported happiness (with marginal to small sr values varying between −.04 (presence of SAD) to −.17 (depression severity on the IDS)). Moreover, changes in happiness were associated with changes in psychiatric disorders and their symptom severity, in particular with depression severity on the IDS (sr = − 0.46; 95%CI = −.50 - -.42).

Conclusions

Results support the view of rather stable interindividual differences in subjective happiness, although level of happiness is inversely associated with changes in psychiatric disorders and their symptom severity, in particular depressive disorder and depression severity.
Comparative analyses on epidemiological characteristics of dengue fever in Guangdong and Yunnan, China, 2004–2018
Authors: Yue Yujuan , Liu Qiyong , Liu Xiaobo , Wu Haixia , Xu Mingfang
Published: July 2021

Background

In China, Guangdong and Yunnan are the two most dengue-affected provinces. This study aimed to compare the epidemiological characteristics of dengue fever in Guangdong and Yunnan during 2004–2018.

Methods

Descriptive analyses were used to explore the temporal, spatial, and demographic distribution of dengue fever.

Results

Of the 73,761 dengue cases reported in mainland China during 2004–2018, 93.7% indigenous and 65.9% imported cases occurred in Guangdong and Yunnan, respectively. A total of 55,970 and 5938 indigenous cases occurred in 108 Guangdong and 8 Yunnan counties, respectively during 2004–2018. Whereas 1146 and 3050 imported cases occurred in 84 Guangdong and 72 Yunnan counties, respectively during 2004–2018. Guangdong had a much higher average yearly indigenous incidence rate (3.65 (1/100000) vs 0.86 (1/100000)), but a much lower average yearly imported incidence rate (0.07 (1/100000) vs 0.44(1/100000)) compared with Yunnan in 2004–2018. Furthermore, dengue fever occurred more widely in space and more frequently in time in Guangdong. Guangdong and Yunnan had similar seasonal characteristics for dengue fever, but Guangdong had a longer peak period. Most dengue cases were clustered in the south-western border of Yunnan and the Pearl River Delta region in Guangdong. Most of the imported cases (93.9%) in Guangdong and Yunnan were from 9 Southeast Asian countries. Thailand, Cambodia, and Malaysia imported mainly into Guangdong while Myanmar and Laos imported into Yunnan. There was a strong male predominance among imported cases and an almost equal gender distribution among indigenous cases. Most dengue cases occurred in individuals aged 21–50 years, accounting for 57.3% (Guangdong) vs. 62.8% (Yunnan) of indigenous and 83.2% (Guangdong) vs. 62.6% (Yunnan) of imported cases. The associated major occupations (house worker or unemployed, retiree, and businessman, for indigenous cases; and businessman, for imported cases), were similar. However, farmers accounted for a larger proportion of dengue cases in Yunnan.

Conclusions

Identifying the different epidemiological characteristics of dengue fever in Guangdong and Yunnan can be helpful to formulate targeted, strategic plans, and implement effective public health prevention measures in China.
Hospitalization of unintentional fall injuries in Kuwait: a national database study
Authors: Ibrahim Islam Kamal , AlAsoomi Fatima
Published: July 2021

Background

Accidental falls are a major cause of morbidity placing pressure on hospital capacity and utilizing costly services. Evaluating the burden of falls is key for planning, implementation, and evaluation of prevention strategies. To date, no studies have been published on accidental falls at the population level in Kuwait. We studied the burden of accidental falls on public hospital inpatient capacity in Kuwait and identified the subgroups with the highest utilization of inpatient service days.

Methods

From the national database of inpatient hospitalizations, we selected hospitalizations of patients admitted to Kuwait’s public hospitals for unintentional injury caused by an accidental fall from 1 January through 31 December 2016. We studied the number of inpatient service days (bed days), length of stay (LOS), and number of hospitalizations by age group, gender, and nationality. Mann–Whitney, Kruskal-Wallis, and Chi square tests were used for comparison. Logistic regression was used to quantify the risk of prolonged LOS and fractures among fall-related hospitalizations.

Results

Accidental falls were responsible for 2.9% of inpatient hospitalizations, 3.7% of inpatient service days (61,140 days) with an ALOS of 9.1 days in Kuwait’s public hospitals in 2016. Accidental falls were responsible for 4.6% of older adult service days, and an even higher 5.6% of older women service days. In the age group 13–64, fall-related service days for non-Kuwaitis (5.7%) were more than triple those for Kuwaitis (1.8%) with a substantial percentage among male non-Kuwaitis (8.1%). The risk factors for exceeding the national ALOS for fall-related hospitalizations were female gender (OR 1.36), age 65 and older (OR 9.72), age 13–64 (OR 5.20), being non-Kuwaiti (OR 1.39), sustaining a femur fracture (OR 11.67), and undergoing surgery (OR 2.63). Fall-related hospitalizations associated with a higher risk of fractures were females (OR 1.22), patients 65 years and older (OR 5.09), patients aged 13–64 (OR 3.65), and non-Kuwaitis (OR 1.28).

Conclusions

Accidental falls impose a considerable burden on inpatient service utilization in Kuwait. This varies by age, gender, and nationality. To reduce this burden, prevention programs should target working-age non-Kuwaiti males and older females.
A qualitative assessment of the sexual-health education, training and service needs of young adults in Tehran
Authors: Sheikhansari Narges , Abraham Charles , Denford Sarah , Eftekhar Mehrdad
Published: July 2021

Background

Sexual Health and Relationships Education (SHRE) provides individuals with knowledge and skills to manage risky behaviors and take informed decisions to protect themselves against STIs, and unintended pregnancy. Only minimal SHRE is provided in Iranian schools and universities and previous research has highlighted needs and demands for improved SHRE and sexual services in Iran. This study explored young, Iranian adults’ experience of, and need for sexual health education, sexual skills training and sexual healthcare services, as well their views on how to augment and improve existing provision.

Design and methods

Semi-structured interviews were conducted with a sample of 25 young adults who lived in Tehran, Iran and had volunteered to participate in the study. Transcripts were analyzed using thematic analysis.

Results

Participants explained their needs and demands for sexual health education and sexual healthcare. They unanimously expressed their dissatisfaction with available SHRE and sexual health care provision. They highlighted barriers to gaining sexual health information and seeking advice and healthcare, including a lack of reliable resources, taboo and cultural barriers, lack of trust and protected confidentiality. This has resulted in ambiguities and misconceptions, including those regarding the cause and transmission of STIs and correct use of contraceptives. Participants recommended improvements, including holding mixed-gender extracurricular workshops with a comprehensive approach to sexual health and relationships education.

Conclusions

There is a clear need and demand for provision of relevant and reliable sexual health and relationships education for young adults in Tehran. This should be addressed to empower young people to make informed choices and avoid risky sexual behavior.
Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa
Authors: Shahmanesh Maryam , Okesola Nonhlanhla , Chimbindi Natsayi , Zuma Thembelihle , Mdluli Sakhile , Mthiyane Nondumiso , Adeagbo Oluwafemi , Dreyer Jaco , Herbst Carina , McGrath Nuala , Harling Guy , Sherr Lorraine , Seeley Janet
Published: July 2021

Background

Despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa – especially among adolescents and young people. We used community-based participatory research (CBPR), informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in KwaZulu-Natal (KZN).

Methods

Between March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapta biosocial peer-led intervention to support HIV prevention. Men and women aged 18–30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016–2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial (NCT04532307).

Results

Following written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create theThetha Nami(`talk to me’). The intervention includedpeer-led health promotionto improve self-efficacy and demand for HIV prevention,referrals to social and educational resources,andaaccessible youth-friendly clinical servicesto improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 were linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “onward referral”. In the third participatory workshop 54 peer-navigators refined theThetha Namiintervention to add three components:structured assessment toolto tailor health promotion and referrals,safe spaces and community advocacyto create an enabling environment, andpeer-mentorship and navigationof resources to improve retention in HIV prevention.

Conclusion

Local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.
Development of an online curriculum for California early care and education providers on healthy beverages
Authors: Hazard Kimberly , Lee Danielle , Ritchie Lorrene , Rose Roberta , Rios L. Karina Díaz , Plank Kaela , Alkon Abbey
Published: July 2021

Background

Children’s consumption of sugar-sweetened beverages is associated with obesity, diabetes, and dental decay. California’s Healthy Beverages in Child Care Act (AB 2084) requires all licensed child care centers and family child care homes to comply with healthy beverages standards, however many licensed providers in California are unaware of the law and few are fully compliant with the law’s requirements. The aim of the current project is to describe the development of a self-paced online training on best practices and implementation of AB 2084 in English and Spanish for family child care home and child care center providers; and to evaluate the feasibility, defined as being accessible, acceptable, and satisfactory to providers, of this new online course.

Methods

The project was broken into two main stages: (1) development of the online course; and (2) evaluation of the final online course. The first stage was completed in five phases: (1) identify relevant course content and develop narration script; (2) conduct in-person focus groups with child care providers to review and edit the content; (3) adapt course content and translate for Spanish-speaking providers; (4) build the online course and resources; and (5) pilot online course and evaluate accessibility. The second stage, evaluation of the acceptability and satisfaction of the final course was rated on a Likert scale from 1 to 4; the evaluation was completed as part of a larger randomized control trial with 43 child care providers. The course features four key requirements of AB 2084 as the main sections of the course (milk, sweetened beverages, juice, and water), plus background information about beverages and children’s health, special topics including caring for children with special needs, family engagement, written policies, and child engagement.

Results

The child care providers who completed the evaluation found the online training was easily understandable (median(Q1,Q3,IQR) = 4 (4,4,0)), included new information (3 (1, 3, 4)), provided useful resources (4(4,4,0)), and was rated with high overall satisfaction (3 (1, 3, 4)).

Conclusion

Online training in English and Spanish designed for child care providers is a feasible medium to deliver important health messages to child care providers in an accessible, acceptable, and satisfactory manner.
Do perceived social neighborhood factors explain the association between neighborhood age composition and mental health among Dutch older adults?
Authors: Verspoor Eline , Beenackers Mariëlle A. , Oude Groeniger Joost , van Lenthe Frank J.
Published: July 2021

Background

In the light of urbanization and aging, a crucially relevant policy question is how to shape neighborhoods to foster healthy aging. An important debate is whether older adults should group in neighborhoods, or whether a more mixed neighborhood age composition is more beneficial to health and well-being. We therefore assessed the association between neighborhood age structure and mental health and the mediating role of individual perceptions of neighborhood social factors.

Methods

We conducted multivariable linear regression models and causal mediation analyses in 1255 older adults of the Dutch Globe study. The neighborhood age structure was measured in 2011 as the homogeneity of the age composition (using the Herfindahl-Hirschman index, range from 0 to 100, a higher score indicating more homogeneity) and the percentage of specific age groups in a neighborhood. Mental health was measured in 2014 by the Mental Health Inventory-5 score (range 0 to 100, a higher score indicating better mental health). Potential mediators were assessed in 2011 and included perceptions of neighborhood social cohesion, feeling at home in a neighborhood, and social participation.

Results

A more homogeneous age composition (not specified for age) and a higher percentage of children living in a neighborhood were associated with better mental health, the other age categories were not. Social cohesion, feeling at home and social participation did not mediate the associations.

Conclusions

The neighborhood age composition may be an interesting but currently insufficiently understood entry point for policies to improve older adult’s mental health status.
Effect combined learning on oral health self-efficacy and self-care behaviors of students: a randomized controlled trial
Authors: Hashemi Zahra Sadat , Khorsandi Mahboobeh , Shamsi Mohsen , Moradzadeh Rahmatollah
Published: July 2021

Background

In order to prevent oral diseases, the use of appropriate oral health education at childhood is one of the most important strategies for improving oral health knowledge and by extension positive oral health habits. Therefore, the present study aimed to evaluate the effect of animations and games as a strategy for improving oral health self-efficacy and self-care behaviors among 6–12-aged students.

Methods

In this interventional study, 82 students were selected based on cluster random sampling including 38 for the case and 44 for the control group. The case group received four sessions of combined learning per week including animations and games while the control group received routine school education. The data were collected in six domains including demographics, self-care, knowledge, attitude, behavior and self-efficacy before and 5 months after the intervention using a questionnaire. SPSS version 20 was used for data analysis.

Results

Five months after the intervention, the mean score of self-care, self-efficacy, behavior increased from 3.8 to 4.8, 36.8 to 48.9, and 17.07 to 18.29, respectively indicating a significant change (p < 0.05). However, no significant change was reported in these variables in the control group (p  > 0.05).

Conclusion

The use of animation combined with other strategies for oral health self-care education can positively influence the students' performance and self-efficacy.

IRCT registration number This trial was registered at IRCT. IRCT2017042133565N1 Registration date: 2017–05-17 https://en.irct.ir/trial/25851
Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication
Authors: Chen Yi-Hsuan , Chen Marcelo , Chen Yu-Hsin
Published: July 2021

Background

Malignant obstruction and associated hydronephrosis is a common complication of advanced cervical cancer. Percutaneous nephrostomy (PCN) followed by antegrade stenting is often required to relieve obstruction as retrograde access fails in considerable proportion of such patients. Reno-pleural fistula is a rare complication of PCN which creates a patent connection between the renal collecting system and the thoracic cavity, and urine accumulation in the pleural space can cause pleural effusion (i.e., urinothorax). Upward or downward migration is a complication of indwelling ureteric stents. Further migration with extrusion outside of the urinary tract is uncommon. Herein we present an unprecedented case in adult of ureteric stent upward migration through a reno-pleural fistula into the thoracic cavity managed by thoracoscopy.

Case presentation

A 66-year-old female was diagnosed of advanced stage cervical cancer with suspicious bladder invasion. Given her bilateral hydronephrosis with impaired renal function, she underwent bilateral PCN and subsequent antegrade ureteric stenting. However, she presented with dyspnea, right back pain, and oliguria four days after bilateral PCN catheter removal. Computed tomography reported massive right pleural effusion and an intrathoracic ureteric stent within reno-pleural fistula. Thoracoscopy with thoracostomy was performed to remove the ureteric stent and urine in right pleural space. A week later, urinothorax had resolved and right PCN was performed again. She was discharged after regaining normal renal function with right PCN and a left ureteric stent in place.

Conclusions

A reno-pleural fistula can serve as a route for ureteric stent migration and that continuous drainage of urine can cause urinothorax once the stent reaches the thoracic cavity. Anytime a supracostal approach is used for PCN, even when using small caliber catheters, clinicians should pay special attention given the risk of pleural injury and subsequent complications.
Pushing poverty off limits: quality improvement and the architecture of healthcare values
Authors: Mitchell Polly , Cribb Alan , Entwistle Vikki , Singh Guddi
Published: July 2021

Background

Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI).

Discussion

Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health.

Conclusions

We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.
Non-medical risk factors associated with postponing elective surgery: a prospective observational study
Authors: Becker Julia , Huschak Gerald , Petzold Hannes-Caspar , Thieme Volker , Stehr Sebastian , Bercker Sven
Published: July 2021

Background

Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons.

Methods

In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–WhitneyUtest and Fisher's exact test/χ2-test.

Results

Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer.

Conclusions

Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery.

Trial registrationDRKS00015836. Retrospectively registered.
Comparison of alternative integration sites in the chromosome and the native plasmids of the cyanobacterium Synechocystis sp. PCC 6803 in respect to expression efficiency and copy number
Authors: Nagy Csaba , Thiel Kati , Mulaku Edita , Mustila Henna , Tamagnini Paula , Aro Eva-Mari , Pacheco Catarina C. , Kallio Pauli
Published: July 2021

Background

Synechocystis sp. PCC 6803 provides a well-established reference point to cyanobacterial metabolic engineering as part of basic photosynthesis research, as well as in the development of next-generation biotechnological production systems. This study focused on expanding the current knowledge on genomic integration of expression constructs in Synechocystis, targeting a range of novel sites in the chromosome and in the native plasmids, together with established loci used in literature. The key objective was to obtain quantitative information on site-specific expression in reference to replicon copy numbers, which has been speculated but never compared side by side in this host.

Results

An optimized sYFP2 expression cassette was successfully integrated in two novel sites in Synechocystis chromosome (slr0944; sll0058) and in all four endogenous megaplasmids (pSYSM/slr5037-slr5038; pSYSX/slr6037; pSYSA/slr7023; pSYSG/slr8030) that have not been previously evaluated for the purpose. Fluorescent analysis of the segregated strains revealed that the expression levels between the megaplasmids and chromosomal constructs were very similar, and reinforced the view that highest expression in Synechocystis can be obtained using RSF1010-derived replicative vectors or the native small plasmid pCA2.4 evaluated in comparison. Parallel replicon copy number analysis by RT-qPCR showed that the expression from the alternative loci is largely determined by the gene dosage in Synechocystis, thereby confirming the dependence formerly proposed based on literature.

Conclusions

This study brings together nine different integrative loci in the genome of Synechocystis to demonstrate quantitative differences between target sites in the chromosome, the native plasmids, and a RSF1010-based replicative expression vector. To date, this is the most comprehensive comparison of alternative integrative sites in Synechocystis, and provides the first direct reference between expression efficiency and replicon gene dosage in the context. In the light of existing literature, the findings support the view that the small native plasmids can be notably more difficult to target than the chromosome or the megaplasmids, and that the RSF1010-derived vectors may be surprisingly well maintained under non-selective culture conditions in this cyanobacterial host. Altogether, the work broadens our views on genomic integration and the rational use of different integrative loci versus replicative plasmids, when aiming at expressing heterologous genes in Synechocystis.