bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the kinetics and magnitude of antibody responses to different SARS-CoV-2 proteins in Sinopharm/BBIBP-CorV vaccinees following the BNT162b2 booster or natural infection
Authors: Jeewandara Chandima , Aberathna Inoka Sepali , Dayarathna Shashika , Nimasha Thashmi , Ranasinghe Thushali , Jayamali Jeewantha , Kamaladasa Achala , Karunanada Maneshka , Perera Lahiru , Ogg Graham S. , Malavige Gathsaurie Neelika
Published: October 2022

The kinetics and magnitude of antibody responses to different proteins of the SARS-CoV-2 virus in Sinopharm/BBIBP-CorV vaccinees has not been previously studied. Therefore, we investigated antibody responses to different SARS-CoV-2 proteins at 2 weeks, 3 months, and 6 months post-second dose in previously infected (n = 20) and uninfected (n = 20) Sinopharm/BBIBP-CorV vaccinees. The IgG antibodies to the S, S1 and S2 and N were several folds higher in those who had natural infection compared to uninfected individuals at all time points. We then compared the persistence of antibody responses and effect of natural omicron infection or BNT162b2 booster in Sinopharm/BBIBP-CorV vaccinees. We measured the total antibodies to the RBD, ACE2 blocking antibodies and antibody responses to different SARS-CoV-2 proteins in Sinopharm vaccinees at 7 months post second dose, including those who remained uninfected and not boosted (n = 21), or those who had previous infection and who did not obtain the booster (n = 17), those who were not infected, but who received a BNT162b2 booster (n = 30), or those who did not receive the booster but were infected with omicron (n = 29). At 7 months post second dose uninfected (no booster) had the lowest antibody levels to the RBD, while omicron infected vaccinees showed significantly higher anti-RBD antibody levels (p = 0.04) than vaccinees who received the booster. Only 3/21 cohort A (14.3%) had ACE2 blocking antibodies, while higher frequencies were observed in naturally infected individuals (100%), those who received the booster (18/21, 85.7%), and omicron infected individuals (100%). Pre-vaccination, naturally infected had the highest antibody levels to the N protein. These data suggest that those previously infected Sinopharm/BBIBP-CorV vaccinees have a robust antibody response, 7 months post vaccination, while vaccinees who were naturally infected with omicron had a similar immune response to those who received the booster. It will be important to investigate implications for subsequent clinical protection.
Racial and ethnic differences in cervical cancer screening barriers and intentions: The My Body My Test-3 HPV self-collection trial among under-screened, low-income women
Authors: Zeno Erica E. , Brewer Noel T. , Spees Lisa P. , Des Marais Andrea C. , Sanusi Busola O. , Hudgens Michael G. , Jackson Sarah , Barclay Lynn , Wheeler Stephanie B. , Smith Jennifer S.
Published: October 2022

Under-screened women are more likely to be diagnosed with invasive cervical cancer at later stages and have worse survival outcomes. Under- or un-insured women, low-income women, and minoritized groups face barriers to screening. Intention to screen is an indicator of future screening behavior, yet is understudied among low-income, under-screened women. Participants were 710 low-income, uninsured or publicly insured women ages 25–64 years in North Carolina who were not up to date on cervical cancer screening according to national guidelines. Participants were asked about barriers to screening and intention to screen. We estimated reported barriers to cervical cancer screening stratified by race and ethnicity (categorized as White, Black, and Hispanic) and assessed predictors of intention to screen. Sixty-one percent of all participants reported 5 or more barriers to screening. The most commonly reported reasons for not getting screened were lack of insurance (White: 71%, Black: 62%, Hispanic/Latina: 63%) and cost (White: 55%, Black: 44%, Hispanic/Latina: 61%). Women were more likely to have an intention to screen if they reported “it was not hard to get screening” (OR: 1.47 (1.00, 2.15)). Older women reported being less likely to intend to screen. Black women reported being more likely to intend to screen than White women. Lack of health insurance and cost were frequently reported barriers to cervical cancer screening. Increasing knowledge of affordable clinics and expanding access to Medicaid may reduce barriers and increase cervical cancer screening uptake.
Social connectedness as a determinant of mental health: A scoping review
Authors: Wickramaratne Priya J. , Yangchen Tenzin , Lepow Lauren , Patra Braja G. , Glicksburg Benjamin , Talati Ardesheer , Adekkanattu Prakash , Ryu Euijung , Biernacka Joanna M. , Charney Alexander , Mann J. John , Pathak Jyotishman , Olfson Mark , Weissman Myrna M.
Published: October 2022

Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.
Cardiovascular and renal protective effects of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation
Authors: Choi Seong Huan , Kim Mina , Kim Hoseob , Kim Dae-Hyeok , Baek Yong-Soo
Published: October 2022

Aim

Data on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in relation to the risk of cardiovascular (CV) disease and renal protection among patients with atrial fibrillation (AF), are relatively sparse. We aimed to compare the effectiveness and safety of NOACs with those of warfarin for vascular protection in a large-scale, nationwide Asian population with AF.

Methods and results

Patients with AF who were prescribed oral anticoagulants according to the Korean Health Insurance Review and Assessment database between 2014 and 2017 were analyzed. The warfarin and NOAC groups were balanced using propensity score weighting. Clinical outcomes included ischemic stroke, myocardial infarction, angina pectoris, peripheral artery disease, chronic kidney disease (CKD), end-stage renal disease (ESRD), CV death, and all-cause death. NOAC use was associated with a lower risk of angina pectoris (HR, 0.79 [95% CI, 0.69–0.89] p<0.001), CKD stage 4 (HR, 0.5 [95% CI, 0.28–0.89], p = 0.02), and ESRD (HR, 0.15[95% CI, 0.08–0.32], p<0.001) than warfarin use. NOACs and warfarin did not significantly differ with respect to stroke reduction (HR, 1.05 [95% CI, 0.88–1.25], p = 0.19). NOAC use was associated with a lower risk of intracranial hemorrhage (HR, 0.6 [95% CI, 0.44–0.83], p = 0.0019), CV death (HR, 0.55 [95% CI, 0.43–0.70], p<0.001), and all-cause death (HR, 0.6 [95% CI, 0.52–0.69], p<0.001) than warfarin use.

Conclusion

NOACs were associated with a significantly lower risk of adverse CV and renovascular outcomes than warfarin in patients with AF.
Incidence, survival time and associated factors of virological failure among adult HIV/AIDS patients on first line antiretroviral therapy in St. Paul’s Hospital Millennium Medical College—A retrospective cohort study
Authors: Andarge Demeke Eshetu , Hailu Haimanot Ewnetu , Menna Takele
Published: October 2022

Introduction

Human Immune deficiency Virus or Acquired Immune deficiency Syndrome (HIV/AIDS) is a pandemic affecting millions around the world. The 2020 the Joint United Nations Programme on HIV/AIDS report stated that the estimated number of people living with HIV (PLHIV) is 38 million globally by 2019. Ethiopia is among HIV high burden countries in Africa. By 2021, PLHIV in Ethiopia is estimated to be 754, 256. Globally out of 25.4 million PLHIV on ART, 41% reported virally non-suppressed. According to UNAIDS, the estimated viral non-suppression in Ethiopia is about 27%.

Methodology

A hospital based retrospective cohort study was conducted among 323 patients who were enrolled to ART from July 2016 to December 2020. The medical records of study participants were selected using simple random sampling technique & data was collected using data extraction checklist. The collected data was entered and cleaned using SPSS V.25. Kaplan–Meier is used to estimate the cumulative hazard of virological failure at different time points. During bivariate analysis variables with p<0.25 were taken for Multivariate Cox regression analysis to assess predictors of virological failure & statistically significant association was declared at p<0.05 with 95% confidence interval.

Result

The overall incidence rate of virological failure was 1.75 per 1000 months of observations. The mean survival time of virological failure was 14.80 months. Disclosure of sero-status (AHR = 0.038, 95% CI: 0.008–018), poor adherence (AHR = 4.24, 95% CI: 1.04–16), having OIs (Opportunistic infections) (AHR = 4.59, 95% CI: 1.17–18) and use of cotrimoxazole (CPT) prophylaxis (AHR = 0.13, 95% CI: 0.026–0.68) have shown statistically significant association with virological failure.

Conclusion

The incidence of virological failure among patients on first line ART in St. Paul’s hospital is low. Disclosure of sero-status, poor adherence, having OIs and use of CPT prophylaxis were associated with virological failure. Therefore, a due attention needs to be given to these factors in order to minimize virological failure in patients on ART.
Impacts of COVID-19 pandemic on professional identity development of intern nursing students in China: A scoping review
Authors: Luo Wen-ting , Mao Aimei
Published: October 2022

Purpose

Clinical experience plays a vital role in the development of the professional identity (PI) of nursing students. China has applied a strict zero- COVID health policy in combating the COVID-19 pandemic since December 2019 and studies have been conducted in different places of China to explore PI development of nursing students during the pandemic time among the intern nursing students who are on clinical practices. This review study aims to synthesize the previous studies and provide a comprehensive picture of the impacts of the pandemic on the PI development of intern nursing students.

Methods

Arksey and O’Malley’s five-stage scoping review framework was used. Combinations of keywords were used to search relevant articles in both Chinese and English databases published from inception of the articles until the final search date (10 March 2022). The initially included articles were also appraised for their quality, and those that passed the appraisal were left for data analysis. The analytic results were cross-checked among the reviewers.

Result

Three themes emerged from the included studies: 1) the PI levels, 2) the impacts of personal and social factors of PL, and 3) the specific impact of the COVID-19 pandemic. The levels of students’ PI ranged from 66%-80% of the total scores in PI instruments, almost the same levels as in pre-pandemic time, despite the elevated social image of nurses after the COVID-19 pandemic. There is no consensus about the impacts of most personal and social factors on students’ PI across the studies. The impacts of COVID-19 on PI were both positive and negative.

Conclusions

COVID-19 epidemic exerted complicated impacts on the PI of intern nursing students. While it is necessary to address the fear of the COVID-19 pandemic among intern nursing students, the pandemic may not be an opportunistic time to enhance the students’ PI.
Acute physiological response to different recreational team handball game formats in over 60-year-old inactive men
Authors: Carneiro Ivone , Krustrup Peter , Castagna Carlo , Pereira Rita , Coelho Eduardo , Póvoas Susana
Published: October 2022

This study described the physical and physiological demands, activity profile and fun levels of recreational team handball (TH) game formats in over 60-year-old men with no previous experience with this sport (n = 17, 67.4±3.3 years). The participants performed 5v5, 6v6 and 7v7 matches (3x15-min periods) with fixed pitch size (40x20 m). In all testing sessions, heart rate (HR), differential ratings of perceived exertion and blood lactate were evaluated to measure internal load. Locomotor profile, game actions and accelerometer data were used to access external load. Also, fun levels were registered at the end of all testing sessions. Mean (76–77%HRmax) and peak HR (84–86%HRmax) decreased from the first to the third match period, in 6v6 and 7v7 (p≤0.034, d = 0.730). Blood lactate increased from baseline to the first period and decreased from the first to the third period in all game formats (p<0.001, d = 1.646). The participants covered longer total distances in 6v6 vs 5v5 (p≤0.005, d = 0.927) and spent more time in fast running in 6v6 vs 5v5 and 7v7 (p<0.001, d = 1.725) and in 5v5 vs 7v7 (p = 0.007, d = 0.912). A higher number of throws was performed in 5v5 vs 6v6 and 7v7 (p<0.001, d = 1.547), and in 6v6 vs 7v7 (p = 0.031, d = 0.779). The number of stops and total actions in 7v7 was significantly lower vs 5v5 and 6v6 (p≤0.003, d = 1.025). Recreational TH is a high-intensity and motivating exercise mode for middle-aged and older men, regardless the game format. However, higher high-intensity demands were observed during 5v5 and 6v6 game formats. Therefore, it is suggested a multiple game format (5v5, 6v6 and 7v7) training plan, with more use of 5v5 and 6v6 game formats, with training sessions lasting up to 15-min of warm-up and 3x15-min periods of match-play, when prescribing recreational TH to improve cardiovascular and musculoskeletal health in this population.
Diabetic retinopathy as a predictor for peripheral compression neuropathies, a registry-based study
Authors: Olsson Caroline , Rydberg Mattias , Zimmerman Malin
Published: October 2022

Diabetes is characterized by hyperglycaemia and entails many complications, including retinopathy and entrapment neuropathies, such as ulnar nerve entrapment (UNE) and carpal tunnel syndrome (CTS). Hyperglycaemia damages the nerves of the retina, as well as peripheral nerves. There is a correlation between entrapment neuropathies and retinopathy in patients with diabetes, but whether patients with diabetic retinopathy are more prone to develop CTS and UNE is uncertain. Hence, the aim was to investigate if retinopathy can be used as a factor predicting the development of CTS and UNE. Data from 95,437 individuals from the National Diabetes Registry were merged with data from the Skåne Healthcare Registry. The population was analysed regarding prevalence of CTS or UNE and retinopathy status. Population characteristics were analysed using the Chi2-test, Student’s Independent T-test, and the Mann-Whitney U-test. Two logistic regression models were used to analyse the odds ratio (OR) for development of CTS and UNE depending on retinopathy status, adjusted for possible confounders. Both CTS and UNE were more frequent among those with retinopathy, compared to those without (CTS: 697/10,678 (6.5%) vs. 2756/83,151 (3.3%; p<0.001), (UNE: 131/10,678 (1.2%) vs. 579/83,151 (0.7%; p<0.001)). The OR for developing CTS for individuals with type 1 diabetes and retinopathy was 2.40 (95% CI 2.06–2.81; p<0.001) and of developing UNE was 1.53 (0.96–2.43; p = 0.08). The OR for developing CTS for individuals with type 2 diabetes and retinopathy was 0.93 (0.81–1.08; p = 0.34) and for UNE 1.02 (0.74–1.40; p = 0.90). Diabetic retinopathy is associated with a higher risk of developing CTS and UNE, but the association seems to be mediated by the duration of the diabetes. Higher HbA1c levels, longer diabetes duration and higher BMI are significant risk factors for developing CTS and UNE in type 1 and type 2 diabetes.
Integrating ZooMS and zooarchaeology: New data from the Uluzzian levels of Uluzzo C Rock Shelter, Roccia San Sebastiano cave and Riparo del Broion
Authors: Silvestrini Sara , Lugli Federico , Romandini Matteo , Real Cristina , Sommella Eduardo , Salviati Emanuela , Arrighi Simona , Bortolini Eugenio , Figus Carla , Higgins Owen Alexander , Marciani Giulia , Oxilia Gregorio , Delpiano Davide , Vazzana Antonino , Piperno Marcello , Crescenzi Carlo , Campiglia Pietro , Collina Carmine , Peresani Marco , Spinapolice Enza Elena , Benazzi Stefano
Published: October 2022

In this study we explore the potential of combining traditional zooarchaeological determination and proteomic identification of morphologically non-diagnostic bone fragments (ZooMS) collected from the Uluzzian levels of three Italian sites: Uluzzo C Rock Shelter, Roccia San Sebastiano cave, and Riparo del Broion. Moreover, we obtained glutamine deamidation ratios for all the contexts analysed during routine ZooMS screening of faunal samples, giving information on collagen preservation. We designed a selection protocol that maximizes the efficiency of the proteomics analyses by excluding particularly compromised fragments (e.g. from taphonomic processes), and that aims to identify new human fragments by favouring bones showing morphological traits more similar to Homo. ZooMS consistently provided taxonomic information in agreement with the faunal spectra outlined by traditional zooarchaeology. Our approach allows us to delineate and appreciate differences between the analysed contexts, particularly between the northern and southern sites, related to faunal, environmental, and climate composition, although no human remains were identified. We reconstructed the faunal assemblage of the different sites, giving voice to morphologically undiagnostic bone fragments. Thus, the combination of these analyses provides a more complete picture of the faunal assemblage and of the paleoenvironment during the Middle-Upper Palaeolithic transition in Italy.
Ratio of abundances of ciliates behavioral groups as an indicator of the treated wastewater impact on rivers
Authors: Babko Roman , Pliashechnyk Volodymyr , Zaburko Jacek , Danko Yaroslav , Kuzmina Tatiana , Czarnota Joanna , Szulżyk-Cieplak Joanna , Łagód Grzegorz
Published: October 2022

A method for assessing the degree of impact of wastewater treatment plant discharge on receiving rivers was proposed, based on the structural indicators of the population of ciliated protozoa. It was shown that the ratio of attached, crawling and free-swimming forms in bottom sediments changes under the influence of discharge. In the points subject to organic pollution, the share of attached filter-feeding bacteriovorous ciliates increases in the assemblage of ciliated protozoa. The proposed Attached Form Index (AFI) takes this ratio into account. The use of AFI makes it possible to assess the restructuring of the assemblage of ciliated protozoa under the influence of point sources of pollution, to establish a zone of negative influence of runoff, to assess the degree of restoration of the aquatic ecosystem, as the influence of the pollution source weakened.
A novel multi-agent simulation based particle swarm optimization algorithm
Authors: Du Shuhan , Fan Wenhui , Liu Yi
Published: October 2022

Recently, there has been considerable research on combining multi-agent simulation and particle swarm optimization in practice. However, most existing studies are limited to specific engineering fields or problems without summarizing a general and universal combination framework. Moreover, particle swarm optimization can be less effective in complex problems due to its weakness in balancing exploration and exploitation. Yet, it is not common to combine multi-agent simulation with improved versions of the algorithm. Therefore, this paper proposes an improved particle swarm optimization algorithm, introducing a multi-level structure and a competition mechanism to enhance exploration while balancing exploitation. The performance of the algorithm is tested by a set of comparison experiments. The results have verified its capability of converging to high-quality solutions at a fast rate while holding the swarm diversity. Further, a problem-independent simulation-optimization approach is proposed, which integrates the improved algorithm into multi-agent systems, aiming to simulate realistic scenarios dynamically and solve related optimization problems simultaneously. The approach is implemented in a response planning system to find optimal arrangements for response operations after the Sanchi oil spill accident. Results of the case study suggest that compared with the commonly-used shortest distance selection method, the proposed approach significantly shortens the overall response time, improves response efficiency, and mitigates environmental pollution.
Modelling the impacts of COVID-19 on nurse workload and quality of care using process simulation
Authors: Qureshi Sadeem Munawar , Bookey-Bassett Sue , Purdy Nancy , Greig Michael A. , Kelly Helen , Neumann W. Patrick
Published: October 2022

Higher acuity levels in COVID-19 patients and increased infection prevention and control routines have increased the work demands on nurses. To understand and quantify these changes, discrete event simulation (DES) was used to quantify the effects of varying the number of COVID-19 patient assignments on nurse workload and quality of care. Model testing was based on the usual nurse-patient ratio of 1:5 while varying the number of COVID-19 positive patients from 0 to 5. The model was validated by comparing outcomes to a step counter field study test with eight nurses. The DES model showed that nurse workload increased, and the quality of care deteriorated as nurses were assigned more COVID-19 positive patients. With five COVID-19 positive patients, the most demanding condition, the simulant-nurse donned and doffed personal protective equipment (PPE) 106 times a shift, totaling 6.1 hours. Direct care time was reduced to 3.4 hours (-64% change from baseline pre-pandemic case). In addition, nurses walked 10.5km (+46% increase from base pre-pandemic conditions) per shift while 75 care tasks (+242%), on average, were in the task queue. This contributed to 143 missed care tasks (+353% increase from base pre-pandemic conditions), equivalent to 9.6 hours (+311%) of missed care time and care task waiting time increased to 1.2 hours (+70%), in comparison to baseline (pre-pandemic) conditions. This process simulation approach may be used as potential decision support tools in the design and management of hospitals in-patient care settings, including pandemic planning scenarios.
Convective heat transfer of the Taylor flow in a two-dimensional piston pump
Authors: Chang Liang , Li Zhiwei , Jia Wenang , Li Sheng , Ruan Jian
Published: October 2022

Heat accumulation has become a key factor limiting the speed and pressure of pumps. Therefore, heat transfer analysis is an important and urgent task to analyze the mechanical efficiency and cooling performance. The derivation of the correct convective heat transfer coefficient is a basic work of calculating the accurate thermal state. This paper focuses on the Taylor flow heat transfer in a two-dimensional piston pump. Firstly, the theoretical and experimental studies are carried out on its thermal model to investigate the annular convective heat transfer coefficients, from 1000 rpm to 6000 rpm. Furthermore, the data are set in the transient thermal simulation model with Ansys software and the simulation results are mutually validated with the experimental ones. The Nusselt numbers are also calculated and compared with the empirical formulas. Two new Taylor flow relations, within 15% mean deviation, are deduced. As the rotational speed and oil temperature rise, the oil cavitation becomes more severe, restricting the convective heat transfer. Therefore, the thermal analysis must adopt the experimental ones rather than the empirical ones, above 3000 rpm. Finally, a modified relation is introduced to the gas-liquid two-phase flow heat transfer of the pump transmission.
Clinical evaluation of AI-assisted screening for diabetic retinopathy in rural areas of midwest China
Authors: Hao Shaofeng , Liu Changyan , Li Na , Wu Yanrong , Li Dongdong , Gao Qingyue , Yuan Ziyou , Li Guanyan , Li Huilin , Yang Jianzhou , Fan Shengfu
Published: October 2022

Background

Although numerous studies have described the application of artificial intelligence (AI) in diabetic retinopathy (DR) screening among diabetic populations, studies among populations in rural areas are rare. The purpose of this study was to evaluate the application value of an AI-based diagnostic system for DR screening in rural areas of midwest China.

Methods

In this diagnostic accuracy study, diabetes mellitus (DM) patients in the National Basic Public Health Information Systems of Licheng County and Lucheng County of Changzhi city from July to December 2020 were selected as the target population. A total of 7824 eyes of 3933 DM patients were enrolled in this screening; the patients included 1395 males and 2401 females, with an average age of 19–87 years (63±8.735 years). All fundus photographs were collected by a professional ophthalmologist under natural pupil conditions in a darkroom using the Zhiyuan Huitu fundus image AI analysis software EyeWisdom. The AI-based diagnostic system and ophthalmologists were tasked with diagnosing the photos independently, and the consistency rate, sensitivity and specificity of the two methods in diagnosing DR were calculated and compared.

Results

The prevalence rates of DR according to the ophthalmologist and AI diagnoses were 22.7% and 22.5%, respectively; the consistency rate was 81.6%. The sensitivity and specificity of the AI system relative to the ophthalmologists’ grades were 81.2% (95% confidence interval [CI]: 80.3% 82.1%) and 94.3% (95% CI: 93.7% 94.8%), respectively. There was no significant difference in diagnostic outcomes between the methods (χ2 = 0.329, P = 0.566, P>0.05), and the AI-based diagnostic system had high consistency with the ophthalmologists’ diagnostic results (κ = 0.752).

Conclusion

Our research demonstrated that DR patients in rural area hospitals can be screened feasibly. Compared with that of the ophthalmologists, however, the accuracy of the AI system must be improved. The results of this study might lend support to the large-scale application of AI in DR screening among different populations.
Education and income-related inequalities in multimorbidity among older Brazilian adults
Authors: Bof de Andrade Fabíola , Thumé Elaine , Facchini Luiz Augusto , Torres Juliana Lustosa , Nunes Bruno Pereira
Published: October 2022

Objectives

This study aimed to evaluate the existence of socioeconomic inequalities related to the prevalence of multimorbidity in the Brazilian population aged 60 and older.

Methods

This was a cross-sectional study with data from the last Brazilian National Health Survey (PNS) collected in 2019. Multimorbidity was the dependent variable and was defined as the presence of two or more chronic diseases. All the diseases were assessed based on a self-reported previous medical diagnosis. Education and per capita family income were the measures of socioeconomic position. Socioeconomic inequalities related to multimorbidity were assessed using two complex measures of inequality; the Slope Index of Inequality (SII) and the Concentration Index (CI).

Results

The prevalence of multimorbidity in Brazil was 56.5% 95% CI (55.4; 57.6) and varied from 46.9% (44.3; 49.6) in the North region to 59.3% (57.0; 61.5) in the South region. In general, individuals with higher socioeconomic positions had a lower prevalence of multimorbidity. Significant absolute and relative income inequalities were observed in the South region [SII -9.0; CI -0.054], Southeast [SII -9.8; CI -0.06], and Middle-east [SII -10.4; CI -0.063]. Absolute and relative education inequalities were significant for the country and two of its regions (Southeast [SII -12.7; CI -0.079] and South [SII -19.0; CI -0.109]).

Conclusions

The prevalence of multimorbidity is high in Brazil and all of its macro-regions. The significant findings concerning the inequalities suggest that the distribution of this condition is more concentrated among those with lower education and income.
Genetic variants determine intrafamilial variability of SARS-CoV-2 clinical outcomes in 19 Italian families
Authors: Azzarà Alessia , Cassano Ilaria , Paccagnella Elisa , Tirindelli Maria Cristina , Nobile Carolina , Schittone Valentina , Lintas Carla , Sacco Roberto , Gurrieri Fiorella
Published: October 2022

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a wide range of outcomes characterized by a high heterogeneity in both symptomatology and susceptibility to the disease. In such a perspective, COVID-19 may be considered as a multifactorial disease featured by the interaction between the environment, which is the virus itself, and the genetic profile of the host. Our analysis aimed at investigating the transmission dynamics of SARS-CoV-2 within families whose members responded in different ways to the infection, although the exposure was common to the entire group and occurred before the availability of any vaccine. The goal was to understand how the genetic background of each subject can influence the viral infection outcome and hence the above-mentioned clinical variability. We performed a segregation analysis in 19 Italian families with a designed custom panel of 42 genes involved in immunity and virus entry and which have also been shown to be related to SARS-CoV-2 host response. We carried out both a familial segregation analysis and a global statistical analysis. In the former we identified eighteen risk variants co-segregating with a COVID-positive status and six variants with a possible protective effect. In addition, sixteen variants showed a trend of association to a severe phenotype. Together with common SNPs, we detected private rare variants that may also provide insight into the observed clinical COVID-19 heterogeneity. The global statistical analysis confirmed statistically significant positive associations between SARS-CoV-2 individual response and some specific gene variants identified in familial analysis. In conclusion our data confirm that the clinical expression of COVID-19 is markedly influenced by the host genetic profile both with a mendelian transmission pattern and a polygenic architecture.
Effects of vitamin D supplementation during pregnancy on bone health and offspring growth: A systematic review and meta-analysis of randomized controlled trials
Authors: Luo Ting , Lin Yunzhu , Lu Jiayue , Lian Xianghong , Guo Yuanchao , Han Lu , Guo Yixin
Published: October 2022

Background

Whether vitamin D supplementation during pregnancy is beneficial to bone health and offspring growth remains controversial. Moreover, there is no universal agreement regarding the appropriate dose and the time of commencement of vitamin D supplementation during pregnancy.

Objective

We aimed to systematically review the effects of vitamin D supplementation during pregnancy on bone development and offspring growth.

Methods

A literature search for randomized controlled trials (RCTs) was performed in 7 electronic databases to identify relevant studies about the effects of vitamin D supplementation during pregnancy on bone development and offspring growth from inception to May 22, 2022. A Cochrane Risk Assessment Tool was used for quality assessment. Vitamin D supplementation was compared with placebo or standard supplements. The effects are presented as the mean differences (MDs) with 95% CIs. The outcomes include bone mineral content (BMC), bone mineral density (BMD), bone area (BA), femur length (FL) and humeral length (HL); measurement indicators of growth, including length, weight and head circumference; and secondary outcome measures, including biochemical indicators of bone health, such as the serum 25(OH)D concentration. Additionally, subgroup analyses were carried out to evaluate the impact of different doses and different initiation times of supplementation with vitamin D.

Results

Twenty-three studies with 5390 participants met our inclusion criteria. Vitamin D supplementation during pregnancy was associated with increased humeral length (HL) (MD 0.13, 95% CI 0.06, 0.21, I2= 0, P = 0.0007) during the fetal period (third trimester). Vitamin D supplementation during pregnancy was associated with a significantly increased length at birth (MD 0.14, 95% CI 0.04, 0.24, I2= 24%, P = 0.005) and was associated with a higher cord blood 25(OH)D concentration (MD 48.74, 95% CI 8.47, 89.01, I2= 100%, P = 0.02). Additionally, subgroup analysis revealed that birth length was significantly higher in the vitamin D intervention groups of ≤1000 IU/day and ≥4001 IU/day compared with the control group. Prenatal (third trimester) vitamin D supplementation was associated with a significant increase in birth length, while prenatal (second trimester) vitamin D supplementation was associated with a significant increase in birth weight.

Conclusion

Vitamin D supplementation during pregnancy may be associated with increased humeral length (HL) in the uterus, increased body length at birth and higher cord blood 25(OH)D concentration. Evidence of its effect on long-term growth in children is lacking. Additional rigorous high-quality, long-term and larger randomized trials are required to more fully investigate the effects of vitamin D supplementation during pregnancy.
Outcome of transcatheter edge-to-edge mitral valve repair in patients with diabetes mellitus: Results from a real-world cohort
Authors: Kirschfink Annemarie , Alachkar Mhd Nawar , Alnaimi Anas , Vogt Felix , Schroeder Joerg , Lehrke Michael , Frick Michael , Reith Sebastian , Marx Nikolaus , Almalla Mohammad , Altiok Ertunc
Published: October 2022

Background

There are only limited data on patients with diabetes undergoing transcatheter edge-to-edge repair (TEER) in real-world settings. Previous data indicated patients with diabetes to have a worse prognosis. This study sought to evaluate safety and efficacy of TEER in patients with diabetes in a real-world cohort.

Methods

In this monocentric study 340 consecutive patients with severe primary and secondary mitral regurgitation (MR) undergoing TEER were included. Immediate results of the procedure, intrahospital and one-year outcome were compared between patients with and without diabetes.

Results

Diabetes was present in 109 patients (32%). Patients with diabetes were younger (77 y (71, 81) vs. 79 y (74, 83); p = 0.003), had more often ischemic cardiomyopathy (68% vs. 48%; p<0.001), previous coronary-artery bypass graft (35% vs. 20%; p = 0.002) and arterial hypertension (89% vs. 75%; p<0.001) compared to those without diabetes. Baseline NYHA class, type of MR (primary vs. secondary), left ventricular dimensions and function (ejection fraction: 37% (28, 50) vs. 40% (29, 55); p = 0.10) as well as severity of MR were not different between both groups. Success of the procedure (95% vs. 95%; p = 0.84), intrahospital mortality (5.5% vs. 4.8%; p = 0.98) and one-year follow-up regarding all-cause mortality (24.2% vs. 23.0%; p = 0.72), hospitalization for heart failure (37.4% vs. 31.0%, p = 0.23), NYHA class (p = 0.14) or MR severity (p = 0.59) did not differ between both groups.

Conclusion

Our real-world data suggest that TEER seems to be similarly safe and effective in patients with severe MR and diabetes compared to those without diabetes.
How do executives’ synergistic allocation and organizational slack drive enterprise technological innovation?
Authors: Bai Guiyu , Zhao Jing , Xu Peng
Published: October 2022

Enterprise group is an important promoter to break the segmentation and achieve economies of scale. Technological innovation within the group is the key to improving market competitiveness, which has attracted common attention from academia and practitioners, but the decision-making mechanism of technology innovation in subsidiary is still needed. Based on the background of Chinese enterprises, through empirical analysis of panel data of 773 listed manufacturing companies for 5 consecutive years, we found: Parent-subsidiary executives’ synergistic allocation has a positive impact on the technological innovation of subsidiary; Parent-subsidiary executives’ synergistic allocation has a positive impact on the organizational slack of the subsidiary; The positive effect of executives’ synergistic allocation in parent-subsidiary corporations on the technological innovation of the subsidiary is realized by increasing organizational slack; Compared with private enterprise group, the positive influence of parent-subsidiary executives’ synergistic allocation on the technological innovation of subsidiary in state-owned enterprise groups is weaker; The longer the executive tenure is, the weaker the positive impact of organizational slack on technological innovation of subsidiary will be. On the one hand, this study enriches the theoretical research of technological innovation decision-making motivation; on the other hand, it provides empirical thinking for the improvement of parent-subsidiary executive collaborative governance mechanism and the improvement of governance efficiency.
A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades
Authors: Storrar Joshua , Gill-Taylor Tarra , Chinnadurai Rajkumar , Chrysochou Constantina , Poulikakos Dimitrios , Rainone Francesco , Ritchie James , Lamerton Elizabeth , Kalra Philip A. , Sinha Smeeta
Published: October 2022

Introduction

Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immunosuppression. Here, we describe the natural history of this condition in a large tertiary centre in the UK.

Methods

178 patients with primary membranous nephropathy were identified over 2 decades. We collected data on demographics, baseline laboratory values, treatment received and outcomes including progression to renal replacement therapy and death. Analysis was performed on the whole cohort and specific subgroups. Univariate and multivariate Cox regression was also performed.

Results

Median age was 58.3 years with 63.5% male. Median baseline creatinine was 90μmol/L and urine protein-creatinine ratio 664g/mol. Remission (partial or complete) was achieved in 134 (75.3%), either spontaneous in 60 (33.7%) or after treatment with immunosuppression in 74 (41.6%), and of these 57 (42.5%) relapsed. Progression to renal replacement therapy was seen in 10.1% (much lower than classically reported) with mortality in 29.8%. Amongst the whole cohort, those who went into remission had improved outcomes compared to those who did not go into remission (less progression to renal replacement therapy [4.5% vs 28%] and death [20.1% vs 67%]. Those classified as high-risk (based on parameters including eGFR, proteinuria, serum albumin, PLA2R antibody level, rate of renal function decline) also had worse outcomes than those at low-risk (mortality seen in 52.6% vs 10.8%, p<0.001). The median follow-up period was 59.5 months.

Conclusion

We provide a comprehensive epidemiologic analysis of primary membranous nephropathy at a large tertiary UK centre. Only 10.1% progressed to renal replacement therapy. For novelty, the KDIGO risk classification was linked to outcomes, highlighting the utility of this classification system for identifying patients most likely to progress.
Homocysteine is associated with higher risks of ischemic stroke: A systematic review and meta-analysis
Authors: Rabelo Nícollas Nunes , Telles João Paulo Mota , Pipek Leonardo Zumerkorn , Farias Vidigal Nascimento Rafaela , Gusmão Rodrigo Coimbra de , Teixeira Manoel Jacobsen , Figueiredo Eberval Gadelha
Published: October 2022

Background

High levels of homocysteine (Hct) have been associated with great risks of ischemic stroke. However, some controversy still exists. We performed a systematic review and meta-analysis to compare the levels of Hct between patients with ischemic stroke and controls.

Methods

We performed a systematic literature search for articles reporting Hct levels of patients with occurrence of ischemic stroke. We employed a random-effects inverse-variance weighted meta-analytical approach in order to pool standardized mean differences, with estimation of τ2 through the DerSimonian-Laird method.

Results

The initial search yielded 1361 studies. After careful analysis of abstracts and full texts, the meta-analysis included data from 38 studies, which involved almost 16 000 stroke events. However, only 13 studies reported means and standard deviations for cases and controls, and therefore were used in the meta-analysis. Those studies presented data from 5002 patients with stroke and 4945 controls. Standardized mean difference was 1.67 (95% CI 1.00–2.25, P < 0.01), indicating that Hct levels were significantly larger in patients with ischemic stroke compared to controls. Between-study heterogeneity was very large (I2 = 99%), particularly because three studies showed significantly large mean differences.

Conclusion

This meta-analysis shows that patients with ischemic stroke have higher levels of Hct compared to controls. Whether this is a modifiable risk factor remains to be assessed through larger prospective cohorts.
Race (black-white) and sex inequalities in tooth loss: A population-based study
Authors: Terra e Souza Lívia Helena , Diaz-Quijano Fredi Alexander , de Azevedo Barros Marilisa Berti , Lima Margareth Guimarães
Published: October 2022

The effect of health inequalities is determined by different socioeconomic, sex, and race conditions. This study aimed to analyze the association of tooth loss with race (defined by self-reported skin color) and sex. Based on the hypothesis that the association between tooth loss and race may be modified by sex, we also aimed to evaluate possible interactions between race and sex in association with this event, in a population-based study in the city of Campinas, Brazil. A directed acyclic graph was used to select covariates. The prevalence, of tooth loss was 19% higher in black women compared to white men (Prevalence ratio [PR]: 1.19; 95%CI: 1.05–1.34). Moreover, the prevalence of tooth loss in black women was 26% higher than in white women (PR: 1.26; 95%CI: 1.13–1.42); and, within the strata of black people, black women had 14% higher dental loss (PR: 1.14; 95%CI: 1.02–1.27) compared to black men. This study found a significant interaction between race and sex in tooth loss, with a disadvantage for black women. In addition, this work contributes to the discussion of health inequities and can support policies for the provision of universal dental care.
Comprehensive analyses reveal the role of histone deacetylase genes in prognosis and immune response in low-grade glioma
Authors: Shen Lin , Li Yanyan , Li Na , Shen Liangfang , Li Zhanzhan
Published: October 2022

Many studies have shown that Histone deacetylases (HDAC) is involved in the occurrence of malignant tumors and regulates the occurrence, proliferation, invasion, and migration of malignant tumors through a variety of signaling pathways. In the present, we explored the role of Histone deacetylases genes in prognosis and immune response in low-grade glioma. Using consensus clustering, we built the new molecular clusters. Using HDAC genes, we constructed and validated the prognostic model in two independent cohort datasets. Patients were divided into high-risk and low-risk groups. Then, we explored the molecular characteristics, clinical characteristics, tumor microenvironment and immune infiltration levels of two clusters and risk groups. Receiver operating characteristic analyses were built for model assessment. We finally detected the expression levels of signature genes between tumor and normal tissues. Low-grade can be separated into two molecular clusters using 11 HDACs genes. Two clusters had different clinical characteristics and prognosis. Nex, we constructed a prognosis model using six HDAC genes (HDAC1, HDAC4, HDAC5, HDAC7, HDAC9, and HDAC10), which was also validated in an independent cohort dataset. Furthermore, multivariate cox regression indicated that the calculated risk score was independently associated with prognosis in low-grade glioma, and risk score can predict the five-year survival probability of low-grade glioma well. High-risk patients can be attributed to multiple complex function and molecular signaling pathways, and the genes alterations of high- and low-risk patients were significantly different. We also found that different survival outcomes of high- and low- risk patients could be involved in the differences of immune filtration level and tumor microenvironment. Subsequently, using signature genes, we identified several small molecular compounds that could be useful for low-grade glioma patients’ treatment. Finally, we detected the expression levels of signature genes in tumor tissues. our study uncovers the biology function role of HDAC genes in low-grade glioma. We identified new molecular subtypes and established a prognostic model based on six HDAC genes, which was well applied in two independent cohort data. The regulation of HDAC genes in low-grade glioma involved in multiple molecular function and signaling pathways and immune infiltration levels. Further experiments in vivo and vitro were required to confirm the present findings.