bluuebunny/crossref_metadata_2025 huggingface dataset:
Opportunity costs of attending surgical clinic appointments and experiences with telemedicine for follow-up care
Authors: Thatcher Mitchell D , Thatcher Michael W , Smith Mckinley C , McCarron Michelle , Reed Jeremy
Published: September 2021

Objectives:

Telemedicine has been rapidly implemented in orthopedics during the coronavirus (COVID-19) pandemic. The purpose of this study was to quantify opportunity costs for patients attending typical in-person appointments and understand their perceptions of telemedicine for follow-up care.

Methods:

A cross-sectional study was performed by surveying patients who had elective orthopedic surgery and attended at least one in-person and one phone call appointment. The survey assessed opportunity costs associated with in-person appointments, experience with telemedicine, and preferred type of future appointment.

Results:

Of the 49 eligible patients, 41 (83.7%) completed the survey. The median travel distance to the clinic was 108 km, and the time spent in the clinic was 60 min. Participants responded “yes” to various forms of opportunity costs associated with attending in-person appointments, including missed work (46.3%), lost income (34.1%), recreational activities (26.8%), home or yard care (14.6%), socializing with friends or family (12.2%), school (2.4%), and childcare (2.4%). In addition, elements of the telemedicine appointment were rated from 1 (least favorable) to 10 (most favorable), and averages were calculated for ease of use (9.2), convenience (8.4), confidence in the doctor’s diagnostic ability (8.2), likelihood of using the service again (6.4), and overall satisfaction (8.2). Preferred future appointment types included having the first visit in-person and subsequent visits via telephone (61.0%), in-person only (36.6%), and unsure (2.4%).

Conclusion:

This study identifies various opportunity costs associated with in-person orthopedic appointments and a favorable view toward telemedicine for follow-up care.
Age is measured with systematic measurement error in developing country surveys: A diagnosis and analysis of consequences
Authors: Rosenzweig Steven C.
Published: September 2021

Research in political science and other social sciences often relies on survey data to study a range of questions about politics in the developing world. This study identifies systematic measurement error in some of the most frequently used datasets with respect to one commonly employed variable: respondent’s age. It shows evidence of substantial measurement error that is correlated with observable characteristics, and discusses and illustrates the implications for empirical analysis with an example from a recently published study. In doing so, it demonstrates tools for identifying and diagnosing systematic measurement error in survey data, as well as for investigating the robustness of one’s findings when the problem arises.
Demystifying the COVID-19 Infodemic: Conspiracies, Context, and the Agency of Users
Authors: Gagliardone Iginio , Diepeveen Stephanie , Findlay Kyle , Olaniran Samuel , Pohjonen Matti , Tallam Edwin
Published: September 2021

This article presents new empirical insights into what people do with conspiracy theories during crises. By suppressing the impulse to distinguish between truth and falsehood, which has characterized most scholarship on the COVID-19 “infodemic,” and engaging with claims surrounding two popular COVID-19 conspiracies—on 5G and on Bill Gates—in South Africa and Nigeria, we illustrate how conspiracies morph as they interact with different socio-political contexts. Drawing on a mixed-method analysis of more than 6 million tweets, we examine how, in each country, conspiracies have uniquely intersected with longer-term discourses and political projects. In Nigeria, the two conspiracies were both seized as opportunities to extend criticism to the ruling party. In South Africa, they produced distinctive responses: while the 5G conspiracy had limited buy-in, the Gates conspiracy resonated with deep-rooted resentment toward the West, corporate interests, and what is seen as a paternalistic attitude of some external actors toward Africa. These findings stress the importance of taking conspiracy theories seriously, rather than dismissing them simply as negative externalities of digital ecosystems. Situating conspiracies in specific dynamics of trust and mistrust can make an important difference when designing responses that are not limited to broadcasting truthful information, but can also enable interventions that account for deeply rooted sentiments of suspicion toward specific issues and actors, which can vary significantly across communities.
Mental Health Stigma and Social Contact Revisited: The Role of Network Closeness and Negativity
Authors: Felix Elizabeth , Lynn Freda
Published: September 2021

Researchers and policymakers are increasingly interested in the extent to which mental health stigma can be mitigated through social contact with people who disclose mental health issues. Empirical research on contact and stigma, however, largely focuses on the presence of contact without fully examining the nature of relationships. Interpersonal ties, for example, can be enduring and supportive, enduring and stressful, or weak yet cooperative. Using a novel egocentric network survey, this study contributes by measuring contact with respect to both the presence of alters with perceived mental health issues and the nature of those connections. Results show that, compared to respondents without any contact, naming more mental health contacts is associated with a reduction in stigma only when those relations are characterized by closeness and a lack of negativity. Among individuals with contact, a higher proportion of relationships perceived as negative or “difficult” exacerbates stigma. Implications of these findings for stigma reduction are discussed.
The Moderation Role of Being Valued by Teachers Over the Association Between School Children Motivation and Need for Competition
Authors: Bostan Cristina Maria , Stanciu Tudor , Andronic Răzvan-Lucian
Published: September 2021

Concordant with classical theoretical guidelines (i.e., social facilitation, social constructivism theory, and the Pygmalion effect) we tested the need for competition and perception of being valued by teachers to be better motivated for learning in school. We extend knowledge by testing these associations mediated by the social economic status given by the well-being of the family (i.e., controlling for gender and socio-economic status). A total of 214 Romanian students (45.3% boys) with ages between 13 and 17 years were administered the PEER questionnaire (i.e., perception of being valued by teachers, school-children motivation, and the need for competition). Results show a positive relation between the need for competition and motivation for learning. We also found positive relations between the perception of being valued by the teacher and motivation for learning and the need for competition. We conclude that motivation is higher when the need for competition is higher and the perception of being valued by teachers is higher.
Laparoscopic surgical approach for the treatment of piriformis syndrome: Intrapelvic decompression technique
Authors: Kale Ahmet , Başol Gülfem , Cansu Gündoğdu Elif , Mat Emre , Yıldız Gazi , Kuru Betül , Aboalhasan Yasmin , Uzun Navdar Doğuş , Usta Taner , tıntaş Mehmet Al , Demirhan Recep
Published: September 2021

Introduction:

Piriformis syndrome is an uncommon disease resulting from the piriformis muscle’s compression of the sciatic nerve. Pain and numbness in the buttocks and down the leg are the most common symptoms. This study analyzes the laparoscopic surgical treatment of piriformis syndrome.

Methods:

We report three cases of piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back pain and sciatica on her right side. Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The second case was a 30 years old woman with a 2-year history of sciatica on her left side. The third case was a 30 years old woman with a 2-year history of sciatica on her right side. All the patients underwent laparoscopic decompression surgery, which was performed to release the sciatic nerve or sacral nerve roots.

Results:

The patients were reexamined at the postoperative 3rd and 6th months. Their visual analog scale (VAS) scores were found to be decreased from 10/10, 9/10, and 7/10 to 0/10, 1/10, and 0/10, respectively.

Conclusion:

Due to the very few cases in the literature, pelvic piriformis syndrome is an exclusively clinical diagnosis. If the sciatica is refractory to conservative treatments, laparoscopic exploration and decompression surgery of the pelvic nerves and piriformis muscle could be an option.
Improving Older People’s Lives Through Digital Technology and Practices
Authors: Marston Hannah R. , Musselwhite Charles B. A.
Published: September 2021

The Aging and Technology special issue showcases twelve papers spanning a range and diversity of international scholarly research within the field of ageing and technology. The collection of papers demonstrates the positive impact technology can have on the lives of older people including improving cognitive performance, physical and mental health and people’s daily activities and practices. There are still barriers to use, including psychological issues of motivation, attitudes, privacy and trust and social issues involving learning to use the technology. In conclusion, to help overcome these barriers, it is recommended that research and development of technology involves older people as co-developers working with stakeholders from different disciplines and backgrounds.
The board of directors and firm innovation: A meta-analytical review
Authors: Sierra-Morán Johana , Cabeza-García Laura , González-Álvarez Nuria , Botella Juan
Published: September 2021

The literature on corporate governance has highlighted the importance of board characteristics related to firm innovation. However, empirical findings have not been totally conclusive, and some seem contradictory. Adopting a new perspective, we have tried to help resolve the puzzle using a meta-analysis that integrates findings from 96 previous studies to analyze the relationship between board attributes, grouped by their relation to structural or demographic diversity, and firm innovation for the period 1988–2018. The results suggest that certain aspects of boards, such as meeting frequency and the proportions of independent directors and outsiders, show the most significant correlations with firm innovation, but the levels of association vary depending on whether innovation is measured as inputs or outputs and depending on the sample considered and the methodology employed. Finally, general guidelines are suggested regarding practical implications and future research.

JEL CLASSIFICATION: O32, G34
Long-term outcomes in patients with severe aplastic anemia treated with immunosuppression and eltrombopag: a phase 2 study
Authors: Patel Bhavisha A. , Groarke Emma M. , Lotter Jennifer , Shalhoub Ruba , Gutierrez-Rodrigues Fernanda , Rios Olga , Quinones Raffo Diego , Wu Colin O. , Young Neal S.
Published: September 2021

Patients with severe aplastic anemia (SAA) are either treated with bone marrow transplant (BMT) or immunosuppression (IST) depending on their age, comorbidities, and available donors. In 2017, our phase 2 trial reported improved hematologic responses with the addition of eltrombopag (EPAG) to standard IST for SAA when compared with a historical cohort treated with IST alone. However, the rates and characteristics of long-term complications, relapse, and clonal evolution, previously described in patients treated with IST alone, are not yet known with this new regimen, IST and EPAG. Patients were accrued from 2012 to 2020, with a total of 178 subjects included in this secondary endpoint analysis. With double the sample size and a much longer median follow-up (4 years) since the original publication in 2017, we report a cumulative relapse rate of 39% in responding patients who received cyclosporine (CSA) maintenance and clonal evolution of 15% in all treated patients at 4 years. Relapse occurred at distinct timepoints: after CSA dose reduction and EPAG discontinuation at 6 months, and after 2 years when CSA was discontinued. Most relapsed patients were retreated with therapeutic doses of CSA +/− EPAG, and two-thirds responded. Clonal evolution to a myeloid malignancy or chromosome 7 abnormality (high-risk) was noted in 5.7% of patients and conferred a poorer overall survival. Neither relapse nor high-risk evolution occurred at a higher rate than was observed in a historical comparator cohort, but the median time to both events was earlier in IST and EPAG treated patients. This trial was registered at www.clinicaltrials.gov as #NCT01623167.
Do age, fitness, and concomitant medications influence management and outcomes of patients with CLL treated with ibrutinib?
Authors: Tedeschi Alessandra , Frustaci Anna Maria , Mauro Francesca Romana , Chiarenza Annalisa , Coscia Marta , Ciolli Stefania , Reda Gianluigi , Laurenti Luca , Varettoni Marzia , Murru Roberta , Baratè Claudia , Sportoletti Paolo , Greco Antonino , Borella Chiara , Rossi Valentina , Deodato Marina , Biagi Annalisa , Zamprogna Giulia , Pelle Angelo Curto , Lapietra Gianfranco , Vitale Candida , Morelli Francesca , Cassin Ramona , Fresa Alberto , Cavalloni Chiara , Postorino Massimiliano , Ielo Claudia , Cairoli Roberto , Di Raimondo Francesco , Montillo Marco , Del Poeta Giovanni
Published: September 2021

Functional reserve of organs and systems is known to be relevant in predicting immunochemotherapy tolerance. Age and comorbidities, assessed by the cumulative illness rating scale (CIRS), have been used to address chemotherapy intensity. In the ibrutinib era, it is still unclear whether age, CIRS, and Eastern Cooperative Oncology Group performance status (ECOG-PS) retain their predictive role on treatment vulnerability. In this series of 712 patients with chronic lymphocytic leukemia (CLL) treated with ibrutinib outside clinical trials, baseline ECOG-PS and neutropenia resulted as the most accurate predictors of treatment feasibility and outcomes. Age did not independently influence survival and ibrutinib tolerance, indicating that not age per se, but age-related conditions, may affect drug management. We confirmed the role of CIRS > 6 as a predictor of a poorer progression- and event-free survival (PFS, EFS). The presence of a severe comorbidity was significantly associated with permanent dose reductions (PDRs), not translating into worse outcomes. As expected, del(17p) and/or TP53mut and previous therapies affected PFS, EFS, and overall survival. No study so far has analyzed the influence of concomitant medications and CYP3A inhibitors with ibrutinib. In our series, these factors had no impact, although CYP3A4 inhibitors use correlated with Cox regression analysis, with an increased risk of PDR. Despite the limitation of its retrospective nature, this large study confirmed the role of ECOG-PS as the most accurate predictor of ibrutinib feasibility and outcomes, and importantly, neutropenia emerged as a relevant tool influencing patients’ vulnerability. Although CIRS > 6 retained a significant impact on PFS and EFS, its value should be confirmed by prospective studies.
Biomarkers for autism spectrum disorder: opportunities for magnetoencephalography (MEG)
Authors: Roberts Timothy P. L. , Kuschner Emily S. , Edgar J. Christopher
Published: September 2021

This paper reviews a candidate biomarker for ASD, the M50 auditory evoked response component, detected by magnetoencephalography (MEG) and presents a position on the roles and opportunities for such a biomarker, as well as converging evidence from allied imaging techniques (magnetic resonance imaging, MRI and spectroscopy, MRS). Data is presented on prolonged M50 latencies in ASD as well as extension to include children with ASD with significant language and cognitive impairments in whom M50 latency delays are exacerbated. Modeling of the M50 latency by consideration of the properties of auditory pathway white matter is shown to be successful in typical development but challenged by heterogeneity in ASD; this, however, is capitalized upon to identify a distinct subpopulation of children with ASD whose M50 latencies lie well outside the range of values predictable from the typically developing model. Interestingly, this subpopulation is characterized by low levels of the inhibitory neurotransmitter GABA. Following from this, we discuss a potential use of the M50 latency in indicating “target engagement” acutely with administration of a GABA-B agonist, potentially distinguishing “responders” from “non-responders” with the implication of optimizing inclusion for clinical trials of such agents. Implications for future application, including potential evaluation of infants with genetic risk factors, are discussed. As such, the broad scope of potential of a representative candidate biological marker, the M50 latency, is introduced along with potential future applications.

This paper outlines a strategy for understanding brain dysfunction in individuals with intellectual and developmental disabilities (IDD). It is proposed that a multimodal approach (collection of brain structure, chemistry, and neuronal functional data) will identify IDD subpopulations who share a common disease pathway, and thus identify individuals with IDD who might ultimately benefit from specific treatments. After briefly demonstrating the need and potential for scope, examples from studies examining brain function and structure in children with autism spectrum disorder (ASD) illustrate how measures of brain neuronal function (from magnetoencephalography, MEG), brain structure (from magnetic resonance imaging, MRI, especially diffusion MRI), and brain chemistry (MR spectroscopy) can help us better understand the heterogeneity in ASD and form the basis of multivariate biological markers (biomarkers) useable to define clinical subpopulations. Similar approaches can be applied to understand brain dysfunction in neurodevelopmental disorders (NDD) in general. In large part, this paper represents our endeavors as part of the CHOP/Penn NICHD-funded intellectual and developmental disabilities research center (IDDRC) over the past decade.
Infants with cystic fibrosis have altered fecal functional capacities with potential clinical and metabolic consequences
Authors: Eng Alexander , Hayden Hillary S. , Pope Christopher E. , Brittnacher Mitchell J. , Vo Anh T. , Weiss Eli J. , Hager Kyle R. , Leung Daniel H. , Heltshe Sonya L. , Raftery Daniel , Miller Samuel I. , Hoffman Lucas R. , Borenstein Elhanan
Published: September 2021

Background

Infants with cystic fibrosis (CF) suffer from gastrointestinal (GI) complications, including pancreatic insufficiency and intestinal inflammation, which have been associated with impaired nutrition and growth. Recent evidence identified altered fecal microbiota taxonomic compositions in infants with CF relative to healthy infants that were characterized by differences in the abundances of taxa associated with GI health and nutrition. Furthermore, these taxonomic differences were more pronounced in low length infants with CF, suggesting a potential link to linear growth failure. We hypothesized that these differences would entail shifts in the microbiome’s functional capacities that could contribute to inflammation and nutritional failure in infants with CF.

Results

To test this hypothesis, we compared fecal microbial metagenomic content between healthy infants and infants with CF, supplemented with an analysis of fecal metabolomes in infants with CF. We identified notable differences in CF fecal microbial functional capacities, including metabolic and environmental response functions, compared to healthy infants that intensified during the first year of life. A machine learning-based longitudinal metagenomic age analysis of healthy and CF fecal metagenomic functional profiles further demonstrated that these differences are characterized by a CF-associated delay in the development of these functional capacities. Moreover, we found metagenomic differences in functions related to metabolism among infants with CF that were associated with diet and antibiotic exposure, and identified several taxa as potential drivers of these functional differences. An integrated metagenomic and metabolomic analysis further revealed that abundances of several fecal GI metabolites important for nutrient absorption, including three bile acids, correlated with specific microbes in infants with CF.

Conclusions

Our results highlight several metagenomic and metabolomic factors, including bile acids and other microbial metabolites, that may impact nutrition, growth, and GI health in infants with CF. These factors could serve as promising avenues for novel microbiome-based therapeutics to improve health outcomes in these infants.
The functional indexes of RBCs and microcirculation in the traumatic brain injury with the action of 2-ethil-6-methil-3-hydroxypiridin succinate
Authors: Polozova Anastasia V. , Boyarinov Gennadii A. , Nikolsky Viktor O. , Zolotova Marina V. , Deryugina Anna V.
Published: September 2021

Research aim

To study the RBCs functional and metabolic parameters and the microcirculatory brain structure at traumatic brain injury (TBI) under the action of 2-ethyl-6-methyl-3-hydroxypyridine succinate.

Methods

A closed TBI was modeled by the free fall of a load on the parietooccipital regions of head. We made studies of the influence of 2-ethil-6-methil-3-hydroxipiridin succinate on aggregation and electrophoretic mobility of RBCs, catalase activity, malonic dialdehyde concentration, adenosine triphosphate and 2.3-biphosphoglycerate (2.3 – BPG) concentrations in RBCs. The state of parenchyma and microcirculatory brain mainstream in post-traumatic period of TBI have been studied on micro-preparations.

Results

The use of 2-ethyl-6-methyl-3-hydroxypyridine succinate under conditions of head injury leads to a decrease in MDA concentration and in aggregation of RBCs, to an increase in the 2.3—BPG concentration and RBC electrophoretic mobility compared to the control (group value). The most pronounced changes under the action of 2-ethyl-6-methyl-3-hydroxypyridine succinate were observed 3–7 days after the TBI. Significant indicators of the restoration of the microvasculature and brain tissue provoked by the use of 2-ethyl-6-methyl-3-hydroxypyridine succinate of were evident from the 7th day unlike the control group, where the restoration of structural morphological parameters was observed only on the 12th day of the post-traumatic period. Fast recovery of blood flow under the action of 2-ethyl-6-methyl-3-hydroxypyridine succinate ensured effective restoration of neurons and glia in comparison with the control group.

Conclusions

Early and long-term cytoprotective correction intensifies the oxygen transport function of the blood, prevents and / or reduces disorders of microvessels, neurons and glia in the post-traumatic period, thereby provides correction of hypoxic state and drives to the restoration of brain tissues homeostasis.
Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review
Authors: Buur Louise Engelbrecht , Madsen Jens Kristian , Eidemak Inge , Krarup Elizabeth , Lauridsen Thomas Guldager , Taasti Lena Helbo , Finderup Jeanette
Published: September 2021

Background

Patients with stage 5 chronic kidney disease (CKD5) collaborate with their clinicians when choosing their future treatment modality. Most elderly patients with CKD5 may only have two treatment options: dialysis or conservative kidney management (CKM). The objective of this systematic review was to investigate whether CKM offers a quantity or quality of life benefit compared to dialysis for some patients with CKD5.

Methods

The databases MEDLINE, EMBASE, the Cochrane Library, and CINAHL were systematically searched for studies comparing patients with CKD5 who had chosen or were treated with either CKM or dialysis. The primary outcomes were mortality and quality of life (QoL). Hospitalization, symptom burden, and place of death were secondary outcomes. For studies reporting hazard ratios, pooled values were calculated, and forest plots conducted.

Results

Twenty-five primary studies, all observational, were identified. All studies reported an increased mortality in patients treated with CKM (pooled hazard ratio 0.47, 95 % confidence interval 0.34–0.65). For patients aged ≥ 80 years and for elderly individuals with comorbidities, results were ambiguous. In most studies, CKM seemed advantageous for QoL and secondary outcomes. Findings were limited by the heterogeneity of studies and biased outcomes favouring dialysis.

Conclusions

In general, patients with CKD5 who have chosen or are on CKM live for a shorter time than patients who have chosen or are on dialysis. In patients aged ≥ 80 years old, and in elderly individuals with comorbidities, the survival benefits of dialysis seem to be lost. Regarding QoL, symptom burden, hospitalization, and place of death, CKM may have advantages. Higher quality studies are needed to guide patients and clinicians in the decision-making process.
Translation, adaptation and validation of the Bulgarian version of the King’s Parkinson’s Disease Pain Scale
Authors: Stoyanova-Piroth Galina , Milanov Ivan , Stambolieva Katerina
Published: September 2021

Background

The purpose of the present study was to translate and cross-culturally adapt the King’s Parkinson’s Disease Pain Scale (KPPS) into Bulgarian and to investigate its psychometric properties in order to provide a validated Parkinson’s disease-specific pain instrument in Bulgarian language (KPPS-BG).

Methods

Translation into Bulgarian and a cultural adaptation were performed to obtain KPPS-BG. A total of 162 patients with idiopathic Parkinson’s disease were screened for pain using the complementary to the KPPS questionnaire – King’s Parkinson’s Disease Pain Questionnaire (KPPQ). KPPS-BG domain and total scores were calculated and internal consistency, construct validity and test-retest reliability were examined for 129 patients having one or more positive items in the KPPQ-BG.

Results

79.6 % of the patients reported one or more types of pain. The most common type was musculoskeletal pain (83.7 %), followed by nocturnal pain (55.0 %), fluctuation-related pain (50.1 %), radicular pain (43.4 %), chronic pain (31.0 %), discoloration, edema/swelling (27.1 %) and, oro-facial pain (14.3 %). Mean KPPS-BG total score was 21.1 ± 17.3 SD. KPPS-BG showed a good reliability (Cronbach’s alpha 0.75). The test-retest reliability of the KPPS-BG was high and the intraclass correlation coefficient was 0.92, demonstrating а good repeatability. KPPS-BG total score was higher in patients with postural instability gait difficulty motor subtype, compared to tremor-dominant or indeterminate subtype. Significant positive correlations were found between KPPS-BG total score and modified H&Y, Movement Disorders Society Unified Parkinson’s Disease Rating Scale part III.

Conclusions

The KPPS-BG constitutes a reliable, comprehensive and useful tool for pain assessment in native Bulgarian patients with Parkinson’s disease.
Antenatal care dropout and associated factors among mothers delivering in public health facilities of Dire Dawa Town, Eastern Ethiopia
Authors: Worku Dereje , Teshome Daniel , Tiruneh Chalachew , Teshome Alemtsehay , Berihun Gete , Berhanu Leykun , Walle Zebader
Published: September 2021

Introduction

More than two-thirds of the pregnant women in Africa have at least one antenatal care contact with a health care provider. However, to achieve the full life-saving potential that antenatal care promises for women and babies, four visits providing essential evidence-based interventions – a package often called focused antenatal care are required. Hence, identifying the factors associated with dropout of maternal health care utilization would have meaningful implications. The study aimed to assess antenatal care dropout and associated factors among mothers delivering in the public health facilities of Dire Dawa town, Ethiopia.

Methods

Facility-based cross-sectional study was conducted from January 1 to 30, 2020. Proportionate sampling and simple random sampling techniques were used to select 230 women. Data were collected using a structured and pretested interview administered questionnaire during delivery. The data were entered into Epidata version 3.1 and analyzed using SPSS version 20. A binary logistic regression model with a 95 % confidence interval was used to analyze the results. Bivariable analysis (COR [crude odds ratio]) and multivariable analysis (AOR [adjusted odds ratio]) was used to analyze the results. From the bivariable analysis, variables with ap-value < 0.25 were entered into the multivariable logistic regression analysis. From the multivariable logistic regression analysis, variables with a significance level ofp-value < 0.05 were taken as factors independently associated with ANC dropout.

Result

The proportion of antenatal care dropouts was 86 (37.4 %) (95 % CI: 31.3–43.9). In logistic regression analyses, those who had no past antenatal care follow up were more likely to have ANC dropout (AOR = 7.89; 95 % CI: 2.109–29.498) and those who had no professional advice were more likely to have antenatal care dropout (AOR = 4.64 95 % CI: 1.246–17.254).

Conclusions

This study indicates that a high number of women had antenatal care dropout. Having no past ANC follow-up and professional advice were the major factors of ANC service utilization dropout. Hence, giving more information during the ANC visit is important to reduce the dropout rate from the maternity continuum of care.
Role of miR-182/PDCD4 axis in aggressive behavior of prostate cancer in the African Americans
Authors: Shiina Marisa , Hashimoto Yutaka , Kulkarni Priyanka , Dasgupta Pritha , Shahryari Varahram , Yamamura Soichiro , Tanaka Yuichiro , Dahiya Rajvir
Published: September 2021

Background

Prostate cancer is one of the most commonly diagnosed cancers among men. African Americans (AA) are at an increased risk of developing prostate cancer compared to European Americans (EA). miRNAs play a critical role in these tumors, leading to tumor progression. In this study, we investigated the role of miR-182 in racial disparity in prostate cancer.

Results

We found significantly increased levels of miR-182 in prostate cancer tissues compared to BPH. Also, miR-182 shows increased expression in AA prostate cancer cell line and tissue samples compared to EA. We performed biochemical recurrence (BCR) - free survival time in AA and EA patients and found that high miR-182 expression had significantly shorter BCR-free survival than patients with low miR-182 expression (P = 0.031). To elucidate the role of miR-182, we knocked down miR-182 in EA (DU-145 and LNCaP) and AA (MDA-PCa-2b) cell lines and found an increase in apoptosis, arrest of the cell cycle, and inhibition of colony formation in the AA cell line to a greater extent than EA cell lines.

Conclusions

Our results showed that PDCD4 is a direct miR-182 target and its inhibition is associated with aggressiveness and high Gleason grade in prostate cancer among AA. These findings show that miR-182 is highly expressed in AA patients and miR-182 may be a target for effective therapy in AA patients.
DNA methylation and gene expression profiles to identify childhood atopic asthma associated genes
Authors: Chen Rui , Piao Li-Zhen , Liu Ling , Zhang Xiao-Fei
Published: September 2021

Background

Asthma is a chronic inflammatory disorder of the airways involving many different factors. This study aimed to screen for the critical genes using DNA methylation/CpGs and miRNAs involved in childhood atopic asthma.

Methods

DNA methylation and gene expression data (Access Numbers GSE40732 and GSE40576) were downloaded from the Gene Expression Omnibus database. Each set contains 194 peripheral blood mononuclear cell (PBMC) samples of 97 children with atopic asthma and 97 control children. Differentially expressed genes (DEGs) with DNA methylation changes were identified. Pearson correlation analysis was used to select genes with an opposite direction of expression and differences in methylation levels, and then Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were performed. Protein–protein interaction network and miRNA–target gene regulatory networks were then constructed. Finally, important genes related to asthma were screened.

Results

A total of 130 critical DEGs with DNA methylation changes were screened from children with atopic asthma and compared with control samples from healthy children. GO and KEGG pathway enrichment analysis found that critical genes were primarily related to 24 GO terms and 10 KEGG pathways. In the miRNA–target gene regulatory networks, 9 KEGG pathways were identified. Analysis of the miRNA–target gene network noted an overlapping KEGG signaling pathway, hsa04060: cytokine-cytokine receptor interaction, in which the gene CCL2, directly related to asthma, was involved. This gene is targeted by eight asthma related miRNAs (hsa-miR-206, hsa-miR-19a, hsa-miR-9,hsa-miR-22, hsa-miR-33b, hsa-miR-122, hsa-miR-1, and hsa-miR-23b). The genes IL2RG and CCl4 were also involved in this pathway.

Conclusions

The present study provides a novel insight into the underlying molecular mechanism of childhood atopic asthma.
Spatial distribution and predictors of domestic violence against women: evidence from analysis of Ethiopian demographic health survey 2016
Authors: Seid Elias , Melese Tesfahun , Alemu Kassahun
Published: September 2021

Background

Violence against women particularly that is committed by an intimate partner is becoming a social and public health problem across the world. Studies show that the spatial variation in the distribution of domestic violence was commonly attributed to neighborhood-level predictors. Despite the prominent benefits of spatial techniques, research findings are limited. Therefore, the current study intends to determine the spatial distribution and predictors of domestic violence among women aged 15–49 in Ethiopia.

Methods

Data from the Ethiopian demographic health survey 2016 were used to determine the spatial distribution of domestic violence in Ethiopia. Spatial auto-correlation statistics (both Global and Local Moran’s I) were used to assess the spatial distribution of domestic violence cases in Ethiopia. Spatial locations of significant clusters were identified by using Kuldorff’s Sat Scan version 9.4 software. Finally, binary logistic regression and a generalized linear mixed model were fitted to identify predictors of domestic violence.

Result

The study found that spatial clustering of domestic violence cases in Ethiopia with Moran’s I value of 0.26, Z score of 8.26, and P value < 0.01. The Sat Scan analysis identifies the primary most likely cluster in Oromia, SNNP regions, and secondary cluster in the Amhara region. The output from regression analysis identifies low economic status, partner alcohol use, witnessing family violence, marital controlling behaviors, and community acceptance of wife-beating as significant predictors of domestic violence.

Conclusion

There is spatial clustering of IPV cases in Ethiopia. The output from regression analysis shows that individual, relationship, and community-level predictors were strongly associated with IPV. Based upon our findings, we give the following recommendation: The government should give prior concern for controlling factors such as high alcohol consumption, improper parenting, and community norm that encourage IPV that were responsible for IPV in the identified hot spot areas.
Does laparoscopic hysterectomy + bilateral salpingectomy decrease the ovarian reserve more than total abdominal hysterectomy? A cohort study, measuring anti-Müllerian hormone before and after surgery
Authors: Tavana Zohreh , Askary Elham , Poordast Tahereh , Soltani Maryam , Vaziri Farideh
Published: September 2021

Background

Decreased ovarian function and reserve is one of the complications of hysterectomy. In this study, we aimed to compare anti-müllerian hormone (AMH) levels between total abdominal hysterectomy (TAH), and total laparoscopic hysterectomy (TLH).

Methods

In this prospective cohort study, serum levels of AMH were compared between the groups undergoing TAH + bilateral salpingectiomy and TLH, in 66 patients (33 in each group) who referred to the hospitals of Shiraz University of Medical Sciences for hysterectomy during one years of work. The collected information included age, weight, gravidity, parity, regularity of menstrual cycle, uterine weight, blood loss during surgery, and serum levels of AMH before and 6 months after surgery, compared between groups.

Results

Most patients (88% in TAH and 73% in TLH group) aged 40–50 years. Mean age, weight, parity of patients was similar in both groups, while blood loss was significantly less in TLH group (P < 0.01). Median (IQR) of pre-surgical AMH values were 0.40 (0.55) ng/ml in the TLH group and 0.92 (1.23) ng/ml in the TAH group (P = 0.12) that decreased to 0.29 (0.44) ng/ml in the TLH group and 0.15 (0.31) ng/ml in the TAH group (P = 0.02). Also Median (IQR) of the difference between pre and post-surgical AMH values were 0.12 (0.31) and 0.58 (1.17) in TLH and TAH group, respectively (P = 0.003).

Conclusion

The serum levels of AMH decreased significantly after both methods of hysterectomy (laparoscopy and laparotomy), while this decrease was greater in TAH group that shows.
A story half told: a qualitative study of medical students’ self-directed learning in the clinical setting
Authors: Liu Tzu-Hung , Sullivan Amy M.
Published: September 2021

Background

Medical educators have promoted self-directed learning (SDL) as an important means of enabling students to take responsibility for their own learning throughout their training and practice. While SDL has been well-studied in classroom settings, it remains a story half told: barriers to and facilitators of SDL in the clinical setting are not yet well described. The goals of this study were to explicate student experiences of SDL in their clinical training and to identify the roles that local social and cultural contexts play in shaping their experiences of SDL.

Methods

To understand students’ conceptualization and experiences of SDL in the clinical setting, we carried out a qualitative study with 15 medical students at Harvard Medical School. The semi-structured interviews were recorded and transcribed. Using an interpretivist approach, data were analyzed both deductively and inductively using the Framework method of content analysis.

Results

Participants described patient care activities as primary motivators for engagement in SDL in the clinical setting. Participants’ descriptions of SDL aligned with Knowles’ steps in SDL, with an additional step of consolidation of learning related to their patients’ diagnosis and management. Participants described using a range of cognitive, social-emotional, and peer learning strategies to enhance their SDL. Participants who described a growth mindset appeared to engage in SDL more easily. Learning environments that fostered SDL were those in which faculty and residents demonstrated an educational orientation, promoted psychological safety, and invited student engagement. Teams with perceived excessive work demands were perceived to be less supportive of SDL.

Conclusions

Our study enhances previous classroom-based models of SDL by providing specific, practical implications for both students and faculty in the clinical training setting. Participants described SDL in the clinical setting as patient-centered, and when effectively implemented, SDL appears to support a mastery rather than performance orientation. Our study paves the way for improving medical students’ clinical SDL and helping them become lifelong learners in the field of medicine.
The efficacy of corticosteroids therapy in patients with moderate to severe SARS-CoV-2 infection: a multicenter, randomized, open-label trial
Authors: Ghanei Mostafa , Solaymani-Dodaran Masoud , Qazvini Ali , Ghazale Amir Hosein , Setarehdan Seyed Amin , Saadat Seyed Hassan , Ghobadi Hassan , Hoseininia Saeed , Elahikhah Maryam , Samadi Ali Hossein , Imani Yousef , Vahedi Ensieh , Babamahmoodi Farhang , Rostami Fatemeh Tajik , Ardebili Mohammad Hossein Azimzadeh , Ansarifar Akram , Golmaei Fatemeh Fallahpoor , Asadollah Atieh
Published: September 2021

Background

We performed a multicenter, randomized open-label trial in patients with moderate to severe Covid-19 treated with a range of possible treatment regimens. Methods: Patients were randomly assigned to one of three regimen groups at a ratio of 1:1:1. The primary outcome of this study was admission to the intensive care unit. Secondary outcomes were intubation, in-hospital mortality, time to clinical recovery, and length of hospital stay (LOS). Between April 13 and August 9, 2020, a total of 336 patients were randomly assigned to receive one of the 3 treatment regimens including group I (hydroxychloroquine stat, prednisolone, azithromycin and naproxen; 120 patients), group II (hydroxychloroquine stat, azithromycin and naproxen; 116 patients), and group III (hydroxychloroquine and lopinavir/ritonavir (116 patients). The mean LOS in patients receiving prednisolone was 5.5 in the modified intention-to-treat (mITT) population and 4.4 days in the per-protocol (PP) population compared with 6.4 days (mITT population) and 5.8 days (PP population) in patients treated with Lopinavir/Ritonavir.

Results

The mean LOS was significantly lower in the mITT and PP populations who received prednisolone compared with populations treated with Lopinavir/Ritonavir (p = 0.028; p = 0.0007). We observed no significant differences in the number of deaths, ICU admission, and need for mechanical ventilation between the Modified ITT and per-protocol populations treated with prednisolone and Lopinavir/Ritonavir, although these outcomes were better in the arm treated with prednisolone. The time to clinical recovery was similar in the modified ITT and per-protocol populations treated with prednisolone, lopinavir/ritonavir, and azithromycin (P = 0.335; P = 0.055; p = 0.291; p = 0.098).

Conclusion

The results of the present study show that therapeutic regimen (regimen I) with low dose prednisolone was superior to other regimens in shortening the length of hospital stay in patients with moderate to severe COVID-19. The steroid sparing effect may be utilized to increase the effectiveness of corticosteroids in the management of diabetic patients by decreasing the dosage.
The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis
Authors: Chen Ching-Yi , Chen Chao-Hsien , Wang Cheng-Yi , Lai Chih-Cheng , Chao Chien-Ming , Wei Yu-Feng
Published: September 2021

Background

The effect of additional antimicrobial agents on the clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) is unclear.

Methods

We performed comprehensive searches of randomized control trials (RCTs) that compared the clinical efficacy of additional antimicrobial agents to those of placebo or usual care in the treatment of IPF patients. The primary outcome was all-cause mortality, and the secondary outcomes were changes in forced vital capacity (FVC), diffusing capacity of the lung for carbon monoxide (DLCO), and the risk of adverse events (AEs).

Results

Four RCTs including a total of 1055 patients (528 receiving additional antibiotics and 527 receiving placebo or usual care) were included in this meta-analysis. Among the study group, 402 and 126 patients received co-trimoxazole and doxycycline, respectively. The all-cause mortality rates were 15.0% (79/528) and 14.0% (74/527) in the patients who did and did not receive additional antibiotics, respectively (odds ratio [OR] 1.07; 95% confidence interval [CI] 0.76 to 1.51; p = 0.71). No significant difference was observed in the changes in FVC (mean difference [MD], 0.01; 95% CI − 0.03 to 0.05; p = 0.56) and DLCO (MD, 0.05; 95% CI − 0.17 to 0.28; p = 0.65). Additional use of antimicrobial agents was also associated with an increased risk of AEs (OR 1.65; 95% CI 1.19 to 2.27; p = 0.002), especially gastrointestinal disorders (OR 1.54; 95% CI 1.10 to 2.15; p = 0.001).

Conclusions

In patients with IPF, adding antimicrobial therapy to usual care did not improve mortality or lung function decline but increased gastrointestinal toxicity.
Association between circulating alpha-1 antitrypsin polymers and lung and liver disease
Authors: Núñez Alexa , Belmonte Irene , Miranda Elena , Barrecheguren Miriam , Farago Georgina , Loeb Eduardo , Pons Mònica , Rodríguez-Frías Francisco , Gabriel-Medina Pablo , Rodríguez Esther , Genescà Joan , Miravitlles Marc , Esquinas Cristina
Published: September 2021

Background

Alpha-1 antitrypsin deficiency (AATD) is considered one of the most common genetic diseases and is characterised by the misfolding and polymerisation of the alpha-1 antitrypsin (AAT) protein within hepatocytes. The relevance of circulating polymers (CP) of AAT in the pathogenesis of lung and liver disease is not completely understood. Therefore, the main objective of our study was to determine whether there is an association between the levels of CP of AAT and the severity of lung and liver disease.

Method

This was a cross-sectional study in patients with different phenotypes of AATD and controls. To quantify CP, a sandwich ELISA was performed using the 2C1 monoclonal antibody against AAT polymers. Sociodemographic data, clinical characteristics, and liver and lung parameters were collected.

Results

A cohort of 70 patients was recruited: 32 Pi*ZZ (11 on augmentation therapy); 29 Z-heterozygous; 9 with other genotypes. CP were compared with a control group of 47 individuals (35 Pi*MM and 12 Pi*MS). ZZ patients had the highest concentrations of CP (p < 0.001) followed by Z heterozygous. The control group and patients with Pi*SS and Pi*SI had the lowest CP concentrations. Pi*ZZ also had higher levels of liver stiffness measurements (LSM) than the remaining AATD patients. Among patients with one or two Z alleles, two patients with lung and liver impairment showed the highest concentrations of CP (47.5 µg/mL), followed by those with only liver abnormality (n = 6, CP = 34 µg/mL), only lung (n = 18, CP = 26.5 µg/mL) and no abnormalities (n = 23, CP = 14.3 µg/mL). Differences were highly significant (p = 0.004).

Conclusions

Non-augmented Pi*ZZ and Z-patients with impaired lung function and increased liver stiffness presented higher levels of CP than other clinical phenotypes. Therefore, CP may help to identify patients more at risk of developing lung and liver disease and may provide some insight into the mechanisms of disease.