bluuebunny/crossref_metadata_2025 huggingface dataset:
Morbidity and psychomotor development of offspring of women with gestational diabetes: a 5-year follow-up
Authors: Bartáková Vendula , Barátová Beáta , Chalásová Katarína , Janků Petr , Kaňková Kateřina
Published: August 2022

Background

Gestational diabetes mellitus (GDM) represents a risk factor for both mother and her offspring in a short-term (perinatal morbidity) and long-term horizon (postpartum diabetes or foetal programming). Several studies focused at peri/postnatal outcomes of GDM mother´s offspring, however relatively few (and none in Czech population) were designed as prospective. The aim of the study was to ascertain eventual anthropometric and developmental abnormalities and/or morbidity in offspring of GDM mothers compare to controls in a 5-year follow-up using a parent-reported parameters related to psychomotor development and common paediatric morbidities including a sub-study of offspring of GDM mothers experiencing adverse perinatal outcomes.

Methods

A 5 year follow up study of offspring of GDM mothers (n = 26) vs those with a normal pregnancy (n = 63). An electronic questionnaire was used to obtain the parameters (such as growth, psychomotor development, vaccination, morbidity history etc.) available to parents from the parent-held infant health record. Data on pregnancy and delivery were available from the previous study.

Results

Offspring of GDM mothers had delayed psychomotor development in early childhood, but in 5 years of age they seemed to gradually achieve results of a control group. Children with macrosomia had a higher percentile of weight-for-height and were significantly more frequently ill than those with a normal birth weight. Offspring of obese mothers had worse verbal language skills in early childhood and a higher percentile of weight-for-height.

Conclusion

Maternal gestational diabetes and obesity can be considered an important determinant of postnatal offspring development and health status, which further advocates for broader implementation of preventive strategies.
Alcohol consumption and tobacco exposure among pregnant women in Ibadan, Nigeria
Authors: Adeoye Ikeola A.
Published: August 2022

Background

Alcohol consumption and tobacco exposure during pregnancy are hazardous behaviours which are increasing significantly in low and middle-income countries, including sub-Saharan Africa. However, they have received little attention in Nigeria’s maternal health research and services. The prevalence, pattern and predictors of alcohol consumption and tobacco exposure among pregnant women in Ibadan, Nigeria, were investigated.

Methods

This is a part of a prospective cohort study among pregnant women in Ibadan, Nigeria (Ibadan Pregnancy Cohort Study (IbPCS), which investigated the associations between maternal obesity, lifestyle characteristics and perinatal outcomes in Ibadan. Alcohol consumption and tobacco exposure of 1745 pregnant women were assessed during enrollment by self-reports using an interviewer-administered questionnaire. Bivariate and multiple logistic regression analyses examined the associations at a 5% level of statistical significance.

Results

The prevalence of pre-pregnancy alcohol consumption and alcohol consumption during pregnancy were 551 (31.7%) and 222 (12.7%), respectively, i.e. (one in every eight pregnancies is exposed to alcohol). Palm wine (52%) and beer (12%) were the most common alcohol consumed among pregnant women. The predictors of alcohol consumption during were pre-pregnancy alcohol use [AOR = 10.72, 95% CI: 6.88–16.70) and religion i.e. Muslims were less likely to consume alcohol during pregnancy compared to Christians: [AOR = 0.60, 95% CI: 0.40–0.92). The prevalence of tobacco exposure in the index pregnancy was 64 (3.7%), i.e. one in every 27 pregnancies is exposed to tobacco. In contrast, cigarette smoking, second-hand smoke and smokeless tobacco were 0.4, 1.7 and 1.8%, respectively. Pre-pregnancy cigarette smoking was reported by 33(1.9%) and was the most significant predictor [AOR = 12.95; 95% CI: 4.93, 34.03) of tobacco exposure during pregnancy in our study population.

Conclusions

Alcohol consumption and tobacco exposure are not uncommon and have been an ongoing but neglected threat to maternal and child health in Nigeria. Alcohol and tobacco control policy and programmes to prevent the use among pregnant and reproductive-age women in Nigeria should be implemented primarily during antenatal care.
The role of the livestock auction mart in promoting help-seeking behavior change among farmers in the UK
Authors: Nye Caroline , Winter Michael , Lobley Matt
Published: August 2022

Certain physical and mental health issues are particularly prevalent in farming occupations, yet frequently, farmers, particularly males, are resistant to seeking help from primary care practitioners. A qualitative approach examined the perspective of stakeholders at livestock auction marts to identify the determinants for, or barriers to, seeking help, perceptions regarding basing primary care services on-site at livestock auction marts, and the role of a site-based approach, i.e. placing primary healthcare services within a traditional farmers’ meeting place, in facilitating changes in help-seeking beliefs and behaviors. Findings support previous studies regarding barriers to seeking help, but demonstrate that by deconstructing these barriers through specifically designed workplace/site-oriented support services, more positive behaviors are facilitated. The study highlights how collaboration between livestock auction marts and primary healthcare services allows access to a hard-to-reach demographic in terms of healthcare, and illustrates how such socially integrative opportunities can contribute to the improvement of the mental and physical health and wellbeing of the agricultural community.
Habit formation of preventive behaviours during the COVID-19 pandemic: a longitudinal study of physical distancing and hand washing
Authors: Zhang Chao , Adriaanse Marieke A. , Potgieter Renske , Tummers Lars , de Wit John , Broersen Jan , de Bruin Marijn , Aarts Henk
Published: August 2022

Background

Since the outbreak of the COVID-19 pandemic, physical distancing and hand washing have been used as effective means to reduce virus transmission in the Netherlands. However, these measures pose a societal challenge as they require people to change their customary behaviours in various contexts. The science of habit formation is potentially useful for informing policy-making in public health, but the current literature largely overlooked the role of habit in predicting and explaining these preventive behaviours. Our research aimed to describe habit formation processes of physical distancing and hand washing and to estimate the influences of habit strength and intention on behavioural adherence.

Methods

A longitudinal survey was conducted between July and November 2020 on a representative Dutch sample (n = 800). Respondents reported their intentions, habit strengths, and adherence regarding six context-specific preventive behaviours on a weekly basis. Temporal developments of the measured variables were visualized, quantified, and mapped onto five distinct phases of the pandemic. Regression models were used to test the effects of intention, habit strength, and their interaction on behavioural adherence.

Results

Dutch respondents generally had strong intentions to adhere to all preventive measures and their adherence rates were between 70% and 90%. They also self-reported to experience their behaviours as more automatic over time, and this increasing trend in habit strength was more evident for physical-distancing than for hand washing behaviours. For all six behaviours, both intention and habit strength predicted subsequent adherence (all ps < 2e-16). In addition, the predictive power of intention decreased over time and was weaker for respondents with strong habits for physical distancing when visiting supermarkets (B = -0.63, p <.0001) and having guests at home (B = -0.54, p <.0001) in the later phases of the study, but not for hand washing.

Conclusions

People’s adaptations to physical-distancing and hand washing measures involve both intentional and habitual processes. For public health management, our findings highlight the importance of using contextual cues to promote habit formation, especially for maintaining physical-distancing practices. For habit theories, our study provides a unique dataset that covers multiple health behaviours in a critical real-world setting.
Lay perceptions of diabetes mellitus and prevention costs and benefits among adults undiagnosed with the condition in Singapore: a qualitative study
Authors: Hashim Jumana , Smith Helen Elizabeth , Tai E Shyong , Yi Huso
Published: August 2022

Background

Therapeutic lifestyle changes can reduce individual risk of type 2 diabetes (T2D) by up to 58%. In Singapore, rates of preventive practices were low, despite a high level of knowledge and awareness of T2D risk and prevention. The study explored the context of the discrepancy between knowledge and practices in T2D prevention among adults undiagnosed with the condition.

Methods

In-depth interviews with 41 adults explored lay beliefs of T2D and the sources of these perceptions, subjective interpretation of how T2D may impact lives, and perceived costs and benefits of practising preventative behaviours. Purposive sampling was used to maximise the variability of participants in demographic characteristics. Thematic analysis was conducted to identify themes related to the domains of inquiry.

Results

Participants’ risk perceptions were influenced by familial, social, and cultural contexts of the representation and management of T2D conditions. The adverse effects of T2D were often narrated in food culture. The cost of adopting a healthy diet was perceived at a high cost of life pleasure derived from food consumption and social interactions. Inconveniences, loss of social functions, dependency and distress were the themes related to T2D management. Participants’ motivation to preventive practices, such as exercise and weight loss, were influenced by short-term observable benefits.

Conclusions

T2D risk communication needs to be addressed in emotionally impactful and interpersonally salient ways to increase the urgency to adopt preventative behaviours. Shifting perceived benefits from long-term disease prevention to short-term observable wellbeing could reduce the response cost of healthy eating.
Abnormal TNS3 gene methylation in patients with congenital scoliosis
Authors: Wu YuanTao , Zhang Hong-qi , Tang Mingxing , Guo Chaofeng , Liu Shaohua , Li Jiong , Wang Yunjia , Xiao Lige , Yang Guanteng
Published: August 2022

Background

Congenital scoliosis (CS) is a congenital deformity of the spine resulting from abnormal and asymmetrical development of vertebral bodies during pregnancy. However, the etiology and mechanism of CS remain unclear. Epigenetics is the study of heritable variations in gene expression outside of changes in nucleotide sequence. Among these, DNA methylation was described first and is the most characteristic and most stable epigenetic mechanism. Therefore, in this study, we aim to explore the association between genome methylation and CS which are not been studied before.

Methods

Two pairs of monozygotic twins were included, with each pair involving one individual with and one without CS. Agilent SureSelect XT Human Methyl-Sequencing was used for genome methylation sequencing. MethylTarget was used to detect methylation levels in target regions. Immunohistochemistry was performed to visualize expression of associated genes in candidate regions.

Results

A total of 75 differentially methylated regions were identified, including 24 with an increased methylation level and 51 with a decreased methylation level in the CS group. Nine of the differentially methylated regions were selected (TNS3,SEMAC3,GPR124,MEST,DLK1,SNTG1,PPIB,DEF8, andGRHL2). The results showed that the methylation level of the promoter region ofTNS3was 0.72 ± 0.08 in the CS group and 0.43 ± 0.06 in the control group (p = 0.00070 < 0.01). There was no significant difference in the degree of methylation ofSEMAC3,GPR124,MEST,DLK1,SNTG1,PPIB,DEF8, orGRHL2between the two groups. Immunohistochemistry showed significantly decreased TNS3 expression in the cartilage of the articular process in CS (CS: 0.011 ± 0.002; control: 0.018 ± 0.006,P = 0.003 < 0.01).

Conclusion

Compared with the control group, high-level methylation of theTNS3promoter region and low TNS3 expression in the cartilage layer of the articular process characterize CS. Thus, DNA methylation and TNS3 may play important roles in the pathogenesis of CS.
Spontaneous resolution of asymptomatic alumina matrix composite ceramic liner dissociation: a case report
Authors: Xiao He , Wang Jian , Zheng Nian-Ye , Shi Zhan-Jun
Published: August 2022

Background

Total hip arthroplasty(THA)is widely used to treat end-stage hip disorders. Ceramic-on-ceramic total hip prostheses are widely used because of their durability. Alumina matrix composite (AMC), known as the fourth-generation ceramics, reduces implant fracture and wear rate compared to their predecessors. However, ceramic acetabular liner dissociation is a complication that necessitates revision of the AMC prostheses. To date, only few cases of AMC liner dissociation have been reported and all of which have been treated with revision surgery. Therefore, the prognosis of non-operated AMC liner dissociation remains unknown so far.

Case presentation

A 57-year-old man with avascular necrosis of the femoral head was treated with THA, wherein a Pinnacle® (DePuy, J&J, Warsaw, IN) acetabular cup and AMC liner were implanted. Intraoperative examination confirmed proper seating of the liner, whereas the initial postoperative radiograph revealed liner dissociation. The patient refused surgical revision due to the absence of symptoms and was discharged and followed-up. The patient made an uneventful recovery, and radiographic follow-up at 6-month post-operation showed that the liner was re-seated to its right position. No clinical or radiographic anomaly was found at the 15-month of postoperative follow-up.

Conclusions

Here, we report an unprecedented case of AMC ceramic liner dissociation with spontaneous resolution. This case shows that ceramic liner dissociation could be asymptomatic, and careful postoperative examination of the patient is important. Spontaneous resolution is possible, but the underlying mechanism and the eligible patient to benefit from it must be investigated. Before clarifying these questions, revision surgery should be the first-line treatment.
Novel Gerota-edge-sling technique facilitates retroperitoneal robot-assisted partial nephrectomy: a comparative study
Authors: Chen Wei , Fang Qixiang , Ren Haomin , Ma Lei , Zeng Jin , Ding Shangshu , Wu Dapeng
Published: August 2022

Background

Retroperitoneal robotic partial nephrectomy is markedly restricted by limited space and visual field. We introduced a novel Gerota-edge-sling (GES) technique with self-designed traction devices to overcome these defects by attaching Gerota fascia to abdominal wall, and comparatively evaluated its utilization with routine technique.

Methods

A retrospective analysis was performed for consecutive patients who underwent routine (control group) or GES assisted (GES group) retroperitoneal robotic partial nephrectomy for localized renal tumors in our hospital between March 2018 and June 2020. Clinical data of perioperative outcomes and complications were collected and compared. Comparison of outcomes between anterior versus posterior tumor subgroups was also conducted. Linear regression analysis was used to define the relationship between dissection time and perinephric fat status in each group.

Results

Totally 103 patients were included, 48 in control and 55 in GES group respectively. All the procedures were completed successfully without conversion or positive surgical margin. GES group had significantly decreased console time (91 ± 36 min vs. 117 ± 41 min, p < 0.01) and dissection time (67 ± 35 min vs. 93 ± 38 min, p < 0.01) than control, while ischemia time, blood loss, and nephrometry score comparable between them. No major postoperative complications occurred. Dissection time of GES group was notably shorter than that of control in both anterior/posterior subgroups. Only in control group, dissection time was positively associated with perinephric fat status.

Conclusions

The GES technique acting as an adjunct to robotic arms with space-sparing feature, notably improves surgical exposure and facilitates dissection in retroperitoneal partial nephrectomy, while having great feasibility, efficacy and safety.
Tislelizumab in combination with gemcitabine plus cisplatin chemotherapy as first-line adjuvant treatment for locally advanced or metastatic bladder cancer: a retrospective study
Authors: Ren Xiang , Tian Yiqun , Wang Zhixian , Wang Jing , Li Xing , Yin Yisheng , Chen Ruibao , Zhan Ying , Zeng Xiaoyong
Published: August 2022

Background

Combining immune checkpoint inhibitors with chemotherapy can synergistically improve antitumor activity and are generally well tolerated. Recently, the efficacy and safety of combination therapy has been demonstrated for many cancers, including urothelial carcinomas. The aim of this retrospective pilot study was to evaluate the efficacy and safety of tislelizumab plus chemotherapy as first-line adjuvant treatment for locally advanced or metastatic bladder cancer.

Methods

We conducted a retrospective analysis of 31 patients with locally advanced or metastatic bladder cancer from December 2020 to January 2022 with an Eastern Cooperative Oncology Group performance status of 0/1. Of the 31 patients, 14 patients received tislelizumab (200 mg i.v. every 3 weeks, Q3W) plus 21 days cycles of chemotherapy (gemcitabine, 1000 mg/m2 i.v. on days 1 and 8 of each cycle + cisplatin, 70 mg/m2 i.v. on day 2 of each cycle) (TGC) treatment and 17 patients received gemcitabine plus cisplatin chemotherapy (GC) treatment. All patients treated with bladder cytoreductive surgery and were treated for four 21 days cycles until disease progression or intolerable treatment-related adverse events (TRAEs). The objective progression-free survival (PFS), overall survival (OS), overall response rate (ORR), disease control rate (DCR), clinical benefit rate (CBR) and TRAEs were recorded and reviewed.

Results

As of the cut-off date (March 25, 2022), PFS, OS, ORR, DCR, CBR and TRAEs were evaluated in 14 patients receiving combination therapy and 17 patients in the chemotherapy alone group. The median PFS was 36.0 [95% confidence interval (CI) 33.1–38.9] weeks in the TGC group and 29.0 (95% CI 25.4–32.6) weeks in the GC group [hazard ratio (HR) 0.15 (95% CI 0.04–0.55)]. In the GC group, the median OS was 48.0 (95% CI 39.7–56.3) weeks; the median OS was not yet mature for the TGC group [HR 0.26 (95% CI 0.07–0.94)]. Treatment with TGC resulted in improved DCR (TGC 71.4%; GC 65.0%) and CBR (TGC 64.3%; GC 52.9%) compared with GC. However, although higher incidences of grade ≥ 3 TRAEs were observed with TGC compared with GC (35.7% vs 23.5%), the difference was not statistically significant (p = 0.47).

Conclusion

This study suggested that TGC provided survivors of locally advanced or metastatic bladder cancer with encouraging antitumor activity and was generally well tolerated.
The perirenal fat thickness was independently associated with serum uric acid level in patients with type 2 diabetes mellitus
Authors: Yang Yuxian , Ma Yan , Cheng Yanan , Xu Yuechao , Fang Yuan , Ke Jing , Zhao Dong
Published: August 2022

Background

Obesity is an important risk factor for hyperuricemia. We aimed to explore the relationship between perirenal fat thickness (PrFT) and paranephric fat thickness (PnFT) and serum uric acid (SUA) in patients with type 2 diabetes mellitus (T2DM).

Methods

This was a cross-sectional study involving 257 patients with T2DM recruited from Beijing Luhe Hospital from September 2019 to May 2020. The basic and clinical information such as age, gender, duration of diabetes was collected through the medical records. All patients underwent a physical examination including height, weight, waist circumference, hip circumference, systolic blood pressures and diastolic blood pressure. The venous blood and urine samples were collected to measure SUA, fasting blood glucose, total cholesterol, triglyceride, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, serum creatinine, blood urea nitrogen and glycosylated hemoglobin. PrFT and PnFT were measured via ultrasonography. Pearson correlation test and linear regression analysis were used to analyze the association between PrFT and PnFT and SUA.

Results

We found that PrFT and PnFT increased according to the tertiles of SUA level (P = 0.001 and P = 0.009, respectively). In addition, the PrFT and PnFT were positively associated with SUA level (r = 0.25, P < 0.001, r = 0.23, P < 0.001, respectively). Moreover, this association was stronger in males, non-obesity patients and patients with normal renal function. In the multivariate analysis, the PrFT was independently associated with SUA level after adjusting confounding factors.

Conclusions

The PrFT was independently associated with SUA level in patients with T2DM.
Self-reported lifestyle behaviours in families with an increased risk for type 2 diabetes across six European countries: a cross-sectional analysis from the Feel4Diabetes-study
Authors: De Craemer Marieke , Van Stappen Vicky , Brondeel Ruben , Iotova Violeta , Chakarova Nevena , Rurik Imre , Lindström Jaana , Kivelä Jemina , Moreno Luis Alberto , Mavrogianni Christina , Manios Yannis , Cardon Greet
Published: August 2022

Background

A healthy lifestyle decreases the risk of developing type 2 diabetes mellitus. The current cross-sectional study aimed to describe self-reported lifestyle behaviours and compare them to current health guidelines in European Feel4Diabetes-families at risk for developing type 2 diabetes across six countries (Belgium, Finland, Spain, Greece, Hungary and Bulgaria).

Methods

Parents and their children were recruited through primary schools located in low socio-economic status areas. Parents filled out the FINDRISC-questionnaire (eight items questioning age, Body Mass Index, waist circumference, PA, daily consumption of fruit, berries or vegetables, history of antihypertensive drug treatment, history of high blood glucose and family history of diabetes), which was used for the risk assessment of the family. Sociodemographic factors and several lifestyle behaviours (physical activity, sedentary behaviour, water consumption, fruit and vegetable consumption, soft drink consumption, sweets consumption, snack consumption, breakfast consumption) of both adults and children were assessed by parental questionnaires. Multilevel regression analyses were conducted to investigate families’ lifestyle behaviours, to compare these levels to health guidelines and to assess potential differences between the countries. Analyses were controlled for age, sex and socio-economic status.

Results

Most Feel4Diabetes-families at risk (parents and their children) did not comply with the guidelines regarding healthy behaviours, set by the WHO, European or national authorities. Less than half of parents and children complied with the physical activity guidelines, less than 15% of them complied with the fruit and vegetable guideline, and only 40% of the children met the recommendations of five glasses of water per day. Clear differences in lifestyle behaviours in Feel4Diabetes-families at risk exist between the countries.

Conclusions

Countries are highly recommended to invest in policy initiatives to counter unhealthy lifestyle behaviours in families at risk for type 2 diabetes development, taking into account country-specific needs. For future research it is of great importance to focus on families at risk in order to counter the development of type 2 diabetes and reduce health inequity.
The effect of preoperative sodium-glucose cotransporter 2 inhibitors on the incidence of perioperative metabolic acidosis: A retrospective cohort study
Authors: Iwasaki Yudai , Sasabuchi Yusuke , Horikita Sho , Furukawa Taku , Shiotsuka Junji , Lefor Alan Kawarai , Sanui Masamitsu
Published: August 2022

Background

Sodium-glucose cotransporter 2 inhibitors are a novel class of anti-hyperglycemic agents. Although several cases of perioperative euglycemic diabetic ketoacidosis have been linked to these medications, the association remains unclear. This study aimed to examine the association between sodium-glucose cotransporter 2 inhibitor use and the incidence of perioperative metabolic acidosis with euglycemia, the surrogating outcome of perioperative euglycemic diabetic ketoacidosis.

Method

This was a retrospective, matched cohort study, which was conducted in the intensive care unit of a tertiary care facility in Japan. We identified patients aged 20 years or older with diabetes mellitus who received pharmacologic therapy and were admitted to the intensive care unit after elective surgery between April 2014 and March 2019. We extracted the following data from the electronic medical record for matching: age, sex, surgery year, surgical site, hemoglobin A1c level, and prescription for sodium-glucose cotransporter 2 inhibitors.

Eligible patients were divided into two groups, those who were prescribed sodium-glucose cotransporter 2 inhibitors (SGLT2-i group) and those who were not (control group). For each patient in the SGLT2-i group, we randomly selected four patients from the control group matched for the extracted characteristics. The primary outcome was the incidence of metabolic acidosis with an elevated anion gap and euglycemia. The secondary outcome was the lowest pH value of each patient during their ICU stay.

Results

A total of 155 patients were included in this study. Patients receiving sodium-glucose cotransporter 2 inhibitors had comparable characteristics to control participants; however, the proportions of patients undergoing dialysis were not similar. Metabolic acidosis with euglycemia was seen in 7/31 (22.6%) patients receiving sodium-glucose cotransporter 2 inhibitors and in 10/124 (8.1%) control patients (p = 0.047).

Conclusions

This study shows that the use of sodium-glucose cotransporter 2 inhibitors is associated with a significantly higher incidence of metabolic acidosis with euglycemia. Patients receiving sodium-glucose cotransporter 2 inhibitors who are scheduled to undergo invasive surgical procedures should be closely monitored for the development of euglycemic diabetic ketoacidosis.
Simulation applications to support teaching and research in epidemiological dynamics
Authors: Getz Wayne M , Salter Richard , Vissat Ludovica Luisa
Published: August 2022

Background

An understanding of epidemiological dynamics, once confined to mathematical epidemiologists and applied mathematicians, can be disseminated to a non-mathematical community of health care professionals and applied biologists through simple-to-use simulation applications. We used Numerus Model Builder RAMP Ⓡ (Runtime Alterable Model Platform) technology, to construct deterministic and stochastic versions of compartmental SIR (Susceptible, Infectious, Recovered with immunity) models as simple-to-use, freely available, epidemic simulation application programs.

Results

We take the reader through simulations used to demonstrate the following concepts: 1) disease prevalence curves of unmitigated outbreaks have a single peak and result in epidemics that ‘burn’ through the population to become extinguished when the proportion of the susceptible population drops below a critical level; 2) if immunity in recovered individuals wanes sufficiently fast then the disease persists indefinitely as an endemic state, with possible dampening oscillations following the initial outbreak phase; 3) the steepness and initial peak of the prevalence curve are influenced by the basic reproductive value R0, which must exceed 1 for an epidemic to occur; 4) the probability that a single infectious individual in a closed population (i.e. no migration) gives rise to an epidemic increases with the value of R0>1; 5) behavior that adaptively decreases the contact rate among individuals with increasing prevalence has major effects on the prevalence curve including dramatic flattening of the prevalence curve along with the generation of multiple prevalence peaks; 6) the impacts of treatment are complicated to model because they effect multiple processes including transmission, recovery and mortality; 7) the impacts of vaccination policies, constrained by a fixed number of vaccination regimens and by the rate and timing of delivery, are crucially important to maximizing the ability of vaccination programs to reduce mortality.

Conclusion

Our presentation makes transparent the key assumptions underlying SIR epidemic models. Our RAMP simulators are meant to augment rather than replace classroom material when teaching epidemiological dynamics. They are sufficiently versatile to be used by students to address a range of research questions for term papers and even dissertations.
Machine learning-based prediction of fainting during blood donations using donor properties and weather data as features
Authors: Suessner Susanne , Niklas Norbert , Bodenhofer Ulrich , Meier Jens
Published: August 2022

Background and objectives

Fainting is a well-known side effect of blood donation. Such adverse experiences can diminish the return rate for further blood donations. Identifying factors associated with fainting could help prevent adverse incidents during blood donation.

Materials and methods

Data of 85,040 blood donations from whole blood and apheresis donors within four consecutive years were included in this retrospective study. Seven different machine learning models (random forests, artificial neural networks, XGradient Boosting, AdaBoost, logistic regression, K nearest neighbors, and support vector machines) for predicting fainting during blood donation were established. The used features derived from the data obtained from the questionnaire every donor has to fill in before the donation and weather data of the day of the donation.

Results

One thousand seven hundred fifteen fainting reactions were observed in 228 846 blood donations from 88,003 donors over a study period of 48 months. Similar values for all machine learning algorithms investigated for NPV, PPV, AUC, and F1-score were obtained. In general, NPV was above 0.996, whereas PPV was below 0.03. AUC and F1-score were close to 0.9 for all models. Essential features predicting fainting during blood donation were systolic and diastolic blood pressure and ambient temperature, humidity, and barometric pressure.

Conclusion

Machine-learning algorithms can establish prediction models of fainting in blood donors. These new tools can reduce adverse reactions during blood donation and improve donor safety and minimize negative associations relating to blood donation.
Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy
Authors: Green Sophie M. C. , French David P. , Graham Christopher D. , Hall Louise H. , Rousseau Nikki , Foy Robbie , Clark Jane , Parbutt Catherine , Raine Erin , Gardner Benjamin , Velikova Galina , Moore Sally J. L. , Buxton Jacqueline ,   ROSETA investigators, Collinson Michelle , Ellison Rachel , Wilkes Hollie , Hartley Suzanne , Mason Ellen , Farrin Amanda , Walwyn Rebecca , Waller Jo , Howdon Daniel , Metherell Jamie , Smith Samuel G.
Published: August 2022

Background

Adjuvant endocrine therapy (AET) reduces the risk of breast cancer recurrence and mortality. However, up to three-quarters of women with breast cancer do not take AET as prescribed. Existing interventions to support adherence to AET have largely been unsuccessful, and have not focused on the most salient barriers to adherence. This paper describes the process of developing four theory-based intervention components to support adherence to AET. Our aim is to provide an exemplar of intervention development using Intervention Mapping (IM) with guidance from the Multiphase Optimisation Strategy (MOST).

Methods

Iterative development followed the six-stage IM framework with stakeholder involvement. Stage 1 involved a literature review of barriers to adherence and existing interventions, which informed the intervention objectives outlined in Stage 2. Stage 3 identified relevant theoretical considerations and practical strategies for supporting adherence. Stage 4 used information from Stages 1-3 to develop the intervention components. Stages 1-4 informed a conceptual model for the intervention package. Stages 5 and 6 detailed implementation considerations and evaluation plans for the intervention package, respectively.

Results

The final intervention package comprised four individual intervention components: Short Message Service to encourage habitual behaviours surrounding medication taking; an information leaflet to target unhelpful beliefs about AET; remotely delivered Acceptance and Commitment Therapy-based guided self-help to reduce psychological distress; and a website to support self-management of AET side-effects. Considerations for implementation within the NHS, including cost, timing and mode of delivery were outlined, with explanation as to how using MOST can aid this. We detail our plans for the final stage of IM which involve feasibility testing. This involved planning an external exploratory pilot trial using a 24-1fractional factorial design, and a process evaluation to assess acceptability and fidelity of intervention components.

Conclusions

We have described a systematic and logical approach for developing a theoretically informed intervention package to support medication adherence in women with breast cancer using AET. Further research to optimise the intervention package, guided by MOST, has the potential to lead to more effective, efficient and scalable interventions.
Optimising acute stroke pathways through flexible use of bed capacity: a computer modelling study
Authors: Wood Richard M. , Moss Simon J. , Murch Ben J. , Vasilakis Christos , Clatworthy Philip L.
Published: August 2022

Background

Optimising capacity along clinical pathways is essential to avoid severe hospital pressure and help ensure best patient outcomes and financial sustainability. Yet, typical approaches, using only average arrival rate and average lengths of stay, are known to underestimate the number of beds required. This study investigates the extent to which averages-based estimates can be complemented by a robust assessment of additional ‘flex capacity’ requirements, to be used at times of peak demand.

Methods

The setting was a major one million resident healthcare system in England, moving towards a centralised stroke pathway. A computer simulation was developed for modelling patient flow along the proposed stroke pathway, accounting for variability in patient arrivals, lengths of stay, and the time taken for transfer processes. The primary outcome measure was flex capacity utilisation over the simulation period.

Results

For the hyper-acute, acute, and rehabilitation units respectively, flex capacities of 45%, 45%, and 36% above the averages-based calculation would be required to ensure that only 1% of stroke presentations find the hyper-acute unit full and have to wait. For each unit some amount of flex capacity would be required approximately 30%, 20%, and 18% of the time respectively.

Conclusions

This study demonstrates the importance of appropriately capturing variability within capacity plans, and provides a practical and economical approach which can complement commonly-used averages-based methods. Results of this study have directly informed the healthcare system’s new configuration of stroke services.
K205R specific nanobody-horseradish peroxidase fusions as reagents of competitive ELISA to detect African swine fever virus serum antibodies
Authors: Zhang Angke , Wu Shuya , Duan Xiaohong , Zhao Huijun , Dong Haoxin , Ren Jiahui , Zhang Mingfang , Li Jiaji , Duan Hong , Zhang Gaiping
Published: August 2022

Background

African swine fever virus (ASFV) is a highly contagious hemorrhagic disease and often lethal, which has significant economic consequences for the swine industry. Due to lacking of commercial vaccine, the prevention and control of ASF largely depend on early large-scale detection and screening. So far, the commercial ELISA kits have a long operation time and are expensive, making it difficult to achieve large-scale clinical applications. Nanobodies are single-domain antibodies produced by camelid animals, and have unique advantages such as smaller molecular weight, easy genetic engineering modification and low-costing of mass production, thus exhibiting good application prospects.

Results

The present study developed a new method for detection of ASFV specific antibodies using nanobody-horseradish peroxidase (Nb-HRP) fusion proteins as probe. By using camel immunization, phage library construction and phage display technology, five nanobodies against K205R protein were screened. Then, Nb-HRP fusion proteins were produced using genetic modification technology. Based on the Nb-HRP fusion protein as specific antibodies against K205R protein, a new type of cELISA was established to detect ASFV antibodies in pig serum. The cut-off value of the cELISA was 34.8%, and its sensitivity, specificity, and reproducibility were good. Furthermore, the developed cELISA exhibited 99.3% agreement rate with the commercial available ELISA kit (kappa value = 0.98).

Conclusions

The developed cELISA method has the advantages of simple operation, rapid and low-costing, and can be used for monitoring of ASFV infection in pigs, thus providing a new method for the prevention and control of ASF.
Costs of treating childhood malaria, diarrhoea and pneumonia in rural Mozambique and Uganda
Authors: Batura Neha , Kasteng Frida , Condoane Juliao , Bagorogosa Benson , Castel-Branco Ana Cristina , Kertho Edmound , Källander Karin , Soremekun Seyi , Lingam Raghu , Vassall Anna ,   the inSCALE study group, Tibenderana James , Meek Sylvia , Hill Zelee , Strachan Daniel , Ayebale Godfrey , Nakirunda Maureen , Counihan Helen , Ndima Sozinho , Muiambo Abel , Salomao Nelson , Kirkwood Betty
Published: August 2022

Background

Globally, nearly half of all deaths among children under the age of 5 years can be attributed to malaria, diarrhoea, and pneumonia. A significant proportion of these deaths occur in sub-Saharan Africa. Despite several programmes implemented in sub-Saharan Africa, the burden of these illnesses remains persistently high. To mobilise resources for such programmes it is necessary to evaluate their costs, costs-effectiveness, and affordability. This study aimed to estimate the provider costs of treating malaria, diarrhoea, and pneumonia among children under the age of 5 years in routine settings at the health facility level in rural Uganda and Mozambique.

Methods

Service and cost data was collected from health facilities in midwestern Uganda and Inhambane province, Mozambique from private and public health facilities. Financial and economic costs of providing care for childhood illnesses were investigated from the provider perspective by combining a top-down and bottom-up approach to estimate unit costs and annual total costs for different types of visits for these illnesses. All costs were collected in Ugandan shillings and Mozambican meticais. Costs are presented in 2021 US dollars.

Results

In Uganda, the highest number of outpatient visits were for children with uncomplicated malaria and of inpatient admissions were for respiratory infections, including pneumonia. The highest unit cost for outpatient visits was for pneumonia (and other respiratory infections) and ranged from $0.5 to 2.3, while the highest unit cost for inpatient admissions was for malaria ($19.6). In Mozambique, the highest numbers of outpatient and inpatient admissions visits were for malaria. The highest unit costs were for malaria too, ranging from $2.5 to 4.2 for outpatient visits and $3.8 for inpatient admissions. The greatest contributors to costs in both countries were drugs and diagnostics, followed by staff.

Conclusions

The findings highlighted the intensive resource use in the treatment of malaria and pneumonia for outpatient and inpatient cases, particularly at higher level health facilities. Timely treatment to prevent severe complications associated with these illnesses can also avoid high costs to health providers, and households.

Trial registration: ClinicalTrials.gov, identifier: NCT01972321.
Disease-specific distress healthcare financing and catastrophic out-of-pocket expenditure for hospitalization in Bangladesh
Authors: Sheikh Nurnabi , Sarker Abdur Razzaque , Sultana Marufa , Mahumud Rashidul Alam , Ahmed Sayem , Islam Mohammad Touhidul , Howick Susan , Morton Alec
Published: August 2022

Background

Financial risk protection and equity are two fundamental components of the global commitment to achieve Universal Health Coverage (UHC), which mandates health system reform based on population needs, disease incidence, and economic burden to ensure that everyone has access to health services without any financial hardship. We estimated disease-specific incidences of catastrophic out-of-pocket health expenditure and distress financing to investigate progress toward UHC financial risk indicators and investigated inequalities in financial risk protection indicators by wealth quintiles. In addition, we explored the determinants of financial hardship indicators as a result of hospitalization costs.

Methods

In order to conduct this research, data were extracted from the latest Bangladesh Household Income and Expenditure Survey (HIES), conducted by the Bangladesh Bureau of Statistics in 2016–2017. Financial hardship indicators in UHC were measured by catastrophic health expenditure and distress financing (sale/mortgage, borrowing, and family support). Concentration curves (CC) and indices (CI) were estimated to measure the pattern and severity of inequalities across socio-economic classes. Binary logistic regression models were used to assess the determinants of catastrophic health expenditure and distress financing.

Results

We found that about 26% of households incurred catastrophic health expenditure (CHE) and 58% faced distress financing on hospitalization in Bangladesh. The highest incidence of CHE was for cancer (50%), followed by liver diseases (49.2%), and paralysis (43.6%). The financial hardship indicators in terms of CHE (CI = -0.109) and distress financing (CI = -0.087) were more concentrated among low-income households. Hospital admission to private health facilities, non-communicable diseases, and the presence of chronic patients in households significantly increases the likelihood of higher UHC financial hardship indicators.

Conclusions

The study findings strongly suggest the need for national-level social health security schemes with a particular focus on low-income households, since we identified greater inequalities between low- and high-income households in UHC financial hardship indicators. Regulating the private sector and implementing subsidized healthcare programmes for diseases with high treatment costs, such as cancer, heart disease, liver disease, and kidney disease are also expected to be effective to protect households from financial hardship. Finally, in order to reduce reliance on OOPE, the government should consider increasing its allocations to the health sector.
HIV prevalence and continuum of care among incarcerated people in Iran from 2010 to 2017
Authors: Shahesmaeili Armita , Karamouzian Mohammad , Tavakoli Fatemeh , Shokoohi Mostafa , Mirzazadeh Ali , Hosseini-Hooshyar Samira , Amirzadeh Googhari Saber , Ghalekhani Nima , Khajehkazemi Razieh , Abdolahinia Zahra , Fahimfar Noushin , Haghdoost AliAkbar , Sharifi Hamid
Published: August 2022

Background

Incarcerated people are at an increased risk of contracting HIV and transmitting it to the community post-release. In Iran, HIV epidemics inside prisons were first detected in the early 1990s. We assessed the HIV prevalence and its correlates, as well as the continuum of care among incarcerated people in Iran from 2010 to 2017.

Methods

We used data collected in three national bio-behavioral surveillance surveys among incarcerated individuals in 2010 (n = 4,536), 2013 (n = 5,490), and 2017 (n = 5,785) through a multistage cluster sampling approach. HIV was tested by the ELISA method in 2010 and 2013 surveys and rapid tests in 2017. Data on demographic characteristics, risky behaviors, HIV testing, and treatment were collected via face-to-face interviews. HIV prevalence estimates along with 95% confidence intervals (CI) were reported. Using data from the 2017 round, multivariable logistic regression models were built to assess the correlates of HIV sero-positivity and conduct HIV cascade of care analysis.

Results

The HIV prevalence was 2.1% (95% CI: 1.2%, 3.6%) in 2010, 1.7% (95% CI: 1.3%, 2.1%) in 2013, and 0.8% (95% CI: 0.6%, 1.1%) in 2017 (trend P value < 0.001). Among people with a history of injection drug use, HIV prevalence was 8.1% (95% CI: 4.6%, 13.8%) in 2010, 6.3% (95% CI: 4.8%, 8.3%) in 2013, and 3.9% (95% CI: 2.7%, 5.7%) in 2017. In 2017, 64% (32 out of 50) of incarcerated people living with HIV were aware of their HIV status, of whom 45% (9 out of 20) were on antiretroviral therapy, and of whom 44% (4 out of 9) were virally suppressed (< 1000 copies/ml).

Conclusions

While HIV prevalence has decreased among incarcerated people in Iran, their engagement in the HIV continuum of care is suboptimal. Further investments in programs to link incarcerated people to HIV care and retain them in treatment are warranted.
Household costs associated with seeking malaria treatment during pregnancy: evidence from Burkina Faso and The Gambia
Authors: Duval Laetitia , Sicuri Elisa , Scott Susana , Traoré Maminata , Daabo Bunja , Tinto Halidou , Grietens Koen Peeters , d’Alessando Umberto , Schallig Henk , Mens Petra , Conteh Lesong
Published: August 2022

Background

Malaria in pregnancy remains a major health threat in sub-Saharan Africa to both expectant mothers and their unborn children. To date, there have been very few studies focused on the out of pocket costs associated with seeking treatment for malaria during pregnancy.

Methods

A cross-sectional survey was undertaken in Burkina Faso and The Gambia to estimate the direct and indirect costs associated with outpatient consultations (OP) and inpatient admissions (IP). Direct costs were broken down into medical (admission fees, drug charges, and laboratory fees), and non-medical (transportation and food). Indirect costs reflected time lost due to illness. In total, 220 pregnant women in Burkina Faso and 263 in The Gambia were interviewed about their treatment seeking decisions, expenditure, time use and financial support associated with each malaria episode.

Results

In Burkina Faso 6.7% sought treatment elsewhere before their OP visits, and 27.1% before their IP visits. This compares to 1.3% for OP and 25.92% for IP in The Gambia. Once at the facility, the average direct costs (out of pocket) were 3.91US$ for an OP visit and 15.38US$ of an IP visit in Burkina Faso, and 0.80US$ for an OP visit and 9.19US$ for an IP visit in The Gambia. Inpatient direct costs were driven by drug costs (9.27US$) and transportation costs (2.72US$) in Burkina Faso and drug costs (3.44 US$) and food costs (3.44 US$) in The Gambia. Indirect costs of IP visits, valued as the opportunity cost of time lost due to the illness, were estimated at 11.85US$ in Burkina Faso and 4.07US$ in The Gambia. The difference across the two countries was mainly due to the longer time of hospitalization in Burkina Faso compared to The Gambia. In The Gambia, the vast majority of pregnant women reported receiving financial support from family members living abroad, most commonly siblings (65%).

Conclusions

High malaria treatment costs are incurred by pregnant women in Burkina Faso and The Gambia. Beyond the medical costs of fees and drugs, costs in terms of transport, food and time are significant drivers. The role of remittances, particularly their effect on accessing health care, needs further investigation.