bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective
Authors: Sharma Sudesh Raj , Matheson Anna , Lambrick Danielle , Faulkner James , Lounsbury David W , Vaidya Abhinav , Page Rachel
Published: August 2020

Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal.

Method: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders.

Results: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use.

Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.
Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson’s disease: a multi-institutional retrospective cohort study
Authors: Kawabata Atsuyuki , Yoshii Toshitaka , Sakai Kenichiro , Hirai Takashi , Yuasa Masato , Inose Hiroyuki , Matsukura Yu , Morishita Shingo , Tomori Masaki , Torigoe Ichiro , Kusano Kazuo , Otani Kazuyuki , Arai Yoshiyasu , Shindo Shigeo , Okawa Atsushi
Published: August 2020

Background: Parkinson’s disease (PD) has been reported to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, those studies are limited, and few have made direct comparisons with patients who do not have PD.
Methods: A retrospective cohort study. We retrospectively reviewed all surgically treated ASD patients with at least a 2-year follow-up. Among them, 27 had PD (PD(+) group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients.
Results: For early complications, the PD(+) group demonstrated a higher rate of delirium than the PD(−) group. Deep vein thrombosis and pulmonary embolism rates tended to be higher in the PD(+) group. With regard to late complications, the rate of pseudarthrosis was significantly higher in the PD(+) group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD(+) group ( p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD(+) group.
Conclusion: Extra attention should be paid to perioperative complications, especially delirium and thrombosis, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of pseudarthrosis were greater in these patients.
Developing and implementing guidelines on culturally adapting the Addenbrooke’s Cognitive Examination Version III (ACE-III): A qualitative illustration
Authors: Waheed Waquas , Mirza Nadine , Waheed Muhammed Wali , Malik Abid , Panagioti Maria
Published: August 2020

Background: Cognitive tests currently used in healthcare and research settings do not account for bias in performance that arises due to cultural context. At present there are no universally accepted steps or minimum criteria for culturally adapting cognitive tests. We propose a methodology for developing specific guidelines to culturally adapt a specific cognitive test and used this to develop guidelines for the ACE-III. We then demonstrated their implementation by using them to produce an ACE-III Urdu for a British South Asian population. Methods: This was a several stage qualitative study. We combined information from our systematic review on the translation and cultural adaptation of the ACE-III with feedback from previous ACE-III adaptors. This identified steps for cultural adaptation. We formatted these into question-by-question guidelines. These guidelines, along with feedback from focus groups with potential users were used to develop ACE-III Urdu questions. Clinical experts reviewed these questions to finalise an ACE-III Urdu. Results: Our systematic review found 32 adaptations and we received feedback from seven adaptors to develop the guidelines. With these guidelines and two focus groups with 12 participants a sample ACE-III Urdu was developed. A consensus meeting of two psychiatrists with a South Asian background and familiarity with cognitive tests and cultural adaptation finalised the ACE-III Urdu. Conclusions: We developed a set of guidelines for culturally adapting the ACE-III that can be used by future adaptors for their own language or cultural context. We demonstrated how guidelines on cultural adaptation can be developed for any cognitive test and how they can be used to adapt it.
Tickborne disease awareness and protective practices among U.S. Forest Service employees from the Upper Midwest, USA
Authors: Schotthoefer Anna , Stinebaugh Kathryn , Martin Michael , Munoz-Zanzi Claudia
Published: August 2020

Background: People with occupations that require them to spend time working outdoors in suitable tick habitats are predicted to be at an increased risk for tick-borne diseases (TBDs). However, few studies have assessed the risks of outdoor employees in the United States.Methods: We conducted a cross-sectional survey to collect data on exposure to ticks and TBD infections among U.S. Forest Service employees in a high TBD incidence region of northern Wisconsin, and to examine employee knowledge, attitudes, and practices (KAPs) regarding TBDs to help guide future education and prevention programs. Chi-square contingency tables, calculations of odds ratios, and logistic regression models were used to identify associations among self-reported employee factors, the proportion of correctly answered knowledge questions, their ranked concern for TBDs, practicing preventive behaviors, and willingness to pay for protective measures. Results: Ninety-five employees completed the survey. Nearly all respondents (97%) reported recent tick exposure, with 27% reporting encountering 10 or more ticks per week during peak tick season. Employee knowledge of TBD was high (median score: 80% correct). Fifty-nine percent of respondents had high concern for TBDs, and there was high adherence to conducting body checks for ticks (83% reported always doing them), but only moderate use of tick repellents (24% reported always and 60% reported occasionally using). High concern for TBD (adjusted odds ratio (aOR) = 6.32 [95% confidence intervals: 1.97 – 20.28]), a history of TBD diagnosis (aOR = 5.88 [1.41-24.55]), and older age (≥ 46 years) (aOR = 3.29 [1.00 – 10.84]) were positively associated with high practice adherence. Respondents suggested they would be willing to pay for personal protective methods and get a hypothetical vaccine for Lyme disease, but not community-wide efforts to control ticks. Conclusions: Our study provides evidence that U.S. Forest Service employees in Wisconsin represent a high risk group for TBD, and despite relatively high TBD knowledge and engagement in tick protection activities, efforts are needed to reduce their risks for tick bites. More generally, our findings suggest that studies to better understand the factors related to the adoption and effectiveness of public health interventions are needed.
The relationship between a microfinance-based healthcare delivery platform, health insurance coverage, health screenings, and disease management in rural Western Kenya
Authors: Rosenberg Molly , Amisi James Akiruga , Szkwarko Daria , Tran Dan N. , Genberg Becky , Luetke Maya , Kianersi Sina , Namae Jane , Laktabai Jeremiah , Pastakia Sonak
Published: August 2020

Background: Structural barriers often prevent rural Kenyans from receiving healthcare and diagnostic testing. The Bridging Income Generation through grouP Integrated Care (BIGPIC) Family intervention facilitates microfinance groups, provides health screenings and treatment, and delivers education about health insurance coverage to address some of these barriers. This study evaluated the association between participation in BIGPIC microfinance groups and health screening/disease management outcomes.

Methods: From November 2018 to March 2019, we interviewed a sample of 300 members of two rural communities in Western Kenya, 100 of whom were BIGPIC microfinance members. We queried participants about their experiences with health screening and disease management for HIV, diabetes, hypertension, tuberculosis, and cervical cancer. We used log-binomial regression models to estimate the association between microfinance membership and each health outcome, adjusting for key covariates.

Results: Microfinance members were more likely to be screened for most of the health conditions we queried, including those provided by BIGPIC [e.g. diabetes: aPR (95% CI): 3.46 (2.60, 4.60)] and those not provided [e.g. cervical cancer: aPR (95% CI): 2.43 (1.21, 4.86)]. Microfinance membership was not significantly associated with health insurance uptake and disease management outcomes.

Conclusions: In rural Kenya, a microfinance program integrated with healthcare delivery may be effective at increasing health screening. Interventions designed to thoughtfully and sustainably address structural barriers to healthcare will be critical to improving the health of those living in low-resource settings.
Determinants of life satisfaction and self-rated health in Iranian children and adolescents: A structure equation model
Authors: Angoorani Pooneh , Mahmoodi Zohreh , Ejtahed Hanieh-Sadat , Heshmat Ramin , Motlagh Mohammad Esmaeil , Qorbani Mostafa , Kelishadi Roya
Published: August 2020

Background: Life satisfaction (LS) and self-rated health (SRH) are related with health outcomes. It is expected that these items are also related to healthy behaviors. Therefore, this study was conducted in order to find out the main determinants of LS and SRH in nationwide representative sample of Iranian children and adolescents.Methods: This study was performed on 13834 students aged 7-18 years who were selected by multistage, stratified cluster sampling method from 30 provinces of Iran. LS and SRH were assessed through a questionnaire based on World Health Organization-Global School-based Student Health Survey protocols. Path analysis was applied to evaluate the relationships among the study variables using the structural modeling. Results: LS was directly affected by age (-0.037 in boys & -0.028 in girls); sedentary time (0.055 in boys & 0.048 in girls); school satisfaction (0.249 in boys & 0.250 in girls); and well-being (0.186 in boys & 0.176 in girls). SRH was directly affected by LS (0.28 in boys & girls) and school satisfaction (0.21 in boys & 0.22 in girls); and indirectly affected by age (-0.046 in boys & -0.017 in girls); sedentary time (-1.99 in boys & -0.145 in girls); family size (-0.005 in boys & -0.014 in girls); and socio-economic status (0.015 in boys & 0.058 in girls). Conclusions: This study indicated that school satisfaction had the greatest positive direct effect on both LS and SRH.
Clinicopathological study of mixed cryoglobulinemic glomerulonephritis secondary to Hepatitis B virus infection
Authors: LI CHAO , LI HANG , SU WEI , WEN YU-BING , YE WEI , YE WEN-LING , CAI JIAN-FANG , QIN XU-ZHEN , LI XUE-MEI , LI XUE-WANG
Published: August 2020

Background Cryoglobulinemic glomerulonephritis (CryoGn) caused by hepatitis B virus (HBV) infection was rarely reported. Our study aimed to investigate the clinical features, renal pathology findings, and prognosis in patients with HBV related CryoGn. Methods This was a retrospective study including seven Chinese patients with HBV related CryoGn in a tertiary referral hospital from April 2016 to March 2019. The clinical and pathological data were collected and analyzed.Results Age at renal biopsy was 47±12 years, with female/male ration 3/4. Urine protein was 5.6(3.0, 6.6) g/d and five cases presented with nephrotic syndrome. The baseline eGFR was 23.5 (20.2, 46.3) ml/min per 1.73m2. The extrarenal manifestations included purpura (n=6), arthralgia (n=1), peripheral neuropathy (n=1), and cardiomyopathy (n=1). Six cases had type II cryoglobulinemia with IgMκ, the other one had type III. The median cryocrit was 4.0 (1.0, 15.0) %. Renal pathologic findings on light microscopy: endocapillary proliferative glomerulonephritis (Gn) (n=3), membranoproliferative Gn (n=3), and mesangial proliferative Gn (n=1). On immunofluorescence microscopy, the predominant type of immunoglobulin deposits was IgM(n=5). HBsAg and HBcAg deposits were found in one case. Ultrastructural studies showed granular subendothelial and mesangial electron-dense deposits in all patients and microtubules in one case. All patients received antiviral medications. They were given corticosteroid alone (n=2) or combined with cyclophosphamide (n=4) or mycophenolate mofetil (n=1). Two patients received plasmapheresis. The median follow-up time was 18 (6, 37) months. Four patients got remission, two patients died of pneumonia, and one progressed to end-stage renal disease (ESRD). At endpoint of follow-up, 24hUP was 2.1 (0.8-5.2) g/d, and eGFR was 55.3 (20.7, 111.8) ml/min per 1.73m2. The median cryocrit decreased to 1.0 (0, 5.75) %.Conclusions The etiology of mixed CryoGn should be screened for HBV infection. Endocapillary proliferative Gn and membranoproliferative Gn were the common pathologic patterns. Diagnosis and treatment in early-stage benefit patients’ renal outcomes. Immunosuppressive therapy should be considered for severe renal disease, based on efficient antiviral therapy.
TNFAIP8 inhibits the proliferation of gastric cancer cells by inhibiting mTOR-Akt-ULK1 signal pathway and activating autophagy
Authors: Chen Zheng , Zhang Jianguo , Dong Chenyang , Li Dongsheng , Yin Yuehan , Yu Wenhai , Chen Yuezhi
Published: August 2020

Background : The purpose of this article was to study the role of TNFAIP8 in gastric cancer.
Methods : RT-PCR was used to detect the expression of TNFAIP8 mRNA and protein level in normal gastric mucosa cells and four gastric cancer cell lines. TNFAIP8 was silenced or overexpressed in two cell lines, CCK-8 cell viability was used, transwell experiment was used to detect cell invasion capability, and flow cytometry was used to detect cell apoptosis. TNFAIP was silenced or overexpressed in a cell line, and nude mice were inoculated to form transplanted tumors. HE staining and immunohistochemistry staining were used to detect the histopathological changes of tumors.
Results : The mRNA and protein expression of TNFAIP8 was significantly up-regulated in GC patients and cells. After silencing and overexpressing TNFAIP8, gastric cancer cells with high expression increased, apoptosis decreased, and cell invasion increased. Expression of mTOR-Akt-ULK1 signal pathway was inhibited and autophagy signal was activated.
Conclusions : Our findings indicate that TNFAIP8 inhibited gastric cancer cells by inhibiting mTOR-Akt-ULK1 signal pathway and activating autophagy signal.
Patients’ perceptions of frequent hospital admissions: A qualitative study with older people above 65 years of age.
Authors: Huang Miaolin , Borght Carolien Van der , Leithaus Merel , Flamaing Johan , Goderis Geert
Published: August 2020

Background
Although ‘frequent flyer’ hospital admissions represent barely 3 to 8% of the total patient population in a hospital, they are responsible for a disproportionately high percentage (12 to 28%) of all admissions. Moreover, hospital admissions are an important contributor to health care costs and overpopulation in various hospitals. The aim of this research is to obtain a deeper insight into the phenomenon of frequent flyer hospital admissions. Our objectives were to understand the patients’ perspectives on the cause of their frequent hospital admissions and to identify the perceived consequences of the frequent flyer status.
Methods
This qualitative study took place at the University Hospital of Leuven. The COREQ guidelines were followed to provide rigor to the study. Patients were included when they had at least four overnight admissions in the past 12 months, an age above 65 years and hospital admission at the time of the study. Data were collected via semi-structured interviews and encoded in NVivo.
Results
Thirteen interviews were collected. A total of 17 perceived causes for frequent hospital admission were identified, which could be divided into the following six themes: patient, drugs, primary care, secondary care, home and family. Most of the causes were preventable or modifiable. The perceived consequences of being a frequent flyer were divided into the following six themes: body, daily life functioning, social participation, mental status and spiritual dimension. Negative experiences were linked to frequent flying and could be situated mainly in the categories of social participation, mental status and spiritual dimensions.
Conclusions
Frequent hospital admissions may be conceived as an indicator, i.e., a ‘red flag’, of patients’ situations characterized by physical, mental, spiritual and social deprivation in their home situation.
Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: Secondary outcomes from a cluster randomized controlled trial (DiaFOTo)
Authors: Iversen Marjolein Memelink , Igland Jannicke , Smith-Strøm Hilde , Østbye Truls , Tell Grethe Seppola , Skeie Svein , Cooper John G. , Peyrot Mark , Graue Marit
Published: August 2020

BACKGROUND Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. METHODS The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer–Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. RESULTS In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. CONCLUSIONS There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants’ health, well-being and quality of life.
Frailty and healthcare utilisation across care settings among community-dwelling older adults in Singapore
Authors: LIXIA GE , Yap Chun Wei , Heng Bee Hoon , Tan Woan Shin
Published: August 2020

Background
Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation in different care settings among community-dwelling older adults in Singapore.
Methods
Data from a population health survey among community-dwelling adults were linked with an administrative database to retrieve data of healthcare utilisation (including government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations) occurred during a six-month look-back period and six-month post-baseline respectively. Baseline frailty status was measured using the five-item FRAIL scale, which was categorised into three groups: robust (0), pre-frail (1–2), and frail (3–5). Negative binomial regression was applied to examine the association between frailty with respective healthcare utilisation (dependent variables), controlling for other confounding variables.
Results
In our sample of 701 older adults, 64.8% were of robust health, 27.7% were pre-frail, and 7.6% were frail. Compared to the robust group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2-6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1-8.1), day surgery attendances (IRR: 6.4, 95%CI: 1.3-30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1-21.1) in the six-month period prior to the baseline and in subsequent six months (IRR: 3.3, 95%CI: 1.6-7.1; 6.4, 2.4-17.2; 5.8, 1.3-25.8; 13.1, 4.9-35.0; respectively), controlling for covariates.
Conclusions
Frailty was positively associated with the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations occurred during 6 months prior to and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have potential effect on delaying secondary and tertiary care utilisation.
Media Exposure to COVID-19 Information, Risk Perception, Social and Geographical Proximity, and Self-Rated Anxiety in China
Authors: Liu Miao , Zhang hongzhong , Huang Hui
Published: August 2020

Background
The coronavirus disease 2019 (COVID-19) is an emerging infectious disease that spreads around the world. The lack of effective antiviral drugs and vaccines, along with the relatively high mortality rate and high contagiousness, has raised strong public concerns over COVID-19, especially for people living in the most severely affected areas. This study aimed to clarify the influencing factors for the anxiety level among the Chinese people during the COVID-19 pandemic, with a particular focus on the media exposure to different COVID-19 information.
Methods A total of 4991 respondents were randomly recruited from a national online panel from February 12 th , 2020 to February 14 th , 2020, a period when the number of COVID-19 cases surpassed 10,000 in a single day, with the total cases in China reaching up to 90000. The relationships between media exposure of COVID-19 information, social and geographical proximity to COVID-19, risk perceptions were assessed using hierarchical ordinary least squares regression analysis.
Results
The media exposure to COVID-19 information was differently associated with anxiety. Meanwhile, the anxiety level was found to be high in respondents who personally knew someone infected with COVID-19 or those who living in an area with reported cases. Respondents who perceived more risks also reported a higher level of anxiety.
Conclusions
This study highlights the role of media exposure in affecting individuals’ anxiety level during the COVID-19 pandemic. Besides, it is recommended that government and health professionals are recommended to adopt effective risk communication strategies to protect citizens’ mental health during the pandemic.

Keywords: self-rated anxiety, media exposure, social proximity, geographical proximity, risk perception
The “Healthy Akame!” community – government – university collaboration for health: a community-based participatory mixed-method approach to address health issue in rural Japan
Authors: Haya Marinda Asiah Nuril , Ichikawa Shuhei , Shibagaki Yukino , Board Akame Machijuu Genki Project Community Advisory , Wakabayashi Hideki , Takemura Yousuke
Published: August 2020

Background: Although Japan has a decentralized public health system, local governments have considered expert opinions over those of the community, to decide on public health programs. Differences in community’s interest may create gaps between health program’s objectives and implementation. We hypothesized that community-based participatory research (CBPR), which involves the community at every step, promotes effective program implementation and community empowerment. This study addressed the first step of CBPR, assessing community needs and developing a tailored health program for a rural community in Japan.
Methods: in this study sequential exploratory mixed-method study (qualitative followed by quantitative), we first formed a community advisory board (CAB) representing community organization, city officials, and university researchers. The CAB conducted group discussions with community residents to identify community’s health issues and strength. These group discussions were analyzed using thematic analysis, and the results were used to develop a questionnaire, which was subsequently sent to all households in the community to obtain priority scores for health issues and proposed action and to assess willingness to participate in community health program. The CAB then designed a program based using the overall study results.
Results: Ten group discussions with 68 participants identified the following health issues: 1) diseases, 2) unhealthy behaviors; and 3) unsupportive environment. Nature, vacant lots, and local farms were considered local strength. Of a total of 1470 households in the community, questionnaires were collected from 773 households. Cancer, lifestyle-related diseases, and cerebrovascular diseases were as the most important health problems. Improving services and access to medical checkups, use of public space for exercise, local farming, and collaboration with community health office were considered necessary to address these health problems. Considering feasibility and the availability of resources in the community, the CAB decided to focus on lifestyle-related diseases and designed activities centered on health awareness, nutrition, and exercise. These activities drew on community’s strengths and were adapted to Japanese culture.
Conclusions: The community’s priority health problem was closely related to the epidemiology of diseases. The CBPR approach was useful for identifying community’s needs and for designing a unique community health program that made use of local strengths.
Predictors of young people’s use of sexual and reproductive health services in Nigeria: a mixed-method approach
Authors: Odo Amelia Ngozi , OFUEBE Justina Ifeoma , ANIKE Anthony Ifeanyi , Samuel Efiong S
Published: August 2020

Background Sexual and Reproductive health Services (SRHS) are essential for prevention and control of SRH problems among young people and the achievement of sustainable development goal 3. These services may be available but certain factors interfere with their access and utilization by the young people. This study sought to determine factors that predict the utilization of SRHS among young people in Enugu State, Nigeria. Methods The study adopted mixed method research employing cross-sectional research design. The population of the study comprised young people within the ages of 12 and 22 years. Multi-stage sampling procedure was used to select 1,447 young people used for the study. Questionnaire, in-depth interview, and focus group discussion were used for data collection. Percentages, Chi-square, and logistic regression were used to analyse quantitative data, while qualitative data were thematically analysed using NVivo software.Results Socio-demographic factors of gender, age, education, income and living status (p = < .05) were significant predictors of utilization of SRHS. Psycho-cultural and health system factors (p = < .05) were also significant predictors of utilization of SRHS.Conclusion The study concluded that some socio-demographic factors (of gender, age, level of education, income and living status), psycho-cultural and health system factors can be used to predict young people’s utilization of SRHS. These predictors could be addressed through home sex education, regular training of health care providers on youth-friendly services delivery and policy reforms.
Association between sexual violence and unintended pregnancy among adolescent girls and young women in South Africa
Authors: Ajayi Anthony Idowu , Ezegbe Henrietta Chinelo
Published: August 2020

Background Unintended pregnancy has dire consequences on the health and socioeconomic wellbeing of adolescent girls and young women (AGYW) (aged 15-24 years). While most studies tend to focus on lack of access to contraceptive information and services, and poverty as the main contributing factor to early-unintended pregnancies, the influence of sexual violence has received limited attention. Understanding the link between sexual violence and unintended pregnancy is critical towards developing a multifaceted intervention to reduce unintended pregnancies among AGYW in South Africa, a country with high teenage pregnancy rates. Thus, we estimated the magnitude of unintended pregnancy among AGYW and also examined the effect of sexual violence on unintended pregnancy.Methods Our study adopted a cross-sectional design, and data were obtained from AGYW in a South African university between June and November 2018. A final sample of 451 girls aged 17-24 years, selected using stratified sampling, were included in the analysis. We used adjusted and unadjusted logistic regression analysis to examine the effect of sexual violence on unintended pregnancy. Results The analysis shows that 41.9% of all respondents had experienced an unintended pregnancy, and 26.3% of those unintended pregnancies ended in abortions. Unintended pregnancy was higher among survivors of sexual violence (54.4%) compared to those who never experienced sexual abuse (34.3%). In the multivariable analysis, sexual violence was consistently and robustly associated with increased odds of having an unintended pregnancy (AOR:1.70; 95% CI: 1.08-2.68).Conclusion Our study found a huge magnitude of unintended pregnancy among AGYW. Sexual violence is an important predictor of unintended pregnancy in this age cohort. Thus, addressing unintended pregnancies among AGYW in South Africa requires interventions that not only increase access to contraceptive information and services but also reduce sexual violence and cater for survivors.
Influenza outbreak among students in Ghana: a report from three time points
Authors: Sylverken Augustina Angelina , Owusu Michael , Yeboah Richmond , El-Duah Philip , Gorman Richmond , Bonney Joseph Kofi , Aryeetey Sherihane , Adu Eric , Amoako Yaw Ampem , Adade Titus , Yeboah Eric , Bonney Joseph , Ayisi-Boateng Nana Kwame , Drosten Christian , Phillips Richard Odame
Published: August 2020

Background

Influenza viruses are known to be responsible for a number of respiratory disease outbreaks worldwide. While there exists documented information on influenza which allows for effective strategic preparedness activities in industrialized countries, the same cannot be said of developing and underdeveloped countries. It therefore behoves on developing countries to document information on circulating strains of influenza. Such information will enable prioritization of prevention and more targeted preparedness strategies. In this paper, we report on three different outbreaks of Influenza A among Ghanaian students in December 2017, May 2019 and December 2019 in the Ashanti region of Ghana.

Methods

Throat or nasal samples were collected with flocked swabs, stored in RNAlater and transported to the laboratories of Kumasi Centre for Collaborative Research (KCCR) at ambient temperature. Following viral RNA extraction, detection of viral nucleic acid of both influenza A and its subtypes including H1N1 and H3N2 was done by real-time reverse transcription Polymerase Chain Reaction (RT-PCR).

Results

A total of 112 samples were taken. An overall Influenza A prevalence of 51.8% (95% CI = 42.1-61.3) was recorded during the three outbreak time points. Of these, 11 (9.8%) were confirmed to be H1N1 (pdm09) and 47 (42%) were H3N2 strains. All the 11 H1N1 (pdm09) were identified during the first outbreak. The H3N2 strains were identified during the second and third outbreaks in May 2019 and December 2019 respectively. Our results show that influenza A virus activity was higher during the months of November and December compared to May. Age, contact with infected subjects, temperature, fever within the last 24 hours and headaches showed significant variations (p-value <0.01) with respect to influenza A. Wald’s test revealed that subjects presenting with headaches had about 5 times odds (95% CI = 1.4-17.7) for influenza A infection compared to subjects without headache (p = 0.014).

Conclusion

Our study provides epidemiological information to better understand the incidence and burden of influenza to allow for prioritisation of prevention and control strategies. Such information would aid in controlling and preparing for future influenza epidemics.
Detection of deep low-frequency earthquakes in the Nankai subduction zone over 11 years using a matched filter technique
Authors: Kato Aitaro , Nakagawa Shigeki
Published: August 2020

To improve our understanding of the long-term behavior of low-frequency earthquakes (LFEs) along the tremor belt of the Nankai subduction zone, we applied a matched filter technique to continuous seismic data recorded by a dense and highly sensitive seismic network over an 11 year window, April 2004 to August 2015. We detected a total of ~510,000 LFEs, or ~23× the number of LFEs in the JMA catalog for the same period. During long-term slow slip events (SSEs) in the Bungo Channel, a series of migrating LFE bursts intermittently occurred along the fault-strike direction, with slow hypocenter propagation. Elastic energy released by long-term SSEs appears to control the extent of LFE activity. We identify slowly migrating fronts of LFEs during major episodic tremor and slip (ETS) events, which extend over distances of up to 100 km and follow diffusion-like patterns of spatial evolution with a diffusion coefficient of ~10 4 m 2 /s. This migration pattern closely matches the spatio-temporal evolution of tectonic tremors reported by previous studies. At shorter distances, up to 15 km, we discovered rapid diffusion-like migration of LFEs with a coefficient of ~10 5 m 2 /s. We also recognize that rapid migration of LFEs occurred intermittently in many streaks during major ETS episodes. These observations suggest that slow slip transients contain a multitude of smaller, temporally clustered fault slip events whose evolution is controlled by a diffusional process.
Rheumatoid arthritis patients on persistent moderate disease activity on biologics have adverse 5-years outcome compared to persistent low-remission status and represent a heterogeneous group.
Authors: Genitsaridi Irini , Flouri Irini , Plexousakis Dimitris , Marias Konstantinos , Boki Kyriaki , Skopouli Fotini , Drosos Alexandros , Bertsias George , Boumpas Dimitrios , Sidiropoulos Prodromos
Published: August 2020

Background The long-term outcome of rheumatoid arthritis (RA) patients who in clinical practice exhibit persistent moderate disease activity (pMDA) despite treatment with biologics has not been adequately studied. Herein, we analyzed the 5-year outcome of the pMDA group and assessed for within-group heterogeneity. Methods We included longitudinally-monitored RA patients from the Hellenic Registry of Biologic Therapies with persistent (cumulative time ≥50% of a 5-year period) moderate (pMDA, 3.2<DAS28≤5.1) or remission/low (pRLDA, DAS28≤3.2) disease activity. The former was further classified into persistent lower-moderate (plMDA, DAS28<4.2) and higher-moderate (phMDA, DAS28≥4.2) subgroups. Five-year trajectories of functionality (HAQ) was the primary outcome in comparing pRLDA versus pMDA and assessing heterogeneity within the pMDA subgroups through multivariable mixed-effect regression. We further compared serious adverse events (SAEs) occurrence between the two groups.Results We identified 295 patients with pMDA and 90 patients with pRLDA, the former group comprising of plMDA (n=133, 45%) and phMDA (n=162, 55%). pMDA was associated with worse 5-year functionality trajectory than pRLDA (+0.27 HAQ units, CI 95% +0.22 to +0.33; p<0.0001), while the phMDA subgroup had worse 5-year functionality than plMDA (+0.26 HAQ units, CI 95% 0.18 to 0.36; p<0.0001). Importantly, higher persistent disease activity was associated with more SAEs [pRLDA: 0.2±0.48 vs pMDA: 0.5±0.96, p=0.006; plMDA: 0.32 ±0.6 vs phMDA: 0.64 ±1.16, p=0.038)]. Male gender (p=0.017), lower baseline DAS28 (p<0.001), HAQ improvement >0.22 (p=0.029) and lower average DAS28 during the first trimester since treatment initiation (p=0.001), independently predicted grouping into pRLDA. Conclusions In clinical practice, RA patients with pMDA while on bDMARDs have adverse long-term outcomes compared to lower disease activity status, while heterogeneity exists within the pMDA group in terms of 5-year functionality and SAEs. Targeted studies to better characterize pMDA subgroups are needed, in order to assist clinicians in tailoring treatments.
Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis
Authors: Hu Yang , Fan Jiajun , Xv Yifan , Hu Yingjie , Ding Yuan , Jiang Zhengjie , Tao Qingsong
Published: August 2020

Background: To explore the long-term oncological safety of using self-expanding metal stents(SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery(ES) with elective surgery after the placement of SEMS. Methods: Studies comparing SMES as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for the outcomes under random effects model. Results: A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence ofperineural invasion(RR=0.58, 95% CI=0.48, 0.71, P<0.00001), lymphovascular invasion(RR=0.68, 95%CI=0.47,0.99, P=0.004) and vascular invasion(RR=0.66, 95%CI=0.45,0.99, P=0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion(RR=0.92, 95%CI=0.77,1.09, P=0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group(MD=-3.18, 95% CI=-4.47,-1.90, P<0.00001). While no significant difference was found in the number of positive lymph nodes(MD=-0.11, 95%CI=-0.63,0.42, P=0.69) and N stage[N0(RR=1.03, 95%CI=0.92,1.15, P=0.60), N1(RR=0.99, 95%CI=0.87,1.14, P=0.91), N2(RR=0.94, 95%CI=0.77,1.15, P=0.53)]. Conclusions: SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, it should not be considered as the first treatment for radically resectable colorectal cancer.
The role of nicotinic receptors in SARS-CoV-2 receptor ACE2 expression in intestinal epithelia
Authors: Hove Anne Sophie ten , Brinkman David Jan , Yim Andrew Y.F. Li , Verseijden Caroline , Hakvoort Theo B.M. , Admiraal Iris , Welting Olaf , Hamersveld Patricia H.P. van , Sinniger Valerie , Bonaz Bruno , Luyer Misha D. , de Jonge Wouter J.
Published: August 2020

Background – Recent evidence demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) propagates in intestinal epithelial cells expressing Angiotensin-Converting Enzyme 2 (ACE2), implying that these cells represent an important entry site for the viral infection. Nicotinic receptors (nAChRs) have been put forward as potential regulators of inflammation and of ACE2 expression. As vagus nerve stimulation (VNS) activates nAChRs, we aimed to investigate whether VNS can be instrumental in affecting intestinal epithelial ACE2 expression.Methods – By using publicly available datasets we qualified epithelial ACE2 expression in human intestine, and assessed gene co-expression of ACE2 and SARS-CoV-2 priming Transmembrane Serine Protease 2 (TMPRSS2) with nAChRs in intestinal epithelial cells. Next, we investigated mouse and human ACE2 expression in intestinal tissues after chronic VNS via implanted devices.Results – We show co-expression of ACE2 and TMPRSS2 with nAChRs and α7 nAChR in particular in intestinal stem cells, goblet cells, and enterocytes. However, VNS did not affect ACE2 expression in murine or human intestinal tissue, albeit in colitis setting.Conclusions – ACE2 and TMPRSS2 are specifically expressed in epithelial cells of human intestine, and both are co-expressed with nAChRs. However, no evidence for regulation of ACE2 expression through VNS could be found. Hence, a therapeutic value of VNS with respect to SARS-CoV-2 infection risk through ACE2 receptor modulation in intestinal epithelia could not be established.
The impact of the COVID-19 pandemic on the emergency department visits: a retrospective analysis in Shanghai, China
Authors: Long Wei , Hu Jiudong , Li Lijuan , Zuo Sheng , Yang Qian , Ren Zenghua
Published: August 2020

Background The novel coronavirus diseases (COVID-19) has led to a pandemic and affected people's lives greatly, including their health seeking behavior. We aimed to evaluate the impact of the current COVID-19 pandemic on characteristics and trends of emergency department (ED) visits in Shanghai, China.Methods This was a retrospective observational study using medical record databases from the Shanghai Sixth People's Hospital (East Campus) for years 2016 through 2020. All the patients referred to the ED between January 2016 and June 2020 were retrospectively reviewed. January 1, 2020, was chosen as the cutoff date for the statistical analysis and data of January and February in 2020 was compared with the same period of 2019.Results During the first two months of 2020, there was a 60.9% decline in ED visits when compared with the same period of 2019 (9,904 vs. 25,316, respectively), and the waiting time in ED has been greatly reduced correspondingly (12±4 vs. 66±19 min, p < 0.001); ED visits for acute ischemic stroke (AIS) and acute coronary syndrome(ACS) decreased by 53.9% and 41.2% respectively; proportion of intravenous thrombolysis for AIS has dropped(42.1% vs. 11.4%, p = 0.003), and percutaneous coronary intervention for ACS was similar (70.6% vs. 63.3%, p = 0.668); and onset-to-door time (ODT) of these patients increased significantly (AIS: 217(136-374) vs. 378(260-510)min, ACS: 135(85-195) vs. 226(155-368)min, all p < 0.001).Conclusion The outbreak of COVID-19 pandemic was correlated with a significant decline in the number of ED visits including AIS and ACS patients when compared to the pre-COVID-19 period. ODT of AIS and ACS patients increased significantly. Raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated stroke and myocardial infarction attack.
Psychopathy Predicting Violent Criminal Behaviour among Adult Offenders
Authors: Shagufta Sonia
Published: August 2020

The aim of the present research was to examine the role of psychopathy in predicting violent offending within a sample of adult criminal inmates from the prisons of Khyber Pakhtunkhwa Pakistan (KPK). T-test and logistic regression was used to analyse the data. Logistic regression analysis revealed that a higher level of egocentricity and a higher level of antisocial behaviour predict a greater probability of committing violent offence. These findings provide important implications for future research in Pakistan, specifically concerning psychopathy as a risk factor for criminal and violent behaviour. The present findings will help to inform legal decisions as to whether inmates should be incarcerated as violent criminals or non-violent criminals. The conclusions of the present research are limited to incarcerated adult male offenders only; therefore, the present study remains unable to reflect the development of psychopathy in either females or the general population.

   Keywords: Antisocial, Egocentricity, Incarcerated, Khyber Pakhtunkhwa, Psychopathy
El Inventario de Conciencia Metacognitiva para Docentes (MAIT): Validación de una Muestra de Docentes Colombianos
Authors: Gutierrez de Blume Antonio P. , Montoya Londoño Diana Marcela
Published: August 2020

Comprender cómo operan los constructos inobservables en función de la cultura y el lenguaje es un objetivo importante para los investigadores. Debido a que el idioma y la cultura ejercen una influencia tan poderosa en la forma en que se experimentan los fenómenos psicológicos, los constructos latentes pueden no funcionar universalmente entre culturas e idiomas. Por lo tanto, el propósito del presente estudio fue doble. Primero, se realizó un proceso de adaptación cultural del Inventario de Conciencia Metacognitiva para Docentes (MAIT) de 24 ítems, desarrollado originalmente por Balcikanli (2011). En segundo lugar, se probó y validó el instrumento traducido en una muestra de docentes colombianos (N = 755). Se presume una estructura de factor modificada a partir de la propuesta en el estudio de validación original. Los resultados revelaron que, después de la eliminación de tres ítems que no encajaban, la estructura de factores hipotética propuesta por el equipo para el MAIT-R de 21 ítems demostró un excelente ajuste a los datos.

Palabras clave: Metacognición, conocimiento metacognitivo, regulación metacognitiva, conciencia metacognitiva,docentes