bluuebunny/crossref_metadata_2025 huggingface dataset:
A Mixed Methods Study Describing the Quality of Healthcare Received by Transgender and Gender Nonconforming Patients at a Large Integrated Health System
Authors: Vupputuri Suma , Daugherty Stacie L. , Yu Kalvin , Derus Alphonse J. , Vasquez Laura E. , Wells Ayanna , Truong Christine , Emanuel E. W.
Published: May 2021

Transgender and gender nonconforming (TGNC) patients have been seeking medical care in higher numbers and have faced unique social, personal, and health issues that affect the quality of care they receive. The purpose of this study was to conduct a mixed-methods study to describe TGNC care at Kaiser Permanente Mid-Atlantic States, a large integrated health system. We used a transgender registry to describe a TGNC patient population and compared healthcare utilization between TGNC patients and non-TGNC patients. Four focus groups were also conducted among 28 patients. Atlas.ti software was used to code and analyze themes for the qualitative analysis. Among the 282 adults TGNC patients, the mean age was 32.6 years. Of the study sample, 59% were White, and 27% were Black. TGNC patients demonstrated an increased use of email/telephone visits and the online patient portal and more cancellations and no-shows compared to non-TGNC controls. Of the 28 TGNC patients who participated in the focus groups, 39% identified as female, 21% as a transman, and 18% as non-binary/genderqueer. Participants were predominantly White (68%), highly educated (74%), and reported use of hormones (89%). Themes that emerged from our qualitative analysis included: limited availability of TGNC information; positive and negative sentiments regarding patient–provider interactions; issues with case management; limited access to care; lack of coordination of care; negative staff experiences. We identified specific areas in a health system to improve the quality of care of TGNC patients, including specific TGNC training for providers and staff, a source of TGNC information/resources, and hiring and training TGNC-specific case managers.
Preventive Healthcare and Management for Acute Lymphoblastic Leukaemia in Adults: Case Report and Literature Review
Authors: Chen Wei-Ping , Chiang Wen-Fang , Chen Hung-Ming , Chan Jenq-Shyong , Hsiao Po-Jen
Published: May 2021

Acute lymphoblastic leukaemia (ALL) is diagnosed by the presence of at least 20% lymphoblasts in the bone marrow. ALL may be aggressive and include the lymph nodes, liver, spleen, central nervous system (CNS), and other organs. Without early recognition and timely treatment, ALL will progress quickly and may have poor prognosis in clinical scenarios. ALL is a rare type of leukaemia in adults but is the most common type in children. Precipitating factors such as environmental radiation or chemical exposure, viral infection, and genetic factors can be associated with ALL. We report a rare case of ALL with symptomatic hypercalcaemia in an adult woman. The patient presented with general weakness, poor appetite, bilateral lower limbs oedema, consciousness disturbance, and lower back pain for 3 weeks. She had a history of cervical cancer and had undergone total hysterectomy, chemotherapy, and radiation therapy. Her serum calcium level was markedly increased, at 14.1 mg/dl at admission. Neck magnetic resonance imaging, abdominal sonography, abdominal computed tomography, and bone marrow examination were performed. Laboratory data, including intact parathyroid hormone (i-PTH), peripheral blood smear, and 25-(OH) D3, were checked. Bone marrow biopsy showed B cell lymphoblastic leukaemia. Chemotherapy was initiated to be administered but was discontinued due to severe sepsis. Finally, the patient died due to septic shock. This was a rare case of B cell ALL in an adult complicated by hypercalcaemic crisis, which could be a life-threatening emergency in clinical practice. Physicians should pay attention to the associated risk factors. Early recognition and appropriate treatment may improve clinical outcomes.
Sensitizing Family Caregivers to Influence Treatment Compliance among Elderly Neglected Patients—A 2-Year Longitudinal Study Outcome in Completely Edentulous Patients
Authors: Alqarni Mohammed A. , Mattoo Khurshid , Dhingra Surbhi , Baba Suheel Manzoor , Al Sanabani Fuad , Al Makramani Bandar M. A. , Akkam Hadeel Mohammed
Published: May 2021

Healthcare workers have reported a certain segment of geriatric patients that are suffering from abuse/neglect, which in turn has been associated with anxiety, depression, and helplessness in the individual. Family caregivers (blood relations), being the most common perpetrators of elder abuse and neglect (EAN), have also been shown to respond to sensitization if the type of EAN and the interventions are appropriate. This study was aimed to comparatively analyze the influence of intervention (psychotherapeutic sensitization of FCG) upon long-term (24 months) treatment maintenance and satisfaction in elderly neglected patients. One hundred and fifty patients (aged 41–80 years) suffering from elder neglect (EN) (self-confession) and their respective FCGs, fulfilling the study criteria, participated in this longitudinal 2-year study. The patients were randomly distributed (simple random, convenient) in two equal groups (75 each), namely Group (GP) A (control) and GP B (test). A standardized, complete denture treatment was initiated for all the participants. Both the FCGs and the patients of GP B were sensitized (psychotherapeutic education) for EN, while there was no such intervention in GP A. The influence of such intervention was measured for denture maintenance [denture plaque index (DPI) scores] and treatment satisfaction (10-point visual analog scale). Absolute/relative frequencies and means were major calculations during data analysis. Differences between the groups for any treatment compliance parameter was done through the unpaired t-test, while Karl Pearson’s test determined the level of relationship between variables (p-value < 0.05). Decrease in mean DPI scores (suggesting improvement) was seen among patients in GP A from 1 month (m = 2.92) to 24 months (m = 2.77). A negligible increase in DPI scores was observed among patients of GP B from 1 month (m = 1.38) to 24 months (m = 1.44). Differences in mean values between the two groups were statistically significant at 24-month intervals, while the relationship between the variables was nonsignificant. FCG sensitization through psychotherapeutic education shows a long-term positive influence on the treatment compliance (maintenance and satisfaction). Identifying the existence of EAN among geriatric patients, followed by psychotherapeutic education of FCGs is recommended for routine medical and dental long-duration treatment procedures.
Generation of a High-Density Genetic Map of Pepper (Capsicum annuum L.) by SLAF-seq and QTL Analysis of Phytophthora capsici Resistance
Authors: Li Yi-Fei , Zhang Shi-Cai , Yang Xiao-Miao , Wang Chun-Ping , Huang Qi-Zhong , Huang Ren-Zhong
Published: May 2021

Pepper (Capsicum annuum L.) is an economically significant global crop and condiment. Its yield can be severely reduced by the oomycete plant pathogen, Phytophthora capsici (P. capsici). Here, a high-density genetic map was created with a mapping panel of F2 populations obtained from 150 individuals of parental lines PI201234 and 1287 and specific-locus amplified fragment sequencing (SLAF) that was then utilized to identify loci that are related to resistance to P. capsici. The sequencing depth of the genetic map was 108.74-fold for the male parent, 126.25-fold for the female parent, and 22.73-fold for the offspring. A high-resolution genetic map consisting of 5565 markers and 12 linkage groups was generated for pepper, covering 1535.69 cM and an average marker distance of 0.28 cM. One major quantitative trait locus (QTL) for the P. capsici resistance (CQPc5.1) was identified on Chr05 that explained the observed 11.758% phenotypic variance. A total of 23 candidate genes located within the QTL CQPc5.1 interval were identified, which included the candidate gene Capana05g000595 that encodes the RPP8-like protein as well as two candidate genes Capana05g000596 and Capana05g000597 that encodes a RPP13-like protein. Quantitative reverse-transcription PCR (qRT-PCR) revealed higher expression levels of Capana05g000595, Capana05g000596, and Capana05g000597 in P. capsici resistance accessions, suggesting their association with P. capsici resistance in pepper.
Effects of Shade Net Colors on Mineral Elements and Postharvest Shelf Life and Quality of Fresh Fig (Ficus carica L.) under Rain-Fed Condition
Authors: Jokar Ali , Zare Hamid , Zakerin Abdolrasool , Aboutalebi Jahromi Abdolhossein
Published: May 2021

Photoselective netting is well known for filtering the intercepted solar radiation, thus affecting light quality. While its effects on leaf mineral elements have been well investigated, how color netting affects fruit mineral nutrients remains elusive. This study was conducted to evaluate the effects of shade provided by blue and yellow nets on mineral nutrients of fig trees under rain-fed conditions. The experiment was arranged as a split-plot treatment in a randomized complete block design with three replications. Cultivars “Sabz” and “Siah” were covered with color nets or left uncovered (as the control group). The highest nitrogen content (8710 ppm) was recorded for cultivar “Sabz” covered with blue net. Color nets enhanced calcium concentration in cultivar “Siah”. Covering fig trees with yellow net increased magnesium content in cultivar “Siah” and phosphorus content in cultivar “Sabz”. Our observation showed the significant positive effect of photo selective nets on postharvest quality, by decreasing fig fruit weight loss and extending shelf life of fruits. In general, color nets as a new agro-technological approach can maintain fruit nutrition under rain-fed conditions and increase postharvest shelf life and quality of fresh fig.
Multi-Omics Analysis to Visualize Ecotype-Specific Heterogeneity of the Metabolites in the Mesocarp Tissue of Three Avocado (Persea Americana Mill.) Ecotypes
Authors: Ge Yu , Zang Xiaoping , Liu Yuanzheng , Wang Lixia , Wang Jiashui , Li Yanxia , Ma Weihong
Published: May 2021

The huge amount of metabolites in avocado mesocarp influences the commercial production of specific avocado fruits for consumption and for industrial applications. Additionally, the diversity in the metabolite content may be used as biomarker for differentiating among various avocado ecotypes. However, the differences in metabolites in avocado remain unclear among various avocado ecotypes. In this study, we first compared the lipid droplets, fatty acid compositions, and gene expression profiles of the mature avocado mesocarps of three ecotypes, and confirmed the differences in the mesocarp oil contents. Furthermore, the lipidomics and metabolomics based on the ultra-high-performance liquid chromatography-triple and time-of-flight mass spectrometry and ultra-high performance liquid chromatography-Q exactive-mass spectrometry were completed, respectively, which revealed considerable differences in the relative amounts of lipids from 10 classes and other metabolites from seven super-classes among the examined avocado ecotypes. The profiles of 65 lipids and 15 other metabolites could be potential candidate biomarkers useful for identifying diverse avocado ecotypes. This is the first comprehensive metabolomics-based comparative investigation of lipid and other metabolites among three avocado ecotypes.
Effect of 5-Aminolevulinic Acid (5-ALA) on Leaf Chlorophyll Fast Fluorescence Characteristics and Mineral Element Content of Buxus megistophylla Grown along Urban Roadsides
Authors: Yang Hao , Zhang Jianting , Zhang Haiwen , Xu Yi , An Yuyan , Wang Liangju
Published: May 2021

It is well known that trees grown on roadsides suffer from stressful environments, including poor soils, bad weather, and harmful gases from automobile exhaust. Improving the adaptability of roadside trees to adverse environments is important for urban management. An experiment was carried out with six-year-old Buxus megistophylla Levl. hedgerows, where 20 mg/L 5-aminolevulinic acids (5-ALA) solution was sprayed on the blade surface at the end of April. Three months later, plant morphology, chlorophyll fast fluorescence characteristics, antioxidant enzyme activities and the mineral element content were investigated. The results showed that leaf size and thickness were significantly greater with 5-ALA treatment, and the leaf color was also greener than those of the control. 5-ALA treatment significantly promoted the electron transfer activity of the PSII reaction center on the donor side, the reaction center itself and the receptor side. It reduced energy dissipation through the heat with increased photochemical quantum yields. The activities of antioxidant enzymes, including superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD) in leaves and roots, were stimulated by 5-ALA treatment. The content of soluble sugars and free proline in leaves was significantly increased by 5-ALA treatment, as were the absorption and accumulation of several kinds of mineral nutrient elements, such as nitrogen, phosphate, calcium, magnesium, iron, copper and boron. Additionally, 5-ALA application significantly increased the content of cadmium, mercury, chromium and lead in the roots but decreased them in the leaves. This implies that 5-ALA may induce a mechanism in B. megistophylla in which toxic elements were intercepted in roots to avoid accumulation in leaves, which ensured healthy growth of the aboveground tissues. 5-ALA may regulate the absorption and utilization of mineral nutrient elements in soil with the interception of toxic heavy metal elements in roots, promote leaf photosynthetic performance, induce the accumulation of soluble sugars and free proline, and improve the antioxidant enzyme systems for plants to adapt to the stressful environment of urban roads. These results provide a basis for 5-ALA applications alongside city roads.
Quality Evaluation of Indoor-Grown Microgreens Cultivated on Three Different Substrates
Authors: Bulgari Roberta , Negri Marco , Santoro Piero , Ferrante Antonio
Published: May 2021

The microgreens are innovative products in the horticultural sector. They are appreciated by consumers thanks to their novelty and health-related benefits, having a high antioxidant concentration. This produce can be adopted for indoor production using hydroponic systems. The aim of the present work was to investigate the influence of three growing media (vermiculite, coconut fiber, and jute fabric) on yield and quality parameters of two basil varieties (Green basil—Ocimum basilicum L., Red basil—Ocimum basilicum var. Purpurecsens) and rocket (Eruca sativa Mill.) as microgreens. Microgreens were grown in floating, in a Micro Experimental Growing (MEG®) system equipped with LED lamps, with modulation of both energy and spectra of the light supplied to plants. Results showed high yield, comprised from 2 to 3 kg m−2. Nutritional quality varied among species and higher antioxidant compounds were found in red basil on vermiculite and jute. Coconut fiber allowed the differentiation of crop performance in terms of sucrose and above all nitrate. In particular, our results point out that the choice of the substrate significantly affected the yield, the dry matter percentage and the nitrate concentration of microgreens, while the other qualitative parameters were most influenced by the species.
Disastrous Flash Floods Triggered by Moderate to Minor Rainfall Events. Recent Cases in Coastal Benguela (Angola)
Authors: Dinis Pedro A. , Huvi João , Cabral Pinto Marina , Carvalho Joel
Published: May 2021

The present work focuses on two recent flash floods in coastal Benguela (Angola), both triggered by moderate rainfall but which had disastrous consequences for local populations (namely 71 deaths in 2015 and 17 in 2019). The research involved a regional survey to establish the effects of these floods combined with a geomorphological and socio-economic analysis of the most affected areas to understand the main forcing factors. The two flash floods produced major damage in restricted sectors within very small coastal catchments (<16 km2). The prevalence of fine-grained sedimentary rocks, relatively steep hills, thin soil cover, and vegetation scarcity are natural factors that promote surface runoff. However, socio-economic conditions are most likely the main reasons of flood damage. Namely, rapid population growth with poor planning and making use of low-quality construction materials, the high waste yields that are not properly managed and the absence of flood risk awareness. In the small valleys around the fast-growing cities of coastal Benguela, hazardous flash floods occur recurrently, even after moderate precipitation. Most affected areas are determined by local conditions that compromise drainage at the time of the rainfall event, being very difficult to predict.
Swinging-Pulse Sprinkling Head for Rain Simulators
Authors: Kavka Petr , Neumann Martin
Published: May 2021

Rainfall simulators are research devices that can be used for studying runoff and sediment transport on the plot scale. This technical note introduces a new solution that combines the two most commonly used methods for generating artificial rain—swinging and pulse jet systems. Reasons for developing this device are its universal use, simple construction, and reduction of water consumption, with better spatial distribution of rain and rainfall kinetic energy close to that of natural conditions. Routine operations of this device are expected for plots of 1 × 1 m, with a height 2–2.5 m. The rained surface could be extended to 2 × 2 m with lower spatial distribution. The sprinkled area in this case was limited by the drain box that also collected the remaining water. The principle of the presented single-nozzle simulator can be extended to multi-nozzle simulators for larger experimental plots.
Calcium and Potassium Nutrition Increases the Water Use Efficiency in Coffee: A Promising Strategy to Adapt to Climate Change
Authors: Ramírez-Builes Victor Hugo , Küsters Jürgen
Published: May 2021

Coffee (Coffea spp.) represents one of the most important sources of income and goods for the agricultural sector in Central America, Colombia, and the Caribbean region. The sustainability of coffee production at the global and regional scale is under threat by climate change, with a major risk of losing near to 50% of today’s suitable area for coffee by 2050. Rain-fed coffee production dominates in the region, and under increasing climate variability and climate change impacts, these production areas are under threat due to air temperature increase and changes in rainfall patterns and volumes. Identification, evaluation, and implementation of adaptation strategies for growers to cope with climate variability and change impacts are relevant and high priority. Incremental adaptation strategies, including proper soil and water management, contribute to improved water use efficiency (WUE) and should be the first line of action to adapt the coffee crop to the changing growing conditions. This research’s objective was to evaluate at field level over five years the influence of fertilization with calcium (Ca+2) and potassium (K+) on WUE in two coffee arabica varieties: cv. Castillo and cv. Caturra. Castillo has resistance against coffee leaf rust (CLR) (Hemileia vastatrix Verkeley and Brome), while Caturra is not CLR-resistant. WUE was influenced by yield changes during the years by climate variability due to El Niño–ENSO conditions and CLR incidence. Application of Ca+2 and K+ improved the WUE under such variable conditions. The highest WUE values were obtained with an application of 100 kg CaO ha−1 year−1 and between 180 to 230 kg K2O ha−1 year−1. The results indicate that adequate nutrition with Ca+2 and K+ can improve WUE in the long-term, even underwater deficit conditions and after the substantial incidence. Hence, an optimum application of Ca+2 and K+ in rain-fed coffee plantations can be regarded as an effective strategy to adapt to climate variability and climate change.
Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit (NICU): Epidemiology and Infection Prevention and Control Measures
Authors: Almeida Teresa L. , Mendo Tânia , Costa Raquel , Novais Cristina , Marçal Mónica , Martins Filomena , Tuna Madalena
Published: May 2021

Infections due to carbapenemase-producing Enterobacterales (CPE) are increasing worldwide and are especially concerning in a neonatal intensive care unit (NICU). Risk factors for CPE gut colonization in neonates need to be clarified. In this work, we describe the epidemiological and clinical features of CPE-colonized newborns and the infection control measures in a Portuguese NICU. We performed a prospective, observational, longitudinal, cohort study for surveillance of CPE colonization. Maternal and neonatal features of colonized newborns and surveillance strategy were described. A statistical analysis was performed with SPSS23.0, and significance was indicated by p-value ≤ 0.05. Between March and November 2019, CPE was isolated in 5.8% of 173 admitted neonates. Carbapenemase-producing Klebsiella pneumoniae were the most frequently isolated. There was no associated infection. Birth weight, gestational age, length of stay, and days of central line were the identified risk factors for CPE colonization (bivariate analysis with Student’s t-test or Mann–Whitney U test, according to normality). No independent risk factors for CPE colonization were identified in the logistic regression analysis. CPE colonization risk factors are still to be determined accurately in the neonatal population. Active surveillance and continuous infection control measures restrained the current cluster of colonized newborns and helped to prevent infection and future outbreaks.
Knowledge of Palliative Care in Ecuador
Authors: Hidalgo-Andrade Paula , Mascialino Guido , Miño Diego , Mendoza Matías , Marcillo Anna Belén
Published: May 2021

Palliative care is a holistic approach to care for people with chronic, advanced, and life-threatening illnesses. It improves the quality of life of patients and their caregivers. However, there is still limited access to palliative care in many countries. Knowledge about palliative care is key to increase its availability. Thus, this article aimed to explore the knowledge of the general population about palliative care in Ecuador. The study had a descriptive cross-sectional design. Through snowball sampling, between September 2019 and January 2020, 257 people completed an anonymous online questionnaire about general and specific aspects of palliative care. Descriptive and ANOVA analyses indicate that people have many misconceptions about palliative care and how it should be provided. Gender, education, training, occupation, and experience as caregivers were related to the total level of knowledge about palliative care. Regression analyses show other variables as predictors of knowledge. This study highlights the lack of knowledge about specific issues within palliative care in the general population in Ecuador. It also shows the need to develop and implement education measures to fill these gaps and enhance access to palliative care in health systems.
Study Protocol of a Multicenter Randomized Controlled Trial to Tackle Obesity through a Mediterranean Diet vs. a Traditional Low-Fat Diet in Adolescents: The MED4Youth Study
Authors: Boqué Noemi , Tarro Lucía , Rosi Alice , Torrell Helena , Saldaña Guillermo , Luengo Elisa , Rachman Zeev , Pires António , Tavares Nuno Tiago , Pires Ana Salomé , Botelho Maria Filomena , Mena Pedro , Scazzina Francesca , Del Rio Daniele , Caimari Antoni
Published: May 2021

Youth obesity is a strong predictor of adult obesity, which has well-known negative health consequences. Thus, addressing adult obesity requires tackling youth obesity. MED4Youth’s main objective is to strengthen the link between the Mediterranean Diet (MD) and the health benefits against youth obesity and associated cardiovascular disease (CVD) risk factors, identifying positive effects exerted by an MD including sourdough bread and healthy products from the Mediterranean basis (chickpeas/hummus, nuts, and pomegranate juice). For this purpose, a multicenter randomized controlled trial in which an MD-based intervention will be compared to a traditional low-fat diet intervention will be carried out with 240 overweight and obese adolescents (13–17 years) from Spain, Portugal, and Italy. Both interventions will be combined with an educational web-application addressed to engage the adolescents through a learning-through-playing approach, using both educational materials and games. To assess the interventions, adherence to the MD, dietary records, physical activity, food frequency, sociodemographic, and quality of life questionnaires as well as classical anthropometric and biochemical parameters will be evaluated. Furthermore, an omics approach will be performed to elucidate whether the interventions can shape the gut microbiota and gut-derived metabolites to gain knowledge on the mechanisms through which the MD can exert its beneficial effects.
Evaluation of Bed Depth Reduction, Media Change, and Partial Saturation as Combined Strategies to Modify in Vertical Treatment Wetlands
Authors: Vera-Puerto Ismael , Valdés Hugo , Correa Christian , Perez Valeria , Gomez Roberto , Alarcon Erica , Arias Carlos
Published: May 2021

The aim of this work was to evaluate the performance of vertical subsurface flow treatment wetlands (VSSF TWs) for treating rural domestic wastewater when strategies such as bed depth reduction and media change are used in combination with bottom saturation. Two treatment wetland systems were implemented: normal (VF-N), with a bed depth of 1.0 m, and modified (VF-M), with a bed depth of 0.5 m and a bottom layer of natural zeolite. Schoenoplectus californicus was used as experimental plant. These two treatment systems were operated at a hydraulic loading rate of 120 mm/d in two phases. Phase I did not use bottom saturation, while Phase II involved a bottom saturation of the zeolite layer of the VF-M system. The results show that bed depth reduction did not have a significant effect (p > 0.05) in terms of organic matter, solids, and ammonium removal. Conversely, it had a significant influence (p < 0.05) on phosphate as well as a negative effect on pathogen removal. This influence could be explained by initial media capacity for phosphorus removal and filtration importance in the case of pathogens. Partial saturation only had a positive influence on total nitrogen removal. The addition of a bottom layer of natural zeolite showed no positive effect on nutrient removal. The plant showed adaptation and positive development in both VF-N and VF-M. The water balance showed that water loss was not influenced by bed depth reduction. Therefore, according to the previous results, a combination of the proposal modifications to VSSF TWs can be introduced for treating rural domestic wastewater.
Association between Internet Addiction and Application Usage among Junior High School Students: A Field Survey
Authors: Kawabe Kentaro , Horiuchi Fumie , Hosokawa Rie , Nakachi Kiwamu , Ueno Shu-ichi
Published: May 2021

The purpose of this study was to elucidate the relationship between the severity of Internet addiction and various media-related applications. The participants were junior high school students between 12 and 15 years old. A total of 529 students (283 males, 246 females) were included. The participants answered Young’s Internet Addiction Test (IAT) and a structural questionnaire about their access to electronic devices and applications. An Internet addiction prevalence of 4.3% (95% CI: 2.8–6.5%) was reported in this study, with an additional 26.3% (95% CI: 22.6–30.2%) of participants possibly addicted. The accessibility of gaming devices was significantly higher in male students than in female students. The use of applications for SNSs was significantly higher in female students than in male students. Twitter accessibility was a factor that contributed to Internet addiction in both genders. The prevalence of severe Internet addiction among school students in Japan was 4.3%, and Twitter was the most important factor associated with this addiction. Media literacy must be increased in adolescents and their friends, teachers, and families.
The Evolution in Anxiety and Depression with the Progression of the Pandemic in Adult Populations from Eight Countries and Four Continents
Authors: Généreux Mélissa , Schluter Philip J. , Landaverde Elsa , Hung Kevin KC , Wong Chi Shing , Mok Catherine Pui Yin , Blouin-Genest Gabriel , O’Sullivan Tracey , David Marc D. , Carignan Marie-Eve , Champagne-Poirier Olivier , Pignard-Cheynel Nathalie , Salerno Sébastien , Lits Grégoire , d’Haenens Leen , Coninck David De , Matthys Koenraad , Champagne Eric , Burlone Nathalie , Qadar Zeeshan , Herbosa Teodoro , Ribeiro-Alves Gleisse , Law Ronald , Murray Virginia , Chan Emily Ying Yang , Roy Mathieu
Published: May 2021

Nearly a year after the classification of the COVID-19 outbreak as a global pandemic, it is clear that different factors have contributed to an increase in psychological disorders, including public health measures that infringe on personal freedoms, growing financial losses, and conflicting messages. This study examined the evolution of psychosocial impacts with the progression of the pandemic in adult populations from different countries and continents, and identified, among a wide range of individual and country-level factors, which ones are contributing to this evolving psychological response. An online survey was conducted in May/June 2020 and in November 2020, among a sample of 17,833 adults (Phase 1: 8806; Phase 2: 9027) from eight countries/regions (Canada, the United States, England, Switzerland, Belgium, Hong Kong, the Philippines, New Zealand). Probable generalized anxiety disorder (GAD) and major depressive episode (MDE) were assessed. The independent role of potential factors was examined using multilevel logistic regression. Probable GAD or MDE was indicated by 30.1% and 32.5% of the respondents during phases 1 and 2, respectively (a 7.9% increase over time), with an important variation according to countries/regions (range from 22.3% in Switzerland to 38.8% in the Philippines). This proportion exceeded 50% among young adults (18–24 years old) in all countries except for Switzerland. Beyond young age, several factors negatively influenced mental health in times of pandemic; important factors were found, including weak sense of coherence (adjusted odds ratio aOR = 3.89), false beliefs (aOR = 2.33), and self-isolation/quarantine (aOR = 2.01). The world has entered a new era dominated by psychological suffering and rising demand for mental health interventions, along a continuum from health promotion to specialized healthcare. More than ever, we need to innovate and build interventions aimed at strengthening key protective factors, such as sense of coherence, in the fight against the adversity caused by the concurrent pandemic and infodemic.
Exploring the Frequency of Anxiety and Depression Symptoms in a Brazilian Sample during the COVID-19 Outbreak
Authors: Ribeiro Fabiana Silva , Santos Flávia H. , Anunciação Luis , Barrozo Lucas , Landeira-Fernandez Jesus , Leist Anja K.
Published: May 2021

The COVID-19 pandemic is a public health emergency of international concern, and the main measures to contain the spread of the coronavirus causing COVID-19 were social distancing, quarantine, and self-isolation. Although these policies are effective in containing the spread of the virus, they might represent a challenge to psychological well-being, increasing levels of depressive and anxiety-related symptoms. Aims: We explored the frequency of anxiety and depression symptoms during COVID-19 restrictions and associations with sociodemographic factors in a Brazilian sample. Method: Data of a total of 936 Brazilian adults (68.2% women) aged 18 to 77 years old (M = 38.95, SD = 13.91) were collected through an online survey. Results: In general, we observed a frequency of 17.36% for severe anxiety and 66.13% for severe depression symptoms, in which younger participants (18–39 years old) and women showed higher scores in anxiety and depression scales compared to older age groups. Logistic regressions showed that women were more likely to present severe symptoms of anxiety (20.4%) compared to men (10.9%), as well as respondents in the educational sector (24.3%) compared to those in the health sector (10%). Conclusions: We highlight the importance of mental health professionals in developing strategies to help younger adults to mitigate the effects of social restriction.
Time Trends in Racial/Ethnic Differences in COVID-19 Infection and Mortality
Authors: Wong Michelle S. , Haderlein Taona P. , Yuan Anita H. , Moy Ernest , Jones Kenneth T. , Washington Donna L.
Published: May 2021

Studies documenting coronavirus disease 2019 (COVID-19) racial/ethnic disparities in the United States were limited to data from the initial few months of the pandemic, did not account for changes over time, and focused primarily on Black and Hispanic minority groups. To fill these gaps, we examined time trends in racial/ethnic disparities in COVID-19 infection and mortality. We used the Veteran Health Administration’s (VHA) national database of veteran COVID-19 infections over three time periods: 3/1/2020–5/31/2020 (spring); 6/1/2020–8/31/2020 (summer); and 9/1/2020–11/25/2020 (fall). We calculated COVID-19 infection and mortality predicted probabilities from logistic regression models that included time period-by-race/ethnicity interaction terms, and controlled for age, gender, and prior diagnosis of CDC risk factors. Racial/ethnic groups at higher risk for COVID-19 infection and mortality changed over time. American Indian/Alaskan Natives (AI/AN), Blacks, Hispanics, and Native Hawaiians/Other Pacific Islanders experienced higher COVID-19 infections compared to Whites during the summertime. There were mortality disparities for Blacks in springtime, and AI/ANs, Asians, and Hispanics in summertime. Policy makers should consider the dynamic nature of racial/ethnic disparities as the pandemic evolves, and potential effects of risk mitigation and other (e.g., economic) policies on these disparities. Researchers should consider how trends in disparities change over time in other samples.
A Methodology for Harmonizing Safety and Health Scales in Occupational Risk Assessment
Authors: Ji Zuzhen , Pons Dirk , Pearse John
Published: May 2021

Successful implementation of Health and Safety (H&S) systems requires an effective mechanism to assess risk. Existing methods focus primarily on measuring the safety aspect; the risk of an accident is determined based on the product of severity of consequence and likelihood of the incident arising. The health component, i.e., chronic harm, is more difficult to assess. Partially, this is due to both consequences and the likelihood of health issues, which may be indeterminate. There is a need to develop a quantitative risk measurement for H&S risk management and with better representation for chronic health issues. The present paper has approached this from a different direction, by adopting a public health perspective of quality of life. We have then changed the risk assessment process to accommodate this. This was then applied to a case study. The case study showed that merely including the chronic harm scales appeared to be sufficient to elicit a more detailed consideration of hazards for chronic harm. This suggests that people are not insensitive to chronic harm hazards, but benefit from having a framework in which to communicate them. A method has been devised to harmonize safety and harm risk assessments. The result was a comprehensive risk assessment method with consideration of safety accidents and chronic health issues. This has the potential to benefit industry by making chronic harm more visible and hence more preventable.
Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, “Passing” Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil
Authors: Catelan Ramiro Figueiredo , Saadeh Alexandre , Lobato Maria Inês Rodrigues , Gagliotti Daniel Augusto Mori , Costa Angelo Brandelli
Published: May 2021

This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, “passing” concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher “passing” concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and “passing” concerns in transgender populations.
Food Insecurity and Dietary Intake among Rural Indian Women: An Exploratory Study
Authors: Sims Alice , van der Pligt Paige , John Preethi , Kaushal Jyotsna , Kaur Gaganjot , McKay Fiona H
Published: May 2021

Food insecurity is an important contributor to health and a factor in both underweight and malnutrition, and overweight and obesity. Countries where both undernutrition and overweight and obesity coexist are said to be experiencing a double burden of malnutrition. India is one example of a country experiencing this double burden. Women have been found to experience the negative impacts of food insecurity and obesity, however, the reasons that women experience the impact of malnutrition more so than men are complex and are under-researched. This current research employed a mixed methods approach to begin to fill this gap by exploring the dietary intake, anthropometric characteristics, and food security status of rural Indian women. In total, 78 household were surveyed. The average waist measurement, waist to hip ratio, and BMI were all above WHO recommendations, with two thirds of participants categorized as obese. Contributing to these findings was a very limited diet, high in energy, and low in protein and iron. The findings of this research suggest that the rural Indian women in this study have a lack of diet diversity and may be at risk of a range of non-communicable diseases.
A Case Control Study on Serum Levels of Potential Biomarkers in Male Breast Cancer Patients
Authors: Ahmed Abdelsalam Kamal Eldin , Asad Mohammed , Ahmed Monjid Ahmed Ibrahim , Asdaq Syed Mohammed Basheeruddin , Mohzari Yahya , Alrashed Ahmed , Alghamdi NajwaJilan , Alrami Kholoud Nasser , Alharbi Wael Ahmed
Published: May 2021

The global incidence of breast cancer among men is steadily growing. Despite this, compared to female breast cancer patients, there are very few studies on biomarkers in male breast cancer patients. A cross-sectional case control study was carried out to determine the serum levels of melatonin, ghrelin, dopamine, serotonin, epinephrine, and GABA in male breast cancer. All the recruited patients were obese, old, and had recently been diagnosed with the disease. They had not received any treatment for the cancer until the time of the study. Melatonin and epinephrine serum levels were significantly higher in breast cancer patients compared to their age-matched controls, whereas ghrelin, dopamine, GABA, and serotonin serum levels were lower in patients compared to the control group. The serum levels of most of the studied biomarkers in male breast cancer patients were similar to those observed in female breast cancer patients, except for serum melatonin levels.
Perceptions of Patient Safety Culture and Medication Error Reporting among Early- and Mid-Career Female Nurses in South Korea
Authors: Jang Sun-Joo , Lee Haeyoung , Son Youn-Jung
Published: May 2021

Reporting medication errors is crucial for improving quality of care and patient safety in acute care settings. To date, little is known about how reporting varies between early and mid-career nurses. Thus, this study used a cross-sectional, secondary data analysis design to investigate the differences between early (under the age of 35) and mid-career (ages 35–54) female nurses by examining their perceptions of patient safety culture using the Korean Hospital Survey on Patient Safety Culture (HSPSC) and single-item self-report measure of medication error reporting. A total of 311 hospital nurses (260 early-career and 51 mid-career nurses) completed questionnaires on perceived patient safety culture and medication error reporting. Early-career nurses had lower levels of perception regarding patient safety culture (p = 0.034) compared to mid-career nurses. A multiple logistic regression analysis showed that relatively short clinical experience (<3 years) and a higher level of perceived patient safety culture increased the rate of appropriate medication error reporting among early-career nurses. However, there was no significant association between perception of patient safety culture and medication error reporting among mid-career nurses. Future studies should investigate the role of positive perception of patient safety culture on reporting errors considering multidimensional aspects, and include hospital contextual factors among early-, mid-, and late-career nurses.
Effect of Mobile-Based Lifestyle Intervention on Body Weight, Glucose and Lipid Metabolism among the Overweight and Obese Elderly Population in China: A Randomized Controlled Trial Protocol
Authors: Zhang Yu , Guo Xiaohui , Zhang Na , Yan Xinyu , Li Muxia , Zhou Mingzhu , He Hairong , Li Yibin , Guo Wen , Zhang Man , Zhang Jianfen , Ma Guansheng
Published: May 2021

Background: Promotion of a healthy lifestyle is considered a good strategy for dealing with chronic diseases. Mobile-based lifestyle interventions have shown beneficial effects in the control and treatment of chronic diseases such as diabetes, obesity and metabolic syndrome. Current clinical trials for mobile-based lifestyle intervention were mainly conducted among non-elderly populations, thus well-designed trials performed among the elderly who are more susceptible to chronic diseases are needed. The study aims to assess the effect of the mobile-based lifestyle intervention on the improvement of body weight, glucose and lipid metabolism among overweight and obese elderly adults in China. Materials and Methods: Participants aged 60–80 years who are overweight or obese will be randomly assigned to receive mobile-based nutrition and exercise intervention, mobile-based exercise intervention and no intervention for 3 months. Before the intervention, participants will receive the training of the mobile application and sports bracelet. The primary outcome will be the between-group (three groups) difference in body mass index at the end of intervention. The secondary outcomes will include body composition, parameters of glucose and lipid metabolism, blood pressure, dietary data and physical activity data. All these outcomes will be assessed at baseline, day 45 and day 90. Ethics and dissemination: The trial has been approved by the Ethics Committee of Peking University Health Science Center (IRB00001052-18039).
Korean Childcare Providers’ Knowledge, Attitudes, Concerns, and Practices of Febrile Convulsions
Authors: Oh Won-Oak , Heo Yoo Jin , Suk Min Hyun , Lee Anna
Published: May 2021

With the increase in the number of childcare facilities, childcare providers’ coping skills to take quick action in emergencies have become crucial. This study was to examine Korean childcare providers’ knowledge, attitudes, concerns, and practices regarding febrile convulsions (FCs), and to identify factors influencing their management of FCs. A cross-sectional study was conducted using a questionnaire of 216 Korean childcare providers. Descriptive statistics were used to describe the sample characteristics and FC questionnaires. The differences in the FC practice by demographic variables were assessed using t-test and one-way analysis of variance. The relationships between FC practice and other variables were investigated using Pearson correlations and regression analysis. The childcare providers showed unfavorable levels of outcomes regarding FCs with a low percentage of correct answers on FC knowledge and recommended practices as well as negative attitudes and concerns toward FCs. Additionally, results indicated that the knowledge, education, attitudes toward, and actual experiences of FCs were related to FC practices. The current findings provide important evidence to develop interventions targeting childcare providers.
Impact of a Pandemic and Remote Learning on Team Development and Elements of Compassion in Prospective Medical Students Taking a Medical Humanities Course
Authors: Van Winkle Lon J. , Schwartz Brian D. , Horst Alexis , Fisher Jensen A. , Michels Nicole , Thornock Bradley O.
Published: May 2021

Introduction: We reported previously that when teams of students reflect on readings about communication, unconscious bias, and service-learning, their critical reflection, implicit bias mitigation, empathy, and compassionate behavior all increase. However, would these gains occur when intimate classroom settings, in-person team meetings, and direct interactions with people served were lost owing to the COVID-19 pandemic and remote learning? Methods: Before an online Medical Humanities course began in August 2020 and following the course in December 2020, 61 prospective medical students (54.1% female) completed reliable surveys of their reflective capacity (RC) and cognitive empathy (compassion). Students also completed surveys about their implicit biases and team community service in December 2020. Results: Both RC and empathy scores increased in students after they reflected on difficulties in communication, unconscious biases, and team service-learning experiences in the course. In written reflections, they reported how their compassionate behavior also grew owing to bias mitigation. Most students concurred that “unconscious bias might affect some of (their) clinical decisions or behaviors as a healthcare professional” and vowed to remain aware of these biases in clinical settings. Conclusions: Compared to previous years, the pandemic and remote learning had minimal effects on the benefits of our Medical Humanities course.