bluuebunny/crossref_metadata_2025 huggingface dataset:
Risky sexual behavior and its associated factors among patients with severe mental disorder in University of Gondar Comprehensive Specialized Hospital, 2018
Authors: Gebeyehu Daniel Ayelegne , Mulatie Missaye
Published: January 2021

Background

People with severe mental disorders are more likely to engage in high-risk sexual behaviors. As a result of these high-risk behaviors, they might contract sexually transmitted infections and become pregnant unintentionally. Despite the high burden of this problem, very little is known about the association between mental disorders and high-risk sexual behaviors; for this reason, the current study aimed at determining the association between these two behaviors in patients with mental disorders attending an outpatient clinic at the University of Gondar Comprehensive Specialized Hospital, Psychiatric Clinic.

Methods

A total of 223 study participants were recruited via a stratified sampling followed by a systematic sampling technique. An institutional-based cross-sectional study was conducted from April to May 2018. Data were collected using a pretested interviewer-based questionnaire. A four-item questionnaire was adopted from a behavioral surveillance survey and different literature sources. A multivariable logistic regression model was fitted to assess the strength in addition to the direction of the association between risky sexual behavior and independent variables. An interpretation was made based on the adjusted odds ratio and p-value at a 95% confidence interval (CI).

Result

Nearly half of the study participants (49.8, 95% CI; 43.9–56.5%) presented risky sexual behavior. The study found that male gender (2.98; adjusted odds ration [AOR] = 2.98; 95% CI; 1.49–5.95), no ability to read and write (3.99; AOR = 3.99; 95% CI: 1.53–10.4), history of hospitalization (3.95; AOR = 3.95; 95% CI: 1.87–8.32), perceived internal stigma (2.45, AOR = 2.45; 95% CI: 1.18–5.11), and poor social support (3.07, AOR = 3.07; 95% CI: 1.29–7.30) were significant predictors of risky sexual behaviors among patients with severe mental disorder.

Conclusion

Risky sexual behavior among patients with a severe mental disorders was high (49.8%). Special attention should be given to male patients, incorporating people with severe mental disorders into the adult education programs, continuous health education regarding risky sexual behavior and utilization of condoms, building self-esteem, and engaging others to provide good social support systems are strongly recommended to alleviate this type of behavior in this population.
Suubi+Adherence-Round 2: A study protocol to examine the longitudinal HIV treatment adherence among youth living with HIV transitioning into young adulthood in Southern Uganda
Authors: Ssewamala Fred M. , Sensoy Bahar Ozge , Nabunya Proscovia , Thames April D. , Neilands Torsten B. , Damulira Christopher , Mukasa Barbara , Brathwaite Rachel , Mellins Claude , Santelli John , Brown Derek , Guo Shenyang , Namatovu Phionah , Kiyingi Joshua , Namuwonge Flavia , McKay Mary M.
Published: January 2021

Background

Youth living with HIV (YLHIV) in Sub-Saharan African (SSA) are less likely to adhere to antiretroviral therapy (ART) and other health-related regimens. As a consequence, YLHIV are not only at risk for health problems and mental health comorbidities, but are also at risk for cognitive deficits, including in areas of memory and executive functioning. The Suubi+Adherence study followed 702 adolescents (10-16 years of age) receiving bolstered standard of care and a family economic empowerment intervention comprising an incentivized youth financial savings account (YSA) augmented with financial literacy training (FLT) and peer mentorship. The study findings pointed to superior short-term viral suppression and positive adolescent health and mental health functioning among participants receiving the intervention. The original group of adolescents who received Suubi+Adherence are now transitioning into young adulthood. This paper presents a protocol for the follow-up phase titled Suubi+Adherence Round 2.

Methods

The original cohort in Suubi+Adherence will be tracked for an additional five years (2020-2025). Specifically, the long term follow-up will allow to: 1) ascertain the extent to which the short term outcomes identified in the first 6 years of the intervention are maintained as the same group transitions through young adulthood; and 2) address new scientific questions regarding ART adherence; HIV care engagement; protective health behaviors; and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. Additionally, the team examines the potential mechanisms through which the observed long-term outcomes happen. Moreover, the Suubi+Adherence-Round 2 adds a qualitative component and extends the cost effectiveness component.

Discussion

Guided by asset and human development theories, Suubi+Adherence-R2 will build on the recently concluded Suubi+Adherence study to conduct one of the largest and longest running studies of YLHIV in SSA as they transition into young adulthood. The study will address new scientific questions regarding long-term ART adherence, HIV care engagement, protective health behaviors, and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. The findings may inform efforts to improve HIV care among Uganda’s YLHIV, with potential replicability in other low-resource countries.

Trial registration

ClinicalTrials.gov, ID:NCT01790373
Cultural adaptation, translation and validation of the Spanish version of Past-day Adults’ Sedentary Time
Authors: Aguilar-Farias Nicolas , Martino-Fuentealba Pía , Chandia-Poblete Damian
Published: January 2021

Background

To better understand sedentary behaviour and favour international comparisons, more evidence from different countries are needed. However, there are a few tools available in Spanish to measure sedentary behaviour. This study aimed to culturally adapt, translate and validate the Past-day Adults’ Sedentary Time (PAST) questionnaire in Chilean adults compared with the ActivPAL.

Method

One hundred one workers wore an ActivPAL for 1 week and were asked to respond to the Spanish version of the PAST twice on different visits at a 7-day interval. The PAST assesses sedentary behaviour in several domains, including working time, during the previous day. Reliability was assessed with the intraclass correlation coefficient (ICC). Correlations and Bland-Altman methods were used to determine accuracy properties of the PAST compared with the ActivPAL.

Results

Seventy-seven participants provided valid data (51.0% male; age = 39.0 ± 12.39 years). The PAST showed moderate reliability (ICC = 0.63). For the total time in sedentary behavior per day, the PAST showed no correlation (r = 0.21, p = 0.07) and a mean bias of 54.9 min/day (LoA 95%: − 484.3, 594.2 min/day) with the ActivPAL. For the total time in SB at work, the PAST showed moderate reliability (ICC = 0.40), weak correlation (r = 0.37, p < 0.002), and mean bias was 33.8 min/day (LoA 95%: − 285.7, 353.3 min/day).

Conclusions

The PAST performed better when estimating sedentary behaviour during working hours compared with the whole day. In this setting, accuracy properties were comparable with other self-report tools.
The direct digital workflow in fixed implant prosthodontics: a narrative review
Authors: Michelinakis George , Apostolakis Dimitrios , Kamposiora Phophi , Papavasiliou George , Özcan Mutlu
Published: January 2021

Background

The purpose of this narrative review was to examine the applicability of IOS procedures regarding single and multiple fixed implant restorations. Clinical outcomes for monolithic zirconia and lithium disilicate restorations produced through a direct digital workflow were reported.

Methods

A MEDLINE (Pubmed) search of the relevant English-language literature spanning from January 1st 2015 until March 31st 2020 was conducted. In vitro studies comparing digital implant impression accuracy by different IOS devices or in vitro studies examining differences in accuracy between digital and conventional impression procedures were included. Also, RCTs, clinical trials and case series on the success and/or survival of monolithic zirconia and lithium disilicate restorations on implants, manufactured completely digitally were included. In vitro and in vivo studies reporting on restorations produced through an indirect digital workflow, case reports and non-English language articles were excluded. The aim was to investigate the accuracy of IOS for single and multiple fixed implant restorations compared to the conventional impression methods and report on the variables that influence it. Finally, this study aimed to report on the survival and success of fixed implant-retained restorations fabricated using the direct digital workflow.

Results

For the single and short-span implant sites, IOS accuracy was high and the deviations in the position of the virtual implant fell within the acceptable clinical limits. In the complete edentulous arch with multiple implants, no consensus regarding the superiority of the conventional, splinted, custom tray impression procedure compared to the IOS impression was identified. Moreover, complete-arch IOS impressions were more accurate than conventional, non-splinted, open or close tray impressions. Factors related to scanbody design as well as scanner generation, scanning range and interimplant distance were found to influence complete-arch scanning accuracy. Single implant-retained monolithic restorations exhibited high success and survival rates and minor complications for short to medium follow-up periods.

Conclusions

The vast majority of identified studies were in vitro and this limited their clinical significance. Nevertheless, intraoral scanning exhibited high accuracy both for single and multiple implant restorations. Available literature on single-implant monolithic restorations manufactured through a complete digital workflow shows promising results for a follow-up of 3–5 years.
The micro revolution: effect of Bite-Sized Teaching (BST) on learner engagement and learning in postgraduate medical education
Authors: Manning Kimberly D. , Spicer Jennifer O. , Golub Lucas , Akbashev Mikhail , Klein Robin
Published: January 2021

Context

Bite-sized learning is an instructional method that utilizes brief, focused learning units. This approach may be beneficial in medical education given demands on learner time and cognitive load. This study aims to assess the impact of this approach on knowledge acquisition and learner attitudes in postgraduate medical education.

Methods

An instructional method, termed Bite-Sized Teaching (BST), was implemented within the curriculum at a US Internal Medicine postgraduate training program. In BST, content is distilled into manageable units focused on relevant schemas and delivered via brief peer teaching. A two-fold assessment of BST was performed that included cross sectional survey to assess learner attitudes and experiences and a controlled study to assess knowledge acquisition with BST and case-based teaching control.

Results

One hundred and six of 171 residents (62% response rate) completed the survey. Most residents (79.8%) reported BST was among the best conference types in the curriculum. Important components of BST cited by residents include the distilled content, multiple short talk format and peer teaching. Residents report incorporating what they learned via BST into their teaching (76.1%) and clinical practice (74.1%). Resident who had participated as speaker were significantly more likely to report incorporating learning from BST into their teaching (87.2% vs 63.0%, p < 0.01, Cramer’s V effect size = 0.37) and clinical practice (89.7% vs 65.3%, p = 0.02, Cramer’s V effect size 0.28).

Fifty-one residents participated in the knowledge assessment. Residents taught via BST scored significantly higher on immediate post-test compared to case-based teaching (score [SE] 62.5% [1.9] vs 55.2% [2.4], p = 0.03, Hedges g effect size 0.66). While both groups improved over pretest, there was no significant difference in scores between BST and case-based teaching at two (score [SE] 57.1 [2.1] vs 54.8 [2.5], p = 0.54) and six weeks (score [SD] 55.9 [2.1] vs 53.0 [2.9], p = 0.43).

Conclusions

Teaching via brief, focused learning units delivered by peers is well received by learners and appears to have a significantly greater impact on immediate knowledge recall than case-based teaching. Further study on long term knowledge retention and behaviors is needed. Bite-Sized Teaching may be a promising instructional approach in medical education.
Leveraging Telehealth to improve access to care: a qualitative evaluation of Veterans’ experience with the VA TeleSleep program
Authors: Nicosia Francesca M. , Kaul Bhavika , Totten Annette M. , Silvestrini Molly C. , Williams Katherine , Whooley Mary A. , Sarmiento Kathleen F.
Published: January 2021

Background

Obstructive sleep apnea is common among rural Veterans, however, access to diagnostic sleep testing, sleep specialists, and treatment devices is limited. To improve access to sleep care, the Veterans Health Administration (VA) implemented a national sleep telemedicine program. The TeleSleep program components included: 1) virtual clinical encounters; 2) home sleep apnea testing; and 3) web application for Veterans and providers to remotely monitor symptoms, sleep quality and use of positive airway pressure (PAP) therapy. This study aimed to identify factors impacting Veteran’s participation, satisfaction and experience with the TeleSleep program as part of a quality improvement initiative.

Methods

Semi-structured interview questions elicited patient perspectives and preferences regarding accessing and engaging with TeleSleep care. Rapid qualitative and matrix analysis methods for health services research were used to organize and describe the qualitative data.

Results

Thirty Veterans with obstructive sleep apnea (OSA) recruited from 6 VA telehealth “hubs” participated in interviews. Veterans reported positive experiences with sleep telemedicine, including improvements in sleep quality, other health conditions, and quality of life. Access to care improved as a result of decreased travel burden and ability of both clinicians and Veterans to remotely monitor and track personal sleep data. Overall experiences with telehealth technology were positive. Veterans indicated a strong preference for VA over non-VA community-based sleep care. Patient recommendations for change included improving scheduling, continuity and timeliness of communication, and the equipment refill process.

Conclusions

The VA TeleSleep program improved patient experiences across multiple aspects of care including a reduction in travel burden, increased access to clinicians and remote monitoring, and patient-reported health and quality of life outcomes, though some communication and continuity challenges remain. Implementing telehealth services may also improve the experiences of patients served by other subspecialties or healthcare systems.
S. pseudintermedius and S. aureus lineages with transmission ability circulate as causative agents of infections in pets for years
Authors: Ruiz-Ripa Laura , Simón Carmen , Ceballos Sara , Ortega Carmelo , Zarazaga Myriam , Torres Carmen , Gómez-Sanz Elena
Published: January 2021

Background

Staphylococcus pseudintermedius (SP) and Staphylococcus aureus (SA) are common colonizers of companion animals, but they are also considered opportunistic pathogens, causing diseases of diverse severity. This study focused on the identification and characterization of 33 coagulase-positive staphylococci isolated from diseased pets (28 dogs and five cats) during 2009–2011 in a veterinary hospital in Spain in order to stablish the circulating lineages and their antimicrobial resistance profile.

Results

Twenty-eight isolates were identified as SP and five as SA. Nine methicillin-resistant (MR) isolates (27%) carrying the mecA gene were detected (eight MRSP and one MRSA). The 55% of SP and SA isolates were multidrug-resistant (MDR). MRSP strains were typed as ST71-agrIII-SCCmecII/III-(PFGE) A (n=5), ST68-agrIV-SCCmecV-B1/B2 (n=2), and ST258-agrII-SCCmecIV-C (n=1). SP isolates showed resistance to the following antimicrobials [percentage of resistant isolates/resistance genes]: penicillin [82/blaZ], oxacillin [29/mecA] erythromycin/clindamycin [43/erm(B)], aminoglycosides [18–46/aacA-aphD, aphA3, aadE], tetracycline [71/tet(M), tet(K)], ciprofloxacin [29], chloramphenicol [29/catpC221], and trimethoprim-sulfamethoxazole [50/dfrG, dfrK]. The dfrK gene was revealed as part of the radC-integrated Tn559 in two SP isolates. Virulence genes detected among SP isolates were as follow [percentage of isolates]: siet [100], se-int [100], lukS/F-I [100], seccanine [7], and expB [7]. The single MRSA-mecA detected was typed as t011-ST398/CC398-agrI-SCCmecV and was MDR. The methicillin-susceptible SA isolates were typed as t045-ST5/CC5 (n=2), t10576-ST1660 (n=1), and t005-ST22/CC22 (n=1); the t005-ST22 feline isolate was PVL-positive and the two t045-ST45 isolates were ascribed to Immune Evasion Cluster (IEC) type F. Moreover, the t10576-ST1660 isolate, of potential equine origin, harbored the lukPQ and scneq genes. According to animal clinical history and data records, several strains seem to have been acquired from different sources of the hospital environment, while some SA strains appeared to have a human origin.

Conclusions

The frequent detection of MR and MDR isolates among clinical SP and SA strains with noticeable virulence traits is of veterinary concern, implying limited treatment options available. This is the first description of MRSA-ST398 and MRSP-ST68 in pets in Spain, as well the first report of the dfrK-carrying Tn559 in SP. This evidences that current transmissible lineages with mobilizable resistomes have been circulating as causative agents of infections among pets for years.
Volumetric measurements of paranasal sinuses and examination of sinonasal communication in healthy Shetland ponies: anatomical and morphometric characteristics using computed tomography
Authors: Köhler Lisa , Schulz-Kornas Ellen , Vervuert Ingrid , Gittel Claudia , Winter Karsten , Berner Dagmar , Gerlach Kerstin
Published: January 2021

Background

Despite clinical importance and frequent occurrence of sinus disease, little is known about the size of paranasal sinuses and their communication in ponies and small horses. To examine the shape and volume of the paranasal sinuses and evaluate the sinonasal communication, three-dimensional (3D) reconstructions of computed tomography (CT) datasets of 12 healthy adult Shetland ponies were performed and analysed. Linear measurements of head length and width were taken. Using semi-automatic segmentation, 3D-models of all sinus compartments were created. Volumetric measurement of the seven sinus compartments were conducted and statistical analysis was performed. Sinus volumes were compared between the left and right sinuses and the relation to age and head size was evaluated.

Results

Structure and shape of the paranasal sinus system in Shetland ponies was similar to that of large horses. All seven sinus compartments on each side of the head were identified (rostral maxillary sinus, ventral conchal sinus, caudal maxillary sinus, dorsal conchal sinus, middle conchal sinus, frontal sinus, sphenopalatine sinus). The existence of a bilateral cranial and a caudal system formed by a maxillary septum was visible in all 12 individuals. The volumetric sizes of the left and right sinuses did not differ significantly (p > 0.05). A positive correlation between the size of the paranasal sinuses and the head length was shown. A relation between sinus volumes and age could not be proved in adult ponies aged > six years. Communication between single sinus compartments was identified. Furthermore, communication with the nasal cavity over the nasomaxillary aperture (Apertura nasomaxillaris) and a common sinonasal channel (Canalis sinunasalis communis) as well as its splitting up into a rostral and a caudolateral channel could be seen. Examination of the sinonasal communication was challenging and only a descriptive evaluation was possible.

Conclusions

Our findings concerning the size, shape and volumetric dimensions of Shetland pony CT images could help improve CT interpretation of abnormal clinical cases as well as aiding clinicians to develop and select appropriate instruments for medical inspection and treatments.
Ten-year cardiovascular risk in diabetes patients without obstructive coronary artery disease: a retrospective Western Denmark cohort study
Authors: Olesen Kevin Kris Warnakula , Madsen Morten , Gyldenkerne Christine , Thrane Pernille Gro , Thim Troels , Jensen Lisette Okkels , Bøtker Hans Erik , Sørensen Henrik Toft , Maeng Michael
Published: January 2021

Background

Diabetes patients without obstructive coronary artery disease as assessed by coronary angiography have a low risk of myocardial infarction, but their myocardial infarction risk may still be higher than the general population. We examined the 10-year risks of myocardial infarction, ischemic stroke, and death in diabetes patients without obstructive coronary artery disease according to coronary angiography, compared to risks in a matched general population cohort.

Methods

We included all diabetes patients without obstructive coronary artery disease examined by coronary angiography from 2003 to 2016 in Western Denmark. Patients were matched by age and sex with a cohort from the Western Denmark general population without a previous myocardial infarction or coronary revascularization. Outcomes were myocardial infarction, ischemic stroke, and death. Ten-year cumulative incidences were computed. Adjusted hazard ratios (HR) then were computed using stratified Cox regression with the general population as reference.

Results

We identified 5734 diabetes patients without obstructive coronary artery disease and 28,670 matched individuals from the general population. Median follow-up was 7 years. Diabetes patients without obstructive coronary artery disease had an almost similar 10-year risk of myocardial infarction (3.2% vs 2.9%, adjusted HR 0.93, 95% CI 0.72–1.20) compared to the general population, but had an increased risk of ischemic stroke (5.2% vs 2.2%, adjusted HR 1.87, 95% CI 1.47-2.38) and death (29.6% vs 17.8%, adjusted HR 1.24, 95% CI 1.13–1.36).

Conclusions

Patients with diabetes and no obstructive coronary artery disease have a 10-year risk of myocardial infarction that is similar to that found in the general population. However, they still remain at increased risk of ischemic stroke and death.
Anti-tumor activity of resveratrol against gastric cancer: a review of recent advances with an emphasis on molecular pathways
Authors: Ashrafizadeh Milad , Rafiei Hossein , Mohammadinejad Reza , Farkhondeh Tahereh , Samarghandian Saeed
Published: January 2021

Gastric cancer (GC) is one of the most common cancers with high malignancy. In spite of the great development in diagnostic tools and application of anti-tumor drugs, we have not witnessed a significant increase in the survival time of patients with GC. Multiple studies have revealed that Wnt, Nrf2, MAPK, and PI3K/Akt signaling pathways are involved in GC invasion. Besides, long non-coding RNAs and microRNAs function as upstream mediators in GC malignancy. GC cells have acquired resistance to currently applied anti-tumor drugs. Besides, combination therapy is associated with higher anti-tumor activity. Resveratrol (Res) is a non-flavonoid polyphenol with high anti-tumor activity used in treatment of various cancers. A number of studies have demonstrated the potential of Res in regulation of molecular pathways involved in cancer malignancy. At the present review, we show that Res targets a variety of signaling pathways to induce apoptotic cell death and simultaneously, to inhibit the migration and metastasis of GC cells.
Co‐developing a common glossary with stakeholders for engagement on new genetic approaches for malaria control in a local African setting
Authors: Chemonges Wanyama Elinor , Dicko Bakara , Pare Toe Lea , Coulibaly Mamadou B. , Barry Nourou , Bayala Traore Korotimi , Diabate Abdoulaye , Drabo Mouhamed , Kayondo Jonathan K. , Kekele Souleymane , Kodio Souleymane , Ky Anselme Dinyiri , Linga Richard Ronny , Magala Emmanuel , Meda Wilfrid Ihibna , Mukwaya Solome , Namukwaya Annet , Robinson Benjamin , Samoura Hatouma , Sanogo Kadiatou , Thizy Delphine , Traoré Fatoumata
Published: January 2021

Stakeholder engagement is an essential pillar for the development of innovative public health interventions, including genetic approaches for malaria vector control. Scientific terminologies are mainly lacking in local languages, yet when research activities involve international partnership, the question of technical jargon and its translation is crucial for effective and meaningful communication with stakeholders. Target Malaria, a not-for-profit research consortium developing innovative genetic approaches to malaria vector control, carried out a linguistic exercise in Mali, Burkina Faso and Uganda to establish the appropriate translation of its key terminology to local languages of sites where the teams operate. While reviewing the literature, there was no commonly agreed approach to establish such glossary of technical terms in local languages of the field sites where Target Malaria operates. Because of its commitment to the value of co-development, Target Malaria decided to apply this principle for the linguistic work and to take the opportunity of this process to empower communities to take part in the dialogue on innovative vector control. The project worked with linguists from other institutions (whether public research ones or private language centre) who developed a first potential glossary in the local language after better understanding the project scientific approach. This initial glossary was then tested during focus groups with community members, which significantly improved the proposed translations by making them more appropriate to the local context and cultural understanding. The stepwise process revealed the complexity and importance of elaborating a common language with communities as well as the imbrication of language with cultural aspects. This exercise demonstrated the strength of a co-development approach with communities and language experts as a way to develop knowledge together and to tailor communication to the audience even in the language used.
Improving malaria preventive practices and pregnancy outcomes through a health education intervention: A randomized controlled trial
Authors: Balami Ahmed Dahiru , Said Salmiah Md. , Zulkefli Nor Afiah Mohd , Norsa’adah Bachok , Audu Bala
Published: January 2021

Background

The prevalence of malaria in pregnancy and its complications, remain very high in Nigeria. This study aimed to determine the effects of a malaria health educational intervention based on the information-motivation-behavioural skills (IMB) model on malaria preventive practices and pregnancy outcomes.

Methods

The study was a randomized controlled parallel-group study, where 372 randomly selected antenatal care attendees were randomly assigned to one of either two groups after collecting baseline data. The intervention group then received a four-hour health education intervention in Hausa language, which was developed based on the IMB model, while the control group received a similarly designed health education on breastfeeding. Follow up data were then collected from the participants at a first (2 months post-intervention) and second (4 months post-intervention) follow up, and at the end of their pregnancies.

Results

For both groups, reported ITN use had increased from baseline (Intervention: Often–14.0%, Almost always–9.1; Control: Often–12.4%; Almost always 16.1%) to the time of second follow up (Intervention: Often –28.10%, Almost always–24.5; Control: Often–17.2%; Almost always 19.5%). Reported IPTp uptake at second follow up was also higher for the intervention group (Intervention: Two doses–59.0%, Three doses 22.3%; Control group: Two doses–48.4%, Three doses–7.0%). The drop in the haematocrit levels was greater for the control group (32.42% to 30.63%) compared to the intervention group (33.09% to 31.93%). The Generalized Linear Mixed Models (GLMM) analysis revealed that the intervention had significantly improved reported ITN use, reported IPTp uptake, and haematocrit levels, but had no significant effect on the incidence of reported malaria diagnosis or babies’ birth weights.

Conclusions

The intervention was effective in improving ITN use, IPTp uptake, and haematocrit levels. It is, therefore, recommended for the modules to be adopted and incorporated into the routine antenatal care programmes in health centres with predominantly Hausa speaking clients.

Trial registration: Pan African Clinical Trial Registry, PACTR201610001823405. Registered 26 October 2016, www.pactr.org.
Does universal health insurance coverage reduce unmet healthcare needs in China? Evidence from the National Health Service Survey
Authors: Zhou Shenping , Huang Tianyu , Li Anqi , Wang Zhonghua
Published: January 2021

Background

China has nearly achieved universal health insurance coverage, but considerable unmet healthcare needs still exist. Although this topic has attracted great attention, there have been few studies examining the relationship between universal health insurance coverage and unmet healthcare needs. This study aimed to clarify the impact of universal health insurance coverage and other associated factors on Chinese residents’ unmet healthcare needs.

Methods

Data was derived from the fourth, fifth, and sixth National Health Service Survey of Jiangsu Province, which were conducted in 2008, 2013, and 2018, respectively. Descriptive statistics were used to analyze the prevalence of unmet healthcare needs. Binary multivariate logistic regression was used to estimate the association between unmet healthcare needs and universal health insurance coverage, along with other socioeconomic factors.

Results

8.99%, 1.37%, 53.37%, and 13.16% of the respondents in Jiangsu Province reported non-use of outpatient services, inpatient services, physical examinations, and early discharge from hospital, respectively. The trend in the prevalence of unmet healthcare needs showed a decline from 2008 to 2018. Health insurance had a significant reducing effect on non-use of outpatient services, inpatient services, or early discharge from hospital. People having health insurance in 2013 and 2018 were significantly less likely to report unmet healthcare needs compared to those in 2008. The effect of health insurance and its universal coverage on reducing unmet healthcare needs was greater in rural than in urban areas. Other socioeconomic factors, such as age, marital status, educational level, income level, or health status, also significantly affected unmet healthcare needs.

Conclusions

Universal health insurance coverage has significantly reduced Chinese residents’ unmet healthcare needs. Policy efforts should pay more attention to the benefits of health insurances in rural areas and optimize urban-rural health resources to promote effective utilization of healthcare.
Chemotherapy and adverse cardiovascular events in colorectal cancer patients undergoing surgical resection
Authors: Koo Chieh Yang , Tai Bee-Choo , Chan Dedrick Kok Hong , Tan Li Ling , Tan Ker Kan , Lee Chi-Hang
Published: January 2021

Background

Colorectal cancer patients undergoing surgical resection are at increased short-term risk of post-operative adverse events. However, specific predictors for long-term major adverse cardiac and cerebrovascular events (MACCE) are unclear. We hypothesised that patients who receive chemotherapy are at higher risk of MACCE than those who did not.

Methods

In this retrospective study, 412 patients who underwent surgical resection for newly diagnosed colorectal cancer from January 2013 to April 2015 were grouped according to chemotherapy status. MACCE was defined as a composite of cardiovascular death, myocardial infarction, stroke, unplanned revascularisation, hospitalisation for heart failure or angina. Predictors of MACCE were identified using competing risks regression, with non-cardiovascular death a competing risk.

Results

There were 200 patients in the chemotherapy group and 212 patients in the non-chemotherapy group. The overall prevalence of prior cardiovascular disease was 20.9%. Over a median follow-up duration of 5.1 years from diagnosis, the incidence of MACCE was 13.3%. Diabetes mellitus and prior cardiovascular disease were associated with an increased risk of MACCE (subdistribution hazard ratio, 2.56; 95% CI, 1.48-4.42) and 2.38 (95% CI, 1.36-4.18) respectively. The chemotherapy group was associated with a lower risk of MACCE (subdistribution hazard ratio, 0.37; 95% CI, 0.19-0.75) compared to the non-chemotherapy group.

Conclusions

Amongst colorectal cancer patients undergoing surgical resection, there was a high incidence of MACCE. Diabetes mellitus and prior cardiovascular disease were associated with an increased risk of MACCE. Chemotherapy was associated with a lower risk of MACCE, but further research is required to clarify this association.
Direct from the COVID-19 crisis: research and innovation sparks in Brazil
Authors: Rosa Mário Fabrício Fleury , da Silva Everton Nunes , Pacheco Christina , Diógenes Marcos Vinícius Pereira , Millett Christopher , Gadelha Carlos Augusto Grabois , Santos Leonor Maria Pacheco
Published: January 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic has spread throughout more than 160 countries, infecting millions of people worldwide. To address this health emergency, countries have organized the flow of production and innovation to reduce the impact on health. This article shows the response of the Brazilian scientific community to meet the urgent needs of the public unified health system [SUS], aiming to guarantee universal access to an estimated population of 211 million. By December 2020, Brazil had recorded more than six million cases and approximately 175,000 deaths.

Methods

We collected data on research, development and innovation projects carried out by 114 public universities (plus Oswaldo Cruz Foundation [Fiocruz] and Butantan Institute), as reported on their websites. Additionally, we examined the studies on COVID-19 approved by the National Comission for Research Ethics, as well as those reported on the Ministry of Education website as of May 15, 2020.

Results

The 789 identified projects were classified according to research categories as follows: development and innovation (n = 280), other types of projects (n = 226), epidemiologic research (n = 211), and basic research on disease mechanisms (n = 72). Most proposals focused on the development and innovation of personal protective equipment, medical devices, diagnostic tests, medicines and vaccines, which were rapidly identified as research priorities by the scientific community. Some promising results have been observed from phase III vaccine trials, one of which is conducted in partnership with Oxford University and another of which is performed with Sinovac Biotech. Both trials involve thousands of volunteers in their Brazilian arms and include technology transfer agreements with Fiocruz and the Butantan Institute, respectively. These vaccines proved to be safe and effective and were immediately licensed for emergency use. The provision of doses for the public health system, and vaccination, started on January 17, 2021.

Conclusions

The mobilized Brazilian scientific community has generated comprehensive research, development and innovation proposals to meet the most urgent needs. It is important to emphasize that this response was only possible due to decades of investment in research, development and innovation in Brazil. We need to reinforce and protect the Brazilian science, technology and innovation system from austerity policies that disregard health and knowledge as crucial investments for Brazilian society, in line with the constitutional right of universal health access and universal health coverage.
3D printed Ti6Al4V bone scaffolds with different pore structure effects on bone ingrowth
Authors: Deng Fuyuan , Liu Linlin , Li Zhong , Liu Juncai
Published: January 2021

The microstructure of porous scaffolds plays a vital role in bone regeneration, but its optimal shape is still unclear. In this study, four kinds of porous titanium alloy scaffolds with similar porosities (65%) and pore sizes (650 μm) and different structures were prepared by selective laser melting. Four scaffolds were implanted into the distal femur of rabbits to evaluate bone tissue growth in vivo. Micro-CT and hard tissue section analyses were performed 6 and 12 weeks after the operation to reveal the bone growth of the porous scaffold. The results show that diamond lattice unit (DIA) bone growth is the best of the four topological scaffolds. Through computational fluid dynamics (CFD) analysis, the permeability, velocity and flow trajectory inside the scaffold structure were calculated. The internal fluid velocity difference of the DIA structure is the smallest, and the trajectory of fluid flow inside the scaffold is the longest, which is beneficial for blood vessel growth, nutrient transport and bone formation. In this study, the mechanism of bone growth in different structures was revealed by in vivo experiments combined with CFD, providing a new theoretical basis for the design of bone scaffolds in the future.
Rare functional missense variants in CACNA1H: What can we learn from Writer’s cramp?
Authors: Huang Miaozhen , Nibbeling Esther A. R. , Lagrand Tjerk J. , Souza Ivana A. , Groen Justus L. , Gandini Maria A. , Zhang Fang-Xiong , Koelman Johannes H. T. M. , Adir Noam , Sinke Richard J. , Zamponi Gerald W. , Tijssen Marina A. J. , Verbeek Dineke S.
Published: January 2021

Writer’s cramp (WC) is a task-specific focal dystonia that occurs selectively in the hand and arm during writing. Previous studies have shown a role for genetics in the pathology of task-specific focal dystonia. However, to date, no causal gene has been reported for task-specific focal dystonia, including WC. In this study, we investigated the genetic background of a large Dutch family with autosomal dominant‒inherited WC that was negative for mutations in known dystonia genes. Whole exome sequencing identified 4 rare variants of unknown significance that segregated in the family. One candidate gene was selected for follow-up, Calcium Voltage-Gated Channel Subunit Alpha1 H, CACNA1H, due to its links with the known dystonia gene Potassium Channel Tetramerization Domain Containing 17, KCTD17, and with paroxysmal movement disorders. Targeted resequencing of CACNA1H in 82 WC cases identified another rare, putative damaging variant in a familial WC case that did not segregate. Using structural modelling and functional studies in vitro, we show that both the segregating p.Arg481Cys variant and the non-segregating p.Glu1881Lys variant very likely cause structural changes to the Cav3.2 protein and lead to similar gains of function, as seen in an accelerated recovery from inactivation. Both mutant channels are thus available for re-activation earlier, which may lead to an increase in intracellular calcium and increased neuronal excitability. Overall, we conclude that rare functional variants in CACNA1H need to be interpreted very carefully, and additional studies are needed to prove that the p.Arg481Cys variant is the cause of WC in the large Dutch family.
Ameliorative effect of recombinant human lactoferrin on the premature ovarian failure in rats after cyclophosphamide treatments
Authors: Li Shubin , Liu Mengnan , Ma Hongmeng , Jin Qin , Ma Yuzhen , Wang Chunyu , Ren Jingyu , Liu Gang , Dai Yanfeng
Published: January 2021

This study investigated the effect of recombinant human lactoferrin (rhLF) on the premature ovarian failure (POF) of rats. After cyclophosphamide treatments, the POF rats were divided into the following groups: normal control group (NC), low-dose group (LD), medium-dose group (MD) and high-dose group (HD) of rhLF. After drug administrations, the ovarian indexes and hormonal levels were detected. After follicle number count, the proliferation and apoptosis were analyzed with the expressions of genes related with oogenesis, reactive oxygen species (ROS) production and apoptosis detected, followed by the calculation of oxidative stress and protein expressions. After 4-hydroperoxy cyclophosphamide (4-HC) treatments, the effect of rhLF on the proliferation, ROS production and gene expressions of primary rat granulosa cells (GCs) cultured in vitro were detected. After mating, the fertilities of POF rats were recorded. The result showed that the rhLF administrations up-regulated the ovarian index with the number of developing follicles increased and the decreases of hormonal levels conferred. The Ki-67 intensities of the MD and HD groups were up-regulated with the Tunnel intensities decreased. The rhLF treatments significantly promoted the expression of oogenesis, antioxidant and anti-apoptosis related genes. The expression of Bax and Caspase 3 were decreased with the expression of Bcl-2 up-regulated after rhLF administrations. The in vitro treatments of rhLF effectively conferred the toxicity of 4-HC on primary rat GCs. The fertility assessment showed the rhLF treatments up-regulated the offspring’s’ folliculogenesis, which confirmed the ameliorative role of rhLF on the POF damages via the inhibition of ROS production in GCs.
Minimal genome-wide human CRISPR-Cas9 library
Authors: Gonçalves Emanuel , Thomas Mark , Behan Fiona M. , Picco Gabriele , Pacini Clare , Allen Felicity , Vinceti Alessandro , Sharma Mamta , Jackson David A. , Price Stacey , Beaver Charlotte M. , Dovey Oliver , Parry-Smith David , Iorio Francesco , Parts Leopold , Yusa Kosuke , Garnett Mathew J.
Published: January 2021

CRISPR guide RNA libraries have been iteratively improved to provide increasingly efficient reagents, although their large size is a barrier for many applications. We design an optimised minimal genome-wide human CRISPR-Cas9 library (MinLibCas9) by mining existing large-scale gene loss-of-function datasets, resulting in a greater than 42% reduction in size compared to other CRISPR-Cas9 libraries while preserving assay sensitivity and specificity. MinLibCas9 provides backward compatibility with existing datasets, increases the dynamic range of CRISPR-Cas9 screens and extends their application to complex models and assays.
Acupuncture for Hashimoto thyroiditis: study protocol for a randomized controlled trial
Authors: Wang Shanze , Zhao Jiping , Zeng Weimei , Du Wanqing , Zhong Tenghui , Gao Hui , Xiao Yi , Yang Chao
Published: January 2021

Background

The incidence rate of Hashimoto thyroiditis (HT) has gradually increased in recent years. There has been no specific etiological treatment for HT. Even though with normal level of thyroid hormone, the patients may still suffer from various clinical symptoms, such as anterior neck discomfort, fatigue, and mood swings, which seriously impair their quality of life. Acupuncture has long been used in the treatment of thyroid diseases, but there has been no related standardized clinical study as of today. This study aims to assess the feasibility, efficacy, and safety of acupuncture for HT.

Methods

This is a randomized, black-controlled assessor-blinded pilot trial. A total of 60 patients will be recruited and divided into the experimental group (n = 30) or the control group (n = 30). The experimental group will undergo acupuncture therapy (penetration needling of Hand-Yangming meridian, PNHM) for 16 weeks, followed by a 16-week follow-up period, and the control group will first go through an observation period for 16 weeks, followed by a 16-week compensation PNHM therapy. The primary outcome will be the change of the concentrations of anti-thyroperoxidase antibodies (TPOAb), antithyroglobulin antibodies (TgAb), and thyroid hormone, including total thyroxine (FT4), free thyroxine (FT3), and thyroid-stimulating hormone (TSH). The secondary outcome measurements include the thyroid-related quality of life questionnaire short-form (ThyPRO-39), The Mos 36-item Short Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HAD). Data collection will be performed before the start of the study (the baseline assessment) and at weeks 8, 16, 24, and 32.

Discussion

The study is designed to assess the feasibility and effectiveness of PNHM in reducing the thyroid antibody level and improving the quality of life of HT patients with hypothyroidism or subclinical hypothyroidism. Results of this trial will assist further analyses on whether the acupuncture treatment can alleviate symptoms for patients with HT.

Trial registration

Acupuncture-Moxibustion Clinical Trial Registry AMCTR-IOR-19000308 (ChiCTR1900026830). Registered on 23 October 2019.
Evaluation of a panel of tumor-specific differentially-methylated DNA regions in IRF4, IKZF1 and BCAT1 for blood-based detection of colorectal cancer
Authors: Young Graeme P. , Symonds Erin L. , Nielsen Hans Jørgen , Ferm Linnea , Christensen Ib J. , Dekker Evelien , van der Vlugt Manon , Mallant-Hent Rosalie C. , Boulter Nicky , Yu Betty , Chan Michelle , Tevz Gregor , LaPointe Lawrence C. , Pedersen Susanne K.
Published: January 2021

Background

Differentially-methylated regions (DMRs) are characteristic of colorectal cancer (CRC) and some occur more frequently than common mutations. This study aimed to evaluate the clinical utility of assaying circulating cell-free DNA for methylation in BCAT1, IKZF1 and IRF4 for detection of CRC.

Methods

A multiplexed real-time PCR assay targeting DMRs in each of the three genes was developed. Assay accuracy was explored in plasma specimens banked from observational cross-sectional trials or from volunteers scheduled for colonoscopy or prior to CRC surgery.

Results

1620 specimens were suitable for study inclusion including 184 and 616 cases with CRC and adenomas, respectively, and 820 cases without neoplasia (overall median age, 63.0 years; 56% males). Combining the PCR signals for all targeted DMRs returned the best sensitivity for CRC (136/184, 73.9%, 95% CI 67.1–79.7), advanced adenomas (53/337, 15.7%, 95% CI 12.0–20.1) and high-grade dysplastic (HGD) adenomas (9/35, 25.7%, 95% CI 14.0–42.3) with a 90.1%, specificity for neoplasia (739/820, 95% CI 87.9–92.0, p < 0.01). Detection of methylation in all three genes were more likely in CRC cases than those without it (OR 28.5, 95% CI 7.3–121.2, p < 0.0001). Of the 81 positive cases without neoplasia, 62 (76.5%) were positive by a single PCR replicate only and predominantly due to detection of methylated BCAT1 (53.2%). Single replicate positivity was significantly higher than that in CRC (26/136, 19.1%, p < 0.0001), and single BCAT1 replicate positivity was more likely in cases without neoplasia than in CRC (OR 17.7, 95% CI 6.6–43.3, p < 0.0001). When a positive result was limited to those with ≥ 1 PCR replicate positive for either IKZF1 or IRF4, or at least two replicates positive for BCAT1, the multi-panel test maintained a high sensitivity for CRC (131/184, 71.2%, 95% CI 64.3–77.3) and HGD adenomas (8/35, 22.9%, 95% CI 11.8–39.3, p = 0.029) but improved specificity significantly (772/820, 94.1%, 95% CI 92.3–95.6, p < 0.0001 vs. any PCR replicate positive).

Conclusion

The multi-panel methylation assay differentiates cases with CRC from those without it and does so with high specificity when criteria for BCAT1 detection are applied. The marker panel is flexible and studies in those at average risk for CRC are now warranted to determine which panel configuration best suits screening goals.

Trial registration: ACTRN12611000318987. Registered 25 March 2011, https://www.anzctr.org.au/ ACTRN12611000318987.