bluuebunny/crossref_metadata_2025 huggingface dataset:
“Am I entitled to take a break in caregiving?”: Perceptions of leisure activities of family caregivers of loved ones with dementia in China
Authors: Xu Xin Yi , Leung Doris , Leung Angela Yee Man , Kwan Rick Yiu Cho , Liang Ting Na , Chai Ai Jun
Published: April 2022

Leisure activities are essential for family caregivers of loved ones with dementia living in the community, yet these caregivers tend not to engage in them, especially in China, wherein it may have a negative impact on their physical and psychological health. To date, limited knowledge exists regarding underlying reasons that deter these family caregivers from doing leisure activities. This study aims to explore perceptions of family caregivers of people living with dementia and their engagement in leisure activities. A qualitative descriptive research design was used with semi-structured, face-to-face, individual in-depth interviews. The data were collected in Shijiazhuang, China between October and November 2019. Content analysis was used to develop categories. Results of 20 family caregivers (5 men and 15 women, mean age = 55.6±12.7) reported their perceptions under four main categories: (i) “the condition of leisure life,” (ii) “needs for leisure activities,” (iii) “reasons for the reluctance to do leisure activities,” and (iv) “motivations supporting the implementation of leisure activities.” In addition to the heavy caregiving workload and lack of support, traditional Chinese beliefs including filial commitment and “fatalistic voluntarism” were the reasons that prevented Chinese family caregivers of people living with dementia from doing leisure activities. However, engaging their loved ones in leisure activities, like doing exercise together, could motivate family caregivers themselves to participate in leisure activities. These findings encourage healthcare professionals to consider the influence of culture on family caregivers’ engagement in leisure activities which is one of the ways to reduce stress. Family caregivers may benefit from the leisure activities by learning how to better cope with and balance caregiving tasks with their leisure pursuits in the community.
Understanding the Audience for a Digital Capacity-Building Platform for Micro-Retailers in Nairobi, Kenya: A Latent Class Segmentation Analysis
Authors: Kumoji Evelyn , Oyenubi Olamide , Rhoades Alice , Cassaniti Jarret , Rariewa Fred , Ohkubo Saori
Published: April 2022

Background: Digital programs need to understand the characteristics of their audiences to develop services that meet the needs of different user groups.Focus of the Article: This manuscript is related to research and evaluation, and to four social marketing benchmarks: Consumer Research, Segmentation and Targeting, Consumer Orientation, and Exchange.Research Question: What are the behavioral characteristics and user profiles among duka owners who are using a digital business capacity-building platform in Nairobi, Kenya.Design/Approach: Survey assessment of use of a mobile-friendly online platform for promoting business growth among underserved micro-retail shop (duka) owners in Nairobi, Kenya. The UJoin platform offers duka owners access to business and financial courses, online mentoring, networking opportunities, and access to product information.Importance to the Field: The research will provide critical insights into program and audience needs for use of digital platforms, including promoting, scaling, and strengthening digital services.Methods: 805 shop owners in Nairobi, Kenya participated in a survey about perceptions and use of the internet. Latent class analysis identified homogeneous “classes” within the sample, and behavioral profiles and predictors of platform use.Results: Analysis yielded a 3-class model. Class 1 Endorsers endorsed community norms, social support, learning, networking, and perceived business benefits from websites. Class 2 Skeptics did not support collaboration and learning. Class 3 Unengaged lacked support to use online platforms. Predictors of frequent use of digital platforms were self-efficacy (OR: 5.95, p < .001), Endorser (OR: 3.13, p < .001) and Unengaged (OR: 2.42, p < .055) class, and agreeing that connections to duka owners is important (OR: 3.02, p < .003).Conclusion: Diversified strategies to promote use of online platforms may meet different needs of sub-groups among user groups.Recommendations for Research and Practice: Multiple strategies are needed to address different needs of sub-groups within a larger audience. Programs may benefit from investments to characterize the audience during recruitment to better understand attitudes towards, and efficacy to use, the internet, level of motivation, technology and support needs, and attitudes towards learning and networking.Limitations: The survey sample was a non-random selection of duka owners and relied on self-reported data which may be subject to social-desirability bias and recall. Some of the survey questions about perceptions were derived from single-item variables rather than an index or scale. The cross-sectional design of the survey precludes causal inferences.
Major Amputation In Non-Healing Ulcers: Outcomes and Economic Issues. Data from a Cohort of Patients with Diabetic Foot Ulcers
Authors: Monami Matteo , Ragghianti Benedetta , Nreu Besmir , Lorenzoni Valentina , Pozzan Marco , Silverii Antonio , Turchetti Giuseppe , Mannucci Edoardo
Published: April 2022

Background: Foot ulcers have a relevant economic impact on Health Care Systems and the cost-effectivenesseffectiveness of options is not clear. The aim of this study was the assessment of costs for ulcers treatment after 6, 12, and 18 months of follow-up, compared to those for major amputation. Methods: A retrospective study was carried out on 196 types 2 diabetic patients with foot ulcers. The principal endpoints were 1) the proportion of recovered patients among those with ulcers not healed after 6 and 12 months; 2) the assessment of direct costs for treatment of ulcers 6, 12, and 18 months of follow-up, as compared to the cost of major amputation. The economic evaluation was performed considering the perspective of the local health system. Results: Out of 196 patients, 85(46.2%), 131(71.6%), and 140(85.9%) healed within 6, 12, and 18 months, respectively. The average health cost during the 18-month follow-up was 5402€ per patient. We calculated hypothetical costs for three different scenarios, in which patients who did not heal within 6 months underwent a major amputation at 6, 1,2, or 18 months. Costs for the standard of care for all these scenarios (6,094, 7,256, and 7649€ for 6, 12, or 18 months, respectively) were significantly lower than that for major amputations (21,065€). Conclusions: A conservative approach appears more convenient than major amputations in ulcers not healing after 6 months, irrespective of the estimated risk of individual patients.
Yarn unevenness prediction using generalized regression neural network under various optimization algorithms
Authors: Jiang Hao , Song Jiuxiang , Zhang Baowei , Wang Yonghua
Published: April 2022

Unevenness is one of the important parameters for evaluating yarn quality, but the current prediction accuracy of yarn unevenness is low. One of the important reasons is that there are few sample dataset for yarn unevenness prediction. For this problem, this paper applies generalized regression neural network to predict the unevenness of the yarn. Then, the generalized regression neural network is optimized by using particle swarm optimization, fruit fly optimization algorithm, and gray wolf optimizer, respectively. Finally, the optimized models were experimentally validated for their effectiveness. The experimental results show that the generalized regression neural network optimized by gray wolf optimizer has the best effect and the fastest optimization speed; the generalized regression neural network optimized by particle swarm optimization algorithm has the middle optimization speed; the generalized regression neural network optimized by fruit fly optimization algorithm has the worst effect and the slowest optimization speed.
Multiple vascular reconstructions during pancreatectomy: Surgical techniques and strategies
Authors: Kaya Kaan , Mungan Ufuk
Published: April 2022

Objectives

Pancreatic body and tail tumors account for one-third of all pancreatic tumors and can be diagnosed later than pancreatic head tumors because they present symptoms much later. When analyzed, most of them are generally unresectable because they are invaded into adjacent organs and vascular structures. We aimed to present our cases of vascular resection and anastomosis, where isolated tumor resection cannot be performed due to invasion of adjacent vascular structures.

Methods

Between January 2019 and January 2021, the files of eight patients who had one or more vascular invasions due to the pancreatic body and tail tumor and therefore underwent vascular resection in addition to pancreatectomy were accessed.

Results

Portal vein and hepatic artery repair were performed in all eight patients. Superior mesenteric artery anastomosis was performed in four patients, inferior vena cava repair was performed in two patients, and renal vein anastomosis was performed in two patients. Primary end-to-end repair, Dacron graft, ring-enforced polytetrafluoroethylene graft, and saphenous vein graft techniques were used during vascular interventions.

Conclusions

We wanted to share our experience with the resection of vascular structures and anastomosis techniques. We believe that the indications of tumor surgery can be improved and redesigned by performing more routinely vascular resections and reconstructions in the future.
Application of metalloporphyrin sensitizers for the treatment or diagnosis of tumors
Authors: Luo Hongyu , Yu Wenmei , Chen Si , Wang Zhenyu , Tian Zejie , He Jun , Liu Yunmei
Published: April 2022

At present, metalloporphyrin compounds demonstrate three main uses as anticancer sensitizers: (1) photosensitizers, (2) photothermal conversion agents, and (3) ultrasound sensitizers. Developing efficient sensitizers for cancer with excellent controllability and biocompatibility is an important goal of oncology medicine. Because of the different structural diversity of anticancer sensitizers, such sensitizers are used for treating cancers by employing a variety of tumor treatment methods such as mature photodynamic therapy, commonly used clinically photothermal therapy and promising sonodynamic therapy. Among the many sensitizers, metalloporphyrin-complex sensitizers attract wide attention due to their excellent performance in tumor treatment and diagnosis. This review briefly describes some metalloporphyrin anticancer drugs and diagnostic agents related to photodynamic, photothermal and sonodynamic therapy, and discusses the roles of metal atoms in these drugs.
Combined transarterial and transvenous embolization of multi-hole pial arteriovenous fistula with large varix
Authors: Yamada Hiroki , Akiyama Takenori , Kamamoto Dai , Yoshida Keisuke , Fukumura Mariko , Toda Masahiro
Published: April 2022

Background

Pial arteriovenous fistula (AVF) is a vascular fistulous disease in which the cerebral pial artery and vein are directly connected without the intervening nidus within a sub-pial space. Multi-hole pial AVFs, wherein multiple feeders flow into one drainer, are usually formed with complex angioarchitecture and are difficult to treat.

Methods

A rare case of an adult patient with hereditary hemorrhagic telangiectasia and multi-hole pial AVF was described. A 23-year-old woman was referred to our hospital. She was previously diagnosed with left cerebellar pial AVF with multiple feeders (bilateral superior cerebellar artery and common trunk of the left anterior inferior cerebellar artery and posterior inferior cerebellar) and large varix that had been untreated for 9 years. The enlargement of the large varix with the new second varix formation was revealed by angiography. Although asymptomatic, considered to be a risk for future hemorrhage was the continuous high hemodynamic stress.

Results

Endovascular embolization was performed by securing safe transarterial n-butyl-2-cyanoacrylate injection by transarterial and transvenous coil placement to the shunt points and feeders, resulting in total occlusion of the fistula without any complications. Extensive transvenous coil placement inside the varix allowed safe embolization of the entire fistula with multiple high-flow feeders. Moreover, bidirectional (transarterial and transvenous) retrograde coil embolization enabled firm obliteration of the shunt points.

Conclusions

Performing combined transarterial and transvenous embolization in a well-balanced manner was considered to treat multi-hole pial AVF to provide a safe and effective embolization.
Contrast-enhanced ultrasound of breast tumors: an initial experience
Authors: Kristiansen Merete U , Martiniussen Marit A , Larsen Anne Sofie F
Published: April 2022

Background

The increase of neoadjuvant treatment for breast cancer creates a capacity challenge as response evaluation by magnetic resonance imaging (MRI) is a limited resource. Contrast-enhanced ultrasound (CEUS) has been proposed as an alternative imaging strategy.

Purpose

To get experience with examination of malignant breast tumors with CEUS and evaluate the potential for future use in response evaluation of neoadjuvant treatment.

Material and methods

In this pilot study, the dynamic contrast-enhancement of ultrasound and MRI examinations were analyzed in 14 women with histologically verified breast cancer.

Results

Analysis of the time intensity curve of CEUS demonstrated the difference between tumor and normal tissue. The peak intensity was five times higher in tumor tissue (mean increase 397%, 95% CI 250–545). The curve was steeper for tumor tissue (mean 1.76, 95% CI 1.26–2.26) than for normal tissue (mean 0.43, 95% CI 0.24–0.62).

Conclusion

CEUS is a feasible method of examining blood flow in malignant breast tumors.
Examining the Effects of Information Systems Usage and Managerial Commitment on Supply Chain Performance: The Mediating Role of Supply Chain Integration
Authors: Som Justice Odei , Anyigba Hod
Published: April 2022

The aim of the study is to investigate the effect of Information Systems Usage on Supply Chain. Information systems involve creating specific environment for the fulfilment of organizational strategy. However, information system affords an organization an enormous benefit that materializes in the long-run. Unfortunately, realization of information system is also accompanied with risk which mostly deters management from taking the initiative hence missing out on the intended benefits of implementing information system usage in organizations. Without overemphasizing the crucial role played by information system in the supply chain performance, this study seeks to focus on investigating the effect of Explorative Information Systems Usage and Exploitative Information Systems Usage on Supply Chain Performance. Even though Information Systems is an increasingly important element of academic research and discussions, there seems to be no consensus in the extant literature on the impact of information systems (IS) usage on the supply chain. Most importantly the study investigates moderating functions of supply chain integration (SCI) and managerial commitment (MC). Survey instruments were collected from manufacturing companies in Ghana. Simple random sampling was used to select 100 companies of which 1,300 respondents were identified, and questionnaires were administered. The study showed that Managerial Commitment, Explorative Information Systems Usage, and Exploitative Information Systems Usage impact significantly and positively on Supply Chain Performance. Additionally, the findings concluded that Supply Chain Integration, specifically operational integration significantly and positively mediates the relationship between the usage of Information Systems and Performance of Supply Chain. In this regard, these results imply that operational integration between partners can help influence the performance of supply chains.
Safety and Reoperation Rates in Non-instrumented Lumbar Fusion Surgery: Secondary Report From a Randomized Controlled Trial of ABM/P-15 vs Allograft With Minimum 5 years Follow-Up
Authors: Andresen Andreas K. , Carreon Leah Y. , Overgaard Søren , Jacobsen Michael K. , Andersen Mikkel Ø.
Published: April 2022

Study Design

Randomized controlled trial with minimum of 5-years follow-up.

Objective

The purpose of this study is to evaluate the peri- and postoperative complications rates, ectopic bone migration, and reoperation rates, and secondly evaluate the 5-year patient reported outcomes (PROs), in patients treated with decompression and non-instrumented posterolateral fusion with ABM/P-15 or allograft.

Methods

Patients with degenerative spondylolisthesis were enrolled in a Randomized Clinical Trial and randomized 1:1 to either ABM/P-15 or allograft bone. Patient Reported Outcomes were collected at 5-year follow-up, and patients were invited to a clinical follow-up including a computed tomography scan (CT) to evaluate signs of osteolysis, ectopic bone formation, and bone migration.

Results

Of 101 subjects enrolled in the primary study, 83 patients were available for the 5-year follow-up. We found a statistically significant difference in back pain and Oswestry Disability Index between groups. Fifty-eight patients agreed to participate in the CT study. Sixty percentage in the ABM/P-15 group vs 30% in the allograft group was classified as fused ( P = .037). There were no differences in complications, reoperation-, or infection rates between the 2 groups. We found 2 patients with migration of graft material. Both patients were asymptomatic at minimum 5-year follow-up.

Conclusion

Our study indicated that complication rates are no higher in patients treated with ABM/P-15 than allograft. We found significantly higher fusion rates in the AMB/P-15 group than in the allograft group, and patients in the ABM/P-15 group reported less back pain and lower disability score at 5-year follow-up.
Polymer/graphene nanofoam nanocomposites: Properties and potential
Authors: Kausar Ayesha
Published: April 2022

Graphene is a nano-allotrope of carbon. It is a two dimensional (2D) one atom thick single layer of sp2 hybridized carbon atoms. An important form of graphene is the three dimensional (3D) graphene, also known as graphene nanofoam. This review article précises progress in the field of 3D graphene-based polymeric nanocomposites. The 3D macroscopic graphene nanostructures when used to reinforce polymer matrices attain superior structural and physical properties. This article considers the design, fabrication, characteristics, and promising applications of polymer/graphene nanofoam nanocomposites. The graphene nanofoam and polymer/graphene nanofoam nanocomposites have been prepared through advance approaches. The microstructure, electrical conductivity, specific capacitance, radiation shielding, mechanical properties, and other physical properties of the polymer/graphene nanofoam architectures have been studied. Interactions between the polymers and 3D graphene architecture are essential to enhance the nanocomposite performance. Polymer/graphene nanofoam nanocomposites applications are for solar cells, fuel cells, supercapacitors, and electromagnetic interference (EMI) shielding.
Insight into the CBL and CIPK gene families in pecan (Carya illinoinensis): identification, evolution and expression patterns in drought response
Authors: Zhu Kaikai , Fan Pinghua , Liu Hui , Tan Pengpeng , Ma Wenjuan , Mo Zhenghai , Zhao Juan , Chu Guolin , Peng Fangren
Published: April 2022

Background

Calcium (Ca2+) serves as a ubiquitous second messenger and plays a pivotal role in signal transduction. Calcineurin B-like proteins (CBLs) are plant-specific Ca2+ sensors that interact with CBL-interacting protein kinases (CIPKs) to transmit Ca2+ signals. CBL-CIPK complexes have been reported to play pivotal roles in plant development and response to drought stress; however, limited information is available about the CBL and CIPK genes in pecan, an important nut crop.

Results

In the present study, a total of 9 CBL and 30 CIPK genes were identified from the pecan genome and divided into four and five clades based on phylogeny, respectively. Gene structure and distribution of conserved sequence motif analysis suggested that family members in the same clade commonly exhibited similar exon-intron structures and motif compositions. The segmental duplication events contributed largely to the expansion of pecan CBL and CIPK gene families, and Ka/Ks values revealed that all of them experienced strong negative selection. Phylogenetic analysis of CIPK proteins from 14 plant species revealed that CIPKs in the intron-poor clade originated in seed plants. Tissue-specific expression profiles of CiCBLs and CiCIPKs were analysed, presenting functional diversity. Expression profiles derived from RNA-Seq revealed distinct expression patterns of CiCBLs and CiCIPKs under drought treatment in pecan. Moreover, coexpression network analysis helped to elucidate the relationships between these genes and identify potential candidates for the regulation of drought response, which were verified by qRT–PCR analysis.

Conclusions

The characterization and analysis of CBL and CIPK genes in pecan genome could provide a basis for further functional analysis of CiCBLs and CiCIPKs in the drought stress response of pecan.
Aging metrics incorporating cognitive and physical function capture mortality risk: results from two prospective cohort studies
Authors: Cao Xingqi , Chen Chen , Zhang Jingyun , Xue Qian-Li , Hoogendijk Emiel O. , Liu Xiaoting , Li Shujuan , Wang Xiaofeng , Zhu Yimin , Liu Zuyun
Published: April 2022

Background

Aging metrics incorporating cognitive and physical function are not fully understood, hampering their utility in research and clinical practice. This study aimed to determine the proportions of vulnerable persons identified by three existing aging metrics that incorporate cognitive and physical function and the associations of the three metrics with mortality.

Methods

We considered three existing aging metrics including the combined presence of cognitive impairment and physical frailty (CI-PF), the frailty index (FI), and the motoric cognitive risk syndrome (MCR). We operationalized them using data from the China Health and Retirement Longitudinal Study (CHARLS) and the US National Health and Nutrition Examination Survey (NHANES). Logistic regression models or Cox proportional hazards regression models, and receiver operating characteristic curves were used to examine the associations of the three metrics with mortality.

Results

In CHARLS, the proportions of vulnerable persons identified by CI-PF, FI, and MCR were 2.2, 16.6, and 19.6%, respectively. Each metric predicted mortality after adjustment for age and sex, with some variations in the strength of the associations (CI-PF, odds ratio (OR) (95% confidence interval (CI)) 2.87 (1.74–4.74); FI, OR (95% CI) 1.94 (1.50–2.50); MCR, OR (95% CI) 1.27 (1.00–1.62)). CI-PF and FI had additional predictive utility beyond age and sex, as demonstrated by integrated discrimination improvement and continuous net reclassification improvement (all P < 0.001). These results were replicated in NHANES.

Conclusions

Despite the inherent differences in the aging metrics incorporating cognitive and physical function, they consistently capture mortality risk. The findings support the incorporation of cognitive and physical function for risk stratification in both Chinese and US persons, but call for caution when applying them in specific study settings.
Predictors of maternal role adaptation in Iranian women: a cross-sectional study
Authors: Ahmadpour Parivash , Jahanfar Shayesteh , Hamed Bieyabanie Monireh , Mirghafourvand‬‬‬‬‬‬‬‬‬‬‬‬‬‬ Mojgan
Published: April 2022

Background

Numerous factors play a role in maternal identity formation and function. Recognizing the aspects related to adaptation to the mother role can effectively provide a solution to help mothers construct maternal roles. Consequently, this study aimed to determine the predictors of adaptation to the maternal role in Iranian women.

Methods

This cross-sectional study was performed on 564 women who gave birth within one to four months after delivery with a record in Tabriz-Iran health centers, 2020–21. Participants were selected by cluster sampling. Data were collected using questionnaires of socio-demographic and obstetrics characteristics, Birth Satisfaction Scale-Revised (BSS-R), Lipz Maternal Self-Confidence Scale (LMSCS), and maternal role adaptation questionnaire. The general linear model was used to estimate the effect of each of the independent variables (socio-demographic and obstetrics characteristics, childbirth satisfaction, and self-confidence) on the dependent variable (maternal role adaptation).

Results

The mean (± SD) total scores of adaptation to the maternal role, childbirth satisfaction, and maternal self-confidence were 77.4 (± 15.2) (score range: 33–165), 17.0 (± 5.9) (score range: 0–40), and 65.1 (± 13.5) (score range: 24–144), respectively. Based on the Pearson correlation test, there was a significant direct correlation between the overall score of adaptation to the maternal role with childbirth satisfaction (r = 0.462, P < 0.001) and maternal self-confidence (r = 0.652, P < 0.001). Based on the adjusted general linear model, the variables of maternal self-confidence, childbirth satisfaction, adequacy of household income, and spouse support were predictors of adaptation to the mother role. They explained 50.6% of the variance in the adaptation to the mother role score.

Conclusions

Concerning the study results, adaptation to the maternal role is related to childbirth satisfaction and some socio-demographic variables. Therefore, considering the impact of maternal role on other aspects of women's life and child care, healthcare providers' and policymakers' critical role is to create positive childbirth experiences and strengthen mothers' self-confidence.
Efficacy of MP-3 microperimeter biofeedback fixation training for low vision rehabilitation in patients with maculopathy
Authors: Qian Tianwei , Xu Xian , Liu Xinyi , Yen Manni , Zhou Hao , Mao Manman , Cai Huiting , Shen Hangqi , Xu Xun , Gong Yuanyuan , Yu Suqin
Published: April 2022

Background

To evaluate the efficacy of MP-3 microperimeter biofeedback fixation training (MBFT) in vision rehabilitation of low-vision patients affected by macular disease with central vision loss.

Methods

Seventeen eyes (7 age-related macular degeneration, 10 myopic maculopathy) of 17 patients were included in this prospective, interventional study. The preferred retinal locus was determined by comprehensive ophthalmoscopic fundus evaluation including fundus photography, autofluorescence, optical coherence tomography, and microperimetry. The rehabilitation consisted of three 10-min sessions per eye to be performed twice per week for 20 consecutive weeks using the MP-3 microperimeter. Best corrected visual acuity (BCVA), reading speed, mean central sensitivity, the percentages of fixation points within specified regions, bivariate contour ellipse area (BCEA) and the 25-item National Eye Institute visual function questionnaire (NEI-VFQ-25) were recorded pre- and post-training.

Results

The final BCVA, reading speed and mean central sensitivity all showed significant improvements after rehabilitation (P <  0.0001,P = 0.0013, andP = 0.0002, respectively). The percentages of fixation points located within 2° and 4° diameter circles both significantly increased after training (P = 0.0008 andP = 0.0007, respectively). The BCEA encompassing 68.2, 95.4, 99.6% of fixation points were all significantly decreased after training (P = 0.0038,P = 0.0022, andP = 0.0021, respectively). The NEI-VFQ-25 scores were significantly increased at the end of the rehabilitation training (P <  0.0001).

Conclusion

Rehabilitation with MP-3 MBFT is a user-friendly therapeutic option for improving visual function, fixation stability, and quality of life in advanced macular disease.

Trial registration

The prospective study was registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn/). Trial Registration Number:ChiCTR2000029586. Date of registration: 05/02/2020.
A distance-based, randomized controlled trial for reducing sedentary behavior among prostate cancer survivors: a study protocol
Authors: Trinh Linda , Sabiston Catherine M. , Alibhai Shabbir M. H. , Jones Jennifer M. , Arbour-Nicitopoulos Kelly P. , Mina Daniel Santa , Campbell Kristin , Faulkner Guy E.
Published: April 2022

Background

Prostate cancer survivors (PCS) experience long-term side effects beyond treatment such as fatigue, depression and anxiety. Quality and engaging supportive care programs are needed to reduce these chronic and debilitating effects. Independent of physical activity (PA), high volumes of sedentary behavior (SB) are associated with chronic disease-related risk factors and poorer cancer-specific quality of life (QoL). Simultaneously increasing PA and decreasing SB may be an effective health promotion strategy. Given that PCS may face several barriers to engaging in supervised programs, there is a need to develop and assess the efficacy of interventions that employ distance-based approaches for behavior change. The primary aim of this study is to determine the effects of a 12-week intervention (Fitbit + behavioral counselling) vs. Fitbit-only control group in reducing SB among PCS. Secondary outcomes include light-intensity PA, QoL, motivational outcomes, and patient satisfaction.

Methods

This two-armed, randomized controlled trial will recruit inactive PCS (stage I-IV) across Canada who self-report engaging in >8 hours/day of SB. Participants will be randomized to the intervention (n=60; Fitbit and behavioral support) or active control group (n=60; Fitbit-only). The intervention consists of the use of a Fitbit and a series of six behavioral support sessions (two group, four individual) to aid PCS in gradually replacing SB with light-intensity PA by increasing their daily step counts to 3,000 steps above their baseline values. The Fitbit-only control condition will receive a Fitbit and public health PA resources. The primary outcome is change in SB measured objectively using activPAL inclinometers. All secondary outcomes will be measured via self-report, except for PA which will be measuring using Fitbits. Data will be collected at baseline, post-intervention, and at 6-month post-intervention.

Discussion

Reducing SB and increasing light-intensity PA plays an important, yet often undervalued role in the health and well-being of PCS. This study will create a unique distance-based platform that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for PCS.

Trial Registration

ClinicalTrials.gov IdentifierNCT05214937. Registered January 28, 2022

Protocol version: v.1
Health beliefs and (timely) use of facility-based care for under-five children: lessons from the qualitative component of Nigeria’s 2019 VASA
Authors: Kunnuji Michael , Wammanda Robinson Daniel , Ojogun Tellson Osifo , Quinley John , Oguche Stephen , Odejimi Adeyinka , Weiss William , Abba Bintu Ibrahim , King Rebekah , Franca-Koh Ana
Published: April 2022

Background

Nigeria’s under-five health outcomes have improved over the years, but the mortality rates remain unacceptably high. The qualitative component of Nigeria’s 2019 verbal and social autopsy (VASA) showed that caregivers’ health beliefs about causes of illnesses and efficacious treatment options contribute to non-use/delay in use of facility-based healthcare for under-five children. This study explored how these health beliefs vary across zones and how they shape how caregivers seek healthcare for their under-five children.

Methods

Data for this study come from the qualitative component of the 2019 Nigeria VASA, comprising 69 interviews with caregivers of under-five children who died in the five-year period preceding the 2018 Nigeria Demographic and Health Survey (NDHS); and 24 key informants and 48 focus group discussions (FGDs) in 12 states, two from each of the six geo-political zones. The transcripts were coded using predetermined themes on health beliefs from the 2019 VASA (qualitative component) using NVivo.

Results

The study documented zonal variation in belief in traditional medicine, biomedicine, spiritual causation of illnesses, syncretism, and fatalism, with greater prevalence of beliefs discouraging use of facility-based healthcare in the southern zones. Driven by these beliefs and factors such as availability, affordability, and access to and perceived quality of care in health facilities, caregivers often choose one or a combination of traditional medicines, care from medicine vendors, and faith healing. Most use facility-based care as the last option when other methods fail.

Conclusion

Caregivers’ health beliefs vary by zones, and these beliefs influence when and whether they will use facility-based healthcare services for their under-five children. In Nigeria’s northern zones, health beliefs are less likely to deter caregivers from using facility-based healthcare services, but they face other barriers to accessing facility-based care. Interventions seeking to reduce under-five deaths in Nigeria need to consider subnational differences in caregivers’ health beliefs and the healthcare options they choose based on those beliefs.
The association between smoking behaviors and prices and taxes per cigarette pack in the United States from 2000 through 2019
Authors: Le Thuy T. T. , Jaffri Mohammed A.
Published: April 2022

Objective

The conclusions on how tax and price increases affect smoking behaviors are mixed. This work is devoted to re-evaluating the relationship between cigarette prices and taxes and smoking behaviors.

Methods

Using 2000–2019 Behavioral Risk Factor Surveillance System data, we employed linear mixed-effect models to re-examine the impact of cigarette prices and taxes on smoking prevalence and the proportion of current smokers having tried to quit smoking in the past 12 months. All the analyses were conducted for the general population, then by age group, gender, race/ethnicity, and income level.

Results

The results indicate that higher cigarette prices and taxes were associated with a decrease in smoking prevalence and an increased likelihood of quitting smoking. Cigarette tax and price increases produced the most powerful impact on the smoking prevalence of 18- to 24-year-olds. The estimates also show that males tended to be more price-sensitive than females. Raising cigarette prices and taxes was estimated to be more effective in reducing the smoking prevalence among non-Hispanic Blacks and Hispanics when compared to non-Hispanic whites. Cigarette price and tax changes were likely to have a smaller effect on individuals with annual income under $25,000 relative to individuals with higher income levels.

Conclusions

Increases in cigarette prices and taxes are significantly associated with a reduction in smoking prevalence and an increased likelihood of quitting smoking among adults across different demographic and socioeconomic groups. However, as cigarette price and tax changes disproportionately affect low-income individuals, raising cigarette prices and taxes may deepen income disparities.
Work-related stress and future sick leave in a working population seeking care at primary health care centres: a prospective longitudinal study using the WSQ
Authors: Hultén Anna-Maria , Bjerkeli Pernilla , Holmgren Kristina
Published: April 2022

Background

Studying the relationship between work-related stress and sick leave is valuable in identifying and assessing employees at risk of sick leave, but also in developing interventions and taking actions for workers’ health. The overall aim of this study was to analyse the association between work-related stress, measured with the work stress questionnaire (WSQ), and registered sick leave in a working population seeking care at primary health care centres in Sweden.

Methods

A prospective longitudinal study was performed with 232 employed patients aged 18–64 years seeking care for mental and/or physical health complaints at seven primary health care centres. Bivariate logistic regression analysis adjusted for educational level, occupational class and marital status was performed using questionnaire data on work-related stress and sociodemographic factors collected between May 2015 until January 2016 together with registered sick leave data from a national database.

Results

High stress due to indistinct organization and conflicts was reported by 21% (n = 49), while 45% (n = 105) reported high stress due to individual demands and commitment. Thirty-six percent were on sick leave for 15 days or more during 12 months after baseline. The odds of being on registered sick leave during this period was approximately twice as high for patients perceiving high stress due to indistinct organization and conflicts (OR 2.25, 95% CI 1.18;4.26), high stress due to individual demands and commitment (OR 2.21, 95% CI 1.28;3.82), low influence at work (OR 2.07, 95% CI 1.20;3.57), or high interference between work and leisure time (OR 2.19, 95% CI 1.27;3.80). Perceiving high stress due to both indistinct organization and conflicts as well as individual demands and commitment quadrupled the odds of sick leave, OR 4.15 (95% CI 1.84; 9.38).

Conclusions

Work-related stress and sick leave were prevalent among the patients. Perceiving one or more of the work-related stressors and stress increased the odds of registered sick leave between two to four times. Hence, to capture the dynamic interaction between the individual and the work environment, a wide spectrum of factors must be considered. In addition, primary health care could be a suitable arena for preventing sick leave due to work-related stress.

Trial registration

ClinicalTrials.gov. Identifier: NCT02480855. Registered 20 May 2015.
Establishing a minimum data set for suicide and attempted suicide registry system in Iran
Authors: Shafiee Mohsen , Shanbehzadeh Mostafa , Kazemi-Arpanahi Hadi
Published: April 2022

Background

Suicidal behavior is a major cause of mortality and disability worldwide. Accurate and consistent collection of data on suicide, suicide ideation, and suicide attempts presents many challenges for public health practitioners, policymakers, and researchers. This study aimed to establish a minimum data set (MDS) for integrating data across suicide registries and other data sources.

Methods

The MDS proposed in this study was developed in two-stepwise stages. First, an extensive literature review was performed in order to identify the potential data items. Then, we conducted a two-round Delphi stage to reach a consensus among experts regarding essential data items and a supplementary one-round Delphi stage for validating the content of the final MDS by calculating the individual item content validity index (CVI) and content validity ratio (CVR) and using other statistical tests.

Results

After the literature review, 189 data items were extracted and sent to a panel of experts in the form of a questionnaire. In the Delphi stage and CVI calculation, 55 and 10 experts participated in kappa and CVR calculation, respectively. Finally, the MDS of the suicide registry was finalized with 84 data elements that were classified into four categories, including patient profile, socio-economic status, clinical and psychopathological status, and suicide circumstances.

Conclusions

The suicide MDS can become a standardized and consistent infrastructure for meaningful evaluations, reporting, and benchmarking of suicidal behaviors across regions and countries. We hope this MDS will facilitate epidemiological surveys and support policymakers by providing higher quality data capture to guide clinical practice and improve patient-centered outcomes.
Association of lymphocyte subsets with efficacy and prognosis of immune checkpoint inhibitor therapy in advanced non-small cell lung carcinoma: a retrospective study
Authors: Yan Yi , Wang Xinyan , Liu Chenan , Jia Junmei
Published: April 2022

Background

Immune checkpoint inhibitors (ICIs) have achieved promising effects in patients with non-small cell lung cancer (NSCLC). However, not all patients with NSCLC benefit from immunotherapy. There is an urgent need to explore biomarkers that could predict the survival outcomes and therapeutic efficacy in advanced NSCLC patients treated with immunotherapy. In this study, we aimed to assess the changes in peripheral blood lymphocyte subsets and their association with the therapeutic efficacy and clinical prognosis of advanced NSCLC patients treated with immunotherapy.

Methods

A total of 276 patients with advanced NSCLC were enrolled. Peripheral blood lymphocyte subsets including CD4+ T cells, CD8+ T cells, CD4+/CD8+ ratio, NK cells, Tregs and B cells were collected before any treatment, before immunotherapy or chemotherapy, and after 4 cycles of immunotherapy or chemotherapy. T-test was used to analyze the factors influencing lymphocyte subsets and their changes before and after therapy. Logistic regression was used to plot ROC curves and analyze the relationship between lymphocyte subsets and therapeutic efficacy. Log-rank test and Cox regression model were used to evaluate the relationship between lymphocyte subsets and progression-free survival (PFS).

Results

Gender, distant metastasis, and EGFR mutation status are known to affect the proportion of peripheral blood lymphocyte subsets in patients with advanced NSCLC. The proportions of CD4+ T cells, CD8+ T cells, Tregs and B cells were found to decrease after chemotherapy as compared to the baseline. The proportion of CD4+ T cells, CD8+ T cells, CD4+/CD8+ ratio, NK cells and Tregs were higher after immunotherapy than after chemotherapy. Compared to the baseline, the effective group showed significant increase in the proportions of CD4+ T cells, CD4+/CD8+ ratio, NK cells and Tregs, and the number of CD8+ T cells was significantly lower in the peripheral blood after 4 cycles of immunotherapy. On the contrary, the ineffective group did not show any significant differences in the above parameters. Baseline CD4+ T cells and NK cells were independent predictors of immunotherapy efficacy and PFS. Baseline Tregs were independent predictor of immunotherapy efficacy.

Conclusion

Immune checkpoint inhibitors induced changes in the proportion of peripheral blood lymphocyte subsets in patients that responded well to immunotherapy. The levels of the different lymphocyte subsets could serve as valuable predictive biomarkers of efficacy and clinical prognosis for NSCLC patients treated with immunotherapy.
Likely uptake of a future lung cancer screening programme in Hodgkin lymphoma survivors: a questionnaire study
Authors: Broadbent Rachel , Armitage Christopher J. , Crosbie Philip , Radford John , Linton Kim
Published: April 2022

Background

Many Hodgkin lymphoma (HL) survivors are at increased risk of subsequent malignant neoplasms (SMN), including lung cancer, due to previous treatment for HL. Lung cancer screening (LCS) detects early-stage lung cancers in ever smokers but HL survivors without a heavy smoking history are ineligible for screening. There is a rationale to develop a targeted LCS. The aim of this study was to investigate levels of willingness to undergo LCS in HL survivors, and to identify the psycho-social factors associated with screening hesitancy.

Methods

A postal questionnaire was sent to 281 HL survivors registered in a long-term follow-up database and at increased risk of SMNs. Demographic, lung cancer risk factors, psycho-social and LCS belief variables were measured. Multivariable logistic regression analysis was performed to determine the factors associated with lung cancer screening hesitancy, defined as those who would ‘probably’ or ‘probably not’ participate.

Results

The response rate to the questionnaire was 58% (n = 165). Participants were more likely to be female, older and living in a less deprived area than non-participants. Uptake (at any time) of breast and bowel cancer screening among those previously invited was 99% and 77% respectively. 159 participants were at excess risk of lung cancer. The following results refer to these 159. Around half perceived themselves to be at greater risk of lung cancer than their peers. Only 6% were eligible for lung cancer screening pilots aimed at ever smokers in the UK. 98% indicated they would probably or definitely participate in LCS were it available. Psycho-social variables associated with LCS hesitancy on multivariable analysis were male gender (OR 5.94 CI 1.64–21.44, p < 0.01), living in an area with a high index of multiple deprivation decile (deciles 6–10) (OR 8.22 CI 1.59–42.58, p < 0.05) and lower levels of self-efficacy (OR 1.64 CI 1.30–2.08 p < 0.01).

Conclusion

HL survivors responding to this survey were willing to participate in a future LCS programme but there was some hesitancy. A future LCS trial for HL survivors should consider the factors associated with screening hesitancy in order to minimise barriers to participation.
Probiotic in the prevention of ventilator-associated pneumonia in critically ill patients: evidence from meta-analysis and trial sequential analysis of randomized clinical trials
Authors: Sun Yue-chen , Wang Chen-yi , Wang Hai-li , Yuan Yao , Lu Jian-hong , Zhong Lei
Published: April 2022

Background

Probiotic might have a role in the prevention of ventilator-associated pneumonia (VAP) among mechanically ventilated patients, but the efficacy and safety remained inconsistent. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of probiotic (prebiotic, synbiotic) versus placebo in preventing VAP in critically ill patients undergoing mechanical ventilation.

Methods

PubMed, Embase and the Cochrane library databases were searched to 10 October 2021 without language restriction for randomized or semi-randomized controlled trials evaluating probiotic (prebiotic, synbiotic) vs. placebo in prevention of VAP in critically ill mechanically ventilated patients. The pooled relative risk (RR) along with 95% confidence intervals (CI) were combined using a random-effects model. Furthermore, the trial sequential analysis (TSA) and subgroup analyses were performed. Statistical significance was regarded asP < 0.05.

Results

Twenty-three trials involving 5543 patients were eligible for this meta-analysis. The combined RR of decreasing the risk of VAP by probiotic was 0.67 (0.56, 0.81) for all eligible studies, 0.69 (n = 5136; 95% CI = 0.57 to 0.84;P < 0.01) for adults studies and 0.55 (n = 407; 95%CI = 0.31 to 0.99;P = 0.046) for neonates/children studies. Additionally, the above-mentioned positive finding in 20 adults studies was verified by the results of TSA, subgroup analyses and cumulative meta-analysis. Ample evidences demonstrated a 31% decrease in RR of incidence of VAP was noted when prophylactic probiotic therapy was administrated among adult patients. Finally, there were no effects on the ICU/hospital/28-/90-day mortality, bacteremia, CRBSI, diarrhea, ICU-acquired infections, infectious complications, pneumonia, UTI and wound infection between two groups (P > 0.05 for all).

Conclusions

Based on the results of our study, the current evidences suggested that prophylactic administration of probiotic might be utilized as a preventive method for VAP in neonates/children and adults patients who required mechanical ventilation. However, further large, high-quality RCTs are warranted to assess the efficacy and safety of probiotic treatment in critically ill patients, especially for the neonates/children studies and the long-term consequences of this therapy.