bluuebunny/crossref_metadata_2025 huggingface dataset:
The importance of cardiorespiratory fitness and sleep duration in early CVD prevention. BMI, resting heart rate and questions about sleep patterns are suggested in risk assessment of young adults, 18-25 years.
Authors: Fernström Maria , Fernberg Ulrika , Hurtig-Wennlöf Anita
Published: November 2020

Background: Cardiorespiratory fitness (CRF) and sleep habits are lifestyle factors with potential to prevent cardiovascular disease (CVD). CVD is the leading cause of death worldwide. It is therefore important to establish a healthy lifestyle at a young age. In the Lifestyle, Biomarkers and Atherosclerosis (LBA) study we have examined 834 healthy non-smoking adults, aged 18-25 years. The general purpose of the LBA study was to study the effect of lifestyle on traditional biomarkers known to influence CVD risk. The aims of the present study were to evaluate sleep habits of young adult women and men participating in the LBA study, and to compare the importance of sleep and other lifestyle habits on clinically relevant biomarkers for CVD. An additional aim was to find easy and reliable non-invasive biomarkers to detect young adults with increased risk of developing CVD later in life. Methods: The participants had previously been examined for lifestyle factors, biomarkers and CVD risk score. They filled in a validated computerized questionnaire about their general physical and mental health. The questionnaire included questions on sleep duration and experienced quality of sleep. Results: In total 27% of the young adult participants reported difficulties falling asleep or experienced troubled sleep with frequent awakenings per night. The experienced troubled sleep was not related to a higher CVD risk score, but sleep quality and duration were correlated. Shorter sleep duration was significantly associated to higher body mass index (BMI), body fat (%), homeostasis model assessment of insulin resistance (HOMA-IR) and CVD risk. The modifiable lifestyle factor with the highest odds ratio (OR) for CVD risk was CRF. Sleep duration was the second most influential lifestyle factor, more important than moderate- and vigorous physical activity (MVPA) and food habits. Correlations between CRF and heart rate (HR), (P<0.01) and HOMA-IR and BMI (P<0.01) were observed, indicating that BMI and resting HR in combination with questions about sleep patterns are easy and reliable non-invasive biomarkers to detect young adults who need counselling on a healthy lifestyle. Conclusion: Decreased sleep duration in combination with decreased CRF, in young adults, is a serious health issue.
Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil
Authors: Magno Laio , Leal Andrea Fachel , Knauth Daniela , Dourado Ines , Guimarães Mark Guimarães Drew Crosland , Santana Elis Santana Passos , Jordão Tiago Jordão , Rocha Gustavo Rocha Machado , Veras Maria Amélia Amélia , Kendall Carl Kendall , Pontes Alexandre Pontes Kerr , Brito Ana Maria , Kerr Ligia Kerr , Group The Brazilian HIV/MSM Surveillance
Published: November 2020

Background: Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result.Methods: Respondent-driven sampling (RDS) was used to recruit 4,176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times).Results: For this analysis, 3,605 MSM were included. The acceptability of HIVST was 49.1%, lower among those had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability.Conclusions: The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.
Physicians’ attitudes in relation to End-of-life Decisions in Neonatal Intensive Care Units: a national multicenter survey
Authors: Chatziioannidis Ilias , Iliodromiti Zoi , Boutsikou Theodora , Pouliakis Abraham , Giougi Evangelia , Sokou Rozeta , Vidalis Takis , Xanthos Theodoros , Cuttini Marina , Iacovidou Nicoletta
Published: November 2020

Background: End-of-life decisions for neonates with adverse prognosis are controversial and raise ethical and legal issues. In Greece, data on physicians’ profiles, motivation, values and attitudes underlying such decisions and the correlation with their background are scarce. The aim was to investigate neonatologists' attitudes in neonatal intensive care units and correlate them with self-reported practices of end-of-life decisions and with their background data.Methods: A structured questionnaire was distributed to all 28 Neonatal Intensive Care Units in Greece. One hundred and sixty two out of 260 eligible physicians answered anonymously the questionnaire (response rate 66%). Demographic and professional characteristics, self-reported practices and opinions were included in the questionnaire, along with a questionnaire of 12 items measuring physicians’ attitude and views ranging from value of life to quality of life approach (scale 1 to 5).Results: Continuation of treatment in neonates with adverse prognosis without adding further therapeutic interventions was the most commonly reported EoL practice, when compared to withdrawal of mechanical ventilation. Physicians with a high attitude score (indicative of value of quality-of-life) were more likely to limit, while those with a low score (indicative of value of sanctity-of-life) were more likely for continuation of intensive care. Physicians’ educational level (p:0.097), involvement in research (p:0.093), religion (p:0.024) and position on the existing legal framework (p<0.001) were factors that affected the attitude score.Conclusions: Physicians presented with varying end-of-life practices. Limiting interventions in neonates with poor prognosis was strongly related to their attitudes. The most important predictors for physicians' attitudes were religiousness and belief for Greek legal system reform.
Comparative Study on Optic Disc Features of Premature Infants and full-term newborns
Authors: Feng Xiaofen , Nan Yan , Pan Jiandong , Zou Ruitao , Shen Lijun , chen feng
Published: November 2020

Background: To study optic disc features of premature infants and compare to that of term infants to explore the pattern and features of newborn optic disc development and provide the basis for the diagnosis of newborn optic disc disease. Methods: This was a prospective clinical research. Newborns underwent newborn fundus disease screening from January 1st, 2016 to October 31st, 2016 in the neonatal ward of Ruian City Maternal and Child Health Hospital were selected. RetCam 3 Version6.1.25.0 Wide-Field Digital Pediatric Retinal Imaging System developed by Clarity Medical Systems, Inc was adopted to conduct fundus examination on both eyes, 130 degree wide-angle lens was used to film the images centering optic disc. Results: For both premature infants and full-term newborns, vertical diameter of the optic disc to lateral diameter of the optic disc ratio was >1, and the shape of the optic disc was a vertical oval. The difference of each optic disc parameter between premature infants and full-term newborns was not statistically significant (P>0.05). There’s a difference of constitution of sclerotic ring type on optic disc between premature infants and full-term newborns. Among which, the proportion of single ring type and double ring type in premature infants was higher than that in full-term newborns (P<0.05). The proportion of no ring type in full-term newborns was higher than that in premature infants (P<0.05). The proportion of mixed type had no significant difference (P>0.05) between premature infants and full-term newborns.Conclusions: We found that The proportion of mature types (single ring type and double ring type) in full-term newborns was higher than that in premature infants. While there’s no statistical difference of the proportion of mixed types between premature infants and full-term newborns. Double ring type was a normal stage of the development of optic disc.
Psychological distress and somatization in immigrants in primary health care practices.
Authors: García-Sierra Rosa , Fernández-Cano María Isabel , Manresa-Domínguez Josep Maria , Feijoo-Cid María , Gabriel Eduard Moreno , Arreciado-Marañón Antonia , Ramos-Roure Francesc , Segura Jordi , Torán-Monserrat Pere
Published: November 2020

Background: The process of international migration causes a situation of vulnerability in people's health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from 4 communities: Maghrebis, Sub-Saharans, South Americans and South Asians.Methods: A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the Primary Care Centres of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI).Results: The average psychosocial risk obtained was 0.35, with the highest values in the sub-Saharan community. Psychological distress showed a mean value of 0.66, with the sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress.Conclusions: Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations.
Modelling health belief predictors of oral health and dental anxiety among adolescents based on the Health Belief Model: a cross-sectional study
Authors: Xiang Bilu , Wong Hai Ming , Perfecto Antonio P. , McGrath Colman P.J.
Published: November 2020

Background: A vicious cycle exists between dental anxiety, oral health behaviors and oral health status. Based on previous research, psychological factors of the Health Belief Model (HBM) are associated with oral health behaviors and oral health, and are likely involved in this cycle. However, little is known about the relationship between HBM factors and dental anxiety of adolescents. The purpose of this cross-sectional study was to investigate the relationship between health belief factors, oral health and dental anxiety based on the constructs of the HBM.Methods: 1207 Grade 2 students from 12 secondary schools in Hong Kong were randomly selected and measured for the decayed, missing and filled permanent teeth (DMFT) index. Data for oral health behaviors, HBM constructs and dental anxiety were collected using questionnaires. The hierarchical entry of explanatory variables into logistic regression models estimating prevalence odds ratios (POR) were analyzed and 95% confidence intervals (95% CI) for DMFT and dental anxiety were generated. Path analysis was used to evaluate the appropriateness of the HBM as predictors for oral health behaviors, DMFT and dental anxiety.Results: Based on the full model analysis, individuals with higher perceived susceptibility of oral diseases (POR: 1.33, 95% CI: 1.14-1.56) or girls or whose mother received higher education level were likelier to have a DMFT≥1, while those with higher perceived severity (POR: 1.31, 95%CI: 1.09-1.57), flossing weekly, DMFT≥1 or higher general anxiety level statistically increases the possibility of dental anxiety. The results from path analysis indicated that stronger perceived susceptibility, greater severity of oral diseases, less performing of oral health behaviors and a higher score of DMFT were directly related to increased dental anxiety level. Other HBM variables, such as perceived susceptibility, self-efficacy beliefs, cues to action and perceived barriers, might influence dental anxiety through oral health behaviors and caries status.Conclusions: Clarifying the propositional structures of the HBM may help the future design of theory-based interventions in reducing dental anxiety and preventing dental caries.
Uterine Evacuation before Operative Hysteroscopy in Patients with Active Uterine Bleeding: A randomized controlled trial
Authors: Sayyah-Melli Manizheh , Kazemi-Shishavan Maryam , Behravan Nooshin , Gharabaghi Parvin Mostafa , Rahmani Vahideh
Published: November 2020

Background: Concurrent bleeding or existing clots usually obscure the vision field and decrease the hysteroscopy success rate. Therefore, any efforts made to have a clear view during the hysteroscopy will improve the diagnostic or treatment outcomes. In this study, we examined the effect of preoperative clot evacuation on hysteroscopy and patient outcomes.Methods: In this parallel-group clinical trial conducted from December 2018 to September 2019 at the Oncology Center of Alzahra Teaching Hospital in Tabriz, Iran, 114 patients with uterine bleeding were randomly assigned to receive either clot evacuation before standard operative hysteroscopy or standard hysteroscopy alone. The investigated endpoints were the clarity of vision, the volume of used distension media, duration of the procedure, amount of bleeding, and postoperative complications.Results: All 114 participants completed the study. There were statistically significant differences in the frequency of the clear vision (p<.001), the severity of bleeding (p=.0006), mean serum volume used (p<.001), mean procedure time (p<.001), and the postoperative hematocrit levels (p<.001) between groups, in favor of women with preprocedural intrauterine evacuation. There was no difference in in-hospital stay (p=0.081) and anesthetic complications among the patients (p=0.182). The procedure was successfully performed on all patients of both groups with zero postoperative complications.Conclusion: Removal of clots and other uterine contents before inserting hysteroscope rendered better and faster access to the uterine wall to observe existing abnormalities and reduce the hysteroscopy time. This additional surgical step could take a significant impact on surgical and clinical outcomes.Trial registration: Clinical trial registry name: Iranian Registry of Clinical Trials URL: https://en.irct.ir/trial/33369 The registration number: IRCT20101130005283N13 Date of trial registration: 2018-11-16
Carriage of ESBL-producing Gram-negative bacteria by flies captured in a hospital and its suburban surroundings in Ethiopia
Authors: Tufa Tafese B , Fuchs Andre , Wienemann Tobias , Eggers Yannik , Abdissa Sileshi , Schneider Marlen , Jensen Björn-Erik Ole , Bode Johannes G. , Pfeffer Klaus , Häussinger Dieter , Mackenzie Colin , Orth Hans Martin , Feldt Torsten
Published: November 2020

Background: Local data from the Asella Teaching and Referral Hospital in the town of Asella, Ethiopia reveal a high prevalence of extended-spectrum β-lactamase- (ESBL) producing Gram-negative bacteria (GNB) in clinical isolates. To investigate a possible route of transmission, we determined the proportions ESBL-producing GNB in isolates from flies caught in the hospital and in the town of Asella. Methods: Flies were collected in August 2019 from the neonatal intensive care unit (NICU), the orthopedic ward, the hospital’s waste disposal area, and from a butchery situated 1.5 km from the hospital. After trapping, the flies were macerated and suspended in sterile normal saline. The suspensions were inoculated on MacConkey agar and incubated overnight. Species identification and antimicrobial susceptibility testing were performed using Vitek®-MS and VITEK® 2. Results: In total, 103 bacterial isolates were obtained from 85 flies (NICU: 11 isolates from 20 flies, orthopedic ward: 10 isolates from 12 flies, waste disposal area: 37 isolates from 26 flies, butchery: 45 isolates from 27 flies). The proportions of ESBL-producing bacteria among isolates obtained from flies collected in the hospital compound were significantly higher (82%, 90%, and 57% in NICU, orthopedic ward and waste disposal area, respectively) compared to flies collected outside of the hospital compound (2% (1/45) in the butchery) (p≤0.001). The proportion of ESBL was 67% (6/9) among Raoultella spp. 67% (4/6) among Kluyvera spp., 56% (5/9) among Enterobacter spp., 50% (5/10) among E. coli, and 44% (8/18) among Klebsiella spp.. Of the 40 ESBL-genes detected, 85% were CTX-M-like, 83% TEM-like, 23% SHV-like, and 2% CTX-M-2-like. ESBL-producing bacteria showed higher rates of resistance against ciprofloxacin (66% vs. 5%), gentamicin (68% vs. 3%), piperacillin-tazobactam (78% vs. 5%), and trimethoprim-sulfamethoxazole (88% vs. 16%), compared to non-ESBL-producing bacteria. Conclusion: A high proportion of ESBL was identified in isolates from flies caught in the hospital compound compared with isolates of flies collected at a distance of 1.5 km from the hospital. Flies can be potential vectors for transmission of multidrug-resistant (MDR) bacteria within hospitals. Further studies are needed to determine the source of MDR colonization in flies and possible impact of MDR for nosocomial infections.
The effects of management of infection source of echinococcosis in Linzhi, Tibet autonomous region of China
Authors: Wang Ying , Ma Bing-Cheng , Wang Liying , Quzhen Gongsang , Pang Hua-Sheng
Published: November 2020

Background Echinococcosis is highly endemic in western and northern China, Tibet Autonomous Region （TAR）is one of the most serious prevalent areas where the prevalence of echinococcosis in 2016 was 1.66% in humans and dog infection rate was 7.30%. Linzhi is located in southeastern part of TAR where the prevalence of echinococcosis in 2016 was 1.55% in humans and in dog infection rate was 7.28%.Dogs are the main infection source for the transmission of echinococcosis to humans. A control and prevention campaignbased on dog management has been conductedin the past three years. This study is toevaluate the effects of dog management on infection rate of dogs.Methods Data of dog population, registration and de-worming of 7 counties/district in Linzhi from 2017 to 2019 were collected. Domestic dog fecal samples were collected from each endemic town of7 counties/district in Linzhiin 2019 to determine the infection of dogsusing coproantigen ELISA. Data analysis was processed using SPSS statistics to compare dog infection rate between 2016 and 2019 by chi-square test, and maps were mapped using ArcGIS.Results In Linzhi, domestic dog population decreased from 17407 in 2017, 16512 in 2018, to 12663 in 2019, whilethe registration rate increased from 75.92% in 2017, 95.48% in 2018, to 98.64% in 2019. Similarly, stray dog populationdecreased from 14336 in 2017, 13067 in 2018, to 11837 in 2019, while sheltered rateincreased from 84.63% in 2017, 92.32% in 2018, to 96.63% in 2019.Dog de-worming frequency increased from 4 times per annum in 2017 to 12 times in 2019, indicating almost every dog was dewormed monthly. A total of 2715 dog fecal samples were collected for coproantigen ELISA assay. The dog infection rate was 2.84% (77/2715) in 2019, which was significantly lower than7.28% (45/618) in 2016 (P＜0.05).Conclusion Increased dog registration, decreased dog population and increased dog de-worming frequency contributed to significantly decreased dog infection rate in Linzhi, TAR. Control and prevention campaign based on dog management can significantly decrease dog infection with Echinococcus spp in echinococcosis endemic areas.
A cross sectional study of unmet need for health services amongst urban refugees and asylum seekers in Thailand in comparison with Thai population, 2019
Authors: SUPHANCHAIMAT RAPEEPONG , Sinam Pigunkaew , Phaiyarom Mathudara , Pudpong Nareerut , Julchoo Sataporn , Kunpeuk Watinee , Thammawijaya Panithee
Published: November 2020

BackgroundAlthough the Thai government has introduced policies to promote the health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected. This study aimed to explore the degree of healthcare access through the perspective of unmet need in URAS, relative to the Thai population.MethodsA cross-sectional survey, using a self-reporting questionnaire adapted from the Thai Health and Welfare Survey (HWS), was performed in late 2019, with 181 URAS completing the survey. The respondents were were randomly selected from the roster of the Bangkok Refugee Center. The data of the URAS survey were combined with data of the Thai population (n=2,941) from the HWS. Unmet need for health services was defined as the status of needing healthcare in the past twelve months but failing to receive it. Bivariate analysis was conducted to explore the demographic and unmet need difference between URAS and Thais. Multivariable logistic regression and mixed-effects (ME) model were performed to determine factors associated with unmet need.ResultsOverall, URAS were young, less educated and living in more economically deprived households, compared with Thais. About 98% of URAS were uninsured by any of the existing health insurance schemes. The prevalence of unmet need among URAS was significantly higher than among Thais in both outpatient (OP) and inpatient (IP) services (54.1% versus 2.1% and 28.0% versus 2.1%, respectively). Being uninsured showed the strongest association with unmet need, especially for OP care. The association between insurance status and unmet need was more pronounced in the ME model, relative to multivariable logistic regression. URAS migrating from Arab nations suffered from unmet need to a greater extent, compared with those originating from non-Arab nations.ConclusionThe prevalence of unmet need in URAS was drastically high, relative to the prevalence in Thais. Factors correlated with unmet need included advanced age, lower educational achievement, and, most evidently, being uninsured. Policy makers should consider a policy option to enrol URAS in the nationwide public insurance scheme to create health security for Thai society.
Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis
Authors: Zhang Ge , Li Ming , Qu Xiangyang , Cao Yujiang , Liu Xing , Luo Cong , Zhang Yuan
Published: November 2020

Background: The purpose of this study was to evaluate the efficacy after closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups. Mehtods: The study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. The failure rate of CR and the underlying risk factors were evaluated. Meanwhile, the incidence of AVN and the related risk factors among the successful CR cases were assessed.Results: The overall failure rate of DDH treated by CR in present study was 31.16% (43/138). Risk factors for the CR failure was older age at the time of CR (≥18.35 month), large medical interval before CR (≥35.35 millimeters), and severer dislocation of the affected hip (IDHI grade III and IV). The incidence of AVN was 8.33% (6/72) in the patients with successful CR at last follow-up. No significant risk factors had been established in present study that associated with the AVN occurrence.Conclusions: For the treatment of DDH with CR, patients with younger age might achieve better outcomes, early diagnosis and early treatment might be the key point in the DDH treatment.
Use of Gracile and Semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears
Authors: Protais Marie , Laurent-Perrot Maxime , Artuso Mickaël , Moody M. Christian , Sautet Alain , Soubeyrand Marc
Published: November 2020

Purpose
Irreparable rotator cuff tears are common and difficult to treat. Techniques for "filling the loss of substance" require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula.
Methods
This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SE) and upper infraspinatus (IE) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed.
Results
The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases.
Conclusion
This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial "spacer" effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.
Comparing Charlson and Elixhauser comorbidity indices with different weightings to predict in-hospital mortality: an analysis of national inpatient data
Authors: Sharma Narayan , Schwendimann René , Endrich Olga , Ausserhofer Dietmar , Simon Michael
Published: November 2020

Background: Understanding how comorbidity measures contribute to patient mortality is essential both to describe patient health status and to adjust for risks and potential confounding. The Charlson and Elixhauser comorbidity indices are well-established for risk adjustment and mortality prediction. Still, a different set of comorbidity weights might improve the prediction of in-hospital mortality. The present study, therefore, aimed to derive a set of new Swiss Elixhauser comorbidity weightings, to validate and compare them against those of the Charlson and Elixhauser-based van Walraven weightings in an adult in-patient population-based cohort of general hospitals. Methods: Retrospective analysis was conducted with routine data of 102 Swiss general hospitals (2012–2017) for 6.09 million inpatient cases. To derive the Swiss weightings for the Elixhauser comorbidity index, we randomly halved the inpatient data and validated the results of part 1 alongside the established weighting systems in part 2, to predict in-hospital mortality. Charlson and van Walraven weightings were applied to Charlson and Elixhauser comorbidity indices. Derivation and validation of weightings were conducted with generalized additive models adjusted for age, gender and hospital types. Results: Overall, the Elixhauser indices, c-statistic with Swiss weights (0.867, 95% CI: 0.865–0.868) and van Walraven’s weights (0.863, 95% CI: 0.862-0.864) had substantial advantage over Charlson’s weights (0.850, 95% CI: 0.849–0.851) and in the derivation and validation groups. The net reclassification improvement of new Swiss weights improved the predictive performance by 1.6% on the Elixhauser-van Walraven and 4.9% on the Charlson weightings.Conclusions: All weightings confirmed previous results with the national dataset. The new Swiss weightings model improved slightly the prediction of in-hospital mortality in Swiss hospitals. The newly derive weights support patient population-based analysis of in-hospital mortality and seek country or specific cohort-based weightings.
Optimal timing of ureteroscopic lithotripsy after the initial drainage treatment and risk factors for postoperative febrile urinary tract infection in patients with obstructive pyelonephritis: a retrospective study
Authors: Itami Yoshitaka , Miyake Makito , Owari Takuya , Iwamoto Takashi , Gotoh Daisuke , Momose Hitoshi , Fujimoto Kiyohide , Hirao Shuya
Published: November 2020

Background: A history of preoperative obstructive pyelonephritis has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). But there is no clear evidence of risk factors for developing fUTI including the optimal timing of URSL after obstructive pyelonephritis treatment.Methods: Of the 1361 patients, who underwent URSL at our hospital from January 2011 to December 2017, 239 patients had a history of pre-URSL obstructive pyelonephritis. The risk factors were analyzed by comparing the patients’ backgrounds with the presence or absence of fUTI after URSL. The factors examined were age, gender, body mass index, comorbidity, presence or absence of preoperative ureteral stent, stone position, stone laterality, stone size, Hounsfield unit (HU) value on computed tomography scan, history of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, ureteral stenting period, operation time, and presence or absence of access sheath at URSL. In addition, the stone components and renal pelvic urinary culture bacterial species during pre-URSL pyelonephritis were also examined.Results: Post-URSL fUTI developed in 32 of 239 patients (13.4%), and 11 of these 32 cases led to sepsis (34.4%). Univariate analysis showed that stone position, stone maximum HU value, presence of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, pre-URSL ureteral stent placement, operation time were risk factors of fUTI. Stone components and urinary cultures during pyelonephritis were not associated with risk of fUTI. Multivariate analysis showed that renal stone position, pre-URSL ureteral stent placement > 21 days, and operation time > 75 minutes were independent risk factors of fUTI following the URSL.Conclusions: F-UTI following the URSL could be avoided by ureteral stent placement period 21 days or less and operation time 75 minutes or less in patients with obstructive pyelonephritis.
Improving case detection of tuberculosis in hospitalised Kenyan children– employing the Behaviour Change Wheel to aid intervention design and implementation
Authors: Oliwa Jacquie Narotso , Nzinga Jacinta , Masini Enos , Hensbroek Michaël Boele van , Jones Caroline , English Mike , Hoog Anja van't
Published: November 2020

Background The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. Guidelines for tuberculosis clinical decision-making are in place in Kenya and the National Tuberculosis programme conducts several trainings on them yearly. By 2018, there were 183 GeneXpert® machines in Kenyan public hospitals. Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. We describe the process of designing a contextually appropriate, theory-informed intervention to improve case detection of TB in children and implementation guided by the Behaviour Change Wheel.Methods We used an iterative process, going back and forth from quantitative and qualitative empiric data to reviewing literature, and applying the Behaviour Change Wheel guide. The key questions reflected on included: i) what is the problem we are trying to solve; ii) what behaviours are we trying to change and in what way; iii) what will it take to bring about desired change; iv) what types of interventions are likely to bring about desired change; v) what should be the specific intervention content and how should this be implemented?Results The following behaviour change intervention functions were identified: i) training: imparting practical skills; ii) modelling: providing an example for people to aspire/imitate; iii) persuasion: using communication to induce positive or negative feelings or stimulate action; iv) environmental restructuring: changing the physical or social context; and v) education: increasing knowledge or understanding. The process resulted in a multi-faceted intervention package composed of redesigning of child tuberculosis training; careful selection of champions; use of audit and feedback linked to group problem solving; and work flow restructuring with role specification.Conclusion The intervention components were selected for their effectiveness (from literature), affordability, acceptability and practicability and designed so that TB programme officers and hospital managers can be supported to implement them with relative ease, alongside their daily duties. This work contributes to the field of implementation science by utilising clear definitions and descriptions of underlying mechanisms of interventions that will guide others to do likewise in their settings for similar problems.
Efficacy of EUS-guided FNB using a Franseen needle for tissue acquisition and microsatellite instability evaluation in unresectable pancreatic lesions
Authors: Sugimoto Mitsuru , Irie Hiroki , Takagi Tadayuki , Suzuki Rei , Konno Naoki , Asama Hiroyuki , Sato Yuki , Nakamura Jun , Takasumi Mika , Hashimoto Minami , Kato Tsunetaka , Kobashi Ryoichiro , Kobayashi Yasuyuki , Hashimoto Yuko , Hikichi Takuto , Ohira Hiromasa
Published: November 2020

Background: The efficacy of immune checkpoint blockade in the treatment of microsatellite instability (MSI)-high tumors was recently reported. Therefore, the acquisition of histological specimens is desired in cases of unresectable solid pancreatic lesions (UR SPLs). This study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for UR SPL tissue acquisition and MSI evaluation.Methods: A total of 195 SPL patients who underwent EUS-guided fine-needle aspiration (EUS-FNA) or EUS-FNB (EUS-FNAB) between January 2017 and March 2020 were enrolled in this study. Among them, 89 SPL patients (FNB: 28, FNA: 61) underwent EUS-FNAB using a 22-G needle (UR SPLs: 58, FNB: 22, FNA: 36) (UR SPLs after starting MSI evaluation: 23, FNB: 9, FNA: 14).Results: The puncture number was significantly lower with FNB than with FNA (median (range): 3 (2-5) vs 4 (1-8), P < 0.01, UR SPLs: 3 (2-5) vs 4 (1-8), P = 0.036). Histological specimen acquisition was more commonly achieved with FNB than with FNA (92.9% (26/28) vs 68.9% (42/61), P = 0.015, UR SPLs: 100% (22/22) vs 72.2% (26/36), P < 0.01). The histological specimen required for MSI evaluation was acquired more often with FNB than with FNA (88.9% (8/9) vs 35.7% (5/14), P = 0.03).Conclusions: EUS-FNB using a Franseen needle is efficient for histological specimen acquisition and sampling the required amount of specimen for MSI evaluation in UR SPL patients.Trial registrationNot applicable
Maternal factors of newborn low birthweight in malaria endemic settings of Nanoro, rural Burkina Faso
Authors: Lingani Moussa , Zango Serge H. , Valéa Innocent , Valia Daniel , Sanou Maïmouna , Samandoulougou Sékou O. , Robert Annie , Tinto Halidou , Dramaix Michèle , Donnen Philippe
Published: November 2020

Background. In sub-Saharan Africa, the intermittent preventive treatment of malaria in pregnancy using sulphadoxine pyrimethamine (IPTp-SP) strategy is recommended to limit malaria adverse effects on birth outcomes. Ten year after IPTp-SP was adopted in Burkina Faso, we assessed the magnitude and maternal factors of low birthweight (LBW) in Nanoro.Methods. A secondary analysis of data from a cross-sectional study was carried out in women who gave birth at Nanoro peripheral health centers using a binary multivariate logistic regression. Maternal socio-demographic factors, gyneco-obstetrical history and relevant medical characteristics were evaluated to identify associated factors. A p-value less than 0.05 was considered statistically significant.Results. Of 291 delivery records examined, 14 % of women received three or more doses of SP while 80% used bed nets the night before their admission for delivery. Malaria was detected in 36.1% and anemia in 52.9% of women. The average neonate birthweight was 2933 g and 12 % were born with a low birthweight. By multivariate analysis, first delivery (OR = 8.84, [95% CI: 3.72-21.01]), and being multiparous with history of stillbirth (OR = 5.03, [95% CI: 1.54-16.40]) were significantly associated with an increased risk of LBW.Conclusion. LBW was still prevalent in rural Nanoro and the uptake of three or more doses of SP for the IPTp was low. In addition, to improving the coverage of the 3-dose IPTp-SP, it may be necessary to target interventions aiming to reduce maternal anemia such as adequate nutrients uptake to mitigate the issue of adverse birth outcomes.
Is oxygen therapy beneficial for normoxemic patients with acute heart failure? A propensity score matched study
Authors: Yu Yue , Yao Ren-qi , Zhang Yu-feng , Wang Su-yu , Xi Wang , Wang Jun-nan , Huang Xiao-yi , Yao Yong-ming , Wang Zhinong
Published: November 2020

Background: The clinical efficiency of routine oxygen therapy is uncertain in patients with acute heart failure (AHF) who do not have hypoxemia. The aim of this study was to investigate the association between oxygen therapy and clinical outcomes in normoxemic patients hospitalized with AHF using real-world data.Methods: Normoxemic patients diagnosed with AHF on ICU admission from the electronic ICU (eICU) Collaborative Research Database were included in the current study, in which the study population was divided into the oxygen therapy group and the ambient-air group. Propensity score matching (PSM) was applied to create a balanced covariate distribution between patients receiving supplemental oxygen and those exposed to ambient air. Linear regression and logistic regression models were performed to assess the associations between oxygen therapy and length of stay (LOS), and all-cause in-hospital as well as ICU mortality rates, respectively. A series of sensitivity and subgroup analyses were conducted to further validate the robustness of our findings.Results: A total of 2,922 normoxemic patients with AHF were finally included in the analysis. Overall, 42.1% (1,230/2,922) patients were exposed to oxygen therapy, and 57.9% (1,692/2,922) patients did not receive oxygen therapy (defined as the ambient-air group). After PSM analysis, 1,122 pairs of patients were matched: each patient receiving oxygen therapy was matched with a patient without receiving supplemental oxygen. The multivariable logistic model showed that there was no significant interaction between the ambient air and oxygen group for all-cause in-hospital mortality (odds ratio [OR] 1.30; 95% confidence interval [CI] 0.92-1.82; P＝0.138) or ICU mortality (OR 1.39; 95% CI 0.83-2.32; P＝0.206) in the post-PSM cohorts. In addition, linear regression analysis revealed that oxygen therapy was associated with prolonged ICU LOS (OR 1.11; 95% CI 1.06-1.15; P＜0.001) and hospital LOS (OR 1.06; 95% CI 1.01-1.10; P＝0.009) after PSM. Furthermore, the absence of an effect of supplemental oxygen on mortality was consistent in all subgroups.Conclusions: Routine use of supplemental oxygen in AHF patients without hypoxemia was not found to reduce all-cause in-hospital mortality or ICU mortality.
The Practice of China CDC’s Emergency Operations Center (EOC)
Authors: Ding Fan , Li Qun , Jin Lianmei
Published: November 2020

Background: The EOC of Chinese Center for disease Control and Prevention (China CDC) was officially established in 2016, which has become the core department for the public health emergencies and risk response. In recent years, we have continued to improve and summarize the EOC's role and functions in different events. And we also want to share the construction status and operation management experience of the EOC of China CDC. It is also to promote the construction of global emergency operation management system.Main text: We searched the websites of WHO, USCDC and ECDC for the EOC-related concepts. And through expert interviews and personal communication with experts, we collected relevant opinions and identify additional published literature, then described the current situation of construction of China CDC’s EOC. For EOC, different organizations / agencies have different definitions. In China, the EOC is a place where CDC organizes and conducts the related emergency response work. And it is also an important part of public health emergency system construction. The China CDC’s EOC had developed a series of incident action plan (IAP) and the standardized forms for each incident. The event-specific data, context-specific data and event management data are usually obtained by different system and channel. The China CDC’s EOC would improve the staff’s abilities through an ongoing series of training and exercises. Comparing with before, the efficiency of incident response has been greatly increased after the establishment of EOC.Conclusions: The China CDC’s EOC is still growing and groping phase. It is necessary to continue theoretical learning and practice to continuously improve the capacity of the construction and operations of the EOC system. We need continued close collaboration and partnership with international organizations to enable more to be accomplished through leveraging individual institutional strengths. The standardize approach to respond to public health emergencies meet global standards needs.
Epidemiology of interdigital infections of toe web spaces in Shanghai, China: Etiology, risk factors, and therapeutic approaches
Authors: Yu Qian , Li Wei , Kan Siyue , Liu Xiaoping , Yang Hong , Gao Zhiqin , Chen Jian , Yang Lianjuan
Published: November 2020

Background

Interdigital infections are frequently misdiagnosed as tinea pedis and remain intractable to treatments because of high recurrence rates and potential complications. We aimed to understand the epidemiology of interdigital infections in Shanghai, China.
Methods

We conducted a cross-sectional study at Shanghai Dermatology Hospital from January 2019 to December 2019, enrolling 57 patients with acute interdigital inflammation. Patients received antibiotic therapy and underwent long-term follow-up. Clinical features and medical histories, including blood, bacterial, and mycologic examination results, cultures and drug susceptibility test results, and follow-up data were analyzed for pathogenic agents.
Results

We found Pseudomonas aeruginosa (40.35%), Staphylococcus aureus (36.84%), and other bacteria (22.8%). Compared to other bacteria, P. aeruginosa interdigital infection were more inclined to co-infect with fungal agents. Further, P. aeruginosa interdigital infections were frequently seen in the spring and autumn and in patients aged 60–69 years. However, interdigital infections caused by S. aureus occurred more frequently in the summer and in patients aged 31–40 years. We found that levofloxacin had excellent therapeutic effects.
Conclusion

Our findings may inform treatment and diagnostic guidelines and, subsequently, help reduce the rate of recurrence and improve patient outcomes following interdigital infections.
NR4A1 suppresses cancer replication stress through R-loop-dependent inhibition of immediate early gene transcriptional elongation
Authors: Haber Daniel , Guo Hongshan , Golczer Gabriel , Wittner Ben , Langenbucher Adam , Zachariah Marcus , Dubash Taronish , Hong Xin , Comaills Valentine , Burr Risa , Horwitz Elad , Vuille Joanna , Wiley Devon , Reeves Brittany , zhang Jiamin , Niederhoffer Kira , Lu Chenyue , Wesley Benjamin , Ho Uyen , Toner Mehmet , Zou Lee , Mostoslavsky Raul , Maheswaran Shyamala , Lawrence Michael
Published: November 2020

Deregulation of oncogenic proliferative signals triggers replication stress in cancer cells to which they must adapt1,2. Immediate early genes (IEGs), identified by their rapid stress-induced transient bursts of expression, are critical to integrating downstream signaling pathways3,4. In studying tumor initiation by patient-derived breast cancer cells, we observed acquisition of open chromatin domains at the genebody and 3’-UTR of IEGs, uniquely across the genome. Through in vivo and in vitro modeling, we show that the IEG and orphan nuclear receptor NR4A15 localizes across multiple IEG genebodies, where it binds to RNA Pol II, arresting transcriptional elongation and generating extensive R-loops and accessible chromatin. Acute stress promptly removes NR4A1 from IEG genebodies, triggering immediate release of their poised transcripts. In breast cancer cells, NR4A1 overexpression increases tumorigenesis; conversely, its deletion leads to uncompensated replication stress, chromosomal instability and mitotic catastrophe, driven by deregulation of its IEG target FOS. A large fraction of primary breast and other cancers exhibit open genebody chromatin at IEGs, consistent with preserved NR4A1 function. Thus, NR4A1 mediates a novel transcriptional elongation checkpoint, unique to stress-induced genes and required for their rapid bursts of expression. Cancers that have retained this mechanism in adapting to chronic replication stress may be dependent on NR4A1 for proliferation.
In situ structure determination using single particle cryo-electron microscopy images
Authors: Cheng Jing , Li Bufan , Si Long , Zhang Xinzheng
Published: November 2020

Cryo-electron microscopy (cryo-EM) tomography is a powerful tool for in situ structure determination. However, this method requires the acquisition of tilt series, and its time consuming throughput of acquiring tilt series severely slows determination of in situ structures. By treating the electron densities of non-target protein as non-Gaussian distributed noise, we developed a new target function that greatly improves the efficiency of the recognition of the target protein in a single cryo-EM image without acquiring tilt series. Moreover, we developed a sorting function that effectively eliminates the false positive detection, which not only improves the resolution during the subsequent structure refinement procedure but also allows using homolog proteins as models to recognize the target protein. Together, we developed an in situ single particle analysis (isSPA) method. Our isSPA method was successfully applied to solve structures of glycoproteins on the surface of a non-icosahedral virus and Rubisco inside the carboxysome. The cryo-EM data from both samples were collected within 24 hours, thus allowing fast and simple structural determination in situ.