bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of unruptured intracranial aneurysms in patients with Marfan syndrome: A cross-sectional study and meta-analysis
Authors: Vornetti Gianfranco , De Martino Sara Rosa Maria , Baroni Maria Chiara , Rossi Cesare , Seri Marco , Mariucci Elisabetta , Donti Andrea , Tonon Caterina , Lodi Raffaele , Spinardi Luca
Published: January 2023

Introduction:

Marfan syndrome (MFS) is the most common inherited connective tissue disorder and its association with intracranial aneurysms (ICAs) has been debated for more than two decades. Here, we report the prevalence of ICAs at screening neuroimaging in a population of genetically confirmed MFS patients and present the results of a meta-analysis including our cohort of patients and those of previous studies.

Patients and methods:

We enrolled 100 consecutive MFS patients, who underwent screening with brain magnetic resonance angiography at our tertiary center between August 2018 and May 2022. We did a PubMed and Web of Science search to retrieve all studies on the prevalence of ICAs in patients with MFS published before November, 2022.

Results:

Of the 100 patients included in this study (94% Caucasians, 40% females, mean age 38.6 ± 14.6 years), three had an ICA. We pooled the current study with five previously published studies, including a total of 465 patients, 43 of which harbored at least one unruptured ICA, leading to an overall ICA prevalence of 8.9% (95% CI 5.8%–13.3%).

Discussion and conclusion:

In our cohort of genetically confirmed MFS patients, the prevalence of ICAs was 3%, which is substantially lower compared to previous studies based on neuroimaging. The high frequency of ICA found in previous studies could be explained by selection bias and lack of genetic testing, which may have led to the inclusion of patients with different connective tissue disorders. Further studies, including several centers and a large number of patients with genetically confirmed MFS, are needed to confirm our results.
Endovascular therapy outcome in isolated posterior cerebral artery occlusion strokes: A multicenter analysis of the Swiss Stroke Registry
Authors: Maulucci F , Disanto G , Bianco G , Pileggi M , Fischer U , Padlina G , Strambo D , Michel P , Kahles T , Nedeltchev K , Fisch U , Bonati L , Kägi G , Escribano Paredes JB , Carrera E , Nyffeler T , Bolognese M , Wegener S , Luft A , Schelosky L , Medlin F , von Reding A , Peters N , Renaud S , Mono M-L , Remonda L , Machi P , Psychogios M-N , Kaesmacher J , Mordasini P , Cereda C W
Published: January 2023

Purpose:

There is little data on the safety and efficacy of endovascular treatment (EVT) in comparison with intravenous thrombolysis (IVT) in acute ischemic stroke due to isolated posterior cerebral artery occlusion (IPCAO). We aimed to investigate the functional and safety outcomes of stroke patients with acute IPCAO treated with EVT (with or without prior bridging IVT) compared to IVT alone.

Methods:

We did a multicenter retrospective analysis of data from the Swiss Stroke Registry. The primary endpoint was overall functional outcome at 3 months in patients undergoing EVT alone or as part of bridging, compared with IVT alone (shift analysis). Safety endpoints were mortality and symptomatic intracranial hemorrhage. EVT and IVT patients were matched 1:1 using propensity scores. Differences in outcomes were examined using ordinal and logistic regression models.

Findings:

Out of 17,968 patients, 268 met the inclusion criteria and 136 were matched by propensity scores. The overall functional outcome at 3 months was comparable between the two groups (EVT vs IVT as reference category: OR = 1.42 for higher mRS, 95% CI = 0.78–2.57, p = 0.254). The proportion of patients independent at 3 months was 63.2% in EVT and 72.1% in IVT (OR = 0.67, 95% CI = 0.32–1.37, p = 0.272). Symptomatic intracranial hemorrhages were overall rare and present only in the IVT group (IVT = 5.9% vs EVT = 0%). Mortality at 3 months was also similar between the two groups (IVT = 0% vs EVT = 1.5%).

Conclusion:

In this multicenter nested analysis, EVT and IVT in patients with acute ischemic stroke due to IPCAO were associated with similar overall good functional outcome and safety. Randomized studies are warranted.
Multifunctional Modification with TiO2, SiO2, and Flame Retardant Agent on Upholstery Fabrics Produced From Recycled Cotton Fibers
Authors: Özdil Nilgün , Dalbaşı Eylen Sema , Özgüney Arif Taner , Atiker Leman
Published: January 2023

Environmental pollution threatens the life of the world nowadays. Increasing the world population, rapidly changing fashion trends, and marketing activities have caused serious increases in textile production and consumption. As the size of the production volume increases, the effects of the textile industry on the ecosystem are increased as well. Recycling is critical in textiles to use less energy, water, and chemicals and to pollute our environment less. The aim of this study to develop functional and high value-added upholstery fabrics by recycling textile wastes. In the scope of this study, the effects of wastes obtained from different sources and different recycling fiber ratios on fabric properties were investigated. Furthermore, fabrics containing recycled cotton wastes blended with polyester fiber were also included. First, the abrasion resistance test was carried out on the fabrics produced from these waste fibers, and the fabrics with the best performance for upholstery fabrics were determined, and then flame retardant, water repellency, and soil release finishing processes were applied to these fabrics. It was concluded that the flame retardant, water, and stain repellent upholstery fabrics from recycled fibers were successfully developed. Also, fabrics containing 15% recycled cotton fabrics obtained better results among the fabrics.
A Case Series Evaluating Postoperative Complications of Foot and Ankle Surgeries in Adult Patients With Neuromuscular Disease
Authors: Levine Joshua , Mavrommatis Sophia , Vang Sandy , Anderson Sarah
Published: January 2023

Background:

Patients with neuromuscular diseases such as cerebral palsy (CP) are living longer because of advances in medicine, yielding a larger number of adult patients that could benefit from corrective surgery. However, some surgeons are hesitant to offer surgery to these patients because of concern for postoperative complications. A paucity of literature exists that describes complications in patients undergoing foot and ankle surgery for neuromuscular diseases. The primary study outcome was to identify the postoperative complication rates associated with foot and ankle surgery in adult patients with neuromuscular disease.

Methods:

The charts of patients with neuromuscular diseases who had foot and ankle surgery by the senior author at a single institution from March 2010 to March 2020 were reviewed. Patient charts were reviewed for demographic data, medical history and diagnoses, and surgical treatment information. Only patients’ index procedures with the senior author were evaluated for surgical data. Patient charts were assessed to determine the presence or absence of a postoperative complication following an index procedure.

Results:

In a cohort of 42 patients, females comprised 60% of the patient cohort. The average age was 35 (range, 20-69) years old. CP was the most common neuromuscular diagnosis at 52% (22 of 42) patients. Eighteen percent (11 of 60) of the index surgeries had 1 or more complication with a total of 13 complications. The overall wound complication rate was 10% (6 of 60), infection rate was 8% (5 of 60), and the nonunion rate following arthrodesis was 10% (2 of 21).

Conclusion:

We conclude that foot and ankle surgery in this complex population can be done safely, with postoperative complication rates similar to the average population. Although these patients may present with unique challenges, surgeons should not forgo surgery out of concern for postoperative complications.

Level of Evidence:

Level IV, retrospective cohort study at a single institution.
Longitudinal neurobehavioral profiles in children and young adults with PTEN hamartoma tumor syndrome and reliable methods for assessing neurobehavioral change
Authors: Busch Robyn M. , Frazier II Thomas W. , Sonneborn Claire , Hogue Olivia , Klaas Patricia , Srivastava Siddharth , Hardan Antonio Y. , Martinez-Agosto Julian A. , Sahin Mustafa , Eng Charis
Published: January 2023

Background

Individuals
with PTEN hamartoma tumor syndrome (PHTS) demonstrate a distinct neurobehavioral profile suggesting primary disruption of frontal lobe symptoms, with more severe cognitive deficits in those with associated autism spectrum disorder (ASD) that extend to other areas of neurobehavioral function as well (e.g., adaptive behavior, sensory deficits). The current study sought to characterize longitudinal neurobehavioral profiles in individuals with PHTS who completed serial assessments (2–3 evaluations) over a 2-year time period.

Methods

Comprehensive neurobehavioral evaluations were conducted on 92 participants (age range 6–21) with PHTS and/or ASD. Spaghetti plots and linear mixed effects models were used to visualize the individual patient profiles and group trends and examine the group differences in cognitive/behavioral test scores over time. Practice-adjusted reliable change indices (RCIs) and standardized regression-based change scores (SRBs) were calculated for those measures in the battery with adequate sample sizes and test–retest reliabilities for future use in assessing neurobehavioral change in children and young adults with PHTS.

Results

Wide individual differences were observed at baseline across all measures. Encouragingly, baseline differences between patient groups persisted at the same magnitude over a 2-year time period with no differences in longitudinal neurobehavioral profiles within any one group. Test–retest reliabilities were generally high, ranging from 0.62 to 0.97, and group mean change from baseline to 12 months was small (range − 3.8 to 3.7). A Microsoft Excel calculator was created that clinicians and researchers can use to automatically calculate RCI and SRB thresholds at both 80% and 90% confidence intervals using test scores from a given child or young adult with PHTS.

Conclusions

Our results suggest that the neurobehavioral phenotypes observed in individuals with PHTS remain relatively stable over time, even in those with ASD. The RCIs and SRBs provided can be used in future research to examine patient outcomes at the individual level as well as to detect negative deviations from the expected trajectory that can be used to inform intervention strategies.
A simple-to-use nomogram for predicting prolonged mechanical ventilation for children after Ebstein anomaly corrective surgery: a retrospective cohort study
Authors: Liu Qiao , Luo Qipeng , Li Yinan , Wu Xie , Wang Hongbai , Huang Jiangshan , Jia Yuan , Yuan Su , Yan Fuxia
Published: January 2023

Background

Prolonged mechanical ventilation (PMV) after pediatric cardiac surgery imposes a great burden on patients in terms of morbidity, mortality as well as financial costs. Ebstein anomaly (EA) is a rare congenital heart disease, and few studies have been conducted about PMV in this condition. This study aimed to establish a simple-to-use nomogram to predict the risk of PMV for EA children.

Methods

The retrospective study included patients under 18 years who underwent corrective surgeries for EA from January 2009 to November 2021. PMV was defined as postoperative mechanical ventilation time longer than 24 hours. Through multivariable logistic regression, we identified and integrated the risk factors to develop a simple-to-use nomogram of PMV for EA children and internally validated it by bootstrapping. The calibration and discriminative ability of the nomogram were determined by calibration curve, Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) curve.

Results

Two hundred seventeen children were included in our study of which 44 (20.3%) were in the PMV group. After multivariable regression, we obtained five risk factors of PMV. The odds ratios and 95% confidence intervals (CI) were as follows: preoperative blood oxygen saturation, 0.876(0.805,0.953); cardiothoracic ratio, 3.007(1.107,8.169); Carpentier type, 4.644(2.065,10.445); cardiopulmonary bypass time, 1.014(1.005,1.023) and postoperative central venous pressure, 1.166(1.016,1.339). We integrated the five risk factors into a nomogram to predict the risk of PMV. The area under ROC curve of nomogram was 0.805 (95% CI, 0.725,0.885) and it also provided a good discriminative information with the corresponding Hosmer-Lemeshow p values > 0.05.

Conclusions

We developed a nomogram by integrating five independent risk factors. The nomogram is a practical tool to early identify children at high-risk for PMV after EA corrective surgery.
“Decline and uneven recovery from 7 common long-term conditions managed in the Catalan primary care after two pandemic years: an observational retrospective population-based study using primary care electronic health records”
Authors: Mora Núria , Fina Francesc , Méndez-Boo Leonardo , Cantenys Roser , Benítez Mència , Moreno Nemesio , Balló Elisabet , Hermosilla Eduardo , Fàbregas Mireia , Guiriguet Carolina , Cos Xavier , Rodoreda Sara , Mas Ariadna , Lejardi Yolanda , Coma Ermengol , Medina Manuel
Published: January 2023

Background

The incidence of chronic diseases during the COVID-19 pandemic has drastically been reduced worldwide due to disruptions in healthcare systems. The aim of our study is to analyse the trends in the incidence of 7 commonly managed primary care chronic diseases during the last 2 years of the COVID-19 pandemic in Catalonia.

Methods

We performed an observational retrospective population-based study using data from primary care electronic health records from January 2018 to August 2022 (5.1 million people older than 14 years). We divided the study period into two: a pre-pandemic period (before 14 March 2020) and a pandemic period. We performed a segmented regression analysis of daily incidence rates per 100,000 inhabitants of 7 chronic diseases: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), heart failure (HF), hypertension and hypercholesterolemia. In addition, we compared annual incidence between pandemic years (2020, 2021 and 2022) and 2019. Associated incidence rate ratios (IRR) were also calculated. Finally, we estimated the number of expected diagnoses during the pandemic period using data from 2019 and we compared it with the observed data.

Results

We analysed 740,820 new chronic diseases’ diagnoses. Daily incidence rates of all 7 chronic diseases were drastically interrupted on 14 March 2020, and a general upward trend was observed during the following months. Reductions in 2020 were around 30% for all conditions except COPD which had greater reductions (IRR: 0.58 [95% CI: 0.57 to 0.6]) and HF with lesser drops (IRR: 0.86 [95% CI: 0.84 to 0.88]). Some of the chronic conditions have returned to pre-pandemic diagnosis levels, except asthma, COPD and IHD. The return to pre-pandemic diagnosis levels compensated for the drops in 2020 for T2DM and HF, but not for hypertension which presented an incomplete recovery. We also observed an excess of hypercholesterolemia diagnoses of 8.5% (95%CI: 1.81% to 16.15%).

Conclusions

Although primary care has recovered the pre-pandemic diagnosis levels for some chronic diseases, there are still missing diagnoses of asthma, COPD and IHD that should be addressed.
Factors associated with referral to physiotherapists for adult patients consulting for musculoskeletal disorders in primary care; an ancillary study to ECOGEN
Authors: Peurois M. , Bertin M. , Fouquet N. , Adjeroud N. , Roquelaure Y. , Ramond-Roquin A.
Published: January 2023

Background

Musculoskeletal disorders (MSD) are multifactorial requiring multidisciplinary treatment including physiotherapy. General practitioners (GP) have a central role in managing MSDs and mostly solicit physiotherapists accounting for 76.1% of physiotherapy referrals in France. Patient, physician, and contextual factors, including healthcare accessibility, can influence physiotherapy referral rates.

Objective

To identify patient, physician, and contextual factors associated with physiotherapy referral in adult patients with MSDs in general practice.

Methods

This study is based on the 2011/2012 French cross-sectional ECOGEN study. Analyses included working-age patients consulting their GP for any MSD. Physiotherapy referral was assessed initially, then adjusted multilevel logistic model analysis of patient, physician, geographical area-related factors associated with these referrals was performed.

Results

Among the 2305 patients included, 456 (19.8%) were referred to a physiotherapist. Following multilevel multivariate analyses, physiotherapist referral was more frequent for female patients (OR 1.28; 95% CI [1.03, 1.59]) with spinal (OR 1.47; 95% CI [1.18, 1.83]) and upper limb disorders (OR 1.66; 95% CI [1.20, 2.29]), and less frequent for patients ≥ 50 years (OR 0.69; 95% CI [0.52, 0.91]), living in deprived geographical areas (OR 0.60; 95% CI [0.40, 0.90]). GPs referred to a physiotherapist less frequently if they were ≥ 50 years (OR 0.50; 95% CI [0.39, 0.63]), had a high number of annual consultations, or were practicing in semi-urban area in a multidisciplinary team.

Conclusion

This multilevel analysis identifies factors associated with physiotherapy referral for patients with MSDs, including living in deprived geographical areas. This constitutes an original contribution towards addressing healthcare disparities.
Validation of the Benefits of Being a Caregiver Scale (BBCS) – further development of an independent characteristic of informal caregiving
Authors: Pendergrass Anna , Weiß Saskia , Rohleder Nicolas , Graessel Elmar
Published: January 2023

Background

Although larger amounts of scientific attention have been directed toward the concept of positive aspects of caregiving (PAC) in recent years, a globally uniform definition and a suitable, scientifically valid questionnaire for all informal caregivers have yet to be developed. On the basis of the questionnaires that already exist for measuring PAC, the authors aimed to (a) concretize the concept and (b) develop a new scale by focusing only on items that show that family caregivers experience a benefit for themselves and that the benefit they experience is the result of their caregiving activities.

Methods

The Benefits of Being a Caregiver Scale (BBCS) was validated on data from 961 informal caregivers. Cronbach's alpha was calculated to assess the internal consistency of the items, and a factor analysis was conducted to determine the structure of the BBCS. The discriminatory power and item difficulties were examined. Construct validity was established by testing four hypotheses.

Results

The factor analysis confirmed the single-factor structure of the BBCS. Cronbach's alpha for the total scale was 0.922. One of the 15 items did not show good to very good discriminatory power and was excluded from the final version of the scale. A higher BBCS score was observed if the caregiver experienced more positive aspects of caregiving and tended to have better general coping skills and a positive relationship with the care-receiver. The BBCS score was not associated with the subjective burden of the caregiver. Results confirmed the validity of the BBCS.

Conclusion

The BBCS is a valid assessment instrument for measuring the benefits that caregivers experience from their caregiving work and can easily be used in research and practice. The BBCS is available free of charge in English and German (http://www.caregiver-benefits.de).
Relationship between healthy eating index and sarcopenia in elderly people
Authors: Ghoreishy Seyed Mojtaba , Koujan Soraya Ebrahimpour , Hashemi Rezvan , Heshmat Ramin , Motlagh Ahmadreza Dorosty , Esmaillzadeh Ahmad
Published: January 2023

Background

Data on the association of Alternative Healthy Eating Index-2010 (AHEI-2010) with sarcopenia are scarce. We aimed to evaluate the association between adherence to AHEI-2010 and sarcopenia and its components including low muscle mass, low muscle strength, and low muscle performance among elderly people.

Methods

In this cross-sectional study, which was conducted on 300 older people (150 men and 150 women) aged ≥55 years. Dietary information was done using a valid 117-item food frequency questionnaire (FFQ). To construct AHEI-2010 score, earlier studies were used. Sarcopenia and its components were described based on both former and new European Working Group on Sarcopenia in Older People (EWGSOP) guidelines.

Results

We found no significant association between AHEI-2010 score and odds of EWGSOP2-sarcopenia, either before (OR for the highest vs. lowest tertiles: 0.55; 95% CI: 0.19, 1.55) or after (OR: 0.44; 95% CI: 0.14, 1.34) adjustment for confounders. In gender-stratified analyses, we found a significant protective association between adherence to the AHEI-2010 score and odds of EWGSOP2-sarcopenia among women after controlling for confounders (0.20; 95%CI: 0.04, 0.91).

Conclusions

In conclusion, healthy eating was inversely associated with odds of sarcopenia among women, but not in men. Further studies with a large sample size and prospective design are needed to examine this association.
Normalization of tumor markers and a clear resection margin affect progression-free survival of patients with unresectable pancreatic cancer who have undergone conversion surgery
Authors: Li Xiang , Liu Xinyuan , Lu Na , Chen Yiwen , Zhang Xiaochen , Guo Chengxiang , Xiao Wenbo , Xue Xing , Sun Ke , Wang Meng , Gao Shunliang , Shen Yan , Zhang Min , Wu Jian , Que Risheng , Yu Jun , Bai Xueli , Liang Tingbo
Published: January 2023

Background

With the advent of intensive combination regimens, an increasing number of patients with unresectable pancreatic cancer (UPC) have regained the opportunity for surgery. We investigated the clinical benefits and prognostic factors of conversion surgery (CS) in UPC patients.

Methods

We retrospectively enrolled patients with UPC who had received CS following first-line systemic treatment in our center between 2014 to 2022. Treatment response, safety of the surgical procedure and clinicopathological data were collected. We analyzed the prognostic factors for postoperative survival among UPC patients who had CS.

Results

Sixty-seven patients with UPC were enrolled (53 with locally advanced pancreatic cancer (LAPC) and 14 with metastatic pancreatic cancer (MPC)). The duration of preoperative systemic treatment was 4.17 months for LAPC patients and 6.52 months for MPC patients. All patients experienced a partial response (PR) or had stable disease (SD) preoperatively according to imaging. Tumor resection was unsuccessful in four patients and, finally, R0 resection was obtained in 81% of cases. Downstaging was determined pathologically in 87% of cases; four patients achieved a complete pathological response. Median postoperative-progression-free survival (PO-PFS) was 9.77 months and postoperative overall survival (PO-OS) was 31.2 months. Multivariate logistic regression analyses revealed that the resection margin and postoperative changes in levels of tumor markers were significant prognostic factors for PO-PFS. No factors were associated significantly with PO-OS according to multivariate analyses.

Conclusions

CS is a promising strategy for improving the prognosis of UPC patients. The resection margin and postoperative change in levels of tumor markers are the most important prognostic factors for prolonged PFS. Multidisciplinary treatment in high-volume centers is strongly recommended. Prospective studies must be undertaken to resolve the various problems regarding optimal regimens, the duration of treatment, and detailed criteria for CS.
A nurse-inserted peripherally inserted central catheter program in general pediatrics: a single-center experience
Authors: Yu Zhuowen , Hu Xiaojing , Xu Xiaofeng , Lin Lili , Gu Ying , Zhou Jianguo
Published: January 2023

Background

A peripherally inserted central catheter (PICC) with its tip preferably in the vena cava is essential in caring for patients with chronic conditions in general pediatrics. However, PICC-related complications are concerning and warrant further investigations.

Objectives

To share the experience of a nurse-inserted peripherally inserted central catheters (PICC) program initiated in a general pediatric department.

Methods

A retrospective descriptive cohort study based on a prospectively collected database was conducted. All PICCs inserted in the departments of gastroenterology and pulmonology in a tertiary pediatric center from Dec. 2015 to Dec. 2019 were included in the study. Complications and risk factors were analyzed by comparing cases with and without complications. We also reported arm movements in correcting mal-positioned newly-inserted PICCs.

Results

There were 169 cases with a median (IQR) age of 42(6, 108) months who received PICC insertion during a 4-year period. Inflammatory bowel disease was the leading diagnosis accounting for 25.4% (43/169) of all cases. The overall complication rate was 16.4 per 1000 catheter days with malposition and occlusion as the two most common complications. Multivariate models performed by logistic regression demonstrated that young age [p = 0.004, OR (95%CI) = 0.987(0.978, 0.996)] and small PICC diameter (1.9Fr, p = 0.003, OR (95%CI) = 3.936(1.578, 9.818)] were risk factors for PICC complications. Correction of malpositioned catheters was attempted and all succeeded in 9 eligible cases by using arm movements.

Conclusion

The nurse-inserted PICC program in general pediatrics is feasible with a low rate of complications. PICC tip malposition and occlusion were two major PICC-related complications when low age and small catheter lumina were major risk factors. Furtherly, arm manipulation potentially is an easy and effective approach for correcting malpositioned newly-inserted PICC catheters.
Findings in percutaneous trans-hepatic cholecysto-cholangiography in neonates and infants presenting with conjugated hyperbilirubinemia: emphasis on differential diagnosis and cholangiographic patterns
Authors: Parra Dimitri A. , Peters Shannon E. , Kohli Ruhail , Chamlati Racha , Connolly Bairbre L. , Wolinska Justyna M. , Ng Vicky L. , Temple Michael J. , John Philip R. , Kamath Binita M. , Ling Simon C. , Fecteau Annie , Amirabadi Afsaneh , Amaral Joao G.
Published: January 2023

Background

Biliary atresia (BA) is one of the causes of conjugated hyperbilirubinemia in infants which if untreated leads to end-stage liver disease and death. Percutaneous Trans-hepatic Cholecysto-Cholangiography (PTCC) is a minimally invasive study which can be utilized in the diagnostic work-up of these patients. This study’s purpose is to describe the experience with PTCC in neonates, the imaging findings encountered, and the abnormal patterns which warrant further investigation.

Methods

A 16-year single-center retrospective study of patients with persistent neonatal cholestasis (suspected BA) undergoing PTCC. Patient demographics, laboratory values, PTCC images, pathology and surgical reports were reviewed.

Results

73 patients underwent PTCC (68% male, mean age 8.7 weeks, mean weight 4.0 Kg). The majority of studies were normal (55%). Abnormal patterns were identified in 33 cases, 79% were diagnosed with BA and 12% with Alagille syndrome. Non-opacification of the common hepatic duct with a narrowed common bile duct (42%) and isolated small gallbladder (38%) were the most common patterns in BA.

Conclusion

PTCC is a minimally invasive study in the diagnostic work-up of infants presenting with conjugated hyperbilirubinemia (suspected BA). Further invasive investigations or surgery can be avoided when results are normal.
Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review
Authors: Goldschmidt T. , Kippe Y. , Finck A. , Adam M. , Hamadoun H. , Winkler J. G. , Bermpohl F. , Schouler-Ocak M. , Gutwinski S.
Published: January 2023

Background

Most studies agree that the Covid-19 pandemic and the subsequent lockdown had a negative impact on mental health. On the other hand, international studies have shown that psychiatric emergency departments (pED) experienced a decrease in presentations and admissions.

Methods

Retrospective chart review of all pED presentations and admissions during the first wave of Covid-19 pandemic in Germany (Covid-19 period: 3/2/20 to 05/24/20) in a psychiatric hospital in Berlin compared to 1 year earlier (pre-Covid-19 period). Descriptive statistics and logistic regression were performed.

Results

We observed no statistical significant changes in overall pED presentations and overall hospital admissions during the Covid-19 period compared to the pre-Covid-19 period (813 vs. 894, − 9.1%, p = 0.064 and (363 vs. 437, − 16.9%, p = 0.080 respectively). In the subgroup analysis, less patients with depressive disorders (p = 0.035) and with personality disorders (p = 0.002) presented to the pED, a larger number of presentations with schizophrenia was observed (p = 0.020). In the Covid-19 period, less patients with substance use disorder and paranoid schizophrenia were admitted to the hospital via the pED than in the pre-Covid-19 period (p = 0.035 and p = 0.006, respectively). Bed capacity was reduced in the Covid-19 period by − 32.8% (p <  0.001).

Presentations in police custody were 13.7% (p = 0.029) higher during the Covid-19 compared to pre-Covid-19 period, with higher rates in female presentations (p = 0.008) and suicide attempts (p = 0.012) and less hospital admissions (p = 0.048). Logistic regression analyses revealed that positive predictors for pED presentation during Covid-19 period were police custody (p <  0.001), being redirected from another hospital (p <  0.001), suicide attempt (p = 0.038), suicidal thoughts (p = 0.004), presentation with paranoid schizophrenia (p = 0.001) and bipolar and manic disorders (p = 0.004), negative predictors were hospital admission (p <  0.001), depressive disorders (p = 0.021) and personality disorders (p <  0.001).

Conclusions

A larger number of presentations in police custody during the Covid-19 period may represent untreated medical needs. This was seen predominantly in female patients, suggesting this subgroup might have suffered particularly under lockdown measures. Patients with paranoid schizophrenia were the only subgroup, which increased in absolute numbers, also suggesting a particular lockdown effect. Reduced bed capacity due to infection curbing measures is suggestive to have played an important role in augmenting the threshold for hospital admissions.
Prevalence and related risks of cyberbullying and its effects on adolescent
Authors: Gohal Gassem , Alqassim Ahmad , Eltyeb Ebtihal , Rayyani Ahmed , Hakami Bassam , Al Faqih Abdullah , Hakami Abdullah , Qadri Almuhannad , Mahfouz Mohamed
Published: January 2023

Background

Cyberbullying is becoming common in inflicting harm on others, especially among adolescents. This study aims to assess the prevalence of cyberbullying, determine the risk factors, and assess the association between cyberbullying and the psychological status of adolescents facing this problem in the Jazan region, Saudi Arabia.

Methods

A cross-sectional study was conducted on 355 students, aged between 12–18 years, through a validated online questionnaire to investigate the prevalence and risk factors of cyberbullying and assess psychological effects based on cyberbullying questionnaire and Mental Health Inventory-5 (MHI-5) questions.

Results

The participants in this study numbered 355; 68% of participants were females compared to 32% were males. Approximately 20% of the participants spend more than 12 h daily on the Internet, and the estimated overall prevalence of cyberbullying was 42.8%, with the male prevalence slightly higher than females. In addition, 26.3% of the participants were significantly affected in their academic Performance due to cyberbullying. Approximately 20% of all participants considered leaving their schools, 19.7% considered ceasing their Internet use, and 21.1% considered harming themselves due to the consequences of cyberbullying. There are essential links between the frequency of harassment, the effect on academic Performance, and being a cyber victim.

Conclusions

Cyberbullying showed a high prevalence among adolescents in the Jazan region with significant associated psychological effects. There is an urgency for collaboration between the authorities and the community to protect adolescents from this harmful occurrence.
Seasonal agricultural workers' personal well-being and preventive behaviors about Covid- 19 in Turkey
Authors: Yaman Sevda , Kilic Mahmut
Published: January 2023

Background

Seasonal agricultural workers working and living in inappropriate sanitary conditions are at great risk for public health. This study aimed to determine the relationships between the sociodemographic variables and life satisfaction of seasonal agricultural workers, and their knowledge, risk perception, and protective behaviors about the COVID-19 pandemic.

Methods

This is a cross-sectional study, that included agricultural workers who are 18 years of age or older and worked seasonally in Yozgat, Turkey, during the period between August 2020 and October 2020. The well-being level was measured using the Personal Wellbeing Index-Adult form (PWIA). The data were collected using the face-to-face survey method and with 739 workers who voluntarily participated in the research.

Results

All participants disclosed having insufficient information about Covid-19 and indicated their peers and television as their sources of information. The vast majority of the workers stated that they complied with the mask mandates, social distancing, and hand hygiene. No correlations were found between knowledge, attitudes, and behaviors about Covid-19 and the level of wellbeing. The mean PWIA score of the workers was low (53.7) while they were mostly satisfied with their personal relationships (96.6) and health (76.1). The multivariable linear regression analysis revealed that being male (β = 0.245) and not having an ongoing health issue (β = 0.689) were associated with more PWIA; on the other hand, having more children (β = -0.52) was related to less PWIA.

Conclusions

The well-being level of seasonal workers was lower while it was not associated with knowledge, attitudes, and behaviors about Covid-19.
The relationship between the sources of confidence in overcoming COVID-19 and the improvement of medical students' professional identity: mediation by medical students' attention to COVID-19
Authors: Zhu Na , Zhang Zhiyuan , Xie Jun , Ou Yangli , Tan Jia , Gao Hong
Published: January 2023

Background

The prevalence of COVID-19 highlights the shortage of human medical resources, and improving medical students' professional identity is crucial to improving this situation. The sources of confidence in overcoming COVID-19 and medical students' attention to COVID-19 were significant factors affecting their professional identity. However, no study has investigated the mediating role of medical students' attention to COVID-19 in their relationship. This study investigates the relationship between these three factors in three medical university students in Hunan Province.

Methods

A cross-sectional survey study that used convenience sampling method was conducted on 2775 medical students from three universities in the Hunan Province of China from March 15 to April 19, 2020. An intermediary model was established to evaluate the role of medical students' attention to COVID-19 in the sources of confidence in overcoming COVID-19 and the improvement of medical students' professional identity.

Results

The sources of confidence in overcoming COVID-19, medical students' attention to national crisis events, and the improvement of medical students' professional identity was positively associated with each other (β = 0.328 ~ 0.464, P < 0.001). The mediating effect accounted for 23.3% of the total effect and 30.4% of the direct effect. Medical students' attention to COVID-19 partially mediates the relationship between the sources of confidence to overcome COVID-19 and the improvement of medical students' professional identity.

Conclusions

This study found that the sources of confidence in overcoming COVID-19 and medical students' attention to national crisis events have a significant predictive effect on the improvement of medical students' professional identity. Medical students' attention to COVID-19 mediated the relationship between the sources of confidence to overcome COVID-19 and the improvement of medical students' professional identity. The findings have emphasized the theoretical and practical significance of professional identity education for medical students.
Impact of removing prescription co-payments on the use of costly health services: a pragmatic randomised controlled trial
Authors: Norris Pauline , Cousins Kim , Horsburgh Simon , Keown Shirley , Churchward Marianna , Samaranayaka Ariyapala , Smith Alesha , Marra Carlo
Published: January 2023

Objectives

To determine whether exempting people (with high health needs and living in areas of high deprivation) from a $5 prescription charge reduces hospital use.

Design

Two-group parallel prospective randomised controlled trial.

Setting

People living in the community in various regions of New Zealand.

Participants

One thousand sixty one people who lived in areas of high socioeconomic deprivation, and either took medicines for diabetes, took antipsychotic medicines, or had chronic obstructive pulmonary disease (COPD). Of the 1053 who completed the study, just under half (49%) were Māori.

Interventions

Participants were individually randomized (1–1 ratio) to either be exempted from the standard $5 charge per prescription item for one year (2020-2021) (n = 591) or usual care (n = 469). Those in the intervention group did not pay the standard NZ$5 charge, and pharmacies billed the study for these. Participants continued to pay any other costs for prescription medicines. Those in the control group continued to pay all prescription charges for the year although they may have received one-off assistance from other agencies.

Main outcome measures

The primary outcome was length of stay (hospital bed-days). Secondary outcomes presented in this paper included: all-cause hospitalisations, hospitalisations for diabetes/mental health problems/COPD, deaths, and emergency department visits.

Results

The trial was under-powered because the recruitment target was not met. There was no statistically significant reduction in the primary outcome, hospital bed-days (IRR = 0.68, CI: 0.54 to 1.05). Participants in the intervention group were significantly less likely to be hospitalised during the study year than those in the control group (OR = 0.70, CI: 0.54 to 0.90). There were statistically significant reductions in the number of hospital admissions for mental health problems (IRR = 0.39, CI: 0.17 to 0.92), the number of admissions for COPD (IRR = 0.37, CI: 0.16 to 0.85), and length of stay for COPD (IRR 0.20, CI: 0.07 to 0.60). Apart from all-cause mortality and diabetes length of stay, all measures were better for the intervention group than the control group.

Conclusions

Eliminating a small co-payment appears to have had a substantial effect on patients’ risk of being hospitalised. Given the small amount of revenue gathered from the charges, and the comparative large costs of hospitalisations, the results suggest that these charges are likely to increase the overall cost of healthcare, as well as exacerbate ethnic inequalities.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001486213 registered on 04/09/2018.
Equity and efficiency of medical and health service system in China
Authors: Zhao Na , Chen Kai
Published: January 2023

Background

Equity and efficiency are basic value dimensions to evaluate the effectiveness of China’s medical and health service system (MHS) reform and development. Coordinated development of equity and efficiency is necessary to realize high-quality development of medical and health services. This study aims to evaluate the equity, efficiency, and combined efforts in coordinating the MHS during 1991–2020 reform.

Methods

Data on China’s MHS were obtained from the China Statistical Yearbook 1992–2021. Ratios of urban to rural residents’ medical expenditure and number of medical professionals per 10,000 people were employed to evaluate MHS’s equity. The data envelopment analysis-Malmquist model was employed to evaluate MHS’s efficiency. We constructed a combined-efforts-in-coordination model to examine the coordination degree between equity and efficiency.

Results

Equity of medical expenditure burden significantly improved from during 1991–2007. Urban residents’ 1991 medical expenditure burden was 87.8% of that of rural residents, which increased to 100.1% in 2007. Urban areas’ mean medical expenditure burden was 105.94% of that in rural areas during 1991–2007. The gap in equity of medical expenditure burden between urban and rural areas slowly widened after 2007, with urban areas’ mean burden being 68.52% of that in rural areas during 2007–2020. Medical and health resources allocation shows an alarming inequity during this period, with mean number of medical professionals per 10,000 people in urban areas being 238.30% of that in rural areas. Efficiency experienced several fluctuations before 2008. Since 2008, efficiency was high (0.915) and remained stable, except in 2020. The combined-efforts-in-coordination score for medical expenditure burden was less than 0.2 for 80% of the years, while that for in medical and health resources was more than 0.5 for 99.67% of the years.

Conclusions

MHS inequity remains between urban and rural China, primarily because of disproportionate allocation of medical and health resources. The government should enhance rural medical professionals’ salary and welfare and provide medical subsidies for rural residents to adjust resource allocation levels in urban and rural areas, control differences in medical expenditure burden between urban and rural residents to a reasonable range, and continuously improve urban and rural residents’ equity level.
Short-term effects and economic burden of air pollutants on acute lower respiratory tract infections in children in Southwest China: a time-series study
Authors: He Yi , Jiang Wanyanhan , Gao Xi , Lin Chengwei , Li Jia , Yang Lian
Published: January 2023

Background

There are few studies on the effects of air pollutants on acute lower respiratory tract infections (ALRI) in children. Here, we investigated the relationship of fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2) with the daily number of hospitalizations for ALRI in children in Sichuan Province, China, and to estimate the economic burden of disease due to exposure to air pollutants.

Methods

We collected records of 192,079 cases of childhood ALRI hospitalization between January 1, 2017 and December 31, 2018 from nine municipal/prefecture medical institutions as well as the simultaneous meteorological and air pollution data from 183 monitoring sites in Sichuan Province. A time series-generalized additive model was used to analyze exposure responses and lagged effects while assessing the economic burden caused by air pollutant exposure after controlling for long-term trends, seasonality, day of the week, and meteorological factors.

Results

Our single-pollutant model shows that for each 10 μg/m3 increase in air pollutant concentration (1 μg/m3 for SO2), the effect estimates of PM2.5, PM10, SO2, and NO2 for pneumonia reached their maximum at lag4, lag010, lag010, and lag07, respectively, with relative risk (RR) values of 1.0064 (95% CI, 1.0004–1.0124), 1.0168(95% CI 1.0089–1.0248), 1.0278 (95% CI 1.0157–1.0400), and 1.0378 (95% CI, 1.0072–1.0692). By contrast, the effect estimates of PM2.5, PM10, SO2, and NO2 for bronchitis all reached their maximum at lag010, with RRs of 1.0133 (95% CI 1.0025–1.0242), 1.0161(95% CI 1.0085–1.0238), 1.0135 (95% CI 1.0025–1.0247), and 1.1133(95% CI 1.0739–1.1541). In addition, children aged 5–14 years were more vulnerable to air pollutants than those aged 0–4 years (p < 0.05). According to the World Health Organization’s air quality guidelines, the number of ALRI hospitalizations attributed to PM2.5, PM10, and NO2 pollution during the study period was 7551, 10,151, and 7575, respectively, while the incurring economic burden was CNY 2847.06, 3827.27, and 2855.91 million.

Conclusion

This study shows that in Sichuan Province, elevated daily average concentrations of four air pollutants lead to increases in numbers of childhood ALRI hospitalizations and cause a serious economic burden.
Curcumin suppresses cell proliferation and reduces cholesterol absorption in Caco-2 cells by activating the TRPA1 channel
Authors: Qin Si , Su Qian , Li Xiang , Shao Muqing , Zhang Yindi , Yu Fadong , Ni Yinxing , Zhong Jian
Published: January 2023

Background

Curcumin (Cur) is a bioactive dietary polyphenol of turmeric with various biological activities against several cancers. Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths. Intestinal cholesterol homeostasis is associated with CRC. Chemotherapy for CRC is related to varied adverse effects. Therefore, natural products with anti-cancer properties represent a potential strategy for primary prevention of CRC.

Methods

The present study used Cur as a therapeutic approach against CRC using the Caco-2 cell line. The cells were treated with different concentrations of Cur for different duration of time and then the proliferation ability of cells was assessed using Cell Counting Kit-8 and 5-Ethynyl-2′-deoxyuridine assays. Oil red O staining and cholesterol assay kit were used to evaluate cellular lipid content and cholesterol outward transportation. Finally, the protein expressions of cholesterol transport-related protein and signal transduction molecules were assessed using Western blot assay.

Results

Cur inhibited cell proliferation in Caco-2 cells in a dose- and time-dependent manner by activating the transient receptor potential cation channel subfamily A member 1 (TRPA1) channel. Activation of the TRPA1 channel led to increased intracellular calcium, peroxisome proliferator-activated receptor gamma (PPARγ) upregulation, and the subsequent downregulation of the specificity protein-1 (SP-1)/sterol regulatory element-binding protein-2 (SREBP-2)/Niemann-Pick C1-like 1 (NPC1L1) signaling pathway-related proteins, and finally reduced cholesterol absorption in Caco-2 cells.

Conclusions

Cur inhibits cell proliferation and reduces cholesterol absorption in Caco-2 cells through the Ca2+/PPARγ/SP-1/SREBP-2/NPC1L1 signaling by activating the TRPA1 channel, suggesting that Cur can be used as a dietary supplement for the primary prevention of CRC.

Graphical Abstract

In Caco-2 cells, Cur first stimulates calcium influx by activating the TRPA1 channel, further upregulates PPARγ and downregulates SP-1/SREBP-2/NPC1L1 signaling pathway, and finally inhibits the absorption of cholesterol. TRPA1, transient receptor potential cation channel subfamily A member 1; NPC1L1, Niemann-Pick C1-like 1; PPARγ, peroxisome proliferator-activated receptor gamma; SP-1, specificity protein-1; SREBP-2, sterol regulatory element-binding protein-2; Cur, curcumin.