bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological Investigation on Pregnant Women during the Outbreak of COVID-19
Authors: Chen Shaoqi , Zhuang Jiamian , Chen Qingzi , Tan Xuerui
Published: August 2020

Background COVID-19(Corona Virus Disease 2019) outbreaks around the world and is highly infectious, which may cause people prone to anxiety and depression. Pregnant women, as a particular group, need more attention. The aim of this study is to investigate the mental health status of pregnant women during the outbreak of COVID-19, analyze factors affecting their mental health status, understand their cognition, behavioral responses and provide solution guidance for psychological problems. Methods Using a self-designed questionnaire, self-rated anxiety scale(SAS), self-rated depression scale (SDS), we conducted a web-based survey on 1160 pregnant women during the outbreak of COVID-19. Results Compared with general adults in some regions of China during the outbreak of COVID-19, the scores of SAS and SDS of pregnant women were both significantly higher (P<0.05). The results of multivariate regression analysis unveiled that age, levels of education, and duration of pregnancy were factors influencing pregnant women's psychological status. In terms of psychological problems, compared with pregnant women aged < 30 years old, the risk of psychological problems in pregnant women aged ≥ 30 years old was 0.646 times (95% CI:0.486-0.858). Besides, compared with women with a level of high school or below, those with a junior college degree or above had a poor mental health risk of 0.551 times (95%CI: 0.416-0.731). Compared with women in early pregnancy, women in middle pregnancy and in last pregnancy had a risk of 0.543 times (95% CI:0.398-0.739) and 0.636 times (95% CI: 0.466-0.867) in poor mental health.Conclusions During the outbreak of COVID-19, pregnant women are prone to anxiety or depression, highlighting the necessity of further attention to mental health. It is of great significance to provide on-time psychological counseling and intervention for pregnant women with poor mental health during the COVID-19 outbreak.
Long Term Trends of Hydrology, Sediment Yield and Crop Productivity in Andit Tid Watershed Central Highlands of Ethiopia
Authors: Desalegn Ayele , Getachew Tilahun , Yilma Temesgen , Chanie Tilashwork
Published: August 2020

Background: Previously in Ethiopia reliable climatic and hydro-meteorological data are not available and not maintained properly but the long-term database is needed for the assessment and planning of resource dynamics. To minimize the lack of reliable database, the Soil Conservation Research Program (SCRP) established observatory model watersheds since 1981. Andit tid watershed is one of these watersheds established for monitoring the long term trends of climatic, hydrologic, sediment loss and crop production system as a representative site for central high land parts of Ethiopia at 1982. This research paper compiles the analysis of spatial and temporal distribution of the rain fall; trends of run off and sediment loss and their relation and the influence of position of terraces on crop production. Result: From the rainfall trend analysis result the rainfall of the watershed has insignificant spatial (PCI=1.07) and temporal (CV=16.7%) variation. The precipitation coefficient (%) value of the watershed indicates that July and August have big rain with high concentration; September have big rain with moderate concentration and these three months could contribute more than one twelfth of total rainfall amount. The highest runoff and sediment yield were observed in August and July, while sediment concentration was generally high in June. All crops delivered statistically highest yield (P<0.05) immediately above bunds (zone a). Conclusion: The rainfall spatial and temporal distribution trend analysis results conclude that the watershed is not vulnerable for future drought. The highest sediment concentration occurred in June was because of the reason that the lands are plowed and prepared for crop growth; following this small rainfall can carry much soil and can contribute for high suspended sediment concentration. The highest grain yield obtained from above bunds is because of the trapped and accumulated soil and plant nutrient could contribute for better performance and production of crops. To obtain better crop yield; to minimize sediment loss and improve the stream flow it is better to maintain the existed soil and water conservation structures and apply the new interventions.
Status and Challenges of Urban Green Infrastructure Access in Rapidly Urbanizing Cities of Africa: the Case of Addis Ababa City, Ethiopia
Authors: Azagew Sileshi , Worku Hailu
Published: August 2020

Background: Many studies have been conducted on the challenges underpinning the depletion and inaccessibility of urban green infrastructures (UGI) in cities of developed countries. Contrary to this, similar studies in rapidly urbanizing cities of Africa are scant. In this study, we assessed the status, accessibility and constraints of UGI in rapidly urbanizing city Addis Ababa, Ethiopia. We first mapped and calculated the status of UGI from 2003 to 2016 based on the land use data in Arch GIS. We then analyzed UGI access such as recreational parks based on proximate and per capita green indicators by using the land use maps, road network and gridded population data. Finally, we examined the challenges behind the current states of UGI based on document review, expert interview and field observation. Results: Our study disclosed that the land use of UGI from 2003 to 2016 is decreased by 9.2%. The land use of urban agriculture decreased significantly (by 11.9%) followed by urban forest (by 3.7%). The accessibility indicators also revealed that the city residents have no sufficient recreational UGI. The city’s park per capita was very small (0.5m2) compared to Ethiopian UGI standards (15m2) and the large portion of the city’s population (above 90%) has no access to existing parks within the minimum walking distance thresholds. Expansion of built up environment, density, weak implementation of policies and plans, and lack of priority for UGI development were identified as the major constraints behind the current state of UGI in the city. Conclusion: we conclude that UGI is degrading and insufficiently accessible for the city residents due to weak enforcement of development plans, density, built up area expansion, and lack of priority for UGI. Thus, strict adherence to the development plans and regulations is of paramount importance to maintain UGI in the city. Moreover, developing small to median size parks in already proposed areas, new expansion and renewal parts of the city is vital to enhance recreational park access. We hope that this study serves as a benchmark for policy and planning to ensure accessible and adequate UGI in rapidly urbanizing city Addis Ababa and beyond.
Development and Validation of Tongue Diagnostic Parameters-Based Diagnostic Signatures in Coronary Artery Disease Patients with Clopidogrel Resistance after Percutaneous Coronary Intervention
Authors: Liang Bo , Liang Cai-Hong , Lu Jia , Gu Ning
Published: August 2020

Background: Credible diagnostic stratification remains a challenge for coronary artery disease (CAD) patients with clopidogrel resistance (CR) after percutaneous coronary intervention (PCI). Tongue Diagnostic parameters (TDP)-based diagnostic signatures might predict the diagnostic. Methods: Clinical and TDP data were obtained from CAD patients with CR after PCI patients and then analyzed. TDP-based diagnostic signatures were developed and validated. Diagnostic prediction was assessed using a receiver operating characteristic (ROC) curve. Results: A total of 101 patients were consecutively identified. Then, TDP were identiﬁed as signiﬁcantly associated with CR diagnostic and were combined with risk factors to develop a model. ROC curve analysis showed that TDP-based diagnostic signatures performed well in diagnosing CR with an area under the ROC curve value of 0.766. Conclusions: This study identiﬁed and validated a novel TDP-based diagnostic signatures to reliably distinguish CR diagnosis in CAD patients undergone PCI. Further larger, multicenter prospective studies are desired to validate this model.
Joint Effect of Endothelial Dysfunction and New-onset Diabetes Mellitus in Predicting Cardiovascular Outcomes in Hypertensive Patients: a Cohort Study
Authors: Perticone Maria , Maio Raffaele , Suraci Edoardo , Fiorentino Vanessa , Martino Francesco , Andreozzi Francesco , Sesti Giorgio , Perticone Francesco
Published: August 2020

Background. Endothelial dysfunction, induced by some cardiovascular risk factors, is the early determinant of atherosclerotic cardiovascular disease. Moreover, it predicts incident type-2 diabetes that is associated with an increased risk of fatal and nonfatal cardiovascular events; however, no data demonstrating a possible interaction between them in predicting cardiovascular outcomes are available. Thus, we designed present study to evaluate the prognostic significance of the joint effect of endothelial dysfunction and new-onset type-2 diabetes in hypertensives.Methods. We enrolled 653 white never-treated hypertensive outpatients free of cardiovascular events from the CATanzaro Metabolic Risk factors (CATAMERI) study. All subjects were without type-2 diabetes, heart failure and chronic kidney disease. Endothelium-dependent vasodilation was investigated by intra-arterial infusion of acetylcholine, and laboratory determinations were obtained by standard procedures. Follow-up included periodic control visits every six months in our out-patients Clinic and ranged from 26-206 months (median 113). Patients were treated to reduce blood pressure <140/90 mmHg using standard lifestyle and pharmacological treatment. Incident type-2 diabetes and following cardiovascular events were monitored: fatal and nonfatal myocardial infarction and stroke, TIA, unstable angina, coronary revascularization procedures and symptomatic aortoiliac occlusive disease.Results. We documented 191 new cardiovascular morbid events (3.1%) at the cardiac (n=134), cerebrovascular (n=50), or peripheral (n=7) level. Dividing the study population in progressors and non-progressors, progressors were older and had a higher baseline heart rate, fasting insulin, HOMA, creatinine, and hs-CRP mean values, while e-GFR and acetylcholine-stimulated forearm blood flow (FBF) were lower. Similarly, incident type-2 diabetes was higher in the progressors group. In the multiple Cox regression analysis, incident diabetes (HR=2.015, 95%CI=1.416-2.868), hs-CRP (HR=1.306, 95%CI=1.213-1.407) and acetylcholine-stimulated FBF (HR=0.729, 95%CI=0.633-0.839) maintained an independent association with the outcomes. The interaction between new-onset diabetes and FBF demonstrated that patients with new diabetes and maximal FBF under the median show a higher risk for subsequent cardiovascular events (HR=7.411, 95%CI=4.875-11.265).Conclusions. Endothelial dysfunction and new-onset diabetes predict cardiovascular events and their joint effect greatly increases this risk. These results highlight the importance of interaction between hemodynamic and metabolic alterations in predicting cardiovascular events.
Effects of miR-155 on High Glucose Induced-Cardiac Developmental Defects of Zebrafish Embryos
Authors: Zhang Kai , Zhang Yijian , Huang Mengyuan , Yuan Xiangjiang , Wei Liyuan , Li Deli , Zhang Yan , Liang Hongjiao , Wang Lintao , Wang Xuejun , Jin Bai , Tao Zhengxian , Yuan Li
Published: August 2020

Background: Gestational diabetes mellitus (GDM) is known to have a teratogenic effect on heart development. However, the underlying mechanisms are still unclear. Former studies determined that miR-155 is elevated in GDM patients. Besides, miR-155 is a key molecule for development. In the present study, we explored the potential role of miR-155 in heart development and the effect of miR-155 on high glucose-induced cardiac developmental defects.Methods: Zebrafish embryos were exposed to 2% D-Glucose in a fluctuating manner. Activators or inhibitors of miR-155, Ets1, and Igf1 were injected into one-cell stage embryos. The expression levels of miR-155, Ets1 and cardiac specific genes were evaluated by real-time PCR. The regulation of Igf1 by Ets1 was examined using luciferase assays. The levels of reactive oxygen species (ROS) were analyzed by DCFH-DA. Proteins involved in Igf1 pathway were detected by western blot analysis. Maternal serum miR-155 was determined using ELISA. Fetal cardiac structural and functional characteristics in diabetic or healthy pregnancies were performed by echocardiography.Results: miR-155 levels are increased in serum from GDM patients and are correlated with fetal cardiac structural changes. High glucose exposure in zebrafish embryos altered the morphology of the heart, impaired the heart function, and increased the expression of miR-155 as well as cardiac specific genes. Upregulation of miR-155 activated Igf1-Akt-Gsk3β pathway by targeting Ets1 and increased the production of ROS and may thereby exert teratogenic effect on cardiac development. In addition, knockdown of miR-155 blocked Igf1 survival pathway and induced apoptosis and may thus induced zebrafish cardiac developmental defects.Conclusion: miR-155 is a key molecule for heart development and is involved in high glucose-induced cardiac malformation, and it might be a novel biomarker as well as a potential drug target of high glucose-induced cardiac defects.
Screening History and Diagnostic Characteristics of Cervical Adenocarcinoma: a Retrospective Study
Authors: Li Jing , Ye Minjuan , Ye Huixia , He Junxian , Li Xiaomao , Zhang Yu
Published: August 2020

Background: An increasing trend in incidence of cervical adenocarcinoma has been observed in recent years. This research aims to study the screening history and diagnostic characteristics of cervical adenocarcinoma.Methods: Cervical cancer patients hospitalized in the Gynecology Department of the Third Affiliated Hospital of Sun Yat-sen University between 1st Jan 2017 and 31st Mar 2020 were included. Cervical screening history investigation and analysis were carried out by medical record data inquiry and case investigation.Results: (1)The chief complaint of 72.0% of cervical squamous cell carcinoma was vaginal bleeding. 75.6% of adenocarcinoma came in for abnormal vaginal discharge, p<0.001. (2)The HPV infection rate in adenocarcinoma(74.2%) was lower than that in squamous cell carcinoma(92.9%), p<0.001. (3)The participation rate of cervical screening before diagnosis of adenocarcinoma(21.2%) was higher than that of squamous cell carcinoma(2.8%), p＜0.01. (4) The proportion of early-stage in adenocarcinoma (46.3%) was larger than in SCC (28.3%), p<0.01. Conclusion: Compared to cervical squamous cell carcinoma, HPV infection was found to be less closely associated with adenocarcinoma of uterine cervix. The participation rate and frequency of cervical screening of patients with cervical adenocarcinom were more than squamous cell carcinoma. The screening methods at present may not be sensitive enough for precancerous lesion of adenocarcinoma, but regular and multiple screening are still of great significance for early diagnosis of adenocarcinoma of uterine cervix.
The role of NLRC4 inflammasome on intracerebral hemorrhage-caused inflammation in rats
Authors: Gan Hui , Zhang Li , Chen Hui , Xiao Han , Wang Lu , Zhai Xuan , Jiang Ning , Liang Ping , Zhao Jing
Published: August 2020

Background: The NLRC4 inflammasome, a member of nucleotide-binding and oligomerization domain-like receptor (NLR) family, amplifies the neuroinflammation by facilitating the processing of caspase-1, interleukin (IL)–1β and IL-18. We explored whether NLRC4 knockdown alleviated inflammatory injury following intracerebral hemorrhage (ICH). Furthermore, whether NLRC4 inflammasome activation can be adjusted by the RGS2/LRRK2 pathway was investigated.Methods: 50μl arterial blood was drawn and injected into basal ganglions to simulate the ICH model. NLRC4 small interfering RNAs(siRNA) were utilized to knockdown NLRC4. LRRK2 inhibitor (GNE7915) was injected into the abdominal cavity. Short hairpin (sh) RNA lentiviral and lentivirus containing RGS2 were designed and applied to knockdown and promote RGS2 expression. Neurological functions, brain edema, western blot, enzyme-linked immunosorbent, hematoxylin and eosin staining, nissl staining, immunoprecipitation, immunofluorescence assay and evans blue dye extravasation and autofluorescence assay were evaluated.Results: It was shown that the NLRC4 inflammasome was activated following ICH injury. NLRC4 knockdown extenuated neuronal death, damage of the blood-brain barrier, brain edema and neurological deficiencyat 3 d after ICH. NLRC4 knockdown reduced myeloperoxidase (MPO) cells as well as IL-1β and IL-18 following ICH. GNE7915 reduced LRRK2 kinase, the combination of LRRK2 and NLRC4 and NLRC4 inflammasome activation. RGS2 suppressed the combination of LRRK2 and NLRC4，and NLRC4 inflammasome activation though regulating LRRK2 Kinase Activity. Conclusion: Our study demonstrated that the NLRC4 inflammasome may aggravate the inflammatory injury induced by ICH and RGS2/LRRK2 may relieve inflammatory injury by restraining the NLRC4 inflammasome activation.
The Economic Burden of Measles in Children Under Five in Bangladesh
Authors: de Broucker Gatien , Ahmed Sayem , Hasan Md. Zahid , Mehdi Gazi Golam , Campo Jorge Martin del , Ali Md. Wazed , Uddin Md. Jasim , Constenla Dagna , Patenaude Bryan
Published: August 2020

Background: This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives.Method: We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their estimates supported by administrative data from the healthcare perspective. We conducted 100 face-to-face caregiver interviews at discharge and phone interviews 7 to 14 days post-discharge to capture all expenses, including time costs related to measles. All costs are in 2018 USD ($).Results: From a societal perspective, a hospitalized and ambulatory measles cost $159 and $18, respectively. On average, the government spent $22 per hospitalized measles. At the same time, caregivers incurred $131 and $182 in economic costs, including $48 and $83 in out-of-pocket expenses in public and private not-for-profit facilities, respectively. Seventy-eight percent of the poorest caregivers faced catastrophic health expenditures compared to 21% of the richest. In 2018, 2263 cases of measles were confirmed, totaling $348,073 in economic costs to Bangladeshi society, with $121,842 in out-of-pocket payments for households.Conclusion: Households face substantial out-of-pocket expenses and productivity loss related to measles. Improving vaccination coverage in Sylhet division would likely alleviate most of this burden.
Nod-like Receptor Protein 3 (Nlrp3) Inflammasomes Inhibition by Metformin Limits Myocardial Ischemia/reperfusion Injury
Authors: Zhang Jing , Yang Liu , Zhang Qin , Shi Xing , Hua Fuzhou , Ma Jianyong , Zhu Wengen , Liu Xiao , Zhang Jiru , Cai Xia , Shen Yunfeng , Liu Jianping , Lai Xiaoyang , yu peng
Published: August 2020

Background

Ischemia/reperfusion (I/R) injury is a life-threatening vascular emergency following myocardial infarction. Our previous study showed cardioprotective effects of metformin against myocardial I/R injury. In this study, we further examined the involvement of AMPK mediated activation of NLRP3 inflammasome in this cardioprotective effect of metformin.
Methods

Myocardial I/R injury was simulated in a rat heart Langendorff model and neonatal rat ventricle myocytes (NRVMs) were subjected to hypoxi/reoxygenation (H/R) to establish an in vitro model. Outcome measures included myocardial infarct size, hemodynamic monitoring, myocardial tissue injury, myocardial apoptotic index and the inflammatory response. myocardial infarct size and cardiac enzyme activities.
Results

First, we found that metformin postconditioning can not only significantly alleviated myocardial infarct size, attenuated cell apoptosis, and inhibited myocardial fibrosis. Furthermore, metformin activated phosphorylated AMPK, decreased pro-inflammatory cytokines, TNF-α, IL-6 and IL-1β, and decreased NLRP3 inflammasome activation. In isolated NRVMs metformin increased cellular viability, decreased LDH activity and inhibited cellular apoptosis and inflammation. Importantly, inhibition of AMPK phosphorylation by Compound C (CC) resulted in decreased survival of cardiomyocytes mainly by inducing the release of inflammatory cytokines and increasing NLRP3 inflammasome activation. Finally, in vitro studies revealed that the NLRP3 activator nigericin abolished the anti-inflammatory effects of metformin in NRVMs, but it had little effect on AMPK phosphorylation.
Conclusions

Collectively, our study confirmed that metformin exerts cardioprotective effects by regulating myocardial I/R injury-induced inflammatory response, which was largely dependent on the enhancement of the AMPK pathway, thereby suppressing NLRP3 inflammasome activation.
Economy-wide effects of reducing the time spent for water fetching and firewood collection in Ethiopia
Authors: Mosa Abdulaziz , Grethe Harald , Siddig Khalid
Published: August 2020

Background: Water fetching and firewood collection are among home activities that are part of the daily routine of many households in rural Ethiopia. Households travel long distances and spend large amounts of time every day for collecting water and firewood. Fetching water and firewood reduce labor available for market related activities such as agriculture that affects production and productivity of these sectors negatively. Better access to water facility and energy efficient technology (such as improved stoves) is expected to release labor for market related activities that can have economy-wide impacts. The objective of this study is to investigate the economy-wide effects of access to water facility and improved stoves. Methods: The study uses the updated 2004/05 Social Accounting Matrix (SAM) of Ethiopia. The SAM is modified to account for a detailed representation of water fetching, firewood collection and leisure activities and commodities. This study applies a single country Computable General Equilibrium (CGE) model to the updated SAM of Ethiopia. The simulation scenario is a 50% increase in the Total Factor Productivity (TFP) of both water fetching and firewood collection activities due to better access to water infrastructure and cooking improved stoves. Results: The findings of the study show that better access to drinking water supply and improved stoves reduces labor time spent for water fetching and firewood collection. The released labor from water fetching and firewood collection partly reallocated to leisure consumption and partly to market related activities. Those freed labors that are reallocated to marketed sectors including agricultural and non-agricultural activities leads to increase employment and enhance domestic production. Better access to drinking water and improved stoves also enhances household welfare. Households that allocate a relatively large proportion of labor to water fetching and firewood collection gain relatively more welfare. Macroeconomic indicators such as GDP, total domestic production, absorption and imports are also positively affected due to improved access to water and energy efficient technology. Conclusions : It is helpful to recognize the economic significance of labor released from water fetching and firewood collection in any developing economy with a limited supply of water facility and access to energy technology.
Understanding the Impact of Patients’ Disease Types on Caregiving Time and Caregiver Burden: An Analysis of the Health Information National Trends Survey
Authors: Su Zhaohui , Zhou Zi , Gelfond Jonathan
Published: August 2020

Background: Patients with different medical conditions often have distinctive caregiving needs that could result in varying levels of caregiver burden. However, despite empirical advances in this area, little is known about how patients’ disease types interact with caregiving time and caregiver burden. To bridge this gap, we examined the impact of patients’ disease types on caregiving time and burden. Methods: Data were analyzed from the 2018 Health Information National Trends Survey 5 Cycle 2. Only participants self-identified as caregivers were included in the final analysis. Data on patients’ disease types, caregiving time (i.e., caregiving duration and caregiving hours spent per week), and caregiver burden (i.e., caregivers’ self-rated health, body mass index, and psychological distress) were examined using logistic regression analysis.Results: Patients’ disease types impacted caregiving time and burden. Caregivers of patients with neurological disease spent the greatest amount of time. For caregiver burden, caregivers of patients with cancer or aging related disease experienced worst self-rated health, caregivers of patients with orthopedic disease have the greatest likelihood to be overweight or obese, while cancer caregivers experienced greatest levels of psychological distress. Conclusions: Patients’ disease types had highly varied effects on caregiving time and burden. This study underscores the need for healthcare researchers to adopt a nuanced approach in acknowledging and addressing the burden of care experienced by caregivers, such as tailoring interventions based on both patients and caregivers’ characteristics and preferences.
Breastfeeding practice in China from 2013 to 2018: a study from a national dynamic follow-up surveillance
Authors: Kang Leni , Liang Juan , He Chunhua , Miao Lei , Li Xiaohong , Dai Li , Li Qi , Liu Zheng , Zhu Jun , Wang Yanping , Liu Hanmin
Published: August 2020

Background
Breastfeeding is vital to children’s lifelong health and reduces costs for families and societies. Basic data on breastfeeding practices in China are crucial for understanding how to advance health-related goals.
Methods
This was an observational study. We used data from the Under-5 Child Nutrition and Health Surveillance System in China for the period 2013–2018. The prevalence of EIBF and EBF were calculated for each year for urban and rural areas and for East, Central and West China. The Cochran-Armitage test was used to explore the time trends. The annual percent of change (APC) were calculated by log-linear regression followed by exp transformation.
Results
The prevalence of EIBF and EBF increased significantly from 44.57% (95% CI: 44.07, 45.07) and 16.14% (95% CI: 15.10, 17.18) in 2013 to 55.84% (95% CI: 55.29, 56.38) and 34.90% (95% CI: 33.54, 36.26) in 2018 (Ptrend<0.001). The respective APCs were 4.67% (95% CI: 3.51, 5.85) and 14.90% (95% CI: 9.97, 20.04). Increases were observed in both urban and rural areas, with urban areas showing greater APCs for EIBF (6.05%; 95% CI: 4.22, 7.92 v.s. 2.26%; 95% CI: 1.40, 3.12) and EBF (18.21%; 95% CI: 11.53, 25.29 v.s. 9.43%; 95% CI: 5.52, 13.49). Disparities existed among different geographic regions in China.
Conclusion
Breastfeeding practices in China are improving in recent years, though with disparities between urban and rural areas and among East, Central and West China. More efforts should be made to protect and promote breastfeeding to achieve near- and long-term goals in child health.
Do childhood measles and DTaP vaccination decrease the mortality rate caused by SARS CoV-2 in OECD countries?: An Epidemiologic Study
Authors: Guven Ramazan , Sasmaz Muhammed Ikbal , Eyupoglu Gokhan , Semerci Seda Yilmaz
Published: August 2020

Background The mortality rates caused by SARS CoV-2 differ between countries and this difference might be explained by several reasons. Childhood vaccination rate is thought to be one of them. Therefore, present study aimed to examine the possible relationship between DTaP (diphtheria, tetanus, acellular pertussis vaccine) and measles vaccination rates of Organization for Economic Co-operation and Development (OECD) countries and case fatality rate (CFR) caused by SARS CoV-2.Methods A total of 32 OECD countries, of northern hemisphere, have been included in this study. Statistical analysis performed according to the CFR data of these countries based on SARS CoV-2. The CFR data calculated according to the total mortality count of a specific country for the 3-month period down from the date when first SARS CoV-2 case was observed. Results Based on the correlation levels of vaccination rates of OECD countries with a period of 3-month CFR, a strong negative correlation of significance between CFR and measles (r=-0.479, p=0.006) were pointed, while a negative but not significant correlation were seen between CFR and DTaP vaccination rates (r=-264.0, p=0.145). Conclusion Depending on the results of the study, lower CFR based on COVID-19, is suggested to be related to the successful vaccination rates of those OECD countries. Therefore, further effort is required to improve rates of childhood vaccination not only for specified diseases, but either possible protection against COVID-19 worldwide. Trial Registration: This study is registered to clinicaltrials.gov with trial number: NCT04468802.
A randomised controlled trial to reduce highest priority critically important antimicrobial prescription in companion animals
Authors: Singleton David , Rayner Angela , Brant Bethaney , Smyth Steven , Noble Peter-John , Radford Alan , Pinchbeck Gina
Published: August 2020

Robust evidence supporting antimicrobial stewardship schemes in companion animals is limited, despite frequent highest priority critically important antimicrobial (HPCIA) prescription. In this randomised controlled trial, electronic prescription data were utilised (August 2018–January 2019) to evenly assign 60 above average HPCIA-prescribing practices into a control group (CG) and two intervention groups. In March 2019, the light intervention group (LIG) and heavy intervention group (HIG) were notified of their above average status, and were provided with educational material (LIG, HIG), in-depth benchmarking (HIG), and follow-up meetings (HIG). Post-intervention, in the HIG a 30% and 42% significant reduction in canine (0.5% of consultations, 95% confidence interval, 0.4–0.6) and feline (4.4%, 3.4–5.5) HPCIA-prescribing consultations was observed, and maintained for three and six months, respectively, compared to the CG (dogs: 0.7% (0.5–0.8); cats: 7.6% (6.1-9.0)). The LIG was not associated with significant variation. This evidence is now informing development of a national stewardship scheme.
Development, validation and evaluation of a scale for identifying falsified hand sanitizer in the UAE: Public and regulatory authorities collaborative perspective for COVID-19
Authors: Jairoun Ammar Abdulrahman , Al-Hemyari Sabaa Saleh , Shahwan Moyad , El-Dahiyat Faris , Jamshed SHAZIA
Published: August 2020

BackgroundFrom the time the WHO announced that a global pandemic of COVID-19 had begun, falsified hand sanitizer began to appear more regularly in the markets. These pose a possible danger to public health, especially as they may include undeclared methanol. The current study developed and validated a novel tool to document falsified hand sanitizer in the UAE community.MethodA descriptive cross-sectional community-based study was conducted among Ajman University (AU) students and staff in the UAE. Simple random-sampling selection was used to choose the study sample. Respondents were sent a web-based electronic link to the survey via email. Content validity, factor analyses and known group validity were used to develop and validate a new scale to identify falsified hand sanitizer. Test-retest reliability, internal consistency, item internal consistency (IIC), and intraclass correlation coefficients (ICCs) were used to assess the reliability of the scale. SPSS version 24 was used to conduct data analysis.ResultsA total of 1280 participants were enrolled in the study. The content validity index (CVI) was 0.83 with the final scale of 12 items. The Kaiser-Meyer-Olkin (KMO) value was 0.788, with the Bartlett test of sphericity achieving statistical significance (p < 0.001). Our factor analysis revealed a 3-component model. The 3-factor solution was confirmed by PCFA analysis and had associations with good fit values. The PCFA for NFI was 0.970, CFI 0.978, and TLI 0.967. All values were in excess of 0.95, with RMSEA values below 0.06 at 0.03; all of these values indicated a good model fit. The Cronbach's alpha was good overall (0.867). All factors had a Cronbach's alpha value in excess of 0.70. The instrument demonstrated that every item met the IIC correlation standard ≥ 0.40. The scale displayed good overall ICC statistics of 0.867 (95% CI 0.856–0.877) with statistical significance (p < 0.001). The scale's test-retest reliability was assessed through correlation of the falsified hand sanitizer identification score of respondents at the two time points. The test-retest correlation coefficient was 0.770 (p value < 0.01). Participants with post-graduate education were more likely to identify the falsified hand sanitizer compared to those with high school education. (p < 0.001).ConclusionsThis study developed and validated a new scale for the measurement of falsified hand sanitizer. This research could promote greater collaboration between the health regulators and the public, improve customer satisfaction and encourage the public to participate more with regard to this issue.
Factors Associated with Duration of Breastfeeding in Bangladesh: Evidence from Bangladesh Demographic and Health Survey 2014
Authors: Ayesha Ummay , Mamun ASMA , Sayem Md. Abu , Hossain Golam
Published: August 2020

Background: Breastfeeding is one of the most effective ways for reducing infant mortality and confirming optimal growth and development of children. The aim of this study was to find the effect of socio-demo­graphic determinants on duration of breast­feeding among Bangladeshi mothers.Methods: The data was extracted from the Bangladesh Demographic and Health Survey (BDHS)-2014. A total of 3541 married non–pregnant Bangladeshi mothers in reproductive age who had at least one child aged 6-36 months were included. Independent sample t-test and ANOVA were used to find the significance deference in duration of breastfeeding between two and more than two groups respectively. Multiple linear regression model was utilized to determine the effect of some quantitative variables on duration of breastfeeding among Bangladeshi mothers. Results: This study raveled that the mean duration of breastfeeding among Bangladeshi mothers was 18.91±7.98 (95% CI: 18.65-19.17) and median was 19.00 month. Independent sample t-test provided that short duration of breastfeeding was observed among; (i) mothers received antenatal care facilities during their pregnancy period, (ii) Muslim and (iii) delivered their last child by caesarean section. ANOVA showed that duration of breastfeeding significantly influenced by (i) parents’ education, (ii) geographical location and (iii) household wealth quintile. Multiple regression analysis demonstrated that mothers’ age, mothers’ body mass index, total number of children and mothers’ mothers’ age at first birth were important predictors of duration of breastfeeding.Conclusion: Health care providers and decision makers can consider these findings to make plan for counseling of mothers and family members to promote optimal duration of breastfeeding practice in first three years of baby’s life.
Safety of IL-23/17 Antagonists in Patients with Psoriasis or Other Immune-mediated Inflammatory Diseases: A Systematic Meta-Analysis.
Authors: Li Siying , Zhang Suhan , Tang Guishao , Wu Ruifang , Su Yuwen
Published: August 2020

Background: The IL-23/17 axis plays central role in the pathogenesis of several immune-mediated inflammatory diseases (IMIDs). IL-23/17 antagonists showed significant improvement in the treatment for psoriasis and other IMIDs, including psoriasis(PSO), psoriatic arthritis(PsA), rheumatoid arthritis(RA) and ankylosing spondylitis(AS).Objective: To assess the safety of IL-23/17 antagonists therapy on patients with psoriasis and other IMIDs.Methods: Pooled analysis from thirty-nine placebo-controlled randomized clinical trials (RCTs) of IL-23/17 axis antagonists for IMIDs. Incidences of adverse events (AEs), serious adverse events (SAEs) and AEs of interest were applied to evaluate the safety profile.Result: A Total of 15967 patients were exposed to IL-23/17 axis antagonists. The proportions of patients suffered at least one AE in antagonists group and placebo-control group are 67.5% and 51.1% respectively. Incidence of SAE was increased in patients treated with IL-23/17 axis antagonists compared to patients given placebo (relative risk 2.03; 95% CI, 1.62, 2.56). Incidence of AEs of interest were all increased in patients treated with IL-23/17 axis antagonists compared to patients given placebo.Conclusion: In this analysis, we found increased risk of AEs, SAEs, nervous system disorder, cardiovascular disorder and hypertension among patients with IMIDs treated with IL-23/17 axis antagonists.
A predictive formula for difficult endotracheal intubation in the emergency department
Authors: Liao En-Chih , Chang Wen-Han , Yu Ching-Hsiang , Shen Cheng-Ying , Sun Fang-Ju , Lai Wen-Jyun , Chien Ding-Kuo
Published: August 2020

Background

Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula.
Methods

This was a 17-month prospective observational study. For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variable.
Results

The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p < 0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938).
Conclusions

Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.
Pragmatic Trial to Enhance Medication Adherence: Protocol for the NUDGE Trial
Authors: Glasgow Russell E. , Knoepke Christopher E. , Magid David , Grunwald Gary K. , Glorioso Thomas J. , Waughtal Joy , Marrs Joel C. , Bull Sheana , Ho P. Michael
Published: August 2020

Background: Nearly half of patients do not take their cardiovascular medications as prescribed, resulting in increased morbidity, mortality, and healthcare costs. Mobile and digital technologies for health promotion and disease self-management offer an opportunity to adapt behavioral “nudges” using ubiquitous mobile phone technology to facilitate medication adherence. The Nudge pragmatic clinical trial uses population-level pharmacy data to deliver nudges via mobile phone text messaging and an artificial intelligent interactive chat bot with the goal of improving medication adherence and patient outcomes in three integrated healthcare delivery systems. Methods: The Theory of mHealth, the Expanded RE-AIM/PRISM, and the PRECIS-2 frameworks were used for program planning, implementation and evaluation, along with a focus on dissemination and cost considerations. During the planning phase, the Nudge study team developed and piloted a technology-based nudge message and chat bot of optimized interactive content libraries for a range of diverse patients. Inclusion criteria are very broad and include patients in one of three diverse health systems who take medications to treat hypertension, atrial fibrillation, coronary artery disease, diabetes, or hyperlipidemia. A target of approximately 10,000 participants will be randomized to one of 4 study arms: usual care (no intervention), generic nudge (text reminder), optimized nudge, and optimized nudge plus interactive AI chat bot. The PRECIS-2 tool indicated that the study protocol is very pragmatic, although there is variability across PRECIS-2 dimensions. Discussion: The primary effectiveness outcome is medication adherence defined by the proportion of days covered (PDC) using pharmacy refill data. Implementation outcomes are assessed using the RE-AIM framework, with particular focus on reach, consistency of implementation, adaptations, cost, and maintenance/sustainability. The project has limitations including limited power to detect some subgroup effects, medication complications (bleeding) and longer-term outcomes (myocardial infarction). Strengths of the study include the diverse health care systems, a feasible and generalizable intervention, transparent reporting using established pragmatic research and implementation science frameworks, strong stakeholder engagement and planning for dissemination and sustainment. Trial registration: The study was funded by the NIH grant number is 4UH3HL144163-02 issued 4/5/19. The Clinicaltrial.gov identifier number is NCT03973931 which was registered on 6/4/2019. URL: https://clinicaltrials.gov/ct2/show/NCT03973931
Clinical symptoms and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship
Authors: Shen Xingrong , Shen Jilu , Pan Yaping , Cheng Jing , Chai Jing , Bowker Karen , MacGowan Alasdair , Oliver Isabel , Lambert Helen , Wang Debin
Published: August 2020

Background: This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural China and implications for future antibiotic stewardship.Methods: The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.Results: A total of 1068 completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR=1.91), season (OR=0.41 to 0.60), days since infection onset (OR=1.54 to 1.81), and runny or blocked nose (OR=1.39 to 1.61), cough with green or white sputum (OR=1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR=0.53) and sore throat (OR=1.64).Conclusions: The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.
Infectious Mononucleosis Complicated With Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review
Authors: Ren Yong , Wang Qiong , Liu Qiang , Zhang Jinsheng
Published: August 2020

Background: Epstein-Barr virus (EBV) is the cause of infectious mononucleosis (IM), a self-limited lymphoproliferative disorder among patients. EBV usually infects B-lymphocytes rather than T-lymphocytes. The clinicopathologic features of the idiopathic thrombocytopenic purpura (ITP) patients complicated with EBV-positive IM have been rarely described.Case presentation: We describe a case of a 19-year-old man complained with epistaxis and thrombocytopenia for one year, who was admitted to hospital for high grade fever after catching a cold. A lot of petechiae were found on the skin of both lower limbs and both hands during physical examination. Multiple enlarged lymph nodes could be touched in both sides of the neck. Ultrasound examination showed abnormal lymph nodes enlargement on both sides of the neck and supraclavicular area, and a strong echo mass was found in the liver. Serological tests for EBV revealed high level of IgM and IgG antibodies against viral capsid antigen (VCA), virus DNA quantitative<1000UI/mL. CD8-positive cytotoxic T cells accounted for up to 92.94% by flow cytometry. T cells were positive for CD38, CD57 and HLA-DR marker. Bone marrow cytology showed that the proportion of lymphocytes had increased considerably, and the rate of abnormal lymphocyte was as high as 29.5%. EBV virus encoded RNA was demonstrated in lymph node biopsy by in-situ hybridization (ISH) analysis. Immunohistochemically, there were more CD8-positive cells than CD4-positive cells in lymph node biopsy. The expression of CD7 was missing. CD99 was diffuse positive. The MIB-1/ki-67 labeling index was about 70%. EBER in situ hybridization revealed positive signals located in the nucleus. The patient was diagnosed as Infectious mononucleosis complicated with idiopathic thrombocytopenic purpura. The patient was hospitalized and discharged after recovery.Conclusions: ITP patients complicated with EBV-positive IM have been rarely reported in the literature. Comprehensive understanding of its clinicopathological features will help diagnose of this disease.