bluuebunny/crossref_metadata_2025 huggingface dataset:
Pertussis outbreak in Southern Ethiopia: challenges of detection, management and response
Authors: Mitiku Aychiluhim Damtew , Argaw Mesele Damte , Desta Binyam Fekadu , Tsegaye Zergu Taffesse , Atsa Afework Ayele , Tefera Bekele Belayihun , Teferi Ephreme , Rogers Deirdre , Bershir Ismael Ali , Gebeyehu Asrat , Anjulo Desta , Abate Derebe Tadesse , Sendeku Agegnehu Gebru , Mulowa Rudzani
Published: July 2020

Background: Despite the availability of effective vaccines, pertussis remains endemic with high fatality rates in low and middle-income countries (LMIC).This study aims to describe an outbreak of pertussis in a health district of Ethiopia. The study highlights the challenges faced by the health system in identifying pertussis cases and appropriately responding to the outbreak at the district level. Methods: a descriptive cross-sectional study was conducted using data sourced from the District Public Health Emergency and Management (PHEM) surveillance service and outbreak management field reports. Stratified attack rates and fatality rates for pertussis are described. Systemic problems leading to the outbreak are explored and narrated. A modified CDC pertussis case definition was employed with a polymerase chain reaction used to confirm cases. Results: From September 2018 to January 2019, 1840 suspected, probable, and confirmed pertussis cases and six deaths were identified. Pertussis cases ranged from 1 month to 51 years in age and an outbreak occurred in 14 out of the 24 villages of Dara Malo district. The overall attack rate was 1708 per 100,000 population with a fatality rate of 3.3 per 1,000 pertussis cases. The highest attack rate of 12,689/100,000 was seen in infants. Among confirmed, probable and suspected pertussis cases, only 41.1% had completed the three-dose pertussis vaccine's primary schedule. The household survey revealed the population coverage of 73.4% and 40.8% for Pentavalent vaccine dose one and three respectively. Investigations suggested the existence of a poor cold chain management system in the study area. Conclusions: There is an urgent need to build capacity to strengthen routine vaccination services and improving the maintenance of the vaccine cold chain. Other Low-and Middle -Income Countries (LMICs), are urged to take lessons learned from this outbreak and strengthen their own vaccination programs and capacitate health workers to manage local outbreaks.
Surgery Outcomes of Lamellar Macular Eyes with or without Lamellar Hole-Associated Epiretinal Proliferation: A Meta-Analysis
Authors: xu hanyue , Qin Ling , Zhang Yifan , Zhang Ming
Published: July 2020

Purpose: This study aimed at comparing both the structural and functional outcomes of lamellar macular hole (LMH) with and without lamellar hole-associated epiretinal proliferation (LHEP) after surgery. Method: Publications up to July 2020 that compared the surgical outcomes of LMH patients with and without LHEP were included. Forest plots were created using a weighted summary of proportion meta-analysis. Fixed or random effects modes were used based on I2 heterogeneity estimates. To evaluate the stability of the meta-analysis, sensitivity analysis was carried out. Result: Eight pertinent publications containing a total of 176 eyes without LHEP and 173 eyes with LHEP were included. They were all retrospective studies and had a mean follow-up of at least 6 months. In all studies, the preoperative best corrected visual acuity (BCVA) had no significant differences between the two groups and BCVA improved in both groups after surgery. Pooled results of the improved BCVA was 0.18 (95 % CI, 0.10 to 0.26; P< 0.01) between with and without LHEP groups. However, the odd ratio of restored ellipsoid zone was 0.80 (95% CI, 0.26 to 2.44; p = 0.69) among the group with LHEP and the group without LHEP. In conclusion, patients without LHEP had better postoperative BCVA than patients with LHEP. No significant difference was found in REZ among the two groups. The necessity of surgery for patients with LHEP needs more studies to identify.
The association between doctors’presenteeism and job burnout: a cross-sectional survey study in China
Authors: pei pei , Lin Guohua , Li Gaojie , Zhu Yifan , Xi Xiaoyu
Published: July 2020

Background: It is necessary to examine doctors working with illness from a professional point of view, because it is not only related to their occupational health, but also, more importantly, will affect the treatment effect of patients and the overall medical level of the hospital. Research shows that physicians often report job burnout and have a high level of presenteeism, but few studies concerns the relationship between job burnout and presenteeism. The purpose of this study was to explore the relationship between physiciandoctors’ presenteeism and three dimensions of job burnout in China, and to identify other aspects that are associated with presenteeism.Methods: A cross-sectional survey involving physiciandoctors in second-and third-class medical institutions (except for primary doctors) was conducted in the interior of China. Using one item measure about presenteeism and a 15-item Chinese version of the BMI-GS questionnaire, this study investigated prevalence of physiciandoctors' presenteeism behavior and job burnout, and determined the relationship between presenteeism and job burnout by logistical model.Results: Relationships between presenteeism and three dimensions of job burnout were explored, and the influence of demography and work factors were evaluated. The survey was completed by 1376/1547 hospital doctors, with a response rate of 88.9%. Presenteeism was reported by 30.7% of participants. 30.7%(n=422) of the subjects reported having presenteeism behavior. Using MBI-GS, 86.8% (n=1195) of all physiciandoctors had moderate job burnout and 6.0%(n=82) were severe job burnout. Logistic regression analysis showed that physiciandoctors with medium, high degree of emotional exhaustion and high degree of cynicism were more likely to associate with presenteeismpractice presenteeism (all p < 0.05). In addition, two other work-related factors, including the physiciandoctor's department and position, were also more likely to relate with theirpresenteeism (all p < 0.05).Conclusions: By examining the relationship between presenteeism and job burnout, this study determined that there is indeed a significant correlation between the two. This result has a certain reference value for the development of work health, especially presenteeism and job burnout theory, and also makes a certain contribution to the relevant research literature.At present, there is quite presenteeism among physicians in the second-and third-class medical institutions in China, which is significantly related to emotional exhaustion and cynicism. Considering the modifiable job-related factors, health care institutions must take appropriate measures to relieve physicians' job burnout, help them adjust their self-awareness properly, and ensure occupational mental health to alleviate the prevalence of presenteeism.
Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: A retrospective study in the Pediatric Intensive Care Unit
Authors: Shi Jingyi , Sun Ting , Cui Yun , Wang Chunxia , Wang Fei , Zhou Yiping , Miao Huijie , Shan Yijun , Zhang Yucai
Published: July 2020

Background Multidrug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors and overall mortality for MDR/XDR Acinetobacter baumannii infected pediatric patients. Methods This retrospective study included 102 pediatric patients who developed MDR/XDR Acinetobacter baumannii infection in the pediatric intensive care unit (PICU) of Shanghai Children’s Hospital in China from December 2014 to May 2018. Acinetobacter baumannii clinical isolates were recovered from different specimens including blood, sputum, bronchoalveolar lavage fluid, cerebrospinal fluid, ascites, hydrothorax, and urine. Antibiotic susceptibility test was determined according to the Clinical and Laboratory Standards Institute interpretive criteria. Clinical and biological data were obtained from the patients’ medical records. Results 102 patients with Acinetobacter baumannii infection were enrolled. The median age was 36 (9.6, 98.8) months, and there were 63 male in the case group. The overall mortality rate was 29.4%, while the Acinetobacter baumannii -associated mortality rate was 16.7% (17/102, 12 bloodstream infections, 4 meningitis and 1 intra-abdominal infection). Bloodstream infections occurred in 28 patients (27.5%), and 10 patients (9.8%) among them had central line-associated bloodstream infections (6 central venous catheters, 2 PICCs, 1 venous infusion port and 1 arterial catheter). Cerebrospinal fluid (CSF) cultures were positive in 4(3.9%) patients. 14(13.7%) patients got positive cultures in ascites and hydrothorax. Lower respiratory isolates (56/102) accounted for 54.9% of all patients. Non-survival patients appeared to have a lower NK cell activity (6.2%±3.61% vs. 9.15%±6.21%, P =0.029), higher CD4+ T cell ratio (39.67%±12.18% vs. 32.66%±11.44%, P = 0.039),and a higher serum level of interlukin-8 (IL-8, 15.25 (1.62, 47.22)pg/ml vs. 0.1 (0.1, 22.99)pg/ml, P=0.01) when Acinetobacter baumannii infection developed. Multivariate logistic analysis indicated that high serum level of Cr (RR, 0.934, 95%CI, 0.890-0.981；P=0.007) and high BUN/ALB level (RR, 107.893, 95%CI, 1.425-870.574; p= 0.005) were associated with high risk of mortality in MDR/XDR Acinetobacter baumannii infected patients. Conclusion MDR/XDR Acinetobacter baumannii infection is a serious concern in pediatric patients with high mortality. Bloodstream and central nervous infection accounted for high risk of death. Acute kidney injury is associated with high risk of mortality.
Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis
Authors: Zhang Rongyuan , Wang Xu , Li Shoujun , Yan Jun
Published: July 2020

Background: Acute respiratory distress syndrome (ARDS) in infants undergoing cardiac surgery is associated with significant mortality and prolonged ventilation; surfactant administration may be a useful therapy. The purpose of this study was to evaluate the effect of low-dose exogenous surfactant therapy on infants suffering ARDS after cardiac surgery. Methods: We conducted a case-control study of infants diagnosed with moderate-to-severe ARDS (PaO2/FiO2 < 150) after cardiac surgery. A case was defined as a patient that received surfactant and standard therapy, while a control was defined as a patient that underwent standard therapy. The primary endpoint was the improvement in oxygenation index (OI) after 24-hour of surfactant treatment; and secondary endpoints were the ventilator time and PICU time. Results: Twenty-two infants treated with surfactant were matched with 22 controls. Early low-dose (20mg/kg) surfactant treatment was associated with improved outcomes. After surfactant administration for 24-hour, the surfactant group was much better compared with the control group at the 24-hour in OI (difference in average change from baseline, -6.7 [95% CI, -9.3 to -4.1]) (P < 0.01) and ventilation index (VI, mean difference, -11.9 [95% CI, -18.1 to -5.7]) (P < 0.01). Ventilation time and PICU time were significantly shorter in the surfactant group compared with the control group (133.6h±27.2 vs 218.4h±28.7, P < 0.01 ; 10.7d±5.1 vs 17.5d±6.8, P < 0.01). Infants in the surfactant group under 3 months benefit more from OI and VI than the infants over 3 months in a preliminary exploratory analysis. Conclusions: In infants with moderate-to-severe ARDS after cardiac surgery, early low-dose exogenous surfactant treatment could prominently improve oxygenation and reduce mechanical ventilation time and PICU time. Infants younger than 3 months may get more benefit of oxygenation than the older ones. Randomized controlled trials are needed to explore the effect of surfactant to ARDS of cardiac surgical infants.
Geospatial and Explanatory Models for Heart Failure Admissions, 2016 through 2018
Authors: Kruse Clemens Scott , Beauvais Bradley M. , Brooks Matthew S. , Mileski Michael , Fulton Lawrence
Published: July 2020

Background. About 5.7 million individuals in the United States have heart failure, and the disease was estimated to cost about $42.9 billion in 2020. This research provides geographical incidence models of this disease in the U.S. and explanatory models to account for hospitals’ number of heart failure DRGs using technical, workload, financial, geographical, and time-related variables. The research also provides updated financial and demand estimates based on inflationary pressures and disease rate increases. Understanding patterns is important to both policymakers and health administrators for cost control and planning. Methods. Maps of heart failure diagnosis-related groups (DRGs) from 2016 through 2018 depicted areas of high incidence as well as changes. Spatial regression identified no significant spatial correlations. Simple expenditure forecasts were calculated for 2016 through 2018. Linear, lasso, ridge, and Elastic Net models as well as ensembled tree regressors including were built on an 80% training set and evaluated on a 20% test set. Results: The incidence of heart failure has increased over time with highest intensities in the East and center of the country; however, several Northern states (e.g., Minnesota) have seen large increases in rates from 2016. The best traditional regression model explained 75% of the variability in the number of DRGs experienced by hospital using a small subset of variables including discharges, DRG type, percent Medicare reimbursement, hospital type, and medical school affiliation. The best ensembled tree models achieved R2 over .97 on the blinded test set and identified discharges, percent Medicare reimbursement, hospital acute days, affiliated physicians, staffed beds, employees, hospital type, emergency room visits, medical school affiliation, geographical location, and the number of surgeries as highly important predictors. Conclusions. Overall, the total cost of the three DRGs in the study has increased approximately $61 billion from 2016 through 2018 (average of two estimates). The increase in the more expensive DRG (DRG 291) has outpaced others with an associated increase of $92 billion in expenditures. With the increase in demand (linked to obesity and other factors) as well as the relatively steady-state supply of cardiologists over time, the costs are likely to balloon over the next decade.
Study of laboratory staff' knowledge of biobanking in Côte d'Ivoire
Authors: Kintossou Ambroise Kouamé , N'Dri Mathias Kouamé , Money Marcelle , Cisse Souleymane , Doumbia Simini , Man-Koumba Soumahoro , Coulibaly Amadou Founzégué , Djaman Joseph Allico , Dosso Mireille
Published: July 2020

Background: The biobank is a structure that manages and makes available biological resources. The biobank has medical, scientific and economic interests in an ethical manner. In 2009, Côte d'Ivoire established a biobank, which has housed the regional biobank of Economic Community of West African States (ECOWAS) countries since 2018. To ensure optimal and efficient use of this biobank, scientific stakeholders must be aware of its existence and role. It was therefore necessary to assess the knowledge of laboratory staff on the role and activities of a biobank.Methods: This is a descriptive study conducted with staff of human, animal and plant health laboratories located in southern Côte d'Ivoire. Results: A total of 205 people agreed to complete the proposed questionnaire. Of these, 34.63% are biologists, 7.32% engineers, 48.78% technicians and 9.27% PhD students. The average professional experience was 10.11 ± 7.83 years. Respectively, 47.32% and 43.41% have never heard of biocollection and biobank. Only 48.78% of participants had a good understanding of the role of a biobank. Technicians and PhD students were less educated on the notion of biobank (p<0.000001). Biologists, although they were more educated on this issue, 21.13% of them had a misconception of biobank. Good knowledge of the role of a biobank was not significantly related to the duration of professional experience (p>0.88). Conclusion: The level of knowledge of laboratory staff about biobanking remains to be improved. Training on the role, activities and interests of the biobank is important.
Long noncoding RNA XIST suppresses tumorigenesis and enhances radiosensitivity in neuroblastoma cells through regulating miR-653-5p/HK2 axis
Authors: Mou Liping , Wang Lili , Zhang Shaoming , Wang Qinghua
Published: July 2020

Background: Abnormal expression of long noncoding RNAs (lncRNAs) was usually involved in tumorigenesis and radiosensitivity of various cancers. The aim of this study was to explore the biological function and regulatory mechanism of lncRNA X-inactive specific transcript (XIST) in tumorigenesis and radiosensitivity of neuroblastoma (NB). Methods: The expression levels of XIST, microRNA-653-5p (miR-653-5p) and hexokinase 2 (HK2) were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Methylthiazolyldiphenyl tetrazolium bromide (MTT) assay, colony formation assay and transwell assay were utilized to detect cell viability, colony formation and cell invasion abilities. Glucose consumption or lactate production was measured by glucose assay kit or lactate assay kit, respectively. The mice xenograft model was established to investigate the role of XIST in vivo . The interaction between miR-653-5p and XIST or HK2 was predicted by starBase v2.0 and verified by dual-luciferase reporter assay. Western blot was used to measure the protein expression of HK2. Results: XIST and HK2 were highly expressed whilst miR-653-5p was lowly expressed in NB tissues and cells. XIST knockdown inhibited tumorigenesis by repressing NB cell proliferation and invasion. Meanwhile, XIST downregulation increased the radiosensitivity via inhibiting colony formation rates and glycolysis. Moreover, miR-653-5p could bind to XIST and its downregulation reversed the effects of XIST knockdown on tumorigenesis and radiosensitivity. Additionally, HK2 was a direct target of miR-653-5p and its overexpression attenuated the effects of miR-653-5p restoration on suppression of tumorigenesis and promotion of radiosensitivity. Besides, XIST functioned as a molecular sponge of miR-653-5p to regulate HK2 expression. Furthermore, XIST knockdown also suppressed tumor growth by upregulating miR-653-5p and downregulating HK2 in vivo . Conclusion: XIST interference inhibited tumorigenesis and increased radiosensitivity in NB by regulating miR-653-5p/HK2 axis, providing a novel therapeutic strategy for NB.
A single oral fixed-dose praziquantel-miltefosine nanocombination for effective control of experimental schistosomiasis mansoni
Authors: Eissa Maha Mohamed , El-Azzouni Mervat , El-Khordagui Labiba Khalil , Bary Amany Abdel , El-Moslemany Riham Mohamed , Salam Sara Ahmed Abdel
Published: July 2020

Background: The control of schistosomiasis has been centered to date on a single drug, praziquantel, with shortcomings including treatment failure, reinfection, and emergence of drug resistance. Drug repurposing, combination therapy or nanotechnology were explored to improve antischistosomal treatment. The aim of the present study was to utilize a novel combination of the three strategies to improve the therapeutic profile of praziquantel. This was based on a fixed dose nanocombination of praziquantel and miltefosine, an antischistosomal repurposing candidate, co-loaded at reduced doses into lipid nanocapsules, for single dose oral therapy.Methods: Two nanocombinations were prepared to provide 250 mg praziquantel-20 mg miltefosine/kg (higher fixed dose) or 125 mg praziquantel-10 mg miltefosine/kg (lower fixed dose) respectively. Their antischistosomal efficacy in comparison with nontreated control and their praziquantel or miltefosine singly loaded counterparts was assessed in murine schistosomiasis mansoni. A single oral dose of either formulation was administered on the initial day of infection, the 21st and 42nd days post infection. Scanning electron microscopic, parasitological and histopathological studies were used for assessment. Preclinical data were subjected to analysis of variance and Tukey post hoc test for pairwise comparisons.Results: Lipid nanocapsules (~58 nm) showed high entrapment efficiency of both drugs (>97%). Compared to singly loaded praziquantel-lipid nanocapsules, the higher dose nanocombination showed a significant increase in antischistosomal efficacy in terms of statistically significant decrease in mean worm burden, particularly against invasive and juvenile worms, and amelioration of hepatic granulomas (p ≤0.05). In addition, scanning electron microscopic examination showed extensive dorsal tegumental damage with noticeable deposition of nanostructures. Conclusions: The therapeutic profile of praziquantel could be improved by a novel multiple approach integrating drug repurposing, combination therapy and nanotechnology. Multistage activity and amelioration of liver pathology could be achieved by a new praziquantel-miltefosine fixed dose nanocombination providing 250 mg praziquantel-20 mg miltefosine/kg. To the best of our knowledge, this is the first report of a fixed dose nano-based combinatorial therapy for schistosomiasis mansoni. Further studies are needed to document the nanocombination safety and explore its prophylactic activity and potential to hinder the onset of resistance to the drug components.
A risk score based on pediatric Sequential Organ Failure Assessment predicts 90-day mortality in children with Klebsiella pneumoniae bloodstream infection
Authors: Li Shuang , Liu Jingxian , Chen Feng , Cai Kang , Tan Jintong , Xie Wei , Qian Rong , Liu Xiaoqin , Zhang Wenhong , Liu Ying , Huang Lisu
Published: July 2020

Background: Klebsiella pneumoniae bloodstream infection (Kp-BSI) is a serious threat to pediatric patients. The objective of this study was to explore the risk factors, validate the prediction efficiency of pediatric Sequential Organ Failure Assessment (SOFA) and establish better early predictors of mortality in pediatric patients with Kp-BSI. Methods: All children diagnosed with Kp-BSI were included in this retrospective cohort study from January 2009 to June 2019. Basic characteristics, symptoms and physical examinations, treatments, laboratory statistics, and SOFA at the onset of Kp-BSI were recorded. The Cox proportional hazard model and receiver operating characteristic curves were used to assess the association between the variables and the 90-day mortality and their predictive value. DeLong's test of receiver operating characteristic curves and integrated discrimination improvement index were used to determine the improvement in predictive capacity of the modified SOFA models. A predictive score was developed using multivariate logistic regression. Results: Of the 146 children enrolled, 33 (22.6%) patients died within 90 days. Hospitalization in the last six months, intra-abdominal source of infection, presence of organ failure, and altered levels of blood biomarkers, including C-reactive protein, albumin, and lactate were significant risk factors for 90-day mortality. The area under the curve (AUC) of SOFA for predicting 90-day mortality was 0.80 (95% CI 0.71–0.89). Moreover, we found that a prediction model combining SOFA with two other parameters, namely hospitalization in the last six months and intra-abdominal source of infection, was better at predicting mortality (AUC = 0.89, 95% CI 0.82–0.96; sensitivity = 0.86; specificity = 0.84). According to this novel risk model, we defined three statistically different groups: low-risk, medium-risk and high-risk groups, with an observed 90-day mortality of 5.4%, 35.7%, and 72.0%, respectively. With reference to the low-risk patients, the medium-risk and high-risk groups had a higher mortality, with hazard ratios of 8.36 (95% CI 3.60–27.83) and 20.27 (95% CI 7.47–54.95), respectively. Conclusions: The modified SOFA may be better than the original score to predict 90-day mortality in pediatric patients with Kp-BSI. Future prospective studies are required to validate this novel scoring system in external cohorts.
Can virtual reality improve traditional anatomy education programmes? A mixed-methods study on the use of a 3D skull model
Authors: Chen Shi , Zhu Jiawei , Cheng Cheng , Pan Zhouxian , Liu Lingshan , Du Jianhua , Shen Xinhua , Shen Zhen , Zhu Huijuan , Liu Jihai , Yang Hua , Ma Chao , Pan Hui
Published: July 2020

Background: Realistic, portable, and scalable lectures, cadaveric models, 2D atlases and computer simulations are being combined more frequently for teaching anatomy, resulting in major increases in user satisfaction. However, while digital simulations may be more portable, interesting, or motivating than traditional teaching tools, whether they are superior in terms of student learning remain unclear. This paper presents a study in which the educational effectiveness of a virtual reality (VR) skull model is compared with that of cadaveric skulls and atlases. The purpose of this study was to compare the results of teaching with VR to those of teaching with traditional teaching methods by administering objective questionnaires and perception surveys. Methods: A mixed-methods study with 73 medical students was carried out with three different groups: the VR skull (N=25), cadaveric skull (N=25) and atlas (N=23) groups. Anatomical structures were taught through an introductory lecture and model-based learning. All students completed the pre- and post-intervention tests, which were composed of a theory test and an identification test. Results: The participants in all three groups had significantly higher total scores on the post-intervention test than on the pre-intervention test; the post-interview test score in the VR group was not statistically significantly higher than those of the other groups (VR: 30 [22-33.5], cadaver: 26 [20-31.5], atlas: 28[20-33]; p=0.571). The participants in the VR and cadaver groups provided more positive feedback on their learning models than the atlas group (VR: 26 [19-30], cadaver: 25 [19.5-29.5], atlas: 12 [9-20]; p<0.0001).Conclusions: The skull VLR was equally efficient with cadaver skull and atlas in teaching anatomy structures. Such a model can aid individuals in understanding complex anatomical structures with a higher level of motivation and tolerable adverse effects.
Scaled-Up Nutrition Education on Pulse-Cereal Complementary Food Practice in Ethiopia: A Cluster-Randomized Trial
Authors: Teshome Getenesh Berhanu , Whiting Susan J. , Green Timothy J. , Mulualem Demelash , Henry Carol J.
Published: July 2020

Background

Improving children's weight status through nutrition education (NE) for mothers about using pulses in complementary feeding has been demonstrated in pilot studies, but no effect on stunting was reported. The aim of the study was to evaluate the effectiveness of a 9-month pulse-nutrition education program on mothers' knowledge, attitude, and practices (KAP) towards pulses, as well as its impact on children's dietary diversity, and nutritional status. The NE was delivered by Health Extension Workers (HEWs).

Methods

A cluster randomized study was employed for the community-based interventional study. Twelve randomly selected villages in Sidama Zone, Southern Ethiopia were included in the study. A total of 772 mother-child pairs involved in the study; where 386 mother-child pairs in the intervention group received additional messages about pulse-cereal complementary food, and 386 pairs (the control) received only routine health education for 9 months. A survey on mothers’ KAP and anthropometric measurements of the children were taken at baseline, midline, and endline.

Results

At baseline and endline, maternal KAP and the dietary diversity score of the children (mean age at endline 18.8 ± 2.9 mo) were assessed. Results : Intervention mothers’ KAP improved ( p <0.001) at midline and endline compared to that of the control group, as did frequency of pulse consumption and DDS among children. At 9 months, the prevalence of stunting, wasting, and underweight was significantly reduced in the intervention group compared to the control group ( p =0.001).

Conclusions

NE delivered by HEWs improved KAP of mothers regarding pulse consumption and dietary diversity of children led to improved nutritional status of the children. Training HEWs on the use of pulses for CF may be an effective way to improve the health of children in Ethiopian communities.
Influences on NHS Health Check behaviours: a systematic review
Authors: Atkins Lou , Stefanidou Chryssa , Chadborn Tim , Thompson Katherine , Michie Susan , Lorencatto Fabi
Published: July 2020

Background

National Health Checks were introduced in the English National Health Service (NHS) in 2009 to reduce cardiovascular disease (CVD) risks and events. Following Public Health England’s (PHE’s) 2017 Digital review, NHS Health Checks were identified as a Digital Exemplar for PHE forming part of the Predictive Prevention programme, setting out the government’s vision for putting prevention at the heart of the nation’s health. This study applied behavioural science frameworks to: i) identify behaviours and actors relevant to uptake, delivery and follow up of NHS Health Checks and influences on these behaviours and; ii) signpost to example intervention content, with a focus on digital intervention development.

Methods

A systematic review of studies reporting NHS Health Check-related behaviours of patients, health care professionals (HCPs) and commissioners. Influences on behaviours were coded using theory-based models: COM-B and Theoretical Domains Framework (TDF). Potential intervention types and behaviour change techniques (BCTs) were suggested to target key influences.

Results

We identified 37 studies reporting nine behaviours and influences for eight of these. The most frequently identified influences were physical opportunity including HCPs having space and time to deliver NHS Health Checks and patients having money to adhere to recommendations to change diet and physical activity. Other key influences were motivational, such as beliefs about consequences about the value of NHS Health Checks and behaviour change, and social, such as influences of others on behaviour change. The following techniques are suggested for websites or smartphone apps: Adding objects to the environment, e.g. provide HCPs with electronic schedules to guide timely delivery of Health Checks to target physical opportunity, Social support (unspecified) , e.g. include text suggesting patients to ask a colleague to agree in advance to join them in taking the ‘healthy option’ lunch at work; Information about health consequences , e.g. quotes and/or videos from patients talking about the health benefits of changes they have made.

Conclusions

Through the application of behavioural science we identified key behaviours and their influences which informed recommendations for digital intervention content. To ascertain the extent to which this reflects existing interventions we recommend a review of relevant evidence.
Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: A randomized controlled clinical trial.
Authors: khodabakhshi adeleh , Seyfried Thomas N. , Kalamian Miriam , mahmoudi maryam , Davoodi Sayed Hossein
Published: July 2020

Introduction: Despite recent interest in the use of ketogenic diets (KDs) for cancer, evidence of beneficial effects is lacking. This study examined the impact of a randomly assigned KD on quality of life, physical activity and biomarkers in patients with breast cancer.Method: A total of 80 patients with locally advanced or metastatic breast cancer and without a history of renal disease or diabetes were randomly assigned to either a KD or a control group for this 12-week trial. Concurrent with the first, third, and fifth chemotherapy sessions, quality of life, physical activity, and biomarkers (thyroid function tests, electrolytes, albumin, ammonia, ALP, lactate and serum ketones) were assessed. Dietary intake was also recorded on admission and the end of the treatment.Results: No significant differences were seen in quality of life or physical activity scores between the two groups after 12 weeks; however, the KD group showed higher global quality of life and physical activity scores compared to the control group at 6 weeks (P=0.02 P= 0.01). Also, serum lactate and ALP levels decreased significantly in the KD group compared to the control group at the end of the intervention (10.7±3 vs 13.3±4, 149±71 vs 240±164, P=0.02 and P=0.007, respectively). A significant inverse association was observed between total carbohydrate intake and serum beta-hydroxybutyrate at 12 weeks (r= -0.77 P <0.001). No significant differences between groups were observed in thyroid hormones, electrolytes, albumin, LDH or ammonia. Compliance among KD subjects ranged from 66.7% to 79.2% as assessed by dietary intake and serum ketones levels of >0.5.Conclusion: According to our results, besides a higher global quality of life and physical activity scores compared to the control group at 6 weeks, KD diet combined to chemotherapy in patients with breast cancer does not bring additional benefit about quality of life and physical activity at 12 weeks. However, decreases seen in levels of lactate and ALP in the KD group suggest that a KD may benefit patients with breast cancer.
Investigating the healthcare pathway through patient’s experience and profiles: implications for the breast cancer healthcare providers
Authors: CHERIF Emna , VERDIER Elisabeth MARTIN , ROCHETTE Corinne
Published: July 2020

Background Healthcare systems are facing many changes. Particularly, patients are more engaged in the care process. The medical perspective of the process is insufficient to provide patients with high quality care and service personalisation. This research presents an attempt to complete this medical perspective through an experiential perspective, especially for chronic diseases such as cancer. We investigated patients’ experiences and profiles to reach a deeper understanding of their needs and expectations when they confront the disease.The objectives of this research were to model the key stages underling the patient pathway and to identify the challenging touch points of the interactions between patients and healthcare providers. Bringing together findings of patient experience, pathway, and profiles would help all the stakeholders involved to develop better practices for the healthcare process.Methods A qualitative observational nethnography on a French specialized forum for breast cancer patients “les Impatientes” was conducted. A total of 967 reviews were collected over a complete year period from all over France. Thematic and lexicometric content analysis were performed according to the experience dimensions, the pathway stages and touch points, as well as the patients’ profiles.Results Data analysis shows that the healthcare pathway experienced by the patients is built around three stages. The discovery stage is closely related to the emotional dimension regarding the patient and physician relationship. The examination stage is characterized by a more technical and informational needs for the types of treatments. The follow-up and survivorship stage illustrates the patients’ need to assess the treatments’ effectiveness and the quality of the follow-up. Moreover, three profiles of patients were identified. The newcomers, the altruists and the autonomous are characterized by different attitudes depending on the stage of the healthcare pathway they were living.Conclusions Our research presents an original modelling of the patient pathway and profiles beyond the medical process. It gives practical tracks to improve the healthcare pathway. Patients expect healthcare providers to integrate and strengthen several challenging touch points in order to create satisfactory patient experiences and high quality service.
High insecticide resistances levels in Anopheles gambiaes s.l. in northern Uganda and its relevance for future malaria control
Authors: Echodu Richard , Iga Julius , Oyet William Sam , Mireji Paul , Anena Juliet , Onanyang David , Iwiru Tereza , Lutwama Julius Julian , Opiyo Elizabeth Auma
Published: July 2020

Objective: The aim of the study was to determine the level of insecticide resistance and diversity in Anopheles mosquitoes in northern Uganda. Standard WHO insecticide susceptibility test assays were used to test for susceptibility to 0.5% malathion, 0.1% bendiocarb, 0.05% deltamethrin and 0.75% permethrin on 3-5 day old generation one progeny. We also screened for species diversity and knockdown resistance using PCR assay.Results: Anopheles gambiae s.s. is the predominant malaria vector in northern Uganda followed by An. arabiensis. An. gambiae s.s. was susceptible to malathion and bendiocarb with the observed mortality rate of 100% and 98-100% observed respectively while very high resistance was observed with deltamethrin and permethrin. Minimal KDR-eastern variant homozygous forms of 8.3% in An. gambiae s.s. were detected in Oyam district. In conclusion, this study confirms that An. gambiae s.s. females are susceptible to malathion and bendiocarb while high intensity of resistance was observed with deltamethrin and permethrin in the same area. Use of carbamate and organophosphate insecticides bendiocarb and malathion for indoor residual spraying activities in northern Uganda is highly recommended since high levels of pyrethroids resistance (deltamethrin & permethrin) was detected in the area.
Transcriptome Analysis of Aedes aegypti Aag2 Cells in Response to Dengue Virus-2 Infection
Authors: Li Man-jin , Lan Ce-jie , Gao He-ting , Xing Dan , Gu Zhen-yu , Su Duo , Zhao Tong-yan , Yang Hui-ying , Li Chun-xiao
Published: July 2020

Background: Dengue virus (DENV) is a flavivirus transmitted by mosquitoes that is prevalent in tropical and subtropical countries and has four serotypes (DENV1-4). Aedes aegypti, as the main transmission vector of DENV, exhibits strong infectivity and transmission. With the aim of obtaining a better understanding of the Ae. aegypti-DENV interaction, the transcriptome changes in DENV-2-infected Aag2 cells were studied to describe the immune responses of mosquitoes using the Ae. aegypti Aag2 cell line as a model.Methods: RNAseq technology was used to sequence the transcripts of the Ae. aegypti Aag2 cell line before and after infection with DENV-2. A bioinformatics analysis was then performed to assess the biological functions of the differentially expressed genes, and the sequencing data were verified by quantitative reverse transcription-polymerase chain reaction (qRT-PCR).Results: The transcriptome analysis generated 8,866 unigenes that were found in both groups, 225 unigenes that were only found in the infection group, and 683 unigenes that only existed in the control group. A total of 1199 differentially expressed genes, including 1014 upregulated and 185 downregulated genes, were identified. The bioinformatics analysis showed that the differentially expressed genes were mainly involved in the longevity regulating pathway, circadian rhythm, DNA replication, and peroxisome, purine, pyrimidine, and drug metabolism. The qRT-PCR verification results showed the same trend, which confirmed that the expression of the differentially expressed genes had changed and that the transcriptome sequencing data were reliable.Conclusions: This study investigated the changes in the transcriptome levels in the DENV-2-infected Ae. aegypti Aag2 cell line, which provides a faster and effective method for discovering genes related to Ae. aegypti pathogen susceptibility. The findings provide basic data and directions for further research on the complex mechanism underlying host-pathogen interactions.
Clinical features of gingivostomatitis due to primary infection of Herpes simplex virus in children
Authors: Huang Chen-Wei , Hsieh Chi-Hsien , Lin Ming-Ru , Huang Yhu-Chering
Published: July 2020

Background

Primary herpetic gingivostomatitis (PHGS) in children, though usually self-limited, might mimic bacterial and enteroviral pharyngitis clinically. We conducted a study to define the clinical features of PHGS in children.

Methods

Between January 2012 to December 2016, 282 inpatients aged less than 19 years with cell culture-confirmed herpes simplex virus (HSV) infection in a medical center were identified from the virologic laboratory logbook. Clinical data were retrospectively collected.

Results

Among the 282 inpatients, 185 cases were considered as PHGS and included for analysis. 99.5% had fever. The mean duration of fever was 5.11 days (±2.24) with the longest being 17 days. The common oral manifestations included oral ulcers (84.3%), which equally resided in the anterior and posterior part of the oral cavity (65.4% vs. 63.2%), gum swelling and/or bleeding (67.6%), and exudate coated tonsils (16.8%). Leukocytosis (WBC count >15,000/uL3) was noted in 52 patients (28.1%) and a serum C-reactive protein level >40 mg/L in 55 patients (29.7%). 65 patients (35%) were diagnosed as PHGS on admission and were significantly more likely to have ulcers over the anterior oral cavity (76.1% vs. 26.7%) and gum swelling/bleeding (76.2% vs. 7.5%, p-value all <0.001) on admission and were significantly less likely to receive antibiotic treatment (16.9 vs. 36.7%, p-value < 0.01) than others. 46 patients (25%) undiagnosed as PHGS on discharge were significantly more likely to have exudate coated on tonsils, receive antibiotic treatment and significantly less likely to have gum swelling/bleeding and oral ulcers (all p values < 0.01).

Conclusions

Meticulously identifying specific oral manifestations of gum swelling/bleeding and ulcers over the anterior oral cavity in children can differentiate PHGS from both bacterial and enteroviral pharyngitis and subsequently reduce unnecessary prescription of antibiotics.
Beyond clinical food prescriptions and mobile markets: parent views on the role of a healthcare institution in increasing healthy eating in food insecure families
Authors: DeWit Emily L. , Meissen-Sebelius Emily M. , Shook Robin P. , Pina Kimberly Ann , De Miranda Evelyn Donis , Summar Michelle J. , Hurley Emily A.
Published: July 2020

Background: Children in food-insecure families face increased barriers to meeting recommendations for fruit and vegetable consumption. Hospitals and pediatric healthcare institutions have attempted to alleviate food-insecurity through various internal programs like food prescriptions, yet little evidence for these programs exist. Consistent with a patient-centered perspective, we sought to develop a comprehensive understanding of barriers to fruit and vegetable consumption and a parent-driven agenda for healthcare system action. Methods: We conducted six qualitative focus group discussions (four in English, two in Spanish) with 29 parents and caregivers of patients who had screened positive for food-insecurity during visits to a large pediatric healthcare system in a midwestern U.S. city. Our iterative analysis process consisted of audio-recording, transcribing and coding discussions, aiming to produce a) a conceptual framework of barriers to fruit and vegetable consumption and b) a synthesis of participant programmatic suggestions for their healthcare system.Results: Participants were 90% female, 38% Black/African American and 41% Hispanic/Latino. Barriers to fruit and vegetable consumption in their families fell into three intersecting themes: affordability, accessibility and desirability. Participant-generated intervention recommendations were multilevel, suggesting healthcare systems focus not only on clinic and community-based action, but also advocacy for broader policies that alleviate barriers to acquiring healthy foods. Conclusion: Parents envision an expanded role for healthcare systems in ensuring their children benefit from a healthy diet. Findings offer critical insight on why clinic-driven programs aimed to address healthy eating may have failed and healthcare organizations may more effectively intervene by adopting a multilevel strategy.
A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis. A randomized controlled trial protocol.
Authors: Rodríguez-Sánchez-Laulhé Pablo for the Management of Health Research of Seville F , Luque-Romero Luis Gabriel , Blanquero Jesús , Suero-Pineda Alejandro , Biscarri-Carbonero Ángela , Barrero-García Francisco José , Heredia-Rizo Alberto Marcos
Published: July 2020

Background: Therapeutic exercise is a safe and cost-effective approach to alleviate hand rheumatoid arthritis (RA) related symptoms. This study aims to investigate the differences in self-management between a smartphone app (CareHand), using hand exercises and educational advices, compared with a standard approach, on hand overall function, pain intensity, stiffness, and grip and pinch strength in patients with hand RA. Methods: The project is a prospective, longitudinal, superiority, randomized controlled trial. Fifty-eight participants with hand RA will be randomly assigned into an experimental group (CareHand app) or a control group (conventional treatment). Control intervention involves a paper sheet with exercises and recommendations, and the experimental group includes the use of a smartphone app, which provides individualized exercise programmes, self-management and educational strategies to promote adherence to treatment. Both intervention protocols will last for 3 months. The principal investigator will conduct an educational session at baseline for all participants. Primary outcome comprises the overall hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary outcomes include self-reported functional ability with the Quick DASH questionnaire, self-reported pain intensity and morning stiffness using a Visual Analogue Scale (VAS), and hand grip and pinch strength (dynamometer). Outcome measures will be collected at baseline, and at 1 month and 3-month follow-up. Discussion: This study will evaluate the effectiveness of a telerehabilitation tool, which uses exercise and self-management strategies, compared to a conventional approach, in patients with hand RA. The smartphone app will allow to monitor the patient´s status, and to enhance patient-therapist communication. Some limitations may be related to the short follow-up duration and the lack of evaluation of psychosocial factors. Overall, this new way of promoting long-term effects in patients with a chronic rheumatic disease could be feasible and easy to implement in daily life clinical practice and current musculoskeletal care.