bluuebunny/crossref_metadata_2025 huggingface dataset:
Perioperative Care Models for Neonates With Congenital Heart Disease: Evolving Role of Neonatology Within the Cardiac Intensive Care Unit
Authors: Chaudhry Paulomi M. , Sen Shawn , Steurer Martina , Levy Victor Y. , Gowda Sharada , Ball Molly K. , Ashrafi Amir , Emani Sitaram M. , Bacha Emile A. , Checchia Paul A. , Levy Philip T. , Krishnamurthy Ganga
Published: June 2023

A multidisciplinary team is needed to optimally care for infants with congenital heart disease (CHD). Different compositions of teams trained in cardiology, critical care, cardiothoracic surgery, anesthesia, and neonatology have been identified as being primarily responsible for perioperative care of this high-risk population in dedicated cardiac intensive care units (CICUs). Although the specific role of cardiac intensivists has become more well defined over the past two decades, the responsibilities of neonatologists remain highly variable in the CICU with neonatologists providing care along with a unique spectrum of primary, shared, or consultative care. The neonatologist can function as the primary physician and assume all or share responsibility with the cardiac intensivists for the management of infants with CHD. A neonatologist can provide care as a secondary consultant physician in a supportive role for the primary CICU team. Additionally, neonates with CHD can be mixed with older children in a CICU, cohorted in a dedicated space within the CICU or placed in a stand-alone infant CICU without older children. Although variations exist between centers on which model of care is deployed and the location within a CICU, characterization of current practice patterns represents the initial step required to determine optimal best practices to improve the quality of care for neonates with cardiac disease. In this manuscript, we present four models utilized in the United States in which the neonatologist provides neonatal-cardiac-focused care in a dedicated CICU. We also outline the different permutations of location where neonates can be cared for in dedicated pediatric/infant CICUs.
Individual goal-setting in municipal homecare: A participatory appreciative action and reflection study
Authors: Tavemark Sofia , Kihlgren Annica , Norell Pejner Margaretha , James Inger
Published: June 2023

Background:

There is a need for structural change in municipal homecare to shift power to older persons and to center the individuals in need. To make this change, the individual older persons should have enough self-determination to formulate their own individual homecare goals. Our aim was to explore how stakeholders reason about individual goal-setting in homecare.

Design and methods:

We theoretically and methodologically used a participatory appreciative action and reflection (PAAR) design. The stakeholders, that is, the older persons, the older persons’ relatives, and the multi-professional team, were seen as co-researchers. Data were collected between 2019 and 2020 through in depth-interviews, focus group discussions, and reference groups. The data were analyzed using thematic analysis.

Results:

We learned from the stakeholders that it was a struggle to sustain the individual’s goal to continue life as usual, that is, being an ordinary human being with an ordinary everyday life and maintaining individual roles. The individual wants to improve health, be active, and enjoying life. The individuals were struggling against the homecare organization, which tended to overshadow the individual’s goals. The individual’s goals fall under several legal jurisdictions and come to be overshadowed by the professionals’ dominant goal. The organization is rigid, with finances and resources creating the framework.

Conclusion:

We learned that older persons receiving homecare must have the same rights as other citizens in society, which is in line with public health goals.
Why I Climb Mountains With Students: Using Metaphor as a Teaching Tool
Authors: Buckner-Capone Anji
Published: June 2023

Metaphor is essential to human cognition and central to teaching and learning. In this case study, the author documents the use of metaphor in a senior-level course as a strategy to build community, provide a sense of direction, and unite the class around a shared experience. Students who experienced the metaphor as a teaching tool were invited to share their memories and reflect on the impact ( N = 395). Through content analysis, three themes were identified in the responses: (1) Appreciating the Journey, (2) Building and Supporting a Classroom Community, and (3) Finding Motivation, Purpose, and Willingness to Face the Unknown. Overall, most respondents remembered and valued the metaphor immediately and, in the months, and years following the course. The use of metaphors is recommended in public health teaching and learning.
Using Market-Research Panels for Behavioral Science: An Overview and Tutorial
Authors: Moss Aaron J. , Hauser David J. , Rosenzweig Cheskie , Jaffe Shalom , Robinson Jonathan , Litman Leib
Published: June 2023

Behavioral scientists looking to run online studies are confronted with a bevy of options. Where to recruit participants? Which tools to use for survey creation and study management? How to maintain data quality? In this tutorial, we highlight the unique capabilities of market-research panels and demonstrate how researchers can effectively sample from such panels. Unlike the microtask platforms most academics are familiar with (e.g., MTurk and Prolific), market-research panels have access to more than 100 million potential participants worldwide, provide more representative samples, and excel at demographic targeting. However, efficiently gathering data from online panels requires integration between the panel and a researcher’s survey in ways that are uncommon on microtask sites. For example, panels allow researchers to target participants according to preprofiled demographics (“Level 1” targeting, e.g., parents) and demographics that are not preprofiled but are screened for within the survey (“Level 2” targeting, e.g., parents of autistic children). In this article, we demonstrate how to sample hard-to-reach groups using market-research panels. We also describe several best practices for conducting research using online panels, including setting in-survey quotas to control sample composition and managing data quality. Our aim is to provide researchers with enough information to determine whether market-research panels are right for their research and to outline the necessary considerations for using such panels.
The exposome in respiratory diseases: multiple preventable risk factors from early life to adulthood
Authors: Savouré Marine , Eminson Katie , Sese Lucile , Dumas Orianne , Cai Yutong Samuel
Published: June 2023

The increasing global burden of respiratory diseases over the last decades raises questions about the impact of environmental factors during industrialisation and urbanisation. Although the knowledge of environmental epidemiology is growing, it is still unclear what the most critical exposure windows are for respiratory health. In addition, the relationships between different environmental exposures can be complex. The exposome approach investigating all non-genetic factors on health has been developed in recent years but has been little applied in respiratory health to date. This journal club article reviews three recent publications investigating the effects of environmental exposures, considered separately or in an exposome approach with different exposure windows, on respiratory health outcomes. These three studies highlight targets for action in primary and secondary prevention. Two studies, using data from the INMA and RHINESSA cohorts, support the regulation and reduction of phthalates and air pollution, respectively. Moreover, the exposome approach conducted in the NutriNet-Santé cohort emphasises that risk reduction must involve a multi-interventional approach targeting both specific early-life risk factors and promotion of a healthy lifestyle in adulthood. These three articles also present research perspectives in environmental epidemiology.
RegCloser: a robust regression approach to closing genome gaps
Authors: Cao Shenghao , Li Mengtian , Li Lei M.
Published: June 2023

Background

Closing gaps in draft genomes leads to more complete and continuous genome assemblies. The ubiquitous genomic repeats are challenges to the existing gap-closing methods, based on either the k-mer representation by the de Bruijn graph or the overlap-layout-consensus paradigm. Besides, chimeric reads will cause erroneous k-mers in the former and false overlaps of reads in the latter.

Results

We propose a novel local assembly approach to gap closing, called RegCloser. It represents read coordinates and their overlaps respectively by parameters and observations in a linear regression model. The optimal overlap is searched only in the restricted range consistent with insert sizes. Under this linear regression framework, the local DNA assembly becomes a robust parameter estimation problem. We solved the problem by a customized robust regression procedure that resists the influence of false overlaps by optimizing a convex global Huber loss function. The global optimum is obtained by iteratively solving the sparse system of linear equations. On both simulated and real datasets, RegCloser outperformed other popular methods in accurately resolving the copy number of tandem repeats, and achieved superior completeness and contiguity. Applying RegCloser to a plateau zokor draft genome that had been improved by long reads further increased contig N50 to 3-fold long. We also tested the robust regression approach on layout generation of long reads.

Conclusions

RegCloser is a competitive gap-closing tool. The software is available at https://github.com/csh3/RegCloser. The robust regression approach has a prospect to be incorporated into the layout module of long read assemblers.
GBA1 in Parkinson’s disease: variant detection and pathogenicity scoring matters
Authors: Gabbert Carolin , Schaake Susen , Lüth Theresa , Much Christoph , Klein Christine , Aasly Jan O. , Farrer Matthew J. , Trinh Joanne
Published: June 2023

Background

GBA1 variants are the strongest genetic risk factor for Parkinson’s disease (PD). However, the pathogenicity of GBA1 variants concerning PD is still not fully understood. Additionally, the frequency of GBA1 variants varies widely across populations.

Objectives

To evaluate Oxford Nanopore sequencing as a strategy, to determine the frequency of GBA1 variants in Norwegian PD patients and controls, and to review the current literature on newly identified variants that add to pathogenicity determination.

Methods

We included 462 Norwegian PD patients and 367 healthy controls. We sequenced the full-length GBA1 gene on the Oxford Nanopore GridION as an 8.9 kb amplicon. Six analysis pipelines were compared using two aligners (NGMLR, Minimap2) and three variant callers (BCFtools, Clair3, Pepper-Margin-Deepvariant). Confirmation of GBA1 variants was performed by Sanger sequencing and the pathogenicity of variants was evaluated.

Results

We found 95.8% (115/120) true-positive GBA1 variant calls, while 4.2% (5/120) variant calls were false-positive, with the NGMLR/Minimap2-BCFtools pipeline performing best. In total, 13 rare GBA1 variants were detected: two were predicted to be (likely) pathogenic and eleven were of uncertain significance. The odds of carrying one of the two common GBA1 variants, p.L483P or p.N409S, in PD patients were estimated to be 4.11 times the odds of carrying one of these variants in controls (OR = 4.11 [1.39, 12.12]).

Conclusions

In conclusion, we have demonstrated that Oxford long-read Nanopore sequencing, along with the NGMLR/Minimap2-BCFtools pipeline is an effective tool to investigate GBA1 variants. Further studies on the pathogenicity of GBA1 variants are needed to assess their effect on PD.
Multi-environment evaluations across ecological regions reveal climate and soil effects on amides contents in Chinese prickly ash peels (Zanthoxylum bungeanum Maxim.)
Authors: Zheng Tao , Zeng Hai-tao , Sun Bing-yin , Liu Shu-ming
Published: June 2023

Background

Environmental factors difference is the key factor for the difference in the production, transformation and accumulation of effective components in plants. UPLC-MS/MS and multivariate statistical methods were applied to describe the region difference of amides compounds in Chinese prickly ash peels from different regions and their correlation with climatic factors and soil factors.

Results

Amides compounds contents were significantly higher in high altitude areas, with obvious altitude change trend. Two ecotypes were classified based on the amides compounds contents, one was the high altitude-cool type from Qinghai, Gansu, Sichuan and western Shaanxi province, and the other one was low altitude-warm type from eastern Shaanxi, Shanxi, Henan, Hebei and Shandong province. Amides compounds content were negatively correlated with annual mean temperature, max temperature of warmest month, mean temperature of wettest quarter and mean temperature of warmest quarter (P < 0.01). Except for hydroxy-γ-sanshool and ZP-amide A, the residual amides contents were significantly positively correlated with organic carbon, available nitrogen, phosphorus and potassium in soil and negatively correlated with soil bulk density. Low temperature, low precipitation and high organic carbon in soil were conducive to amides accumulation.

Conclusions

This study aided in site specific exploration of high amides contents yielding samples, enriched the environment factors effects on amides compounds, and provided scientific foundation for the improvement of Chinese prickly ash peels quality and the location of high-quality production areas.
Effect of continuous spinal anesthesia on the hemodynamics of labor analgesia in hypertensive pregnant women: a comparative, randomized clinical trial
Authors: Han Bin , Xu Mingjun
Published: June 2023

Background

To observe the changes in hemodynamic, stress and inflammatory responses during labor and their labor outcomes after continuous spinal anesthesia labor analgesia for hypertensive pregnant women, and to evaluate whether the continuous spinal anesthesia had any advantages compared to continuous epidural analgesia for hypertensive pregnant women and their newborns.

Methods

A total of 160 hypertensive pregnant women were selected and randomly divided into continuous spinal anesthesia analgesia group (CSA group) and continuous epidural analgesia group (EA group). Participant age, height, weight and gestational week were recorded; MAP, VAS score, CO and SVR were recorded after the onset of regular uterine contractions (T0), 10 min after analgesia (T1), 30 min (T2), 60 min (T3), when the uterine opening was complete (T4) and when the fetus was delivered (T5); the duration of the first stage of labor and the second stage of labor were recorded; the number of cases of treatment with oxytocin and antihypertensive therapy, mode of delivery, eclampsia and postpartum hemorrhage were counted; pregnant women Bromage scores were recorded at T2. We also recorded neonatal weight, Apgar scores at 1, 5 and 10 min after birth; arterial blood gas analysis of the umbilical cord was performed in newborns; finally, TNF-α, IL-6, and cortisol in pregnant women venous blood were measured at T0, T5, and 24 h after delivery (T7). The number of successful compressions and the total drug dosage administered by the analgesic pump were recorded for both groups.

Results

The first stage of labor in CSA was longer than EA (P < 0.05); the MAP, VAS and SVR value in CSA were lower than EA group at T1, T3 and T4 (P < 0.05); in contrast, the CO in CSA at T3 and T4 was higher than in EA (P < 0.05). The oxytocin was more often used whereas the antihypertensive drugs were less used in CSA as compared to EA. The level of TNF-α, IL-6, Cor in the CSA at T5 was lower than the EA group (P < 0.05), and the level of TNF-α in the CSA group at T7 was lower than the EA group (P < 0.05).

Conclusion

For pregnant women with hypertension during pregnancy, continuous spinal anesthesia labor analgesia has no significant effect on the final mode of delivery, but shows precise analgesic effect and stabilizes circulatory system, it is recommended to perform continuous spinal anesthesia early in labor for hypertensive pregnant women, which can effectively reduce the stress reaction.

Trial registration

ChiCTR-INR-17012659.

Date of registration: 13/09/2017.
Rationale and design of the Birkebeiner Ageing Study – a prospective cohort study of older endurance athletes
Authors: Myrstad Marius , Johansen Kristoffer Robin , Sørensen Eivind , Ranhoff Anette Hylen
Published: June 2023

Background

While regular physical activity is associated with reduced mortality and morbidity in general populations, health outcomes and functional capacity related to upholding strenuous endurance exercise beyond the age of 65 years are only sparsely studied. The aim of this study is to assess associations of prolonged strenuous endurance sport practice with ageing, functional decline, morbidity and longevity among older recreational endurance athletes, during long-term follow-up.

Methods

Prospective cohort study of older recreational endurance athletes in Norway. All skiers aged 65 years and older who participated in a long-distance endurance competition, the annual 54-km Birkebeiner cross-country ski race in 2009 or 2010, were invited. The participants answered an extensive baseline questionnaire about lifestyle habits, including leisure-time physical activity and endurance sport participation, diseases, medication use and physical and mental health, with follow-up questionnaires planned every fifth year until 2029. New participants may be invited with the aim to increase the study size. Endpoints such as all-cause and disease-specific mortality, incidence and cumulative prevalence of diseases, use of medication, physical and mental health and functional decline will be assessed subsequently.

Out of 658 invited skiers (51 women), 551(84%) completed the baseline questionnaire and were included in the study. The mean age was 68.8 years (median 68, range 65- 90). At baseline, the participants had completed the Birkebeiner race for an average of 16.6 years and reported an average of 33.4 years of regular endurance exercise, with one out of five reporting at least 50 years of exercise. In all, 479 (90%) reported that they were still practicing leisure-time physical activity of moderate or vigorous intensity at least twice weekly. The prevalence of cardiovascular risk factors and diseases was low.

Discussion

This prospective study of a cohort of recreational athletes exposed to prolonged and strenuous endurance exercise, could complement population-based studies by providing data on associations between life-long endurance sport participation, aging, functional decline and health outcomes during long-term follow-up.
Sociodemographic and clinical predictors for COVID-19 preventive measures compliance among pregnant women in Saudi Arabia: a multicenter study
Authors: Ghamri Ranya A. , Ghamri Kholoud A.
Published: June 2023

Objective

To assess the levels of adherence among pregnant women to the basic COVID-19 preventive measures, and to analyze the effect of risk perception and sociodemographic and clinical factors on adherence.

Method

A multicenter, cross-sectional study was conducted at the obstetrics clinics of 50 primary care centers selected using a multistage sampling method. An online-administered, structured questionnaire was used to collect self-reported levels of adherence to four basic preventive measures against COVID-19, along with perceived COVID-19 severity, infectiousness, and harmfulness to the baby, besides sociodemographic and clinical data including obstetrical and other medical history.

Results

A total of 2460 pregnant women were included with a mean (SD) age of 30.21 (6.11) years. Levels of self-reported compliance were highest for hand hygiene (95.7%), followed by social distancing (92.3%), masking (90.0%), and avoidance of contact with a COVID-19 infected person (70.3%). Perceived COVID-19 severity and infectiousness, and harmfulness to the baby were observed in 89.2%, 70.7%, and 85.0% of the participants, respectively, and were variably associated with compliance to preventive measures. Analysis of sociodemographic factors highlighted the significance of education and economic status in determining adherence to preventive measures, which represents a potential inequity in the risk of COVID-19 infection.

Conclusion

This study highlights the importance of patients’ education to enable functional perception of COVID-19 that promotes self-efficacy, besides investigating the specific social determinants of health to tackle inequalities in terms of prevention efficiency and the subsequent health outcomes.
Reducing the number of unnecessary biopsies for mammographic BI-RADS 4 lesions through a deep transfer learning method
Authors: Meng Mingzhu , Li Hong , Zhang Ming , He Guangyuan , Wang Long , Shen Dong
Published: June 2023

Background

In clinical practice, reducing unnecessary biopsies for mammographic BI-RADS 4 lesions is crucial. The objective of this study was to explore the potential value of deep transfer learning (DTL) based on the different fine-tuning strategies for Inception V3 to reduce the number of unnecessary biopsies that residents need to perform for mammographic BI-RADS 4 lesions.

Methods

A total of 1980 patients with breast lesions were included, including 1473 benign lesions (185 women with bilateral breast lesions), and 692 malignant lesions collected and confirmed by clinical pathology or biopsy. The breast mammography images were randomly divided into three subsets, a training set, testing set, and validation set 1, at a ratio of 8:1:1. We constructed a DTL model for the classification of breast lesions based on Inception V3 and attempted to improve its performance with 11 fine-tuning strategies. The mammography images from 362 patients with pathologically confirmed BI-RADS 4 breast lesions were employed as validation set 2. Two images from each lesion were tested, and trials were categorized as correct if the judgement (≥ 1 image) was correct. We used precision (Pr), recall rate (Rc), F1 score (F1), and the area under the receiver operating characteristic curve (AUROC) as the performance metrics of the DTL model with validation set 2.

Results

The S5 model achieved the best fit for the data. The Pr, Rc, F1 and AUROC of S5 were 0.90, 0.90, 0.90, and 0.86, respectively, for Category 4. The proportions of lesions downgraded by S5 were 90.73%, 84.76%, and 80.19% for categories 4 A, 4B, and 4 C, respectively. The overall proportion of BI-RADS 4 lesions downgraded by S5 was 85.91%. There was no significant difference between the classification results of the S5 model and pathological diagnosis (P = 0.110).

Conclusion

The S5 model we proposed here can be used as an effective approach for reducing the number of unnecessary biopsies that residents need to conduct for mammographic BI-RADS 4 lesions and may have other important clinical uses.
Paracentral acute middle maculopathy presenting as a sign of impending central retinal artery occlusion: a case report
Authors: Louie Emily , Tang Anthony , King Benjamin
Published: June 2023

Background

To report a case of paracentral acute middle maculopathy (PAMM) that progressed to central retinal artery occlusion (CRAO) on spectral domain-optical coherence tomography (SD-OCT).

Case Presentation

A 63-year-old male presented with a paracentral scotoma that began several days ago. His past medical history consisted of third-degree atrioventricular heart block requiring a pacemaker. Giant cell arteritis was unlikely given the patient’s labs, demographics and review of systems. SD-OCT revealed a characteristic hyperreflective band in the inner nuclear layer consistent with PAMM in his left eye. Fluorescein angiography was obtained and was unremarkable. Five days later, the patient developed no light perception in the left eye. SD-OCT showed a diffuse inner retinal hyperreflectivity consistent with CRAO.

Conclusion

PAMM can be a harbinger event for complete CRAO. Complete stroke evaluation should be performed to prevent a cerebrovascular event or progression to complete blindness in the involved eye.
The role of parental health beliefs in seeking an eye examination for their child
Authors: Masarwa Dua , Niazov Yulia , Ben Natan Merav , Mostovoy Dina
Published: June 2023

Background

We aimed to explore the role of parental health beliefs in parent seeking of eye examinations for their children, using the Health Belief Model.

Methods

In this quantitative correlational survey study, 100 parents who presented to Barzilai University Medical Center in July 2021 to perform an eye examination to their child completed a questionnaire.

Results

Only 29.6% of the parents knew that a vision screening is performed in first grade, and 10% of the parents were unsure about where to find local eye care for their kids. Moreover, 19% of the parents indicated that they were concerned that their child would be prescribed glasses unnecessarily, and 10% believed that wearing glasses would weaken their child’s eyes. Various parental health beliefs regarding children’s eye examinations were found associated with parent seeking of eye examinations for their child. Thus, perceived susceptibility (r = 0.52, p < 0.01), perceived benefits (r = 0.39, p < 0.01), and perceived barriers (r=-0.31, p < 0.01) are associated with parent seeking of eye examinations for their child. Also, parents’ level of knowledge was associated with seeking eye examinations for their child (r = 0.20, p < 0.01).

Conclusion

Parent perceptions of the child’s susceptibility to vision problems and perceived barriers to seeking eye examinations predicted parents seeking of eye examinations for their child. Interventions aimed at increasing timely eye examinations among children should focus on raising parent awareness of vision problems in childhood, dispelling misconceptions, and providing parents with practical information regarding available services.
Collagen cross-linking as monotherapy in experimentally induced corneal abscess in rabbits
Authors: Saad Zeinab A. , Elnashar Hazem , Negm Sahar , Elsayed Hala A. , Abdallah Mohamed Gaber , Abuamara Tamer M. M. , Abd-Elhay Wagih M. , Elghonemy Hanan M.
Published: June 2023

Background and purpose

Collagen cross-linking (CXL) has evolved as an essential therapeutic approach for corneal infections, allowing for rapidly eliminating the infecting microorganism while reducing inflammation. This study aims to evaluate the efficacy of CXL as a monotherapy for managing infectious keratitis caused by Fusarium solani and Pseudomonas aeruginosa.

Materials and methods

Forty-eight white New Zealand rabbits weighing approximately 1.5–2 KG were included. The cornea of one eye of each rabbit was inoculated with either Fusarium solani or Pseudomonas aeruginosa. Group A served as a control and was subdivided into two subgroups, A1 and A2; each subgroup consisted of 8 eyes and was injected with either Fusarium solani or Pseudomonas aeruginosa, respectively. Group B (16 eyes) was inoculated with Fusarium solani, while group C (16 eyes) were inoculated with Pseudomonas aeruginosa. All animals in Group B and C received CXL treatment one week after inoculation of the organisms and after corneal abscess formation was confirmed. At the same time, animals in Group A were left untreated.

Results

There was a statistically significant reduction in the number of colony-forming units (CFU) in Group B following CXL. No growth existed in any samples at the end of the 4th week. There was a statistically significant difference in the number of CFU between group B and the control group (p < 0.001). In group C, there was a statistically significant reduction in the CFU at the end of the first week after CXL. However, there was regrowth in all samples afterward. All 16 models in Group C showed uncountable and extensive growth during the subsequent follow-ups. There was no statistically significant difference between the number of CFU in Group C and the control group. Histopathology showed lesser corneal melting in CXL-treated Pseudomonas aeruginosa.

Conclusions

Collagen cross-linking is promising monotherapy and alternative treatment in managing infective keratitis caused by Fusarium solani but is less effective in Pseudomonas aeruginosa as monotherapy.
The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project
Authors: D’Avanzo Barbara , Barbato Angelo , Monzio Compagnoni Matteo , Caggiu Giulia , Allevi Liliana , Carle Flavia , Di Fiandra Teresa , Ferrara Lucia , Gaddini Andrea , Sanza Michele , Saponaro Alessio , Scondotto Salvatore , Tozzi Valeria D , Giordani Cristina , Corrao Giovanni , Lora Antonio
Published: June 2023

Background

The assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipolar disorders taken-in-care by mental health services of four Italian areas (Lombardy, Emilia-Romagna, Lazio, province of Palermo).

Methods

Thirty-six quality indicators were implemented to assess quality of mental health care for patients with bipolar disorders, according to three dimensions (accessibility and appropriateness, continuity, and safety). Data were retrieved from healthcare utilization (HCU) databases, which contain data on mental health treatments, hospital admissions, outpatient interventions, laboratory tests and drug prescriptions.

Results

29,242 prevalent and 752 incident cases taken-in-care by regional mental health services with a diagnosis of bipolar disorder in 2015 were identified. Age-standardized treated prevalence rate was 16.2 (per 10,000 adult residents) and treated incidence rate 1.3. In the year of evaluation, 97% of prevalent cases had ≥ 1 outpatient/day-care contacts and 88% had ≥ 1 psychiatric visits. The median of outpatient/day-care contacts was 9.3 interventions per-year. Psychoeducation was provided to 3.5% of patients and psychotherapy to 11.5%, with low intensity. 63% prevalent cases were treated with antipsychotics, 71.5% with mood stabilizers, 46.6% with antidepressants. Appropriate laboratory tests were conducted in less than one-third of prevalent patients with a prescription of antipsychotics; three quarters of those with a prescription of lithium. Lower proportions were observed for incident patients. In prevalent patients, the Standardized Mortality Ratio was 1.35 (95% CI: 1.26–1.44): 1.18 (1.07–1.29) in females, 1.60 (1.45–1.77) in males. Heterogeneity across areas was considerable in both cohorts.

Conclusions

We found a meaningful treatment gap in bipolar disorders in Italian mental health services, suggesting that the fact they are entirely community-based does not assure sufficient coverage by itself. Continuity of contacts was sufficient, but intensity of care was low, suggesting the risk of suboptimal treatment and low effectiveness. Care pathways were monitored and evaluated using administrative healthcare databases, adding evidence that such data may contribute to assess the quality of clinical pathways in mental health.
Exploration of the food environment in different socioeconomic areas in Hong Kong and Singapore: a cross-sectional case study
Authors: Ho Ivan , Chng Tricia , Kleve Sue , Choi Tammie , Brimblecombe Julie
Published: June 2023

This study explored the local food environment of Hong Kong and Singapore using a qualitative case study approach to inform future upstream public health nutrition policies. Food outlets that provide food to be eaten in the home were mapped in selected areas of high and low socioeconomic status (SES) of Hong Kong and Singapore. Food outlet density relative to land area was determined. In both countries, lower SES areas surveyed were shown to have higher food outlet density while higher SES areas had fewer but larger food outlets. In Hong Kong, both SES areas reported similar proportions of healthy and unhealthy food outlets.

This study highlights the accessibility of food outlet types through their geographical location and density. Future research assessing the differences in eating culture between these two countries should be considered alongside this study’s findings, to investigate strategies influencing the food environment in order to promote healthier eating habits.
Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study
Authors: Khosropour Christine M. , Riley Taylor , Healy Elise , Backus Kandis V. , Gomillia Courtney E. , Mena Leandro , Lockwood Khadijra R. , Gordon Felicia M. , Means Arianna R. , Ward Lori M.
Published: June 2023

Introduction

Mississippi has one of the highest rates of HIV in the United States but low PrEP uptake. Understanding patterns of PrEP use can improve PrEP initiation and persistence.

Methods

This is a mixed-method evaluation of a PrEP program in Jackson, Mississippi. Between November 2018-December 2019, clients at high risk for HIV attending a non-clinical testing site were referred to a pharmacist for same-day PrEP initiation. The pharmacist provided a 90-day PrEP prescription and scheduled a follow-up clinical appointment within three months. We linked client records from this visit to electronic health records from the two largest PrEP clinics in Jackson to determine linkage into ongoing clinical care. We identified four distinct PrEP use patterns, which we used for qualitative interview sampling: 1) filled a prescription and linked into care within three months; 2) filled a prescription and linked into care after three months; 3) filled a prescription and never linked into care; and 4) never filled a prescription. In 2021, we purposively sampled patients in these four groups for individual interviews to ascertain barriers and facilitators to PrEP initiation and persistence, using guides informed by the Theory of Planned Behavior.

Results

There were 121 clients evaluated for PrEP; all were given a prescription. One-third were less than 25 years old, 77% were Black, and 59% were cisgender men who have sex with men. One-quarter (26%) never filled their PrEP prescription, 44% picked up the prescription but never linked into clinical care, 12% linked into care at some point after three months (resulting in a gap in PrEP coverage), and 18% linked into care within 3 months. We interviewed 26 of 121 clients. Qualitative data revealed that cost, stigmas related to sexuality and HIV, misinformation about PrEP, and perceived side effects were barriers to uptake and persistence. Individuals’ desire to stay healthy and the support of PrEP clinic staff were facilitators.

Conclusions

The majority of individuals given a same-day PrEP prescription either never started PrEP or stopped PrEP within the first three months. Addressing noted barriers of stigma and misinformation and reducing structural barriers may increase PrEP initiation and persistence.
Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice
Authors: Bahns Carolin , Kopkow Christian
Published: June 2023

Background

Osteoarthritis (OA) of the hip and the knee is common and leads to pain, stiffness and disability. Clinical practice guidelines (CPG) provide recommendations to assist healthcare professionals in clinical decision-making. Although evidence-based physiotherapy has been shown to be effective in the management OA, a gap between clinical practice and guideline recommendations exists. Little is known about OA management provided by physiotherapists in Germany and whether treatment aligns with CPGs. The objectives of this study were (1) to investigate the current physiotherapy practice in patients with hip and/or knee OA in Germany, (2) to evaluate physiotherapists’ adherence to guideline recommendations and (3) to explore barriers and facilitators to guideline use.

Methods

A cross-sectional online survey was conducted among physiotherapists. The questionnaire collected information on demographic characteristics, physiotherapists’ management of hip and knee OA and the use of CPGs in clinical practice. Guideline adherence was evaluated by comparing the survey findings with guideline recommendations. Full adherence was assumed if all recommended treatment options were chosen.

Results

In total, 447 (74.9%) of 597 eligible physiotherapists completed the survey. Data from 442 participants (mean age 41.2 ± 12.8 years; 288 female (65.1%)) were included in the analysis. The most common treatment choices for both hip and knee OA were exercise therapy (hip OA: 424/442, 95.9%; knee OA: 426/442, 96.4%), self-management advice (hip OA: 413/442, 93.2%; knee OA: 395/442, 89.4%) and education (hip OA: 325/442, 73.5%; knee OA: 331/442, 74.9%), followed by manual therapy (hip OA: 311/442, 70.4%; knee OA: 311/442, 70.4%) and joint traction (hip OA: 208/442, 47.1%; knee OA: 199/442, 45.0%). Full guideline adherence was found in 17.2% (76/442) of physiotherapists for hip OA management and in 8.6% (38/442) for knee OA. Less than half of the respondents (212/430, 49.3%) were aware of an OA guideline.

Conclusions

In accordance with current guideline recommendations, most physiotherapists provide exercise therapy and education for patients with hip and/or knee OA. Interventions with low or conflicting evidence were also frequently provided. The limited awareness of existing OA guidelines and the low guideline adherence indicate an insufficient implementation of CPGs in German physiotherapy practice.

Trial registration

German Clinical Trials Register (DRKS00026702). Registered 14 October 2021.
Comparison of the plantar pressure distribution and mechanical alignment in patients with varus knee osteoarthritis following high tibial osteotomy
Authors: Li Ke , Sun Feng-Long , Guo Heng-Bing , Shi Zhan-Jun , Yao Ran , Zhang Hao
Published: June 2023

Purpose

The changes in the lower limb alignment were vitally important after high tibial osteotomy (HTO). Therefore, the purpose of present study was to analyze the characteristics of plantar pressure distribution after HTO, and to investigate the effect of plantar pressure distribution on postoperative limb alignment.

Methods

Between May 2020 and April 2021, varus knee patients undergoing HTO were evaluated in the present study. The peak pressure of plantar regions, medial-lateral pressure ratio (MLPR), foot progression angle (FTA), anteroposterior COP (AP-COP), lateral symmetry of COP (LS-COP), and the radiographic parameters were evaluated preoperatively and at the final follow-up. Compared among the slight valgus (SV), moderate valgus (MV) and large valgus (LV) groups at the final follow-up, the peak pressure of HM, HC and M5 regions, and the MLPR were compared; the Knee Injury and Osteoarthritis Outcome Score4 (KOOS4) including four subscales, and the American of orthopedic foot and ankle society (AOFAS) were evaluated.

Results

The WBL%, HKA and TPI angle changed significantly after HTO (P < 0.001). The preoperative group exhibited a lower peak pressure in the HM region (P < 0.05) and higher peak pressure in the M5 region (P < 0.05); the pre- and postoperative groups exhibited a lower peak pressure in the HC region (P < 0.05); the rearfoot MLPR was significantly lower and LS-COP was significantly higher in the preoperative group (P = 0.017 in MLPR and 0.031 in LS-COP, respectively). Comparison among the SV, MV and LV groups, the SV group indicated a lower peak pressure in the HM region (P = 0.036), and a lower MLPR in the rearfoot (P = 0.033). The KOOS Sport/Re score in the MV and LV groups increased significantly compared with the SV group (P = 0.042).

Conclusion

Plantar pressure distribution during the stance phase in patients with varus knee OA following HTO exhibited a more medialized rearfoot plantar pressure distribution pattern than that before surgery. Compared with the small valgus alignment, a moderate to large valgus alignment allows patients to walk with a more even medial and lateral plantar pressure distribution, which is more similar to healthy adults.
Biopsychosocial, work-related, and environmental factors affecting work participation in people with Osteoarthritis: a systematic review
Authors: Ching Angela , Prior Yeliz , Parker Jennifer , Hammond Alison
Published: June 2023

Purpose

Osteoarthritis (OA) causes pain and disability, with onset often during working age. Joint pain is associated with functional difficulties and may lead to work instability. The aims of this systematic review are to identify: the impact of OA on work participation; and biopsychosocial and work-related factors associated with absenteeism, presenteeism, work transitions, work impairment, work accommodations, and premature work loss.

Methods

Four databases were searched, including Medline. The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with narrative synthesis to pool findings due to heterogeneity of study designs and work outcomes.

Results

Nineteen studies met quality criteria (eight cohort; 11 cross-sectional): nine included OA of any joint(s), five knee-only, four knee and/or hip, and one knee, hip, and hand OA. All were conducted in high income countries. Absenteeism due to OA was low. Presenteeism rates were four times greater than absenteeism. Performing physically intensive work was associated with absenteeism, presenteeism, and premature work loss due to OA. Moderate-to-severe joint pain and pain interference were associated with presenteeism, work transition, and premature work loss. A smaller number of studies found that comorbidities were associated with absenteeism and work transitions. Two studies reported low co-worker support was associated with work transitions and premature work loss.

Conclusions

Physically intensive work, moderate-to-severe joint pain, co-morbidities, and low co-worker support potentially affects work participation in OA. Further research, using longitudinal study designs and examining the links between OA and biopsychosocial factors e.g., workplace accommodations, is needed to identify targets for interventions.

Systematic review registration

PROSPERO 2019 CRD42019133343.
Comparison of clinical outcomes of arthroscopic rotator cuff repair utilizing suture-bridge procedures with or without medial knots: a meta-analysis
Authors: Huang Qiu , Li Xiaoyu , Zhang Ye , Jian Changchun , Mou Hai , Ou Yunsheng
Published: June 2023

Purpose

This investigation aimed to compare the medical efficacy of the knotted and knotless suture-bridge procedures in rotator cuff repair.

Methods

The Pubmed, Embase, and Cochrane Library datasets were searched for all available publications comparing the medical results of arthroscopic rotator cuff repairs utilizing knotted or knotless suture-bridge procedures. Two researchers utilized Newcastle-Ottawa Scale and Cochrane risk-of-bias tool to evaluate the included studies. Employing Revman 5.3 software, meta-analysis was conducted following the PRISMA reporting guideline.

Results

Eleven investigations with 1083 patients were considered suitable for the final meta-analysis. 522 individuals were assigned to the knotted group, whereas 561 were assigned to the knotless group. No statistical difference was found between the knotted and knotless groups, regarding VAS score (WMD, 0.17; 95% CI, − 0.10 to 0.44; P = 0.21); Constant score (WMD, -1.50; 95% CI, − 3.52 to 0.52; P = 0.14); American Shoulder and Elbow Surgeons Shoulder (WMD, -2.02; 95% CI, − 4.53 to 0.49; P = 0.11); University of California Los Angeles score (WMD, -0.13; 95% CI, − 0.89 to 0.63; P = 0.73); ROM of flexion (WMD, 1.57; 95% CI, − 2.11 to 5.60; P = 0.37), abduction (WMD, 1.08; 95% CI, − 4.53 to 6.70; P = 0.71) and external rotation (WMD, 1.90; 95% CI, − 1.36 to 5.16; P = 0.25); re-tear rate (OR, 0.74; 95% CI, 0.50 to 1.08; P = 0.12), and medical complications (OR, 0.90; 95% CI, 0.37 to 2.20; P = 0.82).

Conclusion

For arthroscopic rotator cuff repairs, there were no statistical differences in medical results among knotted and knotless suture-bridge procedures. Overall, both techniques showed excellent clinical outcomes and could be safely utilized to treat rotator cuff injuries.
Therapeutic strategy for acute appendicitis based on laparoscopic surgery
Authors: Shiihara Masahiro , Sudo Yasuhiro , Matsushita Norimasa , Kubota Takeshi , Hibi Yasuhiro , Osugi Harushi , Inoue Tatsuo
Published: June 2023

Purpose

The treatment strategies for acute appendicitis differ depending on the facility, and various studies have investigated the usefulness of conservative treatment with antibiotics, laparoscopic surgery, and interval appendectomy (IA). However, although laparoscopic surgery is widely used, the clinical strategy for acute appendicitis, especially complicated cases, remains controversial. We assessed a laparoscopic surgery-based treatment strategy for all patients diagnosed with appendicitis, including those with complicated appendicitis (CA).

Methods

We retrospectively analysed patients with acute appendicitis treated in our institution between January 2013 and December 2021. Patients were classified into uncomplicated appendicitis (UA) and CA groups based on computed tomography (CT) findings on the first visit, and the treatment course was subsequently compared.

Results

Of 305 participants, 218 were diagnosed with UA and 87 with CA, with surgery performed in 159 cases. Laparoscopic surgery was attempted in 153 cases and had a completion rate of 94.8% (145/153). All open laparotomy transition cases (n = 8) were emergency CA surgery cases. No significant differences were found in the incidence of postoperative complications in successful emergency laparoscopic surgeries. In univariate and multivariate analyses for the conversion to open laparotomy in CA, only the number of days from onset to surgery ≥ 6 days was an independent risk factor (odds ratio: 11.80; P < 0.01).

Conclusion

Laparoscopic surgery is preferred in all appendicitis cases, including CA. Since laparoscopic surgery is difficult for CA when several days from the onset have passed, it is necessary that surgeons make an early decision on whether to operate.