bluuebunny/crossref_metadata_2025 huggingface dataset:
Infrastructuring drip irrigation: The gendered assembly of farmers, laborers and state subsidy programs
Authors: Birkenholtz Trevor
Published: May 2022

This paper examines the relationship between the diffusion of drip irrigation technology, state subsidy programs to encourage its adoption by farmers, and gendered labor dynamics. Drip irrigation is promoted globally as a water conserving agricultural innovation that enhances water-use and productive efficiency by increasing yields with less water, while freeing up “saved” water for other uses. India leads the world in its rate of expansion and in total area. Relying on analyses of government drip irrigation policies and ethnographic field research conducted between 2015 and 2020 in the Indian state of Rajasthan, I find the successful diffusion of drip irrigation is dependent upon state subsidies, farmer adoption decisions and the availability of female labor. I engage conceptual work on water conservation technologies, and from feminist political ecology and infrastructure studies to argue: (1) the diffusion of drip irrigation is better understood as a gendered process of infrastructuring; which (2) is an ongoing process of the assembly of state subsidies, the aggregation of decentralized individual farmer adoption decisions, and the availability of on-demand, underpaid female labor; where (3) female laborers provide a “feminine labor subsidy” that produces productive efficiency gains and lends drip irrigation infrastructure its durability. Conceptualizing drip irrigation as a gendered process of infrastructuring, renders visible its emergent and gendered material politics. The conclusion discusses prospects for reassembling drip irrigation infrastructure in more materially just ways and its implications for the political ecology of water infrastructure.
Temporomandibular disorder and headache prevalence: A systematic review and meta-analysis
Authors: Yakkaphan Pankaew , Smith Jared G , Chana Pav , Renton Tara , Lambru Giorgio
Published: May 2022

Background:

Temporomandibular disorders (TMD) and headaches are prevalent among the global population. Patients often suffer from both conditions, and they are likely to be associated in a bidirectional way. However, the nature of the association remains unclear. Understanding the epidemiological aspects of the relationship between these conditions could have important clinical implications.

Objective:

To evaluate the prevalence of headaches in TMD patients as well as the prevalence of TMD in patients who suffer from headaches.

Method:

A systematic literature search was conducted using electronic databases. Studies published in English and those that used an acknowledged diagnostic criteria for TMD and headaches were included. Study quality was assessed using the Newcastle-Ottawa scale and meta-analyses were performed to generate pooled prevalence estimates.

Result:

Thirty-one studies met the selection criteria for the review; 16 studies evaluated the prevalence of headache in TMD patients and 15 studies evaluated the prevalence of TMD in headache patients. The included studies were of moderate-to-high quality. Meta-analyses revealed moderate-to-large heterogeneities across included studies. Pooled prevalence estimates from meta-analyses indicated similar rates of headaches in TMD patients and of TMD in headache patients (61.58%, 95% CI 45.26–76.66 and 59.42%, 95% CI 51.93–66.60, respectively). Migraines were more commonly observed in TMD patients (40.25%, 95% CI 35.37–45.23) compared to tension-type headaches (18.89%, 95% CI 12.36–26.44). The prevalence of headaches was particularly high in painful-TMD (82.80%, 95% CI 75.41–89.10).

Conclusion:

Despite large variance in prevalence rates across included studies, this review suggests headache and TMD frequently co-occur, particularly in the case of migraines and muscle related TMD. This association has important clinical, pathophysiological and therapeutic implications.
Disc–fovea distance and choroidal thickness: is there a relationship?
Authors: Cevher Selim , Barış Üçer Mehmet , Şahin Tayfun
Published: May 2022

Background:

The distance between the optic disc center and the fovea is a biometric parameter; however, it is unclear whether DFD (disc–fovea distance) affects the choroidal thickness.

Objective:

The aim of this study is to investigate the association between DFD and choroidal thickness.

Design:

This is a prospective, and cross-sectional study.

Methods:

Two hundred fifty eyes of 250 healthy participants were examined in terms of DFD, age, axial length, spherical equivalent, and choroidal thickness. Inclusion criteria included aged between 20–40 years, no posterior segment disorders, and participants with best-corrected visual acuity (10/10 according to Snellen’s chart). Participants with high hypermetropia (>4 diopter) or myopia (>6 diopter) or any systemic disease likely to affect choroidal thickness were excluded. Choroidal thickness measurements were performed at subfoveal, 1.0 mm temporal, and 1.0 mm nasal using the enhanced-depth imaging optical coherence tomography.

Results:

The mean age of all the participants was 26.21 ± 5.73 years, mean DFD was 4634.29 ± 274.70 µm, mean axial length was 23.62 ± 0.83 mm, and mean spherical equivalent was −0.61 ± 1.06 diopter. The mean subfoveal, nasal, and temporal choroidal thicknesses were 388.73 ± 90.15 µm, 351.26 ± 88.09 µm, and 366.50 ± 79.56 µm, respectively. A negative correlation was found between subfoveal, nasal, and temporal choroidal thicknesses and axial length ( r = −0.157, p = 0.013; r = −0.168, p = 0.008; r = −0.174, p = 0.006, respectively). Insignificant correlation was found between choroidal thicknesses and spherical equivalent ( p > 0.05). There was not a statistically significant correlation between DFD and subfoveal, nasal, and temporal choroidal thicknesses ( r = −0.028, p = 0.655; r = 0.030, p = 0.641; r = −0.025, p = 0.699, respectively). In addition, there was not a statistically significant correlation between age and choroidal thickness.

Conclusion:

This study shows that DFD and spherical equivalent do not affect choroidal thickness; axial length negatively affects choroidal thickness. In addition, age does not affect choroidal thickness between 20 and 40 years.
A case report a delayed diagnosis of tracheomalacia resulting in prolonged steroid therapy, repeated hospital admissions and CT scans
Authors: Hardy Chris , Clark Gwynedd
Published: May 2022

A 30-year-old patient was admitted with shortness of breath and cough. Previous electronic entries state a history of asthma and hay fever. Repeated clerking by junior doctor states admission for treatment of likely exacerbation of asthma. The patient failed to fully improve with repeated courses of oral corticosteroids, regular nebulisers and oral antibiotics. The patient failed to improve even after several repeated admissions for similar admissions. On each admission she was subjected to CT scan and steroid courses, and at one point even had the authenticity of her symptoms questioned. Eventually she was found to have a case of tracheomalacia. Unfortunately, despite the eventual diagnosis, the patient has suffered side effects due to the delayed diagnosis and repeated treatment courses.
Unresolved Cases of Homicide: A Solvability Comparison of Two Time-Based Definitions by Victim, Event and Investigating Agency Characteristics
Authors: Rogers David , Unnithan N. Prabha
Published: May 2022

We review the literature on the general solvability of homicides to learn if characteristics pertaining to the victim, the event and the investigating agency may help predict which unresolved or ‘cold’ cases are likely to be ultimately resolved. We utilize two definitions of when a case becomes ‘cold,’ the conventional or Traditional (unresolved after a year) and the Alternate (unresolved after 30 days). We use binomial logistic regression (BLR) to analyse data collected from the National Incident-Based Reporting System (NIBRS) and the Law Enforcement Management System. Several factors (e.g., child victim, location of residence of victim, location where body was found, region of agency, type of investigating agency, agency salary level and educational requirements) are suggestive and need to be examined further.
Responsive Regulation and Tax Investigations: The Tax Investigation Diamond Model Assumptions
Authors: Marques João Araújo , Tavares Ana Helena
Published: May 2022

This is an exploratory study to analyse whether the Tax Investigation Diamond (TID) model is a necessary and useful tool for tax investigations. The TID meant to have a special role within tax compliance as an alternative strategy mechanism to maximise the likelihood of restoration by the offender. Through an analysis of interviews of Portuguese Tax Inspectors, we show that in tax investigations it is not always desirable to fulfil all steps of escalation. This study provides data that indicates that TID can be an innovative strategy for adapting responsive regulation strategies to tax investigations, based on the tax inspector’s perception of the taxpayer’s motivational posture and the way in which power actions are used according to these motivational postures.
The First Case of Coxiella Burnetti Infection Detected Through Bone Marrow Biopsy in Vietnam
Authors: Thi Vinh An Do , Thi Viet Ha Bui , Xuan Co Dao , Minh Tam Vu , Thi Diem Tuyet Le , Van Truong Vu
Published: May 2022

Coxiella burnetii is an obligate intracellular bacterium that causes the zoonotic infectious disease, Q fever. The common clinical presentation is fever, hepatitis, and pneumonia; laboratory examination could reveal pancytopenia, elevated liver enzymes. In bone marrow, many fibrin ring granulomas, also known as “Doughnut” granulomas can be seen and suggest the diagnosis of Q fever. However, these bone marrow granulomas can also be presented in infectious diseases by other pathogens such as EBV, CMV, and HBV; therefore, other serology or PCR—based tests are needed to confirm the diagnosis of Q fever. We report the first case of acute Q fever in Vietnam, presented as a fever of unknown origin with hepatitis in a 53-year-old male patient. A bone marrow biopsy was performed and showed various fibrin ring granulomas; therefore, Coxiella was suspected and the diagnosis was confirmed by PCR. Some infectious diseases can cause specific changes in the bone marrow, such as Doughnut granulomas in Q fever. These features can help direct the diagnosis and decide earlier treatment for the patient.
Gender Microaggressions: An Examination of Existing Research on the Experiences of Female Band Directors
Authors: Shouldice Heather Nelson
Published: May 2022

Women continue to be statistical minorities in the field of secondary band teaching, and past researchers have described the unique challenges and struggles of female band directors. Many of these experiences can be uniquely understood through the lens of gender microaggressions. In this literature review, I provide an overview of the various types of gender microaggressions with corresponding examples documented in existing research on the experiences of female band directors. Based on this analysis, I suggest gender microaggressions are an issue in the field of secondary band teaching and conclude by discussing possible ways to combat gender microaggressions and make the secondary band profession more equitable for women.
“Unlearning and Relearning”: Adolescent Students’ Perspectives on Transitioning to a New Teacher and Environment
Authors: Mio Vanessa , Brenner Brenda
Published: May 2022

Throughout the learning process, it is common for students to transition to a new teacher, whether they relocate, decide to change teachers, or study at a summer program. During this transition, students must adapt to a potentially different pedagogical philosophy, language, and performance expectations. Using a multiple case study research design, we explored the perceptions of four adolescent violin students who experienced this transitional process while studying with Mimi Zweig at the four-week Indiana University Summer String Academy. We analyzed the interview data, observations, and external data sources through the lens of attribution theory. Results indicated that the participants not only acquired greater self-efficacy and motivation after studying with a new teacher but also endured performance anxiety. These findings inform studio instrumental instructors of the challenges students experience when studying with a new teacher and the physiological and emotional challenges that often accompany change.
Transcriptome and metabolome reveal the accumulation of secondary metabolites in different varieties of Cinnamomum longepaniculatum
Authors: Zhao Xin , Yan Yue , Zhou Wan-hai , Feng Rui-zhang , Shuai Yong-kang , Yang Li , Liu Meng-jie , He Xiu-yan , Wei Qin
Published: May 2022

Background

Cinnamomum longepaniculatum (Gamble) N. Chao ex H. W. Li, whose leaves produce essential oils, is a traditional Chinese medicine and economically important tree species. In our study, two C. longepaniculatum varieties that have significantly different essential oil contents and leaf phenotypes were selected as the materials to investigate secondary metabolism.

Result

The essential oil content and leaf phenotypes were different between the two varieties. When the results of both transcriptome and metabolomic analyses were combined, it was found that the differences were related to phenylalanine metabolic pathways, particularly the metabolism of flavonoids and terpenoids. The transcriptome results based on KEGG pathway enrichment analysis showed that pathways involving phenylpropanoids, tryptophan biosynthesis and terpenoids significantly differed between the two varieties; 11 DEGs (2 upregulated and 9 downregulated) were associated with the biosynthesis of other secondary metabolites, and 12 DEGs (2 upregulated and 10 downregulated) were related to the metabolism of terpenoids and polyketides. Through further analysis of the leaves, we detected 196 metabolites in C. longepaniculatum. The abundance of 49 (26 downregulated and 23 upregulated) metabolites differed between the two varieties, which is likely related to the differences in the accumulation of these metabolites. We identified 12 flavonoids, 8 terpenoids and 8 alkaloids and identified 4 kinds of PMFs from the leaves of C. longepaniculatum.

Conclusions

The combined results of transcriptome and metabolomic analyses revealed a strong correlation between metabolite contents and gene expression. We speculate that light leads to differences in the secondary metabolism and phenotypes of leaves of different varieties of C. longepaniculatum. This research provides data for secondary metabolite studies and lays a solid foundation for breeding ideal C. longepaniculatum plants.
How accurate are geriatricians’ fall predictions?
Authors: Wilbur Jason , Jogerst Gerald , Butler Nicholas , Xu Yinghui
Published: May 2022

Background

Older patients are at increased risk of falling and of serious morbidity and mortality resulting from falls. The ability to accurately identify older patients at increased fall risk affords the opportunity to implement interventions to reduce morbidity and mortality. Geriatricians are trained to assess older patients for fall risk. If geriatricians can accurately predict fallers (as opposed to evaluating for individual risk factors for falling), more aggressive and earlier interventions could be employed to reduce falls in older adult fallers. However, there is paucity of knowledge regarding the accuracy of geriatrician fall risk predictions. This study aims to determine the accuracy of geriatricians in predicting falls.

Methods

Between October 2018 and November 2019, a convenience sample of 100 subjects was recruited from an academic geriatric clinic population seeking routine medical care. Subjects performed a series of gait and balance assessments, answered the Stay Independent Brochure and were surveyed about fall incidence 6–12 months after study entry. Five geriatricians, blinded to subjects and fall outcomes, were provided the subjects’ data and asked to categorize each as a faller or non-faller. No requirements were imposed on the geriatricians’ use of the available data. These predictions were compared to predictions of an examining geriatrician who performed the assessments and to fall outcomes reported by subjects.

Results

Kappa values for the 5 geriatricians who used all the available data to classify participants as fallers or non-fallers compared with the examining geriatrician were 0.42 to 0.59, indicating moderate agreement. Compared to screening tools’ mean accuracy of 66.6% (59.6–73.0%), the 5 geriatricians had a mean accuracy for fall prediction of 67.4% (57.3–71.9%).

Conclusions

This study adds to the scant knowledge available in the medical literature regarding the abilities of geriatricians to accurately predict falls in older patients. Studies are needed to characterize how geriatrician assessments of fall risk compare to standardized assessment tools.
Adverse effects following COVID-19 vaccination in Iran
Authors: Babaee Ebrahim , Amirkafi Ali , Tehrani-Banihashemi Arash , SoleimanvandiAzar Neda , Eshrati Babak , Rampisheh Zahra , Asadi-Aliabadi Mehran , Nojomi Marzieh
Published: May 2022

Background

Vaccination is a key intervention to prevent COVID-19. Many vaccines are administered globally, yet there is not much evidence regarding their safety and adverse effects. Iran also faces this challenge, especially as data regarding the Sputnik V vaccine is sparse. Therefore, the aim of this study is to determine the adverse effects of the most commonly used vaccines in Iran.

Methods

Using a retrospective cohort study design, 6600 subjects aged 18 years or older who had received two doses of any of the three COVID-19 vaccines (Sinopharm, AstraZeneca, and Sputnik V) were selected using a random sampling method between March and August 2021. Subjects were asked about any adverse effects of the vaccines by trained interviewers via telephone interview. Vaccine-related adverse effects in individuals during the first 72 h and subsequently following both doses of the vaccines were determined. The demographic variables, type of administered vaccine, adverse effects, and history of the previous infection with COVID-19 were collected. Descriptive statistics (mean, standard deviation) and analytical statistics (Chi-squared and Wilcoxon tests) were performed at a 95% significance level using STATA software version 15 (STATA Corp, College Station, TX, USA).

Results

From 6600 participants, 4775 responded (response rate = 72.3%). Of the participants, 1460 (30.6%) received the AstraZeneca vaccine, 1564 (32.8%) received the Sinopharm vaccine and 1751 (36.7%) received the Sputnik V vaccine. 2653 participants (55.56%) reported adverse effects after the first dose and 1704 (35.7%) after the second dose. Sputnik V caused the most adverse effects with 1449 (82.7%) vaccine recipients reporting symptoms after the first or second dose, compared with 1030 (70.5%) for AstraZeneca and only 585 (37.4%) for the Sinopharm vaccine. The most common adverse effects after the first dose were fatigue (28.37%), chill/fever (26.86%), and skeletal pain (22.38%). These three adverse effects were the same for the second dose, although their prevalence was lower.

Conclusions

In this study, we demonstrate that the Sputnik V vaccine has the highest rate of adverse effects, followed by the AstraZeneca and Sinopharm vaccines. COVID-19 vaccines used in Iran are safe and there were no reports of serious adverse effects.
Severe disease exacerbation after mRNA COVID-19 vaccination unmasks suspected multiple sclerosis as neuromyelitis optica spectrum disorder: a case report
Authors: Lohmann Lisa , Glaser Felix , Möddel Gabriel , Lünemann Jan D. , Wiendl Heinz , Klotz Luisa
Published: May 2022

Background

Since the beginning of the COVID-19 pandemic and development of new vaccines, the issue of post-vaccination exacerbation or manifestation of demyelinating central nervous system (CNS) disorders has gained increasing attention.

Case presentation

We present a case of a 68-year-old woman previously diagnosed with multiple sclerosis (MS) since the 1980s who suffered a rapidly progressive severe sensorimotor paraparesis with loss of bladder and bowel control due to an acute longitudinal extensive transverse myelitis (LETM) after immunization with the mRNA Pfizer–BioNTech COVID-19 vaccine. Detection of Aquaporin-4-antibodies (AQP4) in both serum and CSF led to diagnosis of AQP4-antibody positive neuromyelitis optica spectrum disorder (NMOSD). Treatment with intravenous corticosteroids and plasmapheresis led to a slight improvement of the patient’s symptoms.

Conclusions

Pathogenic mechanisms of post-vaccination occurrence of NMOSD are still unknown. However, cases like this should make aware of rare neurological disorders manifesting after vaccination and potentially contribute to improvement of management of vaccinating patients with inflammatory CNS disorders in the future. So far two cases of AQP4-antibody positive NMOSD have been reported in association with viral vector COVID-19 vaccines. To our knowledge, we report the first case of AQP4-antibody positive NMOSD after immunization with an mRNA COVID-19-vaccine.
The impact of antenatal massage practice on intrapartum massage application and their associations with the use of analgesics during labour
Authors: Lai Chit Ying , Wong Margaret Kit Wah , Tong Wing Hung , Lau Kam Yan , Chu Suk Yin , Tam Agnes Mei Lee , Hui Lai Ling , Lao Terence T. H. , Leung Tak Yeung
Published: May 2022

Background

Massage during labour is one form of intrapartum non-pharmacological pain relief but it is not known whether the frequency of practicing these massage techniques among couples during the antenatal period could enhance the effectiveness of intrapartum massage. This study was to evaluate the association between compliance of antenatal massage practice with intrapartum application and their impact on the use of analgesics during labour.

Methods

This was a sub-analysis of a childbirth massage programme which was carried out in two public hospitals with total births of around 8000 per year. Data from women who were randomized to the massage group were further analysed. After attending the pre-birth training class on massage at 36 weeks gestation, couples would be encouraged to practice at home. Their compliance with massage at home was classified as good if they had practiced for at least 15 minutes for three or more days in a week, or as poor if the three-day threshold had not been reached. Application of intrapartum massage was quantified by the duration of practice divided by the total duration of the first stage of labour. Women’s application of intrapartum massage were then divided into above and below median levels according to percentage of practice. Logistic regression was used to assess the use of epidural analgesia or pethidine, adjusted for duration of labour and gestational age when attending the massage class.

Results

Among the 212 women included, 103 women (48.6%) achieved good home massage compliance. No significant difference in the maternal characteristics or birth outcomes was observed between the good and poor compliance groups. The intrapartum massage application (median 21.1%) was inversely associated with duration of first stage of labour and positively associated with better home massage practice compliance (p = 0.04). Lower use of pethidine or epidural analgesia (OR 0.33 95% CI 0.12, 0.90) was associated with above median intrapartum massage application but not antenatal massage compliance, adjusted for duration of first stage of labour.

Conclusions

More frequent practice of massage techniques among couples during antenatal period could enhance the intrapartum massage application, which may reduce the use of pethidine and epidural analgesia.

Trial registration

(CCRBCTR) Unique Trial Number CUHK_ CCRB00525.
Pioglitazone and breast cancer risk in female patients with type 2 diabetes mellitus: a retrospective cohort analysis
Authors: Tseng Chin-Hsiao
Published: May 2022

Background

Whether pioglitazone may affect breast cancer risk in female diabetes patients is not conclusive and has not been investigated in the Asian populations.

Methods

The reimbursement database of Taiwan’s National Health Insurance was used to enroll an unmatched cohort and a propensity score-matched cohort of ever users and never users of pioglitazone in female patients with newly diagnosed type 2 diabetes during 1999–2008. The patients were alive on January 1, 2009 and were followed up for breast cancer incidence until December 31, 2011. Cox regression was used to estimate hazard ratios for ever users and tertiles of cumulative duration of pioglitazone therapy versus never users, and for cumulative duration of pioglitazone therapy treated as a continuous variable. Three models were created for the unmatched cohort and the matched cohort, respectively: 1) without adjustment for covariates; 2) after adjustment for covariates that differed with statistical significance (P-value < 0.05) between ever users and never users; and 3) after adjustment for all covariates.

Results

There were 174,233 never users and 6926 ever users in the unmatched cohort; and 6926 never users and 6926 ever users in the matched cohort. After a median follow-up of 2.8 years, the numbers of incident breast cancer were 1044 in never users and 35 in ever users in the unmatched cohort and were 41 and 35, respectively, in the matched cohort. Hazard ratios suggested a null association between pioglitazone and breast cancer in all three models in either the unmatched cohort or the matched cohort. The overall hazard ratio after adjustment for all covariates was 0.758 (95% confidence interval: 0.539–1.065) in the unmatched cohort and was 0.824 (95% confidence interval: 0.524–1.296) in the matched cohort. None of the hazard ratios for the tertiles of cumulative duration of pioglitazone therapy and for the cumulative duration being treated as a continuous variable were statistically significant.

Conclusions

This study suggests a null association between pioglitazone and breast cancer risk in female patients with type 2 diabetes mellitus. However, because of the small breast cancer cases and the limited follow-up time, further studies are warranted to confirm our findings.
Prevalence of child undernutrition measures and their spatio-demographic inequalities in Bangladesh: an application of multilevel Bayesian modelling
Authors: Das Sumonkanti , Baffour Bernard , Richardson Alice
Published: May 2022

Micro-level statistics on child undernutrition are highly prioritized by stakeholders for measuring and monitoring progress on the sustainable development goals. In this regard district-representative data were collected in the Bangladesh Multiple Indicator Cluster Survey 2019 for identifying localised disparities. However, district-level estimates of undernutrition indicators - stunting, wasting and underweight - remain largely unexplored. This study aims to estimate district-level prevalence of these indicators as well as to explore their disparities at sub-national (division) and district level spatio-demographic domains cross-classified by children sex, age-groups, and place of residence. Bayesian multilevel models are developed at the sex-age-residence-district level, accounting for cross-sectional, spatial and spatio-demographic variations. The detailed domain-level predictions are aggregated to higher aggregation levels, which results in numerically consistent and reasonable estimates when compared to the design-based direct estimates. Spatio-demographic distributions of undernutrition indicators indicate south-western districts have lower vulnerability to undernutrition than north-eastern districts, and indicate significant inequalities within and between administrative hierarchies, attributable to child age and place of residence. These disparities in undernutrition at both aggregated and disaggregated spatio-demographic domains can aid policymakers in the social inclusion of the most vulnerable to meet the sustainable development goals by 2030.
Association between obesity and mortality in the Costa Rican elderly: a cohort study
Authors: Santamaría-Ulloa Carolina , Chinnock Anne , Montero-López Melina
Published: May 2022

Background

Costa Rica, along with other Latin American countries, is undergoing population aging, with an increase in the prevalence of chronic conditions, many of them resulting from a growing prevalence of obesity. As a result of the demographic and epidemiological transitions, the causes of morbidity and mortality have changed from communicable to non-communicable diseases. An increase in overweight and obesity is hypothesized to be related to premature mortality. This study assesses the association between obesity and both all-cause and cardiovascular mortality in a Costa Rican elderly population.

Methods

This is a secondary data analysis of the Costa Rican Longevity and Healthy Aging Study (CRELES, for its Spanish acronym), a longitudinal nationally representative cohort study of health and life-course experiences of the Costa Rican elderly. A baseline (n = 2827) and two subsequent 2-year follow-up interviews were conducted. Data analyses include descriptive statistics and survival models. Cox and Gompertz distributions were used to model general mortality and cardiovascular mortality as a function of obesity and controlling for confounders. Anthropometric measures used were Body Mass Index (BMI) and Waist Circumference (WC).

Results

Each one-unit increment in BMI was significantly associated to a 3,1% (p < 0.001) and 2,6% (p = 0.021) increment in general and cardiovascular mortality respectively. Each one-unit increment in WC was significantly associated with a 0,8% (p = 0.006) increment in general mortality, whereas WC was not significantly associated with cardiovascular mortality.

Conclusions

Obesity is associated with mortality in the Costa Rican elderly. This association is strongest between obesity and all-cause mortality. As general obesity increases, all-cause and cardiovascular mortality also increase in this population. Similarly, as central obesity increases, all-cause mortality increases. Policies aimed at preventing obesity and chronic conditions are warranted for a better survival in this population.
Socio-cultural integration and holistic health among Indigenous young adults
Authors: Walls Melissa , Hautala Dane , Cole Ashley , Kosobuski Lucas , Weiss Nicole , Hill Kyle , Ozhaawashkodewe’iganiikwe Williams Stephanie
Published: May 2022

Background

Research on associations between social integration and wellbeing holds promise to inform policy and practice targets for health promotion. Yet, studies of social connection too frequently rely on overly simplistic measures and give inadequate attention to manifestation and meanings of social integration across diverse groups. We use the term socio-cultural integration to describe expanded assessment of both social and cultural aspects of belonging and connection.

Methods

We examined 7 distinct indicators of socio-cultural integration, identified heterogeneous patterns of responses across these indicators using latent profile analysis, and determined their relevance for wellbeing using survey data from a study with Indigenous communities in the U.S. and Canada. Wellbeing was measured using holistic ratings of self-rated physical, emotional, and spiritual health.

Results

Latent profile analysis (LPA) of responses to the 7 socio-cultural integration variables yielded a 3-class model, which we labeled low, moderate, and high integration. Mean scores on self-rated physical, mental and spiritual health were significantly associated with LPA profiles, such that those in the low integration group had the lowest self-rated health scores and those in the high integration group had the highest health scores. With the exception of similar ratings of cultural identification between low and moderate integration profiles, patterns of responses to the diverse socio-cultural integration measures varied significantly across the 3 latent profiles.

Conclusions

Results underscore the importance of expanding our assessment of social integration with attention to the interrelationships of family, community, culture, and our environment. Such concepts align with Indigenous conceptions of wellbeing, and have relevance for health across cultures. More concretely, the indicators of socio-cultural integration used in this study (e.g., cultural identity, having a sense of connectedness to nature or family, giving or receiving social support) represent malleable targets for inclusion in health promotion initiatives.
Where do you live? North versus Central-South differences in relation to Italian patients with oral lichen planus: a cross-sectional study from the SIPMO (Italian Society of Oral Pathology and Medicine)
Authors: Adamo Daniela , Calabria Elena , Canfora Federica , Coppola Noemi , Lo Muzio Lorenzo , Spirito Francesca , Giuliani Michele , Azzi Lorenzo , Maurino Vittorio , Colella Giuseppe , Colella Chiara , Montebugnoli Lucio , Gissi Davide Bartolomeo , Gabriele Mario , Nisi Marco , Sardella Andrea , Lodi Giovanni , Varoni Elena Maria , Giudice Amerigo , Antonelli Alessandro , Arduino Paolo Giacomo , Gambino Alessio , Vescovi Paolo , Majorana Alessandra , Bardellini Elena , Campisi Giuseppina , Panzarella Vera , Spadari Francesco , Garagiola Umberto , Pentenero Monica , Sutera Samuele , Biasotto Matteo , Ottaviani Giulia , Gobbo Margherita , Guarda Nardini Luca , Romeo Umberto , Tenore Gianluca , Serpico Rosario , Lucchese Alberta , Lajolo Carlo , Rupe Cosimo , Aria Massimo , D’Aniello Luca , Mignogna Michele Davide ,   SIPMO (Italian Society of Oral Pathology and Medicine)
Published: May 2022

Background

Oral lichen planus (OLP) is an immune-mediated inflammatory chronic disease of the oral mucosa, with different patterns of clinical manifestations which range from keratotic manifestations (K-OLP) to predominantly non-keratotic lesions (nK-OLP). The aim of the study was to analyze the differences in the clinical, psychological profile and symptoms between Italian patients of the North and Central-South with K-OLP and nK-OLP.

Methods

270 K-OLP and 270 nK-OLP patients were recruited in 15 Italian universities. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were administered.

Results

The Central-South K-OLP (CS-K-OLP) patients reported a higher frequency of pain/burning compared with the K-OLP patients of the North (N-K-OLP) with higher scores in the NRS and T-PRI (p value < 0.001**). The CS-K-OLP and the CS-nK-OLP patients showed higher scores in the HAM-D, HAM-A, PSQI and ESS compared with the Northern patients (p value < 0.001**). Multivariate logistic regression revealed that the NRS and T-PRI showed the greatest increase in the R2 value for the CS-K-OLP (DR2 = 9.6%; p value < 0.001**; DR2 = 9.7% p value < 0.001**; respectively) and that the oral symptoms (globus, itching and intraoral foreign body sensation) and PSQI showed the greatest increase in the R2 value for the CS-nK-OLP (DR2 = 5.6%; p value < 0.001**; DR2 = 4.5% p value < 0.001** respectively).

Conclusions

Pain and mood disorders are predominant in patients with OLP in the Central-South of Italy. Clinicians should consider that the geographical living area may explain the differences in oral symptoms and psychological profile in OLP.
Eleven-year retrospective study characterizing patients with severe brain damage and poor neurological prognosis -role of physicians’ attitude toward life-sustaining treatment
Authors: Wakatake Haruaki , Hayashi Koichi , Kitano Yuka , Hsu Hsiang-Chin , Yoshida Toru , Masui Yoshihiro , Taira Yasuhiko , Fujitani Shigeki
Published: May 2022

Background

Severe brain hemorrhage/infarction and cardiac arrest constitute the most critical situations leading to poor neurological prognosis. Characterization of these patients is required to offer successful end-of-life care, but actual practice is affected by multiple confounding factors, including ethicolegal issues, particular in Japan and Asia. The aim of this study is to evaluate the clinical courses of patients with severe brain damage and to assess the preference of end-of-life care for these patients in Japanese hospitals.

Methods

A retrospective observational study was conducted between 2008 and 2018. All intracranial hemorrhage/infarction and cardiac arrest out-patients (n = 510) who were admitted to our two affiliated hospitals and survived but with poor neurologic outcomes were included. Demographic characteristics as well as prognosis and treatment policies were also assessed.

Results

Patients were divided into two categories; cases with absent brainstem reflex (BSR) (BSR[-]) and those with preserved BSR (BSR[ +]). The survival rate was higher and the length of hospitalization was longer in patients with BSR[ +] than in those with BSR[-]. Among three life-sustaining policies (i.e., aggressive treatment, withdrawal of treatment, and withholding of treatment), withholding of treatment was adopted to most patients. In BSR[-], the proportion of three treatment policies performed at the final decision did not differ from that at the initial diagnosis on neurological status (p = 0.432). In contrast, this proportion tended to be altered in BSR[ +] (p = 0.072), with a decreasing tendency of aggressive treatment and a modest increasing tendency of withdrawal of treatment. Furthermore, the requests from patients’ families to withdraw life-sustaining treatment, including discontinuation of mechanical ventilation, increased, but actual implementation of withdrawal by physicians was less than half of the requests.

Conclusions

BSR constitutes a crucial determinant of mortality and length of hospitalization in comatose patients with severe brain damage. Although the number of withdrawal of life-sustaining treatment tends to increase over time in BSR[ +] patients, there are many more requests from patients’ families for withdrawal. Since physicians has a tendency to desist from withdrawing life-sustaining treatment, more in-depth communication between medical staff and patients’ families will facilitate mutual understanding over ethicolegal and religious issues and may thus improve end-of-life care.
Extent of knowledge and attitudes on plagiarism among undergraduate medical students in South India - a multicentre, cross-sectional study to determine the need for incorporating research ethics in medical undergraduate curriculum
Authors: Raj Jeffrey Pradeep , Venkatachalam Shreeraam , Amaravati Rajkumar. S. , Baburajan Ramya , Oommen Aswathy Maria , Jose Jesin Elsa , R Rajad. , R Reshmi. , George Melvin , Ramraj Balaji , Gopalakrishnan Bhuvaneswari , Kumar T. Suresh , Saleem Ahammed K. , Rai Mohandas , Penumutsa Vijay Subbaraju , Bodda Deepthi Rani , Prasanna B. Lakshmi , Manderwad Guru Prasad , S Rajiv , Bhandare Basavaraj , Mada Prashanth , Mathai Dilip , Aiyappan Rajalakshmi , Mathew Philip
Published: May 2022

Background

Undergraduate medical students in India participate in various research activities However, plagiarism is rampant, and we hypothesize that it is the lack of knowledge on how to avoid plagiarism. This study’s objective was to measure the extent of knowledge and attitudes towards plagiarism among undergraduate medical students in India.

Methods

It was a multicentre, cross-sectional study conducted over a two-year period (January 2018 – December 2019). Undergraduate medical students were given a pre-tested semi-structured questionnaire which contained: (a) Demographic details; (b) A quiz developed by Indiana University, USA to assess knowledge; and (c) Attitudes towards Plagiarism (ATP) questionnaire.

Results

Eleven medical colleges (n = 4 government medical colleges [GMCs] and n = 7 private medical colleges [PMCs]) participated. A total of N = 4183 students consented. The mean (SD) knowledge score was 4.54 (1.78) out of 10. The factors (adjusted odds ratio [aOR]; 95% Confidence interval [CI]; p value) that emerged as significant predictors of poor knowledge score were early years of medical education (0.110; 0.063, 0.156; < 0.001) and being enrolled in a GMC (0.348; 0.233, 0.463; < 0.001).The overall mean (SD) scores of the three attitude components namely permissive, critical and submissive norms were 37.56 (5.25), 20.35 (4.20) and 31.20 (4.28) respectively, corresponding to the moderate category.

Conclusion

The overall knowledge score was poor. A vast majority of study participants fell in the moderate category of attitude score. These findings warrant the need for incorporating formal training in the medical education curriculum.
Prediction of acute kidney injury risk after cardiac surgery: using a hybrid machine learning algorithm
Authors: Petrosyan Yelena , Mesana Thierry G. , Sun Louise Y.
Published: May 2022

Background

Acute kidney injury (AKI) is a serious complication after cardiac surgery. We derived and internally validated a Machine Learning preoperative model to predict cardiac surgery-associated AKI of any severity and compared its performance with parametric statistical models.

Methods

We conducted a retrospective study of adult patients who underwent major cardiac surgery requiring cardiopulmonary bypass between November 1st, 2009 and March 31st, 2015. AKI was defined according to the KDIGO criteria as stage 1 or greater, within 7 days of surgery. We randomly split the cohort into derivation and validation datasets. We developed three AKI risk models: (1) a hybrid machine learning (ML) algorithm, using Random Forests for variable selection, followed by high performance logistic regression; (2) a traditional logistic regression model and (3) an enhanced logistic regression model with 500 bootstraps, with backward variable selection. For each model, we assigned risk scores to each of the retained covariate and assessed model discrimination (C statistic) and calibration (Hosmer–Lemeshow goodness-of-fit test) in the validation datasets.

Results

Of 6522 included patients, 1760 (27.0%) developed AKI. The best performance was achieved by the hybrid ML algorithm to predict AKI of any severity. The ML and enhanced statistical models remained robust after internal validation (C statistic = 0.75; Hosmer–Lemeshow p = 0.804, and AUC = 0.74, Hosmer–Lemeshow p = 0.347, respectively).

Conclusions

We demonstrated that a hybrid ML model provides higher accuracy without sacrificing parsimony, computational efficiency, or interpretability, when compared with parametric statistical models. This score-based model can easily be used at the bedside to identify high-risk patients who may benefit from intensive perioperative monitoring and personalized management strategies.
“One-time interventions, it doesn’t lead to much” – healthcare provider views to improving sexual and reproductive health services for young migrants in Sweden
Authors: Tirado Veronika , Engberg Siri , Holmblad Ingrid Siösteen , Strömdahl Susanne , Ekström Anna Mia , Hurtig Anna Karin
Published: May 2022

Background

Sexual and reproductive health and rights (SRHR) is an important aspect for young people. In Sweden, young migrants often encounter barriers to accessing and using sexual and reproductive health (SRH) services, despite that these services are free of charge for young people (ages 15–25). Healthcare providers’ views and best practices are of great importance for improving the utilisation of existing SRH services, particularly for young people. This study aims to understand healthcare providers’ experiences and perspectives on barriers to SRHR among young migrants and their suggestions for strategies to improve the provision of SRH services to this group.

Methods

Midwives, counsellors and nurses with at least five years of professional experience within SRHR were reached through a purposeful sample at primary care clinics, specialised clinics and youth-friendly clinics, which provide SRH services to migrant youths in Stockholm. Twelve interviews were conducted from May 2018 to February 2020. Qualitative content analysis was performed.

Results

The analysis identified one theme: Improving the fragmentation in the SRH services, and four sub-themes: 1. Being unaware of SRHR; 2. Creating trust and responsive interactions; 3. Communicating in the same language; and 4. Collaborating to build bridges. The barriers included distrust in the healthcare system, socio-cultural norms surrounding SRHR, incomplete translations, and a need for long-lasting collaboration with SRH services and other range of services for migrants. The strategies for improvement as suggested by participants included involving existing cultural groups and organisations to enable trust, consistent and dependable interpreters, a streamline of SRH services with other healthcare staff and health facilities, and collaborations with homes designated for young migrants and language schools for a direct linkage to service providers.

Conclusions

Findings indicate that there are fragmentations in SRH services, and these include lack of knowledge about SRHR among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. While initiatives and strategies from healthcare providers for improvement of SRH services exist, the implementation of some strategies may also require involving the regional and national decision-makers and multi-stakeholders like communities, civil society and young migrants themselves.
The effect of TCF7L2 polymorphisms on inflammatory markers after 16 weeks of legume-based dietary approach to stop hypertension (DASH) diet versus a standard DASH diet: a randomised controlled trial
Authors: Hosseinpour-Niazi Somayeh , Mirmiran Parvin , Hadaegh Farzad , Daneshpour Maryam S. , Hedayati Mehdi , Azizi Fereidoun
Published: May 2022

Backgrounds

This randomized controlled trial aimed to investigate the effects of replacing red meat with legumes in the dietary approach to stop hypertension (DASH) diet on inflammatory markers over 16 weeks in overweight and obese individuals with type 2 diabetes. Also, the modulatory effects of TCF7L2 rs7903146 variant on this effect were assessed.

Methods

In this trial, 300 participants with type 2 diabetes, aged 30–65 years with an identified TCF7L2 rs7903146 genotype, were studied. The participants were randomly assigned to the DASH diet or the legume-based DASH diet over 16 weeks. In the DASH diet group, the participants were instructed to follow the standard DASH diet. The legume-based DASH diet was similar to the standard DASH diet, with the exception that one serving of red meat was replaced with one serving of legumes at least five days a week. At the beginning of the study and 16-week follow-up, venous blood samples were collected from all participants who fasted for 12–14 h overnight. The serum concentration of High-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) was measured using an enzyme-linked immunosorbent assay (ELISA) kit. Also, the serum malondialdehyde (MDA) concentration was assessed based on a colorimetric method using a commercial kit. The primary outcome was the difference in hs-CRP changes between the diets. A secondary outcomes was the difference in IL-6, TNF-α, and MDA between the groups among total population and based on TCF7L2 rs7903146 risk allele (CT + TT) and non-risk allele (CC) separately.

Results

The hs-CRP level reduced in the legume-based DASH diet group as compared to the DASH diet group in the 16-week follow-up group. The levels of TNF-α, IL-6, and MDA reduced after the legume-based DASH diet relative to the DASH diet. Reduction of inflammatory markers was observed in both carriers of rs7903146 risk allele and non-risk allele.

Conclusions

Substituting one serving of red meat with one serving of legumes in DASH diet, at least five days a week, could improve the hs-CRP, TNF-α, IL-6, and MDA in participants with type 2 diabetes regardless of having rs7903146 risk or non-risk allele.

Trial registration IRCT, IRCT20090203001640N17.