bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between physical activity, low-grade inflammation, and labour market attachment among people with multimorbidity: A cross-sectional study from the Lolland-Falster Health Study, Denmark
Authors: Poulsen Vivian Rueskov , Fischer Linda Kjær , Aadahl Mette , Mortensen Ole Steen , Skou Søren T , Jørgensen Lars Bo , Jepsen Randi , Møller Anne , Petersen Therese Lockenwitz , Brønd Jan Christian , Tang Lars , Korshøj Mette
Published: August 2023

Aim

Evidence suggests low-grade inflammation (LGI) to be associated with multimorbidity. Furthermore, there are links between inflammation markers, physical activity (PA), and labour market participation. The aims of this study were to examine the association between PA and LGI in people with multimorbidity and if this association was moderated by self-reported labour market attachment.

Methods

Cross-sectional data were collected in the Lolland-Falster Health Study (LOFUS) from 2016–2020. We included 1,106 participants with multimorbidity and valid accelerometer data. PA was measured as the average counts per minute (CPM) per day during wake time and split in time spent in moderate to vigorous intensity (MVPA) and light intensity (LPA). Degree of inflammation was determined by high sensitive C-reactive protein (hsCRP) level. Associations were investigated using multiple logistic regression analyses, stratified by labour market attachment.

Results

The odds of having LGI was higher with lower amount of daily LPA. The highest odds of LGI was observed for CPM < 200 per day (odds ratio (OR) 2.55; 95% confidence interval (CI) 1.46–4.43), MVPA < 15 minutes per day (OR 2.97; 95 % CI 1.56–5.62), and LPA < 90 (OR 2.89; 95 % CI 1.43–5.81) with the reference groups being CPM ≥ 400 per day, MVPA ≥ 30, and LPA ≥ 180 min per day, respectively. We could not preclude an interaction between LPA and labour market attachment ( p = 0.109).

Conclusion

PA recommendations should be developed with attention to people with chronic diseases, who may experience barriers to reach PA at high intensities. People with no labour market attachment may benefit from primary and secondary prevention of multimorbidity.
Leveraging Key Informant Interviews to Inform Intervention Development: The Greater Lawndale Healthy Work Project
Authors: Grant Alexis K , Felner Jennifer K , Castañeda Yvette , Pratap Preethi , Hebert-Beirne Jeni
Published: August 2023

Background

The Greater Lawndale Healthy Work project is a sequential mixed methods community based participatory research project that examines work as a structural determinant of health and builds community capacity for healthy work in a predominantly Black and Latinx community in Chicago known as Greater Lawndale (GL).

Objectives

We interviewed community leaders in GL as key informants to understand the barriers to healthy work and inform intervention development.

Methods

We conducted a directed content analysis of transcripts from 20 key informants and coded the social ecology and type of intervention.

Results

Every key informant mentioned at least one asset in GL, showing an opportunity to employ a capacity-oriented approach to intervention development. Key informants suggested a variety of interventions to address precarious work across levels of the social ecology, with individual and community level interventions being the most salient.

Conclusion

Through this approach, we were able to navigate tensions and challenges in conducting research for community-wide change. Key informant stakeholder interviews can be leveraged to meaningfully inform intervention development and support the development of multi-level, sustainable, and culturally acceptable interventions that advance health equity.
A Footpad Structure with Reusable Energy Absorption Capability for Deep Space Exploration Lander: Design and Analysis
Authors: Dou Weiyuan , Qiu Xiaohang , Xiong Zhiwei , Guo Yanzhao , Zhang Lele
Published: August 2023

The footpad structure of a deep space exploration lander is a critical system that makes the initial contact with the ground, and thereby plays a crucial role in determining the stability and energy absorption characteristics during the impact process. The conventional footpad is typically designed with an aluminum honeycomb structure that dissipates energy through plastic deformation. Nevertheless, its effectiveness in providing cushioning and energy absorption becomes significantly compromised when the structure is crushed, rendering it unusable for reusable landers in the future. This study presents a methodology for designing and evaluating structural energy absorption systems incorporating recoverable strain constraints of shape memory alloys (SMA). The topological configuration of the energy absorbing structure is derived using an equivalent static load method (ESL), and three lightweight footpad designs featuring honeycomb-like Ni-Ti shape memory alloys structures and having variable stiffness skins are proposed. To verify the accuracy of the numerical modelling, a honeycomb-like structure subjected to compression load is modeled and then compared with experimental results. Moreover, the influence of the configurations and thickness distribution of the proposed structures on their energy absorption performance is comprehensively evaluated using finite element simulations. The results demonstrate that the proposed design approach effectively regulates the strain threshold to maintain the SMA within the constraint of maximum recoverable strain, resulting in a structural energy absorption capacity of 362 J/kg with a crushing force efficiency greater than 63%.
Effect of nanoparticle size on their distribution and retention in chronic inflammation sites
Authors: Aldayel Abdulaziz M. , Hufnagel Stephanie , O’Mary Hannah L. , Valdes Solange A. , Alzhrani Riyad F. , Xu Haiyue , Cui Zhengrong
Published: August 2023

Nanomedicines are increasingly researched and used for the treatment of chronic inflammatory diseases. Herein, the effect of the size of nanoparticles on their distribution and retention in chronic inflammatory sites, as compared to healthy tissues, was studied in a mouse model with chronic inflammation in one of the hind footpads. Using PEGylated gold nanoparticles of 2, 10, 100, and 200 nm, we found that although the smaller nanoparticles of 2 and 10 nm showed greater distribution and slower clearance in the inflamed footpad than the relatively larger nanoparticles of 100 and 200 nm, the larger nanoparticles of 100 and 200 nm were more selectively distributed in the inflamed hind footpad than in the healthy hind footpad in the same mouse. Based on these findings, we prepared protein nanoparticles of 100–200 nm with albumin, IgG antibody, or anti-TNF-α monoclonal antibody (mAb). The nanoparticles can release proteins in response to high redox activity and/or low pH, conditions seen in chronic inflammation sites. We then showed that upon intravenous injection, those stimuli-responsive protein nanoparticles distributed more selectively in the inflamed footpad than free proteins and remained longer in the inflamed footpad than similar protein nanoparticles that are not sensitive to high redox activity or low pH. These findings support the feasibility of increasing the selectivity of nanomedicines and protein therapeutics to chronic inflammation sites and prolonging their retention at the sites by innovative nanoparticle engineering.

Graphical Abstract
Extreme environmental adaptation mechanisms of Antarctic bryophytes are mainly the activation of antioxidants, secondary metabolites and photosynthetic pathways
Authors: Zhang Liping , Zhang Zhi , Cao Junhan , Wang Kai , Qin Ling , Sun Yongjun , Ju Wenming , Qu Changfeng , Miao Jinlai
Published: August 2023

The environment in Antarctica is characterized by low temperature, intense UVB and few vegetation types. The Pohlia nutans M211 are bryophytes, which are the primary plants in Antarctica and can thrive well in the Antarctic harsh environment. The transcriptional profiling of Pohlia nutans M211 under low temperature and high UVB conditions was analyzed to explore their polar adaptation mechanism in the extreme Antarctic environment by third-generation sequencing and second-generation sequencing. In comparison to earlier second-generation sequencing techniques, a total of 43,101 non-redundant transcripts and 10,532 lncRNA transcripts were obtained, which were longer and more accurate. The analysis results of GO, KEGG, AS (alternative splicing), and WGCNA (weighted gene co-expression network analysis) of DEGs (differentially expressed genes), combined with the biochemical kits revealed that antioxidant, secondary metabolites pathways and photosynthesis were the key adaptive pathways for Pohlia nutans M211 to the Antarctic extreme environment. Furthermore, the low temperature and strong UVB are closely linked for the first time by the gene HY5 (hlongated hypocotyl 5) to form a protein interaction network through the PPI (protein–protein interaction networks) analysis method. The UVR8 module, photosynthetic module, secondary metabolites synthesis module, and temperature response module were the key components of the PPI network. In conclusion, this study will help to further explore the polar adaptation mechanism of Antarctic plants represented by bryophytes and to enrich the polar gene resources.
Laboratory indices of hospitalized sickle cell disease patients, prevalence and antimicrobial susceptibility of pathogenic bacterial isolates at MRCG ward in the Gambia
Authors: Dibbasey Mustapha , Dahaba Mamudou , Sarfo Francess , Jallow-Manneh Ida , Ceesay Buntung , Umukoro Solomon , Diop Mouhamadou Fadel , Amambua-Ngwa Alfred
Published: August 2023

Background

The aim of this study was to determine the prevalence of invasive bacterial infections and their antimicrobial resistance patterns in sickle cell disease (SCD) patients admitted at the Medical Research Council the Gambia (MRCG) Ward in the era of PCV and Hib vaccination in the Gambia.

Methods and Results

This study was conducted in the clinical laboratory department of MRCG. We retrospectively generated haematological, and blood culture data from our electronic medical records from 2015 to 2022 of SCD patients admitted to MRCG Ward. Of 380 SCD patients, blood culture was requested only for 159. Of the 159 admitted SCD, 11 patients had qualified positive blood cultures. Five different types of bacterial pathogens were isolated from these positive blood cultures: 4 Staphylococcus aureus, 3 Streptococcus pneumoniae, 2 Salmonella species, 1 Enterococcus species, and 1 Shigella boydii. No episode of bacteremia caused by Haemophilus influenzae type b was identified. The molecular serotyping of the Streptococcus pneumoniae isolates revealed non-vaccine serotypes 10 A, 12 F and 12 F. Penicillin resistance was recorded in two of the three Streptococcus pneumoniae. The Staphylococcus aureus isolates were penicillin resistant but cefoxitin sensitive, hence no methicillin (oxacillin) resistant Staphylococcus aureus was reported. Generally, the isolated pathogens were all sensitive to chloramphenicol, and vancomycin. The haematological indices were not significantly varied between SCD patients with and without microbiologically confirmed bacterial infection.

Conclusion

Streptococcus pneumoniae and Staphylococcus aureus were the most common cause of bacteremia in these admitted SCD patients. The presence of non-typhoidal Salmonella and Shigella infection coupled with penicillin resistance should be considered during penicillin prophylaxis and empirical treatment regimens for SCD patients and future SCD management policies in the Gambia. The haematological parameters may not be reliable biomarkers in differentiating bacterial from non-bacterial infections in SCD patients.
Rapid implementation of an emergency on-site CKRT dialysate production system during the COVID-19 pandemic
Authors: Teixeira J. Pedro , Saa Lisa , Kaucher Kevin A. , Villanueva Ruben D. , Shieh Michelle , Baca Crystal R. , Harmon Brittany , Owen Zanna J. , Mendez Majalca Ismael , Schmidt Darren W. , Singh Namita , Shaffi Saeed K. , Xu Zhi Q. , Roha Thomas , Mitchell Jessica A. , Demirjian Sevag , Argyropoulos Christos P.
Published: August 2023

Background

On December 29, 2021, during the delta wave of the Coronavirus Disease 2019 (COVID-19) pandemic, the stock of premanufactured solutions used for continuous kidney replacement therapy (CKRT) at the University of New Mexico Hospital (UNMH) was nearly exhausted with no resupply anticipated due to supply chain disruptions. Within hours, a backup plan, devised and tested 18 months prior, to locally produce CKRT dialysate was implemented. This report describes the emergency implementation and outcomes of this on-site CKRT dialysate production system.

Methods

This is a single-center retrospective case series and narrative report describing and reporting the outcomes of the implementation of an on-site CKRT dialysate production system. All adults treated with locally produced CKRT dialysate in December 2021 and January 2022 at UNMH were included. CKRT dialysate was produced locally using intermittent hemodialysis machines, hemodialysis concentrate, sterile parenteral nutrition bags, and connectors made of 3-D printed biocompatible rigid material. Outcomes analyzed included dialysate testing for composition and microbiologic contamination, CKRT prescription components, patient mortality, sequential organ failure assessment (SOFA) scores, and catheter-associated bloodstream infections (CLABSIs).

Results

Over 13 days, 22 patients were treated with 3,645 L of locally produced dialysate with a mean dose of 20.0 mL/kg/h. Fluid sample testing at 48 h revealed appropriate electrolyte composition and endotoxin levels and bacterial colony counts at or below the lower limit of detection. No CLABSIs occurred within 7 days of exposure to locally produced dialysate. In-hospital mortality was 81.8% and 28-day mortality was 68.2%, though illness severity was high, with a mean SOFA score of 14.5.

Conclusions

Though producing CKRT fluid with IHD machines is not novel, this report represents the first description of the rapid and successful implementation of a backup plan for local CKRT dialysate production at a large academic medical center in the U.S. during the COVID-19 pandemic. Though conclusions are limited by the retrospective design and limited sample size of our analysis, our experience could serve as a guide for other centers navigating similar severe supply constraints in the future.
The potential effect and mechanism of Saikosaponin A against gastric cancer
Authors: Wang Chao , Zhang Ruijuan , Chen Xu , Yuan Mengyun , Wu Jian , Sun Qingmin , Miao Chunrun , Jing Yali
Published: August 2023

Background

Saikosaponin A (SSA) shows a series of pharmacological activities, such as anti-inflammatory, antioxidant and antitumor. However, there is a lack of comprehensive research or sufficient evidence regarding the efficacy of SSA in treating gastric cancer (GC), and the specific mechanisms by which it inhibits GC growth and progression are still not fully understood.

Methods

MTT and clonogenic assays were employed to detect the effect of SSA on the proliferation of GC cells. Bioinformatics predicted the SSA targets in the treatment of GC. The core genes and the underlying mechanism of SSA in anti-GC were obtained by analyzing the intersecting targets; molecular docking and Western blot were used to check the reliability of core genes. Flow cytometry was used to analyze apoptosis and cell cycle in GC cells treated with varying concentrations of SSA. Western blot was employed to detect the expression levels of related proteins.

Results

SSA significantly blocked GC cells in the S phase of the cell cycle and induced apoptosis to suppress the proliferation of GC cells. Network pharmacology revealed that the underlying mechanisms through which SSA acts against GC involve the modulation of several signaling pathways, including the PI3K-Akt, MAPK, RAS, and T-cell signaling pathways. Molecular docking showed pivotal target genes with a high affinity to SSA, including STAT3, MYC, TNF, STAT5B, Caspase-3 and SRC. Furthermore, western blot results revealed that SSA significantly increased the protein levels of Bax and Cleaved Caspase-3, whereas decreased the expression levels of p-JAK, p-STAT3, MYC, Bcl-2, p-PI3K, p-AKT and p-mTOR, confirming that the reliability of hub targets and SSA could promote GC cell apoptosis by suppressing PI3K/AKT/mTOR pathway.

Conclusions

The results suggest that SSA has the ability to trigger apoptosis in GC cells by blocking the PI3K/AKT/mTOR pathway. These findings highlight the potential of SSA as a promising natural therapeutic agent for the treatment of GC.
Cytotoxic, anti-proliferative, and apoptotic evaluation of Ramalina sinensis (Ascomycota, Lecanoromycetes), lichenized fungus on oral squamous cell carcinoma cell line; in-vitro study
Authors: Koopaie Maryam , Karimi Hanieh , Sohrabi Mohammad , Norouzi Hooman
Published: August 2023

Background

Scientists and medical professionals are actively striving to improve the efficacy of treatment methods for oral squamous cell carcinoma (OSCC), the most frequently occurring cancer within the oral cavity, by exploring the potential of natural products. The active pharmacological compounds found in lichenized fungi have shown potential for aiding in cancer treatment. Recent research aims to evaluate the impact of the lichenized fungus Ramalina sinensis (R. sinensis) on the cell viability and apoptosis of OSCC cell lines, considering the anti-inflammatory and anti-cancer capabilities of lichens.

Methods

Ramalina sinensis (Ascomycota, Lecanoromycetes) was selected for investigation of its effects on a human oral squamous cell carcinoma cell line. Acetone and methanol extracts of R. sinensis on an OSCC cell line (KB cell line, NCBI Code: C152) were investigated. Viability was assessed by MTT assay analysis, and apoptotic cells were measured using flow cytometry analysis. Scratch assay was used to assess cell migration. The chemical composition and metabolic profiling of R. sinensis were investigated.

Results

The growth and multiplication of KB cells were observed to undergo a gradual but remarkable inhibition when exposed to various concentrations. Specifically, concentrations of 6.25, 12.5, 25, 50, 100, and 200 μg/mL exhibited a significant suppressive effect on the proliferation of KB cells. The inhibition of cell proliferation exhibited a statistically significant difference between the extracts obtained from acetone and methanol. Flow cytometry results show an increase in apoptosis of OSCC cells by acetone extract. R. sinensis exerted a concentration-dependent inhibitory effect on the migration of OSCC cells. The chemical composition of R. sinensis was investigated using liquid chromatography positive ion electrospray ionization tandem mass spectrometry (LC–ESI–MS/MS), and 33 compounds in the acetone and methanol extracts of R. sinensis were detected.

Conclusion

The findings provide evidence supporting the beneficial effects of R. sinensis extract on inducing apoptosis in OSCC cells and exerting anti-cancer properties.
Neuroprotective effect of nose-to-brain delivery of Asiatic acid in solid lipid nanoparticles and its mechanisms against memory dysfunction induced by Amyloid Beta1-42 in mice
Authors: Islamie Ridho , Myint Su Lwin Lwin , Rojanaratha Tissana , Ritthidej Garnpimol , Wanakhachornkrai Oraphan , Wattanathamsan Onsurang , Rodsiri Ratchanee
Published: August 2023

Background

Amyloid-β1-42 (Aβ1-42) plays an essential role in the development of the early stage of Alzheimer’s disease (AD). Asiatic acid (AA), an active compound in Centella asiatica L, exhibit neuroprotective properties in previous studies. Due to its low bioavailability, the nose-to-brain delivery technique was used to enhance AA penetration in the brain. In this study, AA was also loaded in solid lipid nanoparticles (SLNs) as a strategy to increase its absorption in the nasal cavity.

Methods

Memory impairment was induced via direct intracerebroventricular injection of Aβ1-42 oligomer into mouse brain. The neuroprotective effect and potential underlying mechanisms were investigated using several memory behavioral examinations and molecular techniques.

Results

The intranasal administration of AA in SLNs attenuated learning and memory impairment induced by Aβ1-42 in Morris water maze and novel object recognition tests. AA significantly inhibited tau hyperphosphorylation of pTau-S396 and pTau-T231 and prevented astrocyte reactivity and microglial activation in the hippocampus of Aβ1-42-treated mice. It is also decreased the high levels of IL-1β, TNF-α, and malondialdehyde (MDA) in mouse brain.

Conclusions

These results suggested that nose-to-brain delivery of AA in SLNs could be a promising strategy to treat the early stage of AD.
How often do medical students change career preferences over the course of medical school?
Authors: Rachoin Jean-Sebastien , Vilceanu M. Olguta , Franzblau Natali , Gordon Sabrina , Cerceo Elizabeth
Published: August 2023

Introduction

During the preclinical years, students typically do not have extensive exposure to clinical medicine. When they begin their clinical rotations, usually in the third year, the majority of the time is spent on core rotations with limited experience in other fields of medicine. Students then must decide on their careers early in their fourth year. We aimed to analyze how often medical students change their career preferences between the end of their second and their fourth year.

Methods

We conducted a retrospective, cohort study using the American Association of Medical Colleges Year 2 Questionnaire (Y2Q) and Graduating Questionnaire (GQ) from 2016 to 2020.

Results

20,408 students answered both surveys, but 2,165 had missing values on the career choice question and were excluded. Of the remaining students, 10,233 (56%) changed their career choice between the Y2 and GQ surveys. Fields into which students preferentially switched by the GQ survey included anesthesia, dermatology, ENT, family medicine, OB/GYN, pathology, PM&R, psychiatry, radiology, urology, and vascular surgery. Many characteristics, including future salary, the competitiveness of the field, and the importance of work-life balance, were significantly associated with a higher likelihood of changing career choices. On the other hand, having a mentor and the specialty content were associated with a lower likelihood of change.

Conclusion

A majority of students switched their career preferences from the Y2Q to the GQ. Additional research should be focused on curricular design that optimizes student satisfaction with career decisions. This may include early integration of a variety of specialties.
Exploring challenges and facilitators to E-learning based Education of nursing students during Covid-19 pandemic: a qualitative study
Authors: Mojarad Fereshteh Araghian , Hesamzadeh Ali , Yaghoubi Tahereh
Published: August 2023

Background

During the COVID-19 pandemic, there was a shift to e-learning and online education in educational and learning processes. Research has shown that nursing students who are satisfied with e-learning tend to have better learning outcomes. Therefore, this qualitative study aimed to explore the challenges and facilitators of e-learning for nursing students during the pandemic.

Methods

This qualitative study utilized a content analysis approach. Sixteen participants with nursing education experience were purposively selected and interviewed using a semi-structured format. The data collected were analyzed using the conventional qualitative content analysis approach.

Results

Through data analysis, two main categories were identified: e-learning challenges and facilitators. The e-learning challenges included subcategories such as inexperienced teachers, ineffective learning, academic cheating, system problems, and inappropriate evaluation. The facilitators included subcategories such as improving education, and promoting online exams.

Conclusions

While e-learning was adopted as a substitute for in-person education during the COVID-19 pandemic, its implementation involves both challenges and facilitators. By addressing the challenges and optimizing the facilitators of e-learning, nursing schools can successfully adapt to this new mode of education in the post-pandemic era and provide high-quality education to their students.
“We should be resourcing their liberation:” a qualitative formative study to guide introduction of a systems engineering intervention at a King County, WA juvenile detention center clinic
Authors: Borges Madeline , Schipper Lois , Gonzalez George , Goode Sean , Hersh Dorene , Pham Do-Quyen , Kaplan Ben , Ronen Keshet , Sherr Kenneth , Gimbel Sarah
Published: August 2023

Background

There are ongoing efforts to eliminate juvenile detention in King County, WA. An essential element of this work is effectively addressing the health needs of youth who are currently detained to improve their wellbeing and reduce further contact with the criminal legal system. This formative study sought to inform adaptation and piloting of an evidence-based systems engineering strategy – the Systems Analysis and Improvement Approach (SAIA) – in a King County juvenile detention center clinic to improve quality and continuity of healthcare services. Our aims were to describe the priority health needs of young people who are involved in Washington’s criminal legal system and the current system of healthcare for young people who are detained.

Methods

We conducted nine individual interviews with providers serving youth. We also obtained de-identified quantitative summary reports of quality improvement discussions held between clinic staff and 13 young people who were detained at the time of data collection. Interview transcripts were analyzed using deductive and inductive coding and quantitative data were used to triangulate emergent themes.

Results

Providers identified three priority healthcare cascades for detention-based health services—mental health, substance use, and primary healthcare—and reported that care for these concerns is often introduced for the first time in detention. Interviewees classified incarceration itself as a health hazard, highlighting the paradox of resourcing healthcare quality improvement interventions in an inherently harmful setting. Fractured communication and collaboration across detention- and community-based entities drives systems-level inefficiencies, obstructs access to health and social services for marginalized youth, and fragments the continuum of care for young people establishing care plans while detained in King County. 31% of youth self-reported receiving episodic healthcare prior to detention, 15% reported never having medical care prior to entering detention, and 46% had concerns about finding healthcare services upon release to the community.

Conclusions

Systems engineering interventions such as the SAIA may be appropriate and feasible approaches to build systems thinking across and between services, remedy systemic challenges, and ensure necessary information sharing for care continuity. However, more information is needed directly from youth to draw conclusions about effective pathways for healthcare quality improvement.
Quality communication can improve patient-centred health outcomes among older patients: a rapid review
Authors: Sharkiya Samer H.
Published: August 2023

Background

Effective communication is a cornerstone of quality healthcare. Communication helps providers bond with patients, forming therapeutic relationships that benefit patient-centred outcomes. The information exchanged between the provider and patient can help in medical decision-making, such as better self-management. This rapid review investigated the effects of quality and effective communication on patient-centred outcomes among older patients.

Methods

Google Scholar, PubMed, Scopus, CINAHL, and PsycINFO were searched using keywords like “effective communication,“ “elderly,“ and “well-being.“ Studies published between 2000 and 2023 describing or investigating communication strategies between older patients (65 years and above) and providers in various healthcare settings were considered for selection. The quality of selected studies was assessed using the GRADE Tool.

Results

The search strategy yielded seven studies. Five studies were qualitative (two phenomenological study, one ethnography, and two grounded theory studies), one was a cross-sectional observational study, and one was an experimental study. The studies investigated the effects of verbal and nonverbal communication strategies between patients and providers on various patient-centred outcomes, such as patient satisfaction, quality of care, quality of life, and physical and mental health. All the studies reported that various verbal and non-verbal communication strategies positively impacted all patient-centred outcomes.

Conclusion

Although the selected studies supported the positive impact of effective communication with older adults on patient-centred outcomes, they had various methodological setbacks that need to be bridged in the future. Future studies should utilize experimental approaches, generalizable samples, and specific effect size estimates.
Explaining gender inequalities in overweight people: a Blinder-Oaxaca decomposition analysis in northern Sweden
Authors: Yusuf Fethi Mohammed , San Sebastián Miguel , Vaezghasemi Masoud
Published: August 2023

Background

Being overweight and obesity are considered serious public health concerns worldwide. At the population level, factors contributing to overweight as well as the differences in overweight between men and women in terms of prevalence or associated factors are relatively well-known. What is less known is what explains the inequalities in overweight between men and women. In this study, we examined the contribution of material, behavioural, and psychosocial factors in explaining the gender differences in overweight among adults in northern Sweden.

Methods

This study was based on the 2018 Swedish Health on Equal Terms survey, which was carried out in Sweden’s four northernmost regions. The analytical sample consisted of 20,855 participants (47% men) aged 20–84 years. Overweight (including obesity) was the outcome, and the selected explanatory variables were grouped according to three theoretical perspectives: material, behavioural and psychosocial. Descriptive statistics and Blinder-Oaxaca decomposition were applied for analysing the data.

Results

Our study showed that the prevalence of overweight was 64% and 52% among men and women, respectively. It, therefore, revealed a gender gap in overweight people of 11.7% points with explanatory factors accounting for 39% of that gap. This gender gap in overweight people was mostly explained by behavioural variables (19.3%), followed by the materialistic variables and age accounting for 16.2% and 3.1%, respectively. Specifically, having low education, being in the lowest income quintile, alcohol drinking and snus usage contributed to explain 8.4%, 8.9%, 2.8% and 6.3% of the gender difference, respectively.

Conclusions

We found a considerable gender inequality in overweight between men and women. The findings highlight that future overweight prevention initiatives would benefit from targeting the uncovered contributing factors to reduce gender inequalities in overweight people.
An alternative method of indexation in aortic stenosis: height-adjusted effective orifice area
Authors: Gamaza-Chulián Sergio , González-Testón Fátima , Díaz-Retamino Enrique , Zafra-Cobo Francisco M. , González-Caballero Eva
Published: August 2023

Background

Although indexing effective orifice area (EOA) by body surface area (BSA) is recommended, this method has several disadvantages, since it corrects by acquired fatty tissue. Our aim was to analyze the value of EOA normalized by height for predicting cardiovascular outcome in patients with aortic stenosis (AS).

Methods

Patients with AS (peak velocity > 2 m/s) evaluated in our echocardiography laboratory between January 2015 and June 2018 were prospectively enrolled. EOA was indexed by BSA and height. A composite primary endpoint was defined as cardiac death or aortic valve replacement. A receiver operating characteristic curve was plotted to determine the best cutoff value of EOA/height for predicting cardiovascular events.

Results

Four-hundred and fifteen patients were included (52% women, mean age 74.8 ± 11.6 years). Area under the curve was similar for EOA/BSA (AUC 0.75, p < 0.001) and EOA/height (AUC 0.75, p < 0.001). A cutoff value of 0.60 cm2/m for EOA/height had a sensitivity of 84%, specificity of 61%, positive predictive value of 60% and negative predictive value of 84%. One-year survival from primary endpoint was significantly lower in patients with EOA/height ≤ 0.60 cm2/m (48 ± 5% vs 91 ± 4%, log-rank p < 0.001) than EOA/height > 0.60 cm2/m. The excess of risk of cardiovascular events seen in univariate analysis persists even after adjustment for other demonstrated adverse prognostic variables (HR 5.91, 95% CI 3.21–10.88, p < 0.001). In obese patients, there was an excess of risk in patients with EOA/height < 0.60 cm2/m (HR 10.2, 95% CI 3.5–29.5, p < 0.001), but not in EOA/BSA < 0.60 cm2/m2 (HR 0.14, 95% CI 0.14–1.4, p = 0.23).

Conclusions

We could identify a subgroup of patients with AS at high risk of cardiovascular events. Consequently, we recommend using EOA/height as a method of indexation in AS, especially in obese patients, with a cutoff of 0.60 cm2/m for identifying patients with higher cardiovascular risk.

Graphical Abstract
Seroprevalence of herpes simplex virus type 1 and type 2 among the migrant workers in Qatar
Authors: Nasrallah Gheyath K. , Dargham Soha R. , Al-Sadeq Duaa W. , Amanullah Fathima H. , Shurrab Farah M. , Nizamuddin Parveen B. , Chemaitelly Hiam , Ayoub Houssein H. , Abdeen Sami , Abdelkarim Ashraf , Daraan Faisal , Ismail Ahmed , Mostafa Nahid , Sahl Mohamed , Suliman Jinan , Tayar Elias , Kasem Hasan Ali , Agsalog Meynard J. A. , Akkarathodiyil Bassam K. , Alkhalaf Ayat A. , Alakshar Mohamed Morhaf M. H. , Al-Qahtani Abdulsalam Ali A. H. , Al-Shedifat Monther H. A. , Ansari Anas , Ataalla Ahmad Ali , Chougule Sandeep , Gopinathan Abhilash K. K. V. , Poolakundan Feroz J. , Ranbhise Sanjay U. , Saefan Saed M. A. , Thaivalappil Mohamed M. , Thoyalil Abubacker S. , Umar Inayath M. , Al Kuwari Einas , Coyle Peter , Jeremijenko Andrew , Kaleeckal Anvar Hassan , Abdul Rahim Hanan F. , Yassine Hadi M. , Al Thani Asmaa A. , Chaghoury Odette , Al Kuwari Mohamed Ghaith , Farag Elmoubasher , Bertollini Roberto , Al Romaihi Hamad Eid , Al Khal Abdullatif , Al-Thani Mohamed H. , Abu-Raddad Laith J.
Published: August 2023

Background

Limited data exists on herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infections in migrant populations. This study investigated HSV-1 and HSV-2 seroprevalences and associations among craft and manual workers (CMWs) in Qatar who constitute 60% of Qatar’s population.

Methods

A national population-based cross-sectional seroprevalence survey was conducted on the CMW population, all men, between July 26 and September 9, 2020. 2,612 sera were tested for anti-HSV-1 IgG antibodies using HerpeSelect 1 ELISA IgG kits and for anti-HSV-2 IgG antibodies using HerpeSelect 2 ELISA IgG kits (Focus Diagnostics, USA). Univariable and multivariable logistic regression analyses were conducted to identify associations with HSV-1 and HSV-2 infections.

Results

Serological testing identified 2,171 sera as positive, 403 as negative, and 38 as equivocal for HSV-1 antibodies, and 300 sera as positive, 2,250 as negative, and 62 as equivocal for HSV-2 antibodies. HSV-1 and HSV-2 seroprevalences among CMWs were estimated at 84.2% (95% CI 82.8–85.6%) and 11.4% (95% CI 10.1–12.6%), respectively. HSV-1 infection was associated with nationality, educational attainment, and occupation. HSV-2 infection was associated with age, nationality, and educational attainment.

Conclusions

Over 80% of CMWs are infected with HSV-1 and over 10% are infected with HSV-2. The findings highlight the need for sexual health programs to tackle sexually transmitted infections among the CMW population.
Development of in vitro osteoporosis model in minipig proximal humerus and femur: validation in histological and biomechanical study
Authors: Seo Jeonghyeon , Kim Hyojune , Min Joongkee , Kim Yongwoo , Jeon In-Ho , D’Lima Darry , Koh Kyoung Hwan
Published: August 2023

Background

The minipig has been used for research in various fields of medicine, even in orthopedics. Though previous studies have already suggested other methods to create osteoporotic bone, those methods had some disadvantages for taking time and efforts. Therefore, we aimed to generate osteoporotic proximal humerus and proximal femur of minipig using EDTA solution and validate their properties through dual energy X-ray absorptiometry (DEXA), micro-CT study, histological and biomechanical ways.

Methods

Six minipigs were used. Out of a total of 12 proximal humerus (PH) and 12 proximal femurs (PF), 6 PH and 6 PF were used as the decalcified group and the opposite side as the non-decalcified group. In vitro decalcification with Ca-chelating agents (0.5 M EDTA solution, pH 7.4) was used. Area BMD (aBMD) was measured using DEXA, Volumetric BMD (vBMD), and microstructure were measured using micro-CT. Universal testing machine was used to measure ultimate load to failure (ULTF). Each group was compared using two types of suture anchors (all-suture anchor, ASA, and conventional screw type anchor, CA).

Results

There was a significant difference in aBMD and cortical thickness (aBMD: decalcified, 0.433 ± 0.073 g/cm2, undecalcified, 0.962 ± 0.123 g/cm2, p < 0.001; cortical thickness: decalcified, 0.33 ± 0.34 mm, undecalcified, 1.61 ± 0.45 mm, p < 0.001). In the case of ASA, the ULTF was significantly lower in the decalcified group (decalcified: 176.6 ± 74.2 N, non-decalcified: 307.7 ± 116.5 N, p = 0.003). In the case of CA, there was no significant difference (decalcified: 265.1 ± 96.0 N, undecalcified: 289.4 ± 114.5 N, p = 0.578).

Conclusion

We demonstrated that decalcification with EDTA solution significantly decreased aBMD, vBMD, and cortical thickness. Decalcified minipig bone using EDTA resulted in similar biomechanical properties as osteoporotic human bone with respect to anchor pull-out.
Machine learning based study for the classification of Type 2 diabetes mellitus subtypes
Authors: Ordoñez-Guillen Nelson E. , Gonzalez-Compean Jose Luis , Lopez-Arevalo Ivan , Contreras-Murillo Miguel , Aldana-Bobadilla Edwin
Published: August 2023

Purpose

Data-driven diabetes research has increased its interest in exploring the heterogeneity of the disease, aiming to support in the development of more specific prognoses and treatments within the so-called precision medicine. Recently, one of these studies found five diabetes subgroups with varying risks of complications and treatment responses. Here, we tackle the development and assessment of different models for classifying Type 2 Diabetes (T2DM) subtypes through machine learning approaches, with the aim of providing a performance comparison and new insights on the matter.

Methods

We developed a three-stage methodology starting with the preprocessing of public databases NHANES (USA) and ENSANUT (Mexico) to construct a dataset with N = 10,077 adult diabetes patient records. We used N = 2,768 records for training/validation of models and left the remaining (N = 7,309) for testing. In the second stage, groups of observations –each one representing a T2DM subtype– were identified. We tested different clustering techniques and strategies and validated them by using internal and external clustering indices; obtaining two annotated datasets Dset A and Dset B. In the third stage, we developed different classification models assaying four algorithms, seven input-data schemes, and two validation settings on each annotated dataset. We also tested the obtained models using a majority-vote approach for classifying unseen patient records in the hold-out dataset.

Results

From the independently obtained bootstrap validation for Dset A and Dset B, mean accuracies across all seven data schemes were $$85.3\%$$

85.3
%

($$\pm 9.2\%$$

±
9.2
%

) and $$97.1\%$$

97.1
%

($$\pm 3.4\%$$

±
3.4
%

), respectively. Best accuracies were $$98.8\%$$

98.8
%

and $$98.9\%$$

98.9
%

. Both validation setting results were consistent. For the hold-out dataset, results were consonant with most of those obtained in the literature in terms of class proportions.

Conclusion

The development of machine learning systems for the classification of diabetes subtypes constitutes an important task to support physicians for fast and timely decision-making. We expect to deploy this methodology in a data analysis platform to conduct studies for identifying T2DM subtypes in patient records from hospitals.
How does the clinical practice of Aotearoa New Zealand podiatrists align with international guidelines for the prevention of diabetes‐related foot disease? A cross‐sectional survey
Authors: Jepson Hannah , Lazzarini Peter A , Garrett Michele , Carroll Matthew R
Published: August 2023

Background

Given the importance of preventive care for the lower limb in people with diabetes, and the absence of local guidelines in Aotearoa New Zealand (NZ), the aim of this study was to determine the alignment of assessment and management used in the prevention of diabetes‐related foot disease by NZ podiatrists to the international prevention guideline recommendations.

Methods

A 37‐item web‐based survey was developed using a 5‐point Likert scale (0 = always; 5 = never) based on the International Working Group of the Diabetic Foot (IWGDF) 2019 prevention guidelines and included domains on participant demographics, sector, caseloads, guidelines, screening, management, education, and referral. The survey was distributed to NZ podiatrists through the NZ podiatry association and social media. Participants completing > 50% of items were included. The Mann‐Whitney U test was used to examine differences between sector subgroups.

Results

Seventy‐seven responses (16.3% of the NZ podiatry workforce) were received, of which 52 completed > 50% of items and were included. Of those 52 podiatrists, 73% were from the private sector. Public sector podiatrists reported higher weekly caseloads of patients with diabetes (p = 0.03) and foot ulcers (p < 0.001). The New Zealand Society for the Study of Diabetes (NZSSD) risk stratification pathway and IWGDF guidelines were the two most frequently utilised guidance documents. Participants reported median scores of at least “often” (< 2) for all items in the assessment and management, inspection, examination, and education provision domains for people with a high‐risk foot. More than 50% of respondents reported screening more frequently than guideline recommendations for people with a very low to moderate risk foot. Structured education program was only used by 4 (5%) participants. Public sector podiatrists reported greater provision of custom‐made footwear (p = 0.04) and multi‐disciplinary team care (p = 0.03).

Conclusion

NZ podiatrists generally follow international guideline recommendations with respect to screening, self‐care education, appropriate footwear, and treatment of risk factors for people at‐risk of diabetes‐related foot disease. However there may be over‐screening of people with very low to medium risk occurring in clinical practice. Increasing access to integrated healthcare, custom‐made footwear and structured educational programmes appear to be areas of practice that could be developed in future to help prevent diabetes‐related foot disease in NZ.
A randomized control trial to support smoke-free policy compliance in public housing
Authors: Hernandez Diana , Khan Farzana , Albert David , Giovenco Daniel , Branas Charles , Valeri Linda , Navas-Acien Ana
Published: August 2023

Background

Smoke-free housing policies in multiunit housing are increasingly widespread interventions to reduce smoking and secondhand smoke exposure. Little research has identified factors that impede compliance with smoke-free housing policies in low-income multiunit housing and test corresponding solutions.

Methods

We are using an experimental design to test two compliance support interventions: (A) a “compliance through reduction (via relocation and reduction in personal smoking) and cessation” intervention targets households with smokers and involves support to shift smoking practices to areas beyond the apartment or building setting, reduce personal smoking, and deliver in-residence smoking cessation support services via trained peer educators and (B) a “compliance through resident endorsement” intervention involving voluntary adoption of smoke-free living environments through personal pledges, visible door markers, and/or via social media. We will compare randomly sampled participants in buildings that receive A or B or A plus B to the NYCHA standard approach.

Discussion

This RCT addresses key gaps in knowledge and capitalizes on key scientific opportunities by (1) leveraging the federal mandate to ban smoking in a public housing system of more than sufficient size to conduct an adequately powered RCT; (2) expanding our understanding of smoke-free policy compliance beyond policy implementation by testing two novel treatments: (a) in-residence smoking cessation and (b) resident endorsement, while (3) addressing population and location-specific tobacco-related disparities. At the conclusion of the study, this RCT will have leveraged a monumental policy shift affecting nearly half a million NYC public housing residents, many of whom disproportionately experience chronic illness and are more likely to smoke and be exposed to secondhand smoke than other city residents. This first-ever RCT will test the effects of much-needed compliance strategies on resident smoking behavior and secondhand smoke exposure in multiunit housing.

Trial registration

Clinical Trials Registered, NCT05016505. Registered on August 23, 2021.
Community-based integrated care for patients with diabetes and depression (CIC-PDD): study protocol for a cluster randomized controlled trial
Authors: Wang Yanshang , Guo Dan , Wang Ming , Hu Mingzheng , Zhu Dawei , Yu Qianqian , Li Zhansheng , Zhang Xiaoyi , Ding Ruoxi , Zhao Miaomiao , He Ping
Published: August 2023

Background

Managing the multimorbidity of diabetes and depression remains a clinical challenge for patients and healthcare professionals due to the fragmented healthcare delivery system. To effectively cope with multimorbidity, there is an urgent need for the health system to transform into people-centered integrated care (PCIC) system globally. Therefore, this paper describes the protocol of community-based integrated care for patients with diabetes and depression (CIC-PDD) project, an integrated and shared-care intervention project.

Methods/design

CIC-PDD project is conducted in two phases, namely “care model development” and “implementation and evaluation.” In the first phase, CIC-PDD model was designed and developed based on the four criteria of collaborative care model (CCM) and was subsequently adjusted to align with the context of China. The second phase entails a pragmatic, two-arm, cluster randomized controlled implementation trial, accompanied by parallel mixed-methods process evaluation and cost-effectiveness analysis.

Discussion

We anticipate CIC-PDD project will facilitate the development and innovation of PCIC model and related theories worldwide, particularly in low- and middle-income countries (LMICs). In addition, CIC-PDD project will contribute to the exploration of primary health care (PHC) in addressing the multimorbidity of physical and mental health issues.

Trial registration

ClinicalTrials.gov registration ChiCTR2200065608 (China Clinical Trials Registry https://www.chictr.org.cn). Registered on November 9, 2022.