bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnitude and associated factors of VIA positive test results for cervical cancer screening among refugee women aged 25–49 years in North Ethiopia
Authors: Hailemariam Gebretsadik , Gebreyesus Hailay , Wubayehu Tewolde , Gebregyorgis Tsgehana , Gebrecherkos Kidanemariam , Teweldemedhin Mebrahtu , Kifle Manaye
Published: September 2020

Background

Worldwide cervical cancer is the third most common malignancy in women. It usually arises from the cervical area which is susceptible to Human Papilloma virus induced malignancy changes. In low-resource setting visual inspection with acetic acid (VIA) is an alternative sensitive cervical screening method. Therefore the aim of this study was to assess the magnitude and associated factors of VIA positive test results for Cervical Cancer screening among Eritrean refugee women aged 25–49 years in northern Ethiopia refugee camps.

Methods

A community based cross-sectional study was conducted among 412 Eritrean refugee women aged 25–49 years from august 10 to September 25, 2018. Study subjects were selected by simple random sampling method. Data were collected using pretested structured questioner through Face-to-face interview and cervical examination. Data were coded and entered to Epi info software version 7 and then exported to Statistical package for Social Science (SPSS) version 21 for analysis. Bivariable and multivariable logistic regression analysis was made to test the association between the independent variables and the outcome variable. P-value of less than 0.05 with 95% CI was considered to declare statistical significance.

Result

In this study the magnitude of VIA positive precancerous cervical lesions was 9% (95% CI: 6.3–11.8%). Previous history of sexually transmitted infections (STI) [AOR (95%CI) = 2.84(1.07–7.53)] and presence of STI during cervical examination [AOR (95%CI) =3.97(1.75–9.00)] were found significantly associated with VIA positive precancerous cervical lesions.

Conclusions

In this study the magnitude of VIA positive precancerous cervical lesions was high. Previous history of sexually transmitted infections (STI) and presence of STI during cervical examination were found associated with VIA positive precancerous cervical lesions. Efforts such as early screening for sexually transmitted disease shall be done to prevent precancerous cervical lesions.
Contribution of BRCA1 and BRCA2 germline mutations to early onset breast cancer: a series from north of Morocco
Authors: Bakkach Joaira , Mansouri Mohamed , Derkaoui Touria , Loudiyi Ali , El Fahime ElMostafa , Barakat Amina , Ghailani Nourouti Naima , Martinez De Villarreal Jaime , Cortijo Bringas Carlos , Bennani Mechita Mohcine
Published: September 2020

Background

To date, the contribution of BRCA1/2 mutations in Moroccan early onset breast cancer patients remains unknown. Here we assess these genetic alterations for the first time in a cohort from North of Morocco.

Methods

Thirty-three patients diagnosed with breast cancer at the age of ≤40 years were recruited irrespective of breast and/or ovarian cancer family history. Coding regions and intron-exon boundaries of BRCA1 and BRCA2 genes were sequenced from peripheral blood DNA using Ion Proton (Thermo Fisher Scientific) next generation sequencing platform.

Results

Overall, five BRCA germline mutations were identified (15.1%). The frequency of mutations among patients with family history of breast cancer was 16.7%. Three mutations were found in BRCA1 (9%) and two within the BRCA2 gene (6%). These are three frameshift mutations (c.798_799del, c.2125_2126insA, c.5116_5119delAATA), one missense (c.116G > A) and one nonsense mutation (c.289G > T). The mutation c.5116_5119delAATA has a founder effect in North Africa. Moreover, one variant of unknown significance was identified in BRCA2 (c.4090A > G). Most BRCA mutations carriers (80%) had no family history of breast cancer.

Conclusion

Our data do not support the hypothesis that BRCA mutations alone explain the higher frequency of breast cancer in Moroccan young women. The young age (≤40 years) for breast cancer diagnosis seems to be strongly predictive of BRCA mutation status in Moroccan patients. These results will help in decision making with regard to genetic counseling and testing in the national scale.
Lgr5 and stem/progenitor gene expression in gastric/gastroesophageal junction carcinoma – significance of potentially retained stemness
Authors: Yoon Ju-Yoon , Brezden-Masley Christine , Streutker Catherine J.
Published: September 2020

Background

Gastric/gastroesophageal junction (GEJ) adenocarcinomas are heterogeneous, comprising four molecularly distinct subtypes, namely EBV-positive, microsatellite instability (MSI), chromosomal instability (CIN) and genomically stable (GS) subtypes, and a part of this heterogeneity may hypothesized to be different cells-of-origin. Stem/progenitor cell hierarchy in the stomach is complex, which include the Lgr5(+) gastric stem cells (GSCs).

Methods

While previous studies have focused on non-nuclear Lgr5 expression, nuclear Lgr5 expression has been reported in a subset of stem cells, and we examined nuclear Lgr5 expression in a local cohort of 95 cases of gastric/GEJ adenocarcinoma. mRNA levels for LGR5 and other stem cell marker genes were examined in the TCGA cohort.

Results

We observed nuclear Lgr5 expression in a 18/95 cases. Near mutual exclusivity was seen between nuclear Lgr5 and strong non-nuclear Lgr5. Both strong non-nuclear and nuclear Lgr5 expression tended to be seen more frequently with the intestinal histotype and approximated CIN molecular subtype. With respect to overall survival (OS), nuclear Lgr5 expression appears to be protective, with the worst survival being seen in the cases lacking nuclear Lgr5 and with low non-nuclear Lgr5 expression. When compared to other stem/progenitor cell markers, LGR5 mRNA expression clusters with other GSC marker genes, including VIL1. Higher expression of these GSC marker genes was associated with better OS.

Conclusions

Our results show that Lgr5 expression is dynamic in gastric/GEJ adenocarcinoma and heterogeneous across the several disease attributes. We postulate that this may reflect “retained stemness” in the form of Lgr5High-GSC signature that appears to be associated with better survival.
Patient and service-level factors affecting length of inpatient stay in an acute mental health service: a retrospective case cohort study
Authors: Crossley Neil , Sweeney Brian
Published: September 2020

Background

The NHS Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this.

Previous studies have attempted to analyse factors influencing length of stay in mental health units, focussing mostly on patient factors. These models fail to sufficiently explain the variation in duration of inpatient stay. We assess how the type of service delivered by a trust, in addition to patient factors, influences length of stay.

Methods

We conducted a retrospective case cohort study in a large inner-city NHS mental health trust for all admissions in a 1 month period. Data was gathered from electronic notes of 105 patients. Descriptive univariate and bivariate analyses were conducted on the data, with multiple regression analysis conducted on statistically significant data.

Results

Short-stay assessment ward admission significantly reduced length of stay. Patients under outpatients or under care co-ordination, admitted through Mental Health Act assessment and formally detained all had longer length of stay. Out of area admissions, locum Consultant care, changing Responsible Clinician and ward transfers all led to longer length of stay. Factors indicating more severe illness such as increased observation level and polypharmacy, as well as diagnoses of psychosis or bipolar disorder were associated with longer duration of stay. Discharges requiring referral to accommodation or rehabilitation led to longer stays. The most significant factors that influenced length of stay were higher observation levels, diagnosis of psychotic illness or bipolar, and discharge to rehabilitation placement.

The final model, taking into account all these factors, was able to account for 59.6% of the variability in length of stay.

Conclusions

The study backs up existing literature which shows patient-factors have an influence on length of stay. The study also demonstrates that service-level factors have an impact on the duration of stay. This data may be used to inform further studies which may aid provision of inpatient and community services in the future.
Piloting an acceptable and feasible menstrual hygiene products disposal system in urban and rural schools in Bangladesh
Authors: Jahan Farjana , Nuruzzaman Md. , Sultana Farhana , Mahfuz Mehjabin Tishan , Rahman Mahbubur , Akhand Farhana , Luby Stephen P. , Unicomb Leanne , Winch Peter J.
Published: September 2020

Background

Access to washroom facilities and a place to dispose of menstrual waste are prerequisites for optimal menstrual hygiene management in schools. Like other low- and middle-income countries, Bangladeshi schools lack facilities for girls to change and dispose of their menstrual absorbents. We explored existing systems for disposing of menstrual absorbent wastes in urban and rural schools of Bangladesh and assessed the feasibility and acceptability of alternative disposal options.

Methods

We explored how girls dispose of their menstrual products, identified girls’ preferences and choices for a disposal system and piloted four disposal options in four different schools. We then implemented one preferred option in four additional schools. We explored girls’, teachers’, and janitors’ perspectives and evaluated the acceptability, feasibility, and potential for sustainability of the piloted disposal system.

Results

Barriers to optimal menstrual hygiene management included lack of functional toilets and private locations for changing menstrual products, and limited options for disposal. Girls, teachers, and janitors preferred and ranked the chute disposal system as their first choice, because it has large capacity (765 L), is relatively durable, requires less maintenance, and will take longer time to fill. During implementation of the chute disposal system in four schools, girls, teachers, and janitors reported positive changes in toilet cleanliness and menstrual products disposal resulting from the intervention.

Conclusions

The chute disposal system for menstrual products is a durable option that does not require frequent emptying or regular maintenance, and is accepted by schoolgirls and janitors alike, and can improve conditions for menstrual hygiene management in schools. However, regular supervision, motivation of girls to correctly dispose of their products, and a long-term maintenance and management plan for the system are necessary.
Understanding public interest and needs in health policies through the application of social network analysis on a governmental Facebook fan page
Authors: Huang Hsiang-Min , Chiu Ching-Ju
Published: September 2020

Background

This study analyzed the interactions between agencies, policies, and the interest of the public using a social network analysis.

Methods

Open data on the 2017 Facebook fan page of the Ministry of Health and Welfare (MoHW) in Taiwan, including 18,193 messages, were analyzed by conducting a social network analysis, NodeXL (Network Overview, Discovery and Exploration for Excel), creating visualized explorations using size volumes to present the degree of strength between agencies and policies to further calculate the network centrality indicators of agencies and policies.

Results

Agencies of the “Social and Family Affairs Administration” and “Health Promotion Administration” contributed the most policy posts. The policy of “Physical and mental health promotion” entailed the most agencies to be involved. The “Department of Nursing and Health Care” received the largest public response, for which “Long-term care” received the most public interest.

Conclusions

A social network analysis of fan page of Taiwan’s top level health government agency can reveal the government’s most emphasized core policies, the strength of correlations between agencies and policies, and provide an understanding of public interest toward the policies.
Effect of a free healthy school meal on fruit, vegetables and unhealthy snacks intake in Norwegian 10- to 12-year-old children
Authors: Vik Frøydis N. , Heslien Kaia E. P. , Van Lippevelde Wendy , Øverby Nina C.
Published: September 2020

Background

Norwegian children have a lower intake of fruit, vegetables, and a higher intake of unhealthy snacks compared to dietary guidelines. Such dietary inadequacies may be detrimental for their current and future health. Schools are favorable settings to establish healthy eating practices. Still, no school meal arrangement is provided in Norway, and most children typically bring packed lunches from home. The aim of this study was to investigate whether serving a free healthy school meal for one year resulted in a higher intake of fruit and vegetables and a lower intake of unhealthy snacks in total among 10–12-year-olds in Norway.

Methods

The School Meal Project in Southern Norway was a non-randomized trial in two elementary schools in rural areas in the school year 2014/2015. The study sample consisted of 10- to 12-year-old children; an intervention group (N = 55) and a control group (N = 109) resulting in a total of 164 school children at baseline. A food frequency questionnaire was completed by the children at baseline, at five months follow-up and after one year to assess fruit, vegetable, and snacks intake. Multiple linear regression analyses were performed to assess intervention effects on overall intake of fruit and vegetables and unhealthy snacks.

Results

Serving of a free healthy school meal for one year was associated with a higher weekly intake of vegetables on sandwiches in the intervention group compared to the control group, adjusted for baseline intake (B: 1.11 (95% CI: .38, 1.85)) at the end of the intervention. No other significant intervention effects were found for the remaining fruit and vegetables measures. Serving of a free healthy school meal was not associated with a lower weekly intake of unhealthy snacks (i.e. potato chips, candy, sugar sweetened beverages) in the intervention group compared to the control group.

Conclusions

A free healthy school meal was associated with a higher weekly intake of vegetables on sandwiches but did not significantly change any other investigated dietary behaviors. However, given the inadequate intake of vegetables among children and that even moderate improvements have public health relevance, a free healthy school meal for all school children could be beneficial.

Trial registration

ISRCTN61703361.

Date of registration: December 3rd, 2018.

Retrospectively registered.
Examining relationship between occupational acid exposure and oral health in workplace
Authors: Chen Wei-Liang , Chen Yuan-Yuei , Wu Wei-Te , Lai Ching-Huang , Sun Yu-Shan , Wang Chung-Ching
Published: September 2020

Background

Acid mist can suspend in the air and enter the body via skin contact, the respiratory tract, or even oral intake, which pose various health hazards. Previous studies have shown that occupational exposure to acid mist or acidic solutions is a major risk factor for oral diseases. However, the findings are inconsistent and do not consider individual factors and lifestyles that may cause the same oral diseases. Therefore, we conducted a comprehensive oral health survey and collected detail information to confirm the effect of acidic solution exposure on worker’s oral health.

Methods

From 4 acidic solution factories, a total of 309 subjects (157 in control and 152 in exposed group) was enrolled. All participants competed oral examinations and self-report questionnaire, including the decayed, missing, and filled teeth (DMFT) index, community periodontal index (CPI), loss of attachment (LA) index, and tooth erosion. Multivariate logistic regression analysis was used to determine the association between the acidic solution exposure and oral health.

Results

The results showed that acid exposure was correlated with soft oral tissue injury rather than hard oral tissue in our survey. In the multivariate model (adjusted for sex, age, worked years, education level, mouthwash use, dental floss use, tooth brushing, mask use, smoking, drinking, chewing areca and dietary habits with acidic foods), significant relationships of acid exposure with LA score were observed (OR = 2.32, 95% CI 1.03–5.26). However, the presence of acid exposure was not significantly associated with tooth erosion, DMFT, and CPITN.

Conclusion

Our study highlighted that occupational acid exposure was an independent risk factor for periodontal health, especially LA. It is important to strengthen occupational hazard control, educate workers on oral disease and related factors, and raise the awareness of oral hygiene.
Status of dental caries and associated factors in Tibetan adults: findings from the fourth China National Oral Health Survey
Authors: Guan Lingxia , Guo Jing , Ban Jinghao , Li Gang , Tong Juan , Chuan Aiyun , Tian Tian , Han Bing , Xuan Kun , Wang Shengchao
Published: September 2020

Background

Tibet, a region where average elevation is above 3500 m and socio-economic development is relatively lower, was not included in National Oral Health Survey over decades. The cross-sectional study aimed to investigate the status of dental caries and associated factors in Tibetan adults.

Methods

Participants aged 35–44, 55–64 and 65–74 years were selected. Decayed, missing, and filled tooth (DMFT), decayed and filled root (DF-Root) and root canal index (RCI) were used to evaluate dental caries. Questionnaire survey on demographic information, socioeconomic status, dietary habits, and oral health knowledge and behavior was conducted. Mann-Whitney U test, logistic regression were used for the statistical analyses.

Results

A total of 446 participants were enrolled in the survey. Of these: 222 (49.8%) were females, 224 (50.2%) were males; 149 (33.4%), 151 (33.9%), 146 (32.7%) were aged 35–44, 55–64 and 65–74 years respectively. The mean DMFT (SD) was 7.62 (4.84), 12.46 (8.16), and 21.38 (8.93). The filling rate was very low in all age groups (1.77%, 0.98%, 0.45%). The mean DF-Root (SD) was 0.50 (1.04), 1.04 (2.02), 1.32 (2.14), respectively. Root caries index was 42.27, 44.78 and 57.60%. Older age (65–74 age group) was positively associated with crown caries (odds ratio = 31.20, 95% confidence interval: 10.70–90.96). College degree and above and brushing teeth at least once a day were negatively associated with crown caries (odds ratio = 0.28, 95% confidence interval: 0.09–0.89; odds ratio = 0.39, 95% confidence interval: 0.21–0.72, respectively). Rural area, high income level and brushing teeth at least once a day were negatively and tooth with attachment loss was positively associated with root caries.

Conclusions

The status of dental caries in the adults in Tibet is severe and the treatment rate is very low. The study suggests a correlation between crown caries and the variables age, level of education and frequency of tooth brushing; correlation between root caries and residence, income level, frequency of tooth brushing and exposed root surfaces. These findings could be as reference to develop community based interventions to reduce the prevalence of caries in Tibet.
Impacts of contracted endodontic cavities compared to traditional endodontic cavities in premolars
Authors: Xia Juan , Wang Weidong , Li Zhengmao , Lin Bingpeng , Zhang Qian , Jiang Qianzhou , Yang Xuechao
Published: September 2020

Background

This study aims to compare the percentage of dentin removed, instrumentation efficacy, root canal filling and load at fracture between contracted endodontic cavities, and traditional endodontic cavities on root canal therapy in premolars.

Methods

Forty extracted intact human first premolars were imaged with micro-CT and randomly assigned to the contracted endodontic cavity (CEC) or traditional endodontic cavity (TEC) groups. CEC was prepared with the aid of a 3D-printed template, canals were prepared with a 0.04 taper M-Two rotary instrument, and cavities were restored with resin. Specimens were loaded to fracture in an Instron Universal Testing Machine after a fatigue phase. The data were analyzed by the independent samples T test and Mann-Whitney U test, appropriate post hoc tests.

Results

In the premolars tested in vitro, the percentage of dentin removed in the premolars with two dental roots in the CEC group (3.85% ± 0.42%) was significantly smaller (P < 0.05) than in the TEC group (4.94% ± 0.5%). The untouched canal wall (UCW) after instrumentation for TECs (16.43% ± 6.56%) was significantly lower (P < .05) than the UCW (24.42% ± 9.19%) for CECs in single-rooted premolars. No significant differences were observed in the increased canal volume and surface areas in premolars between the TEC and CEC groups (P > 0.05). CECs conserved coronal dentin in premolars with two dental roots but no impact on the instrument efficacy.

There were no differences between the CEC groups and the TEC groups in the percentage of filling material and voids (P > 0.05). In addition, the mean load at failure of premolars did not significantly differ between the CEC and TEC groups and there was no significant difference in the type of fracture (P > 0.05).

Conclusion

The results of this study suggest that CEC could not improve the fracture resistance of the endodontically treated premolars. The instrumentation efficacy and the percentage of filling material did not significantly differ between CECs and TECs in premolars.
Using the technology acceptance model to explore health provider and administrator perceptions of the usefulness and ease of using technology in palliative care
Authors: Nguyen M. , Fujioka J. , Wentlandt K. , Onabajo N. , Wong I. , Bhatia R. S. , Bhattacharyya O. , Stamenova V.
Published: September 2020

Background

Studies have shown that telehealth applications in palliative care are feasible, can improve quality of care, and reduce costs but few studies have focused on user acceptance of current technology applications in palliative care. Furthermore, the perspectives of health administrators have not been explored in palliative care and yet they are often heavily involved, alongside providers, in the coordination and use of health technologies. The study aim was to explore both health care provider and administrator perceptions regarding the usefulness and ease of using technology in palliative care.

Methods

The Technology Acceptance Model (TAM) was used as the guiding theoretical framework to provide insight into two key determinants that influence user acceptance of technology (perceived usefulness and ease of use). Semi-structured interviews (n = 18) with health providers and administrators with experience coordinating or using technology in palliative care explored the usefulness of technologies in palliative care and recommendations to support adoption. Interview data were analyzed using inductive thematic analysis to identify common, meaningful themes.

Results

Four themes were identified; themes related to perceived usefulness were: enabling remote connection and information-sharing platform. Themes surrounding ease of use included: integration with existing IT systems and user-friendly with ready access to technical support. Telehealth can enable remote connection between patients and providers to help address insufficiencies in the current palliative care environment. Telehealth, as an information sharing platform, could support the coordination and collaboration of interdisciplinary providers caring for patients with palliative needs. However, health technologies need to passively integrate with existing IT systems to enhance providers’ workflow and productivity. User-friendliness with ready access to technical support was considered especially important in palliative care as patients often experience diminished function.

Conclusion

Participants’ perspectives of technology acceptance in palliative care were largely dependent on their potential to help address major challenges in the field without imposing significant burden on providers and patients.
Knowledge of pharmacy workers on antihypertensive and anticonvulsant drugs for managing pre-eclampsia and eclampsia in Bangladesh
Authors: Roy Shongkour , Sultana Kanij , Hossain Sharif Mohammed Ismail , Sripad Pooja , Warren Charlotte E.
Published: September 2020

Background

Pharmacy workers in Bangladesh play an important role in managing pregnancy complications by dispensing, counselling and selling drugs to pregnant women and their families. This study examined pharmacy workers’ drug knowledge and practice for pre-eclampsia and eclampsia (PE/E) management, including antihypertensives and anticonvulsants, and determine factors associated with their knowledge.

Methods

A cross-sectional survey with 382 pharmacy workers in public facilities (government) and private pharmacies and drug stores assessed their knowledge of antihypertensive and anticonvulsant drugs. ‘Pharmacy workers’ include personnel who work at pharmacies, pharmacists, family welfare visitors (FWVs), sub-assistant community medical officers (SACMOs), drug storekeepers. Exploratory and multivariate logistic models were used to describe association between knowledge of medicines used in pregnancy and demographic characteristics of pharmacy workers.

Results

Overall, 53% pharmacy workers interviewed were drug store owners in private pharmacies while 27% FWVs/SACMOs, who are government service providers also work as drug prescribers and/or dispensers in public facility pharmacies. Majority of pharmacy workers had poor knowledge compared to correct knowledge on both antihypertensive (77.8% vs 22.3%; p < 0.001) and anticonvulsant drugs (MgSO4) (82.2% vs 17.8%; p < 0.001). Multivariate analysis showed SACMOs and FWVs were greater than 4 times more likely to have correct knowledge on anti-hypertensives (AOR = 4.2, 95% CI:1.3–12.3, P < 0.01) and anticonvulsant drugs (AOR = 4.9, 95% CI:1.3–18.1, P < 0.01) compared to pharmacists. Pharmacy workers who had received training were more likely to have correct knowledge on antihypertensive and anticonvulsant drugs than those who had no training.

Conclusions

Pharmacy workers’ knowledge and understanding of antihypertensive and anticonvulsant drugs, particularly for prevention and management of PE/E is limited in Bangladesh. Most pharmacies surveyed are private and staffed with unskilled workers with no formal training on drugs. Expansion of maternal and newborn health programs should consider providing additional skills training to pharmacy workers, as well as regulating these medicines at informal pharmacies to mitigate any harmful practices or adverse outcomes of unauthorized and incorrectly prescribed and used drugs. It is important that correct messaging and medicines are available as drug stores are often the first point of contact for most of the women and their families.
Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: a systematic review and meta-analysis
Authors: Kassa Zemenu Yohannes , Tsegaye Berhan , Abeje Abebaw
Published: September 2020

Background

Disrespectful and abusive treatment of women by health care providers during the process of childbirth at health facility is an international problem. There is a lack of data on disrespect and abuse of women during the process of childbirth at health facilities in Sub-Saharan Africa. The purpose of this study was to determine the prevalence of disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa.

Methods

The PRISMA guideline protocol was followed to write the systematic review and meta-analysis. Published studies were searched from Medline, PubMed, CINAHL, EMBASE, Maternal and infant care, science direct, and PsycINFO. Articles were accessed by three reviewers (ZY, BT and AA) using the following key terms, “attitude of health personnel” AND “delivery obstetrics*/nursing” OR “maternity care” AND “disrespect” OR “abuse” OR “professional misconduct” AND “parturition” AND “prevalence” AND “professional-patient relations” AND “Sub-Saharan Africa”. Additional articles were retrieved by cross referencing of reference. The heterogeneity of studies were weighed using Cochran’s Q test and I2test statistics. Publication bias was assessed by Egger’s test.

Results

Thirty three studies met the inclusion and included in this systematic review and meta–analysis of disrespect and abuse of women during the process of childbirth at health facilities. The pooled prevalence of disrespect and abuse women during the process of childbirth at health facilities in Sub-Saharan Africa was 44.09% (95% CI: 29.94–58.24).Particularly physical abuse was 15.77% (95% CI: 13.38–18.15), non-confidential care was 16.87% (95% CI: 14.49–19.24), abandonment was 16.86% (95% CI: 13.88–19.84) and detention was 4.81% (95% CI: 3.96–5.67).

Conclusion

In this study disrespect and abuse of women during the process of childbirth at health facilities are high compared with other studies, particularly non-confidential care and abandonment his high compared with other studies. This study points out that the ministry of health, health care providers, maternal health experts shall due attention to women’s right during the process of childbirth at health facilities.
How to design a pre-specified statistical analysis approach to limit p-hacking in clinical trials: the Pre-SPEC framework
Authors: Kahan Brennan C. , Forbes Gordon , Cro Suzie
Published: September 2020

Results from clinical trials can be susceptible to bias if investigators choose their analysis approach after seeing trial data, as this can allow them to perform multiple analyses and then choose the method that provides the most favourable result (commonly referred to as ‘p-hacking’). Pre-specification of the planned analysis approach is essential to help reduce such bias, as it ensures analytical methods are chosen in advance of seeing the trial data. For this reason, guidelines such as SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and ICH-E9 (International Conference for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use) require the statistical methods for a trial’s primary outcome be pre-specified in the trial protocol. However, pre-specification is only effective if done in a way that does not allow p-hacking. For example, investigators may pre-specify a certain statistical method such as multiple imputation, but give little detail on how it will be implemented. Because there are many different ways to perform multiple imputation, this approach to pre-specification is ineffective, as it still allows investigators to analyse the data in different ways before deciding on a final approach. In this article, we describe a five-point framework (the Pre-SPEC framework) for designing a pre-specified analysis approach that does not allow p-hacking. This framework was designed based on the principles in the SPIRIT and ICH-E9 guidelines and is intended to be used in conjunction with these guidelines to help investigators design the statistical analysis strategy for the trial’s primary outcome in the trial protocol.
Multi-slice representational learning of convolutional neural network for Alzheimer’s disease classification using positron emission tomography
Authors: Kim Han Woong , Lee Ha Eun , Oh KyeongTaek , Lee Sangwon , Yun Mijin , Yoo Sun K.
Published: September 2020

Background

Alzheimer’s Disease (AD) is a degenerative brain disorder that often occurs in people over 65 years old. As advanced AD is difficult to manage, accurate diagnosis of the disorder is critical. Previous studies have revealed effective deep learning methods of classification. However, deep learning methods require a large number of image datasets. Moreover, medical images are affected by various environmental factors. In the current study, we propose a deep learning-based method for diagnosis of Alzheimer’s disease (AD) that is less sensitive to different datasets for external validation, based upon F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT).

Results

The accuracy, sensitivity, and specificity of our proposed network were 86.09%, 80.00%, and 92.96% (respectively) using our dataset, and 91.02%, 87.93%, and 93.57% (respectively) using the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset. We observed that our model classified AD and normal cognitive (NC) cases based on the posterior cingulate cortex (PCC), where pathological changes occur in AD. The performance of the GAP layer was considered statistically significant compared to the fully connected layer in both datasets for accuracy, sensitivity, and specificity (p < 0.01). In addition, performance comparison between the ADNI dataset and our dataset showed no statistically significant differences in accuracy, sensitivity, and specificity (p > 0.05).

Conclusions

The proposed model demonstrated the effectiveness of AD classification using the GAP layer. Our model learned the AD features from PCC in both the ADNI and Severance datasets, which can be seen in the heatmap. Furthermore, we showed that there were no significant differences in performance using statistical analysis.
Low high-density lipoprotein level is correlated with the severity of COVID-19 patients: an observational study
Authors: Wang Guyi , Zhang Quan , Zhao Xianmei , Dong Haiyun , Wu Chenfang , Wu Fang , Yu Bo , Lv Jianlei , Zhang Siye , Wu Guobao , Wu Shangjie , Wang Xiaolei , Wu Ying , Zhong Yanjun
Published: September 2020

Background

The purpose of the study is to describe the blood lipid levels of patients diagnosed with coronavirus disease 2019 (COVID-19) and to analyze the correlation between blood lipid levels and the prognosis of COVID-19 patients.

Methods

In the clinical retrospective analysis, a total of 228 adults infected with COVID-19 were enrolled between January 17, 2020 and March 14, 2020, in Changsha, China. One thousand one hundred and forty healthy participants with matched age and gender were used as control. Median with interquartile range and Mann-Whitney test were adopted to describe and analyze clinical data. The Kaplan-Meier (KM) curve and Cox regression analysis were used to analyze the correlation between high-density lipoprotein cholesterol (HDL-C) and the severity of COVID-19.

Results

Compared with control, COVID-19 patients showed significantly lower levels of total cholesterol (TC) [median, 3.76 vs 4.65 mmol/L, P = 0.031], triglyceride [median, 1.08 vs 1.21 mmol/L, P <  0.001], low-density lipoprotein cholesterol (LDL-C) [median, 2.63 vs 2.83 mmol/L, P <  0.001], and HDL-C [median, 0.78 vs 1.37 mmol/L, P <  0.001], while compared with non-severe patients, severe COVID-19 patients only presented lower levels of HDL-C [median, 0.69 vs 0.79 mmol/L, P = 0.032]. In comparison with patients with high HDL-C, patients with low HDL-C showed a higher proportion of male (69.57% vs 45.60%, P = 0.004), higher levels of C-reactive protein (CRP) (median, 27.83 vs 12.56 mg/L, P <  0.001) and higher proportion of severe events (36.96% vs 14.84%, P = 0.001). Moreover, patients with low HDL-C at admission showed a higher risk of developing severe events compared with those with high HDL-C (Log Rank P = 0.009). After adjusting for age, gender and underlying diseases, they still had elevated possibility of developing severe cases than those with high HDL-C (HR 2.827, 95% CI 1.190–6.714, P = 0.019).

Conclusions

HDL-C level was lower in COVID-19 adult patients, and low HDL-C in COVID-19 patients was correlated with a higher risk of developing severe events.
HIF-1α expression in liver metastasis but not primary colorectal cancer is associated with prognosis of patients with colorectal liver metastasis
Authors: Wada Yuma , Morine Yuji , Imura Satoru , Ikemoto Tetsuya , Saito Yu , Takasu Chie , Yamada Shinichiro , Shimada Mitsuo
Published: September 2020

Background

The role of hypoxia-inducible factor-1α (HIF-1α) in primary colorectal cancer (CRC) and colorectal liver metastasis (CRLM) has remained unclear. The aim of this study was to investigate HIF-1α expression and its association with prognosis in patients with CRLM with a focus on hepatic stellate cells (HSCs).

Methods

Colon cancer cells were cultured in HSC-conditioned medium (CM), and HIF-1α expression and cell migration were analyzed. Seventy-five patients with CRLM who underwent an initial curative hepatectomy were enrolled. We examined HIF-1α expressions and patient prognosis between primary CRCs and the matched liver metastatic specimens.

Results

Activated HSCs induced HIF-1α mRNA and protein expression in colon cancer cells (p < 0.01) and promoted cell migration (p < 0.01). The positive rates of HIF-1α expression in primary CRCs and liver metastases were 68.0 and 72.0%, respectively. There were no differences in overall (OS) and disease-free survival (DFS) of HIF-1α expression in primary CRC. However, HIF-1α expression in liver metastasis correlated to poor prognosis in both OS and DFS. Furthermore, patients with HIF-1α positive expression in liver metastasis had poor prognosis.

Conclusion

HIF-1α expression in liver metastasis determines poor prognosis of CRLM patients. HSCs might play a key role in aggressive phenotypes of tumor cells.
Cessation of breastfeeding and associated factors in the era of elimination of mother to child transmission of HIV at Ndejje health center, Uganda: a retrospective cohort study
Authors: Ngbapai Jackslina Gaaniri , Izudi Jonathan , Okoboi Stephen
Published: September 2020

Background

Breastfeeding an infant exposed to Human Immunodeficiency Virus (HIV) carries the risk of HIV acquisition whilst not breastfeeding poses a higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at 1 year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda.

Methods

This retrospective cohort study involved all mothers living with HIV and enrolled in HIV care for ≥12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at 1 year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t - tests, and established independently associated factors using modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results.

Results

Of 235 participants, 150 (63.8%) had ceased breastfeeding at 1 year and this was independently associated with the infant being male (Adjusted Risk Ratio [aRR] 1.25, 95% confidence interval [CI] 1.04, 1.50), the mother being multiparous (aRR 1.26, 95% CI 1.04–1.53), and the initiation of breastfeeding being on the same-day as birth (aRR 0.06, 95% CI 0.01–0.41). The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth.

Conclusion

Suboptimal proportion of infants were ceased from breastfeeding at 1 year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among male infants and multiparous mothers but less likely when breastfeeding was initiated on the same-day as birth. Interventions to enhance cessation of breastfeeding should target none multiparous mothers and those with female infants.
Does new instrument for Oxford unicompartmental knee arthroplasty improve short-term clinical outcome and component alignment? A meta-analysis
Authors: Sun Xiao Wei , Lu Fei Fan , Zou Kun , Hong Mao , Zhang Qi Dong , Guo Wan Shou
Published: September 2020

Background

The Microplasty (MP) instrumentation designed for the Phase III Oxford mobile-bearing unicompartmental knee arthroplasty (UKA) system is considered a better option to achieve more accurate component positioning and alignment. In the present study, we focused on short-term clinical and radiological outcomes to determine whether the MP instrumentation can reduce the short-term revision rate and occurrence of outliers of metallic components.

Methods

The literature in PubMed, Embase, the Cochrane Library, and Web of Science was searched up to May 2020. Studies were scrutinized by two independent authors, and the revision rate, complication spectrum, and radiological assessment with outlier rates were specifically analyzed. RevMan 5.3 was used for the statistical analysis.

Results

Seven studies were included in the meta-analysis. Four studies reported both clinical and radiological outcomes, two reported only radiological outcomes, and one reported only clinical outcomes. The pooled analysis showed that the revision rate in the MP instrumentation group was 0.866 per 100 component years, while that in the control group was 1.124 (odds ratio, 0.77; p < 0.05). The subgroup analysis of the bearing dislocation rate showed a significantly greater reduction in the Korean population than in the populations of other countries (p < 0.05). The radiological assessment showed that the alignment of the femoral component was significantly improved (p < 0.05), while that of the tibial component was not (p > 0.05).

Conclusion

The newly developed MP instrumentation for Oxford UKA significantly reduced the revision rate of this treatment. The positioning of the femoral component was also proven to be better by radiological assessments.
A large deletion in the COL2A1 gene expands the spectrum of pathogenic variants causing bulldog calf syndrome in cattle
Authors: Jacinto Joana Gonçalves Pontes , Häfliger Irene Monika , Letko Anna , Drögemüller Cord , Agerholm Jørgen Steen
Published: September 2020

Background

Congenital bovine chondrodysplasia, also known as bulldog calf syndrome, is characterized by disproportionate growth of bones resulting in a shortened and compressed body, mainly due to reduced length of the spine and the long bones of the limbs. In addition, severe facial dysmorphisms including palatoschisis and shortening of the viscerocranium are present. Abnormalities in the gene collagen type II alpha 1 chain (COL2A1) have been associated with some cases of the bulldog calf syndrome. Until now, six pathogenic single-nucleotide variants have been found in COL2A1. Here we present a novel variant in COL2A1 of a Holstein calf and provide an overview of the phenotypic and allelic heterogeneity of the COL2A1-related bulldog calf syndrome in cattle.

Case presentation

The calf was aborted at gestation day 264 and showed generalized disproportionate dwarfism, with a shortened compressed body and limbs, and dysplasia of the viscerocranium; a phenotype resembling bulldog calf syndrome due to an abnormality in COL2A1. Whole-genome sequence (WGS) data was obtained and revealed a heterozygous 3513 base pair deletion encompassing 10 of the 54 coding exons of COL2A1. Polymerase chain reaction analysis and Sanger sequencing confirmed the breakpoints of the deletion and its absence in the genomes of both parents.

Conclusions

The pathological and genetic findings were consistent with a case of “bulldog calf syndrome”. The identified variant causing the syndrome was the result of a de novo mutation event that either occurred post-zygotically in the developing embryo or was inherited because of low-level mosaicism in one of the parents. The identified loss-of-function variant is pathogenic due to COL2A1 haploinsufficiency and represents the first structural variant causing bulldog calf syndrome in cattle. Furthermore, this case report highlights the utility of WGS-based precise diagnostics for understanding congenital disorders in cattle and the need for continued surveillance for genetic disorders in cattle.
Development of canine C-reactive protein assays
Authors: Waritani Takaki , Cutler Dawn , Chang Jessica
Published: September 2020

C-reactive protein (CRP), which is released during tissue damage and inflammation, is a useful nonspecific inflammatory marker in both human and veterinary clinical practice. Veterinarians have often used human CRP assays to analyze samples from canine patients, but cross-reactivities between the species affect assay sensitivity and reliability, leading to inaccurate inflammation assessment. To improve the efficiency of inflammation assessment, we developed a canine CRP detection enzyme-linked immunosorbent assay (ELISA) for quantitative analysis and an immunochromatography assay (ICA) for semiquantitative point-of-care (POC) analysis. The ELISA demonstrated an assay detection limit of 0.5 ng/mL, quantitative linear assay range of 1.6–100 ng/mL, and intra- and inter-assay coefficient of variations of 0.7 to 10.0% and 6.0 to 9.0%, respectively; the recovery rates of samples spiked with purified canine CRP were 105 to 109%, and the parallelism assessments were 82.7 to 104.4%. The correlation between the CRP level results obtained with the ELISA and those of a currently available quantitative POC assay was 0.907 with the regression formula of y = 0.55x + 0.05. In addition, the ICA requires only 5 μL samples and a 10-min assay time, and clearly distinguished positive, weak positive, and negative samples (P < 0.001) at an approximately 5–10 µg/mL cut-off value. The developed canine CRP ELISA and ICA showed reliable assay results and a high correlation with a commercially available POC assay in clinical use. The ICA can be a useful canine CRP screening test for diagnostic purposes in veterinary clinics.
Visualization of activity-regulated BDNF expression in the living mouse brain using non-invasive near-infrared bioluminescence imaging
Authors: Fukuchi Mamoru , Saito Ryohei , Maki Shojiro , Hagiwara Nami , Nakajima Yumena , Mitazaki Satoru , Izumi Hironori , Mori Hisashi
Published: September 2020

Altered levels of brain-derived neurotrophic factor (BDNF) have been reported in neurologically diseased human brains. Therefore, it is important to understand how the expression of BDNF is controlled under pathophysiological as well as physiological conditions. Here, we report a method to visualize changes in BDNF expression in the living mouse brain using bioluminescence imaging (BLI). We previously generated a novel transgenic mouse strain, Bdnf-Luciferase (Luc), to monitor changes in Bdnf expression; however, it was difficult to detect brain-derived signals in the strain using BLI with d-luciferin, probably because of incomplete substrate distribution and light penetration. We demonstrate that TokeOni, which uniformly distributes throughout the whole mouse body after systematic injection and produces a near-infrared bioluminescence light, was suitable for detecting signals from the brain of the Bdnf-Luc mouse. We clearly detected brain-derived bioluminescence signals that crossed the skin and skull after intraperitoneal injection of TokeOni. However, repeated BLI using TokeOni should be limited, because repeated injection of TokeOni on the same day reduced the bioluminescence signal, presumably by product inhibition. We successfully visualized kainic acid-induced Bdnf expression in the hippocampus and sensory stimulation-induced Bdnf expression in the visual cortex. Taken together, non-invasive near-infrared BLI using Bdnf-Luc mice with TokeOni allowed us to evaluate alterations in BDNF levels in the living mouse brain. This will enable better understanding of the involvement of BDNF expression in the pathogenesis and pathophysiology of neurological diseases.