bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of virtual surgical planning and a three‐dimensional‐printed, patient‐specific reduction system to facilitate alignment of diaphyseal tibial fractures stabilized by minimally invasive plate osteosynthesis in dogs: A prospective clinical study
Authors: Scheuermann Logan M. , Lewis Daniel D. , Johnson Matthew D. , Biedrzycki Adam H. , Kim Stanley E.
Published: June 2024

Objective

To evaluate the efficacy of a three‐dimensional (3D)‐printed, patient‐specific reduction system for aligning diaphyseal tibial fractures stabilized using minimally invasive plate osteosynthesis (MIPO).

Study design

Prospective clinical trial.

Sample population

Fifteen client owned dogs.

Methods

Virtual 3D models of both pelvic limbs were created. Pin guides were designed to conform to the proximal and distal tibia. A reduction bridge was designed to align the pin guides based on the guides' spatial location. Guides were 3D printed, sterilized, and applied, in conjunction with transient application of a circular fixator, to facilitate indirect fracture realignment before plate application. Alignment of the stabilized tibiae was assessed using postoperative computed tomography scans.

Results

Mean duration required for virtual planning was 2.5 h and a mean of 50.7 h elapsed between presentation and surgery. Guide placement was accurate with minor median discrepancies in translation and frontal, sagittal, and axial plane positioning of 2.9 mm, 3.6°, 2.7°, and 6.8°, respectively. Application of the reduction system restored mean tibial length and frontal, sagittal, and axial alignment within 1.7 mm, 1.9°, 1.7°, and 4.5°, respectively, of the contralateral tibia.

Conclusion

Design and fabrication of a 3D‐printed, patient‐specific fracture reduction system is feasible in a relevant clinical timeline. Intraoperative pin‐guide placement was reasonably accurate with minor discrepancies compared to the virtual plan. Custom 3D‐printed reduction system application facilitated near‐anatomic or acceptable fracture reduction in all dogs.

Clinical significance

Virtual planning and fabrication of a 3D‐printing patient‐specific fracture reduction system is practical and facilitated acceptable, if not near‐anatomic, fracture alignment during MIPO.
Phylogenomics of the catfish family Pimelodidae with focus on the genus Pimelodus support the recognition of Sorubiminae and Pimelodinae (Teleostei, Siluriformes)
Authors: Silva Gabriel S. C. , Rocha Marcelo S. , Melo Bruno F. , Reia Lais , Roxo Fábio F. , Sabaj Mark H. , Oliveira Claudio
Published: June 2024

Pimelodidae is a family of large‐sized catfishes consisting of 116 valid species divided into 30 genera distributed in the Neotropical region. Despite recent advancements in understanding the pimelodid phylogeny, several internal relationships have remained unclear and have received limited support from various phylogenetic analyses. We provide a new genomic dataset comprising 55 species representing 25 genera of Pimelodidae and related siluriform families Aspredinidae, Auchenipteridae, Cetopsidae, Doradidae, Diplomystidae, Heptapteridae, Loricariidae, and Pseudopimelodidae. Our phylogenetic analyses support the monophyly of Pimelodidae, as well as the existence of four major lineages: the Steindachneridion clade, the Leiarius + Phractocephalus clade, and two major subclades herein classified as Sorubiminae and Pimelodinae. Our topology resolves Phractocephalus sister to Leiarius differing from previous phylogenies. In Sorubiminae, Zungaro is sister to two large clades: one with Sorubim, Sorubimichthys, and Pseudoplatystoma, and the other with Hemisorubim, Platysilurus, Platystomatichthys, Brachyplatystoma, and Hypophthalmus. In Pimelodinae, we found the Pimelodus ornatus clade, the calophysines, and the clade with Exallodontus, Propimelodus, and Pimelodus altissimus closer to the Pimelodus group. Parapimelodus, Duopalatinus, Iheringichthys, and Bergiaria are included within the Pimelodus group. The Pimelodus group contains four main components: (1) Duopalatinus peruanus, (2) the trans‐Andean Pimelodus grosskopfii; (3) Pimelodus maculatus clade with species from the Brazilian Shield in southeastern Brazil; and (4) Pimelodus blochii clade composed by species from the Amazon, Orinoco, Paraná‐Paraguay, Parnaíba, São Francisco and coastal drainages of the Guiana Shield. The P. maculatus clade is composed by phenotypically diverse species, and the P. blochii clade houses species morphologically similar that appear nested within the widely distributed P. blochii.
Genetic analysis of Discogobio (Cypriniformes: Cyprinidae) in the Central Yunnan Basin: Effects of geological events and conservation perspectives
Authors: Che Xing‐Jin , Zhang Yuan‐Wei , Wu An‐Li , Zhang Li‐Mei , Pan Xiao‐Fu , Wang Mo , Yang Jun‐Xing , Wang Xiao‐Ai
Published: June 2024

Geological events can have a major effect on the genetic structure and differentiation of fish populations. The relative importance of key geological events on the distribution and genetic structure of endemic fish of the genus Discogobio in the Yunnan–Guizhou Plateau has not yet been evaluated. Studies of the phylogeography of Discogobio fishes could provide insights into spatial and temporal changes in their population size, dispersal history, and extent of geographical isolation, and the data acquired in such studies can be used to aid their conservation. Here, we used single‐nucleotide polymorphisms (SNP) to characterize the phylogeography of Discogobio fishes. Our analysis supports the endemicity of Discogobio. However, Discogobio samples from different regions contained multiple ancestral components, including admixed and diversified genetic components. This might stem from polymorphism of the ancestors themselves or the infiltration of genes caused by hybridization between Discogobio species. We estimated that the most recent common ancestor (MRCA) of Discogobio fish in the Central Yunnan Basin was approximately 4.63–3.83 million years ago (Ma). We also inferred that the evolution of Discogobio in the Central Yunnan Basin was closely related to the expansion and contraction of the lake basin around 2.59–0.13 Ma. We proposed measures that could be implemented to conserve remaining populations and their corresponding habitats to prevent further declines and preserve the biodiversity of this unique genus.
More than the clock: distinct regulation of muscle function and metabolism by PER2 and RORα
Authors: Mansingh Shivani , Maier Geraldine , Delezie Julien , Westermark Pål O. , Ritz Danilo , Duchemin Wandrille , Santos Gesa , Karrer‐Cardel Bettina , Steurer Stefan A. , Albrecht Urs , Handschin Christoph
Published: June 2024

Circadian rhythms, governed by the dominant central clock, in addition to various peripheral clocks, regulate almost all biological processes, including sleep–wake cycles, hormone secretion and metabolism. In certain contexts, the regulation and function of the peripheral oscillations can be decoupled from the central clock. However, the specific mechanisms underlying muscle‐intrinsic clock‐dependent modulation of muscle function and metabolism remain unclear. We investigated the outcome of perturbations of the primary and secondary feedback loops of the molecular clock in skeletal muscle by specific gene ablation of Period circadian regulator 2 (Per2) and RAR‐related orphan receptor alpha (Rorα), respectively. In both models, a dampening of core clock gene oscillation was observed, while the phase was preserved. Moreover, both loops seem to be involved in the homeostasis of amine groups. Highly divergent outcomes were seen for overall muscle gene expression, primarily affecting circadian rhythmicity in the PER2 knockouts and non‐oscillating genes in the RORα knockouts, leading to distinct outcomes in terms of metabolome and phenotype. These results highlight the entanglement of the molecular clock and muscle plasticity and allude to specific functions of different clock components, i.e. the primary and secondary feedback loops, in this context. The reciprocal interaction between muscle contractility and circadian clocks might therefore be instrumental to determining a finely tuned adaptation of muscle tissue to perturbations in health and disease.

image

Key points

Specific perturbations of the primary and secondary feedback loop of the molecular clock result in specific outcomes on muscle metabolism and function.

Ablation of Per2 (primary loop) or Rorα (secondary loop) blunts the amplitude of core clock genes, in absence of a shift in phase.

Perturbation of the primary feedback loop by deletion of PER2 primarily affects muscle gene oscillation.

Knockout of RORα and the ensuing modulation of the secondary loop results in the aberrant expression of a large number of non‐clock genes and proteins.

The deletion of PER2 and RORα affects muscle metabolism and contractile function in a circadian manner, highlighting the central role of the molecular clock in modulating muscle plasticity.
Influence of recurrent assessments during data collection on caregivers and young children for an agricultural livelihood intervention in Kenya: a qualitative study
Authors: Richards Audrey L , Hiepler Amelia J , Frongillo Edward A , Khan Shameemah , Holding Penny , Nanga Khadija , Kammerer Betsy , Otieno Phelgona , Butler Lisa M
Published: June 2024

Objectives

We sought to understand the influence of recurrent assessments on the behaviour of children and caregivers in a 2-year study of an agricultural livelihood intervention.

Design

This study used qualitative exit interviews from caregivers in the control arm of a large, cluster-randomised control trial, Shamba Maisha.

Setting

The study was conducted in Western Kenya and involved 12 health facilities between 2016 and 2019.

Participants

Participants were 99 caregivers in the control arm who had a child that was 6–36 months in age at the start of the study.

Interventions

Intervention participants within Shamba Maisha received an irrigation pump, farming lessons and a microloan. Control participants received no intervention but were offered the intervention after completing the 2-year study.

Results

Despite receiving no formal benefits, control caregivers reported improved mental health and enhanced knowledge of their child’s health compared with the beginning of the study and reported changes in the child’s play and diet that they attributed to participation in study assessments. Caregivers in the control arm attributed their changed behaviour to recurrent questioning, instrumental support, interactions with study staff and increased health knowledge.

Conclusions

Recurrent assessments altered participant behaviour, which may have made inference of the intervention’s impact more difficult. In designing future, such studies with intervention and control arms, a trade-off between the gains in statistical power provided by recurrent visits and the avoidance of alterations in participants’ behaviour that could affect responses to assessments must be considered when deciding on the number of visits for assessment.

Trial registration numbers

NCT03170986;NCT02815579.
Association between nutritional risk and fatigue in frailty conditions for older adult patients: a multicentre cross-sectional survey study
Authors: Chen Liru , Liu Chengyu , Deng An , Zhang Anqi , Zhu Mingwei , Xi Huan
Published: June 2024

Background and aims

Frailty is widespread in the elderly, while there is a bi-directional relationship between frailty and malnutrition. The objectives of this study were to investigate the prevalence and correlation of frailty and nutritional risk in older adult patients and to analyse the factors associated with fatigue which is one indicator of frailty.

Methods

This cross-sectional multicentre survey study was conducted in five hospitals in the same city from 01 January 2021 to 01 December 2021. We collected information on gender, age, diseases, medication and dietary status. Frailty status was diagnosed using the FRAIL scale, and Nutritional Risk Screening-2002 was used to screen the nutritional risk. Spearman rank correlation was used to analyse the correlation between frailty and nutritional risk. Univariate and multivariate logistic regression analyses were used to analyse the risk factors related to fatigue in all patients and inpatients.

Results

Among 2016 older adult patients, the prevalence of frailty was 15.1% (305/2016), the prevalence of nutritional risk was 16.2% (327/2016) and the overlap prevalence of frailty and nutritional risk was 7.3% (147/2016). Multivariate analysis showed that nutritional risk (OR 3.109, 95% CI 2.384 to 4.056, p<0.001) was an independent risk factor for fatigue in all patients; similar results were found for nutritional risk (OR 2.717, 95% CI 2.068 to 3.571, p<0.001) in hospitalised patients.

Conclusions

Frailty and nutritional risk are prevalent among older adult patients, and nutritional risk is associated with the occurrence of fatigue in older adult patients and older adult inpatients.

Trial registration number

China Clinical Trial Registry (Registered No. ChiCTR-EPC-14005253).
Economics of primary healthcare: cost estimation of clinical services at primary care facilities in the six countries of the Gulf Cooperation Council
Authors: Elmusharaf Khalifa , Poix Sébastien , Grafton Daniel , Jung Johanna S , Gribble Rebecca , Stanton Rachael , Mahmoud Lamia , Al Asfoor Deena Hamza , Alawadi Tayba , Mustafa Mohammed , Shuwaiter Lulwa , Alsuwaidan Mohammed S , Al-Abri Zahir , Al-Sabahi Sultana , Fadda Sherif , Syed Hassan Raza , Almutairi Muneera , Al-Farsi Yahya M , Banatvala Nicholas , Tarlton Dudley
Published: June 2024

Objective

While the Gulf Cooperation Council (GCC) countries have demonstrated a strong commitment to strengthening primary healthcare (PHC), the costs of delivering these services in this region remain relatively unexplored. Understanding the costs of PHC delivery is essential for effective resource allocation and health system efficiency.

Design

We used an ingredient-based method to estimate the cost of delivering a selection of services at PHC facilities in the six GCC countries in 2019. Services were categorised into eight programmes: immunisation; non-communicable diseases (NCDs); oral and dental care; child health; nutrition; mental health; reproductive, maternal, neonatal and child health and general practice. The cost estimation focused on two key ingredients: the costs of drugs and supplies and the healthcare workforce cost. The coverage rates of specific types of health services, including screening and mental health services, were also estimated. Data for the analysis were obtained from ministries of health, health statistics reports, online databases, national surveys and scientific literature.

Results

The estimated costs of delivering the selected services at public PHC facilities in the six GCC countries totalled US$5.7 billion in 2019, representing 0.34% of the combined 2019 GDP. The per capita costs varied from US$69 to US$272. General practice and NCD programmes constituted 79% of the total costs modelled while mental health ranged between 0.0% and 0.3%. Over 8 million individuals did not receive NCD screening services, and over 30 million did not receive needed mental health services in public PHC facilities across the region.

Conclusions

To our knowledge, this is the first study to estimate the costs of services delivered at PHC facilities in the GCC countries. Identifying the main cost drivers and the services which individuals did not receive can be used to help strengthen PHC to improve efficiency and scale up needed services for better health outcomes.
Preventive effect of prenatal maternal oral probiotic supplementation on neonatal jaundice (POPS Study): A protocol for the randomised double-blind placebo-controlled clinical trial
Authors: Alemu Bekalu Kassie , Lee May Wing , Leung Maran Bo Wah , Lee Wing Fong , Wang Yao , wang Chi Chiu , Lau So Ling
Published: June 2024

Introduction

Neonatal jaundice is a common and life-threatening health problem in neonates due to overaccumulation of circulating unconjugated bilirubin. Gut flora has a potential influence on bilirubin metabolism. The infant gut microbiome is commonly copied from the maternal gut. During pregnancy, due to changes in dietary habits, hormones and body weight, maternal gut dysbiosis is common, which can be stabilised by probiotics supplementation. However, whether probiotic supplements can reach the baby through the mother and reduce the incidence of neonatal jaundice has not been studied yet. Therefore, we aim to evaluate the effect of prenatal maternal probiotic supplementation on the incidence of neonatal jaundice.

Methods and analysis

This is a randomised double-blind placebo-controlled clinical trial among 94 pregnant women (47 in each group) in a tertiary hospital in Hong Kong. Voluntary eligible participants will be recruited between 28 and 35 weeks of gestation. Computer-generated randomisation and allocation to either the intervention or control group will be carried out. Participants will take either one sachet of Vivomixx (450 billion colony-forming units per sachet) or a placebo per day until 1 week post partum. Neither the study participants nor researchers will know the randomisation and allocation. The intervention will be initiated at 36 weeks of gestation. Neonatal bilirubin level will be measured to determine the primary outcome (hyperbilirubinaemia) while the metagenomic microbiome profile of breast milk and maternal and infant stool samples as well as pregnancy outcomes will be secondary outcomes. Binary logistic and linear regressions will be carried out to assess the association of the microbiome data with different clinical outcomes.

Ethics and dissemination

Ethics approval is obtained from the Joint CUHK-NTEC Clinical Research Ethics Committee, Hong Kong (CREC Ref: 2023.100-T). Findings will be published in peer-reviewed journals and presented at international conferences.

Trial registration number

NCT06087874.
Evaluation of the passive mast cell activation test for identifying allergens in perioperative anaphylaxis: a study protocol for a prospective diagnostic accuracy study
Authors: Li Zhe , Cai Huamei , Liu Zhen , Liu Xiaowen , Zhao Jing
Published: June 2024

Introduction

Perioperative anaphylaxis (POA) can lead to significant complications. Therefore, accurate identification of allergens for POA patients is critical to ensure the safety of future surgical and anaesthetic procedures. Existing perioperative allergen detection methods face challenges in sensitivity and specificity. The passive mast cell activation test (pMAT) has recently emerged as a potential diagnostic tool. Our study aims to evaluate the diagnostic efficacy of pMAT for identifying perioperative allergens, with a focus on non-depolarising neuromuscular blocking agents, the most common culprits of POA.

Methods and analysis

This prospective diagnostic accuracy study will measure the diagnostic accuracy of pMAT in POA patients. Participants will undergo skin testing (ST), basophil activation testing (BAT) and pMAT. The diagnostic validity of pMAT will be assessed based on the results of ST and BAT. The assessment of diagnostic accuracy will include sensitivity, specificity, likelihood ratios, and false-positive and false-negative rates while measurement of the consistency rate will assess reliability.

Ethics and dissemination

This study has been approved by the Institutional Review Board of China-Japan Friendship Hospital (2023-KY-247). Results will be disseminated through academic presentations and peer-reviewed journal publications and will provide valuable scientific data and some new insights into the diagnostic accuracy of pMAT.
Patient-reported outcomes of psychiatric and/or mental health nursing in hospitals: a systematic review protocol
Authors: Desmet Karel , Vrancken Bruce , Bergs Jochen , Van Hecke Ann , Deproost Eddy , Bracke Piet , Debyser Bart , Cools Olivia , De Fruyt Jürgen , Muylaert Sofie , Verhaeghe Sofie
Published: June 2024

Introduction

There is a lack of distinct and measurable outcomes in psychiatric and/or mental health nursing which negatively impacts guiding clinical practice, assessing evidence-based nursing interventions, ensuring future-proof nursing education and establishing visibility as a profession and discipline. Psychiatric and/or mental health nursing struggle to demonstrate patient-reported outcomes to assess the effectiveness of their practice. A systematic review that summarising patient-reported outcomes, associated factors, measured nursing care/interventions and used measurement scales of psychiatric and/or mental health nursing in the adult population in acute, intensive and forensic psychiatric wards in hospitals will capture important information on how care can be improved by better understanding what matters and what is important to patients themselves. This review can contribute to the design, planning, delivery and assessment of the quality of current and future nursing care

Methods and analysis

This protocol follows the Cochrane methodological guidance on systematic reviews of interventions and The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. The search strategy will be identified by consultations with clinical and methodological experts and by exploring the literature. The databases Ovid MEDLINE, CINAHL, EMBASE, APA PsychARTICLES, Web of Science and Scopus will be searched for all published studies. Studies will be screened and selected with criteria described in the population, intervention, control and outcomes format after a pilot test by two researchers. Studies will be screened in two stages: (1) title and abstract screening and (2) full-text screening. Data extraction and the quality assessment based on the Johanna Briggs Institute guidelines will be conducted by two researchers. Data will be presented in a narrative synthesis.

Ethics and dissemination

No ethical approval is needed since all data are already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.

PROSPERO registration number

CRD42023363806.
Methodological guidelines and publications of benefit–risk assessment for health technology assessment: a scoping review
Authors: Suzumura Erica Aranha , de Oliveira Ascef Bruna , Maia Fernando Henrique de Albuquerque , Bortoluzzi Aline Frossard Ribeiro , Domingues Sidney Marcel , Farias Natalia Santos , Gabriel Franciele Cordeiro , Jahn Beate , Siebert Uwe , de Soarez Patricia Coelho
Published: June 2024

Objectives

To map the available methodological guidelines and documents for conducting and reporting benefit–risk assessment (BRA) during health technologies’ life cycle; and to identify methodological guidelines for BRA that could serve as the basis for the development of a BRA guideline for the context of health technology assessment (HTA) in Brazil.

Design

Scoping review.

Methods

Searches were conducted in three main sources up to March 2023: (1) electronic databases; (2) grey literature (48 HTA and regulatory organisations) and (3) manual search and contacting experts. We included methodological guidelines or publications presenting methods for conducting or reporting BRA of any type of health technologies in any context of the technology’s life cycle. Selection process and data charting were conducted by independent reviewers. We provided a structured narrative synthesis of the findings.

Results

From the 83 eligible documents, six were produced in the HTA context, 30 in the regulatory and 35 involved guidance for BRA throughout the technology’s life cycle. We identified 129 methodological approaches for BRA in the documents. The most commonly referred to descriptive frameworks were the Problem, Objectives, Alternatives, Consequences, Trade-offs, Uncertainty, Risk and Linked decisions and the Benefit–Risk Action Team. Multicriteria decision analysis was the most commonly cited quantitative framework. We also identified the most cited metric indices, estimation and utility survey techniques that could be used for BRA.

Conclusions

Methods for BRA in HTA are less established. The findings of this review, however, will support and inform the elaboration of the Brazilian methodological guideline on BRA for HTA.

Trial registration number

https://doi.org/10.17605/OSF.IO/69T3V.
Dermatological changes in a prospective cohort of acutely ill, hospitalised Malawian children, stratified according to nutritional status
Authors: van den Brink Deborah , Mponda Kelvin , Thompson Debbie , van Hees Colette , Ngong'a Fletchter , Segula Emma , Mbale Emmie , Boele van Hensbroek Michael , Bandsma Robert H J , Walson Judd L , Brals Daniella , Berkely James , Voskuijl Wieger
Published: June 2024

Rationale

Since the first documentation of skin changes in malnutrition in the early 18th century, various hair and skin changes have been reported in severely malnourished children globally. We aimed to describe the frequency and types of skin conditions in children admitted with acute illness to Queen Elizabeth Central Hospital, Blantyre, Malawi across a spectrum of nutritional status and validate an existing skin assessment tool.

Methods

Children between 1 week and 23 months of age with acute illness were enrolled and stratified by anthropometry. Standardised photographs were taken, and three dermatologists assessed skin changes and scored each child according to the SCORDoK tool.

Results

Among 103 children, median age of 12 months, 31 (30%) had severe wasting, 11 (11%) kwashiorkor (nutritional oedema), 20 (19%) had moderate wasting, 41 (40%) had no nutritional wasting and 18 (17%) a positive HIV antibody test. Six (5.8%) of the included patients died. 51 (50%) of children presented with at least one skin change. Pigmentary changes were the most common, observed in 35 (34%), with hair loss and bullae, erosions and desquamation the second most prevalent skin condition. Common diagnoses were congenital dermal melanocytosis, diaper dermatitis, eczema and postinflammatory hyperpigmentation. Severe skin changes like flaky paint dermatosis were rarely identified. Inter-rater variability calculations showed only fair agreement (overall Fleiss’ kappa 0.25) while intrarater variability had a fair-moderate agreement (Cohen’s kappa score of 0.47–0.58).

Discussion

Skin changes in hospitalised children with an acute illness and stratified according to nutritional status were not as prevalent as historically reported. Dermatological assessment by means of the SKORDoK tool using photographs is less reliable than expected.
Correlation of anthropometric measurements with body mass index and estimation of the proportion of metabolic syndrome among overweight and obese children: a hospital-based cross-sectional study
Authors: Ramesh Nithin , Kumar Pradeep , Sweta Sweta , Prasad Arun , Tiwari Lokesh Kumar
Published: June 2024

Background

Early identification of overweight and obesity with the help of simple anthropometric tests can prevent from development of metabolic complications in these children. Body mass index (BMI) is the most commonly used parameter but, measurements such as waist circumference (WC), waist-to-height ratio (WHtR) and wrist circumference (WrC) have also been studied and found to have a better correlation with visceral fat.

Objective

To correlate WC, WHtR and WrC with BMI among overweight and obese children. The secondary objective was to estimate the proportion of metabolic syndrome among obese and overweight children.

Methods

A single-centre, cross-sectional study involving 80 overweight and obese children aged 3–15 years. Anthropometric measures such as WC, WHtR and WrC of the study subjects were correlated with BMI and investigated for metabolic syndrome.

Results

Statistically significant and moderate positive correlation was found between BMI and WC, r (80)=0.45 and p<0.001 with WC explaining 20% of the variation of BMI. There was a statistically significant, moderate positive correlation between WHtR and BMI r (80)=0.34 and p<0.001 with 11% of the variation in BMI. There was a statistically significant strong positive correlation between WC and WrC (80)=0.61 and p<0.001, and WrC explains 37.2% of the variation in WC. However, there was no statistically significant correlation between BMI and WrC. Metabolic syndrome was found in 13 (16.25%) children.

Conclusion

Alternative anthropometric measurements such as WC and WHtR have a significant correlation with BMI and may be of help in defining overweight and obesity in children. There was a statistically significant strong positive correlation between WC and WrC among obese children. Metabolic syndrome is common in these children.
Sex differences in the association of pretransfusion haemoglobin and cognition in preterm infants
Authors: Mostek Amanda M Benavides , Bell Edward F , Feldman Henry A , Josephson Cassandra D , Georgieff Michael K , Nopoulos Peg , Patel Ravi Mangal , Stowell Sean R , Sola-Visner Martha , Conrad Amy L
Published: June 2024

Objectives

To assess sex-specific differences in the association between pre-transfusion haemoglobin values and early neurodevelopmental function.

Design

Observational follow-up of infants with birth weights <1000 g and gestational ages 22–28 weeks who were enrolled in the NICHD Neonatal Research Network Transfusion of Prematures (TOP) Trial at 19 U.S. sites, 2012–2017.

Main outcome measures

Pretransfusion haemoglobin values were obtained longitudinally through 36 weeks’ postmenstrual age. The infant’s mean pretransfusion haemoglobin was used as a marker of degree of anaemia (n=1655 measures). Measures of brain function were obtained at 22–26 months’ corrected age using the Bayley Scales of Infant & Toddler Development, third edition (BSID-III) (n=1290 BSID-III scores). Sex-specific estimates for the linear relation between pretransfusion haemoglobin and BSID-III scores were obtained from repeated-measures regression analysis, adjusted for gestational age, birth weight, study site, clinical characteristics, and demographic covariates.

Results

The relation of pretransfusion haemoglobin with 24-month BSID-III scores showed significant, independent interactions with both (1) sex (p=0.046) and (2) retinopathy of prematurity (ROP; p=0.004). In 614 males, BSID-III scores were higher by 1.07 points per g/dL (95% CI 1.58 to 4.33; p=0.008), not differing significantly among the three subscales (cognitive, language and motor; p=0.94). In 247 infants with ROP, BSID-III scores were higher by 2.95 points per g/dL (95% CI 0.28 to 1.87; p<0.0001), uniformly across subscales (p=0.73). These associations were non-significant in 676 females (p=0.96) and 1043 infants without ROP (p=0.81).

Conclusions

This study demonstrates sex-specific associations between mean pretransfusion haemoglobin (a marker of the severity of anaemia throughout the neonatal intensive care unit [NICU] hospitalisation) and early neurodevelopmental function at 22–26 months’ corrected age.
The moral obligation to have genetically related children
Authors: Pennings Guido
Published: June 2024

Donor conceived persons are likely to have a lower quality of life than persons who are genetically related to both parents. Empirical evidence is presented to corroborate this point. The evidence is subdivided into three sections: (1) negative experience of the donor conception itself, (2) negative effects of secrecy and openness and (3) negative effects of donor anonymity and donor identifiability. The principle of procreative beneficence requires parents to select the child with the best possible life. Given the difference in quality of life, intended parents should try to have a genetically related child. This finding is also a strong reason for society to invest public resources in the development of techniques that enable people to create genetically related children.
Multidisciplinary re-evaluation of neuropsychiatric events to confirm the neuropsychiatric lupus diagnosis at an Indonesian tertiary hospital
Authors: Estiasari Riwanti , Banu Syairah , Widhani Alvina , Octaviana Fitri , Maharani Kartika , Aninditha Tiara , Islami Muthia Huda , Imran Darma , Lastri Diatri Nari
Published: June 2024

Objective

Neuropsychiatric SLE (NPSLE) has a broad spectrum and to date, there is no gold-standard biomarker. The diagnosis relies on clinical assessment, supporting examinations and exclusion of other possible aetiologies. One method that can be used to establish NPSLE is to conduct a re-evaluation by involving several fields of medical science. This study aims to reassess SLE cases with neuropsychiatric (NP) manifestations through multidisciplinary re-evaluation and determine the final diagnosis of NPSLE or non-NPSLE.

Methods

This retrospective cross-sectional study used medical record data from patients with SLE with NP manifestations. Inclusion criteria included patients diagnosed with SLE, who had clinical manifestations of NP and were >18 years old. Multidisciplinary re-evaluation was conducted and agreed upon the diagnosis of NPSLE or non-NPSLE.

Results

We included 94 subjects with a total of 132 NP events consisting of 69 NPSLE and 63 non-NPSLE. After re-evaluating NPSLE events, 33.3% were still concluded to be NPSLE. Meanwhile, from the non-NPSLE group, 22.2% were then declared as NPSLE. There were no significant differences in demographic characteristics between the NPSLE and non-NPSLE groups. The proportion of NP events in both groups was almost the same except for cerebrovascular disease manifestations which were more common in the NPSLE group. Higher Mexican SLE Disease Activity Index scores with (p<0.001) or without NP (p=0.02) were observed in the NPSLE group compared with the non-NPSLE group, as well as higher proportion of active disease (p=0.03), higher anti-double-stranded DNA titres (p<0.001) and lower values of C3 (p=0.018) and C4 (p=0.001).

Conclusions

Multidisciplinary re-evaluation can be used as a method to confirm the diagnosis of NPSLE. There is a tendency for overdiagnosis of NPSLE when clinicians are faced with NP events in patients with SLE. Complete clinical and supporting data are needed to determine the final diagnosis of NPSLE.
Food for thought: dietary nootropics for the optimisation of military operators’ cognitive performance
Authors: Vine Christopher A J , Spurr T J , Blacker Sam D
Published: June 2024

Nootropics are compounds that enhance cognitive performance and have been highlighted as a medium-term human augmentation technology that could support soldier performance. Given the differing ethical, safety and legal considerations associated with the pharmaceutical subset of nootropics, this analysis focuses on dietary supplementation which may enhance cognition during training and operations. Numerous supplements have been investigated as possible nootropics; however, research is often not context specific or of high quality, leading to questions regarding efficacy. There are many other complex cofactors that may affect the efficacy of any dietary nootropic supplement which is designed to improve cognition, such as external stressors (eg, sleep deprivation, high physical workloads), task specifics (eg, cognitive processes required) and other psychological constructs (eg, placebo/nocebo effect). Moreover, military population considerations, such as prior nutritional knowledge and current supplement consumption (eg, caffeine), along with other issues such as supplement contamination, should be evaluated when considering dietary nootropic use within military populations. However, given the increasing requirement for cognitive capabilities by military personnel to complete role-related tasks, dietary nootropics could be highly beneficial in specific contexts. While current evidence is broadly weak, nutritional nootropic supplements may be of most use to the military end user during periods of high military specific stress. Currently, caffeine and L-tyrosine are the leading nootropic supplement candidates within the military context. Future military-specific research on nootropics should be of high quality and use externally valid methodologies to maximise the translation of research to practice.
Population-based disease-group analysis of Spanish excess mortality in the early COVID-19 pandemic period
Authors: Reyes-Santias Francisco , Reboredo-Nogueira Juan Carlos , Garcia-Alvarez Rosa Maria , Cinza-Sanjurjo Sergio , Gonzalez Juanatey Jose Ramon
Published: June 2024

Background and aim

Increased mortality during the COVID-19 pandemic is not explained exclusively by COVID-19 infection and its complications. We analysed non-COVID-19 causes of mortality in a population analysis based on data from the Spanish National Institute of Statistics.

Methods

Using monthly mortality data in Spain (January 2010–December 2020), we analysed deaths associated with cancer, blood, endocrine, mental, nervous, cardiovascular, respiratory and digestive diseases and explored the COVID-19 impact using a difference-in-difference strategy. We calculated monthly interannual variations in mortality and computed percentage change in terms of the log of deaths in monthhof yeartminus the log of deaths in monthhin the previous yeart−1.

Results

In 2020 in Spain, mortality increased 17.9% compared with 2019. COVID-19 was the leading cause of death (n=60 358), followed by ischaemic heart disease (n=29 654). Throughout 2020, monthly interannual variations in cardiovascular mortality showed an average upward trend of 1.7%, while digestive, cancer and blood diseases showed a downward trend.

Conclusions

During the COVID-19 pandemic in Spain in 2020, excess mortality was primarily related to cardiovascular mortality while mortality associated with digestive, cancer and blood diseases was reduced.
International Map of Axial Spondyloarthritis (IMAS): results from the perspective of 5557 patients from 27 countries around the globe
Authors: Garrido-Cumbrera Marco , Poddubnyy Denis , Sommerfleck Fernando , Bundy Christine , Makri Souzi , Correa-Fernández José , Akerkar Shashank , Lowe Jo , Karam Elie , Christen Laura , Navarro-Compan Victoria
Published: June 2024

Background

The International Map of Axial Spondyloarthritis (IMAS) is a global initiative aimed to assess the impact and burden of axial spondyloarthritis (axSpA) and identify the unmet needs from the patient’s perspective.

Method

IMAS is a collaboration between the Axial Spondyloarthritis International Federation (ASIF), the University of Seville, Novartis Pharma AG and steered by a scientific committee. IMAS collected information through an online cross-sectional survey (2017–2022) from unselected patients with axSpA from Europe, Asia, North America, Latin America and Africa who completed a comprehensive questionnaire containing over 120 items.

Results

5557 patients with axSpA participated in IMAS. Mean age was 43.9 ±12.8 years, 55.4% were female, 46.2% had a university education and 51.0% were employed. The mean diagnostic delay was 7.4 ±9.0 years (median: 4.0), and the mean symptom duration was 17.1 ±13.3 years. 75.0% of patients had active disease (Bath Ankylosing Spondylitis Disease Activity Index ≥4), and 59.4% reported poor mental health (12-item General Health Questionnaire ≥3). In the year before the survey, patients had visited primary care physicians 4.6 times and the rheumatologist 3.6 times. 78.6% had taken non-steroidal anti-inflammatory drug ever, 48.8% biological disease-modifying antirheumatic drugs and 43.6% conventional synthetic disease-modifying antirheumatic drugs. Patients’s greatest fear was disease progression (55.9%), while the greatest hope was to be able to relieve pain (54.2%).

Conclusions

IMAS shows the global profile of patients with axSpA, highlighting unmet needs, lengthy delays in diagnosis and high burden of disease in patients with axSpA worldwide. This global information will enable more detailed investigations to obtain evidence on the critical issues that matter to patients around the world to improve their care and quality of life.
Subcutaneous lacosamide for continuous focal seizures
Authors: Crispin Helen , Otway Victoria , Morris Rhiannon
Published: June 2024

Management of continuous focal seizure activity provides a unique challenge in palliative medicine. In cases where the patient is conscious and would prefer to remain so, we need to balance seizure-control with the sedating side effects of anti-seizure medications. Here we present a case in which subcutaneous lacosamide was given as part of a multi-modal treatment regime for a patient with continuous focal seizure activity. Lacosamide is a relatively new anti-seizure medication, that, unlike some anticonvulsants, has few drug interactions, is relatively non-sedating, and has physicochemical properties compatible with administration by the subcutaneous route. This case report adds to the very limited existing literature on the administration of lacosamide by the subcutaneous route. We conclude that lacosamide potentially provides an attractive option to contribute to the individualised care of this group of patients, and it may also have a role in the management of neuropathic pain where the enteral route is not available.
Care training and family caregiver anxiety: prospective cohort study
Authors: Uzun Uğur , Sarıtaş Aykut , Kökçe Sevda , Togay Bilge
Published: June 2024

Objectives

The study aimed to improve family caregivers’ skills and evaluate the effect on their anxiety levels.

Method

In our study, family caregivers of patients unable to perform daily activities were provided with care training. Their anxiety levels were examined before and after the training.

Results

Care training increased the family caregivers’ sense of self-efficacy but caused no significant difference in their anxiety levels. Factors such as gender, education level and employment status influenced anxiety levels. Higher education and income were associated with lower trait anxiety while employment status was linked to higher anxiety levels.

Conclusion

Care training increased the family caregivers’ sense of self-efficacy while causing no difference in their anxiety levels. In order to reduce anxiety, other negative factors affecting the caregiver should be discovered and corrected.
Impact of Standardised Packaging of Tobacco Products Regulations on cigarette consumption and youth smoking in England: interrupted time-series analysis
Authors: Buss Vera Helen , Kock Loren , Beard Emma , Shahab Lion , Brown Jamie , Jackson Sarah
Published: June 2024

Background

In the UK in May 2016, standardised packaging of tobacco products was implemented, including minimum pack sizes of 20 sticks or 30 g loose tobacco. The change was intended to reduce uptake by increasing upfront costs to young people, but there was concern it may unintentionally increase consumption among people smoking. This study aimed to assess whether the introduction of the policy was associated with changes in (1) mean daily factory-made (FM)/roll-your-own (RYO) cigarettes consumption among people smoking predominantly (a) FM and (b) RYO cigarettes; and (2) current smoking prevalence among 16–24-year-olds.

Methods

Data (N=257 929) were from a representative monthly cross-sectional survey of adults (≥16 years) in England, collected between November 2007 and January 2020. Outcome measures were mean daily (FM/RYO) cigarette consumption among those smoking FM/RYO cigarettes, and prevalence of current smoking among 16–24-year-olds. Time-series analyses were conducted using Autoregressive Integrated Moving Average with Exogenous variables (ARIMAX) regression models including a gradual level change starting in June 2017 and ending in May 2018 for cigarette consumption and a step change in June 2016 for prevalence of current smoking.

Results

The ARIMAX model was not able to detect a change in mean daily cigarette consumption—for FM (Badj=−0.543, 95% CI −1.381 to 0.296) or RYO (Badj=0.002, 95% CI −0.518 to 0.522) following the implementation of standardised packaging. The unadjusted analysis suggested the implementation of standardised packaging was associated with a small (3%) decrease in smoking prevalence among 16–24-year-olds (Bunadj=−0.031, 95% CI −0.062 to 0.000), but this association was attenuated after adjustment for covariates (Badj=−0.010, 95% CI −0.039 to 0.019).

Conclusions

The implementation of standardised packaging of tobacco products was not associated with a meaningful change in the mean number of FM or RYO cigarettes consumed by people smoking in England, suggesting the larger pack size has not had an unintended consequence of substantially increasing cigarette consumption. However, there was also little evidence that the policy substantially reduced smoking among 16–24-year-olds.
Update on numbers of tobacco-attributable deaths by country in the South-East Asia region: implications for policy
Authors: Kaur Jagdish , Rinkoo Arvind Vashishta , Richardson Sol
Published: June 2024

Background

The WHO South-East Asia Region is home to around 33% of adult tobacco users. To inform tobacco control policy and practice, we conducted a study using the latest available data to update mortality attributable to overall tobacco use, including smoked tobacco, smokeless tobacco (SLT) and secondhand smoke (SHS) exposure, in the 11 countries of the Region.

Methods

We estimated smoking, SLT use and SHS exposure using the latest available surveys for each country during 2016–2021, and then estimated all-cause and lung cancer-attributable annual deaths for each using the population-attributable fraction method. Finally, we estimated the annual total tobacco-attributable deaths including all three exposures using the multiplicative aggregation method.

Results

We estimated the occurrence of 4 087 920 all-cause deaths and 105 279 lung cancer deaths annually attributable to tobacco use among the 11 countries investigated. India accounted for 63.9% of all-cause tobacco-attributable deaths.

Conclusions

The high annual number of tobacco-attributable deaths in the Region highlights the need for accelerating progress in reducing tobacco use. Implementation of the WHO Framework Convention on Tobacco Control (FCTC) and MPOWER policy package needs prioritisation at the country level. Tobacco cessation services, supply-side measures and policies to counter tobacco industry interference should be strengthened. Further work is needed to monitor progress towards FCTC implementation and analyse the impacts of policies on tobacco-related outcomes, including attributable mortality and disease burden, to inform advocacy efforts.
Technology adoption and management practices used in Canadian cow-calf herds
Authors: Lazurko Madelana M. , Erickson Nathan E.N. , Campbell John R. , Larson Kathy , Waldner Cheryl L.
Published: June 2024

Canadian cow-calf producers are facing pressure to adopt management practices and technologies that help increase the economic and environmental sustainability, and public perception of beef production. Our aim was to describe technology adoption, management and record keeping practices in Canadian cow-calf herds, assess associations between herd attributes, productivity outcomes and adoption; and identify opportunities for improvement. Surveys from 131 Canadian cow-calf producers recruited through a national surveillance program were analyzed. Individual female records (80%) and feed testing (84%) were commonly reported as currently or occasionally used, followed by on-farm weigh scales (66%). Western herds were likely to utilize feed testing and nutritionists, ionophores, and growth promoting implants, while eastern herds commonly used reproductive technologies. Large herds (>300 cows) were more likely to adopt technologies that aid in data capture (i.e., weigh scales) and follow recommended practices (i.e., feed testing). Paper was the main record keeping format. Production records were commonly utilized for culling and replacement heifer selection. Technology use has increased across the country compared to previous surveys and producers are implementing practices to help increase production efficiency. However, there is an opportunity to increase use of technologies that support individual animal and herd data to help inform ranch decisions.