bluuebunny/crossref_metadata_2025 huggingface dataset:
Lesbian, gay and bisexual representation on Australian entertainment television: 1970–2000
Authors: Monaghan Whitney
Published: September 2019

With the exception of a small number of contributions to the study of gay and lesbian representation in Australia, the queer history of Australian entertainment television has been left unexamined. This article seeks to address this gap through analysis of lesbian, gay and bisexual (LGB) characters in Australian entertainment television over a 30-year period from 1970 to 2000. The article examines the rise and fall of LGB representation on prime time Australian television from 1970 onwards in order to understand how key shifts in the politics of Australian cultural life have come to influence Australian television broadcasting. Charting the representation of LGB characters on Australian entertainment television, this article seeks to understand the politics of inclusion and exclusion of LGB characters and provides the basis for further research into Australian queer television history.
Effect of friction coefficient on the mixed lubrication model of rotary lip seals
Authors: Jiang Bingqi , Huang Xing , Guo Fei , Jia Xiaohong , Wang Yuming
Published: September 2019

This study is devoted to the effect of different coefficients on the calculation results of the rotary lip seal mixed lubrication model. It was proved by experiments that the dry friction coefficient used in the previous models was quite different from the boundary lubrication friction coefficient, which was theoretically more accurate. The pumping rate, friction torque, pressure distribution, and oil film thickness were calculated using both the dry friction coefficient and the boundary lubrication coefficient and the results were quite different. A friction coefficient test method under boundary lubrication condition for numerical simulation of rotary lip seals and an improved method for numerical calculation using the boundary lubrication coefficient instead of the dry friction coefficient were proposed. It was verified that the accuracy of numerical calculation can be improved, and the calculation result was closer to the actual working state.
Investor motivations of a New Zealand biopharma start-up: Angels and crowdfunders
Authors: Miller Andrea , Scahill Shane , Warren Lorraine
Published: September 2019

The process of funding any start-up can be a complicated process, with a range of options depending on the nature and stage of the enterprise. This article compares the motivations of Business Angels with equity-based crowdfunders of a New Zealand start-up biopharma company, XYZ, who were developing a therapy for a specific disease. The study finds that contrary to previous research, nonfinancial rewards do play a role in crowdfunding investments. Our results are based on a survey, founded on an Investment Motivational Model (4Ps) with components including Philanthropy, People, Product, and Profit.
Coaches’ implementation strategies in providing social support to Singaporean university athletes: A case study
Authors: Teck Koh Koon , Kokkonen Marja , Rang Bryan Law Heng
Published: September 2019

Coaches are effective providers of social support to their athletes. Although sport-specific measures of social support have been developed to better understand athletes’ perceptions of available support, limited amount of research has addressed how sport coaches implement specific social support strategies. The purpose of this study was to examine university coaches’ implementation strategies in providing various forms of social support to their athletes. A total of eight sport coaches from team and individual sports (four from each sport) were purposefully selected for this study. Coaches were individually interviewed. The interview transcripts were analysed using a thematic analysis. The results revealed that coaches from different sports shared similar strategies across emotional, esteem, informational and tangible dimensions, but with some distinguishable differences in the way these strategies were implemented. In documenting the lived experiences of sport coaches, key strategies valued highly among these coaches were highlighted, providing important implications for coaches to know how to incorporate these strategies into their coaching practice to better support athletes’ well-being and improve the quality of coaching. The findings also provide an implementation framework of social support that emphasizes key strategies for coaches to focus on in their coaching approaches.
Associations of depression-anxiety and dyslipidaemia with subclinical carotid arterial disease: Findings from the Whitehall II Study
Authors: Ellins Elizabeth A , Shipley Martin J , Rees D Aled , Kemp Andrew , Deanfield John E , Brunner Eric J , Halcox Julian P
Published: September 2019

Aims

There is mixed evidence for an association between depression and/or anxiety and carotid intima-media thickness, and limited information on the related role of dyslipidaemia. Here we report associations between depression and/or anxiety and intima-media thickness in the Whitehall II cohort, considering the moderating effects of sex and dyslipidaemia.

Methods

A total of 2822 men and 1112 women (61 ± 6 years) were studied during phase 7 (2002–2004) of the Whitehall II study. Intima-media thickness and lipid levels were assessed, and questionnaires (general health questionnaire and the Centre for Epidemiologic Studies depression scale) were completed. Linear regression was used to explore relationships between depression and/or anxiety and intima-media thickness and the moderating effects of sex and dyslipidaemia.

Results

A total of 1461 participants were categorised with depression and/or anxiety. The association between depression and/or anxiety and intima-media thickness differed between men and women so analyses were undertaken separately by sex. In men, intima-media thickness was significantly associated with dyslipidaemia ( P = 0.002) but not depression and/or anxiety ( P = 0.29). In women, both dyslipidaemia and depression and/or anxiety were independently associated with intima-media thickness ( P = 0.028 and P = 0.031). The greatest intima-media thickness was in women with both depression and/or anxiety and dyslipidaemia. These results were replicated when the general health questionnaire score was substituted for depression and/or anxiety and non-high-density lipoprotein cholesterol for dyslipidaemia.

Conclusions

Depression and/or anxiety is associated with increased intima-media thickness in women but not in men. Dyslipidaemia is associated with intima-media thickness in both men and women. Women with both depression and/or anxiety and dyslipidaemia are potentially at the greatest risk of cardiovascular disease.
Pharmaceutical Benefit-Risk Perception and Older Age: A Pilot Study
Authors: Balog-Way Dominic Hugo Patrick , Löfstedt Ragnar Ernst
Published: September 2019

Background:

Older age plays an important role in pharmaceutical benefit-risk perception. This creates challenges and opportunities, especially for regulatory authorities and advocacy groups seeking to communicate with patients of all ages. This study explored the pharmaceutical benefit-risk perceptions of older versus younger adults to identify age-related effects for further study.

Methods:

80 face-to-face surveys were conducted with samples of older and younger respondents from Boulder, Colorado (USA), and Dublin (Ireland).

Results:

Older adults were more likely than their younger counterparts to view greater risk today than 20 years ago for 14 out of 16 items ranging from diabetes and Alzheimer disease, to patients taking prescription medicines. Both older and younger respondents perceived most medical treatments as high in benefit and low in risk. Older adults construed “risk” variably as (1) side effects, (2) dangers of inappropriate use, and (3) wider issues. Crucially, older adults’ quantitative benefit-risk judgments were strongly influenced by personal experiences and the positive/negative feelings they most associated with different medicines, medical procedures and tests. While positive associations influenced high benefit perceptions, negative associations influenced high risk perceptions.

Conclusion:

Age-related effects on risk perception should be further explored to help improve the effectiveness of benefit-risk communication for adults of all ages.
Danger-associated extracellular ATP counters MDSC therapeutic efficacy in acute GVHD
Authors: Koehn Brent H. , Saha Asim , McDonald-Hyman Cameron , Loschi Michael , Thangavelu Govindarajan , Ma Lie , Zaiken Michael , Dysthe Josh , Krepps Walker , Panthera Jamie , Hippen Keli , Jameson Stephen C. , Miller Jeffrey S. , Cooper Matthew A. , Farady Christopher J. , Iwawaki Takao , Ting Jenny P.-Y. , Serody Jonathan S. , Murphy William J. , Hill Geoffrey R. , Murray Peter J. , Bronte Vincenzo , Munn David H. , Zeiser Robert , Blazar Bruce R.
Published: September 2019

These studies demonstrate how activation of the NLRP3 inflammasome pathway influences the function of myeloid-derived suppressor cells (MDSCs) in the setting of acute graft-versus-host disease (aGVHD).
“Pisando Fuerte”: an evidence-based falls prevention program for Hispanic/Latinos older adults: results of an implementation trial
Authors: Mora Pinzon Maria , Myers Shannon , Jacobs Elizabeth A. , Ohly Sherri , Bonet-Vázquez Militza , Villa Marcia , Castro Al , Mahoney Jane
Published: September 2019

Background

We previously developed Pisando Fuerte (PF), a linguistically and culturally appropriate version of “Stepping On”, an evidence-based fall prevention program building on self-efficacy and adult learning principles. The purpose of this study is to describe the implementation of PF at two community organizations in Wisconsin.

Methods

PF consisted of 2 h sessions delivered in Spanish over the course of 8 weeks by two trained leaders, at two community sites in Wisconsin. Participants identified strategies for falls prevention and practiced progressive balance and strength exercises. The RE-AIM framework guided the mixed-methods evaluation. Falls Behavioral Risk Scale (FaB) (Outcomes), and uptake of protective behaviors (Individual Maintenance) were evaluated 6 months after completion. Fidelity of delivery (Implementation) was evaluated by an independent assessor for three sessions at each site using a-priori criteria based on key elements of Stepping On.

Results

Twenty-four Hispanic/Latino individuals, whose primary language is Spanish, were enrolled in two workshops. The mean age was 70.5 years; 71% were female, and five reported a fall in the year prior. Outcomes: There was a non-statically significant decrease in the number of falls per person [RR: 0.33 (95%CI: 0.096–1.13)] at 6 months. There was a statistically significant improvement of the mean Falls Behavioral Risk Scale (FaB) (baseline = 2.69 vs. 6-months post-intervention = 3.16, p < 0.001). Adoption: Barriers to adoption included leader training in English, time to identify Spanish-speaking guest experts, and time to prepare for each session. Implementation: Satisfactory fidelity of delivery was achieved in 69% of the elements; fidelity lapses were more common in the use of adult learning strategies and programmatic aspects. Eighty eight percent of participants completed the program, and 95% of them adequately demonstrated the exercises. Maintenance: At 6 months, 57.9% of participants continued doing exercises, 94% adopted safer walking strategies, and 67% executed at least one home safety recommendation. These results are similar to those seen in the original Stepping On program.

Conclusions

Our study shows good fidelity of delivery with implementation of “Pisando Fuerte”. Pre-post data demonstrate a significant reduction in falls behavioral risk among Hispanic/Latino participants, similar to results with “Stepping On”.

Trial registration

ClinicalTrials.gov, NCT03895021. Registered March 29, 2019.
Rubella transmission and the risk of congenital rubella syndrome in Liberia: a need to introduce rubella-containing vaccine in the routine immunization program
Authors: Woyessa Abyot Bekele , Ali Mohammed Seid , Korkpor Tiala K. , Tuopileyi Roland , Kohar Henry T. , Dogba John , Baller April , Monday Julius , Abdullahi Suleman , Nagbe Thomas , Mulbah Gertrude , Kromah Mohammed , Sesay Jeremy , Yealue Kwuakuan , Nyenswah Tolbert , Gebrekidan Mesfin Zbelo
Published: September 2019

Background

Rubella is an RNA virus in the genus Rubivirus within the Matonaviridae family. Rubella remains a leading vaccine-preventable cause of birth defects. Most African countries including Liberia do not currently provide rubella-containing vaccine (RCV) in their immunization program. We analyzed the existing surveillance data to describe rubella cases and identify the at-risk population.

Methods

We conducted a retrospective descriptive statistics on the suspected-measles case-based surveillance data that obtained from the national database. Suspected-measles cases who were negative and indeterminate for measles IgM and tested for rubella IgM were extracted from the database. We used only rubella IgM positive cases to calculate trends and percentages by person, place and time. The cumulative-percent curve was used to visually describe the age distribution of rubella cases.

Results

During 2017–2018, a total of 2027 suspected-measles cases with known laboratory results were reported; of which, 1307 were tested for rubella IgM. Among tested cases, 472 (36%) were positive, 769 (59%) were negative and 66 (5%) were indeterminate for rubella IgM. Female contributed 269 (57%) of the confirmed rubella cases respectively. The median age was 7 years with an interquartile range of 5–10 years. From the total rubella cases, 6 (1%) were under 1 year, 109 (23%) were 1–4 years, 207 (44%) were 5–9 years, 87 (18%) were 10–14 years and 56 (12%) were more than or equal to 15 years. Women in their reproductive-age contributed 23 (5%) of rubella cases with 17% positivity rate. Two-thirds or 307 (65%) of the cases were reported from February to May which is dry season in Liberia.

Conclusions

Our analysis revealed that rubella was widely circulating in Liberia. Majority of the cases were reported among children < 15 years. However, rubella was also reported among women of reproductive age and infants < 1 year with no report of congenital rubella syndrome (CRS). Detail investigation of rubella cases among infants of < 1 year and women of reproductive age is important to uncover CRS. Establishment of CRS surveillance and the introduction of RCV in the immunization program are crucial to prevent rubella infection and avert the risk of CRS.
Clinical characteristics and mutation Spectrum of NF1 in 12 Chinese families with orbital/periorbital plexiform Neurofibromatosis type 1
Authors: Chai Peiwei , Luo Yingxiu , Zhou Chuandi , Wang Yefei , Fan Xianqun , Jia Renbing
Published: September 2019

Background

Orbital/periorbital plexiform neurofibroma (OPPN) can compromise physical appearance and visual function. However, the clinical characteristics and NF1 mutation landscape in patients with heritable OPPN have not been reported.

Methods

The medical charts of 26 Chinese patients with OPPN from 12 families were reviewed. Mutation analysis of the entire coding region and flanking splice sites of the NF1 gene was performed using next-generation sequencing (NGS). Novel NF1 mutations were confirmed by Sanger sequencing.

Results

Compared to the parental generation, a significantly larger proportion of OPPN patients in the successive generation presented with earlier onset (p = 0.001), amblyopia (p = 0.034), motility disorders (p = 0.009) and bony orbital expansion (p = 0.019). Six novel NF1 mutations were identified in 11 (91.67%) families, including 6 (42.9%) single-base substitutions, 4 (28.5%) splicing mutations, 3 (21.4%) frameshift deletions, and 1 (7.14%) intron mutation.

Conclusions

The successive generation of OPPN patients presented with earlier onset and exhibited more severe ocular signs than did their parents or grandparents. Special attention should be paid to successive generations of OPPN patients. Considering that 6 mutations were novel, comprehensive NF1 mutation analysis is required or necessary or proposed for genetic counselling.
Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO): rationale and design
Authors:   on behalf of the DOMESTICO study group, van Eck van der Sluijs A. , Bonenkamp A. A. , Dekker F. W. , Abrahams A. C. , van Jaarsveld B. C.
Published: September 2019

Background

More than 6200 End Stage Renal Disease patients in the Netherlands are dependent on dialysis, either performed at home or in a dialysis centre. Visiting a dialysis centre three times a week is considered a large burden by many patients. However, recent data regarding the effects of dialysis at home on quality of life, clinical outcomes, and costs compared with in-centre haemodialysis are lacking.

Methods

The Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO) is a nationwide, prospective, observational cohort study that will include adult patients starting with a form of dialysis. Health-related quality of life, as the primary outcome, clinical outcomes and costs, as secondary outcomes, will be measured every 3–6 months in patients on home dialysis, and compared with a control group consisting of in-centre haemodialysis patients. During a 3-year period 800 home dialysis patients (600 peritoneal dialysis and 200 home haemodialysis patients) and a comparison group of 800 in-centre haemodialysis patients will be included from 53 Dutch dialysis centres (covering 96% of Dutch centres) and 1 Belgian dialysis centre (covering 4% of Flemish centres).

Discussion

DOMESTICO will prospectively investigate the effect of home dialysis therapies on health-related quality of life, clinical outcomes and costs, in comparison with in-centre haemodialysis. The findings of this study are expected to ameliorate the shared decision-making process and give more guidance to healthcare professionals, in particular to assess which type of patients may benefit most from home dialysis.

Trial registration

The DOMESTICO study is registered with the National Trial Register on (number: NL6519, date of registration: 22 August 2017) and the Central Committee on Research Involving Human Subjects (CCMO) (number: NL63277.029.17).
Experiences of interactive ultrasound examination among women at risk of preterm birth: a qualitative study
Authors: Pulliainen Henrika , Niela-Vilén Hannakaisa , Ekholm Eeva , Ahlqvist-Björkroth Sari
Published: September 2019

Background

Pregnant women who are at risk of preterm birth are often stressed, anxious and depressed because of worries and fears related to the health of the unborn baby, their own health and uncertainty about the future. Only a few studies have assessed the types of psychological support that would relieve these stress symptoms among women with high-risk pregnancies. The aim of this study was to describe 1) how women at risk of preterm birth experienced an interactive 3/4-dimensional (3/4D) ultrasound examination, and 2) their need for psychological support during the antenatal period.

Methods

This qualitative study was conducted at one university hospital in Finland in 2017. Women with a singleton pregnancy of 26–32 gestational weeks (gwks) were included in the study. The interactive 3/4D ultrasound included a joint observation of the baby, based on the mother’s wishes, with an obstetrician and psychologist. After the examination, the experiences were explored with a semi-structured interview. The data was analyzed using inductive thematic analysis.

Results

The women enjoyed the fact that the staff were focused on her fetus and genuinely present during the session and also enabled the women to actively participate. Watching the baby and her/his activities made the baby more concrete and relieved their concerns. The need for additional psychological support varied individually.

Conclusions

Interactive ultrasound examination is an interesting way to awaken mental images, increase attachment, and reduce stress. The results imply that an interactive way of jointly looking at the fetus supports pregnant women at risk of preterm birth and may be useful in clinical practice.
Reproductive characteristics are associated with gene-specific promoter methylation status in breast cancer
Authors: McCullough Lauren E. , Collin Lindsay J. , Conway Kathleen , White Alexandra J. , Cho Yoon Hee , Shantakumar Sumitra , Terry Mary Beth , Teitelbaum Susan L. , Neugut Alfred I. , Santella Regina M. , Chen Jia , Gammon Marilie D.
Published: September 2019

Background

Reproductive characteristics are well-established risk factors for breast cancer, but the underlying mechanisms are not fully resolved. We hypothesized that altered DNA methylation, measured in tumor tissue, could act in concert with reproductive factors to impact breast carcinogenesis.

Methods

Among a population-based sample of women newly diagnosed with first primary breast cancer, reproductive history was assessed using a life-course calendar approach in an interviewer-administered questionnaire. Methylation-specific polymerase chain reaction and Methyl Light assays were used to assess gene promotor methylation status (methylated vs. unmethylated) for 13 breast cancer-related genes in archived breast tumor tissue. We used case-case unconditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations with age at menarche and parity (among 855 women), and age at first birth and lactation (among a subset of 736 parous women) in association with methylation status.

Results

Age at first birth > 27 years, compared with < 23 years, was associated with lower odds of methylation of CDH1 (OR = 0.44, 95% CI = 0.20–0.99) and TWIST1 (OR = 0.48, 95% CI = 0.28–0.82), and higher odds of methylation of BRCA1 (OR = 1.63, 95% CI = 1.14–2.35). Any vs. no lactation was associated with higher odds of methylation of the PGR gene promoter (OR = 1.59, 95% CI = 1.01–2.49). No associations were noted for parity and methylation in any of the genes assayed.

Conclusions

Our findings indicate that age at first birth, lactation and, perhaps age at menarche, are associated with gene promoter methylation in breast cancer, and should be confirmed in larger studies with robust gene coverage.
A test of the goodness of fit of the generic metacognitive model of psychopathology symptoms
Authors: Nordahl Henrik , Ødegaard Ingunn Harsvik , Hjemdal Odin , Wells Adrian
Published: September 2019

Background

Common mental disorders such as depression and anxiety frequently co-occur and may share etiological mechanisms. The metacognitive model is based on the principle that there are common pathological mechanisms across disorders that account for comorbidity and therefore can be conceptualized in one generic model. A central prediction of the model is that particular metacognitive beliefs concerning the value of worry, and the uncontrollability and danger of cognition are positively correlated with psychopathology symptoms. In the present study, we set out to test the overall fit of this model by assessing generic metacognitive beliefs and judgements of attention control capacity as predictors of common and frequently co-occurring emotional distress symptoms.

Methods

In a cross-sectional design, 645 participants gathered at convenience completed a battery of self-report questionnaires.

Results

Structural equation modelling indicated a good model fit for the generic metacognitive model, and the predictors accounted for 93% of the variance in distress consisting of depression-, generalized- and social anxiety symptoms.

Conclusions

This finding supports the generic model and the implication that it can be used as a basis to formulate and treat multiple presenting problems.
Pilot GWAS of caries in African-Americans shows genetic heterogeneity
Authors: Orlova E. , Carlson J. C. , Lee M. K. , Feingold E. , McNeil D. W. , Crout R. J. , Weyant R. J. , Marazita M. L. , Shaffer J. R.
Published: September 2019

Background

Dental caries is the most common chronic disease in the US and disproportionately affects racial/ethnic minorities. Caries is heritable, and though genetic heterogeneity exists between ancestries for a substantial portion of loci associated with complex disease, a genome-wide association study (GWAS) of caries specifically in African Americans has not been performed previously.

Methods

We performed exploratory GWAS of dental caries in 109 African American adults (age > 18) and 96 children (age 3–12) from the Center for Oral Health Research in Appalachia (COHRA1 cohort). Caries phenotypes (DMFS, DMFT, dft, and dfs indices) assessed by dental exams were tested for association with 5 million genotyped or imputed single nucleotide polymorphisms (SNPs), separately in the two age groups. The GWAS was performed using linear regression with adjustment for age, sex, and two principal components of ancestry. A maximum of 1 million adaptive permutations were run to determine empirical significance.

Results

No loci met the threshold for genome-wide significance, though some of the strongest signals were near genes previously implicated in caries such as antimicrobial peptide DEFB1 (rs2515501; p = 4.54 × 10− 6) and TUFT1 (rs11805632; p = 5.15 × 10− 6). Effect estimates of lead SNPs at suggestive loci were compared between African Americans and Caucasians (adults N = 918; children N = 983). Significant (p < 5 × 10− 8) genetic heterogeneity for caries risk was found between racial groups for 50% of the suggestive loci in children, and 12–18% of the suggestive loci in adults.

Conclusions

The genetic heterogeneity results suggest that there may be differences in the contributions of genetic variants to caries across racial groups, and highlight the critical need for the inclusion of minorities in subsequent and larger genetic studies of caries in order to meet the goals of precision medicine and to reduce oral health disparities.
Herbal or traditional medicine consumption in a Thai worker population: pattern of use and therapeutic control in chronic diseases
Authors: Kanjanahattakij Napatt , Kwankhao Pakakrong , Vathesatogkit Prin , Thongmung Nisakron , Gleebbua Yingampa , Sritara Piyamitr , Kitiyakara Chagriya
Published: September 2019

Background

Herbal and traditional medicines (HTM) are widely used in Asian countries. Specific data on prevalent of HTM usage and association with chronic diseases in the Thai population is currently lacking. We examined the prevalence and factors associated with HTM use in a Thai worker population. In addition, we explored the relationship between HTM use and therapeutic control of cardiovascular risk factors and documented the most common types of HTM used in various chronic diseases.

Methods

Employees of EGAT (The Electric Generating Authority of Thailand) who had participated in a health examination were studied. Each participant documented their HTM consumption and self-reported chronic diseases in a questionnaire. Clinical disease and therapeutic control were also defined by concomitant laboratory tests.

Results

Of a total of 6592 subjects, 32.6% were HTM-users. Age < 50 years, female gender, self-reported history of diabetes, liver disease, cancer, dyslipidemia, and alcohol use were independently associated with HTM use. HTM consumption increased in proportion to the numbers of self-reported chronic diseases. There were no differences in the therapeutic control of cardiovascular risk factors between HTM users and non-users. Liver and kidney function were not different. The most commonly used HTM was turmeric.

Conclusions

HTM consumption is common in community-based Thai subjects, with higher use among those with chronic diseases. Although there were no differences in control of cardiovascular risk factors between HTM users and non-users, many of the commonly used herbs have relevant biological activities for chronic disease prevention or treatment.
An exploration of healthcare providers’ experiences and perspectives of Traditional and complementary medicine usage and disclosure by Indigenous cancer patients
Authors: Gall A. , Anderson K. , Adams J. , Matthews V. , Garvey G.
Published: September 2019

Background

Traditional and complementary medicines (T&CM) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being. Alongside conventional cancer treatments, T&CM usage is increasing; with 19% of indigenous Australians with cancer reporting using T&CM. There is limited evidence surrounding T&CM use and disclosure by indigenous patients. Our aim was to explore healthcare providers’ views about usage, disclosure/non-disclosure of T&CM by Indigenous cancer patients.

Methods

Semi-structured, in-depth interviews with 18 healthcare providers, including three indigenous providers, at a large urban hospital providing care to Indigenous cancer patients were conducted to explore providers’ experiences and attitudes towards T&CM use by Indigenous cancer patients. An interpretive phenomenological approach was used to thematically analyse the data.

Results

Analysis revealed six themes: concern about risk; no ‘real’ benefits; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; ‘patients’ choice’ a double-edged sword; and providers’ lack of knowledge about T&CM. Healthcare providers perceived discord between T&CM and conventional medicine. Most lacked knowledge of T&CM, and had concerns around negative-interactions with conventional treatments. They considered T&CM outside their role, citing this as reasoning for their lack of knowledge. Indigenous healthcare providers had greater understanding and openness towards T&CM.

Conclusions

Given the potential usage of T&CM by Indigenous cancer patients, providers need a more comprehensive understanding of T&CM in order to inform discussion and facilitate effective disclosure on this topic. If indigenous Australians with cancer feel that cancer care providers are unreceptive to discussing T&CM, patient care risks being compromised; particularly given the potential for negative interactions between T&CM and conventional cancer treatments. Fostering health care interactions where indigenous patients feel comfortable to discuss T&CM usage should be a priority for all cancer care services.
Implementation of a large-scale simulation-based cardiovascular clinical examination course for undergraduate medical students – a pilot study
Authors: Arangalage Dimitri , Abtan Jérémie , Gaschignard Jean , Ceccaldi Pierre-François , Remini Sid-Ahmed , Etienne Isabelle , Ruszniewski Philippe , Plaisance Patrick , De Lastours Victoire , Lefort Agnès , Faye Albert
Published: September 2019

Background

We report the implementation of a large-scale simulation-based cardiovascular diagnostics course for undergraduate medical students.

Methods

A simulation-based course was integrated into the curriculum of second-year medical students (> 400 students/year). The first session aimed at teaching cardiac auscultation skills on mannequins and the second at teaching blood pressure measurement, peripheral arterial examination, and the clinical examination of heart failure in a technical skill-based manner and in a scenario.

Results

A total of 414 (99.8%) and 402 (98.5%) students, as well as 102 and 104 educators, participated during the 2016–2017 and 2017–2018 academic years across both types of sessions. The number of positive appreciations by students was high and improved from the first to the second year (session 1: 77% vs. 98%, session 2: 89% vs. 98%; p < 0.0001). Similar results were observed for educators (session 1: 84% vs. 98%, p = 0.007; session 2: 82% vs. 98%, p = 0.01). Feedbacks by students were positive regarding the usefulness of the course, fulfillment of pedagogical objectives, quality of the teaching method, time management, and educator-student interactivity. In contrast, 95% of students criticized the quality of the mannequins during the first year leading to the replacement of the simulation material the following year. Students most appreciated the auscultation workshop (25%), the practical aspect of the course (22%), and the availability of educators (21%).

Conclusions

Despite the need to commit significant human and material resources, the implementation of this large-scale program involving > 400 students/year was feasible, and students and educators reacted favorably.
The effects of industry funding and positive outcomes in the interpretation of clinical trial results: a randomized trial among Dutch psychiatrists
Authors: Tijdink Joeri K. , Smulders Yvo M. , Bouter Lex M. , Vinkers Christiaan H.
Published: September 2019

Background

Most studies are inclined to report positive rather than negative or inconclusive results. It is currently unknown how clinicians appraise the results of a randomized clinical trial. For example, how does the study funding source influence the appraisal of an RCT, and do positive findings influence perceived credibility and clinical relevance? This study investigates whether psychiatrists’ appraisal of a scientific abstract is influenced by industry funding disclosures and a positive outcome.

Methods

Dutch psychiatrists were randomized to evaluate a scientific abstract describing a fictitious RCT for a novel antipsychotic drug. Four different abstracts were created reporting either absence or presence of industry funding disclosure as well as a positive or a negative outcome. Primary outcomes were the perceived credibility and clinical relevance of the study results (10-point Likert scale). Secondary outcomes were the assessment of methodological quality and interest in reading the full article.

Results

Three hundred ninety-five psychiatrists completed the survey (completion rate 45%). Industry funding disclosure was found not to influence perceived credibility (Mean Difference MD 0.12; 95% CI − 0.28 to 0.47, p?) nor interpretation of its clinical relevance (MD 0.14; 95% CI − 0.54 to 0.27, p?). A negative outcome was perceived as more credible than a positive outcome (MD 0.81 points; 95% Confidence Interval (CI) 0.43 to 1.18, p?), but did not affect clinical relevance scores (MD -0.14; 95% CI − 0.54 to 0.27).

Conclusions

In this study, industry funding disclosure was not associated with the perceived credibility nor judgement of clinical relevance of a fictional RCT by psychiatrists. Positive study outcomes were found to be less credible compared to negative outcomes, but industry funding had no significant effects. Psychiatrists may underestimate the influence of funding sources on research results. The fact that physicians indicated negative outcomes to be more credible may point to more awareness of existing publication bias in the scientific literature.
Integrating patient perspectives in medical decision-making: a qualitative interview study examining potentials within the rare disease information exchange process in practice
Authors: Babac Ana , von Friedrichs Verena , Litzkendorf Svenja , Zeidler Jan , Damm Kathrin , Graf von der Schulenburg J.-Matthias
Published: September 2019

Background

Many European countries have recently implemented national rare disease plans. Although the network is strengthening, especially on the macro and meso levels, patients still go a long way through healthcare systems, with many health professionals involved and scarce evidence to gather. Specifically, patient involvement in the form of shared decision-making can offer further potential to increase healthcare systems’ efficiency on a micro level. Therefore, we examine the implementation of the shared decision-making concept thus far, and explore whether efficiency potentials exist—which are particularly relevant within the rare disease field—and how they can be triggered.

Methods

Our empirical evidence comes from 101 interviews conducted from March to September 2014 in Germany; 55 patients, 13 family members, and 33 health professionals participated in a qualitative interview study. Transcripts were analyzed using a directed qualitative content analysis.

Results

The interviews indicate that the decision-making process is increasingly relevant in practice. In comparison, however, the shared decision-making agreement itself was rarely reported. A majority of interactions are dominated by individual, informed decision-making, followed by paternalistic approaches. The patient-physician relationship was characterized by a distorted trust-building process, which is affected by not only dependencies due to the diseases’ severity and chronic course, but an often-reported stigmatization of patients as stimulants. Moreover, participation was high due to a pronounced engagement of those affected, diminishing as patients’ strength vanish during their odyssey through health care systems. The particular roles of “expert patients” or “lay experts” in the rare disease field were revealed, with further potential in integrating the gathered information.

Conclusions

The study reveals the named efficiency potentials, which are unique for rare diseases and make the further integration of shared decision-making very attractive, facilitating diagnostics and disease management. It is noteworthy that integrating shared decision-making in the rare disease field does not only require strengthening the position of patients but also that of physicians. Efforts can be made to further integrate the concept within political frameworks to trigger the identified potential and assess the health-economic impact.
Assessing safety climate in prehospital settings: testing psychometric properties of a common structural model in a cross-sectional and prospective study
Authors: Sørskår Leif Inge K. , Olsen Espen , Abrahamsen Eirik B. , Bondevik Gunnar Tschudi , Abrahamsen Håkon B.
Published: September 2019

Background

Little research exists on patient safety climate in the prehospital context. The purpose of this article is to test and validate a safety climate measurement model for the prehospital environment, and to explore and develop a theoretical model measuring associations between safety climate factors and the outcome variable transitions and handoffs.

Methods

A web-based survey design was utilized. An adjusted short version of the instrument Hospital Survey on Patient Safety Culture (HSOPSC) was developed into a hypothetical structural model. Three samples were obtained. Two from air ambulance workers in 2012 and 2016, with respectively 83 and 55% response rate, and the third from the ground ambulance workers in 2016, with 26% response rate. Confirmatory factor analysis (CFA) was applied to test validity and psychometric properties. Internal consistency was estimated and descriptive data analysis was performed. Structural equation modelling (SEM) was applied to assess the theoretical model developed for the prehospital setting.

Results

A post-hoc modified instrument consisting of six dimensions and 17 items provided overall acceptable psychometric properties for all samples, i.e. acceptable Chronbach’s alphas (.68–.86) and construct validity (model fit values: SRMR; .026–.056, TLI; .95–.98, RMSEA; .031–.052, CFI; .96–.98). A common structural model could also be established.

Conclusions

The results provided a validated instrument, the Prehospital Survey on Patient Safety Culture short version (PreHSOPSC-S), for measuring patient safety climate in a prehospital context. We also demonstrated a positive relation between safety climate dimensions from leadership to unit level, from unit to individual level, and from individual level on the outcome dimension related to transitions and handoffs. Safe patient transitions and handoffs are considered an important outcome of prehospital deliveries; hence, new theory and a validated model will constitute an important contribution to the prehospital safety climate research.
Impact of the Dementia Care in Hospitals Program on acute hospital staff satisfaction
Authors: Murray Margaret E. , Wong Shee Anna , West Emma , Morvell Michelle , Theobald Meredith , Versace Vincent , Yates Mark
Published: September 2019

Background

To evaluate the impact of the Dementia Care in Hospitals Program (DCHP) on clinical and non-clinical staff job satisfaction, level of confidence and comfort in caring for patients with cognitive impairment (CI). Staff perceptions of how organisational support and hospital environment met the needs of patients with CI were also assessed.

Methods

The DCHP was implemented across four acute hospital sites across Australia. Clinical and non-clinical staff received training on CI screening and communication strategies for patients with CI. A staff satisfaction survey was administered pre- and post-implementation of the DCHP.

Results

One thousand seven hundred forty-eight staff received DCHP education and 1375 staff participated in the survey. Self-reported confidence and level of comfort in caring for patients with CI significantly improved following implementation. Staff also reported increased job satisfaction and organisational support at all hospital sites.

Conclusions

The DCHP implementation within an acute hospital setting was found to show an improvement in staff confidence, comfort, and job satisfaction when caring for patients with CI. This study has significant implications for the improvement of care for patients with CI as well as staff retention and job satisfaction. Further research is required to determine whether these improvements are sustained in the longer term.
Waiting times for diagnosis of attention-deficit hyperactivity disorder in children and adolescents referred to Italian ADHD centers must be reduced
Authors:   the Lombardy ADHD Group, Bonati Maurizio , Cartabia Massimo , Zanetti Michele
Published: September 2019

Background

To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers.

Methods

Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013–2017 were analyzed.

Results

The sample comprised 2262 children and adolescents aged 5–17 years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177 days (range 66–375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path.

Conclusions

To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered.
Costs of hospitalization for stroke from two urban health insurance claims data in Guangzhou City, southern China
Authors: Zhang Hui , Yin Yujie , Zhang Chao , Zhang Donglan
Published: September 2019

Background

Stroke remains a major global health problem. In China, stroke was the leading cause of death and imposed a large impact on the healthcare system. This study aimed to examine the hospitalization costs by five stroke types and the associated factors for inpatient costs of stroke in Guangzhou City, Southern China.

Methods

This was a prevalence-based, cross-sectional study. Data were obtained from urban health insurance claims database of Guangzhou city. Samples including all the reimbursement claims submitted for inpatient care with the primary diagnosis of stroke from 2006 to 2013 were identified using the International Classification of Diseases codes. Descriptive analysis and multivariate regression analysis based on the Extended Estimating Equations model were performed.

Results

A total of 114,872 hospitalizations for five stroke types were identified. The average age was 71.7 years old, 54.2% were male and 60.1% received medical treatment in the tertiary hospitals, and 92.3% were covered by the urban employee-based medical insurance. The average length of stay was 26.7 days. Among all the hospitalizations (average cost: Chinese Yuan (CNY) 20,203.1 = $3212.1), the average costs of ischaemic stroke (IS), subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH), transient ischaemic attack (TIA), and other strokes were CNY 17,730.5, CNY 62,494.2, CNY 38,757.6, CNY 10,365.3 and CNY 18,920.6, respectively. Medication costs accounted for 42.9, 43.0 and 40.4% of the total inpatient costs among patients with IS, ICH and TIA, respectively, whereas for patients with SAH, the biggest proportion of total inpatient costs was from non-medication treatment costs (57.6%). Factors significantly associated with costs were stroke types, insurance types, age, comorbidities, severity of disease, length of stay and hospital levels. SAH was linked with the highest inpatient costs, followed by ICH, IS, other strokes and TIA.

Conclusions

The costs of hospitalization for stroke were high and differed substantially by types of stroke. These findings could provide economic evidence for evaluating the cost-effectiveness of interventions for the treatment of different stroke types as well as useful information for healthcare policy in China.
Red meat and dietary iron intakes are associated with some components of metabolic syndrome: Tehran Lipid and Glucose Study
Authors: Esfandiar Zohre , Hosseini-Esfahani Firoozeh , Mirmiran Parvin , Habibi-Moeini Ali-Siamak , Azizi Fereidoun
Published: September 2019

Background

This study was conducted to investigate whether the daily consumption of haem, non-haem, total iron and red meat can affect the occurrence of metabolic syndrome (MetS) and its components.

Methods

Eligible adults (n = 4654) were selected from among participants of the Tehran Lipid and Glucose Study with an average follow-up of 3.8 years. Dietary intakes were assessed using a valid and reliable semi-quantitative food frequency questionnaire. Anthropometrics and biochemical variables were evaluated at baseline and follow-up examinations. The occurrence of MetS and its components were assessed in relation to haem, non-haem, total iron and red meat intakes.

Results

There was no relationship between different types of dietary iron and red meat intakes and the incidence of MetS in the Tehranian population. Risk of hypertension decreased from quartiles 1 to 4 for haem iron (HR: 1.00, 0.92, 0.81, 0.80, Ptrend < 0.01) and red meat intake (HR: 1.00, 0.89, 0.84, 0.77, Ptrend < 0.01). The association between hyperglycemia and the fourth quartile of total iron intake was significant (HR = 1.98, 95% CI 1.08–3.63); and the risk of high triglyceride appeared to increase in higher quartiles of total iron intake (HR: 1.00, 1.17, 1.49, 1.75, Ptrend = 0.01) compared to lower quartiles.

Conclusion

Our study suggests a potentially protective relationship of haem and moderate red meat intake against development of high blood pressure; and higher intake of total iron is related to hyperglycemia and high triglyceride.