bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Frailty Index a better predictor than pre-stroke modified Rankin Scale for neurocognitive outcomes 3-months post-stroke?
Authors: Munthe-Kaas Ragnhild , Aam Stina , Saltvedt Ingvild , Wyller Torgeir Bruun , Pendlebury Sarah T. , Lydersen Stian , Hagberg Guri , Schellhorn Till , Rostoft Siri , Ihle-Hansen Hege
Published: February 2022

Background

The prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated.

Aims

The aim of this study was to compare the predictive value of pre-stroke FI with pre-stroke modified Rankin Scale (mRS) for post-stroke cognitive impairment. Further, we explored the added value of including FI in prediction models for cognitive prognosis post-stroke.

Methods

We generated a 36-item Frailty Index (FI), based on the Rockwood FI, to measure frailty based on pre-stroke medical conditions recorded in the Nor-COAST multicentre prospective study baseline assessments. Consecutive participants with a FI score and completed cognitive test battery at three months were included. We generated Odds Ratio (OR) with NCD as the dependent variable. The predictors of primary interest were pre-stroke frailty and mRS. We also measured the predictive values of mRS and FI by the area (AUC) under the receiver operating characteristic curve.

Results

598 participants (43.0% women, mean/SD age = 71.6/11.9, mean/SD education = 12.5/3.8, mean/SD pre-stroke mRS = 0.8/1.0, mean/SD GDS pre-stroke = 1.4/0.8, mean/SD NIHSS day 1 3/4), had a FI mean/SD score = 0.14/0.10. The logistic regression analyses showed that FI (OR 3.09), as well as the mRS (OR 2.21), were strong predictors of major NCD. When FI and mRS were entered as predictors simultaneously, the OR for mRS decreased relatively more than that for FI. AUC for NCD post-stroke was higher for FI than for mRS, both for major NCD (0.762 vs 0.677) and for any NCD (0.681 vs 0.638).

Conclusions

FI is a stronger predictor of post-stroke NCD than pre-stroke mRS and could be a part of the prediction models for cognitive prognosis post-stroke.

Trial Registration

ClinicalTrials.gov Identifier:NCT02650531.
Dynamic changes of viral load and the duration of viral shedding in patients with hand, foot and mouth disease: a protocol for longitudinal study
Authors: Duan Xiaoxia , Zhang Chaoyong , Chen Zhenhua , Liao Juan , Zeng Yilan , Huang Weiwei , Ren Xueling , Tang Xueqin , Peng Hongxia , Zhang Delan , Wang Xiao , Yuan Ping , Long Lu
Published: February 2022

Background

The duration of virus shedding is necessary for determining the infectious period. But there were few quantitative studies on the changes of viral load and the law of the viral shedding in hand foot and mouth disease (HFMD) patients has not yet been clarified.

Methods

This study will prospectively recruit coxsackievirus A10 (CV-A10), coxsackievirus A16 (CV-A16) and coxsackievirus A6 (CV-A6) infected inpatients from January 2022 to December 2022. A series of samples and questionnaire information will be collected regularly to establish the dynamic function relationship between time and viral load changes and a Bayesian multilevel model will be constructed to clarify the evolvement rules which reflect the dynamic changes of viral load and the duration of viral shedding in patients with HFMD.

Discussion

The results of this study is expected to further clarify the evolvement rules which reflect the dynamic changes of viral load and the duration of viral shedding in HFMD patients under the influence of related factors. It can also provide important evidence for the scientific definition of the infectious period and isolation period of HFMD in China.
A new tool for assessing Pectus Excavatum by a semi-automatic image processing pipeline calculating the classical severity indexes and a new marker: the Volumetric Correction Index
Authors: Trò Rosella , Martini Simona , Stagnaro Nicola , Sambuceti Virginia , Torre Michele , Fato Marco Massimo
Published: February 2022

Background

In clinical assessment of Pectus Excavatum (PE), the indication to surgery is based not only on symptoms but also on quantitative markers calculated from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scans. According to clinical routine, these indexes are measured manually by radiologists with limited computer support. This process is time consuming and potentially subjected to inaccuracy and individual variability in measurements. Moreover, the existing indexes have limitations, since they are based on linear measurements performed on single slices rather than on volumetric data derived from all the thoracic scans.

Results

In this paper we present an image processing pipeline aimed at providing radiologists with a computer-aid tool in support of diagnosis of PE patients developed in MATLAB® and conceived for MRI images. This framework has a dual purpose: (i) to automatize computation of clinical indexes with a view to ease and standardize pre-operative evaluation; (ii) to propose a new marker of pathological severity based on volumetric analysis and overcoming the limitations of existing axial slice-based indexes. Final designed framework is semi-automatic, requiring some user interventions at crucial steps: this is realized through a Graphical User Interface (GUI) that simplifies the interaction between the user and the tools. We tested our pipeline on 50 pediatric patients from Gaslini Children’s Hospital and performed manual computation of indexes, comparing the results between the proposed tool and gold-standard clinical practice. Automatic indexes provided by our algorithm have shown good agreement with manual measurements by two independent readers. Moreover, the new proposed Volumetric Correction Index (VCI) has exhibited good correlation with standardized markers of pathological severity, proving to be a potential innovative tool for diagnosis, treatment, and follow-up.

Conclusions

Our pipeline represents an innovative image processing in PE evaluation, based on MRI images (radiation-free) and providing the clinician with a quick and accurate tool for automatically calculating the classical PE severity indexes and a new more comprehensive marker: the Volumetric Correction Index.
Severe maternal hardships are associated with food insecurity among low-income/lower-income women during pregnancy: results from the 2012–2014 California maternal infant health assessment
Authors: Laraia Barbara A. , Gamba Ryan , Saraiva Carina , Dove Melanie S. , Marchi Kristen , Braveman Paula
Published: February 2022

Background

Assess the associations between ten severe maternal hardships and food insecurity experienced during pregnancy.

Methods

Data on 14,274 low-income/lower-income women (below 400% of the income to federal poverty guideline ratio) from the statewide-representative 2010–2012 California Maternal and Infant Health Assessment were used to estimate food security status prevalence. Prevalence of severe maternal hardships by food security status was estimated. Multinomial logistic regression was used to assess the associations between severe maternal hardship and food security status, adjusting for sociodemographic characteristics.

Results

Food insecurity was common among low- and lower-income pregnant women in California; 23.4% food insecure and an additional 11.5% marginally secure. In adjusted analysis, nine of ten hardships were associated with food security status. Only the respondent or someone close to the respondent having a problem with alcohol or drugs was not associated with food security status after adjusting for socioeconomic factors. Husband/partner losing a job, depressive symptoms, not having practical support and intimate partner violence were consistently associated with marginal, low and very low food security status. Each additional severe maternal hardship a woman experienced during pregnancy was associated with a 36% greater risk of reporting marginal food security (Relative Risk Ratio 1.36, 95% CI: 1.27, 1.47), 54% for low food security (Relative Risk Ratio 1.54, 95% CI: 1.44, 1.64), and 99% for very low food security (Relative Risk Ratio 1.99, 95% CI: 1.83, 2.15).

Conclusions

Food security status was strongly linked with several maternal hardships that could jeopardize maternal and/or infant health.

Services—including prenatal care and nutritional assistance—for a large proportion of pregnant women should address a wide range of serious unmet social needs including food insecurity.
Examining the effects of second-and third-trimester gestational weight gain rates on the perinatal outcomes among Chinese twin pregnancies: a retrospective cohort study
Authors: Lin Li-hua , Weng Yi-lin , Lin Ying-ying , Huang Xiu-xian , Lin Yang , Xiu Xiao yan , Yan Jian-ying , Lin Juan
Published: February 2022

Background

This paper investigated how second- and third-trimester gestational weight gain relates to perinatal outcomes among normal weight women with twin pregnancies in Fujian, China.

Methods

A retrospective study examining the medical records of 931 normal weight twin-pregnant women was conducted in Fujian Maternity and Child Health Hospital from 2014 to 2018.The 2nd and 3rdtrimester weekly weight gain rates were calculated, and women were categorized as gaining below, within, or above the 2009 Institute of Medicine (IOM) recommended rates. The association between the trimester-specific weight gain rate and perinatal outcome was determined by traditional regression analysis among groups.

Results

A total of 25.9%, 19.8% and 54.3% of women had rates of weight gain across the 2nd and 3rd trimesters less than, greater than or within the recommended rates respectively. Multivariate logistic regression analysis showed that weight gain greater than the recommended rate in the 2nd trimester was associated with a decreased risk of preeclampsia (aOR:0.489,95%CI:0.289 ~ 0.974). Weight gain less than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery(aOR:2.079, 95%CI:1.467 ~ 2.968), gestational diabetes mellitus (aOR: 2.048, 95%CI:1.411 ~ 2.971), intrahepatic cholestasis syndrome (aOR:3.015,95%CI: 1.058 ~ 8.587), pre-labour rupture of membrane (aOR: 1.708,95%CI: 1.169 ~ 2.493), average twin birth weight < 2500 g(aOR:1.532,95%CI: 1.125 ~ 2.084) and neonatal respiratory distress syndrome (aOR:4.934,95%CI:1.626 ~ 15.083) and was associated with decreased risks of caesarean section (aOR:0.589,95%CI:0.386 ~ 0.898) and preeclampsia (aOR:0.471, 95%CI:0.274 ~ 0.808). In addition, weight gain greater than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery (aOR:1.589,95%CI:1.428 ~ 2.951) and gestational hypertension (aOR:2.137,95% CI:1.034 ~ 4.415) as well as preeclampsia (aOR:2.246, 95%CI:1.462 ~ 3.452). The stratified analysis of weight gain in the 3rd trimester showed that there was no significant difference in the incidence of adverse pregnancy outcomes compared to the 2nd trimester weight gain groups.

Conclusions

While this study showed that a gestational weight gain rate above or below the recommendation in the 3rd trimester was associated with some adverse maternal and neonatal outcomes, further prospective and multicentre studies are required to explore alternate ranges of gestational weight gain rates in twin pregnancies.
A foresight whole systems obesity classification for the English UK biobank cohort
Authors: Clark Stephen , Lomax Nik , Birkin Mark , Morris Michelle
Published: February 2022

Background

The number of people living with obesity or who are overweight presents a global challenge, and the development of effective interventions is hampered by a lack of research which takes a joined up, whole system, approach that considers multiple elements of the complex obesity system together. We need to better understand the collective characteristics and behaviours of those who are overweight or have obesity and how these differ from those who maintain a healthy weight.

Methods

Using the UK Biobank cohort we develop an obesity classification system using k-means clustering. Variable selection from the UK Biobank cohort is informed by the Foresight obesity system map across key domains (Societal Influences, Individual Psychology, Individual Physiology, Individual Physical Activity, Physical Activity Environment).

Results

Our classification identifies eight groups of people, similar in respect to their exposure to known drivers of obesity: ‘Younger, urban hard-pressed’, ‘Comfortable, fit families’, ‘Healthy, active and retirees’, ‘Content, rural and retirees’, ‘Comfortable professionals’, ‘Stressed and not in work’, ‘Deprived with less healthy lifestyles’ and ‘Active manual workers’. Pen portraits are developed to describe the characteristics of these different groups. Multinomial logistic regression is used to demonstrate that the classification can effectively detect groups of individuals more likely to be living with overweight or obesity. The group identified as ‘Comfortable, fit families’ are observed to have a higher proportion of healthy weight, while three groups have increased relative risk of being overweight or having obesity: ‘Active manual workers’, ‘Stressed and not in work’ and ‘Deprived with less healthy lifestyles’.

Conclusions

This paper presents the first study of UK Biobank participants to adopt this obesity system approach to characterising participants. It provides an innovative new approach to better understand the complex drivers of obesity which has the potential to produce meaningful tools for policy makers to better target interventions across the whole system to reduce overweight and obesity.
Evaluation of the collaborative integrated surveillance system (ViCo) in Guatemala: a qualitative study on lessons learned and future perspectives
Authors: Jaramillo Jahn , Ning Mariangeli Freitas , Cadena Loren , Park Michael , Lo Terrence , Zielinski-Gutierrez Emily , Espinosa-Bode Andres , Reyes Marines , Del Rosario Polo Maria , Henao Olga
Published: February 2022

Background

The collaborative integrated surveillance system known as Vigilancia Integrada Comunitaria (ViCo) was implemented in 2007 to better understand and characterize the burden of diarrheal, respiratory and febrile illnesses in Guatemala.

Methods

To evaluate the usefulness of ViCo and inform a redesign of the system and new surveillance activities in the Central American region, personnel from the United States Centers for Disease Control and Prevention (CDC) conducted thirty-nine in-depth interviews from June—December 2018 with key stakeholders responsible for the design and implementation of ViCo in Guatemala. A semi-structured questionnaire adapted from the Updated CDC Guidelines for Evaluating Public Health Surveillance Systems was used for data collection. We used a grounded theory approach to explore stakeholder perceptions of ViCo and generate recommendations for improvement. Primary qualitative findings were organized based on thematic areas using ATLAS.ti version 8 software.

Results

Emergent themes relevant to the usefulness of ViCo were organized across strengths, weaknesses, and recommendations pertaining to the: (1) Size and Complexity of ViCo, (2) Stakeholder Expectations About the Objectives of ViCo, (3) Data Management and Structure of the Information System, (4) Local Control of Data, (5) Integration of ViCo within the Ministry of Health, and, (6) Improvement of the Operational and Design Aspects of ViCo across System, Process, and Output levels.

Conclusions

Stakeholders perceived ViCo to be useful. They recommended measures to improve system performance and quality, including simplifying the surveillance system, routine data analysis and feedback, and channeling efforts towards integrating surveillance data into the national health information system. To create a well-performing surveillance system and achieve the intended objective of surveillance for public health action, ongoing evaluation and assessment of surveillance activities are necessary.
Participation in primary health care through community-level health committees in Sub-Saharan Africa: a qualitative synthesis
Authors: Karuga Robinson , Kok Maryse , Luitjens Marthe , Mbindyo Patrick , Broerse Jacqueline E. W. , Dieleman Marjolein
Published: February 2022

Background

Health committees are key mechanisms for enabling participation of community members in decision-making on matters related to their health. This paper aims to establish an in-depth understanding of how community members participate in primary health care through health committees in sub-Saharan Africa (SSA).

Methods

We searched peer-reviewed English articles published between 2010 and 2019 in MEDLINE, Popline and CINAHL databases. Articles were eligible if they involved health committees in SSA. Our search yielded 279 articles and 7 duplicates were removed. We further excluded 255 articles following a review of titles and abstracts by two authors. Seventeen abstracts were eligible for full text review. After reviewing the full-text, we further excluded two articles that did not explicitly describe the role of health committees in community participation. We therefore included 15 articles in this review. Two authors extracted data on how health committees contributed to community participation in SSA using a conceptual framework for assessing community participation in health. We derived our themes from five process indicators in this framework, namely, leadership, management and planning, resource mobilization from external sources, monitoring and evaluation and women involvement.

Findings

We found that health committees work well in voicing communities’ concerns about the quality of care provided by health facility staff, day-to-day management of health facilities and mobilizing financial and non-financial resources for health activities and projects. Health committees held health workers accountable by monitoring absenteeism, quality of services and expenditures in health facilities. Health committees lacked legitimacy because selection procedures were often not transparent and participatory. Committee members were left out in planning and budgeting processes by health workers, who perceived them as insufficiently educated and trained to take part in planning. Most health committees were male-dominated, thus limiting participation by women.

Conclusion

Health committees contribute to community participation through holding primary health workers accountable, voicing their communities’ concern and mobilizing resources for health activities and projects. Decision makers, health managers and advocates need to fundamentally rethink how health committees are selected, empowered and supported to implement their roles and responsibilities.
Global trends in incidence and death of neonatal disorders and its specific causes in 204 countries/territories during 1990–2019
Authors: Ou Zejin , Yu Danfeng , Liang Yuanhao , He Huan , He Wenqiao , Li Yongzhi , Zhang Minyi , Gao Yuhan , Wu Fei , Chen Qing
Published: February 2022

Background

Neonatal disorders (ND) are a significant global health issue. This article aimed to track the global trends of neonatal disorders in 204 countries/territories from 1990 to 2019.

Methods

Data was explored from the Global Burden of Disease study 2019. Estimated annual percentage change (EAPC) and age-standardized rate (ASR) were calculated to quantify the trends of neonatal disorders and their specific causes, mainly included neonatal preterm birth (NPB), neonatal encephalopathy due to birth asphyxia and trauma (NE), neonatal sepsis and other neonatal infections (NS), and hemolytic disease and other neonatal jaundice (HD).

Results

In 2019, there were 23,532.23 × 103 incident cases of ND, and caused 1882.44 × 103 death worldwide. During 1990–2019, trends in the overall age-standardized incidence rate (ASIR) of ND was relatively stable, but that of age-standardized death rate (ASDR) declined (EAPC = -1.51, 95% confidence interval [CI]: -1.66 to -1.36). Meanwhile, decreasing trends of ASDR were observed in most regions and countries, particularly Cook Islands and Estonia, in which the respective EAPCs were -9.04 (95%CI: -9.69 to -8.38) and -8.12 (95%CI: -8.46 to -7.77). Among the specific four causes, only the NPB showed decreasing trends in the ASIR globally (EAPC = -0.19, 95%CI: -0.26 to -0.11). Decreasing trends of ASDR caused by ND underlying specific causes were observed in most regions, particularly the HD in Armenia, with the EAPC was -13.08 (95%CI: -14.04 to -12.11).

Conclusions

Decreasing trends of death caused by neonatal disorders were observed worldwide from 1990 to 2019. However, the burden of neonatal disorders is still a considerable challenge, especially in low-resource settings, which need more effective health strategies.
Central airway obstruction: is it time to move forward?
Authors: Guedes Fernando , Branquinho Mariana V. , Sousa Ana C. , Alvites Rui D. , Bugalho António , Maurício Ana Colette
Published: February 2022

Introduction

Central airway obstruction (CAO) represents a pathological condition that can lead to airflow limitation of the trachea, main stembronchi,bronchus intermediusorlobar bronchus.

Main body

It is a common clinical situation consensually considered under-diagnosed. Management of patients with CAO can be difficult and deciding on the best treatment approach represents a medical challenge. This work intends to review CAO classifications, causes, treatments and its therapeutic limitations, approaching benign and malign presentations. Three illustrative cases are further presented, supporting the clinical problem under review.

Conclusion

Management of CAO still remains a challenge. The available options are not always effective nor free from complications. A new generation of costume-tailored airway stents, associated with stem cell-based therapy, could be an option in specific clinical situations.
Short-term effects of postural taping on pain and forward head posture: a randomized controlled trial
Authors: Augustsson Sofia Ryman , Reinodt Sara , Sunesson Evelina , Haglund Emma
Published: February 2022

Background

Balance Body Tape (BBT) is a recently developed taping-method with the aim to reduce pain and improve posture through change in movement behavior. However, the potential effects of a treatment with BBT are scarcely documented. Therefore, the aim with this study was to investigate the effect of a three-week Balance body tape-treatment on the intensity of perceived neck, shoulder and back pain and forward head posture.

Methods

In this RCT study, subjects (n = 26), who reported being university students or having a sedentary work and experiencing pain in neck, back or shoulders, were randomized to either an intervention (n = 12) or control group (n = 14). The intervention group received a three-week treatment with BBT, the control group received no treatment. A questionnaire regarding pain, including a Numeric Rating Scale (NRS) measuring pain intensity, and a Photographic posture analysis measurement (PPAM) regarding the craniovertebral (CV) angle were assessed before and after the intervention for both groups. Wilcoxon’s signed rank test and Mann-Whitney U test was used to assess intra- and between group differences respectively. The relationship between pain intensity and CV angle was assessed using Spearman’s correlation.

Results

No difference in demographic and physical characteristics between the groups were noted at baseline (p > 0.05). Pain intensity at baseline was 5 for the intervention group and 4 for the control group (p = 0.330). At follow up, the intervention group reported a lower score (NRS = 2.5, p = 0.003) whereas the control group had no significant difference in pain intensity (NRS = 3, p = 0.086). No significant change was found in the CV angle (p = 0.058) and no correlation was found between NRS and the CV angle (r = 0.102, p = 0.619).

Conclusion

A short treatment period with BBT may, compared to no treatment, have a small reducing effect on pain intensity in neck, back and/or shoulders. However, no effect was found on forward head posture in this study.

Trial registration

Registered retrospectively on 08/11/2021. NCT05111704.

Trial registration page link:
Quality of knee strengthening exercises performed at home deteriorates after one week
Authors: Mitchell Ulrike H. , Lee Hyunwook , Dennis Hayden E. , Seeley Matthew K.
Published: February 2022

Background

To compare the performance (as determined by lower extremity kinematics) of knee exercises in healthy middle-aged and older individuals immediately after instruction and one week later.

Methods

This is a cross-sectional study in a laboratory setting. Nineteen healthy volunteers (age [y] 63.1 ± 8.6, mass [kg] 76.3 ± 14.7, height [m] 1.7 ± 0.1) participated in this study. High speed video and reflective markers were used to track motion during four exercises. The exercises were knee flexion, straight leg raise, and “V “in supine position, and hip abduction in side lying position. All participants received verbal and tactile cues during the training phase and the therapist observed and, if necessary, corrected the exercises. Upon return a week later the participants performed the same exercises without any further instructions. Knee and hip sagittal and rotational angles were extracted from the motion capture. A repeated measures t-test was used to compare the motions between two visits.

Results

Participants demonstrated more knee flexion during straight leg raise and “V in” exercises at the 2nd visit compared to the 1st visit (both p <  0.05). During the “V out” exercise, they performed more external rotation (p <  0.05) while they showed more internal rotation during the “V in” exercise at the 2nd visit compared to the 1st visit.

Conclusions

Exercise performance declined significantly in healthy middle-aged and older individuals one week after instruction. This decline occurred despite an instructional exercise sheet being given to every participant. Other approaches designed to help individuals retain the ability to perform rehabilitative exercises correctly need to be explored.
The impact of COVID-19 on the well-being, education and clinical practice of general practice trainees and trainers: a national cross-sectional study
Authors: Coenen Lotta , Poel Louise Vanden , Schoenmakers Birgitte , Van Renterghem Arne , Gielis Guy , Remmen Roy , Michels Nele R.
Published: February 2022

Background

COVID-19 has changed General Practice (GP) education as well as GP clinical activities. These changes have had an impact on the well-being of medical trainees and the role of GP plays in the society. We have therefore aimed to investigate the impact that COVID-19 has had on GP trainees and trainers in four domains: education, workload, practice organization and the role of GP in society.

Design: a cross-sectional study design was used.

Methods

The Interuniversity Centre for the Education of General Practitioners sent an online survey with close-ended and open-ended questions to all GP trainees and trainers in Flanders, active in the period March – September 2020. Descriptive statistics were performed to analyze the quantitative data and thematic analysis for the qualitative data.

Results

216 (response 25%) GP trainees and 311 (response 26%) trainers participated. GP trainees (63%, N = 136) and trainers (76%, N = 236) reported new learning opportunities since the COVID-19 pandemic. The introduction of telehealth consulting and changing guidelines required new communication and organizational skills. Most of the GP trainees (75%, n = 162) and trainers (71%, n = 221) experienced more stress at work and an overload of administrative work. The unfamiliarity with a new infectious disease and the fact that COVID-19 care compromised general GP clinical activities, created insecurity among GP trainers and trainees. Moreover, GP trainees felt that general GP activities were insufficiently covered during the COVID-19 pandemic for their training in GP. GP trainers and trainees experienced mutual support, and secondary support came from other direct colleagues. Measures such as reducing the writing of medical certificates and financial support for administrative and (para) medical support can help to reprioritize the core of GP care.

COVID-19 has enhanced the use of digital learning over peer-to-peer learning and lectures. However, GP trainees and trainers preferred blended learning educational activities.

Conclusions

COVID-19 has created learning opportunities such as telehealth consulting and a flexible organization structure. To ensure quality GP education during the pandemic and beyond, regular GP care should remain the core activity of GP trainees and trainers and a balance between all different learning methods should be found.
Role models as a factor influencing career choice among female surgical residents in Saudi Arabia: a cross-sectional study
Authors: Harun Rawan Abdulrahman T. , Almustafa Reem , AlKhalifah Zainab , Nammazi Abdullah , AlBaqami Abdalmohsen , ALSaleh Nourah Mohammed , Kadi Mai , Farsi Ali , Malibary Nadim
Published: February 2022

Background and purpose

Role models in the medical field are professional and experienced persons whose actions unconsciously inspire juniors to strive to be like them. To our knowledge, no studies have examined whether having a female surgical role model has influenced women to pursue a surgical career in Saudi Arabia. Hence, we sought to evaluate whether identifying role models in surgery influences career choice and defined the ideal qualities of a surgical role model as perceived by newly qualified doctors.

Methods

We employed a cross-sectional, survey- based study design, conducted between June 2020 and January 2021, in which female surgical residents completed a questionnaire about their perceptions and influence of role models in general surgery specialty at the time they pursue a career in surgery.

Results

A total of 51 respondents completed the questionnaire. The majority of them (78.4%) had a role model and (19.6%) indicated that their role model was a female. Of those who had a role model, (67.5%) agreed that they experienced a positive influence on their surgical career choice. Clinical and operation skills were reported as the most remarkable factor to be considered in their role models. Working directly with a male surgical consultant and female surgical residents imprinted a positive influence but this did not reach a statistical significance.

Conclusion

The findings of this article contribute empirically to the strong effects of the same-sex role models and highlight the curial role of surgical residents in influencing female’s career choices in general surgery as an achievable and attainable domain. Which encourage the creation of national mentorship programs and exploring more in barriers for pursuing a surgical career.
Correction to: An analysis of the selection criteria for postgraduate physician assistant residency and fellowship programs in the United States
Authors: Kidd Vasco Deon , Vanderlinden Sarah , Spisak Jennifer M.
Published: February 2022

An amendment to this paper has been published and can be accessed via the original article.
Costs associated with treatment of insomnia in Alzheimer’s disease caregivers: a comparison of mindfulness meditation and cognitive behavioral therapy for insomnia
Authors: Bentley Tanya G. K. , Castillo Daisy , Sadeghi Nina , Piber Dominique , Carroll Judith , Olmstead Richard , Irwin Michael R.
Published: February 2022

Background

Among the over 5 million informal caregivers for patients with Alzheimer’s disease (AD) in the United States (US), over 60% experience insomnia. Research on insomnia treatment efficacy in AD caregivers is limited. An ongoing randomized non-inferiority clinical trial, the Caregiver Sleep Research study, is evaluating whether mindfulness meditation is non-inferior to cognitive behavioral therapy for insomnia (CBT-I) in the treatment of insomnia in AD caregivers. The present report examines estimated intervention costs in this ongoing trial.

Methods

Micro-costing was used to itemize and abstract costs of the two interventions: a mindfulness-based intervention known as mindful awareness practices for insomnia (MAP-I); and CBT-I. This approach involves collecting detailed data on resources utilized and the unit costs of those resources, thereby revealing actual resource use and economic costs for each treatment arm. Personnel time, patient time, and supplies were inventoried, and unit costs were applied. Caregiver time costs, including travel, were based on US Labor Bureau home-health aide national mean hourly wages; instructor/staff costs were based on hourly wages. Per-participant and program costs were calculated assuming individual- and group-delivery to reflect real-world implementation. Sensitivity analyses evaluated robustness of estimates.

Results

From the societal perspective, per-participant MAP-I costs were $1884 for individual and $1377 for group delivery; for CBT-I, these costs were $3978 and $1981, respectively. Compared with CBT-I, MAP-I provided cost savings of $2094 (53%) and $604 (30%) per treated caregiver for individual and group delivery, respectively. From the US healthcare system perspective, MAP-I vs. CBT-I participant savings were $1872 (65%) for individual and $382 (44%) for group interventions, respectively. For MAP-I and CBT-I, instructor in-class time was the highest cost component. Results were most sensitive to combined instructor time costs.

Conclusions

Treatment of insomnia with MAP-I, compared to CBT-I, yields substantial cost savings for society and the healthcare system. With this potential for cost savings, results of the ongoing non-inferiority trial have critical implications for insomnia treatment dissemination and its benefits to AD caregivers and other community populations with insomnia.
Medical costs and hospital utilization for hemophilia A and B urban inpatients in China: a national cross-sectional study
Authors: Huang Zhengwei , Nicholas Stephen , Yang Yong , Chen Xiaoping , Maitland Elizabeth , Ma Yong , Shi Xuefeng
Published: February 2022

Background

Hemophilia care in mainland China has been greatly improved since the establishment of the Hemophilia Treatment Center Collaborative Network of China (HTCCNC), and most of drugs for hemophilia have been covered by basic medical insurance schemes. This study assesses whether medical costs and hospital utilization disparities exist between hemophilia A and hemophilia B urban inpatients in China and, second, whether the prescription of coagulation factor concentrates for hemophilia A and hemophilia B inpatients was optimal, from the third payer perspective.

Methods

We conducted a retrospective nationwide analysis based on a 5% random sample from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) schemes from 2010 to 2016. Univariate analysis and multiple regression analysis based on a generalized linear model were conducted.

Result

A total of 487 urban inpatients who had hemophilia were identified, including 407 inpatients with hemophilia A and 80 inpatients with hemophilia B. Total medical cost for hemophilia B inpatients was significantly higher than for hemophilia A inpatients (USD 2912.81 versus USD 1225.60, P < 0.05), and hemophilia B inpatients had a significantly longer length of hospital stay than hemophilia A inpatients (9.00 versus 7.00, P < 0.05). Total medical costs were mostly allocated to coagulation factor products (76.86-86.68%), with coagulation factor cost of hemophilia B significantly higher than hemophilia A (P < 0.05). Both hemophilia cohorts utilized greatest amount of plasma-derived Factor VIII, followed by recombinant Factor VIII and prothrombin complex concentrates.

Conclusions

Patients with hemophilia B experienced significantly higher inpatient cost, coagulation factor cost and longer length of hospital stay than patients with hemophilia A. Our findings revealed the suboptimal use of coagulation factor concentrate drugs and a higher drug cost burden incurred by hemophilia B than hemophilia A inpatients. Our results call for efforts to strengthen drug regulatory management for hemophilia and to optimize medical insurance schemes according to hemophilia types.
Perspectives of stakeholders of the free maternity services for mothers in western Kenya: lessons for universal health coverage
Authors: Ochieng Beverly Marion , Kaseje Margaret , Kaseje Dan Clement Owino , Oria Kevin , Magadi Monica
Published: February 2022

Background

The strategic aim of universal health coverage (UHC) is to ensure that everyone can use health services they need without risk of financial hardship. Linda Mama (Taking care of the mother) initiative focuses on the most vulnerable women, newborns and infants in offering free health services. Financial risk protection is one element in the package of measures that provides overall social protection, as well as protection against severe financial difficulties in the event of pregnancy, childbirth, neonatal and perinatal health care for mothers and their children.

Purpose

The aim of this study was to find out the extent of awareness, and involvement among managers, service providers and consumers of Linda mama supported services and benefits of the initiative from the perspectives of consumers, providers and managers.

Methods

We carried out cross sectional study in four sub counties in western Kenya: Rachuonyo East, Nyando, Nyakach, and Alego Usonga. We used qualitative techniques to collect data from purposively selected Linda Mama project implementors, managers, service providers and service consumers. We used key informant interview guides to collect data from a total of thirty six managers, nine from each Sub -County and focus group discussion tools to collect data from sixteen groups of service consumers attending either antenatal or post-natal clinics, four from each sub county, selecting two groups from antenatal and two from postnatal clinics in each sub county. Data analysis was based on thematic content analysis.

Findings

Managers and service providers were well aware of the initiative and were involved in it. Participation in Linda Mama, either in providing or using, seemed to be more prominent among managers and service providers. Routine household visits by community health volunteers to sensitize mothers and community engagement was core to the initiative. The managers and providers of services displayed profound awareness of how requiring identification cards and telephone numbers had the potential to undermine equity by excluding those in greater need of care such as under-age pregnant adolescents. Maternity and mother child health services improved as a result of the funds received by health facilities. Linda Mama reimbursements helped to purchase drug and reduced workload in the facility by hiring extra hands.

Conclusion

The initiative seems to have influenced attitudes on health facility delivery through: Partnership among key stakeholders and highlighting the need for enhanced partnership with the communities. It enhanced the capacity of health facilities to deliver high quality comprehensive, essential care package and easing economic burden.
Castration-resistant prostate cancer patient presenting with whole genome doubling with CDK-12 mutation
Authors: Baba Yuto , Kosaka Takeo , Kobayashi Hiroaki , Nakamura Kohei , Mikami Shuji , Nishihara Hiroshi , Nakanishi Makoto , Oya Mototsugu
Published: February 2022

Background

The use of whole-genome sequencing in clinical practice has revealed variable genomic characteristics across cancer types, one of which is whole-genome doubling (WGD), which describes the duplication of a complete set of chromosomes. Yet it is relatively rare in prostate cancer and no such case has ever been reported in Japanese patients.

Case presentation

A 54-year-old patient with prostatic adenocarcinoma with bone and lymph node metastases was started on androgen-deprivation therapy. As the prostate cancer turned castration-resistant, multimodal therapies including taxane- and platinum-based chemotherapy, androgen-receptor antagonist inhibitors, radiotherapy and radium-233 were introduced. Good controls of serum prostate-specific antigen (PSA) level and bone metastases were achieved for more than 13 years since after the initial treatment. During the treatment, a metastatic lymph node biopsy was performed to confirm the tumor histology, and spinal decompression surgery were performed for spinal compression due to lumber vertebral metastases. The immunohistochemical analysis identified PSA and androgen receptor positive tumor cells in both metastatic lesions, while no variable cancer cells were detected in the prostate on second biopsy. Whole-genome sequencing was performed on the biopsied metastatic lymph node in search for another possible treatment and it revealed that the tumor had WGD and CDK12 mutation. The WGD-positive tumor cells contained large and polymorphic nucleus, presumably reflecting on the ploidy abnormality of the chromosomes.

Conclusions

This report is the first case of a Japanese patient presenting with WGD, who survived more than 13 years with multimodal chemotherapies and radiotherapies.
Macular pigment-enriched oil production from genome-edited microalgae
Authors: Song Inhwa , Kim Sunbin , Kim Jongrae , Oh Hyeonjun , Jang Junhwan , Jeong Su Jin , Baek Kwangryul , Shin Weon-Sun , Sim Sang Jun , Jin EonSeon
Published: February 2022

Background

The photosynthetic microorganism Chlamydomonas reinhardtii has been approved as generally recognized as safe (GRAS) recently, this can excessively produce carotenoid pigments and fatty acids. Zeaxanthin epoxidase (ZEP), which converts zeaxanthin to violaxanthin, and ADP-glucose pyrophosphorylase (AGP). These are key regulating genes for the xanthophyll and starch pathways in C. reinhardtii respectively. In this study, to produce macular pigment-enriched microalgal oil, we attempted to edit the AGP gene as an additional knock-out target in the zep mutant as a parental strain.

Results

Using a sequential CRISPR-Cas9 RNP-mediated knock-out method, we generated double knock-out mutants (dZAs), in which both the ZEP and AGP genes were deleted. In dZA1, lutein (2.93 ± 0.22 mg g−1 DCW: dried cell weight), zeaxanthin (3.12 ± 0.30 mg g−1 DCW), and lipids (450.09 ± 25.48 mg g−1 DCW) were highly accumulated in N-deprivation condition. Optimization of the culture medium and process made it possible to produce pigments and oil via one-step cultivation. This optimization process enabled dZAs to achieve 81% higher oil productivity along with similar macular pigment productivity, than the conventional two-step process. The hexane/isopropanol extraction method was developed for the use of macular pigment-enriched microalgal oil for food. As a result, 196 ± 20.1 mg g−1 DCW of edible microalgal oil containing 8.42 ± 0.92 mg g−1 lutein of oil and 7.69 ± 1.03 mg g−1 zeaxanthin of oil was produced.

Conclusion

Our research showed that lipids and pigments are simultaneously induced in the dZA strain. Since dZAs are generated by introducing pre-assembled sgRNA and Cas9-protein into cells, antibiotic resistance genes or selective markers are not inserted into the genome of dZA, which is advantageous for applying dZA mutant to food. Therefore, the enriched macular pigment oil extracted from improved strains (dZAs) can be further applied to various food products and nutraceuticals.
District-led malaria surveillance and response as an effective way to manage malaria upsurges following the withdrawal of indoor residual spraying: a case study from Nwoya District, northern Uganda
Authors: Nuwa Anthony , Oola Janet , Obonyo Sam Okot , Feldman Mitra , Karungi Shirah , Kertho Edmound , Odong David Salandini , Kimera Isaac , Magumba Godfrey , Beinomugisha Geofrey , Chitty Alexandra , Tibenderana James , Opigo Jimmy , Abwaimo Francis
Published: February 2022

Background

Malaria remains the number one cause of morbidity and mortality in Uganda. In 2009, the United States President’s Malaria Initiative (PMI) funded an indoor residual spraying (IRS) project in 10 mid-northern districts, resulting in marked reductions in malaria prevalence over 5 years, from 62.5 percent to 7.2 percent. When the project ended and IRS withdrawn, malaria prevalence increased exponentially to pre-IRS level of 63 percent in 2016 and was characterized by frequent life-threatening upsurges that were exacerbated by a weak national led malaria surveillance system with delayed and piece meal responses. Malaria Consortium, in collaboration with Nwoya district local government implemented a district led malaria surveillance and response system. This study was conducted to compare the impact of District led and national led surveillance and response systems on overall malaria burden in two sub-counties in Nwoya district, Northern Uganda.

Methods

The assessment was conducted between week 41 of 2018 and week 10 of 2019 in Anaka and Alero sub counties following the shift from the national to district led malaria surveillance and response system. A district multi-sectoral malaria response taskforce team, known as the District Malaria Surveillance and Response Team (DMSRT), was formed by the Nwoya District Health Team (DHT). The DMSRT was trained and equipped with new surveillance tools for early detection of and response to malaria upsurges within the district, and were mandated to develop a costed district specific malaria response plan.

Results

All (18) targeted health facilities provided weekly malaria reports and continuously updated the malaria normal channel graphs. There was an overall reduction in weekly new malaria cases from 12.9 in week 41 of 2018 to 6.2 cases in week 10 of 2019. Malaria positivity rates (TPR) for Alero and Anaka sub-counties reduced from 76.0 percent and 69.3 percent at week 42 of 2018 to 28 percent and 30.3 percent, respectively at week 10 of 2019.

Conclusions

Malaria surveillance and response, with precisely targeted multipronged activities, when led and implemented by local district health authorities is an effective, efficient, and sustainable approach to prevent malaria upsurges and associated morbidity and mortality.