bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing quality of life in traditional face-to-face visits with a hybrid approach of telemedicine with in-person follow-ups in recent users of advanced closed-loop systems: a randomized controlled clinical trial in patients with type 1 diabetes
Authors: Nattero-Chávez Lía , de La Calle Esther , Lecumberri-Pascual Edurne , Bayona Cebada Ane , Ruiz Gracia Teresa , Quintero Tobar Alejandra , Lorenzo Moñino Mar , Sánchez Rodríguez Cristina , Izquierdo Ana , Escobar-Morreale Héctor F. , Luque-Ramírez Manuel
Published: October 2024

Background:

Our objective was to assess the effect of a hybrid telemedicine approach, in conjunction with face-to-face follow-up, on the quality of life in recent users of an advanced hybrid closed-loop (AHCL) system.

Methods:

A 1-year open randomized (1:1) clinical trial (ClinicalTrials.gov ID NCT04900636). Participants with type 1 diabetes (T1D) recent users of an AHCL system (Minimed® 780G) for at least 2–6 months, and ⩾18 years old were eligible. The primary outcome was the change in quality of life measured by the Type 1 Diabetes Life (ViDa1) Questionnaire from baseline to 12 months of hybrid telemedicine plus face-to-face follow-up compared to standard clinical practice. Additionally, impacts on A1c levels, glucose metrics, advert events, and safety outcomes were assessed.

Results:

Between January and December 2021, 46 participants were randomly assigned in a 1:1 ratio to either the hybrid telemedicine group ( n = 23) or the control group ( n = 23); 45 participants completed the study, with only 1 from the control group withdrawing before visit 3. At baseline, mean age was 37 ± 15 years and A1c was 6.9 ± 0.5%. After 12 months, no statistically significant differences in ViDa1 scores between groups were observed. Despite reducing in-person visits in the hybrid follow-up arm, there were no increases in adverse events. Overall, A1c levels significantly decreased from 6.9 ± 0.5% at baseline to 6.7 ± 0.5% after 12 months ( P = 0.006) without differences between treatment arms, accompanied by reductions in glycemic variability and time below the target range.

Conclusion:

Our study suggests that there were no significant differences in ViDa1 scores between the two groups at the end of the follow-up. However, among adult patients with T1D who recently adopted an AHCL system, satisfactory glycemic control can be attained through a hybrid follow-up approach, reducing face-to-face visits, without increasing technical complications.
Participatory topological mapping: A novel approach for exploring and communicating situated knowledge of complex socio-ecological systems
Authors: Johnsen Kathrine I , Westerveld Levi , Persson Anna-Marja , Stenberg Jörgen , Juntti Karl-Johan
Published: October 2024

Land use change impacts on Sámi reindeer husbandry are well-documented, but existing maps often fail to capture socio-ecological relationships between herders, reindeer and nature. Conventional Geographic Information Systems (GIS) simplify these relationships, lacking local context and excluding valuable knowledge due to their rigid structure. This paper introduces participatory topological mapping, a low-tech, knowledge co-production method that allows communities to share geospatial insights without advanced software. Combining hand-drawn maps with a standardised topological structure facilitates the visualisation of geographical relationships and dynamic land use systems from a local perspective. Developed and assessed through a Swedish case study in collaboration with Vittangi and Malå reindeer herding communities, the method aims to reduce barriers to knowledge exchange and enhance dialogue between Indigenous knowledge-holders, researchers and decision-makers. The paper discusses the authors’ experiences with participatory topological mapping, emphasising its potential and limitations for knowledge exchange. The method is advocated for broader use, recognising its value in articulating concerns about land use change beyond research settings and reindeer husbandry. Participatory topological mapping enables knowledge-holders to control the map and its narrative, deciding what is included or excluded. The maps and accompanying stories are valuable sources for documenting, sharing and analysing local perspectives on landscapes and the effects of land use change. The method treats mapping as a social process with the potential to affect how we understanding the world. When thoughtfully applied, it offers a valuable avenue for knowledge co-production, fostering deeper engagement, supporting informed decision-making and empowering communities.
Circumstantial Factors Among Kentucky Nurse Suicide Decedents, 2005 to 2019
Authors: Norrod Paul E. , Marfell Julie , Walmsley Lee Anne , Brown Sabrina
Published: October 2024

Background: Nurse suicide, a complex occupational health concern, is urgently in need of research due to the personal and occupational suicide risk factors experienced by nurses, namely mental health problems (e.g., depression), job problems, and substance misuse. Therefore, the study aims were to determine the contextual characteristics and circumstantial factors associated with nurse suicide in Kentucky. Methods: Secondary suicide data were obtained from the Kentucky Violent Death Reporting System (KYVDRS) from 2005 to 2019. Nurse suicide cases were identified using the Bureau of Labor Statistics Standard Occupational Classification. A mixed-methods analysis using descriptive statistics and qualitative evaluation was conducted to determine the distributions of demographic, injury, and weapon characteristics, followed by a qualitative analysis of the KYVDRS incident narrative text of nurse suicide decedents. Results: There were 88 decedents identified with a nursing occupation. The predominant means of death for male (59%) and female (45%) nurses involved firearms. Thematic analysis showed nurse decedents experienced a mental health problem (51%) and premeditated (50%) suicide preceding death. Incidentally, 51% of all cases experienced multiple circumstantial factors (e.g., relationship problems and premeditation) preceding their death by suicide. Discussion/Application to Practice: Nurse suicide decedents experienced multifactorial risk factors preceding their death by suicide, namely depression, premeditated suicide, and relationship problems. Occupational health practitioners and health care organizations can implement individual and organizational prevention efforts to help prevent nurse suicide.
Cross-cultural experiences: Voices of the Chinese doctoral students at a Spanish university
Authors: Lin Cai , Weise Crista , Alvarez Ibis M
Published: October 2024

The aim of the study was to investigate the experiences of Chinese doctoral students at a Spanish university, aiming to enhance understanding of transcultural experiences. Challenges perceived during their cultural transition throughout their doctoral studies were explored, along with the strategies they employed to overcome these obstacles. Following a qualitative approach, eight participants were interviewed in depth on critical incidents experienced in academic and sociocultural settings. Effective communication emerged as the main challenge. Most critical incidents in the relationship with supervisors were associated with mismatched expectations and misunderstandings regarding learning objectives and activities. Limitations in writing in English and unfamiliarity with the sociocultural environment of the host university were perceived as hindering the achievement of academic goals and the adaptation to the local culture. Interaction with other doctoral students, self-determination, critical reflexivity, and autonomy were coping strategies that facilitated cross-cultural adaptation. The results confirm the legitimate socio-educational needs of Chinese students and their broad cultural and pedagogical agency. Results are useful for institutional support programs and to help doctoral students and supervisors establish adaptive cross-cultural relationships. Moreover, the study shows the resourcefulness of Chinese students in dealing with the challenges of cross-cultural transition and emphasizes the role that higher education institutions must play in serving international students.
Shrinkage estimation of gene interaction networks in single-cell RNA sequencing data
Authors: Vo Duong H. T. , Thorne Thomas
Published: October 2024

Background

Gene interaction networks are graphs in which nodes represent genes and edges represent functional interactions between them. These interactions can be at multiple levels, for instance, gene regulation, protein-protein interaction, or metabolic pathways. To analyse gene interaction networks at a large scale, gene co-expression network analysis is often applied on high-throughput gene expression data such as RNA sequencing data. With the advance in sequencing technology, expression of genes can be measured in individual cells. Single-cell RNA sequencing (scRNAseq) provides insights of cellular development, differentiation and characteristics at the transcriptomic level. High sparsity and high-dimensional data structures pose challenges in scRNAseq data analysis.

Results

In this study, a sparse inverse covariance matrix estimation framework for scRNAseq data is developed to capture direct functional interactions between genes. Comparative analyses highlight high performance and fast computation of Stein-type shrinkage in high-dimensional data using simulated scRNAseq data. Data transformation approaches also show improvement in performance of shrinkage methods in non-Gaussian distributed data. Zero-inflated modelling of scRNAseq data based on a negative binomial distribution enhances shrinkage performance in zero-inflated data without interference on non zero-inflated count data.

Conclusion

The proposed framework broadens application of graphical model in scRNAseq analysis with flexibility in sparsity of count data resulting from dropout events, high performance, and fast computational time. Implementation of the framework is in a reproducible Snakemake workflow https://github.com/calathea24/ZINBGraphicalModel and R package ZINBStein https://github.com/calathea24/ZINBStein.
Bacterial community dynamics as a result of growth-yield trade-off and multispecies metabolic interactions toward understanding the gut biofilm niche
Authors: Valiei Amin , Dickson Andrew M. , Aminian-Dehkordi Javad , Mofrad Mohammad R. K.
Published: October 2024

Bacterial communities are ubiquitous, found in natural ecosystems, such as soil, and within living organisms, like the human microbiome. The dynamics of these communities in diverse environments depend on factors such as spatial features of the microbial niche, biochemical kinetics, and interactions among bacteria. Moreover, in many systems, bacterial communities are influenced by multiple physical mechanisms, such as mass transport and detachment forces. One example is gut mucosal communities, where dense, closely packed communities develop under the concurrent influence of nutrient transport from the lumen and fluid-mediated detachment of bacteria. In this study, we model a mucosal niche through a coupled agent-based and finite-volume modeling approach. This methodology enables us to model bacterial interactions affected by nutrient release from various sources while adjusting individual bacterial kinetics. We explored how the dispersion and abundance of bacteria are influenced by biochemical kinetics in different types of metabolic interactions, with a particular focus on the trade-off between growth rate and yield. Our findings demonstrate that in competitive scenarios, higher growth rates result in a larger share of the niche space. In contrast, growth yield plays a critical role in neutralism, commensalism, and mutualism interactions. When bacteria are introduced sequentially, they cause distinct spatiotemporal effects, such as deeper niche colonization in commensalism and mutualism scenarios driven by species intermixing effects, which are enhanced by high growth yields. Moreover, sub-ecosystem interactions dictate the dynamics of three-species communities, sometimes yielding unexpected outcomes. Competitive, fast-growing bacteria demonstrate robust colonization abilities, yet they face challenges in displacing established mutualistic systems. Bacteria that develop a cooperative relationship with existing species typically obtain niche residence, regardless of their growth rates, although higher growth yields significantly enhance their abundance. Our results underscore the importance of bacterial niche dynamics in shaping community properties and succession, highlighting a new approach to manipulating microbial systems.
Nested patterns of commensals and endosymbionts in microbial communities of mosquito vectors
Authors: Aželytė Justė , Maitre Apolline , Abuin-Denis Lianet , Wu-Chuang Alejandra , Žiegytė Rita , Mateos-Hernandez Lourdes , Obregon Dasiel , Palinauskas Vaidas , Cabezas-Cruz Alejandro
Published: October 2024

Background

Mosquitoes serve as vectors for numerous pathogens, posing significant health risks to humans and animals. Understanding the complex interactions within mosquito microbiota is crucial for deciphering vector-pathogen dynamics and developing effective disease management strategies. Here, we investigated the nested patterns of Wolbachia endosymbionts and Escherichia-Shigella within the microbiota of laboratory-reared Culex pipiens f. molestus and Culex quinquefasciatus mosquitoes. We hypothesized that Wolbachia would exhibit a structured pattern reflective of its co-evolved relationship with both mosquito species, while Escherichia-Shigella would display a more dynamic pattern influenced by environmental factors.

Results

Our analysis revealed different microbial compositions between the two mosquito species, although some microorganisms were common to both. Network analysis revealed distinct community structures and interaction patterns for these bacteria in the microbiota of each mosquito species. Escherichia-Shigella appeared prominently within major network modules in both mosquito species, particularly in module P4 of Cx. pipiens f. molestus, interacting with 93 nodes, and in module Q3 of Cx. quinquefasciatus, interacting with 161 nodes, sharing 55 nodes across both species. On the other hand, Wolbachia appeared in disparate modules: module P3 in Cx. pipiens f. molestus and a distinct module with a single additional taxon in Cx. quinquefasciatus, showing species-specific interactions and no shared taxa. Through computer simulations, we evaluated how the removal of Wolbachia or Escherichia-Shigella affects network robustness. In Cx. pipiens f. molestus, removal of Wolbachia led to a decrease in network connectivity, while Escherichia-Shigella removal had a minimal impact. Conversely, in Cx. quinquefasciatus, removal of Escherichia-Shigella resulted in decreased network stability, whereas Wolbachia removal had minimal effect.

Conclusions

Contrary to our hypothesis, the findings indicate that Wolbachia displays a more dynamic pattern of associations within the microbiota of Culex pipiens f. molestus and Culex quinquefasciatus mosquitoes, than Escherichia-Shigella. The differential effects on network robustness upon Wolbachia or Escherichia-Shigella removal suggest that these bacteria play distinct roles in maintaining community stability within the microbiota of the two mosquito species.
Exploring the association between phase angle of bioimpedance at 50 kHz and cardiovascular risk
Authors: de Borba Evandro Lucas , Wichbold Cristina , Ceolin Jamile , Gonçalves Marcelo Rodrigues , Cañon-Montañez Wilson , Padoin Alexandre Vontobel , Mattiello Rita
Published: October 2024

Background

Cardiovascular diseases are characterized by chronic inflammation, leading to increased inflammatory markers that can cause cell damage and death. Phase angle has emerged as a marker of cellular health. It is considered a prognostic factor in various acute and chronic conditions. However, few studies have examined its association with cardiovascular disease risk measures. This study aims to investigate the relationship between phase angle, the general Framingham risk score, and the HEARTS cardiovascular risk score.

Methods

This cross-sectional study included a convenience sample of adult patients of 2 primary health care services. Phase angle was measured using multifrequency bioimpedance analysis at 50 kHz. The risk of cardiovascular events was calculated using the Framingham and HEARTS risk scores. Statistical analysis included generalized linear regression models, unadjusted and adjusted according to sex and age, to determine the association between scores, risk factors, and phase angle.

Results

The study included 164 individuals with a mean age 52.2 (SD 17.9). According to the HEARTS score, low-risk patients had higher phase angle values than those with high or very high risk [ß = -0.57 (95% CI -0.95; -0.19), P = 0.003]. Framingham scores showed a trend toward significance for higher mean phase angle values in low-risk than high-risk patients [ß = -0.43 (95% CI -0.88 to 0.02), P = 0.06].

Conclusion

Phase angle values were lower in high and very high-risk patients than in low-risk patients, which shows that phase angle is a promising risk predictor for patients with cardiovascular diseases.
Virtual practice facilitation as an implementation strategy for launching opioid safety committees for quality improvement in primary care: feasibility, acceptability, and intervention fidelity
Authors: Mogk Jessica , Allen Claire L. , Levitz Carly E. , Stefanik-Guizlo Kelsey , Bourcier Emily , Trapp Petty Melissa , Lozano Paula
Published: October 2024

Background

Practice facilitation (PF) is an evidence-based multicomponent in-person implementation strategy. COVID-19-related lockdowns caused many implementation initiatives to rapidly shift to virtual settings, but there is limited evidence on PF deployed exclusively using virtual meeting platforms. Our objective was to assess the feasibility and acceptability of virtual PF used in a primary care setting to implement interdisciplinary opioid safety committees (OSCs) to improve care for patients using opioid medicines for persistent pain and reduce high-dose opioid prescribing. We also describe alignment of virtual PF with the core functions of PF and fidelity of participating clinics to the OSC intervention.

Methods

We applied qualitative and quantitative methods to evaluate virtual PF used to implement a quality improvement project at Kaiser Permanente Washington, an integrated health system in Washington State. We established interdisciplinary OSCs in primary care clinics using virtual PF. OSCs were tasked with promoting opioid safety and high-quality pain care through population management and chart reviews. We used administrative data to calculate feasibility measures including attendance and retention. Acceptability data came from interviews with OSC members conducted by evaluators. Measures of fidelity to the OSC intervention were abstracted from meeting notes and administrative data. We used qualitative methods to assess the adherence of virtual PF to the core functions of PF.

Results

Facilitators carried out a comprehensive PF approach virtually and demonstrated adherence to the core functions of PF. We established OSCs in eight clinics and conducted an average of 17.5 virtual PF meetings over eight months of PF for each clinic. Average attendance was 75% and we had 84% retention. OSC members were highly satisfied with virtual PF. Facilitators effectively supported teams through implementation and technical challenges and OSC members gained skills through virtual PF. We implemented OSCs with high fidelity, suggesting virtual PF is an effective implementation strategy.

Conclusions

We found virtual PF is a feasible and acceptable implementation strategy for this intervention and identified strategies to support care teams through challenges. Our findings can help inform future implementation efforts, especially those hoping to engage geographically dispersed clinics or remote clinical staff.

Trial registration

Not applicable.
Prevalence of potentially inappropriate medications according to STOPP-Frail criteria in nursing home residents, the SHELTER study
Authors: Malek Makan Alireza , van Hout Hein , Onder Graziano , Finne-Soveri Harriet , Fialova Daniela , van Marum Rob
Published: October 2024

Objective

The aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less.

Methods and deign

The study utilized the second edition of the STOPP-Frail criteria to operationalize PIMs in the baseline assessment of nursing home residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) project. The data were collected between 2009 and 2012. The project was conducted in eight countries: Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Cognitive impairment was measured by the cognitive performance scale (CPS). The presence of end-stage disease with a life expectancy of six months or less was recorded. The study included residents aged 60 years or older who underwent a valid medication assessment.

Results

Among the 3,832 eligible residents, 87.9% had at least one PIM. Specifically, 24.3%, 23.5%, 18.8%, and 19.3% of residents had one, two, three, and four or more PIMs, respectively. On average, each person was prescribed 2.16 PIMs. Cognitively impaired residents (n = 1999) had an average of 1.96 PIMs (SD 1.49) per person, while residents with a low CPS score (n = 1783) had an average of 2.40 PIMs (SD 1.57) per person, showing a statistically significant difference (P < 0.001). Similarly, NH residents with life expectancy of six months or less had an average of 1.66 PIMs (SD 1.30), whereas those without had an average of 2.17 PIMs (SD 1.55) (p < 0.001). The average number of PIMs varied across countries, ranging from 3.23 in Finland to 2.15 in the UK (P < 0.001). Anti-platelets and aspirin were the most prescribed PIMs, accounting for over 38.0% of prescriptions.

Conclusions

This study highlights the high prevalence of PIMs among nursing home residents. However, PIMs were somewhat lower in residents with cognitive impairment and life expectancy of six months or less. Efforts must continue to improve the rationale behind prescribing practices in nursing homes.
Short and long-term effects of kidney donation on mineral and bone metabolism
Authors: Duque Eduardo Jorge , Ferreira Gustavo Fernandes , Oliveira Ivone Braga , Dominguez Wagner , Agena Fabiana , Jorgetti Vanda , Lemos Francine , Wolf Myles , David-Neto Elias , Moysés Rosa Maria A.
Published: October 2024

Background

Living kidney donors (LKD) experience an abrupt decline in glomerular filtration rate (GFR) resulting in abnormalities of mineral and bone metabolism (MBD), and this may have implications for skeletal health. We prospectively studied acute and long term MBD adaptation of LKD from two kidney transplant centers (São Paulo, Brazil and Miami, USA).

Methods

Renal function and MBD parameters longitudinally after kidney donation (baseline – D0, day 1, 14, 180 and 360 post-operatively) were measured in 74 patients (40 y, 73% female, 54% Brazilian). A subset of 20 donors from Brazil were reassessed after 10 years of nephrectomy.

Results

At baseline, Brazilian donors presented lower intact FGF23 (20.8 vs. 80.1 pg/mL, P < 0.01) and higher PTH (47.4 vs. 40.1, P = 0.04) than their US counterparts. GFR decreased to 63% of its baseline levels just after donation but improved 10% during the first year. PTH levels increased on D1, returning to baseline levels on D14, while FGF23 remained higher than baseline over the first year. LKD had a significant reduction of serum phosphate on D1, which returned to baseline levels on D180. A higher fractional excretion of phosphate (FEP) was noted since D14. After 10 years of donation, 20 LKD presented a sustained reduction in GFR (74.8 ± 14mL/min). There was a return to baseline in serum FGF23 [21.8 (18–30) pg/mL] and FEP, accompanied by an increase in serum calcium. PTH remained elevated (57.9 ± 18 pg/mL), whereas serum calcitriol and Klotho were lower than before the donation.

Conclusions

The abrupt decline in kidney mass is associated with an increase in PTH and FGF23 that is not explained by phosphate retention. In a long-term evaluation, LKD showed a sustained drop in GFR, with lower serum calcitriol and Klotho, and higher PTH. The effects of these changes should be investigated in further studies.
Changes of bone turnover markers and bone mineral density among postmenopausal Thai women with osteoporosis receiving generic risedronate
Authors: Suwan Ammarin , Tanavalee Chotetawan , Panyakhamlerd Krasean , Ngarmukos Srihatach , Chavaengkiat Suchanant , Tanavalee Aree , Amarase Chavarin , Bumphenkiatikul Thanapob
Published: October 2024

Background

Osteoporosis has been recognized as a significant health issue in Thailand. Pharmacological interventions are important way to prevent fracture. However, one of the main challenges in selecting a medication is high cost, particularly for brand-name drugs. Data on generic bisphosphonate use in Thai are still lacking. Therefore, our study aimed to assess the efficacy and safety of generic risedronate in postmenopausal Thai women with osteoporosis.

Methods

This prospective study was conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from December 2022 to January 2024. Serum C-terminal cross-linking telopeptide of type I collagen (CTX) and procollagen type I N-propeptide (P1NP) were measured at baseline. All participants subsequently received 35 milligrams of oral risedronate once weekly for 52 weeks. Serum CTX and P1NP were remeasured at different time points. BMD was reevaluated at 52 weeks after risedronate treatment initiation.

Results

A total of 80 participants were included. The mean age was 65.2 ± 6.6 years. The mean body mass index (BMI) was 23.45 ± 3.49 kg/m2. The median (IQR) serum CTX level at 12 weeks was significantly lower than that at baseline (0.28 (0.16–0.46) ng/mL versus 0.44 (0.26–0.64) ng/mL, respectively; p value < 0.01). The suppression of serum CTX was confirmed at 52 weeks after treatment initiation. Compared with those at baseline, the serum P1NP levels were significantly lower at 24 weeks after treatment initiation (30.33 (19.19–39.58) ng/mL versus 41.90 (30.33–68.67) ng/mL, respectively; p value < 0.01). In terms of the BMD assessment at 52 weeks, significant improvements were observed in both areal BMD (g/cm2) and T scores at all measured sites compared with baseline. The lumbar spine, femoral neck, and total hip BMD increased from baseline by 4.76%, 3.84% and 4.54%, respectively.

Conclusion

Postmenopausal women with osteoporosis who were treated with generic risedronate demonstrated significant suppression of the bone remodelling process at 3, 6, and 12 months after treatment initiation. Additionally, significant improvements in the lumbar spine, femoral neck, and total hip BMD were observed at 12 months of therapy. These findings suggest that generic risedronate could be considered a reasonable and interesting option for treating postmenopausal women with osteoporosis in Thailand.
Process evaluation of a randomised controlled trial - prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM)
Authors: Ekhammar Annika , Larsson Maria EH , Samsson Karin , Bernhardsson Susanne
Published: October 2024

Background

Musculoskeletal disorders are commonly treated in primary healthcare and may, if not treated adequately, entail a risk for long-term disability and sickness absence. A team-based rehabilitation intervention (PREVention of Sickness Absence for Musculoskeletal disorders, PREVSAM) was evaluated in a randomised controlled trial. The purpose of this study was to evaluate the process of implementing the PREVSAM model in primary care rehabilitation.

Methods

This process evaluation was conducted alongside the trial, collecting quantitative and qualitative data to evaluate how the PREVSAM model was implemented, mechanisms of impact, and contextual factors. Acceptability, feasibility, appropriateness, adaptations, training and support, resources, recruitment, reach, retention, dose, fidelity, and readiness for change were investigated. Qualitative data were collected from healthcare professionals and patients.

Results

Eight of 22 invited rehabilitation clinics (36%) and 28 of 54 healthcare professionals (52%) were included in the PREVSAM trial and this process evaluation. Of 507 eligible patients, 261 (51%) were included. Of those, 134 were randomised to the intervention and 129 (96%) were retained. Twelve healthcare professionals and 15 patients participated in the qualitative evaluations. The model’s essential components; individual assessments and structured, team-based rehabilitation with clear division of responsibilities agreed in a joint health plan; were generally delivered according to protocol. The optional components early access to psychological treatment and workplace contact were delivered to a lesser extent. Perceived acceptability, feasibility, and appropriateness of the PREVSAM model were moderate to high. Several contextual barriers, in the form of missing prerequisites, affected the implementation. Qualitative data showed that the model, with its holistic view, was appreciated by both healthcare professionals and patients.

Conclusions

This process evaluation suggests that PREVSAM is acceptable, feasible and appropriate for patients with MSDs reporting psychological risk factors associated with increased risk for sickness absence. While essential components were implemented with fidelity for most patients, optional components were not. This variability reflects the complexity of the model, its mandatory and optional components, contextual barriers, and the person-centred approach meeting individual patient needs. As all model components were not delivered to all patients, the intervention may have been too similar to treatment as usual to detect differences on a group level. A limitation of the study is that half of the participating rehabilitation clinics withdrew prematurely.
Epicardial fat density obtained with computed tomography imaging - more important than volume?
Authors: Nogajski Łukasz , Mazuruk Maciej , Kacperska Marta , Kurpias Mikołaj , Mączewski Maciej , Nowakowski Maksymilian , Mączewski Michał , Michałowska Ilona , Leszek Przemysław , Paterek Aleksandra
Published: October 2024

Epicardial adipose tissue (EAT) is a unique fat depot located between the myocardium and the visceral layer of pericardium. It can be further subdivided into pericoronary (PCAT), periatrial (PAAT) and periventricular adipose tissue (PVentAT), each of them exhibiting specific characteristics and association with the underlying tissue. Since no physical barrier separates EAT from the myocardium, this fat tissue can easily interact with the underlying cardiac structure. EAT can be visualized using various imaging modalities. Computed tomography provides not only information on EAT volume, but also on its density. Indeed, EAT density reflected by the recently developed fat attenuation index (FAI) is emerging as a useful index of PCAT inflammation, PAAT inflammation and fibrosis, while the relevance of density of PVentAT is much less known. The emerging data indicates that FAI can be an important diagnostic and prognostic tool in both coronary artery disease and atrial fibrillation. Future studies will demonstrate if it also could be used as a marker of efficacy of therapies and whether FAI PVentAT could indicate ventricular pathologies, such as heart failure. The aim of the review is to present computed tomography derived FAI as an important tool both to study and better understand the epicardial fat and as a potential predictive marker in cardiovascular disorders.
Refraining from seeking dental care among the Sámi in Sweden: a cross-sectional study
Authors: Yekkalam Negin , Mienna Christina Storm , Stoor Jon Petter Anders , Sebastian Miguel San
Published: October 2024

Background

While equity in health care is the core of the Swedish health system, social inequalities in accessing health care, particularly regarding dental care, exist. There is however no information on how the Sámi population is affected. This study aimed to assess the prevalence and risk factors for refraining from seeking dental care among the Sámi in Sweden.

Methods

A Sámi sample was constructed from three pre-existing registers. Among the 9,249 invitations for individuals aged 18–84 years old, 3,779 answered the survey during February–May 2021. We first calculated frequencies and proportions of the independent variables in terms of socio-economic, socio-demographic, and cultural-related factors as well as the outcome, refraining from dental care. Then, we summarized the magnitude of the association between the independent variables and self-reported refrain from dental care with the prevalence difference (PD) using the 95% confidence interval (95% CI) for inferential purposes.

Results

Overall, 17.5% of the participants refrained from seeking dental care despite self-reported need in the last three months, with almost the same proportion between men and women. Among the socio-demographic factors, being in the 30–44 years group (PD = 8.0; 95% CI: 3.59, 12.48), in the 45–64 group (PD = 7.3; 95% CI: 2.96, 11.61) and in the 65–84 group (PD = 5.4; 95% CI: 0.92, 9.78) as well as being divorced/widow-er (PD = 6.7; 95% CI: 2.73, 10.70) and unmarried (PD = 3.1; 95% CI: 0.23, 6.04) were statistically significantly associated with refraining from seeking dental care. Among the socio-economic variables, those in the middle-income quintile (PD = 5.3; 95% CI: 1.28, 9.35), in the poor (PD = 8.1; 95% CI: 3.64, 12.51) and poorest (PD = 8.0 95% CI: 3.48, 12.50) quintiles, and especially those experiencing economic stress once (PD = 9.2; 95% CI: 2.93, 15.48) and several times (PD = 26.5; 95% CI: 19.50, 33.43), were strongly associated with refraining.

Conclusions

Approximately one in six of the Sámi participating in this study refrained from seeking dental care despite self-reported need in the last three months. Those who experienced economic difficulties were the most affected group. To achieve equity in dental health care in Sweden, policies removing economic barriers to access dental health care should be implemented.
Prevalence of and factors associated with lipid screening in young people aged 16– to 21 years in the United States: analysis of nationwide cross-sectional data
Authors: Li Nianyan , Zhang Jiayue , Huang Ying , Wang Shuting , Gao Xiangyang , Yang Zhirong , Yang Zuyao
Published: October 2024

Background & Aims

There is no consensus on whether it is worthwhile for young people to undergo lipid screening. An estimate of the national prevalence of lipid screening in this population can serve as a basic parameter in analyses of the utilization and cost-effectiveness of health care services. Previous studies were mostly based on electronic health records or insurance claims data or were restricted to adolescents at younger ages. This study aimed to investigate the prevalence of lipid screening and the factors associated with it in young people aged 16– to 21 years in the United States based on a nationally representative sample.

Methods

A cross-sectional study of 16- to 21-year-old participants from the National Health and Nutrition Examination Survey (NHANES), 2013–March 2020 (four cycles), was conducted. The prevalence of lipid screening uptake was calculated for each cycle as well as for all four cycles combined, and the associations of lipid screening uptake with the covariates were analysed by logistic regression. An appropriate sample weight was incorporated into the analysis as recommended.

Results

A total of 3,600 participants were included in the analysis, and 32.02% of them had ever received lipid screening at the time of the survey, with no statistically significant secular changes observed over the four cycles. Among the participants, 28.83% received lipid screening within the past 5 years. In multivariable regression analysis adjusted for all covariates, non-Hispanic black ethnicity (adjusted odds ratio [AOR]: 1.43), having health insurance (AOR: 1.54), obesity (AOR: 1.65) and sufficient physical activity (AOR: 1.36) were significantly associated with a greater chance of ever receiving lipid screening.

Conclusions

Nearly one-third of young people aged 16– to 21 years in the United States have received lipid screening. Ethnicity, health insurance, weight problems, and physical activity level were associated with the likelihood of lipid screening uptake. These findings could help people understand the current situation of lipid screening in young people in the United States and may serve as fundamental parameters in the assessment of the utilization and cost-effectiveness of related health care services.
HOXA9 and CD163 potentiate pancreatic ductal adenocarcinoma progression
Authors: Hemida Aiat Shaban , Ahmed Mohamed Mohamady , Tantawy Mona Saeed
Published: October 2024

Background

The role of HOXA9 requires investigations in pancreatic ductal adenocarcinoma (PDAC) as HOXA9 inhibitors are being developed. HOXA9 might attract CD163 expressed tumor associated macrophages (TAM) and could affect PDAC prognosis. This work aims to study the expression and relevance of HOXA9 and CD163 in PDAC progression.

Materials and methods

Selected 98 PDAC and 98 adjacent non tumor tissues as a control group were immunostained with HOXA9 and CD163 antibodies.

Results

PDAC displayed highly significant higher HOXA9 staining intensity, percent and H score values than control group. HOXA9 staining of PDAC cases showed significant associations with poor prognostic indicators including larger tumor size, higher grade and advanced stage. PDAC showed highly significant differences regarding CD163 macrophage-specific staining intensity, percent and H score values than control group. CD163 showed significant higher expressions with larger tumor size, higher histological grade and advanced stage group. HOXA9 staining in PDAC showed highly significant direct correlations with CD163 positive macrophages. Follow up of PDAC cases revealed that high median H score of HOXA9 and CD163 were significantly associated with worse overall survival. CD163 was an independent prognostic marker of worse survival.

Conclusions

In conclusion, HOXA9 could potentiate PDAC progression by stimulating CD163 expressed TAM attraction in tumors. HOXA9 and CD163 could participate in PDAC therapy. HOXA9 and CD163 could be predictors of worse prognosis and shorter survival in PDAC.
Effects of metformin phonophoresis and exercise therapy on pain, range of motion, and physical function in chronic knee osteoarthritis: randomized clinical trial
Authors: Abed Marwah Salih , Aziz Marihan Zakaria , AbdelHamid Nabil Mohie , Soliman Elsadat Saad
Published: October 2024

Background

Knee osteoarthritis (KOA) is a common musculoskeletal disorder. Therapeutic ultrasound (US) is a safe and effective treatment for KOA. It relieves knee pain and enhances function. Metformin (MF) regulates chondrocytes, hence providing chondroprotection. Furthermore, it efficiently reduces knee articular cartilage degeneration and retards the progression of osteoarthritis. However, the localized administration of MF by phonophoresis for KOA has yet to be studied.

Purpose

To assess the possible effects of metformin phonophoresis (MFPH) plus exercise therapy (EX) compared to MFPH alone or the US on knee pain, function, and range of motion (ROM) in chronic KOA patients.

Methods

Seventy-eight patients with unilateral mild to moderate chronic KOA were included. Patients were randomly assigned to three groups: group A (MFPH + EX), group B (MFPH alone), and group C (US). The US group used an acoustic-neutral gel, while the MFPH group used a gel containing 1.2% MF. The exercises included hamstring stretches, calf stretches, and knee strengthening exercises. Treatment in the three groups continued for four weeks (three sessions per week). The Visual Analog Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the goniometer were used to assess knee pain, function disability, and ROM, respectively. All measures were recorded before, 2 weeks, and 4 weeks after the intervention in all groups. Multivariate Analysis of Variance (MNOVA) was performed to compare the effects within and between groups for knee ROM and function disability. The Kruskal-Wallis test and the Friedman test analyzed the pain intensity.

Results

When the baseline patient characteristics were compared, there were no significant differences in means of age, gender, body mass index (BMI), or lower limb dominance across the three groups (p > 0.05). After 4 weeks of intervention, clinical outcomes significantly improved in all three groups (p < 0.05). However, patients in the MFPH + EX group improved significantly in all outcomes compared to the MFPH and US groups (p < 0.05).

Conclusion

Post-treatment results showed a statistically and clinically significant improvement in pain intensity, knee ROM, and function in the MFPH group; however, combining MFPH with exercises is more beneficial in reducing KOA symptoms.

Trial registration

Clinical Trial Registry at (pactr.samrc.ac.za) database.

NO: PACTR202311507335269. Date: November 9, 2023 (retrospectively registered).
Anorexia nervosa in children and adolescents: an early detection of risk factors
Authors: Bozzola Elena , Barni Sarah , Marchili Maria Rosaria , Hellmann Romie , Giudice Emanuela Del , De Luca Giampaolo , Cupertino Vita ,   for the Italian Pediatric Society Adolescent Study Group
Published: October 2024

The incidence of eating disorders in children, mainly of anorexia nervosa, is dramatically increased in the last years. A timely identification of the disease is associated with higher rates of recovery. Aim of the work is to underline signs and symptoms that can be used to an early detection of anorexia nervosa in the pediatric age.

A scoping review has been conducted by The Italian Pediatric Society Adolescent Study Group according to the PRISMA Extension guidelines for Scoping Reviews, using the search term “anorexia nervosa” and the following filters “review”, “systematic review”, “age 0–18”, “last 4 years”.

The strategy search produced 657 studies, of which 52 were included in this revision. Screening and red flags were discussed in 23 reports, genetics in 12, neurological pathways in 11, environmental factors in 10, and gut microbiota in 7. An accurate physiological and pathological anamnesis, physical and psychological examination, including the body perception, should be taken in account as well as the presence of co-morbidities, including chronic functional abdominal pain and autoimmune/autoinflammatory diseases. Evidence suggests the role of familiar predisposition as well as of neurological morphology and pathway in anorexia nervosa development. Gut microbiota has also been included among possible risk factor for developing anorexia nervosa due to a complex direct and indirect interactions between gut and brain.

The Italian Pediatric Society Adolescent Study Group suggests performing an accurate familial and personal anamnesis, including psychological evaluation as well as a physical exam including auxological parameters as a screening tool during pediatric checks to better explore the risk of developing anorexia nervosa.
Characterization of NFDQ1 in Cryptosporidium parvum
Authors: Ao Yangsiqi , Gong Xiaoqing , Li Jieping , Zhao Ruiming , Song Shujiao , Guo Yaqiong , Feng Yaoyu , Xiao Lihua , Xu Rui , Li Na
Published: October 2024

Background

Cryptosporidium spp. are important zoonotic parasites that can cause moderate to severe diarrhea in humans and animals. Among the three Cryptosporidium species infecting the intestines of calves, Cryptosporidium parvum has a broad host range and causes severe diarrhea in calves, while Cryptosporidium bovis and Cryptosporidium ryanae mainly infect calves without obvious clinical symptoms. Comparative genomic analysis revealed differences in the copy number of genes encoding the nonfinancial disclosure quality (NFDQ) secretory protein family among the three species, suggesting that this protein family may be associated with the host range or pathogenicity of Cryptosporidium spp. To understand the function of cgd8_10 encoded NFDQ1, tagged and knockout strains were constructed and characterized in this study.

Methods

To determine the localization of NFDQ1, we used clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) technology to tag the C-terminus of NFDQ1 with three hemagglutinin epitopes (3 × HA). The tagged strain was constructed, and the genomic insertion was confirmed by polymerase chain reaction (PCR). Immunofluorescence assays were performed to observe the localization of NFDQ1 both in extracellular sporozoites and at various intracellular developmental stages. Immunoelectron microscopy was used to study the ultrastructural localization of NFDQ1. Then, the ΔNFDQ1 strain was generated by CRISPR/Cas9 and the in vitro growth assay on HCT-8 cells was used to analyze of phenotypic changes after knockout NFDQ1 in parasites.

Results

The NFDQ1 tagging and knockout stains were successfully constructed by CRISPR/Cas9 technology and the insertions of transgenic strains were validated by PCR. The expression of NFDQ1 was validated in parasite by western blot. Immunofluorescence and immune-electron microscopy assay showed that NFDQ1 expressed in both asexual and sexual stages of C. parvum, where it was localized to the cytoplasm of the parasite. Upon ablation of NFDQ1, the ΔNFDQ1 strain showed an apparent growth retardation during sexual replication in vitro.

Conclusions

NFDQ1 is a cytoplasmic protein without specific localization to secretory organelles, and it may participate in C. parvum growth during sexual reproduction. Future study should determine the role of NFDQ1 following C. parvum infection in vivo.

Graphical Abstract