bluuebunny/crossref_metadata_2025 huggingface dataset:
Health care for transgender people in Brazil: a systematic review protocol
Authors: de Lima Rafael Rodolfo Tomaz , Flor Taiana Brito Menezes , Silva Alexandre Bezerra , Noro Luiz Roberto Augusto
Published: September 2020

Background
At the global level, transgender people (transvestites and transsexuals) live in worse health and living conditions due to the stigma and violence they face, including within health services. In Brazil, the Unified Health System must offer comprehensive care to the population, regardless of social class and gender. The aim of this article is to establish a systematic review protocol to analyze how health care occurs for the transgender population in the Unified Health System.
Methods
This protocol was guided by PRISMA-P and the bases SCIELO, LILACS, BVS and PUBMED will be consulted. Empirical studies, with a qualitative or quantitative approach, that deal with health care for the transgender population in the Unified Health System, where the respondents are transgender people, health professionals or health managers, will be included in the systematic review. For the definition of the final sample, the articles will undergo an assessment of methodological quality and risk of bias, with the help of the critical assessment tools of the Joanna Briggs Institute, using a specific checklist for each type of study. The synthesis of the findings will be carried out through the formal narrative and the presentation of tables with summarized data, with the final writing of the review guided by PRISMA.
Discussion
Based on scientific evidence, it is intended to present an overview of health care for the transgender population in the Unified Health System. In addition, to point out possible strategies to qualify the political, organizational and attitudinal aspects related to health care for that population.
Systematic review registration:
PROSPERO CRD42020188719.
Barriers to Receiving the Recommended Standard Care During Pregnancy by Illiterate Women in Rural, Northern Tanzania
Authors: Matovelo Dismas , Ndaki Pendo , Yohani Victoria , Laisser Rose , Bakalemwa Respicious , Ndaboine Edgar , Masatu Zabron , Mwaikambo Magdalena , Brenner Jennifer L. , Wilson Warren M.
Published: September 2020

Background: In 2017, an estimated 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a maternal and neonatal health continuity of patient care, yet most women do not meet this recommendation. Surveys suggest that illiteracy limits uptake of the proposed maternal-newborn package, yet little is known about the association between illiteracy and healthcare seeking, particularly in rural regions of low-income countries. This knowledge gap compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. To begin to address this gap this study explores the experiences related to care-seeking by illiterate, pregnant women in rural Tanzania.Methods: A qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 interviews with illiterate women of reproductive age and seven interviews with members of these communities perceived to have some influence on women’s decisions concerning perinatal care services. Themes were coded and their relative importance determined using frequency reports and cross-tabulations. Findings: Three key themes emerged, illiterate women (1) could not read their healthcare cards or public health messaging; (2) spoke the local language, not Swahili, the language used by healthcare providers, and (3) have endeavored to develop coping strategies to overcome these obstacles. In addition, health service providers are often unaware of who is illiterate.Recommendations: More health needs of this group could be met, in the short term, by developing a protocol for health service providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. In the long term, this barrier may be addressed by ensuring that all Tanzanians receive a high-quality, formal education, supporting community health workers, and recruiting healthcare providers from rural areas. A failure of to address the needs of this at-risk group will likely mean that they will continue to experience barriers to achieving the recommended continuity of patient care with detrimental health outcomes for both mothers and newborns.
miR-186 Regulates the Initiation and Development of Breast Cancer via SHP-1 Methylation
Authors: Wang Kun , Zhou Chunxia , Wang Di , Zhang Bin , Zheng Yongjian , Tong Lifei , Zhang Xia , Zhang Weiguo
Published: September 2020

Background Change in the methylation status of genomic DNA, especially in CpG islands in the promoter region, is considered to be an early event in tumor initiation, leading to silencing of gene expression, subsequent abnormalities in gene structure and function, and malignant transformation of the cell. Due to the abnormal expression of miR-186 and SHP-1 in breast cancer tissues and cells, we propose that miR-186 is closely related to the methylation of SHP-1Method Using 5-azacytidine as a de-methylation agent and Validating with Setylation-specific polymerase chain reaction (MSP) after treatment. Measurement of the viability of breast cancer cells using the CCK-8 method Measurement of the apoptotic rate of breast cancer cells using annexin V-FITC/PI double labeling. Cell metastasis were measured by wound healing assay. Luciferase reporter assays was used to confirm the target of MiR-186. SHP-1 and miR-186 expression was measured by RT-PCR and western blot.Results In the present study, we found that SHP-1 expression was reduced to various degrees in all 5 cell lines (UACC-812, MDA-MB-213, MDA-MB-468, SK-RB-3 and MCF-7). 5-azacytidine can remove the methylation from the SHP-1 promoter region. Apoptosis was observed in MCF-7 cells after demethylation of the SHP-1 gene promoter region by 5-azacytidine, and the effect was time- and concentration-dependent. Luciferase reporter assays showed that miR-186 promotes methylation through binding with the 3’ UTR of the SHP-1 promoter region.Western blot showed miR-186 regulates the initiation and development of tumor cells through the SHP-1-JAK-STAT axis. In animal models, low expression of miR-186 can cause significantly limited tumor growth.Conclusion The low SHP-1 expression may be an important factor in the initiation of breast cancer, and that miR-186 could serve as an excellent molecular diagnostic marker and a possible therapeutic target.
Evaluation of Peripheral Immune Activation in Amyotrophic Lateral Sclerosis
Authors: Wang Mengli , Liu Zhen , Du Juan , Yuan Yanchun , Jiao Bin , Zhang Xuewei , Hou Xuan , Shen Lu , Guo Jifeng , Jiang Hong , Xia Kun , Tang Beisha , Wang Junling
Published: September 2020

Background: Accumulating evidence has revealed that immunity plays an important role in amyotrophic lateral sclerosis (ALS) progression. However, the results regarding the serum levels of immunoglobulin and complement are inconsistent in patients with ALS. Although immune dysfunctions have also been reported in patients with other neurodegenerative diseases, few studies have explored whether immune dysfunction in ALS is similar to that in other neurodegenerative diseases.Methods: Serum levels of immunoglobulin and complement were measured in 245 patients with ALS, 65 patients with multiple system atrophy (MSA), 60 patients with Parkinson’s disease (PD), and 82 healthy controls (HCs). The serum levels of immunoglobulin and complement were compared among different groups, and the differences in the levels of immunoglobulin and complement between ALS patients and HCs were evaluated using meta-analysis including data from this study. In addition, the association between vitamins and clinical ALS characteristics were evaluated.Results: Patients with ALS had higher C4 levels than did HCs. No significant differences existed between patients with ALS and other neurodegenerative diseases in IgG, IgA, IgM, C3, or C4 levels. The IgA levels were lower in early-onset ALS patients than in late-onset ALS patients. The correlations between age at onset of ALS and IgG or IgA levels were significantly positive.Conclusions: Peripheral immunity abnormalities existed in patients with ALS, and lower IgA levels were associated with early-onset ALS.
Dietary Assessment and Patients Perspective Reasons for Diet and Exercise Adherence Post Bariatric Surgery
Authors: Assakran Bandar Saad , Widyan Adel Mefleh , Alhumaidan Najla Abdulaziz , Alharbi Fadiyah Abdullah , Alhnaya Mohammed Abdullah , Aljabali Abdullatif Abdullah , Aleid Mohammed Abdulrahman
Published: September 2020

Objective: Obesity prevalence is increasing and as an outcome; bariatric procedures are on the rise. Previous articles about bariatric surgery disclosed tremendous results. This study aims to estimate the rate and identify the reasons behind poor adherence to diet and exercise in post-bariatric patients.Results: Majority (85.5%) of our patients scored “good”, 12% scored “fair”, and only 2% scored “excellent”. None scored “needs improvement”. Fruits had a mean of 1.51 ± 0.79 and vegetables 1.78 ± 0.76. The main reasons for patient non-adherence to healthy eating were: low self-discipline (48%), lack of motivation (28%), availability of healthy food, and being too busy to prepare healthy meals; both (25%). (55.9%) of the study subjects engaged in physical activity. Lack of time (47%), low self-discipline (38%), and weather (32%) were the primary reasons for not exercising regularly.
A Primer in Resilience Status for German Medical Graduates - A Necessary Step in Building an Emotionally Equipped Healthcare Workforce
Authors: Kiesewetter Jan , HUber Johanna
Published: September 2020

BackgroundResilience is a widely-used catchword in the last couple of years to describe the resistance to psychological strains of life, especially for the healthcare work force. The promises of resilience to burnout sound great and what we all would want: less health impairment despite stress, higher work satisfaction and last but not least higher work performance. However, little is known scientifically regarding the resilience status of the upcoming work-force. With our study we would like to investigate the resilience status of medical graduates from five medical schools within their first year after graduation. MethodsFor the identification of the resilience status we included the 5-point Likert 10-Item Connor-Davidson Resilience Scale, German Version in a graduate survey posted to 5 medical schools and over 1610 eligible participants of whom 610 (60% female) filled out at least parts of the survey. ResultsThe resilience status showed a mean resilience score of M = 37.1 (SD = 6.30). The score ranges from 3.22 (I am not easily discouraged by failure) to 4.26 (I am able to adapt to change). The item “I am able to handle unpleasant feeling” is interesting as one third of the participants did choose not to answer. Relationships to other constructs are presented in the article. ConclusionsThe study shows that the overall resilience status of medical graduates one year after their graduation is rather high, but subjectively they do not feel equivalently resilient for the different aspects they face in their job. Further research needs to see how trainings can provide medical students and professionals with the emotional coping skills that they lack in the moment.
The relationship between empathy and altruistic motivations in nursing studies: A cross-sectional study
Authors: Messineo Linda , Seta Luciano , Allegra Mario
Published: September 2020

Background. According to the biopsychosocial approach and patient-centred models, efficient management of relational competences by healthcare professionals is crucial to affect a patient’s treatment and care process positively. Empathy is one of the major components of the relational skills expected of health professionals. The knowledge of the empathic ability of undergraduate healthcare students represents important information for educators in defining specific and efficient educational programs aimed at supporting or enhancing empathic competences. In this study, we measured the attitude towards the value of health professional empathy in clinical encounters of the first-year undergraduate nursing students. Motivations for a nursing education choice were also evaluated. We expected a significant association between students’ positive attitude towards the value of health professional empathy and the prosocial and altruistic motivations in choosing nursing studies. Methods. A cross-sectional study was performed on 77 first-year nursing students. The Jefferson Scale of Empathy – Health Professions Student Version was administered. The motivations for choosing nursing studies were detected through an open question.Results. Seven distinct themes, distinguishing between internal and external motivational factors, were identified through the thematic analysis of students’ answers regarding their choice for entering the nursing degree course. On the empathy scale, females gained higher scores than males. When the age was considered, this difference was shown only for younger students, with young females’ total scores being higher than that of young males. High scores of empathy were positively associated with altruistic motivational factors. A negative correlation was found between external motivational factors and the scores of the Compassionate Care subscale of the Jefferson Scale of Empathy. Conclusions. Knowing the level of nursing students’ empathy and their motivational factors for entering nursing studies is important for educators to implement training paths that enhance students’ relational attitudes and skills and promote positive motivational aspects central for this profession.
Characterization of BRS1 Functions in Plant Stress Responses
Authors: Zhang Dongzhi , Zhao Peng , Xu Shengbao
Published: September 2020

Background: Brassinosteroid-insensitive 1 suppressor 1 (BRS1), is a serine carboxypeptidase that mediates brassinosteroid signaling and participates in multiple developmental processes in Arabidopsis. However, little is known about the precise role of BRS1 in this context. Results: In this study, we analyzed transcriptional and proteomic profiles of Arabidopsis seedlings overexpressing BRS1 and found that this gene is involved in both biotic and abiotic stress responses and redox regulation. Further proteomic evidence shows that BRS1 regulates cell redox by indirectly interacting with cytosolic NADP+-dependent isocitrate dehydrogenase (cICDH). We identified two novel splice products of BRS1, which might play important roles in development and stress responses in plants. Conclusions: This study highlights the role of BRS1 in plant redox regulation and stress responses, which extends our understanding of extracellular serine carboxypeptidases.
Pneumocystis pneumonia in patients with primary nephrotic syndrome: analysis of 18 cases
Authors: You Xiaohan , Zhang Ji , Zhou Qiongxiu , Zhang Jianna
Published: September 2020

Background

The aim of this study was to analysis the clinical features, risk factors and outcomes of patients with primary nephrotic syndrome (PNS) who developed pneumocystis pneumonia (PCP).

Methods

We systematically reviewed medical records from 18 PNS patients with PCP admitted to our hospital from April 2007 to April 2019. A total of 180 cases were randomly selected as controls from PNS inpatients without infection.

Results

In PCP patients, the mean age at presentation was 48.5 years, mean duration of prednisone treatment was 3.7 months and mean prednisone dose on admission was 31.3 mg/d, the most common clinical manifestation was fever (100%) and average PaO 2 on admission was 59.5 mmHg. Eight patients (44.4%) had coexisting infections, most often was cytomegalovirus (4 patients), 11 patients (61.1%) had ICU admission and 9 patients (50%) had mechanical ventilation. PCP patients had more prednisone, more immunosuppressive therapy, lower CD4+ cell counts and hemoglobin, and higher serum creatinine than those without infections (p<0.05). Logistic regression analysis showed that patients with prednisone usage and lower CD4+ cell counts were more likely to have PCP compared to controls (p<0.05). All patients survived after treatment.

Conclusion

PCP was not unusual in PNS patients, and the most important risk factor was a lower CD4+ cell count, but however, these patients had a good outcome after enough treatments.
Training tomorrow’s doctors: the impact of a Student Selected Component in Global Health during medical school
Authors: Matthews Natasha Roya , Walker Richard
Published: September 2020

Background
Several reports highlight the importance of global health education (GHE) for training tomorrow’s doctors. In 2006, Newcastle University Medical School developed a Student Selected Component (SSC) in Global Health, which has since become increasingly popular. We followed up students who have undertaken the SSC in Global Health to assess the impact on their experience as practising clinicians and postgraduate career development.
Methods
We developed an electronic survey including questions about speciality choice, postgraduate qualifications, extracurricular activity and international work. Surveys were sent to 72 SSC participants identified between 2006–2017 through the Newcastle University Alumni and Supporters network and social media.
Results
Surveys were returned by 37 (51%) SSC participants; 25 (71%) and 16 (46%) believed the SSC had influenced their clinical practice and career choice respectively. Twenty-two (60%) obtained an intercalated degree programme, of whom nine (24.3%) did a Masters programme specifically in Global Health and four (10.8%) and two (5.4%) completed a Masters degree in Epidemiology and Control of Infectious Diseases respectively, both key themes within GHE. Four (11%) undertook and ten (29%) were considering postgraduate study related to global health, of whom three (8.6%) specified undertaking a Diploma in Tropical Medicine and Hygiene (DTM&H) and one (2.9%) studying a Masters degree in Public Health. Five (14%) had and 19 (54%) were planning to work abroad, with most referring to work in humanitarian or low resource settings and GHE programmes.
Conclusions
Participation in an SSC in Global Health may affect significant positive change in student’s clinical practice and help inform academic and clinical career choice. Whilst a causative relationship cannot be inferred, the experience may support or increase the pursuit of further global health opportunities including additional qualifications, research and international health work. Medical schools that endeavour to produce graduates motivated to tackle the global health challenges of our society should champion comprehensive global health modules for students.
In Vitro and in Vivo Evaluation of Paclitaxel-induced Release of Apoptotic Biomarker ccCK18 to Guide Treatment Optimization in Ovarian Cancer
Authors: Thaye Elien De , Vijver Koen Van de , Dorpe Jo Van , Vermeulen An , Bocxlaer Jan Van , Colin Pieter
Published: September 2020

Background: Cytokeratins hold potential as biomarkers due to their epithelial specificity, abundance and cleavage by caspases during apoptosis. We evaluated paclitaxel-induced circulating caspase-cleaved (cc) cytokeratin 18 (CK18) as potential apoptotic cell-death marker to guide treatment optimization in ovarian cancer.Methods: Six ovarian cancer cell lines (SK-OV-3, SK-OV-3lucIP1, Caov-3, NIH:OVCAR-3, PA-1 and PM-LGSOC-01) were exposed in vitro to paclitaxel (PTX, 0 to 1000 nM) for 24h. Extracellular levels of ccCK18 were measured until 5 days after drug exposure. Cell count and ccCK18 release data were analyzed using a phase-nonspecific pharmacodynamic model implemented in NONMEM®. PA-1 and SK-OV-3lucIP1 xenografted female SCID/Beige mice received a placebo or single dose of 50 mg/kg PTX intraperitoneally. Response to PTX was evaluated in vivo using tumor volume and released ccCK18 levels. Results: In vitro, the correlation between cell count and released ccCK18 levels was present in all cell lines (Spearman’s rank correlation coefficient > 0.64). Tumor volume and ccCK18 longitudinal dynamics were markedly different for controls and PTX-treated PA-1 xenografts with changes in ccCK18 release preceding changes in tumor volume. For SK-OV-3lucIP1 xenografts, no differences were found between controls and PTX-treated mice. Conclusions: An association between PTX-induced ccCK18 release and cell count was demonstrated in vitro. The in vivo study supported the presence of an early-apoptotic peak in ccCK18 levels compared to a later observed effect on tumor volume in PTX-sensitive xenografts. Given the heterogeneous character of ovarian cancer, application and implementation of ccCK18 in a clinical setting to optimize or personalize cancer treatment needs further refinement.
Sepsis score performance in women at high and low risk of intraamniotic infection: a retrospective case-control study
Authors: Sela Hen Y , Seri Vered , Zimmerman Frederic S. , Levin Philip D. , Smueloff Arnon , Einav Sharon
Published: September 2020

Background: Early infection identification may improve outcomes in obstetric patients. However, obstetric vital signs and laboratory values differ from the non-pregnant, possibly limiting current sepsis score use. Thus, we evaluated sepsis score use in peripartum infection. Methods: This case-control study evaluates sepsis criteria fulfilment in preterm premature rupture of membranes (PPROM) – at high infection risk– versus in elective caesarean delivery (CD) – at low risk. The study was perfoemd at the departement of obstetrics & gynecologt at Shaare Zedek Medical Center, a 1000-bed university-affiliated acute care hospital. We inlcuded women with PPROM undergoing CD (n=453) at gestational weeks 24-36 versus those undergoing elective term CD (n=2004). The primary and secondary outcome measures were SIRS and qSOFA criteria fullfilment and availability of the score components and clinical intraamniotic infection and positive cultures rates. Results: At admission 14.8% of the study group and 4.6% of control met SIRS criteria (p=0.001), as did 12.5% and 5.5% on post-operation day (POD) 1 (p=0.001), with no significant differences on POD 0 or 2. In the study group more cultures (29.8% versus 1.9% – cervix; 27.4% versus 1.1% – placenta; 7.5% versus 1.7% – blood; p=0.001 – all differences) and more positive cultures (5.5% versus 3.0% – urine – p=0.008; 4.2% versus 0.2% – cervix – p=0.001; 7.3% versus 0.0% – placenta – p=0.001; 0.9% versus 0.1% – blood – p=0.008) were obtained. 10.6% of the study group and 0.4% of control met criteria for intraamniotic infection (p=0.001). Conclusions: Though significant difference was noted in SIRS criteria fulfilment in the study group versus control, there was considerable between-group overlap, questioning utility of SIRS in intraamniotic infection diagnosis.
Integrating Motivational Interviewing into Clinical Care to Increase Physical Activity Levels in Women with Gestational Diabetes
Authors: Smith Ralph , Ridout Ashley , Livingstone Angus , Wango N. , Kenworthy Yvonne , Barlett Katy , Coburn Hazel , Reid Hamish , Jones Natasha , Mackillop Lucy
Published: September 2020

Background: Regular physical activity (PA) improves glycaemic control in women diagnosed with Gestational Diabetes (GDM). However, PA advice competes with other components of care, with many women forgoing the benefits of regular PA. Motivational interviewing (MI) is an effective technique for increasing individual PA levels. A clinical pathway was developed integrating MI on PA into the routine care. This report evaluates the impact of MIs on self-reported PA levels.Methods: Women attending a single centre NHS GDM clinic were invited to engage in an individual PA-focused MI session, delivered by a trained midwife. This included goal setting and activity planning. All women had a confirmed diagnosis of GDM based on a 75g oral glucose tolerance test using the International association of diabetes and pregnancy study group diagnostic thresholds. A modified version of the exercise vital sign was used to evaluate self-reported aerobic PA levels at baseline and two-week telephone follow-up. PA levels were coded into three categories: i) red (<30mins moderate intensity PA (MIPA)/week), ii) amber (30-150mins MIPA/week) and iii) green (150mins MIPA/week). Women with contraindications to PA were excluded. The main outcome was the difference PA levels from baseline to two weeks. The Pearson’s Chi-squared test was used to evaluate statistical difference in self-reported PA levels from baseline to follow-up.Results: Complete follow-up data was obtained from 62 women. Mean gestation was 27+5/40 weeks (9-36+4/40), mean age 31.7y (21-43y) and mean BMI 29.9kg/m2 (18.3-48.2 kg/m2). At baseline, 19 (30.6%) were coded red (<30mins MIPA/week); 26 (41.9%) amber (30-150mins MIPA/week); and 17 (27.4%) green (150mins MIPA/week). Self-reported physical activity levels of these women at two-week follow-up revealed only 3 (4.8%) women coded red, 24 (38.7%) amber and 35 (56.5%) green. This demonstrates a significant association for increased PA levels after MI at two-week follow-up (p=0.0001).Conclusion: This new clinical pathway provides encouraging results, showing that self-reported PA increased significantly at two-week follow-up. Further work is now required to examine the impact on glycaemic control, maternal and fetal outcomes, and maintenance of PA levels. This model of care should be integrated into other high-risk patient groups.
Schizophrenia, autism spectrum disorders and developmental disorders share specific disruptive coding mutations
Authors: Rees Elliott , Creeth Hugo , Hwu Hai-Gwo , Chen Wei , Tsuang Ming , Glatt Stephen , Rey Romain , Kirov George , Walters James , Holmans Peter , Owen Sir Michael , O'Donovan Michael
Published: September 2020

Genes enriched for rare disruptive coding variants in schizophrenia overlap those in which disruptive mutations are associated with neurodevelopmental disorders (NDDs), particularly autism spectrum disorders and intellectual disability. However, it is unclear whether this implicates the same specific variants, or even variants with the same functional effects on shared risk genes. Here, we show that de novo mutations in schizophrenia are generally of the same functional category as those that confer risk for NDDs, and that the specific de novo mutations in NDDs are enriched in schizophrenia. These findings indicate that, in part, NDDs and schizophrenia have shared molecular aetiology, and therefore likely overlapping pathophysiology. We also observe pleiotropic effects for variants known to be pathogenic for several syndromic developmental disorders, suggesting that schizophrenia should be included among the phenotypes associated with these mutations. Collectively, our findings support the hypothesis that at least some forms of schizophrenia lie within a continuum of neurodevelopmental disorders.
Prognostic Factors of Time to First Abortion After Sexual Debut Among Fragile State Congolese Women: A Survival Analysis
Authors: Ekholuenetale Michael , Ekholuenetale Charity Ehimwenma , Barrow Amadou
Published: September 2020

Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to determine median years and factors of time to first abortion after sexual debut among Congolese women.Methods: We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3,622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to first abortion. Furthermore, we examined the factors of time to first abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% confidence intervals (CI). Statistical significance was determined at p<0.05.Results: The prevalence of abortion was 60.0% and median years of time to first abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women’s age and region were notable factors in timing to first abortion. Furthermore, women from poorer, middle, richer and richest households had 34%, 67%, 86% and 94% higher risk of abortion respectively, when compared with women from poorest households. Women currently in union/living with a man and formerly in union had 41% and 29% reduction in the risk of abortion respectively, when compared with those never in union. In addition, women with primary and secondary+ education had 42% and 76% higher risk of abortion respectively, when compared with women with no formal education. Conclusion: There was high prevalence of abortion with short years at first abortion. Abortion was associated with women’s characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women.
The Influence of Empowered Work Environments on the Psychological Experiences of Nursing Assistants During COVID-19: A Qualitative Study
Authors: Travers Jasmine , Schroeder Krista , Norful Allison A. , Aliyu Sainfer
Published: September 2020

Background: Nursing Assistants (NA) who feel empowered tend to perform their duties better, have higher morale and job satisfaction, and are less likely to leave their jobs. Organizational empowerment practices in hospitals likely shape the psychological experiences of empowerment among these personnel; however, little is known about this relationship.Objective: We used qualitative inquiry to explore the relationship between organizational empowerment structural components and feelings of psychological empowerment among hospital frontline workers during a public health emergency.Methods: Kanter’s Theory of Structural Empowerment and Spreitzer’s Psychological Empowerment in the Workplace Framework were applied to identify the conceptual influences of organizational practices on psychological experiences of empowerment. In-depth interviews were conducted with a convenience sample of NAs, caring for hospitalized COVID-19 patients. Directed content analysis was performed to generate a data matrix consisting of the psychological experiences of meaning, competence, self-determination, and impact embedded under the organizational structural components of information, resources, support, and opportunity.Results: Thirteen NAs (mean age = 42 years, 92% female) completed interviews. Information, or lack thereof, provided to the NAs influenced feelings of fear, preparation, and autonomy. Resources (e.g., protocols, equipment, and person-power) made it easier to cope with overwhelming emotions, affected the NAs’ abilities to do their jobs, and when limited, drove NAs to take on new roles. NAs noted that support was mostly provided by nurses and made the NAs feel appreciated, desiring to contribute more. While NAs felt they could consult leadership when needed, several felt leadership showed little appreciation for their roles and contributions. Similar to support, the opportunity to take care of COVID-19 patients yielded a diverse array of emotions, exposed advances and gaps in NA preparation, and challenged NAs to autonomously develop new care practices and processes.Conclusion: Management and empowerment of healthcare workers are critical to hospital performance and success. We found many ways in which the NAs’ psychological experiences of empowerment were shaped by the healthcare system’s empowerment-related structural conditions during a public health emergency. To further develop an empowered and committed critical workforce, hospitals must acknowledge the organizational practice influence on the psychological experiences of empowerment among NAs.
Radiological Staging of Rectal Cancer in a Resource Limited Setting
Authors: Lokuhetty Naradha , Seneviratne Suranjith L , Rahman Fathima Asma , Marapana Thanushka , Niloofa Roshan , De Zoysa Ishan
Published: September 2020

Objective: Current guidelines on Rectal Cancer (RC) management recommend pre-operative MRI for loco-regional staging and CT for staging of metastases. This allows appropriate selection of patients for chemo-radiotherapy (CRT). However, MRI is not freely available in many low-income countries. We assessed the status of pre-operative imaging for RC in Sri Lanka and evaluated the performance of CT in RC staging. Results: A pre-tested interview-administered questionnaire was used to assess the pre-operative use of MRI and CT in RC. CT findings from 37 RC patients were then compared with histopathology findings. Of the 64 surgeons interviewed, 57 (89.1%) did not request an MRI for their RC patients. Reasons cited limited availability and long waiting times due to competing health needs. A CT was requested by all. In RC, the overall accuracy of CT for T staging was 43.2% and 29.7% of T1-T2 tumours were over-staged as T3. The overall accuracy of CT for regional lymph node staging was 70.3%. In summary, CT alone is not suitable for RC staging in any setting. It leads to over-staging and patients may thus receive unnecessary CRT. Steps must be taken to improve access to pre-operative MRI among Sri Lankan RC patients.
Comparative Genomics Reveals Broad Genetic Diversity, Extensive Recombination and Nascent Ecological Adaptation in Micrococcus luteus
Authors: Li Yisong , Sun Zhong-Zhi , Rong Jin-Cheng , Xie Bin-Bin
Published: September 2020

Background: Micrococcus luteus is a group of actinobacteria that is widely used in biotechnology and is being thought as an emerging nosocomial pathogen. With one of the smallest genomes of free-living actinobacteria, it is found in a wide range of environments, but intraspecies genetic diversity and adaptation strategies to various environments remain unclear. Here, comparative genomics, phylogenomics, and genome-wide association studies (GWAS) were used to investigate the genomic diversity, evolutionary history, and the potential ecological differentiation of the species.Results: High-quality genomes of 66 M. luteus strains were downloaded from the NCBI GenBank database and core and pangenome analysis revealed a considerable intraspecies heterogeneity. Phylogenomic analysis, gene content comparison, and average nucleotide identity calculation consistently indicated that the species has diverged into three well-differentiated clades. Population structure analysis revealed four admixed ancestral subpopulations, with three of them corresponding to the three clades, respectively, and the fourth corresponding to an unknown ancestor or the fourth, yet unsampled, clade. Reconstruction of gene gain/loss events along the evolutionary history revealed both early events that contributed to the inter-clade divergence and recent events leading to the intra-clade diversity. We also found convincing evidence that recombination has played a key role of the evolutionary process of the species, with upto two-thirds of the core genes have been affected by recombination. Furthermore, distribution of mammal-associated strains (including pathogens) on the phylogenetic tree strongly suggested that the last common ancestor had a free-living lifestyle, and a few recently diverged lineages have developed a mammal-associated lifestyle separately. Consistently, genome-wide association studies revealed that mammal-associated strains from different lineages shared genes functionally relevant to the host-associated lifestyle, indicating a recent ecological adaption to the new host-associated habitats.Conclusions: These results revealed high intraspecies genomic diversity of M. luteus and highlighted that gene gain/loss events and extensive recombination events played key roles in the genome evolution. Our study also indicated that, as a free-living species, some lineages have recently developed or are developing a mammal-associated lifestyle. This study provides insights into the mechanisms that drive the genome evolution and adaption to various environments of a bacterial species.
Clinical Observations of Anterior Cruciate Ligament (ACL) Lesions in Patients with Chronic Fatigue
Authors: Yu Wang , Xianmin Liu , Chunbao Li , Liangbi Xiang
Published: September 2020

Purpose To explore how chronic fatigue impacts on anterior cruciate ligament (ACL) lesion and observe related clinical characteristics.Methods A retrospective study conducted from December 2015 to December 2019, includes 86 males who involved chronic fatigue （determined by the fatigue self-assessment scale ）and present symptoms of knee pain with no trauma. For those who diagnosed with ACL lesion, we recorded their basic characteristics such as age, BMI（kg/m2）, daily training time, etc. and carried out some tests on them to evaluate their clinical performance and observed their manifestations under X-ray, MRI and arthroscopy around the treatment procedure.Results Of all 86 males with ACL lesion, 59 patients were injured in the left knee while 27 in the right knee. Age, weekly training intensity, BMI, and knee hyperextension are independent influence factors for ACL lesion through multivariate analysis. Physical examinations and radiologic features included resting pain(23[26.7%]); standing pain(56[65.1%]); exercising pain(86[100%]); “powerless knee”(34[39.5%]); anterior patellar pain(41[47.7%]); knee axis tenderness(38[44.2%]); first degree positive in ADT test(34[39.5%]); second to third degree positive in ADT test(23[26.7%]); positive in Lachman test(73[84.9%]); positive in pivot shift test(5[5.8%]); ACL cyst(15[17.4%]); ACL thickness change(75[87.2%]); PCL tortuosity(35[40.7%]); synovitis(80[93.0%]); intra-articular effusion(79[91.9%]).Conclusion The main risk factor of ACL lesion is patients’ training experience time. Knee pain, mild anterior instability of knee joint, synovitis and intra-articular effusion are the most typical clinical manifestations of ACL patients.
Comparative efficacy and safety of β-lactam/β-lactamase inhibitors versus cabapenems for febrile neutropenia empiric therapy: A systematic review and meta analysis
Authors: Meng Haiyang , ZHANG Jingyi , ZHANG Ailing , YANG Jie , LU Jingli , Ma Yanfang , ZHOU Qi , KANG Jian , ZHANG Xiaojian
Published: September 2020

Background

The efficacy and safety of β-lactam/β-lactamase inhibitors (BL/BLIs) versus carbapenems for febrile neutropenia empiric therapy are controversial.
Methods

PubMed, Embase, Cochrane library databases, Web of Science and Google scholar were searched up to 1 April 2020. Studies were included if they compared BL/BLIs versus carbapenem for febrile neutropenia patients undergoing chemotherapy for either solid tumours or haematological malignancies among adults and children. We pooled the treatment success rate, mortality and adverse events.
Results

Nine RCTs were included. There was no differences between carbapenems and BL/BLIs were observed in terms of treatment success without modification (RR 1.04, 95% CI 0.93–1.15), no differences were observed in the subgroups of BL/BLIs, adults and children. No significant differences were found in all-cause mortality (RR 1.15, 95% CI 0.64–2.06). Our study shows that gastrointestinal events are the most common adverse effects, nausea/vomiting were significantly more common with carbapenems (RR 2.83, 95% CI 1.35–5.92, P = 0.006), however, diarrhea were more common with BL/BLIs (RR 0.47, 95% CI 0.27–0.80, P = 0.006).
Conclusions

The efficacy and safety of BL/BLIs with carbapenems were comparable in empiric treatment of febrile neutropenia.
Pattern of Hemoglobinopathies: A Cross-sectional Study in North of Morocco
Authors: Alaoui Fatima Zahra , LAGHMICH Achraf , NOUROUTI Naima GHAILANI , BARAKAT Amina , MECHITA Mohcine BENNANI
Published: September 2020

Background: Hemoglobinopathies are the most frequent widely spread genetic disorders. In Morocco, epidemiological and clinical data are scarce. The present study aims to determine the spectrum and geographic distribution of hemoglobinopathies in Larache province, North of Morocco.Methods: A retrospective cross-sectional study was conducted from January 2015 to December 2018 at the provincial hospital of Larache city. All patients’ records having a hemoglobinopathy were analyzed. Background data (age, gender, and origin) of each case were analyzed. Results: Our study showed an overall frequency of hemoglobinopathies of 3.6%. Sickle cell trait was registered to be the most common disorder in our studied population (42.3%), followed by β-thalassemia Trait (20.2%), sickle cell disease (19.8%), major β-thalassemia (9.8%) and sickle/β-thalassemia (8%). The average age of subjects with hemoglobin disorders was 17.5 years. The majority of the patients (66.5%) were less than 20 years old. A disparity in the diseases geographic distribution was observed, 74.6% of patients came from rural areas. Conclusions: The present study is the first of its kind offering comprehensive data on hemoglobinopathies pattern in Northern Morocco. Our work may lay the foundation for screening programs for better prevention and coverage.
FZD2 Promotes TGF-β-induced Epithelial-to-Mesenchymal Transition in Breast Cancer via Activating Notch Signaling Pathway
Authors: Tuluhong Dilihumaer , Chen Tao , Wang Jingjie , Zeng Huijuan , Li Hanjun , Dunzhu Wangmu , Li Qiurong , Wang Shaohua
Published: September 2020

Background

Breast cancer (BC) is one of the commonest female cancers, which is characterized with high incidence. Although treatments have been improved, the prognosis of BC patients in advanced stages remains unsatisfactory. Thus, exploration of the molecular mechanisms underneath BC progression is necessary to find novel therapeutic methods. Frizzled class receptor (FZD2) belongs to Frizzled family, which has been proven to promote cell growth and invasion in various human cancers. The purpose of our study was to detect the functions of FZD2 and explore its mechanism in BC.

Methods

The level of FZD2 was measured in BC tissues by quantitative realtime polymerase chain reaction (qRT-PCR), western blot, immunohistochemistry (IHC) respectively. Cell Counting Kit-8 (CCK-8), standard colony formation, transwell aasays, wound healing and flow cytometry experiments were adopted separately to test cell viability, invasion, migration, apoptosis and cell cycle distribution. Epithelial-mesenchymal transition (EMT) biomarker were determined by using Immunofluorescence assay. Xenograft tumorigenicity assay was performed to assess the effect of FZD2 on tumor growth in vivo .

Results

We determined that FZD2 mRNA and protein expression was abundant in BC tissues. Moreover, high level of FZD2 had significant correlation with poor prognosis. In vitro functional assays revealed that silencing of FZD2 had suppressive effects on BC cell growth, migration and invasion. Animal study further demonstrated that FZD2 silencing inhibited BC cell growth in vivo. In addition, FZD2 induced EMT in BC cells in a transforming growth factor (TGF)-β1-dependent manner. Mechanistically, knockdown of FZD2 led to the inactivation of Notch signaling pathway.

Conclusion

Based on all these data, we concluded that FZD2 facilitates BC progression and promotes TGF-β1-inudced EMT process through activating Notch signaling pathway.
Factors Contributing to Men’s Grief Following Pregnancy Loss and Neonatal Death: Further Development of an Emerging Model in an Australian Sample
Authors: Obst Kate , Oxlad Melissa , Due Clemence , Middleton Philippa
Published: September 2020

Background: Historically, men’s experiences of grief following pregnancy loss and neonatal death have been under-explored in comparison to women. However, investigating men’s perspectives is important, given potential gendered differences concerning grief styles, help-seeking and service access. Few studies have comprehensively examined the various individual, interpersonal, community and system/policy-level factors which may contribute to the intensity of grief in bereaved parents, particularly for men. Methods: Men (N = 228) who had experienced an ectopic pregnancy, miscarriage, stillbirth, termination of pregnancy for foetal anomaly, or neonatal death within the last 20 years responded to an online survey exploring their experiences of grief. Multiple linear regression analyses were used to examine the factors associated with men’s grief intensity and style. Results: Men experienced significant grief across all loss types, with the average score sitting above the minimum cut-off considered to be a high degree of grief. Eight factors significantly contributed to men’s grief: type of loss experienced, their age at the time of loss, loss history, marital satisfaction, availability of social support, acknowledgement of their grief from family/friends, time spent bonding with the baby during pregnancy, and feeling as though their role of ‘supporter’ conflicted with their grief process. Factors contributing to grief also differed depending on grief style. Intuitive (emotion-focused) grief was associated with viewing an ultrasound during pregnancy, ethnicity, and support received from healthcare professionals. Instrumental (activity-focused) grief was associated with time and quality of attachment to the baby during pregnancy, availability of social support, acknowledgement of men’s grief from their female partner, supporter role interfering with their grief, and tendencies toward self-reliance.Conclusions: Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement and validation from all healthcare professionals, family/friends, community networks and workplaces. Addressing male-specific needs, such as balancing a desire to both support and be supported, requires tailored information and support. Strategies to support men should consider grief styles and draw upon father-inclusive practice recommendations. Further research is required to explore the underlying causal mechanisms of associations found.Trial registration: N/A