bluuebunny/crossref_metadata_2025 huggingface dataset:
Burden of Talaromyces marneffei infection in people living with HIV/AIDS in Asia during ART era: a systematic review and meta-analysis
Authors: Qin Yuanyuan , Huang Xiaojie , Chen Hui , Liu Xinchao , Li Yao , Hou Jianhua , Li Aixin , Chen Yaokai , Yan Xiaofeng
Published: December 2019

Background: Talaromyces marneffei (TM) is a dimorphic fungus mainly prevalent in Southeast Asian countries, which often causes disseminated life-threatening infection. TM infection often occurs in HIV/AIDS patients even in the antiretroviral therapy (ART) era. However, there has not been a systematic analysis of the prevalence of TM infection in HIV-infected populations in Asia.Methods：In this study, we searched Pubmed, Embase, Web of Science, CNKI, and WanFang from inception to 21 November 2018 for studies reporting TM infection in people living with HIV/AIDS (PLWHA). Our meta-analysis included studies investigating the prevalence of TM infection in PLWHA. Reviews, duplicate studies, and animal studies were excluded. Random effects model was used to estimate the pooled prevalence and meta-regression analysis was conducted to explore potential factors for heterogeneity.Results： 159,064 patients with HIV infection in 33 eligible studies were included in our meta-analysis. The pooled prevalence of TM infection in PLWHA was 4.0%. Vietnam had the highest prevalence (6.4%), followed by Thailand (3.9%), China (3.3%), India (3.2%) and Malaysia (2.1%). In China, TM infection was most prevalent in South China (15.0%), while the burden in Southwest China was not very heavy (0.3%). TM infection in PLWHA in lower latitude area was significantly more prevalent than that in higher latitude area (OR 2.838, 95%CI: 2.376-3.390, P<0.001). CD4 counts below 200 cells/mm3 increased the risk of TM infection in PLWHA (OR 12.68, 95%CI: 9.58-16.77). However, accessing ART did not significantly decrease the risk of TM infection in PLWHA. Conclusions： The burden of TM infection is heavy in Asia and varies from region to region. PLWHA in lower latitude areas are more likely to suffer from TM infection. Optimization of diagnostic tools and universal screening of TM in vulnerable people for early case detection and for prompt antifungal treatment should be considered.
Neonatal hand, foot, and mouth disease due to Coxsackievirus A6 in Shanghai
Authors: Xu Shanshan , Li Huajun , Qiao Peng , Xu Guofeng , Zhao Dongying , Lin Xiaoyan , Qin Yu , Yu Huiju , Zhang Xi , Zhang Wanju , Huang Lisu
Published: December 2019

Background: Evidence of hand, foot, and mouth disease (HFMD) in neonates is limited. The aim of this study was to evaluate the clinical symptoms, possible transmission routes, and prognosis of neonatal HFMD in Shanghai.
Methods: This was a case-control study based on the HFMD registry surveillance system. All neonates and infected family members were enrolled between 2016 and 2017 in Shanghai. Neonates with HFMD were followed for at least half a year. Detailed questionnaires, medical history, and physical examination were recorded. Routine blood examination, liver and renal function, immunophenotypes of peripheral blood lymphocytes (CD3, CD4, and CD8 T-cells; NK cells), immunoglobulin (Ig) M, IgG, and IgA, and cytokine interleukin (IL-1β, IL-2R, IL-6, IL-8, IL-10, and TNF-α) levels were measured. All rectal swab specimens were collected and genotyped for enterovirus. T-test or nonparametric test was used to evaluate the differences. Logistic analysis was applied to calculate the risk of clinical symptoms in the group of HFMD neonates and their paired siblings.
Results: There were 16 neonates among the 12608 diagnosed patients with HFMD, accounting for 1.3‰. All neonatal infections were transmitted by other members of the family, mainly the elder siblings, and involved different types of coxsackievirus A6. Coxsackievirus A6 is also the emerging and predominant causative agent of HFMD in Shanghai. None of the neonates with HFMD suffered fever, onychomadesis, or severe complications. However, two elder sibling patients showed lethargy, and one developed hypoperfusion. In the elder siblings with HFMD, the proportion of white blood cells was generally higher than in neonates with HFMD. The immunologic function of the neonates with HFMD was basically normal. The levels of inflammatory markers were higher in both neonates and elder siblings with HFMD compared to their age-matched controls. The clinical symptoms receded after about one week of onset. None of the neonates had sequelae.
Conclusions: All neonates with coxsackievirus A6 HFMD had mild disease with no complications or sequelae. Notably, due to the two-child policy in China, elder siblings may be the main route of HFMD transmission.
Periodontal inflamed surface area in patients on haemodialysis and peritoneal dialysis: a Croatian cross-sectional study
Authors: Smojver Bojana Križan , Altabas Karmela , Knotek Mladen , Jukić Nikolina Bašić , Aurer Andrej
Published: December 2019

Background: Periodontitis is an inflammatory periodontal disease that is caused by bacterial plaque and destroys the connective tissue and bone that support the teeth. Patients with chronic kidney disease have damaged immunological systems because of uremic toxins and are thus prone to infections. The decision to initiate dialysis treatment via haemodialysis (HD) or peritoneal dialysis (PD) is often complex and remains a matter of debate. Although it has been shown that PD can provide similar or better survival rates and better quality of life and that PD is more economical than HD, PD patients represent only 11% of the global dialysis population. PD also better removes middle molecules (uremic toxins) than haemodialysis (HD). The purpose of this study was to investigate the level of inflammatory burden presented by PISA levels in dialysis patients in Croatia to compare PISA between HD and PD patients, thus providing another aspect for consideration in the selection of the optimal dialysis modality. Methods: A cross-sectional study was performed on 58 consecutive patients on HD and 31 consecutive patients on PD. PISA was calculated using measurements of the clinical attachment level, recession and bleeding on probing. We performed the primary analysis using multivariable robust regression. Results: Patients on PD had a 746 mm2 (93%) lower mean PISA than patients on HD after adjustment for 20 possible confounders, including the duration of dialysis. The type of dialysis was independently correlated with PISA (semipartial correlation: -0.50; p=0.017; false discovery rate<5%). Conclusions: PISA levels in dialysis Croatian patients indicate a high need for periodontal treatment. PD is associated with a smaller PISA independent of many sociodemographic, lifestyle, laboratory and clinical factors. The duration of dialysis does not influence PISA levels.
Health coaching for promoting physical activity in low back pain patients: A secondary analysis on the usage and acceptance
Authors: Dejonghe Lea Anna Lisa , Rudolf Kevin , Becker Jennifer , Stassen Gerrit , Froboese Ingo , Schaller Andrea
Published: December 2019

Background: Multicomponent interventions combined with health coaching are widely recommended to improve a healthy lifestyle. The aim of the present study was to analyse the usage and acceptance of a multicomponent intervention (telephone, web and face-to-face coaching) for low back pain patients, and thereby gain an understanding of why this intervention was not as effective as expected. Methods: A secondary analysis of a randomised controlled trial, aimed at promoting physical activity, was conducted. It was a cross-sectional study based on data of a multicomponent intervention group (baseline=201 participants). For evaluating the usage and acceptance, descriptive statistics were applied. Results: Over half (n=118) of the patients participated at least once in the telephone coaching. Approximately half of the participants (44 of 90) rated the telephone coaching as "good". 34 of 92 (37%) participants reported of visiting the web-platform. The web-platform was comprehensible for nearly one-quarter (n=8 of 33) and very useful for one participant. The face-to-face-contact was rated highly (range: 79.4-88.2 out of 100). Conclusion: Usage of the telephone coaching approach was moderate with even fewer participants visiting the web-platform. In addition, these approaches were not rated as very useful. The acceptance of the face-to-face contact was high. Since the usage and acceptance could influence the effectiveness, utilisation and acceptance studies might help to explain the reason for non-effective lifestyle interventions. Therefore, more studies analysing the usage and acceptance are needed. To improve the usage and acceptance, a stronger participatory orientation in the design of interventions and the integration of face-to-face contact could be helpful.
Baicalein neutralizes hypercholesterolemia-induced aggravation of oxidative injury in rats
Authors: Alsaad Abdulaziz MS , Almalki Mohammed S , Almutham Ibrahim , Alahmari Abdulwahab A , Alsulaiman Mohammed , Al-Rejaie Salim Saleh
Published: December 2019

Background: Hypercholesterolemia is a major risk factor for several cardiovascular and metabolic diseases as it triggers oxidative and pro-inflammatory cascades. Baicalein (BL) is a natural flavone with multiple therapeutic properties. The present study aimed to evaluate the potential protective effect of BL supplementation in hypercholesterolemic rats.
Methods: Rats were fed a high-cholesterol diet (HCD) for six weeks and then orally administered BL at two doses (25 and 50 mg/kg body weight/day) for four weeks. Serum lipids, liver enzymes, cardiac enzymes, renal markers, tumor necrosis factor-α, interleukin-6, interleukin-1β, interleukin-10, caspase-3, nitric oxide and prostaglandin-2 were measured. In renal, hepatic, and cardiac tissues, thiobarbituric acid-reactive substance, glutathione, superoxide dismutase, catalase, and glutathione peroxidase activities were measured.
Results: The altered levels of lipoproteins, aminotransferases, creatine kinases, and urea in hypercholesterolemic animals were significantly corrected by BL. Inflammatory and apoptotic biomarkers were also markedly attenuated in the HCD group following BL treatment. Hypercholesterolemia considerably induced the lipid peroxidation product, TBARS, and oxidative radicals in cardiac, hepatic, and renal tissues, which were attenuated by BL treatment, particularly, at the 50 mg/kg/day dose. BL enhanced the activities of superoxide dismutase, catalase, and glutathione peroxidase that were suppressed by HCD. Histological alterations induced by cholesterol overload in cardiac, hepatic, and renal tissues were ameliorated by BL supplementation.
Conclusions: Our results show that the co-administration of BL (25 and 50 mg/kg/day) in HCD rats improved all the altered parameters. Activation of cellular antioxidant enzymes and/or suppression of inflammatory cytokines may be involved in these prominent effects.

Keywords: hypercholesterolemia, baicalein, inflammation, oxidative stress
Maternal healthcare services use in Mwanza Region, Tanzania: A cross-sectional baseline survey
Authors: Orwa James , Mantel Michaela , Mugerwa Micheal , Brownie Sharon , Pallangyo Eunice Siaity , Mwasha Loveluck , Isangula Kahabi , Subi Leonard , Mrema Secilia , Edwards Grace , Siso David , Selestine Edna , Mwansisya Tumbwene , Mbekenga Columba , Temmerman Marleen
Published: December 2019

Background: Improving maternal health by reducing maternal mortality/morbidity relates to Goal 3 of the Sustainable Development Goals. Achieving this goal is supported by antenatal care (ANC), health facility delivery, and postpartum care. This study aimed to understand levels of use and correlates of uptake of maternal healthcare services among women of reproductive age (15–49 years) in Mwanza Region, Tanzania.
Methods: A cross-sectional multi-stage sampling household survey was conducted to obtain data from 1476 households in six districts of Mwanza Region. Data for the 409 women who delivered in the 2 years before the survey were analyzed for three outcomes: four or more ANC visits (ANC4+), health facility delivery, and postpartum visits. Factors associated with the three outcomes were determined using generalized estimating equations to account for clustering at the district level while adjusting for all variables.
Results: Of the 409 eligible women, 58.2% attended ANC4+, 76.8% delivered in a health facility, and 43.5% attended a postpartum clinic. Women from peri-urban, island, and rural regions were less likely to have completed ANC4+ or health facility delivery compared with urban women. Education and early first antenatal visit were associated with ANC4+ and health facility delivery. Mothers from peri-urban areas and those who with health facility delivery were more likely to attend postpartum check-ups.
Conclusion: Use of ANC services in early pregnancy influences the number of ANC visits, leading to higher uptake of ANC4+ and health facility delivery. Postpartum check-ups for mothers and newborns are associated with health facility delivery. Encouraging early initiation of ANC visits may increase the uptake of maternal healthcare services.
Keywords: Antenatal care, health facility delivery, postpartum care, Mwanza, Tanzania
Association Between Developmental Dental Anomalies, Early Childhood Caries And Oral Hygiene Status Of 3-5-Year-Old Children In Ile-Ife, Nigeria
Authors: Folayan Morenike Oluwatoyin , Alade Michael , Adeniyi Abiola , Tantawi Maha El , Finlayson Tracy L
Published: December 2019

Objectives: To determine the association between developmental dental anomalies (DDA), early childhood caries (ECC) and oral hygiene status of 3-5-year-old children resident in Ile-Ife, Nigeria.
Methods: This was a cross-sectional study. We analyzed data for 3-5-year-olds extracted from the dataset of a household survey collected to determine the association between ECC and maternal psychosocial wellbeing in children 0-5-year-olds. The outcome variables for the study were ECC and poor oral hygiene. The explanatory variable was the presence of developmental dental anomalies (supernumerary, supplemental, mesiodens, hypodontia, macrodontia, microdontia, peg-shaped lateral, dens evaginatus, dens invaginatus, talons cusp, fusion/germination, hypoplasia, hypomineralized second molar, fluorosis, amelogenesis imperfecta). The prevalence of each anomaly was determined. Poisson regression analysis was conducted to determine the association between presence of developmental dental anomalies, ECC and oral hygiene status. The model was adjusted for sex, age and socioeconomic status.
Results: Of the 918 children examined, 75 (8.2%) had DDA, 43 (4.7%) had ECC, and 38 (4.1%) had poor oral hygiene. The most prevalent DDA was enamel hypoplasia (3.9%). Of the 43 children with ECC, 6 (14.0%) had enamel hypoplasia and 3 (7.6%) had hypomineralized second primary molar. There was a significant association between ECC and enamel hypoplasia (p<0.001) and a borderline association between ECC and hypomineralized second primary molars (p=0.05). The proportion of children with poor oral hygiene (PR: 2.03; 95% CI: 0.91-4.56; p=0.09) and ECC (PR: 2.02; 95% CI: 0.92-4.46; p=0.08) who had DDA was twice that of children with good oral hygiene and without ECC respectively, although the differences did not reach statistical significance.
Conclusion. Enamel hypoplasia and hypomineralized second primary molars are DDA associated with ECC. DDA also increases the probability of having poor oral hygiene in the population studied.
Integrin α7 knockdown suppresses cell proliferation, migration, invasion and endothelium-mesenchymal transformation in hepatocellular carcinoma
Authors: Wu Zhiyong , Kong Xiaoyu , Wang Zhihui
Published: December 2019

Background The aim was to investigate whether integrin α7 (ITGA7) influenced hepatocellular carcinoma (HCC) progression, and explore its effect on regulating endothelium-mesenchymal transformation (EMT).Methods ITGA7 mRNA and protein expressions in human normal liver epithelial cell line and HCC cell lines were determined by reverse transcription polymerase chain reaction (RT-qPCR) and western blot. ITGA7 siRNA (ITGA7-KD group) and nonsense siRNA (control group) were transfected into Huh7 cells and SUN449 cells. After transfection, ITGA7 mRNA and protein expressions (RT-qPCR and western blot), cell proliferation (Cell Counting Kit-8), apoptosis (Annexin V/Propidium Iodide assay), migration (Wound scratch assay) and invasion (Transwell assay) were determined. E-cadherin and α-SMA expressions (RT-qPCR and western blot) were determined.Results ITGA7 mRNA and protein expressions were increased in Li7, Huh7, SKHEP1 and SNU449 cells compared to THLE-3 cells. In both Huh7 and SNU449 cells, ITGA7 mRNA and protein expressions were decreased in ITGA7-KD group than control group after plasmids transfection, indicating the successful transfection. Then, cell proliferation was decreased at 48h and 72h; cell apoptosis rate was increased at 48h; cell migration rate was reduced at 24h; cell invasive count was decreased at 24h in ITGA7-KD group compared to control group. Furthermore, increased E-cadherin but decreased α-SMA mRNA and protein expressions were discovered in ITGA7-KD group than control group at 24h.Conclusions ITGA7 knockdown suppresses HCC progression and inhibits EMT process in HCC, indicating that ITGA7 might be a potential novel treatment target for HCC therapy.
Correlation between optic disc deformation and retinal vasculature in non-pathological high myopia
Authors: Sun Jiao , Wang Jialin , Wang Yanling
Published: December 2019

Background: The aim of this study was to investigate the correlation between optic disc deformation and retinal vasculature in high myopia.Methods: One hundred and thirty eyes with non-pathological high myopia were included in this cross-sectional study. The optic disc tilt ratio, and horizontal and vertical disc diameters were analyzed using fundus color photography. A 3 × 3 mm2 grid and a 4.5 × 4.5 mm2 grid were used to scan parafoveal and peripapillary regions, respectively, using optical coherence tomography angiography. Vessel flow density (VFD) and fractal dimension of the retina and the foveal avascular zone (FAZ) were analyzed and quantified using en face projection images. Optic disc parameters that were associated with vascular changes were determined using multiple linear regression analysis.Results: Results from the multivariate analysis revealed that the tilt ratio (β = -2.291, p = 0.025) was negatively correlated with three sectors in the deep layer. Age was negatively correlated with the VFD of the retina (β = -2.161; p < 0.034). Additionally, FAZ was not significantly correlated with any factors in the current study. Further, there was a positive correlation between retinal nerve fiber layer thickness and VFD of the optic nerve head (β = -2.146, p = 0.035).Conclusions: Overall, our results demonstrated that optic disc deformation was negatively correlated with the retinal microvasculature in non-pathological high myopia. Therefore, optic disc deformation may be used to predict the retinal vasculature in high myopia.
The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital
Authors: Sun Yue , Fu Zhaoyan , Bo Qijing , Mao Zhen , Ma Xin , Wang Chuanyue
Published: December 2019

Background: To assess the reliability and validity of Patient Health Questionnaire-9 (PHQ-9) for patients with major depressive disorder (MDD) and to assess the feasibility of its use in psychiatric hospitals in China. Methods: 109 outpatients or inpatients with MDD who qualified the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria completed PHQ-9 and Hamilton Depression Scale (HAMD-17). Two weeks after the initial evaluation, 54 randomly selected patients underwent repeat assessment using PHQ-9. For validity analysis, the construct validity and criterion validity were assessed. The internal concordance coefficient and the test-retest correlation coefficients were used for reliability analysis. The correlation between total score and scores for each item and the correlation between scores for various items were evaluated using Spearman correlation coefficient. Results: Principal components factor analysis showed good construct validity of the PHQ-9. PHQ-9 total score showed a positive correlation with HAMD-17 total score (r=0.610, P<0.001). With HAMD as the standard, PHQ-9 depression scores of 7, 15, and 21 points were used as cut-offs for mild, moderate, and severe depression, respectively. Consistency assessment was conducted between the depression severity as assessed by PHQ-9 and HAMD (Kappa=0.229, P<0.001). Intraclass correlation coefficient between PHQ-9 total score and HAMD total score was 0.594 (95% confidence interval: 0.456–0.704, P<0.001). The Cronbach's α coefficient of PHQ-9 was 0.892. Correlation coefficients between each item score and the total score ranged from 0.567–0.789 (P<0.01); the correlation coefficient between various item scores ranged from 0.233–0.747. The test-retest correlation coefficient for total score was 0.737. Conclusions: PHQ-9 showed good reliability and validity, and high adaptability for patients with MDD in psychiatric hospital. It is a simple, rapid, effective, and reliable tool for screening and evaluation of the severity of depression.
Sex-specific Longitudinal Comparison of CES-D and PHQ-9 Depression Scales. A Concordance Analysis using data from the population-based Heinz Nixdorf Recall Study
Authors: Engel Miriam , Peternel Markus , Jöckel Karl-Heinz , Schramm Sara , Slomiany Uta , Moebus Susanne
Published: December 2019

Background: To measure depressive symptoms (DS) in population-based studies, there are two the well-established questionnaires: the Center for Epidemiologic Studies Depression Scale (CES-D) and the Patient Health Questionnaire-9 (PHQ-9). So far, comparisons between both instruments have only been performed using cross-sectional data, and in specific patient groups. Furthermore, comparisons for population-based studies are missing as well as sex-specific analyses. The aim is to evaluate the psychometric properties and concordance of the longitudinal results of CES-D and PHQ-9 in the German population-based Heinz Nixdorf Recall (HNR) study. Methods: We used data of n=3,084 participants (48.8% men, mean age: 66.8 years). CES-D and PHQ-9 were assessed in the 8th (t8) and 9th (t9) annual postal follow up within two years via questionnaires. DS were defined as CES-D score ≥ 17 and PHQ-9 score ≥ 10. Internal consistency reliability, convergent validity, and agreement between PHQ-9 and CES-D were assessed using respectively Cronbach’s alpha, Pearson’s correlation, and Cohen’s kappa. To analyse DS differences between t8 and t9 we used McNemar’s test. Sex-stratified results are presented. Results: The prevalence of DS at t8 was higher for CES-D (7.8%) than for PHQ-9 (4.4%). The prevalence slightly increased for CES-D (8.1%), as well as for PHQ-9 to 4.5% at t9. Internal consistency of the PHQ-9 and CES-D was good at both times (Cronbach’s alpha: CES-D t8 & t9: 0.89, PHQ-9 t8: 0.84; t9: 0.85). Cohen’s kappa of agreement between CES-D and PHQ-9 was moderate at both time points (t8: k=0.57; 95% CI: 0.51, 0.63; t9; k=0.58; 95% CI: 0.52, 0.64). For both instruments, the McNemar’s test revealed no differences in the proportion of depressives between t8 and t9. We could not observe sex-specific differences of psychometric characteristics, whereas the agreement between the CES-D and PHQ-9 performed slightly higher in men than in women (t8: k=0.61, resp. k=0.55). Conclusion: The results do not support the superiority of one of the scales. Both scales perform well in this population-based cohort in both sexes and longitudinal approach. The decision, which scale to use may depend on characteristics other than the accuracy of the scale, including feasibility and clinical usability.
Reported prevalence of suicidal ideation and suicide attempts among men who have sex with men in China: A systematic review and meta-analysis
Authors: Fu Hanlin , Yang Tubao , Wu Xiaobing , Cai Yumao , feng tiejian
Published: December 2019

Background: Men who have sex with men(MSM) in China are at high risk for suicidality but often overlooked. Several studies have reported the prevalence of suicidal ideation and suicide attempts. However, the estimates varies substantially between studies. This systematic review aimed to establish pooled prevalence of suicidal ideation and suicide attempts among MSM in China, in order to arouse the attention of the public.Methods: The relevant studies up to April 2019 were systematically searched via several electronic databases. Studies were screened according to inclusion and exclusion criterion and the random-effects meta-analyses were adopted to calculate the pooled prevalence estimates of suicidal ideation and suicide attempts. Heterogeneity between studies and publication bias was also assessed.Results: A total of 23 articles were eligible for the meta-analysis. The pooled prevalence estimate of suicidal ideation and suicide attempts was 20.1% (95%CI: 16.7%-23.7%) and 6.8%(95%CI: 5.0%-8.9%), respectively. Significant heterogeneity was found for both combined effects. Heterogeneity in the estimates could be partially explained by survey points, HIV infection and average age.Conclusions: The prevalence of suicidal ideation and suicide attempts among MSM in China was moderate high, suggesting that more attention should be paid to the subgroup and effective psychological interventions need to be established and implemented to reduce the suicide-related problems among Chinese MSM.
Magnitude of Problematic Anger and its Predictors in the Millennium Cohort
Authors: Adler Amy , LeardMann Cynthia A. , Roenfeldt Kimberly , Forbes David , Jacobson Isabel
Published: December 2019

Background In military personnel and veterans, problematic anger is associated with heightened risk of mental health problems and difficulty functioning, although previous studies have been limited by sample size and cross-sectional data. Methods The current study used Millennium Cohort survey data (N = 90,266) from two time points (2013 and 2016 surveys) to assess the association of baseline demographics, military factors, mental health, self-mastery, and posttraumatic growth with problematic anger levels reported several years later.ResultsOverall, 17.3% of respondents reported problematic anger. In the fully adjusted logistic regression model, greater risk of problematic anger was predicted by male sex, younger age, current or formerly marital status, being black non-Hispanic or other (vs. white), less educational attainment, childhood trauma, and financial problems. Service members who were in the Army or Marines, active duty (vs. reserve), and previously deployed with high levels of combat had increased risk for problematic anger. Veterans were also more likely to report problematic anger. Mental health predictors included major depressive disorder (MDD), posttraumatic stress disorder (PTSD) and comorbid PTSD/MDD. Higher levels of self-mastery and post-traumatic growth were associated with decreased risk of problematic anger.Conclusion Not only did 1 in 6 respondents report problematic anger, but risk factors were significant even after adjusting for MDD and PTSD, suggesting that problematic anger is more than an expression of these mental health problems. Results identify potential points of early intervention and clinical treatment for addressing problematic anger.
“To be lonely in your own loneliness” – The interplay between self-perceived loneliness and rheumatoid arthritis in everyday life: A qualitative study
Authors: Bay Laila Twisttmann , Ellingsen Torkell , Giraldi Annamaria , Graugaard Christian , Nielsen Dorthe
Published: December 2019

Background: Loneliness has a negative impact on physical health, and rheumatoid arthritis symptoms can lead to social isolation. However, there is a lack of research exploring patients’ perspectives on self-perceived loneliness in everyday life with rheumatoid arthritis. The purpose of this study was to gain insight into the meaning and importance of self-perceived loneliness among adult patients diagnosed with rheumatoid arthritis.Methods: Semi-structured interviews analyzed within a narrative thematic framework.Results: Three themes emerged during the analysis: explanations of loneliness in everyday life with rheumatoid arthritis, disclosing or disguising loneliness, and feelings of loneliness in social life.Conclusion: The findings from this study show that loneliness can be burdensome when living with RA. Narratives of loneliness can be hard for patients to disclose, so health care practitioners should take responsibility for legitimizing this subject. A narrative approach in consultations may be helpful to support patients and to encourage a dialogue about loneliness in everyday life with RA.
Earthquake Preparedness of Households and Its Predictors Based on Health Belief Model
Authors: Rostami-Moez Masoumeh , Rabiee-Yeganeh Mohammad , Shokouhi Mohammadreza , Dosti-Irani Amin , Rezapur-Shahkolai Forouzan
Published: December 2019

Background: Earthquakes are one of the most destructive natural disasters in which many people are injured, disabled, or dead each year. Although Iran has only one percent of the world's population, its earthquake-related deaths are six percent. Therefore, this study aimed to determine the level of earthquake preparedness of households and its predictors using the Health Belief Model (HBM).Methods: This study was conducted on 933 households in Hamadan province, located in the west of Iran, in 2019. Multistage random cluster sampling was used for selecting the participants. The inclusion criteria were having at least 18 years old and being able to answer the questions. A questionnaire was used for data collection including earthquake preparedness, awareness of earthquake response, predictors of earthquake preparedness based on the HBM, and demographic information. Analysis of variance, independent t-test, and a linear regression model were used.Results: The mean age of participants was approximately 38.29 ±12.80 years. Furthermore, 60.83% of participants had less than post-secondary education. Earthquake preparedness was poor and about 30%. There was a significant relationship between earthquake preparedness and gender, home ownership, marriage status, and previous earthquake experience (p <0.001). Regarding the HBM constructs, perceived benefits, cues to action, and self-efficacy had significant predictors of earthquake preparedness (p <0.01).Conclusions: Regarding the low earthquake household preparedness, community intervention for improving households' preparedness for earthquake based on the HBM is recommended. Intervention can be designed considering cues to action, self-efficacy, and perceived benefits.
Is natural (6S)-5-methyltetrahydrofolic acid as effective as synthetic folic acid in increasing serum and red blood cell folate concentrations during pregnancy? A proof-of-concept pilot study
Authors: Cochrane Kelsey M , Mayer Chantal , Devlin Angela M , Elango Rajavel , Hutcheon Jennifer A , Karakochuk Crystal D
Published: December 2019

Background: Health Canada recommends 0.4 mg/day folic acid before conception and throughout pregnancy to reduce the risk of neural tube defects. Folic acid is a synthetic form of folate that must be reduced by dihydrofolate reductase and then further metabolized in the small intestine. Recent evidence suggests that the maximal capacity for this process is limited and unmetabolized folic acid has been detected in circulation. The biological effects of unmetabolized folic acid are not fully understood. A natural form of folate, (6S)-5-methyltetrahydrofolic acid (Metafolin®), may be a superior alternative because it does not need to be reduced in the small intestine. Metafolin® is currently used in some prenatal multivitamins, however it has yet to be evaluated during pregnancy. Methods: This double-blind randomized trial will recruit 60 pregnant women aged 19-42 years. Women will receive either 0.6 mg/day folic acid or an equimolar dose (0.625 mg/day) of (6S)-5-methyltetrahydrofolic acid for 16-weeks. The trial will be initiated at 8-21 weeks gestation (after neural tube closure) to reduce the risk of harm should (6S)-5-methyltetrahydrofolic acid prove less effective. All women will also receive a prenatal multivitamin (not containing folate) to ensure adequacy of other nutrients. Baseline and endline blood samples will be collected to assess primary outcome measures, including serum folate, red blood cell folate and unmetabolized folic acid. Change in primary outcomes from baseline to endline in each group will be calculated using a paired-t-test. Discussion: This proof-of-concept trial is needed to obtain estimates of the effect of (6S)-5-methyltetrahydrofolic acid compared to folic acid on circulating biomarkers of folate status during pregnancy. These estimates will inform the design of a definitive trial which will be powered to assess whether (6S)-5-methyltetrahydrofolic acid is as effective as folic acid in raising blood folate concentrations during pregnancy. Ultimately, these findings will inform folate supplementation policies for pregnant women.
Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery
Authors: Allum laura , Apps Chloe , Hart Nicholas , Pattison Natalie , Connolly Bronwen , Rose Louise
Published: December 2019

Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Healthcare providers report dissatisfaction with provision of care for these longer stay patients due to competing demands from higher acuity patients. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety. However, these tools have not been designed for the specific needs of patients with prolonged ICU stay. The objective of this review is to generate data to inform development and implementation of quality improvement tools for patients with prolonged ICU stay, namely: the content, design and effect of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to understand how these tools were developed and implemented in clinical practice.Methods: We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from 1999 to August 2019. We will include primary research studies recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement measures such as structured care plans or checklists designed to standardize more than one aspect of care delivery. Two authors will independently screen citations for eligible studies and perform data extraction. We will use a narrative synthesis to describe review findings.Discussion: The findings will be used to guide development of tools for use with prolonged ICU stay. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools for patients with prolonged ICU stay. Such tools are needed to standardise practice and thereby improve quality of care for patients with prolonged ICU stay and their families. Illustrating the development and implementation methods used for such tools will help to guide translation for similar tools in ICU and future research.Systematic Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/ , DOI 10.17605/OSF.IO/Z8MRE
Reduced serum BDNF levels are associated with the increased risk for developing MDD: A case-control study with or without antidepressants therapy
Authors: Emon Md. Prova Zaman , Das Rajesh , Nishuty Nuruna Lovely , Qusar M.M.A. Shalahuddin , Bhuiyan Mohiuddin Ahmed , Islam Md. Rabiul
Published: December 2019

Objective We do not have any consistent markers for major depressive disorder (MDD) though various biological factors are involved in the pathophysiology. We aimed to evaluate the serum brain-derived neurotrophic factor (BDNF) levels in MDD patients with or without antidepressant therapy compared to healthy controls (HCs). Results We assessed serum BDNF levels among three groups: drug-naïve MDD patients (n = 41), drug-treated MDD patients (n = 44), and age-and sex-matched HCs (n = 82). Serum BDNF levels were measured by enzyme-linked immunosorbent assay (ELISA) kit. Serum levels of BDNF were detected significantly lower in drug-naïve MDD patients compared to HCs. No significant alterations of serum BDNF levels between drug-treated patients and HCs were identified. Significant negative correlations between serum BDNF levels and Hamilton depression rating (Ham-D) scores were observed in both drug-naïve and drug-treated MDD patients. Receiver operating characteristic (ROC) analysis showed good diagnostic value for serum BDNF levels in drug-naïve MDD patients with the area under the curve at 0.821. The present study suggests that low serum BDNF levels may be involved in the pathophysiology of MDD. The reduced serum BDNF levels might be used as an early risk assessment marker for major depression.
Principal Component Analysis of Adipocytokines and Insulin Associate with Risk Factors of Cardiovascular Diseases
Authors: yarizadeh Habib , Pooyan Sara , sajjadi Seyedeh Forough , Badruj Negin , Mirzaei Khadijeh
Published: December 2019

Objectives: Obesity plays an important role in the development of chronic diseases like cardiovascular diseases and diabetes. The underlying mechanism of this connection is that adipose tissue secretes an array of chemical messenger adipokines proinflammatory cytokines (tumor necrosis factor-alpha, interleukin-6, interleukin-1- beta).Result: Two patterns were identified. The first pattern was galectin-3, plasminogen activator inhibitor-1 and IL-1β and the second one was C-reactive protein, insulin and monocyte chemoattractant protein-1. The second pattern were strongly associated with the higher scores for resting metabolic rate, diastolic blood pressure, homeostasis model insulin resistance index, lipid profile (except low density lipoprotein, total cholesterol), and body composition parameters (except fat free mass index and waist hip ratio), while negatively associated with age and high density lipoprotein level (all p < 0.05). The first pattern was, however, significantly associated with body fat mass, obesity degree percentage, waist circumference, fat mass index, and waist hip ratio (P < 0.05 for all). Keywords: Adipocytokines, Cardiovascular Diseases, Obesity.
The Prevalence and Correlates of Physical Activity/Inactivity and Sedentary Behaviour among High-School Adolescents in Iran: A Cross-Sectional Study
Authors: ZIAEI REZA , Mohammadi Reza , Dastgiri Saeed , Baybordi Elaheh , Rahimi Vahab Asl , Bazargani Homayoun Sadeghi , Viitasara Eija
Published: December 2019

Background Physical inactivity and sedentary behaviour are the main risk factors for non-communicable diseases in all stages of life. However, there is a lack of reliable data regarding the recommended level of physical activity and its correlates related to physical inactivity and sedentary behaviour among school students in Iran. The aim of the present study was to report the prevalence and correlates of physical activity/ inactivity and sedentary behaviour among Iranian high school adolescents.Methods The Global School-based Student Health Survey (GSHS) was used for data collection. Related data comprising socio-demographics, health risk behaviour, and protective factors were obtained from 1,517 high school students. Multivariate logistic regression was used to assess the association between relevant independent variables (e.g. gender) and the dependent outcome variable (physical inactivity/sedentary behaviour).Results The prevalence of recommended physical activity by WHO was 27.8%, physical inactivity 72.2% and sedentary behaviour 71.4%. Being female, being overweight or obese, walking/cycling to or from school on 1-4 days, sitting 3 or more hours/day (sedentary behaviour), insufficient vegetable intake, being bullied, and lack of parental support, peer support and parental connectivity (protective factors) were positively associated with physical inactivity. On the other hand, walking/cycling to or from school on 5-7 days, and inadequate fruit intake was negatively associated with physical inactivity. Walking/cycling to or from school on 1-4 days, being physically inactive, inadequate fruit intake, and being bullied were positively associated with sedentary behaviour.Conclusion The prevalence of physical inactivity and sedentary behaviour was high in our studied sample. Interventions that address the issue of active school transport, sedentary behaviour, fruit and vegetable intake, family and peer support and bullying should be given more priority by the public health authorities.
Genome-wide association study of seed coat color in sesame (Sesamum indicum L.)
Authors: Mei Hongxian , Cui Chengqi , Liu Yanyang , Liu Yan , Cui Xianghua , Du Zhenwei , Wu Ke , Jiang Xiaolin , Zheng Yongzhan , Zhang Haiyang
Published: December 2019

Background: Sesame (Sesamum indicum L.) is an important and ancient oilseed crop. Sesame seed coat color is an extremely important agronomic trait, and is related to biochemical functions involved in protein and oil metabolism, and antioxidant content. Because of its complication, the genetic basis of sesame seed coat color remains poorly understood.Results: Genome-wide association study (GWAS) using 42,781 SNPs was performed with a diverse association-mapping panel comprising 366 sesame germplasm lines in 12 environments. In total, 224 significant SNPs (P < 2.34×10−7) explaining approximately 13.34% of the phenotypic variation on average were identified, and 35 significant SNPs were detected in more than 6 environments. Out of 224 significant SNPs, 22 were located in the confidence intervals of previous reported quantitative trait loci (QTLs). A total of 92 candidate genes were identified in the vicinity of the 4 SNPs that were most significantly associated with sesame seed coat color. Conclusions: The results in this paper will provide new insights into the genetic basis of sesame seed coat color, and should be useful for molecular breeding in sesame.
Effects of Regular Off-farm Activities on Household Agricultural Income: Evidence from Kenya’s Kerio Valley
Authors: Rakotoarisoa Manitra A. , Kaitibie Simeon
Published: December 2019

This paper contributes to clarifying the scientific debate on whether off-farm activities hurt or help agricultural income in the Kerio Valley (Kenya). The main purpose of this research is to estimate the impacts of rural household’s participation in regular off-farm activities on agricultural income. The literature indicates that off-farm activities affect rural household’s income but studies on their effect on agricultural income have remained largely inconclusive. Determining how off farm activities affect agricultural income is highly relevant for the decisions of poor rural households and policy makers to allocate resources efficiently and increase investment to combat poverty. Investigation of the effects of regular off-farm activities is carried out in the following logical sequence: we performed surveys to gather information from rural households located in the Kerio Valley in Kenya; using the matching technique, we compared agricultural income per capita between households that took part in regular off-farm activities and those that did not. Methodological tools of the research were the results of a three-year project focusing on improving rural income. The object of research is the households in Kerio Valley in Kenya because they practiced the typical mix of farm and off-farm activities in rural Kenya. The empirical results of the analysis showed at first that household’s participation in regular off-farm activities had no significant effect on household agricultural income per capita. However, by splitting agricultural income into crop and livestock incomes, we found that participation in regular off-farm activities did not affect crop income per capita but it increased livestock income per capita. The results can be useful to policy makers because it shows the existence of a symbiotic association between regular off-farm activities and livestock production. The results also confirm that creating opportunities for rural households to engage in off-farm activities generates supplemental revenues, and more importantly, reliable assets.
Keywords: matching technique, agricultural income, off-farm activities.
Exploring The Role Of Gastronomy In Tourism
Authors: Tovmasyan Gayane ,
Published: December 2019

This paper summarizes the arguments and counterarguments within the scientific discussion on the issues of gastronomy and gastronomic tourism. Many people travel just for gastronomic purposes. Food is the essential need for human being, and it may become the main motivating factor for deciding to travel. Gastronomy and its role in the promotion of tourism therefore need to be studied in greater detail. The main purpose of the article is a comprehensive analysis of the role of gastronomy in the development of tourism industry in the country. The methodological tool for the research was a survey, some hypotheses were derived, which were analyzed via Crosstabulations with Pearson Chi-square testing. The investigation of the topic and the results of the analysis state that gastronomy is the part of culture and traditions of a country and the art and culture of cooking. The research empirically confirms and theoretically proves that many people prefer local cuisine of the destination despite high prices and they evaluate the importance of good cuisine of the destination very high. Also the overall satisfaction with the journey is influenced also by the local cuisine of the destination. The main conclusion is that gastronomy may promote tourism and countries which have gastronomic heritage, should evaluate it and include it in touristic offers by making a gastronomic brand of the region or country. Countries should have a gastronomic tourism development plan. Gastronomic tourism should contribute to accomplishing of sustainable development goals. It may be a driver force for advancing the economy, creating new jobs, increasing the income of population who works in that sphere, etc. In order to meet the needs of tourists, countries should carry out research to understand the consumer motivations and behavior, and based on it to create gastronomic tourism product. Besides, educational organizations should prepare high qualified professionals for the sphere, as the staff competence has a great impact on service level, which in its turn influences customer satisfaction. The results of the research can be useful for the state organs, private sector, also for researchers of tourism sphere.
Keywords: gastronomy, culinary, tourism, culture, tradition, destination.