bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of political ideology on clinical trial knowledge, invitation, and participation among adults in the United States
Authors: Onyeaka Henry , Weber Daniel B , Chido-Amajuoyi Onyema , Muoghalu Chioma , Amonoo Hermioni L
Published: June 2023

Background

Clinical trials remain a critical component of medical innovation. Evidence suggests that individuals’ political ideologies may impact their health behaviors. However, there is a paucity of literature examining the relationship between political ideologies and clinical trial knowledge and participation.

Methods

Study data were derived from Health Information National Trends Survey 5 Cycle 4 (n = 3300), which was conducted from February to June 2020. We used participants’ characteristics to estimate the prevalence of clinical trial knowledge and participation. We used multivariable logistic regressions to investigate whether political ideology had a significant impact on clinical trial knowledge and participation. Jack-knife replicate weights were applied for population-level estimates.

Results

Most participants were White (64.2%), earned above US$50,000 (62.4%), and lived in urban areas (88.0%). About 59.2% reported having some knowledge of clinical trials, and only 8.9% had ever been invited to participate in clinical trials. A total of 37.0%, 29.5%, and 33.5% of the population endorsed moderate, liberal, and conservative political viewpoints respectively. In the adjusted logistic regression analysis, compared to conservatives, liberals (adjusted odds ratio, 1.92; 95% confidence interval, 1.31–2.80) and moderates (adjusted odds ratio, 1.43; 95% confidence interval, 1.09–1.88) had significantly greater odds of having knowledge of clinical trials. Also, liberals had higher odds of receiving invitations to participate in clinical trials (odds ratio, 1.76; 95% confidence interval, 1.08–2.85; p = 0.023) and greater odds of trial participation (odds ratio, 3.90; 95% confidence interval, 1.47–10.33; p = 0.007) compared to moderates.

Conclusions

The mechanism underlying the higher rates of clinical trial invitations to liberals is unclear and requires further comprehensive investigation. Similarly, further qualitative studies are needed to understand the attributes that promote knowledge and increased likelihood of clinical trial participation among liberals. This will provide crucial insight to help design interventions that further involve conservatives and moderates in clinical trials and scientific enterprise.
Integrating refugee students into Ugandan higher education: Language, othering and everyday enactments of participation
Authors: Nambi Rebecca , Najjuma Rovincer , Gallagher Michael
Published: June 2023

This paper examines the everyday enactments of participation of refugee students in Ugandan higher education emerging from a research project (2020–2022). Habermas’s Theory of Communicative Action was used to determine how students responded to the dominant languages, further noting the acts of othering that occur throughout this process that impact this participation and inclusion. Data were collected from three public and four private universities beginning in 2020 and ending in 2021 through interviews with refugee students and administrative staff who worked routinely with these students. The findings reveal social spaces within universities that allow for participation that largely sit outside the formal curriculum. These include the networks of support for the refugees themselves, and their engagement with informal activity, such as city walks and galas. However, the catalyst that initiated interaction with these spaces emanated from their aspirations for the future and their sense of communicative capacity in relation to those aspirations. Recommendations include providing explicit communication to point them directly to events, spaces and opportunities that they can exploit to advance their integration process.
Online public information about advance care planning: An evaluation of UK and international websites
Authors: Canny Anne , Mason Bruce , Atkins Clare , Patterson Rebecca , Moussa Lorna , Boyd Kirsty
Published: June 2023

Introduction

Healthcare information is increasingly internet-based. Standards require websites to be ‘perceivable, operable, understandable and robust’ with relevant content for citizens in appropriate language. This study examined UK and international websites offering public healthcare information on advance care planning (ACP) using current recommendations for website accessibility and content and informed by a public engagement exercise.

Methods

Google searches identified websites in English from health service providers, governmental or third sector organisations based in the UK and internationally. Target keywords that would be used by a member of the public informed the search terms. Data extraction used criterion-based assessment and web content analysis of the first two pages of each search result. Public patient representatives as key members of the multidisciplinary research team guided the development of the evaluation criteria.

Results

A total of 1158 online searches identified 89 websites, reduced to 29 by inclusion/exclusion criteria. Most sites met international recommendations for knowledge/understanding about ACP. Differences in terminology, lack of information about ACP limitations and non-adherence to recommended reading levels, accessibility standards and translation options were apparent. Sites targeting members of the public used more positive, non-technical language than those for both professional and lay users.

Conclusions

Some websites met accepted standards required to facilitate understanding and public engagement in ACP. Others could be improved significantly. Website providers have important roles and responsibilities in increasing people's understanding of their health conditions, future care options and ability to take an active role in planning for their health and care.
Studying the Downstream Effects of Fact-Checking on Social Media: Experiments on Correction Formats, Belief Accuracy, and Media Trust
Authors: Bachmann Ingrid , Valenzuela Sebastián
Published: June 2023

Repeated exposure to misinformation not only reduces the accuracy of people’s beliefs, but it also decreases confidence in institutions such as the news media. Can fact-checking—journalism’s main weapon against misinformation—worsen or ameliorate distrust in journalists and the media? To answer this question, we conducted two pre-registered experiments in Chile (total N = 1,472) manipulating message and receiver factors known to regulate the persuasiveness of fact-checks: transparency elements, arousing images, and political alignment. The results of both studies show that, across message formats, fact-checks are similarly effective at reducing people’s misperceptions. However, these positive effects on belief accuracy come at a cost: Compared to control groups, users exposed to political fact-checks trust news less and perceive the media as more biased, especially after reading corrections debunking pro-attitudinal misinformation. We close with a discussion of the theoretical and practical implications of these findings.
A Systematic Literature Review of Higher Education Reputation Management: Active/Reactive Framework
Authors: Sun Zhuo , Lim Miguel Antonio
Published: June 2023

The marketisation and internationalisation of higher education (HE) in several national contexts has led to the development of thinking about HE access as ‘buying a service’. This has led to increased prioritisation among universities regarding how to promote their reputation among their targeted audiences. However, recent literature regarding reputation management (RM) in Chinese HE is mainly conducted from an international perspective; this means the analysis is usually focused on international students in Chinese universities, and thus the other aspects such as the rationale and strategies of RM in Chinese HE remains relatively underdeveloped. In this article, we conduct a systematic literature review using the PRISMA convention to illustrate the meaning(s) of RM in Chinese HE and particularly how it is understood and developed. The review comprises branding and RM in HE. Moreover, we contribute to the theory of marketing for HE by proposing a new framework arising from the review: RM as an active-reactive continuum in which we provide a new perspective to characterise and better understand RM, particularly in the Chinese context. Active RM refers to how universities promote themselves; reactive RM refers to how universities cope with crises or other forms of negative events. This contribution helps the field understand Chinese universities’ RM practices and strategies nationally and internationally.
Relationship between functional limitations due to subjective cognitive decline and falling focusing exercise intensity: Results from the Korean Community Health Survey
Authors: Lee Hyeon Ji , Yang Jeong Min , Kim Jae Hyun
Published: June 2023

Background:

To explore the association between functional limitation due to subjective cognitive decline (SCD) and falling by focusing on exercise intensity in the Korean population aged 45 years and older.

Study Design:

The 2019 Korean Community Health Survey (KCHS) was used to analyze 35,387 people by applying individual weights imposed from the raw data.

Methods:

To analyze the association between functional limitation due to SCD and falling in the Korean population aged 45 years and older, weighted logistic regression analysis and weighted zero-inflated Poisson regression analysis were used.

Results:

In both the middle-aged group and the older adult group, the functional limitation due to SCD had a higher fall experience rate and more falls than the non-functional limitation due to SCD group. Additionally, the middle-aged group and the moderate or vigorous physical exercise (MVPE) group had a higher fall experience rate and number of falls than the non-MVPE group; however, the older adult group walking regularly and performing MVPE had a lower fall experience rate and number of falls than the non-exercise group.

Conclusions:

Active participation in exercise is encouraged and should lead to fewer falls in older adults. Furthermore, a group with functional limitations due to SCD should be provided with exercise guidelines and a community program and facilities that enable regular participation should be developed.
“As an Asian”: Sticky Rice Politics as a Logic of Desirability in Queer Asian Women’s Sexual Field
Authors: Pham Barbara Truc
Published: June 2023

This paper explores how queer Asian American women negotiate their racial and political identities through racial dating preferences. I investigate a pattern of desire that has been consistently found in previous studies: Why are queer Asian American women more likely to prefer Asian women over white women? The analysis draws from 192 US-based online surveys and 22 interviews with queer Asian women ages 18–30. The participants were asked about their various preferences for female and (if applicable) male partners. I contribute to the racial dating preferences literature empirically by (1) extending the scope of analysis to queer Asian American women and (2) analyzing bisexuals’ preferences for both male and female partners. I contribute theoretically by (1) testing sexual fields theory against the gender white advantage hypothesis and (2) finding evidence to suggest that homonormativity, as a logic of desirability, is less operative in queer Asian American women’s sexual field. Rather, their sexual fields are defined by an alternative logic of desirability, “sticky rice” politics, that prioritizes dating Asian partners and avoiding white partners to resist and distance oneself from white supremacy. This was clear in Asian American respondents’ overwhelming preference for Asian American partners, even Asian American men, over white partners.
Clinical characteristics of adults with self-reported diagnosed asthma and/or COPD: data from the BOLD Australia Study
Authors: Zhou Yijun , Ampon Maria R. , Abramson Michael J. , James Alan L. , Maguire Graeme P. , Wood-Baker Richard , Johns David P. , Marks Guy B. , Reddel Helen K. , Toelle Brett G.
Published: June 2023

Background

Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the community is variable, often without spirometry. Some studies report that adults with both diagnostic labels (asthma+COPD) have worse health outcomes than those with asthma or COPD only, but data for Australian adults are limited. We investigated the relationship between clinical characteristics and self-reported diagnoses of asthma, COPD and both.

Method

We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites. The BOLD questionnaires and spirometry test were used in all sites. Participants were grouped by self-reported diagnosis. Demographic and clinical characteristics and lung function were compared between groups.

Results

Of the study sample (n=3522), 336 reported asthma only, 172 reported COPD only, 77 reported asthma+COPD and 2937 reported neither. Fewer than half of participants with a COPD diagnosis (with or without asthma) had airflow limitation. Participants with asthma+COPD had more respiratory symptoms and greater airflow limitation than those with either diagnosis alone. Having asthma+COPD was independently associated with a higher probability of having clinically important breathlessness (modified Medical Research Council score ≥2) than asthma only (adjusted OR 3.44, 95% CI 1.86–6.33) or COPD only (adjusted OR 3.28, 95% CI 1.69–6.39). Airflow limitation (Global Initiative for Chronic Obstructive Lung Disease 2 or higher, using post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio <0.7) was similar between asthma only and COPD only, but twice as prevalent in asthma+COPD (adjusted OR 2.18 and 2.58, respectively).

Conclusions

Adults with diagnoses of asthma+COPD have a higher symptom and disease burden than those with diagnoses of asthma only or COPD only. These patients should receive regular comprehensive reviews because of the substantially increased burden of having both diagnoses.
Early prone positioning does not improve the outcome of patients with mild pneumonia due to SARS-CoV-2: results from an open-label randomised controlled trial – the EPCoT study
Authors: Fezzi Miriam , Antolini Laura , Soria Alessandro , Bisi Luca , Iannuzzi Francesca , Sabbatini Francesca , Rossi Marianna , Limonta Silvia , Rugova Alban , Columpsi Paola , Squillace Nicola , Foresti Sergio , Pollastri Ester , Valsecchi Maria Grazia , Migliorino Guglielmo Marco , Bonfanti Paolo , Lapadula Giuseppe
Published: June 2023

Background

Prone positioning is routinely used among patients with COVID-19 requiring mechanical ventilation. However, its utility among spontaneously breathing patients is still debated.

Methods

In an open-label randomised controlled trial, we enrolled patients hospitalised with mild COVID-19 pneumonia, whose arterial oxygen tension to inspiratory oxygen fraction ratio (PaO2/FIO2) was >200 mmHg and who did not require mechanical ventilation or continuous positive airway pressure at hospital admission. Patients were randomised 1:1 to prone positioning on top of standard of care (intervention group)versusstandard of care only (controls). The primary composite outcome included death, mechanical ventilation, continuous positive airway pressure andPaO2/FIO2<200 mmHg; secondary outcomes were oxygen weaning and hospital discharge.

Results

A total of 61 subjects were enrolled, 29 adjudicated to prone positioning and 32 to the control group. By day 28, 24 out of 61 patients (39.3%) met the primary outcome: 16 because of aPaO2/FIO2ratio <200 mmHg, five because of the need for continuous positive airway pressure and three because of the need for mechanical ventilation. Three patients died. Using an intention-to-treat approach, 15 out of 29 patients in the prone positioning groupversusnine out of 32 controls met the primary outcome, corresponding to a significantly higher risk of progression among those randomised to prone positioning (HR 2.38, 95% CI 1.04–5.43; p=0.040). Using an as-treated approach, which included in the intervention group only patients who maintained prone positioning for ≥3 h·day−1, no significant differences were found between the two groups (HR 1.77, 95% CI 0.79–3.94; p=0.165). Also, we did not find any statistically significant difference in terms of time to oxygen weaning or hospital discharge between study arms in any of the analyses conducted.

Conclusions

We observed no clinical benefit from prone positioning among spontaneously breathing patients with COVID-19 pneumonia requiring conventional oxygen therapy.
Treatment and outcome of hepatorenal syndrome in Japan: a retrospective cohort study using a national inpatient database
Authors: Okushin Kazuya , Yamana Hayato , Tateishi Ryosuke , Sato Masaya , Tsutsumi Takeya , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo , Koike Kazuhiko , Fujishiro Mitsuhiro
Published: June 2023

Background

Hepatorenal syndrome (HRS) is a life-threatening complication of end-stage liver disease. This study aimed to clarify the status of HRS in Japan by analyzing the Japanese Diagnosis Procedure Combination database.

Methods

Patients hospitalized for cirrhosis and HRS from July 2010 to March 2019 were sampled. They were divided into two groups according to their prognosis upon discharge: the transplant-free survival group and the death or liver transplantation group. The two groups’ baseline patient characteristics and treatments were compared.

Results

The mean age of the 1,412 participants was 67.3 years (standard deviation: 12.3 years), and 65.4% were male. The Child–Pugh grades was B and C in 18.8% and 81.2%, respectively. Hepatocellular carcinoma was present in 27.1% of the patients, and the proportion of spontaneous bacterial peritonitis was 2.3%. Albumin, noradrenaline, and dopamine were administered to 57.9%, 8.0%, and 14.9% of the patients, respectively; 7.0% of the patients underwent renal replacement therapy; and 5.0% were admitted to the intensive care unit. Intravenous antibiotics were administered to 30.8% of the patients. A total of 925 patients (65.5%) died or underwent liver transplantation. In addition to a higher proportion of patients with poor baseline liver function, the death or liver transplantation group included more males, patients with hepatocellular carcinoma, and those with spontaneous bacterial peritonitis.

Conclusions

HRS in Japan has a high mortality rate. Albumin was administered to over 50% of participants. Although noradrenaline is recommended in Japanese clinical guidelines, dopamine was more frequently used as a vasoconstrictor in clinical practice.
Maternal and perinatal outcomes of prolonged second stage of labour: a historical cohort study of over 51,000 women
Authors: Young Catriona , Bhattacharya Sohinee , Woolner Andrea , Ingram Amy , Smith Nicole , Raja Edwin-Amalraj , Black Mairead
Published: June 2023

Background

Prolonged second stage of labour has been associated with adverse maternal and perinatal outcomes. The maximum length of the second stage from full dilatation to birth of the baby remains controversial. Our aim was to determine whether extending second stage of labour was associated with adverse maternal and perinatal outcomes.

Methods

A retrospective cohort study was conducted using routinely collected hospital data from 51592 births in Aberdeen Maternity Hospital between 2000 and 2016. The hospital followed the local guidance of allowing second stage of labour to extend by an hour compared to national guidelines since 2008 (nulliparous and parous). The increasing duration of second stage of labour was the exposure. Baseline characteristics, maternal and perinatal outcomes were compared between women who had a second stage labour of (a) ≤ 3 h and (b) > 3 h duration for nulliparous women; and (a) ≤ 2 h or (b) > 2 h for parous women. An additional model was run that treated the duration of second stage of labour as a continuous variable (measured in hours). All the adjusted models accounted for: age, BMI, smoking status, deprivation category, induced birth, epidural, oxytocin, gestational age, baby birthweight, mode of birth and parity (only for the final model).

Results

Each hourly increase in the second stage of labour was associated with an increased risk of obstetric anal sphincter injury (aOR 1.21 95% CI 1.16,1.25), having an episiotomy (aOR 1.48 95% CI 1.45, 1.52) and postpartum haemorrhage (aOR 1.27 95% CI 1.25, 1.30). The rates of caesarean and forceps delivery also increased when second stage duration increased (aOR 2.60 95% CI 2.50, 2.70, and aOR 2.44 95% CI 2.38, 2.51, respectively.) Overall adverse perinatal outcomes were not found to change significantly with duration of second stage on multivariate analysis.

Conclusions

As the duration of second stage of labour increased each hour, the risk of obstetric anal sphincter injuries, episiotomies and PPH increases significantly. Women were over 2 times more likely to have a forceps or caesarean birth. The association between adverse perinatal outcomes and the duration of second stage of labour was less convincing in this study.
Prenatal wellbeing of mothers, their partners, and couples: a cross-sectional descriptive study
Authors: Mäkelä Tia , Saisto Terhi , Salmela-Aro Katariina , Miettinen Jenny , Sintonen Harri , Rouhe Hanna
Published: June 2023

Background

Prenatal posttraumatic stress symptoms (PTSS), fear of childbirth (FOC), and depressive symptoms have been related to various negative effects during pregnancy, childbirth, and in the postnatal period. This study evaluates the prevalence of PTSS, FOC, depressive symptoms, and health-related quality of life (HRQoL) among pregnant women, their partners, and as couples.

Methods

In a cohort of 3853 volunteered, unselected women at the mean of 17th weeks of pregnancy with 3020 partners, PTSS was evaluated by Impact of Event Scale (IES), FOC by Wijma Delivery Expectancy Questionnaire (W-DEQ-A), depressive symptoms by Edinburgh Postnatal Depression Scale (EPDS), and HRQoL by 15D instrument.

Results

PTSS (IES score ≥ 33) was identified among 20.2% of the women, 13.4% of the partners, and 3.4% of the couples. Altogether, 5.9% of the women, but only 0.3% of the partners, and 0.04% of the couples experienced symptoms suggestive of phobic FOC (W-DEQ A ≥ 100). Respectively, 7.6% of the women, 1.8% of the partners, and 0.4% of the couples reported depressive symptoms (EPDS ≥ 13). Nulliparous women and partners without previous children experienced FOC more often than those with previous children, but there was no difference in PTSS, depressive symptoms, or HRQoL. Women’s mean 15D score was lower than partners’ and that of age- and gender-standardized general population, while partners’ mean 15D score was higher than that of age- and gender-standardized general population. Women whose partners reported PTSS, phobic FOC, or depressive symptoms, often had the same symptoms (22.3%, 14.3%, and 20.4%, respectively).

Conclusions

PTSS were common in both women and partners, as well as in couples. FOC and depressive symptoms were common in women but uncommon in partners, thus they rarely occurred simultaneously in couples. However, special attention should be paid to a pregnant woman whose partner experiences any of these symptoms.
Ethnic disparities in prevalence of chronic non-communicable diseases and its multimorbidity among older adults in rural southwest China
Authors: Du Ying-rong , Liu Lan , Zhao Yi , Huang Jing-jing , Golden Allison Rabkin , Cai Le
Published: June 2023

Background

As the population ages, chronic non-communicable diseases (NCDs) multimorbidity has emerged as a major public health issue globally. This study examines ethnic disparities in prevalence of NCDs and its multimorbidity among rural southwest Chinese older adults.

Methods

A cross-sectional survey was conducted in rural southwest population aged ≥ 60 years consisting of 5,642 consenting participants of Han and three ethnic minority groups (Dai, Ha Ni, and Bai). Information about participants’ demographic characteristics and lifestyle behaviors was obtained using a standard questionnaire. Anthropometric measurements including height, weight, and waist circumference, fasting blood sugar and blood pressure measurement, as well as post-bronchodilator spirometry test were recorded for each participant.

Results

The age-standardized prevalence of five common chronic NCDs– hypertension, diabetes, coronary heart disease (CHD), stroke, chronic obstructive pulmonary disease (COPD) – and its multimorbidity was 72.8%, 15.9%, 4.0%, 10.0%, 9.8%, and 27.6%, respectively. Bai participants had both the highest overall and sex-specific prevalence rates of hypertension, diabetes, stroke, and COPD, whereas Han participants had the highest rates of CHD (P < 0.01). The results of multivariate logistic regression analysis indicated that female and older participants had a higher probability of chronic NCDs multimorbidity than their counterparts (P < 0.01). Bai ethnic minority participants were more likely to have NCDs multimorbidity while Ha Ni and Dai ethnic minority participants were less likely to have NCD multimorbidity relative to the Han participants (P < 0.05). Older adults with a higher level of education and family history of chronic NCDs, and who were also current smokers, current drinkers, obese, centrally obese, and physically inactive had a greater probability of developing chronic NCDs multimorbidity (P < 0.01).

Conclusions

Ethnicity and individual demographic and lifestyle factors significantly impact prevalence of chronic NCDs multimorbidity. Future chronic NCDs prevention and control strategies must be tailored to address ethnicity, and culturally tailored lifestyle interventions may reduce the prevalence of chronic NCDs multimorbidity in rural southwest China.
The use of feedback in teaching undergraduate dental students: feedback sandwich or Ask-Tell-Ask model?
Authors: Lin Galvin Sim Siang , Tan Wen Wu , Hashim Hasnah , Foong Chan Choong
Published: June 2023

Background

Feedback is regarded as a key component of formative assessment and one of the elements with the greatest impact on students’ academic learning. The present study aimed to evaluate and compare students’ perceptions of the use of two feedback models, namely feedback sandwich and Ask-Tell-Ask (ATA), in teaching dental materials science courses.

Methods

All undergraduate second-year dental students were invited to participate in the dental materials science practical session and were randomly allocated into two groups: Group 1 (feedback) sandwich and Group 2 (ATA). The session began with the teacher giving a short briefing on the commonly used dental materials, followed by a short demonstration of the manipulation of those materials. Students were then allowed to mix and manipulate the materials, and teachers provided feedback accordingly. At the end of the session, 16 close-ended (five-point Likert scales) and an open-ended questionnaire were distributed to students to evaluate their perceptions of the feedback given. Internal reliability of the questionnaire items was evaluated using Cronbach’s alpha. Mean feedback scores were analysed using an independent t-test with ANCOVA for controlling gender and ethnicity. Thematic analysis was used to code the qualitative data.

Results

Sixty-nine students participated in the present study with the majority being females (72.5%) and Chinese (79.7%). Cronbach’s alpha analysis suggested removing three Likert-scale items, with the remaining 13 items being accepted. Generally, no significant difference was noted between the two groups (p = 0.197), but three items were found to be significant (p < 0.05), with higher mean scores in the feedback sandwich group. Moreover, no significant difference was noted between the two feedback models (p = 0.325) when controlling gender and ethnicity. The open-ended question showed that students in the feedback sandwich group expressed greater positive perceptions.

Conclusion

Although students generally had positive perceptions of both feedback models, they tended to favour the feedback sandwich. Neither gender nor ethnicity affected the students’ perceptions of the two feedback models.
Implementation of an mHealth intervention to increase adherence to triage among HPV positive women with HPV—self-collection (ATICA study): post-implementation evaluation from the women's perspective
Authors: Paolino Melisa , Sánchez Antelo Victoria , Kohler Racquel E. , Viswanath Kasisomayajula , Arrossi Silvina
Published: June 2023

Background

Low adherence to triage after positive screening is a widespread problem for cervical cancer screening programs in Low- and Middle-income Countries. Adherence to cytology-based triage can be challenging, especially among women with self-collected tests. SMS-based interventions are accepted by women and can increase screening uptake. The ATICA study was an effectiveness-implementation hybrid type I trial, combining a cluster randomized controlled trial (RCT) with a mixed-methods implementation evaluation involving quantitative and qualitative methods. Although the RCT provided evidence regarding the effectiveness of the SMS-based intervention, less is known about its acceptability, relevance, and usefulness from the women´s perspective.

Methods

We carried out a cross-sectional study based on a structured questionnaire among HPV-positive women who were enrolled in ATICA's intervention group. We measured acceptability, appropriateness, and message content comprehension. Also, we evaluated if the SMS message was considered a cue to encourage women to pick up their HPV test results and promote the triage.

Results

We interviewed 370 HPV-positive women. Acceptability of SMS messages among women who had received at least one message was high (97%). We found high levels of agreement in all appropriateness dimensions. More than 77% of women showed high comprehension of the content. Among women who received at least one SMS message, 76% went to the health center to pick up their results. Among those who got their results, 90% reported that the SMS message had influenced them to go. We found no significant differences in acceptability, appropriateness or message comprehension between women who adhered to triage and those who did not adhere after receiving the SMS messages.

Conclusion

The intervention was highly acceptable, and women reported SMS was an appropriate channel to be informed about HPV test results availability. SMS was also a useful cue to go to the health center to pick up results. The implementation did not encounter barriers associated with the SMS message itself, suggesting the existence of other obstacles to triage adherence. Our results support the RCT findings that scaling up SMS is a highly acceptable intervention to promote cervical screening triage adherence.
Clinical, pathological, and comprehensive molecular analysis of the uterine clear cell carcinoma: a retrospective national study from TMRG and GINECO network
Authors: Nigon Elsa , Lefeuvre-Plesse Claudia , Martinez Alejandra , Chauleur Céline , Lortholary Alain , Favier Laure , Bats Anne-Sophie , Guille Arnaud , AdélaÏde José , Finetti Pascal , de Casteljac Victoire , Provansal Magali , Mamessier Emilie , Bertucci François , Ray-Coquard Isabelle , Sabatier Renaud
Published: June 2023

Background

Uterine clear cell carcinomas (CCC) represent less than 5% of uterine cancers. Their biological characteristics and clinical management remain uncertain. A multicenter study to explore both clinical and molecular features of these rare tumors was conducted.

Methods

This multicenter retrospective national study was performed within the French TMRG (Rare Gynecologic Malignant Tumors) network. Clinical data and, when available, FFPE blocks were collected. Clinical features, treatments, and outcome (progression-free survival (PFS) and overall survival (OS)) were analyzed and correlated to the protein (tissue micro-array), RNA (Nanostring nCounter® technology), and DNA (array-Comparative Genomic hybridization and target-next generation sequencing) levels using the tumor samples available.

Results

Sixty-eight patients with uterine CCC were enrolled, 61 from endometrial localization and 5 with cervix localization. Median age at diagnosis was 68.9 years old (range 19–89.7). Most tumors were diagnosed at an early stage (78% FIGO stage I–II). Hysterectomy (performed in 90%) and lymph node dissection (80%) were the most frequent surgical treatment. More than 70% of patients received external beam radiotherapy and 57% received brachytherapy. Nearly half (46%) of the patients received chemotherapy. After a median follow-up of 24.7 months, median PFS was 64.8 months (95 CI [5.3–124.4]) and median OS was 79.7 (IC95 [31.0–128.4]). Low hormone receptor expression (13% estrogen-receptor positive), frequent PI3K pathway alterations (58% PTEN loss, 50% PIK3CA mutations), and P53 abnormalities (41%) were observed. Mismatch repair deficiency was identified in 20%. P16 expression was associated with shorter PFS (HR = 5.88, 95 CI [1.56–25], p = 0.009). Transcriptomic analyzes revealed a specific transcriptomic profile notably with a high expression of immune response-associated genes in uterine CCC displaying a very good overall prognosis.

Conclusions

Uterine CCC reported to be potentially MSI high, hormone receptors negative, and sometimes TP53 mutated. However, some patients with immune response-associated features and better prognosis may be candidate to treatment de-escalation and immunotherapy.
Cumulative physiological stress is associated with age-related changes to peripheral T lymphocyte subsets in healthy humans
Authors: Snodgrass Ryan G. , Jiang Xiaowen , Stephensen Charles B. , Laugero Kevin D.
Published: June 2023

Background

Progressive age-associated change in frequencies and functional capacities of immune cells is known as immunosenescence. Despite data linking chronic environmental, physiological, and psychosocial stressors with accelerated aging, how stress contributes to immunosenesence is not well characterized.

Objective

To help delineate the contribution of cumulative physiological stress on immunosensence we assessed relationships between a composite measurement of cumulative physiological stress, reflecting the functioning of the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, cardiovascular system, and metabolic processes, and lymphocyte changes typically affiliated with aging in a cohort of healthy volunteers ranging from 18 to 66 y.

Results

Physiological stress load positively correlated with subject age in the study cohort and was significantly higher in adults 50–66 y compared to adults 18–33 y and 34–49 y. Using physiological stress load, we identified a significant age-dependent association between stress load and frequencies of circulating regulatory T lymphocytes (Tregs). Frequencies were higher in younger participants, but only in participants exhibiting low physiological stress load. As stress load increased, frequencies of Tregs decreased in young participants but were unchanged with increasing stress load in middle and older age individuals. Follow-up analysis of stress load components indicated lower circulating DHEA-S and higher urinary norepinephrine as the primary contributors to the effects of total stress load on Tregs. In addition, we identified age-independent inverse associations between stress load and frequencies of naïve Tregs and naïve CD4 T cells and positive associations between stress load and frequencies of memory Tregs and memory CD4 T cells. These associations were primarily driven by stress load components waist circumference, systolic and diastolic blood pressure, CRP, and HbA1c. In summary, our study results suggest that, in younger people, physiological stress load may diminish regulatory T cell frequencies to levels seen in older persons. Furthermore, independent of age, stress load may contribute to contraction of the naïve Treg pool and accumulation of memory Treg cells.

Clinical trial

Registered on ClincialTrials.gov (Identifier: NCT02367287).
Symptoms of posttraumatic stress partially mediate the relationship between gender-based violence and alcohol misuse among South African women
Authors: Nguyen Kim A. , Myers Bronwyn , Abrahams Naeemah , Jewkes Rachel , Mhlongo Shibe , Seedat Soraya , Lombard Carl , Garcia-Moreno Claudia , Chirwa Esnat , Kengne Andre P. , Peer Nasheeta
Published: June 2023

Background

The association of traumatic experiences with problematic alcohol use has been described, but data on possible mediation effects of mental distress are sparse. We examined whether mental ill-health mediated the association between trauma exposure across the lifespan and alcohol use.

Method

We analysed cross-sectional data from a sample of rape-exposed and non-rape-exposed women, living in KwaZulu-Natal, with self-reported data on alcohol misuse (AUDIT-C cut-off ≥ 3) and exposure to childhood maltreatment (CM), intimate partner violence (IPV), non-partner sexual violence (NPSV), other traumatic events, and mental ill-health. Logistic regression and multiple mediation models were used to test the mediation effects of symptoms of depression and PTSS on the association between abuse/trauma and alcohol misuse.

Results

Of 1615 women, 31% (n = 498) reported alcohol misuse. Exposure to any CM (adjusted odds ratio (aOR): 1.59, 95% confidence interval (CI): 1.27–1.99), as well as to sexual, physical and emotional CM, were independently associated with alcohol misuse. Lifetime exposure to any IPV (aOR:2.01, 95%CI:1.59–2.54), as well as to physical, emotional and economic IPV, NPSV (aOR: 1.75, 95%CI: 1.32–2.33), and other trauma (aOR:2.08, 95%CI:1.62–2.66), was associated with alcohol misuse. Exposure to an increasing number of abuse types, and other traumatic events, was independently associated with alcohol misuse. PTSS partially mediated the associations of CM, IPV, NPSV and other trauma exposures with alcohol misuse (ps ≤ 0.04 for indirect effects), but depression symptoms did not.

Conclusions

These findings highlight the need for trauma-informed interventions to address alcohol misuse that are tailored to the needs of women who have experienced violence.
Local implementation of public health policies revealed by the COVID-19 crisis: the French case
Authors: Mériade Laurent , Rochette Corinne , Cassière François
Published: June 2023

Background

Improving health system performance depends on the quality of health policy implementation at the local level. However, in general, the attention of researchers is mainly directed towards issues of health policy design and evaluation rather than implementation at the local level. The management of the COVID-19 crisis, especially in Europe, has particularly highlighted the complexity of implementing health policies, decided at the national or supranational level, at the local level.

Methods

We conducted 23 semi-structured interviews with the main stakeholders in the management of the COVID-19 crisis in the second largest French region in order to identify the different actors and modes of coordination of the local implementation of health policies that this crisis management illustrates in a very visible way. Our methodology is complemented by a content analysis of the main guidelines and decisions related to this implementation.

Results

The analysis of these data allows us to identify three levels of implementation of health policies at the local level (administrative, organizational and operational). Interviews also reveal the existence of different types of coordination specific to each of these levels of local implementation of health policies. These results then make it possible to identify important managerial avenues for promoting global coordination of these three levels of implementation.

Conclusions

Although research on health services emphasizes the existence of several levels of local implementation of health policies, it offers little in the way of definition or characterization of these levels. The identification in this study of the three levels of local implementation of health policies and their specific forms of coordination contribute to a more precise characterization of this implementation in order to promote, in practice, its global coordination.
Engineered circular guide RNAs boost CRISPR/Cas12a- and CRISPR/Cas13d-based DNA and RNA editing
Authors: Zhang Xin , Wang Xinlong , Lv Jie , Huang Hongxin , Wang Jiahong , Zhuo Ma , Tan Zhihong , Huang Guanjie , Liu Jiawei , Liu Yuchen , Li Mengrao , Lin Qixiao , Li Lian , Ma Shufeng , Huang Tao , Lin Ying , Zhao Xiaoyang , Rong Zhili
Published: June 2023

Background

The CRISPR/Cas12a and CRISPR/Cas13d systems are widely used for fundamental research and hold great potential for future clinical applications. However, the short half-life of guide RNAs (gRNAs), particularly free gRNAs without Cas nuclease binding, limits their editing efficiency and durability.

Results

Here, we engineer circular free gRNAs (cgRNAs) to increase their stability, and thus availability for Cas12a and Cas13d processing and loading, to boost editing. cgRNAs increases the efficiency of Cas12a-based transcription activators and genomic DNA cleavage by approximately 2.1- to 40.2-fold for single gene editing and 1.7- to 2.1-fold for multiplexed gene editing than their linear counterparts, without compromising specificity, across multiple sites and cell lines. Similarly, the RNA interference efficiency of Cas13d is increased by around 1.8-fold. In in vivo mouse liver, cgRNAs are more potent in activating gene expression and cleaving genomic DNA.

Conclusions

CgRNAs enable more efficient programmable DNA and RNA editing for Cas12a and Cas13d with broad applicability for fundamental research and gene therapy.
Impact of a recognition package as an incentive to strengthen the motivation, performance, and retention of village health teams in Uganda: a study protocol for a cluster randomized controlled trial
Authors: Agarwal Smisha , Tweheyo Raymond , Pandya Shivani , Obuya Emmanuel , Kiyomoto Arisa , Mitra Paloma , Schleiff Meike , Nagpal Tanvi , Macis Mario , Rutebemberwa Elizeus
Published: June 2023

Introduction

Uganda’s community health worker (CHW), or village health team (VHT), program faces significant challenges with poor retention and insufficient financial and program investment. Adequate compensation comprising financial and non-financial components is critical to retaining any workforce, including CHWs. This study evaluates the impact of a recognition-based non-financial incentives package on the motivation, performance, and retention of VHTs, as well as on the utilization of health services by the community. The incentive package and intervention were developed in collaboration with the district-level leadership and award VHTs who have met predetermined performance thresholds with a certificate and a government-branded jacket in a public ceremony.

Methods

A two-armed cluster randomized controlled trial (RCT), conducted at the parish level in Uganda’s Masindi District, will evaluate the effects of the 12-month intervention. The cluster-RCT will use a mixed-methods approach, which includes a baseline/endline VHT survey to assess the impact of the intervention on key outcomes, with an expected sample of 240 VHTs per study arm; our primary outcome is the total number of household visits per VHT and our multiple secondary outcomes include other performance indicators, motivation, and retention; VHT performance and retention data will be validated using monthly phone surveys tracking key performance indicators and through abstraction of VHT-submitted health facility reports; and focus group discussions will be conducted with VHTs and community members to understand how the intervention was received. Data collection activities will be administered in local languages. To assess the impact of the intervention, the study will conduct a regression analysis using Generalized Estimating Equations adjusting for cluster effect. Further, a difference-in-differences analysis will be conducted.

Discussion

This study utilized a cluster-RCT design to assess the impact of a recognition-based incentives intervention on the motivation, performance, and retention of VHTs in Uganda’s Masindi District. Utilizing a mixed-methods approach, the study will provide insights on the effectiveness and limitations of the intervention, VHT perspectives on perceived value, and critical insights on how non-financial incentives might support the strengthening of the community health workforce.

Trial registration

ClinicalTrials.gov NCT05176106. Retrospectively registered on 4 January 2022.
Sex differences in the nonlinear association of triglyceride glucose index with all-cause and cardiovascular mortality in the general population
Authors: Yu Yu , Wang Jing , Ding Ligang , Huang Hao , Cheng Sijing , Deng Yu , Gu Min , Cai Chi , Ning Xiaohui , Chen Xuhua , Niu Hongxia , Hua Wei
Published: June 2023

Background

The evidence on the association between the triglyceride glucose (TyG) index and the risk of death in the general population remains controversial. This study aims to investigate the relationship between the TyG index and all-cause and cardiovascular mortality in the general population, with a focus on sex differences.

Methods

This prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999–2002), comprising 7,851 US adults. The study employed multivariate Cox proportional hazards regression and two-segment Cox hazard regression models to evaluate the sex-specific differences in the relationship between the TyG index and all-cause and cardiovascular mortality.

Results

After 11,623 person-years of follow-up, there were 539 deaths, with 10.56% due to all-cause mortality and 2.87% due to cardiovascular mortality. After adjusting for multiple variables, our study found a U-shaped association of the TyG index with all-cause and cardiovascular mortality, with inflection points at 9.36 and 9.52. A significant sex difference was observed in the association between the TyG index and mortality. Below the inflection point, the relationship between the TyG index and mortality was consistent in males and females. However, above the inflection point, only males exhibited a positive association between the TyG index and all-cause mortality (adjusted hazard risk [HR], 1.62, 95% confidence interval [CI], 1.24–2.12) and cardiovascular mortality (adjusted HR, 2.28, 95% CI, 1.32–3.92).

Conclusions

Our study showed a U-shaped association between the TyG index and all-cause and cardiovascular mortality in the general population. Furthermore, sex differences were observed in the association between the TyG index and mortality once it exceeded a certain threshold.