bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical utility of fractional exhaled nitric oxide in severe asthma management
Authors: Menzies-Gow Andrew , Mansur Adel H. , Brightling Christopher E.
Published: January 2020

Asthma is a chronic inflammatory disease of the airways, affecting over 350 million people worldwide and placing a significant burden on healthcare providers and wider society. Approximately 5–10% of asthma patients are diagnosed with severe asthma and typically are associated with increased risk of hospitalisation from exacerbations, increased morbidity, mortality and higher asthma-associated healthcare costs. Nitric oxide (NO) is an important regulator of immune responses and is a product of inflammation in the airways that is over-produced in asthma. Fractional exhaled NO (FeNO) is predominantly used as a predictor of response to inhaled corticosteroids (ICSs), to monitor adherence and as a diagnostic tool in ICS-naïve patients. In the UK, the National Institute for Health and Care Excellence (NICE) guidelines recommend the use ofFeNOfor the initial diagnosis of patients with suspected asthma. In the USA, American Thoracic Society (ATS) guidelines recommendFeNOas part of the initial diagnosis of asthma and for monitoring of airway inflammation.FeNOhas also been shown to be a predictive factor for asthma exacerbations, with higher levels being associated with a greater number of exacerbations. In addition, higher levels ofFeNOhave been shown to be associated with a decline in lung function.FeNOtesting is a cost-effective procedure and has been shown to improve patient management when combined with standard assessment methods. Recent evidence suggests thatFeNOmay also be useful as a surrogate biomarker for the assessment and management of severe asthma and to predict responsiveness to some biological therapies.
Early markers of cystic fibrosis structural lung disease: follow-up of the ACFBAL cohort
Authors: Wijker Naomi E. , Vidmar Suzanna , Grimwood Keith , Sly Peter D. , Byrnes Catherine A. , Carlin John B. , Cooper Peter J. , Robertson Colin F. , Massie R. John , Kemner van de Corput Mariette P.C. , Cheney Joyce , Tiddens Harm A.W.M. , Wainwright Claire E.
Published: January 2020

Little is known about early predictors of later cystic fibrosis (CF) structural lung disease. This study examined early predictors of progressive structural lung abnormalities in children who completed the Australasian CF Bronchoalveolar Lavage (ACFBAL) clinical trial at age 5-years and participated in an observational follow-up study (CF-FAB).

Eight Australian and New Zealand CF centres participated in CF-FAB and provided follow-up chest computed-tomography (CT) scans for children who had completed the ACFBAL study with baseline scans at age 5-years. CT scans were annotated using PRAGMA-CF scoring. Ordinal regression analysis and linear regression were used to investigate associations between PRAGMA-CF (Perth–Rotterdam Annotated Grid Morphometric Analysis for CF) outcomes at follow-up and variables measured during the ACFBAL study.

99 out of 157 ACFBAL children (mean±sdage 13±1.5 years) participated in the CF-FAB study. The probability of bronchiectasis at follow-up increased with airway disease severity on the baseline CT scan. In multiple regression (retaining factors at p<0.05) the extent of bronchiectasis at follow-up was associated with baseline atelectasis (OR 7.2, 95% CI 2.4–22; p≤ 0.001), bronchoalveolar lavage (BAL) log2interleukin (IL)-8 (OR 1.2, 95% CI 1.05–1.5; p=0.010) and body mass index z-score (OR 0.49, 95% CI 0.24–1.00; p=0.05) at age 5 years. Percentage trapped air at follow-up was associated with BAL log2IL-8 (coefficient 1.3, 95% CI 0.57–2.1; p<0.001) at age 5 years.

The extent of airway disease, atelectasis, airway inflammation and poor nutritional status in early childhood are risk factors for progressive structural lung disease in adolescence.
Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme
Authors: Nwaru Bright I. , Ekström Magnus , Hasvold Pål , Wiklund Fredrik , Telg Gunilla , Janson Christer
Published: January 2020

Background

Overuse of short-acting β2-agonists (SABA) may indicate poor asthma control and adverse health outcomes. Contemporary population-based data on use, risk factors and impact of SABA (over)use on asthma exacerbations and mortality are scarce, prompting initiation of the global SABINA (SABA use IN Asthma) programme.

Methods

By linking data from Swedish national registries, asthma patients aged 12–45 years with two or more collections of drugs for obstructive lung disease during 2006–2014 were included. SABA overuse was defined as collection of more than two SABA canisters in a 1-year baseline period following inclusion. SABA use was grouped into 3–5, 6–10 and ≥11 canisters per baseline-year. Cox regression was used to examine associations between SABA use and exacerbation (hospitalisations and/or oral corticosteroid claims) and mortality.

Results

The analysis included 365 324 asthma patients (mean age 27.6 years; 55% female); average follow-up was 85.4 months. 30% overused SABA, with 21% collecting 3–5 canisters per year, 7% collecting 6–10 canisters per year and 2% collecting ≥11 canisters per year. Increasing number of collected SABA canisters was associated with increased risk of exacerbation, as follows. 3–5 canisters: hazard ratio (HR) 1.26 (95% CI 1.24–1.28); 6–10 canisters: 1.44 (1.41–1.46); and ≥11 canisters: 1.77 (1.72–1.83), compared to two or fewer canisters per year. Higher SABA use was associated with incrementally increased mortality risk (2564 deaths observed), as follows. 3–5 canisters: HR 1.26 (95% CI 1.14–1.39); 6–10 canisters 1.67 (1.49–1.87); and ≥11 canisters: 2.35 (2.02–2.72) compared to two or fewer canisters per year.

Conclusion

One-third of asthma patients in Sweden collected three or more SABA canisters annually. SABA overuse was associated with increased risks of exacerbation and mortality. These findings emphasise that monitoring of SABA usage should be key in improving asthma management.
Enhanced expression of miR-21 and miR-150 is a feature of anti-mitochondrial antibody-negative primary biliary cholangitis
Authors: Wasik Urszula , Kempinska-Podhorodecka Agnieszka , Bogdanos Dimitrios P. , Milkiewicz Piotr , Milkiewicz Malgorzata
Published: January 2020

Background & Aims

Anti-mitochondrial-autoantibodies (AMA) remain a hallmark of Primary Biliary Cholangitis (PBC) however approximately 10% of patients test negative for these antibodies. They do not differ in terms of biochemistry or clinical presentation from AMA positive ones. Epigenetics play a key role in immune signalling. Two microRNAs (miRs), namely, miR-21 and miR-150 are known to be involved in liver inflammation and fibrosis. The expression of those two microRNAs and their downstream targets were analyze in the context of AMA-status and the stage of liver fibrosis.

Methods

The relative levels of miR-21 and miR-150 and their target genes: cMyb, RAS-guanyl-releasing protein-1(RASGRP1), and DNA-methyltransferase-1(DNMT1) were determined by Real-Time PCR in serum, liver tissue and peripheral blood mononuclear cells (PBMCs) of patients with PBC.

Results

Serum expressions of miR-21 and miR-150 were significantly enhanced in AMA-negative patients, and they inversely correlated with disease-specific AMA titers in PBS patients. In PBMCs, an increased expression of miR-21 correlated with decreased levels of RASGRP1 and DNMT1 mRNAs whereas, the level of miR-150 remained comparable to controls; and cMyb mRNA was downregulated. In cirrhotic livers, the level of miR-21 was unchanged while miR-150 expression was increased.

Conclusion

This study convincingly report, that AMA-negative PBC is characterized by notable alternations of miR-21 and miR-150 and their downstream targets compared to AMA-positive patients underlining their possible importance in the induction of the disease and its progression to fibrosis.
The ubiquitin system: orchestrating cellular signals in non-small-cell lung cancer
Authors: Fan Qiang , Wang Qian , Cai Renjie , Yuan Haihua , Xu Ming
Published: January 2020

The ubiquitin system, known as a common feature in eukaryotes, participates in multiple cellular processes, such as signal transduction, cell-cycle progression, receptor trafficking and endocytosis, and even the immune response. In lung cancer, evidence has revealed that aberrant events in ubiquitin-mediated processes can cause a variety of pathological outcomes including tumorigenesis and metastasis. Likewise, ubiquitination on the core components contributing to the activity of cell signaling controls bio-signal turnover and cell final destination. Given this, inhibitors targeting the ubiquitin system have been developed for lung cancer therapies and have shown great prospects for clinical application. However, the exact biological effects and physiological role of the drugs used in lung cancer therapies are still not clearly elucidated, which might seriously impede the progress of treatment. In this work, we summarize current research advances in cell signal regulation processes mediated through the ubiquitin system during the development of lung cancer, with the hope of improving the therapeutic effects by means of aiming at efficient targets.
Advances of Nano-Structured Extended-Release Local Anesthetics
Authors: He Yumiao , Qin Linan , Huang Yuguang , Ma Chao
Published: January 2020

Extended-release local anesthetics (LAs) have drawn increasing attention with their promising role in improving analgesia and reducing adverse events of LAs. Nano-structured carriers such as liposomes and polymersomes optimally meet the demands of/for extended-release, and have been utilized in drug delivery over decades and showed satisfactory results with extended-release. Based on mature technology of liposomes, EXPAREL, the first approved liposomal LA loaded with bupivacaine, has seen its success in an extended-release form. At the same time, polymersomes has advances over liposomes with complementary profiles, which inspires the emergence of hybrid carriers. This article summarized the recent research successes on nano-structured extended-release LAs, of which liposomal and polymeric are mainstream systems. Furthermore, with continual optimization, drug delivery systems carry properties beyond simple transportation, such as specificity and responsiveness. In the near future, we may achieve targeted delivery and controlled-release properties to satisfy various analgesic requirements.
Biosynthesis and Antibacterial Activity of Silver Nanoparticles Using Yeast Extract as Reducing and Capping Agents
Authors: Shu Mengjun , He Fengjiao , Li Zhaohui , Zhu Xingzhong , Ma Yujie , Zhou Zhihua , Yang Zhi , Gao Feng , Zeng Min
Published: January 2020

Biosynthesis for the preparation of antimicrobial silver nanoparticles (Ag NPs) is a green method without the use of cytotoxic reducing and surfactant agents. Herein, shape-controlled and well-dispersed Ag NPs were biosynthesized using yeast extract as reducing and capping agents. The synthesized Ag NPs exhibited a uniform spherical shape and fine size, with an average size of 13.8 nm. The biomolecules of reductive amino acids, alpha-linolenic acid, and carbohydrates in yeast extract have a significant role in the formation of Ag NPs, which was proved by the Fourier transform infrared spectroscopy analysis. In addition, amino acids on the surface of Ag NPs carry net negative charges which maximize the electrostatic repulsion interactions in alkaline solution, providing favorable stability for more than a year without precipitation. The Ag NPs in combination treatment with ampicillin reversed the resistance in ampicillin-resistant E. coli cells. These monodispersed Ag NPs could be a promising alternative for the disinfection of multidrug-resistant bacterial strains, and they showed negligible cytotoxicity and good biocompatibility toward Cos-7 cells.
Combined Use of Anisotropic Silver Nanoprisms with Different Aspect Ratios for Multi-Mode Plasmon-Exciton Coupling
Authors: Takeshima Naoto , Sugawa Kosuke , Tahara Hironobu , Jin Shota , Noguchi Masaki , Hayakawa Yutaro , Yamakawa Yuhei , Otsuki Joe
Published: January 2020

Absorption enhancement based on interaction between the localized surface plasmon (LSP) and molecular exciton is one of the most important phenomena for the development of high-performance solar devices. In this study, hybrids of plasmonic metal nanoparticles and dye molecules have been developed, which exhibit enhanced absorption at precisely tuned wavelengths in a visible region. The hybrids consist of a porphyrin derivative, which has four absorption peaks (Q-bands) in a range of 500–700 nm, and triangular silver nanoprisms (AgPRs), which are developed by us to exhibit precisely tuned LSP resonance wavelengths. Absorption enhancement over the whole Q-band range is induced by the combined use of three kinds of AgPRs of different aspect ratios. Furthermore, the quantitative evaluation of absorption enhancement based on the LSP-based fluorescence enhancement phenomenon has demonstrated that efficient absorption enhancement can be effected at multiple wavelengths.
Evaluation of androgen receptor status in urothelial carcinoma of the urinary bladder in Egyptian patients: an immunohistochemical study
Authors: Wagih Mohamed , Kamel Marwa
Published: January 2020

Background

The roles of androgen and androgen receptor (AR) signaling in the oncogenesis of prostate cancer are very well established. What is more poorly understood is the role of AR in other human malignancies including bladder cancer. The incidence of bladder cancer is much higher in males than females, but the exact etiology has not been fully elucidated. This gender disparity has raised the possibility of the AR pathway being involved in the genesis of this disease. Thereby, the aim of this work was to evaluate the expression of AR in a group of Egyptian patients with urothelial bladder carcinoma and to assess whether its expression was correlated with other pathological tumor features. Urothelial bladder carcinoma tissue samples from 50 patients were studied by immunostaining for AR expression in tumor cells.

Results

AR was positively expressed in 29 (58%) patients, while negative expression was observed in 21 (42%) patients. No statistically significant difference in AR expression with respect to tumor grade (P = 0.07) and pT stage (P = 0.09) was observed.

Conclusions

The results obtained in this study indicates a clinical value of the AR expression in Egyptian patients with urothelial bladder carcinoma, providing the basis for further studies to evaluate its role and the possibility of new target-based therapies for urothelial bladder carcinoma.
The activation of antioxidant and apoptosis pathways involved in damage of human proximal tubule epithelial cells by PM2.5 exposure
Authors: Huang Xiaoliu , Shi Xiujuan , Zhou Ji , Li Sen , Zhang Lijuan , Zhao Huijun , Kuang Xingya , Li Jue
Published: January 2020

Background

Exposure to airborne fine particulate matter (PM2.5) has been reported to be harmful to the human kidney. However, whether the activation of oxidative stress and cell apoptosis plays key roles in the nephrotoxicity caused by PM2.5 exposure is still poorly understood. The aim of this study was to explore the mechanism of cytotoxicity after PM2.5 exposure in human proximal tubule epithelial cells (HK-2 cells).

Results

PM2.5 exposure resulted in a significant decrease in cell viability, with an increase in LDH release and the early kidney damage marker kidney injury molecule-1 (KIM-1) expression in a dose-dependent manner and time-dependent manner. PM2.5 exposure induced reactive oxygen species (ROS) generation and markedly elevated apoptosis in HK-2 cells. In addition, PM2.5 exposure resulted in the activation of antioxidant pathway, as evidenced by the increased expressions of Nrf2, HO-1 and NQO1 and decreased expression of Keap1. Moreover, PM2.5 exposure also induced the activation of apoptotic pathway, as evidenced by the increased expressions of pro-apoptotic proteins Bax, caspase-3 and caspase-8 and decreased expression of antiapoptotic protein Bcl-2.

Conclusions

Our results demonstrated that both antioxidant pathway and apoptotic pathway played critical roles in the damage mediated by PM2.5 in HK-2 cells. This study would give us a strategy to prevent the impairment of renal function by PM2.5 induced through repression of oxidative stress and apoptosis.
Comparative transcriptomics reveals candidate carotenoid color genes in an East African cichlid fish
Authors: Ahi Ehsan Pashay , Lecaudey Laurène A. , Ziegelbecker Angelika , Steiner Oliver , Glabonjat Ronald , Goessler Walter , Hois Victoria , Wagner Carina , Lass Achim , Sefc Kristina M.
Published: January 2020

Background

Carotenoids contribute significantly to animal body coloration, including the spectacular color pattern diversity among fishes. Fish, as other animals, derive carotenoids from their diet. Following uptake, transport and metabolic conversion, carotenoids allocated to body coloration are deposited in the chromatophore cells of the integument. The genes involved in these processes are largely unknown. Using RNA-Sequencing, we tested for differential gene expression between carotenoid-colored and white skin regions of a cichlid fish,Tropheus duboisi“Maswa”, to identify genes associated with carotenoid-based integumentary coloration. To control for positional gene expression differences that were independent of the presence/absence of carotenoid coloration, we conducted the same analyses in a closely related population, in which both body regions are white.

Results

A larger number of genes (n = 50) showed higher expression in the yellow compared to the white skin tissue than vice versa (n = 9). Of particular interest was the elevated expression level ofbco2ain the white skin samples, as the enzyme encoded by this gene catalyzes the cleavage of carotenoids into colorless derivatives. The set of genes with higher expression levels in the yellow region included genes involved in xanthophore formation (e.g.,pax7andsox10), intracellular pigment mobilization (e.g.,tubb,vim,kif5b), as well as uptake (e.g.,scarb1) and storage (e.g.,plin6) of carotenoids, and metabolic conversion of lipids and retinoids (e.g.,dgat2, pnpla2, akr1b1,dhrs). Triglyceride concentrations were similar in the yellow and white skin regions. Extracts of integumentary carotenoids contained zeaxanthin, lutein and beta-cryptoxanthin as well as unidentified carotenoid structures.

Conclusion

Our results suggest a role of carotenoid cleavage by Bco2 in fish integumentary coloration, analogous to previous findings in birds. The elevated expression of genes in carotenoid-rich skin regions with functions in retinol and lipid metabolism supports hypotheses concerning analogies and shared mechanisms between these metabolic pathways. Overlaps in the sets of differentially expressed genes (includingdgat2,bscl2,faxdc2andretsatl) between the present study and previous, comparable studies in other fish species provide useful hints to potential carotenoid color candidate genes.
Incidence of common opportunistic infections among HIV-infected children on ART at Debre Markos referral hospital, Northwest Ethiopia: a retrospective cohort study
Authors: Melkamu Mamaru Wubale , Gebeyehu Mulugeta Tesfa , Afenigus Abebe Dilie , Hibstie Yitbarek Tenaw , Temesgen Belisty , Petrucka Pammla , Alebel Animut
Published: January 2020

Background

Opportunistic infections (OIs) are the leading cause of morbidity and mortality among children living with human immunodeficiency virus (HIV). For better treatments and interventions, current and up-to-date information concerning occurrence of opportunistic infections in HIV-infected children is crucial. However, studies regarding the incidence of common opportunistic infections in HIV-infected children in Ethiopia are very limited. Hence, this study aimed to determine the incidence of opportunistic infections among HIV-infected children on antiretroviral therapy (ART) at Debre Markos Referral Hospital.

Methods

A facility-based retrospective cohort study was undertaken at Debre Markos Referral Hospital for the period of January 1, 2005 to March 31, 2019. A total of 408 HIV-infected children receiving ART were included. Data from HIV-infected children charts were extracted using a data extraction form adapted from ART entry and follow-up forms. Data were entered using Epi-data™ Version 3.1 and analyzed using Stata™ Version 14. The Kaplan Meier survival curve was used to estimate the opportunistic infections free survival time. Both bi-variable and multivariable Cox proportional hazard models were fitted to identify the predictors of opportunistic infections.

Results

This study included the records of 408 HIV-infected children-initiated ART between the periods of January 1, 2005 to March 31, 2019. The overall incidence rate of opportunistic infections during the follow-up time was 9.7 (95% CI: 8.13, 11.48) per 100 child-years of observation. Tuberculosis at 29.8% was the most commonly encountered OI at follow-up. Children presenting with advanced disease stage (III and IV) (AHR: 1.8, 95% CI: 1.2, 2.7), having “fair” or “poor” ART adherence (AHR: 2.6, 95% CI: 1.8, 3.8), not taking OI prophylaxis (AHR:1.6, 95% CI: 1.1, 2.4), and CD4 count or % below the threshold (AHR:1.7, 95% CI: 1.1, 2.6) were at a higher risk of developing opportunistic infections.

Conclusions

In this study, the incidence rate of opportunistic infections among HIV-infected children remained high. Concerning predictors, such as advanced disease stage (III and IV), CD4 count or % below the threshold, “fair” or “poor” ART adherence, and not taking past OI prophylaxis were found to be significantly associated with OIs.
Chlamydia trachomatis isolated from cervicovaginal samples in Sapporo, Japan, reveals the circulation of genetically diverse strains
Authors: Thapa Jeewan , Watanabe Takanori , Isoba Mana , Okubo Torahiko , Abe Kiyotake , Minami Kunihiro , Yamaguchi Hiroyuki
Published: January 2020

Background

This study was conducted to understand the molecular epidemiology of circulating Chlamydia trachomatis (Ct) strains in Sapporo, Japan.

Methods

A total of 713 endocervical samples collected from April 2016 to March 2019 were screened for Ct. The obtained Ct positive samples were analyzed by ompA genotyping and multilocus sequence analysis (MLSA).

Results

Eighty-three (11.6%) samples were positive for Ct plasmid DNA. Sequence analysis of the ompA gene from the 61 positive cases revealed eight genotypes: F (40.9%), E (19.6%), D (14.7%), G (9.8%), H (6.5%), I (3.2%), K (3.2%), and J (1.6%). The globally dominant genotype E and F strains were highly conserved with 13 ompA genetic variants being detected, whereas genotype D strains were the most diverse. Genetic characterization of D strains revealed that D1 genetic variants may be potentially specific to Sapporo. MLSA revealed 13 unique sequence types (STs) including four novel STs from 53 positive samples, with the globally dominant STs 39 and 19 being predominant. STs 39, 34, and 21 were exclusively associated with genotypes E and F indicating their global dominance. Novel ST70 and ST30 were specifically associated with genotype D.

Conclusion

Our study has revealed the circulation of genetically diverse Ct strains in the women population of Sapporo, Japan. We suggest identifying a transmission network of those successful strains and implementing public health prevention strategies to control the spread of Ct in Sapporo.
Dual-energy spectral CT quantitative parameters for the differentiation of Glioma recurrence from treatment-related changes: a preliminary study
Authors: Lv Yanchun , Zhou Jian , Lv Xiaofei , Tian Li , He Haoqiang , Liu Zhigang , Wu Yi , Han Lujun , Sun Meili , Yang Yadi , Guo Chengcheng , Li Cong , Zhang Rong , Xie Chuanmiao , Chen Yinsheng , Chen Zhongping
Published: January 2020

Background

Differentiating glioma recurrence from treatment-related changes can be challenging on conventional imaging. We evaluated the efficacy of quantitative parameters measured by dual-energy spectral computed tomographic (CT) for this differentiation.

Methods

Twenty-eight patients were examined by dual-energy spectral CT. The effective and normalized atomic number (Zeff and Zeff-N, respectively); spectral Hounsfield unit curve (λHU) slope; and iodine and normalized iodine concentration (IC and ICN, respectively) in the post-treatment enhanced areas were calculated. Pathological results or clinicoradiologic follow-up of ≥2 months were used for final diagnosis. Nonparametric and t-tests were used to compare quantitative parameters between glioma recurrence and treatment-related changes. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and accuracy were calculated using receiver operating characteristic (ROC) curves. Predictive probabilities were used to generate ROC curves to determine the diagnostic value.

Results

Examination of pre-contrast λHU, Zeff, Zeff-N, IC, ICN, and venous phase ICN showed no significant differences in quantitative parameters (P > 0.05). Venous phase λHU, Zeff, Zeff-N, and IC in glioma recurrence were higher than in treatment-related changes (P < 0.001). The optimal venous phase threshold was 1.03, 7.75, 1.04, and 2.85 mg/cm3, achieving 66.7, 91.7, 83.3, and 91.7% sensitivity; 100.0, 77.8, 88.9, and 77.8% specificity; 100.0, 73.3, 83.3, and 73.3% PPV; 81.8, 93.3, 88.9, and 93.3% NPV; and 86.7, 83.3, 86.7, and 83.3% accuracy, respectively. The respective areas under the curve (AUCs) were 0.912, 0.912, 0.931, and 0.910 in glioma recurrence and treatment-related changes.

Conclusions

Glioma recurrence could be potentially differentiated from treatment-related changes based on quantitative values measured by dual-energy spectral CT imaging.
Factors affecting utilization of health facilities for labour and childbirth: a case study from rural Uganda
Authors: Dantas Jaya A. R. , Singh Debra , Lample May
Published: January 2020

Background

Since 2000 considerable attention has been placed on maternal health outcomes as the 5th Millennium Goal. In Uganda, only 65% of births are delivered by a skilled birth attendant, contributing to the 435 women that die in every 100,000 births from unattended complications. Factors that impact a women’s decision on where to deliver include cost and household barriers, poor health services and lack of education.

Methods

Insight into factors impacting maternal health decision-making in two villages in South Eastern Uganda, were explored through a cross-sectional study using focus group discussions (FDGs) with men and women and administering a simple questionnaire.

Results

For men and women in the villages, cultural and community patterns of behavior have the strongest impact on delivery options. While women with no complications could often find options to deliver safely, lack of emergency obstetric care remains a strong factor in maternal deaths.

Conclusions

This article proposes that communities be engaged in identifying and leveraging their strengths to find solutions for challenges facing women in achieving safe deliveries.
Self-medication and knowledge among pregnant women attending primary healthcare services in Malang, Indonesia: a cross-sectional study
Authors: Atmadani Rizka Novia , Nkoka Owen , Yunita Sendi Lia , Chen Yi-Hua
Published: January 2020

Background

Self-medication with over-the-counter (OTC) drugs is an important public health concern, especially in the vulnerable population of pregnant women due to potential risks to both the mother and fetus. Few studies have studied how factors, such as knowledge, affect self-medication. This study investigated self-medication and its associated factors among pregnant women attending healthcare services in Malang, Indonesia.

Methods

A cross-sectional study was conducted from July to September 2018 in five healthcare services. A self-administered questionnaire was used and the data were analyzed using multiple regression models.

Results

Of 333 female participants, 39 (11.7%) used OTC medication. Women with a higher level of knowledge of OTC medication were more likely to self-medicate—adjusted odds ratio (aOR) = 2.15, 95% confidence interval (CI) = 1.03–4.46. Compared with those with less knowledge, pregnant women with more correct knowledge of the possible risk of self-medication were less likely to self-medicate—aOR = 0.29; 95% CI = 0.14–0.60. The effect of a higher level of knowledge of OTC medication was significant among women who had middle school and lower education—aOR = 8.18; 95% CI = 1.70–39.35. The effect of correct knowledge on the possible risks of self-medication was significant only among women with high school and higher education—aOR = 0.17; 95% CI = 0.07–0.42.

Conclusion

Imparting specific knowledge of the potential risks of using non-prescribed medication during pregnancy may help pregnant women navigate and more safely manage their OTC use. We also suggest further collecting data from more healthcare services, such as hospitals, to obtain more findings generalizable to the Indonesian community.
Intestinal parasites among food handlers of food service establishments in Ethiopia: a systematic review and meta-analysis
Authors: Yimam Yonas , Woreta Ambachew , Mohebali Mehdi
Published: January 2020

Background

Intestinal parasites remain considerable public health problems in low-income countries where poor food hygiene practice is common. Food handlers, people involved in preparing and serving food, working with poor personal hygiene could pose a potential threat of spreading intestinal parasites to the public in a community. The aim of this systematic review and meta-analysis was, therefore, to synthesize the pooled prevalence estimate of intestinal parasites and associated pooled odds ratio of hygienic predictors among food handlers of food service establishments in Ethiopia that could aid to further bringing down the burden of intestinal parasites and it can also be used as a springboard for future studies.

Methods

We searched exhaustively for studies Published before 20 April 2019 using eight Databases; PubMed, Science Direct, Web of Science, Scopus, Embase, Google Scholar, ProQuest, and Ovid MEDLINE® complemented by the gray literature search. In the final synthesis, we included twenty study reports. We used the Cochrane Q test and I2 test to assess heterogeneity of studies, while we employed a funnel plot followed by Egger’s regression asymmetry test and Begg rank correlation methods to evaluate publication bias. We also performed a point estimates and 95% confidence interval for each study using STATA version 14 statistical software.

Results

The overall pooled prevalence estimate of intestinal parasites among food handlers of food service establishments in Ethiopia was 33.6% (95%CI: 27.6–39.6%). Among ten intestinal parasites identified from food handlers, Entamoeba histolytica/ dispar (11, 95%CI: 7.9–14.1%) and Ascaris lumbricoides (8.8, 95%CI: 6.4–11.2%) were the most predominant intestinal parasites. Food handlers who washed hands after toilet use had 54% (OR, 0.46, 95% CI: 0.23–0.94) protection from intestinal parasites compared to those who did not.

Conclusions

This study revealed that intestinal parasitic infections are notable among food handlers of food service establishments in Ethiopia, which may be a risk for transmitting intestinal parasites to food and drinks consumers through the food chain. Thus, periodic stool checkup, training on intestinal parasitic infections and personal hygiene should be applied to reduce public health and socio-economic impacts of parasitic infections.
Acceptability of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda: a qualitative study
Authors: Ndejjo Rawlance , Musinguzi Geofrey , Nuwaha Fred , Wanyenze Rhoda K. , Bastiaens Hilde
Published: January 2020

Background

Cardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries where 80% of related deaths are registered. Community CVD prevention programmes utilizing self-care approaches have shown promise in contributing to population level reduction of risk factors. However, the acceptability of these programmes, which affects their uptake and effectiveness, is unknown including in the sub-Saharan Africa context. This study used the Theoretical Framework of Acceptability to explore the prospective acceptability of a community CVD prevention programme in Mukono and Buikwe districts in Uganda.

Methods

This qualitative descriptive study was conducted in March 2019 among community health workers (CHWs), who would implement the intervention and community members, the intervention recipients, using eight focus group discussions. All discussions were audio-recorded, transcribed verbatim and analysed thematically guided by the theoretical framework.

Results

CHWs and community members reported high eagerness to participate in the programme. Whereas CHWs had implemented similar community programmes and cited health promotion as their role, community members looked forward to health services being brought nearer to them. Although the intervention was preventive in nature, CHWs and community members expressed high interest in treatments for risk factors and were skeptical about the health system capacity to deliver them. CHWs anticipated barriers in mobilising communities who they said sometimes may not be cooperative while community members were concerned about failing to access treatment and support services after screening for risk factors. The major cost to CHWs and community members for engaging in the intervention was time that they would have dedicated to income generating activities and social events though CHWs also had the extra burden of being exemplary. CHWs were confident in their ability to deliver the intervention as prescribed if well trained, supported and supervised, and community members felt that if provided sufficient information and supported by CHWs, they could change their behaviours.

Conclusions

The community CVD prevention programme was highly acceptable among CHWs and community members in Mukono and Buikwe districts of Uganda amidst a few burdens and opportunity costs. Suggestions made by study participants to improve programme effectiveness informed programme design and implementation for impact.
Construction and characterization of a high-quality cDNA library of Cymbidium faberi suitable for yeast one- and two-hybrid assays
Authors: Xu Yanqin , Zhou Junjiang , Liu Qingqing , Li Kunpeng , Zhou Yin
Published: January 2020

Background

Cymbidium faberi is one of the oldest cultivars of oriental orchids, with an elegant flower fragrance. In order to investigate the molecular mechanism and the functions of related proteins in the methyl jasmonate (MeJA) signaling pathway, one of the main components of flower fragrance in C. faberi, yeast one- and two-hybrid three-frame cDNA libraries were constructed.

Results

In this study, a modified cDNA library used for yeast one- and two-hybrid screening was successfully constructed, with a recombinant efficiency of 95%. The lengths of inserted fragments ranged from 750~3000 bp, and the library capacity reached 6 × 109 CFU/ μg of cDNA insert, which was suitable for the requirements of subsequent screening. Finally, a homologous protein related with pathogenesis was screened out by the bait vector of CfbHLH36, which may participate in the MeJA signaling pathway.

Conclusion

The yeast one- and two-hybrid library of C. faberi provides large amounts of useful information for the functional genomics research in C. faberi, and this method could also be applied to other plants to screen DNA-protein and protein-protein interactions.
Variation in the implementation of PaTz: a method to improve palliative care in general practice - a prospective observational study
Authors: Koper Ian , Pasman H. Roeline W. , Schweitzer Bart P. M. , van der Zweep Greet , Uyttewaal Gon , Onwuteaka-Philipsen Bregje D.
Published: January 2020

Background

PaTz (palliative care at home) is a method to improve palliative care in the primary care setting in the Netherlands. PaTz has three basic principles: (1) local GPs and DNs meet at least six times per year to identify and discuss their patients with a life-threatening illness; (2) these meetings are supervised by a specialist palliative care professional; (3) groups use a palliative care register on which all identified patients are listed. Since the start in 2010, the number of PaTz-groups in the Netherlands has been growing consistently. Although the theory of all PaTz-groups is the same, the practical functioning of PaTz-groups may vary substantially, which may complicate further implementation of PaTz as well as interpretation of effect studies. This study aims to describe the variation in practice of PaTz-groups in the Netherlands.

Method

In this prospective observational study, ten PaTz-groups logged and described the activities in their meetings as well as the registered and discussed patients and topics of discussions in registration forms for a 1 year follow-up period. In addition, non-participatory observations were performed in all participating groups. Meeting and patient characteristics were analysed using descriptive statistics. Conventional content analysis was performed in the analysis of topic discussions.

Results

While the basic principles of PaTz are found in almost every PaTz-group, there is considerable variation in the practice and content of the meetings of different PaTz-groups. Most groups spend little time on other topics than their patients, although the number of patients discussed in a single meeting varies considerably, as well as the time spent on an individual patient. Most registered patients were diagnosed with cancer and patient discussions mainly concerned current affairs and rarely concerned future issues.

Conclusion

The basic principles are the cornerstone of any PaTz-group. At the same time, the observed variation between PaTz-groups indicates that tailoring a PaTz-group to the needs of its participants is important and may enhance its sustainability. The flexibility of PaTz-groups may also provide opportunity to modify the content and tools used, and improve identification of palliative patients and advance care planning.
Age at first marriage, age at first sex, family size preferences, contraception and change in fertility among women in Uganda: analysis of the 2006–2016 period
Authors: Ariho Paulino , Kabagenyi Allen
Published: January 2020

Background

Uganda’s fertility was almost unchanging until the year 2006 when some reductions became visible. Compared to age at first marriage and contraceptive use, age at sexual debut and family size preferences are rarely examined in studies of fertility decline. In this study, we analyzed the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to change in fertility in Uganda between 2006 and 2016.

Methods

Using data from the 2006 and 2016 Uganda Demographic and Health Survey (UDHS), we applied a nonlinear multivariate decomposition technique to quantify the contribution of age at first marriage, age at first sex, family size preference and contraceptive use to the change in fertility observed during the 2006–2016 period.

Results

The findings indicate that 37 and 63% of the change in fertility observed between 2006 and 2016 was respectively associated with changing characteristics and changing fertility behavior of the women. Changes in proportion of women by; age at first marriage, age at first sex, family size preferences and contraceptive use were respectively associated with 20.6, 10.5 and 8.4% and 8.2% of the change in fertility but only fertility behavior resulting from age at first sex was significantly related to the change in fertility with a contribution of 43.5%.

Conclusions

The study quantified the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to the change in fertility observed between 2006 and 2016. We highlight that of the four factors, only age at sexual debut made a significant contribution on the two components of the decomposition. There is need to address the low age at first sex, accessibility, demand for family planning services and youth-friendly family planning services to young unmarried women such that they can achieve their desired fertility. The contribution of other factors such as education attainment by women and place of residence and their relationship with changes in fertility calls for addressing if further reduction in fertility is to be realised.
Do patients and research subjects have a right to receive their genomic raw data? An ethical and legal analysis
Authors: Schickhardt Christoph , Fleischer Henrike , Winkler Eva C.
Published: January 2020

Background

As Next Generation Sequencing technologies are increasingly implemented in biomedical research and (translational) care, the number of study participants and patients who ask for release of their genomic raw data is set to increase. This raises the question whether research participants and patients have a legal and moral right to receive their genomic raw data and, if so, how this right should be implemented into practice.

Methods

In a first step we clarify some central concepts such as “raw data”; in a second step we sketch the international legal framework. The third step provides an extensive ethical analysis which comprehends two parts: an evaluation of whether there is a prima facie moral right to receive one’s raw data, and a contextualization and discussion of the right in light of potentially conflicting interests and rights of the data subject herself and third parties; in a last fourth step we emphasize the main practical consequences of the ethical analyses and propose recommendations for the release of raw data.

Results

In several legislations like the new European General Data Protection Regulation, patients do in principle have the right to receive their raw data. However, the procedural implementation of this right and whether it involves genetic counselling is at the discretion of the Member States. Even more questions remain with respect to the research context. The ethical analysis suggests that patients and research subjects have a moral right to receive their genomic raw data and addresses aspects which are also of relevance for the legal discussion such as the costs of release of raw data and its impact on academic freedom.

Conclusion

Taking into account the specific nature and implications of genomic raw data and the contexts of research and health care, several concerns and potentially conflicting interests of the data subjects themselves and involved researchers, physicians, biomedical institutions and relatives arise. Instead of using them to argue in favor of restrictions of the data subjects’ legal and moral right to genomic raw data, the concerns should be addressed through provision of information and other measures. To this end, we propose relevant recommendations.
Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis
Authors: Harrison Reema , Hinchcliff Reece Amr , Manias Elizabeth , Mears Steven , Heslop David , Walton Victoria , Kwedza Ru
Published: January 2020

Background

Assessment of clinical variation has attracted increasing interest in health systems internationally due to growing awareness about better value and appropriate health care as a mechanism for enhancing efficient, effective and timely care. Feedback using administrative databases to provide benchmarking data has been utilised in several countries to explore clinical care variation and to enhance guideline adherent care. Whilst methods for detecting variation are well-established, methods for determining variation that is unwarranted and addressing this are strongly debated. This study aimed to synthesize published evidence of the use of feedback approaches to address unwarranted clinical variation (UCV).

Methods

A rapid review and narrative evidence synthesis was undertaken as a policy-focused review to understand how feedback approaches have been applied to address UCV specifically. Key words, synonyms and subject headings were used to search the major electronic databases Medline and PubMed between 2000 and 2018. Titles and abstracts of publications were screened by two reviewers and independently checked by a third reviewer. Full text articles were screened against the eligibility criteria. Key findings were extracted and integrated in a narrative synthesis.

Results

Feedback approaches that occurred over a duration of 1 month to 9 years to address clinical variation emerged from 27 publications with quantitative (20), theoretical/conceptual/descriptive work (4) and mixed or multi-method studies (3). Approaches ranged from presenting evidence to individuals, teams and organisations, to providing facilitated tailored feedback supported by a process of ongoing dialogue to enable change. Feedback approaches identified primarily focused on changing clinician decision-making and behaviour. Providing feedback to clinicians was identified, in a range of a settings, as associated with changes in variation such as reducing overuse of tests and treatments, reducing variations in optimal patient clinical outcomes and increasing guideline or protocol adherence.

Conclusions

The review findings suggest value in the use of feedback approaches to respond to clinical variation and understand when action is warranted. Evaluation of the effectiveness of particular feedback approaches is now required to determine if there is an optimal approach to create change where needed.
Use of a highly-sensitive rapid diagnostic test to screen for malaria in pregnancy in Indonesia
Authors: Unwin Vera T. , Ahmed Rukhsana , Noviyanti Rintis , Puspitasari Agatha M. , Utami Retno A. S. , Trianty Leily , Lukito Theda , Syafruddin Din , Poespoprodjo Jeanne R. , Santana-Morales Maria A. , Ter Kuile Feiko O. , Adams Emily R.
Published: January 2020

Background

The sensitivity of rapid diagnostic tests (RDTs) for malaria is inadequate for detecting low-density, often asymptomatic infections, such as those that can occur when screening pregnant women for malaria. The performance of the Alere™ Ultra-sensitive Malaria Ag Plasmodium falciparum RDT (uRDT) was assessed retrospectively in pregnant women in Indonesia.

Methods

The diagnostic performance of the uRDT and the CareStart™ Malaria HRP2/pLDH VOM (Plasmodium vivax, Plasmodium ovale and Plasmodium malariae) Combo RDT (csRDT) were assessed using 270 stored red blood cell pellets and plasma samples from asymptomatic pregnant women. These included 112 P. falciparum negative and 158 P. falciparum positive samples detected by a composite test (qPCR, LAMP, nPCR) as reference standard. Diagnostic indicators: sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), diagnostic odds ratio (DOR) and the level of agreement (kappa) were calculated for comparison.

Results

Compared with the reference test, the uRDT had a sensitivity of 19.6% (95% CI 13.9–26.8) and specificity of 98.2% (93.1–99.7%). The csRDT was 22.8% (16.7–30.3) sensitive and 95.5% (89.4–98.3) specific for P. falciparum infections. Performance of the uRDT was non-significantly different to the csRDT (p = 0.169). RDT outcome was stratified by qPCR cycling threshold (Ct), and performance of the RDTs was found to be comparable across parasite loads.

Conclusion

The uRDT performed similarly to the currently used csRDTs in detecting P. falciparum infections in asymptomatic pregnant women. In these settings, molecular diagnostics are currently the most sensitive for malaria.