bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of IL-7 on sepsis: a systematic review
Authors: Moraes Filipe Oto Cunha de , Numakura Guilherme Tetsuo Yokoy , Hokama Larissa Tami , Soriano Francisco Garcia
Published: August 2021

Objective: The aim of this systematic review to evaluate the effects and possible therapeutic relevance of interleukin-7, a novel immunoadjuvant agent, against sepsis. Data Sources: We have searched PubMed, Scopus, LILACS and SciELO for any study which had IL-7 as intervention for sepsis. Study Selection: For each source, a single author was chosen to select all studies based on title and abstract. The remaining two authors then proceeded to read the complete text for relevance assessment. Results: Eleven sources were retrieved, consisting of six studies performed on animals, four on ex vivo human cells, and a single clinical trial. Several parameters were evaluated and reported, such as improved animal survival (3 trials; n= 264); improved cell count, activation, cytokine secretion, proliferation and survival; and higher patient CD4+ and CD8+ lymphocyte count (1 trial; n= 27). Major limitations were the heterogeneity of studies and the complexity of sepsis presentation. Data Extraction: Any data related to IL-7 intervention in septic patients was extracted. Animal and in vitro data was chosen according to outcomes in either overall survival or immune response markers. The data extraction from each study was conducted by a single author and then revised by the other two. Bias was assessed by all three authors together, without any specific methodology. Conclusions: Although IL-7 as a potential therapy option for sepsis still requires further investigation and clinical evaluation, current studies show promising results of how the interleukin could act against the disorder.
Diagnóstico endoscópico de fístula aortoentérica primária: relato de caso
Authors: Vieira João Paulo Garcia , Silva Isabela Costa , Brandão Julielly Almeida Andrade , Andrade Bruno Barros de Pádua , Andrade Luiz Carlos de , Nascimento Ariane Flávia do
Published: August 2021

Modelo do estudo: Relato de Caso. Importância do problema: A fístula aortoentérica primária tem incidência de 0,04% a 0,07% na população, tendo mortalidade de quase 100% se não tratada ou quando associada à hemorragia gastrointestinal. O diagnóstico realizado por endoscopia digestiva alta representa apenas 25% dos casos, sendo a tomografia computadorizada o padrão-ouro para confirmar essa afecção. Comentários: Nesse estudo, relatamos uma afecção rara encontrada na terceira porção do duodeno, com intenso sangramento ativo, sendo diagnosticada por endoscopia digestiva alta e realizado a hemostasia do aneurisma com “clip” endoscópico para controle do sangramento. Em seguida o paciente se estabilizou do ponto de vista hemodinâmico, porém, devido a gravidade do caso, foi encaminhado ao Centro de Terapia Intensiva (CTI) com o propósito de melhores cuidados e realização de Tomografia Computadorizada no dia seguinte, e possível intervenção cirúrgica. Entretanto, o paciente evoluiu com quadro hipertensivo, com ressangramento (11 horas após o diagnóstico), sem sucesso com o tratamento clínico e sem condição para realizar nova hemostasia endoscópica, evoluindo para choque hipovolêmico, seguido de parada cardiorrespiratória e óbito.
Corpo e figurino na construção da imagem de Michelle Melo
Authors: Bezerra Amilcar Almeida , Bracchi Daniela Nery , Moraes Fabiana , Silva Amanda Danielle de Lima
Published: August 2021

Este artigo tem como objetivo identificar quais sentidos são produzidos, negociados e tensionados na performance pop da cantora Michelle Melo, mais especificamente na construção de sua imagem por meio do corpo e do figurino. Conhecida no cenário brega-pop dos subúrbios recifenses, Michelle agencia múltiplas referências na construção de uma imagem pública de força e sensualidade para seu público consumidor, tornando-se personagem emblemática a ilustrar dilemas próprios às condições de vida e aos anseios de sua camada social.
Memória e tensividade: as Jornadas de Junho de 2013 na charge e no editorial
Authors: Costa Marcos Rogério Martins
Published: August 2021

As ruas eram tomadas por multidões que gritavam, esbravejavam e queriam grandes reformas econômicas, políticas e sociais em junho de 2013, depois do aumento das tarifas de transporte público nas cidades de São Paulo-SP e Rio de Janeiro-RJ. Esse acontecimento foi nomeado de Jornadas de Junho. Neste artigo, o objetivo é investigar, a partir da construção do corpo do ator manifestante das Jornadas de Junho de 2013, a presença sensível da memória no gênero charge e no gênero editorial. Para tanto, selecionamos como corpus dois textos, um de cada gênero, publicados no mesmo dia, na mesma página e no mesmo veículo midiático, a saber: a charge do cartunista Benett Alberto de Macedo (Macedo, 2013) e o editorial “Retomar a Paulista” (olha de São Paulo, 2013), ambos publicados na página A2 da Folha de São Paulo do dia 13 de junho de 2013. Nosso arcabouço teórico parte da concepção semiótica de corpo que entende a enunciação como instância pressuposta ao enunciado (Discini, 2015; Greimas; Courtés, 2008). Desse modo, exclui-se do âmbito de pertinência da semiótica a pessoa de carne e osso, sto é, o referente é interno, imanente à linguagem. A memória que perscrutamos neste estudo é a de caráter discursivo. A partir do esquema tensivo de Zilberberg (2001) e da proposta de Pessoa de Barros (2011) para o estudo do discurso da memória, os resultados de análise do corpus apontam que a charge, ao privilegiar a concessão, é mais tônica, mais rápida, mais concentrada e mais breve, portanto instaura a memóriaacontecimento; enquanto que o editorial, ao instaurar mais sintagmas implicativos, é mais átono, mais lento, mais difuso, mais alongado, logo, tende a preferir a memória do acontecido.1
Elementos figurativos em Meu Folclore, de Jota Sara
Authors: Cruz Clériston Jesus da , Bitencourt Denise Silva
Published: August 2021

No presente trabalho, alguns trechos de Meu folclore (1957), de José Aras, pelo pseudônimo de Jota Sara, são observados à luz da semiótica greimasiana, no que concerne, especialmente, à percepção dos temas e das figuras, elementos presentes na Semântica Discursiva do Percurso Gerativo de Sentido. Apresentam-se os conceitos semióticos de isotopia e figuratividade. Assim, busca-se elencar os investimentos figurativos, revelando, por conseguinte, o lugar do ideológico no discurso, isto é, a visão conselheirista. Ainda nessa busca, são destacadas as referências religiosas que, no texto em análise, tornaram-se um recurso semântico de construção dos efeitos de veracidade. Para tal efeito, lança-se mão de excertos dos seguintes autores: Belém (1940), Silva (s.d.), Cunegundes (1897), Calasans (1984), bem como de alguns trechos de Santos (1897), da Enciclopédia Católica Popular e outras obras de José Aras (1963, 2003, 2009). Ademais, Fiorin (2006), Barros (2005), Oliver (2013), baseando-se nos estudos greimasianos fornecem subsídios importantíssimos para a efetivação da análise.
Mast Cell Activation Disorder and Postural Orthostatic Tachycardia Syndrome: A Clinical Association
Authors: Kohno Ritsuko , Cannom David S. , Olshansky Brian , Xi Shijun Cindy , Krishnappa Darshan , Adkisson Wayne O. , Norby Faye L. , Fedorowski Artur , Benditt David G.
Published: August 2021

Background

Recently there has been increased interest in a possible association between mast cell activation (MCA) disorder and postural orthostatic tachycardia syndrome (POTS). This study examined the frequency with which symptoms and laboratory findings suggesting MCA disorder occurred in patients diagnosed with POTS.

Methods and Results

Data were obtained from patients in whom symptoms and orthostatic testing were consistent with a POTS diagnosis. Individuals with <4 months symptom duration, evident ongoing inflammatory disease, suspected volume depletion, or declined consent were excluded. All patients had typical POTS symptoms; some, however, had additional nonorthostatic complaints not usually associated with POTS. The latter patients underwent additional testing for known MCA biochemical mediators including prostaglandins, histamine, methylhistamine, and plasma tryptase. The study comprised 69 patients who met POTS diagnostic criteria. In 44 patients (44/69, 64%) additional nonorthostatic symptoms included migraine, allergic complaints, skin rash, or gastrointestinal symptoms. Of these 44 patients, 29 (66%) exhibited at least 1 laboratory abnormality suggesting MCA disorder, and 11/29 patients had 2 or more such abnormalities. Elevated prostaglandins (n=16) or plasma histamine markers (n=23) were the most frequent findings. Thus, 42% (29/69) of patients initially diagnosed with POTS exhibited both additional symptoms and at least 1 elevated biochemical marker suggesting MCA disorder.

Conclusions

Laboratory findings suggesting MCA disorder were relatively common in patients diagnosed with POTS and who present with additional nonorthostatic gastrointestinal, cutaneous, and allergic symptoms. While solitary abnormal laboratory findings are not definitive, they favor MCA disorder being considered in such cases.
The cellophane bees of Colletes Latreille (Hymenoptera: Colletidae) from Xizang (Tibet), China
Authors: FERRARI RAFAEL R. , NIU ZE-QING , KUHLMANN MICHAEL , ZHANG DAN , ZHU CHAO-DONG
Published: August 2021

We present information about the known species of the genus Colletes Latreille found in Xizang (China), including an integrative approach to taxonomy for many of the species. A new species belonging to the C. clypearis Morawitz group, C. splendidus Ferrari, Niu & Zhu sp. nov., is described. Colletes sichuanensis Kuhlmann and C. tuberculatus Morawitz are recorded from Xizang for the first time. The suspected occurrences of both C. bischoffi Noskiewicz and C. packeri Kuhlmann in China are confirmed and their presence in Xizang are also established for the first time. We show that C. fulvicornis Noskiewicz was wrongly recorded from Xizang previously and, therefore, the species is herein removed from the list of the Tibetan Colletes. Thus, 26 species of the genus are now known from Xizang. The putative occurrence of C. annejohnae Kuhlmann in Xizang could not be confirmed, but the species is nonetheless included in the scope of this paper to facilitate its identification by future studies. An illustrated key for the Tibetan species of Colletes is provided.
KWReq—a new instrument for measuring knowledge work requirements of higher education graduates
Authors: Trommer Maximilian , Schaeper Hildegard , Fabian Gregor
Published: August 2021

Starting from the observation that questionnaires for appropriately measuring the changing working conditions and requirements of the highly qualified workforce do not exist, we developed a new German-language instrument focussing on knowledge work. Based on theoretical considerations, we first identified three basic dimensions that constitute knowledge work: novelty, complexity, and autonomy. During the subsequent process of questionnaire development with higher education graduates, including a cognitive pretest, a quantitative development study, and a replication study, these dimensions were operationalised by initially 173 and finally 22 items. Confirmatory factor analysis and structural equation modelling of the data of both the development and the replication study show that the 22-item instrument validly and reliably measures novelty (4 items), complexity with three subdimensions (9 items), and autonomy, also with three subdimensions (9 items). An English version of the questionnaire is available. However, the empirical test of the English-language questionnaire as well as possible refinements of the measurement instrument, which will be discussed in the final section of the paper, are left to future research.
A roadmap to using randomization in clinical trials
Authors: Berger Vance W. , Bour Louis Joseph , Carter Kerstine , Chipman Jonathan J. , Everett Colin C. , Heussen Nicole , Hewitt Catherine , Hilgers Ralf-Dieter , Luo Yuqun Abigail , Renteria Jone , Ryeznik Yevgen , Sverdlov Oleksandr , Uschner Diane ,   for the Randomization Innovative Design Scientific Working Group, Beckman Robert A
Published: August 2021

Background

Randomization is the foundation of any clinical trial involving treatment comparison. It helps mitigate selection bias, promotes similarity of treatment groups with respect to important known and unknown confounders, and contributes to the validity of statistical tests. Various restricted randomization procedures with different probabilistic structures and different statistical properties are available. The goal of this paper is to present a systematic roadmap for the choice and application of a restricted randomization procedure in a clinical trial.

Methods

We survey available restricted randomization procedures for sequential allocation of subjects in a randomized, comparative, parallel group clinical trial with equal (1:1) allocation. We explore statistical properties of these procedures, including balance/randomness tradeoff, type I error rate and power. We perform head-to-head comparisons of different procedures through simulation under various experimental scenarios, including cases when common model assumptions are violated. We also provide some real-life clinical trial examples to illustrate the thinking process for selecting a randomization procedure for implementation in practice.

Results

Restricted randomization procedures targeting 1:1 allocation vary in the degree of balance/randomness they induce, and more importantly, they vary in terms of validity and efficiency of statistical inference when common model assumptions are violated (e.g. when outcomes are affected by a linear time trend; measurement error distribution is misspecified; or selection bias is introduced in the experiment). Some procedures are more robust than others. Covariate-adjusted analysis may be essential to ensure validity of the results. Special considerations are required when selecting a randomization procedure for a clinical trial with very small sample size.

Conclusions

The choice of randomization design, data analytic technique (parametric or nonparametric), and analysis strategy (randomization-based or population model-based) are all very important considerations. Randomization-based tests are robust and valid alternatives to likelihood-based tests and should be considered more frequently by clinical investigators.
Evaluation of a geriatrics primary care model using prospective matching to guide enrollment
Authors: Smith Valerie A. , Van Houtven Courtney Harold , Lindquist Jennifer H. , Hastings Susan N.
Published: August 2021

Background

Few definitive guidelines exist for rigorous large-scale prospective evaluation of nonrandomized programs and policies that require longitudinal primary data collection. In Veterans Affairs (VA) we identified a need to understand the impact of a geriatrics primary care model (referred to as GeriPACT); however, randomization of patients to GeriPACT vs. a traditional PACT was not feasible because GeriPACT has been rolled out nationally, and the decision to transition from PACT to GeriPACT is made jointly by a patient and provider. We describe our study design used to evaluate the comparative effectiveness of GeriPACT compared to a traditional primary care model (referred to as PACT) on patient experience and quality of care metrics.

Methods

We used prospective matching to guide enrollment of GeriPACT-PACT patient dyads across 57 VA Medical Centers. First, we identified matches based an array of administratively derived characteristics using a combination of coarsened exact and distance function matching on 11 identified key variables that may function as confounders. Once a GeriPACT patient was enrolled, matched PACT patients were then contacted for recruitment using pre-assigned priority categories based on the distance function; if eligible and consented, patients were enrolled and followed with telephone surveys for 18 months.

Results

We successfully enrolled 275 matched dyads in near real-time, with a median time of 7 days between enrolling a GeriPACT patient and a closely matched PACT patient. Standardized mean differences of < 0.2 among nearly all baseline variables indicates excellent baseline covariate balance. Exceptional balance on survey-collected baseline covariates not available at the time of matching suggests our procedure successfully controlled many known, but administratively unobserved, drivers of entrance to GeriPACT.

Conclusions

We present an important process to prospectively evaluate the effects of different treatments when randomization is infeasible and provide guidance to researchers who may be interested in implementing a similar approach. Rich matching variables from the pre-treatment period that reflect treatment assignment mechanisms create a high quality comparison group from which to recruit. This design harnesses the power of national administrative data coupled with collection of patient reported outcomes, enabling rigorous evaluation of non-randomized programs or policies.
Retrospective assessment of antimicrobial stewardship initiative in outpatient use of ertapenem for uncomplicated extended spectrum beta lactamase Enterobacteriaceae urinary tract infections
Authors: Wong Carrie P. , Delate Thomas , Hudson Elizabeth , Nguyen Julia K. , Yang Su-Jau , Abraham Mariana
Published: August 2021

Background

Urinary tract infections (UTI) are often over-diagnosed and over-treated, which can induce and select for resistant pathogens. After observing wide-spread outpatient use of ertapenem, a broad-spectrum antibiotic, a structured antimicrobial stewardship initiative (ASI) to improve appropriate antimicrobial prescribing was undertaken. ASI objectives were to achieve a goal of reducing ertapenem utilization for extended spectrum beta lactamase Enterobacteriaceae (ESBL-EB) UTI by 10% and evaluate the clinical outcomes associated with the ASI.

Methods

A pre-to-post cohort study was conducted at a single-center integrated healthcare system between November 1, 2014 and February 26, 2017. An intensive, 90-day, pharmacist-driven, structured ASI was implemented between November 1, 2015 and January 29, 2016. Female patients aged ≥18 years who were treated for an uncomplicated, ESBL-EB urinary tract infection (UTI) were included. Primary outcome was clinical resolution defined as cure, persistence, relapse and recurrence. Secondary outcome measured was monthly ertapenem use expressed as number of days of therapy (DOT)/1000 adjusted patient days (APD). Segmented regression analysis for interrupted time series was performed to estimate ASI intervention effect.

Results

A total of 184 patients were included in the study. Ertapenem utilization decreased from 0.0145 DOT/1000 APD in Nov. 2014 to 0.0078 DOT/1000 APD Feb. 2017(p < 0.01). The mean ertapenem DOT declined 19% overall from the pre vs. post intervention periods (32 vs 26, p < 0.01). Frequency of recurrent UTIs between treatments did not significantly differ and no adverse effects were reported in patients treated with aminoglycosides.

Conclusions

A structured ASI for uncomplicated ESBL-EB UTI was associated with a clinically meaningful decrease in ertapenem utilization and once-daily, 5-day aminoglycoside treatment was well-tolerated.
Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis
Authors: Del Giovane Cinzia , Boncoraglio Giorgio B. , Bertù Lorenza , Banzi Rita , Tramacere Irene
Published: August 2021

Background

Antiplatelet drugs may prevent recurrent ischemic events after ischemic stroke but their relative effectiveness and harms still need to be clarified. Within this network meta-analysis we aimed to summarize the current evidence for using antiplatelet drugs for secondary stroke prevention.

Methods

We searched MEDLINE, EMBASE and CENTRAL up to September 2020. Randomized controlled trials (RCTs) assessing antiplatelet drugs for secondary stroke prevention were included. We did pairwise meta-analyses and network meta-analyses using random-effects models. Primary outcomes were all strokes (ischemic or hemorrhagic) and all-cause mortality.

Results

The review included 57 RCTs, 50 (n = 165,533 participants) provided data for the meta-analyses. Compared to placebo/no treatment, moderate to high-confidence evidence indicated that cilostazol, clopidogrel, dipyridamole + aspirin, ticagrelor, ticlopidine, and aspirin ≤ 150 mg/day significantly reduced the risk of all strokes (odds ratios, ORs and absolute risk difference, ARD): cilostazol 0.51 (95 % confidence interval, CI, 0.37 to 0.71; 3.6 % fewer), clopidogrel 0.63 (95 % CI, 0.49 to 0.79; 2.7 % fewer), dipyridamole + aspirin 0.65 (95 % CI, 0.55 to 0.78; 2.5 % fewer), ticagrelor 0.68 (95 % CI, 0.50 to 0.93; 2.3 % fewer), ticlopidine 0.74 (95﻿ % CI 0.59 to 0.93; 1.9 % fewer), aspirin ≤ 150 mg/day 0.79 (95 % CI, 0.66 to 0.95; 1.5 % fewer). Aspirin > 150 mg/day and the combinations clopidogrel/aspirin, ticagrelor/aspirin, also decrease all strokes but increase the risk of hemorrhagic events. Only aspirin > 150 mg/day significantly reduced all-cause mortality (OR 0.86, 95 % CI 0.76 to 0.97; ARD 0.9 %, 95 %CI 1.5–0.2 % fewer, moderate confidence). Compared to aspirin ≤ 150 mg/day, clopidogrel significantly reduced the risk of all strokes, cardiovascular events, and intracranial hemorrhage outcomes. Cilostazol also appeared to provide advantages but data are limited to the Asian population.

Conclusions

Considering the benefits and harms ratio, cilostazol, clopidogrel, dipyridamole + aspirin, ticagrelor, ticlopidine, and aspirin ≤ 150 mg/day appear to be the best choices as antiplatelet drugs for secondary prevention of patients with ischemic stroke or TIA.

Systematic review registration

PROSPERO CRD42020159896.
The association of selected multiple sclerosis symptoms with disability and quality of life: a large Danish self-report survey
Authors: Gustavsen S. , Olsson A. , Søndergaard H. B. , Andresen S. R. , Sørensen P. S. , Sellebjerg F. , Oturai A.
Published: August 2021

Background

People with multiple sclerosis (MS) experience a wide range of unpredictable and variable symptoms. The symptomatology of MS has previously been reported in large sample registry studies; however, some symptoms may be underreported in registries based on clinician-reported outcomes and how the symptoms are associated with quality of life (QoL) are often not addressed.

The aim of this study was to comprehensively evaluate the frequency of selected MS related symptoms and their associations with disability and QoL in a large self-report study.

Methods

We conducted a cross-sectional questionnaire survey among all patients at the Danish Multiple Sclerosis Center, Copenhagen University Hospital, Denmark. The questionnaire included information on clinical and sociodemographic characteristics, descriptors of QoL and disability, as well as prevalence and severity of the following MS symptoms: impaired ambulation, spasticity, chronic pain, fatigue, bowel and bladder dysfunction, and sleep disturbances.

Results

Questionnaires were returned by 2244/3606 (62%). Participants without MS diagnosis or incomplete questionnaires were excluded, n = 235. A total of 2009 questionnaires were included for analysis (mean age 49.4 years; mean disease duration 11.7 years; and 69% were women).

The most frequently reported symptoms were bowel and bladder dysfunction (74%), fatigue (66%), sleep disturbances (59%), spasticity (51%) and impaired ambulation (38%). With exception of fatigue and sleep disturbances, all other symptoms increased in severity with higher disability level. Invisible symptoms (also referred to as hidden symptoms) such as fatigue, pain and sleep disturbances had the strongest associations with the overall QoL.

Conclusion

We found invisible symptoms highly prevalent, even at mild disability levels. Fatigue, pain and sleep disturbances had the strongest associations with the overall QoL and were more frequently reported in our study compared with previous registry-based studies. These symptoms may be underreported in registries based on clinician reported outcomes, which emphasizes the importance of including standardized patient reported outcomes in nationwide registries to better understand the impact of the symptom burden in MS.
Patients’ perspective on emergency treatment of ophthalmologic diseases during the first phase of SARS-CoV2 pandemic in a tertiary referral center in Germany – the COVID-DETOUR questionnaire study
Authors: Ehlken Christoph , von Medem Constantin , Lüdemann Maya , Kirsch Anna Maria , Roider Johann Baptist
Published: August 2021

Background

During the first wave of the COVID-19 pandemic, the need of treatment of urgent ophthalmological diseases and the possible risk of a SARS-CoV-2 infection had to be weighed against each other. In this questionnaire study, we aimed to analyze potential barriers and patients’ health beliefs during and after the lockdown early 2020 in a tertiary referral center in Kiel, Germany.

Methods

Patients admitted for the treatment of urgent ophthalmic diseases between March 1st, 2020, and June 3rd, 2020, were asked to participate in a questionnaire study. After informed consent was obtained, patients were interviewed using a standardized questionnaire which addressed aspects of their medical history, their health beliefs concerning the COVID-19 pandemic and barriers on their way to the treatment center. The study group was subdivided into two subgroups, depending on the occurrence of their symptoms, before and after the lockdown was ended on April 20th, 2020.

Results

Ninety-three patients were included, 43 in subgroup A (before April 20th) and 50 in subgroup B (April 20th or later). Retinal disorders were the most common causes for admission (approximately 60%).. Only 8 patients (8.6%) experienced a delay between their decision to visit a doctor until the actual examination. Every fourth patient was afraid of a COVID-19 infection, and expected a higher likelihood for an infection at the hospital. Patients with comorbidities tended to be more likely to be afraid of an infection (correlation coefficient 0.183,p = 0.0785) and were significantly more likely to be concerned about problems with organizing follow-up care (corr. Coefficient 0.222,p = 0.0328). Higher age was negatively correlated with fear of infection (corr. Coefficient − 0.218,p-value 0.034).

Conclusion

In this questionnaire study, only a minority of patients indicated a delay in treatment, regardless of whether symptoms occurred before or after the lockdown before April 20th, 2020. While patients with comorbidities were more concerned about infection and problems during follow-up care, patients of higher age – who have a higher mortality – were less afraid. Protection of high-risk groups should be prioritized during the SARS-CoV-2 pandemic.

Trial registration

The study was registered asDRKS00021630at the DRKS (Deutsches Register Klinischer Studien) before the conduction of the study on May 5th, 2020.
The reliability and validity of the Turkish version of the school-based asthma and allergy screening questionnaires
Authors: Kilic Mahmut , Ede Ghaniya , Uzuncakmak Tugba
Published: August 2021

Background

Asthma is an important public health disease affecting children that may result in school absenteeism and hospitalization. This study aims to assess the validity, reliability, and diagnostic accuracy of the Turkish version of the asthma and allergy screening questionnaire.

Methods

This study included primary and secondary school students from grades 2 to 7 and their parents or caregivers. For validity, 40 children with asthma and 39 children with allergies diagnosed by the questionnaire were used to determine the sensitivity. The specificity was calculated by using the data of 100 children without asthma and allergies. The study was completed with the participation of 704 students and parents. The intraclass correlation coefficient (ICC) was used to assess item reliability. Receiver operating characteristic (ROC) analysis was used to assess validity.

Results

When the cutoff point of the questionnaire was 2/3 for asthma, the sensitivity was 80.0% and 82.5% and the specificity was 56.6% and 76.8% according to the student and parent form, respectively. When the cutoff point of the questionnaire was 0/1 for allergies, the sensitivity was 74.4% and 84.6% and the specificity was 66.3% and 54.2% according to the student (SQ) and parent questionnaire (PQ), respectively. The reliability of test-retest correlation values (≥0.68) of asthma and allergy questionnaires were found to be statistically significant. The internal consistency Cronbach’s α values of the asthma SQ and PQ were 0.72 and 0.80, respectively.

Conclusions

According to the Turkish questionnaire for students and their parents, the sensitivity of asthma and allergy questionnaires was similar in proportion to the original questionnaire. The Turkish version of the questionnaire can be used for asthma and allergy screening in schools.
Kaniuwatewara (when we get sick): understanding health-seeking behaviours among the Shawi of the Peruvian Amazon
Authors: Bussalleu Alejandra , Pizango Pedro , King Nia , Ford James , Team I. H. A. C. C. Research , Harper Sherilee L.
Published: August 2021

Background

Detailed qualitative information regarding Indigenous populations’ health-seeking behaviours within Peru’s plural healthcare system is lacking. Such context-specific information is prerequisite to developing evidence-based health policies and programs intended to improve health outcomes for Indigenous populations. To this end, this study aimed to characterize health-seeking behaviours, factors affecting health-seeking behaviours, and barriers to obtaining healthcare in two Indigenous Shawi communities in Peru.

Methods

Community-based approaches guided this work, and included 40 semi-structured interviews and a series of informal interviews. Data were analysed thematically, using a constant comparative method; result authenticity and validity were ensured via team debriefing, member checking, and community validation.

Results

Shawi health-seeking behaviours were plural, dynamic, and informed by several factors, including illness type, perceived aetiology, perceived severity, and treatment characteristics. Traditional remedies were preferred over professional biomedical healthcare; however, the two systems were viewed as complementary, and professional biomedical healthcare was sought for illnesses for which no traditional remedies existed. Barriers impeding healthcare use included distance to healthcare facilities, costs, language barriers, and cultural insensitivity amongst professional biomedical practitioners. Nevertheless, these barriers were considered within a complex decision-making process, and could be overridden by certain factors including perceived quality or effectiveness of care.

Conclusions

These findings emphasize the importance of acknowledging and considering Indigenous culture and beliefs, as well as the existing traditional medical system, within the professional healthcare system. Cultural competency training and formally integrating traditional healthcare into the official healthcare system are promising strategies to increase healthcare service use, and therefore health outcomes.
Health promotion interventions for African Americans delivered in U.S. barbershops and hair salons- a systematic review
Authors: Palmer Kelly N. B. , Rivers Patrick S. , Melton Forest L. , McClelland D. Jean , Hatcher Jennifer , Marrero David G. , Thomson Cynthia A. , Garcia David O.
Published: August 2021

Background

African American adults suffer disproportionately from obesity-related chronic diseases, particularly at younger ages. In order to close the gap in these health disparities, efforts to develop and test culturally appropriate interventions are critical.

Methods

A PRISMA-guided systematic review was conducted to identify and critically evaluate health promotion interventions for African Americans delivered in barbershops and hair salons. Subject headings and keywords used to search for synonyms of ‘barbershops,’ ‘hair salons,’ and ‘African Americans’ identified all relevant articles (from inception onwards) from six databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index). Experimental and quasi-experimental studies for adult (> 18 years) African Americans delivered in barbershops and hair salons that evaluated interventions focused on risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer, and type 2 diabetes were included. Analyses were conducted in 2020.

Results

Fourteen studies met criteria for inclusion. Ten studies hosted interventions in a barbershop setting while four took place in hair salons. There was substantial variability among interventions and outcomes with cancer the most commonly studied disease state (n = 7; 50%), followed by hypertension (n = 5; 35.7%). Most reported outcomes were focused on behavior change (n = 10) with only four studies reporting clinical outcomes.

Conclusions

Health promotion interventions delivered in barbershops/hair salons show promise for meeting cancer screening recommendations and managing hypertension in African Americans. More studies are needed that focus on diabetes and obesity and utilize the hair salon as a site for intervention delivery.

Trial registration

PROSPERO CRD42020159050.
Effectiveness of one-on-one coaching in improving pressurized metered dose inhaler (pMDI) technique among COPD patients: a prospective clinical study
Authors: Kim Jin Sun , Hashweh Nader , Li Hannah , Choudhary Salik , Santosh Sadashiv , Charbek Edward
Published: August 2021

Background

Incorrect use of inhalers among asthma and COPD patients is very prevalent. Yet, no single intervention is considered standard of care. We aimed to conduct a COPD-specific investigation of active one-on-one coaching as the educational intervention to improve pressurized metered dose inhaler (pMDI) technique and COPD symptoms management.

Methods

COPD patients who have pMDI in their treatment regimen were enrolled in this prospective study using the Global Initiative for Chronic Obstructive Lung Disease criteria. After rapid cognitive screen, inhaler technique was assessed and an active one-on-one coaching was provided utilizing the 12-step American Thoracic Society instructions. Patients’ inhaler technique was assessed and scored again at their regular follow-up visits.

Results

One hundred and one patients participated in the study. The percentage of pMDI misuse decreased from 43.5% pre-teaching to 12.9% post-teaching (binomial test p value < 0.001). The mean number of errors decreased from 3.1 errors pre-teaching to 1.7 errors post-teaching (paired t-test p value < 0.001). The number needed to treat was 3.3 patients to prevent one misuse. Patients with an impaired cognitive function were more likely to have inhaler misuse in general and less likely to improve their technique when provided training.

Conclusions

This study reveals that many COPD patients have incorrect pMDI techniques that can be improved with a short training in the clinic.

Trial Registration: Not applicable.
Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection
Authors: Liu Wei , Liu Jia-Ming , Wang Kun , Wang Hong-Wei , Xing Bao-Cai
Published: August 2021

Background

Local treatment remains the best option for recurrent colorectal liver metastasis (CRLM). The current study aimed to investigate predictive factors of survival outcomes and select candidates for local treatment for CRLM at first recurrence.

Methods

Data were collected retrospectively from CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution. A nomogram predicting overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index and calibration curve.

Results

Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated and had resectable and liver-limited disease. Among them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients received only systemic chemotherapy. Multivariable analysis identified primary lymph node positivity, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment as independent risk factors for survival outcomes. Integrating these five variables, the nomogram presented a good concordance index of 0.707. Compared with patients who received only systemic chemotherapy, radical local treatment did not significantly improve survival outcomes (median OS: 21 vs. 15 months, p = 0.126) in the high-risk group (total score ≥ 13).

Conclusion

Radical local treatment improved the survival of recurrent CRLM patients. The proposed model facilitates personalized assessments of prognosis for patients who develop first recurrence in the liver.
Methods women use for induced abortion and sources of services: insights from poor urban settlements of Accra, Ghana
Authors: Agula Caesar , Henry Elizabeth G. , Asuming Patrick O. , Agyei-Asabere Charles , Kushitor Mawuli , Canning David , Shah Iqbal , Bawah Ayaga A.
Published: August 2021

Background

Increasing access to safe abortion methods is crucial for improving women’s health. Understanding patterns of service use is important for identifying areas for improvement. Limited evidence is available in Ghana on factors associated with the type of method used to induce abortion. This paper examined the methods and sources of services used for abortion by women living in poor urban settings of Accra.

Methods

Data are from a survey that was conducted in 2018 among 1233 women aged 16–44 years who reported ever having had an induced abortion. We estimated a multinomial logistic regression model to examine factors associated with the type of abortion methods women used. We further generated descriptive statistics for the source of abortion services.

Results

About 50% women used surgical procedures for their last abortion, 28% used medication abortion (MA), 12% used other pills, 3% used injection, and 7% used non-medical methods. However, nearly half (46%) of the women who terminated a pregnancy within the year preceding the survey used medication abortion (MA), 32% used surgical procedures, while 5% used non-medical methods. Women who terminated a pregnancy within three years preceding the survey had a 60% lower chance of using surgical procedures if they did not use MA compared to those who terminated a pregnancy more than 3 years before the survey (Relative Risk Ratio [RRR] 0.4; 95% CI 0.3–0.5). The vast majority (74%) of women who used MA obtained services from pharmacies.

Conclusions

The use of MA pills to terminate pregnancies has increased in recent years in Ghana and these pills are mostly accessed from pharmacies. This suggests a need for a review of the national guidelines to include pharmacists and chemists in the provision of MA services.
Prevalence and correlates of sexual violence among adolescent girls and young women: findings from a cross-sectional study in a South African university
Authors: Ajayi Anthony Idowu , Mudefi Elmon , Owolabi Eyitayo Omolara
Published: August 2021

Background

Epidemiological data on the prevalence and factors associated with sexual violence is critical to understanding the magnitude of the problem and designing effective interventions. Drawing from cross-sectional data from a South African university, we examined the prevalence and correlates of sexual violence among adolescent girls and young women (AGYW).

Methods

We analysed data of 451 AGYW selected using stratified sampling. Sexual violence was defined as any sexual acts, and attempt to obtain sexual acts without consent. We used adjusted and unadjusted logistic regression models to examine the factors associated with exposure to sexual violence while controlling for relevant covariates.

Results

The lifetime and past-year prevalence of sexual violence was 37.9% and 25.3%, respectively. A higher prevalence of sexual violence was reported by heavy episodic drinkers of alcohol (lifetime 48.4% and past year 34.0%), those who received insufficient financial support (lifetime 58.0% and past year 35.8%) compared to non-users of alcohol (lifetime 27.2% and past year 17.2%),) and those who received adequate financial support (lifetime 20.8% and past year 13.1%). AGYW who reported heavy episodic use of alcohol had higher odds of reporting lifetime (AOR: 1.86; 95% CI: 1.07–3.25) and past year (AOR: 2.03; 95% CI: 1.10–3.75) experience of sexual violence compared to non-users. However, individuals who received adequate family financial support were 76% and 65% less likely to report lifetime and past year experience of sexual violence than those who received inadequate family financial support. Also, AGYW who rated themselves as very religious were 80% and 75% less likely to report lifetime and past year experience of sexual violence compared to those who were not religious.

Conclusion

Our study shows that sexual violence affects a large proportion of girls, requiring intervention that not only focuses on increasing social support for survivors, facilitating reporting, and ensuring perpetrators are convicted, but also target alcohol use reduction and poverty alleviation.
A qualitative study exploring experiences and challenges of combining clinical academic training with family life
Authors: Trusson Diane , Rowley Emma
Published: August 2021

Background

Concerns are being expressed around the lack of diversity at higher levels of clinical academia. This study aimed to explore experiences and challenges associated with combining clinical academic careers with family life.

Methods

Qualitative data were gathered from participants from 4 NHS Trusts and 2 universities in the East Midlands of England using online surveys and semi-structured interviews.

Results

The survey was completed by 67 nurses, midwives and allied health professionals, and 73 medical clinical academic trainees. Interviews were conducted with 16 participants from each group including equal numbers of men and women. Caring responsibilities differed between the two study populations. Medical clinical academic trainees were younger and either had young children or were yet to start a family. In contrast, nurses, midwives and allied health professionals tended to be older when they embarked on a clinical academic career and often waited until their children were school-age or older. Similar concerns were raised regarding working part-time and childcare, and how their career prospects might be affected in terms of fulfilling promotion criteria and being able to relocate for work purposes. The occupation of their partners also featured in participants’ experiences; those who shared childcare with someone who worked ‘regular’ hours, appeared to be better supported to combine a clinical academic career with family life.

Gender stereotyping was identified in some reported experiences highlighting a need for appropriate mentorship and for positive role models who were able to demonstrate that it is possible to survive and thrive as a clinical academic with family responsibilities.

Conclusions

Although people manage to find ways to successfully combine clinical academic roles with family life, findings highlight a need to identify ways of supporting and encouraging trainees with caring responsibilities to ensure that they remain on the clinical academic pathway.
Using the WHO safe childbirth checklist to improve essential care delivery as part of the district-wide maternal and newborn health quality improvement initiative, a time series study
Authors: Bitewulign Befikadu , Abdissa Dereje , Mulissa Zewdie , Kiflie Abiyou , Abate Mehiret , Biadgo Abera , Alemu Haregeweyni , Zelalem Meseret , Kassa Munir , Parry Gareth , Magge Hema
Published: August 2021

Background

Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance and patient care. To date, many studies conducted to improve the quality of essential birth care practices (EBPs) have focused primarily on provider- level and have fallen short of the predicted impact on care quality, indicating that a systems approach is needed to improve the delivery of reliable quality care.

This study evaluates the effect of integrating the use of the World Health Organization Safe Childbirth Checklist (WHO-SCC) into a district-wide system improvement collaborative program designed to improve and sustain the delivery of EBPs as measured by “clinical bundle” adherence over-time.

Methods

The WHO-SCC was introduced in the context of a district-wide Maternal and Newborn Health (MNH) collaborative quality of care improvement program in four agrarian Ethiopia regions. Three “clinical bundles” were created from the WHO-SCC: On Admission, Before Pushing, and Soon After Birth bundles. The outcome of each bundle was measured using all- or- none adherence. Adherence was assessed monthly by reviewing charts of live births.

A time-series analysis was employed to assess the effectiveness of system-level interventions on clinical bundle adherence. STATA version 13.1 was used to analyze the trend of each bundle adherence overtime.

Autocorrelation was checked to assess if the assumption of independence in observations collected overtime was valid. Prais-Winsten was used to minimize the effect of autocorrelation.

Findings

Quality improvement interventions targeting the three clinical bundles resulted in improved adherence over time across the four MNH collaborative. In Tankua Abergele collaborative (Tigray Region), the overall mean adherence to “On Admission” bundle was 86% with β = 1.39 (95% CI; 0.47–2.32;P <  0.005) on average monthly.

Similarly, the overall mean adherence to the “Before Pushing” bundle in Dugna Fango collaborative; Southern Nations, Nationalities and People’s (SNNP) region was 80% with β = 2.3 (95% CI; 0.89–3.74;P <  0.005) on average monthly.

Conclusion

Using WHO-SCC paired with a system-wide quality improvement approach improved and sustained quality of EBPs delivery. Further studies should be conducted to evaluate the impact on patient-level outcomes.