bluuebunny/crossref_metadata_2025 huggingface dataset:
Integração entre atenção primária à saúde e atenção especializada: paralelos entre a experiencia Brasileira e Portuguesa
Authors: Morais Nunes Alexandre
Published: June 2020

O presente artigo tem por objetivo analisar os processos desenvolvidos por Brasil e Portugal para integrar a Atenção Primária à Saúde e a Especializada. Entre as iniciativas mais usuais se destacam a conceção da atenção primários como porta de entrada no sistema sendo atribuído papel de destaque ao médico de família, a territorialização dos serviços por proximidade geográfica saúde, o encaminhamento para consultas de especialidade e a adoção de protocolos clínicos consensuados entre ambas as partes. Como principais resultados verificou-se que, no Brasil, ocorreu a implantação de sistemas descentralizados de regulação, e, em Portugal, a criação de unidades locais de saúde (estruturas do ministério da saúde que integra a atenção primária e especializada com uma mesma equipe de gestão). Em conclusão, destaca-se o desafio da necessidade de desenvolvimento de uma política de verdadeiro investimento para reforçar a capacidade de resposta da atenção especializada e para valorizar mais o trabalho dos profissionais da atenção primária, reforçando a cultura de colaboração que contribuíram para o êxito dos processos de integração com resultados visíveis no estado de saúde e satisfação dos usuários.
Processo de regionalização na Bahia, Brasil: desafios para inovação organizaciona
Authors: Dos Santos Adriano Maia , Ferreira dos Santos Fabiana Rodrigues , Carvalho Paiva Jamille Amorim
Published: June 2020

Introdução: As Diretorias Regionais de Saúde (Dires) tinham a função de desconcentrar as responsabilidades administrativas da Secretaria Estadual de Saúde da Bahia, além da incumbência de apoio à gestão da saúde junto aos municípios nas regiões de saúde. Em 2014, com a reforma administrativa na Bahia, as Dires foram extintas e criados os Núcleos Regionais de Saúde (NRS). Método: Trata-se de pesquisa qualitativa que analisou as mudanças ocorridas no processo de regionalização posterior à mudança das Dires em NRS. Resultados: tratou-se de decisão mais burocrática que técnica, abrupta e sem participação dos trabalhadores. A mudança trouxe grande sobrecarga a equipe de profissionais do NRS, o que prejudicou o andamento das atividades e projetos antes desenvolvidos pelas Dires. Conclusão: Permaneceram as antigas estruturas, mas com outros nomes. Houve aprofundamento das precárias estruturas de trabalho e o comprometimento da capacidade das “novas” instâncias em desenvolverem ações na direção do fortalecimento da regionalização, contradizendo a lógica de organização do Sistema Único de Saúde.
Situación de salud de la población privada de la libertad en Colombia. Una revisión sistemática de la literatura
Authors: Lopera Medina Mónica María , Hernández Pacheco Jeniffer
Published: June 2020

Las personas privadas de la libertad (PPL) están sujetas a condiciones adversas para su salud y problemas estructurales en los diferentes establecimientos penitenciarios y carcelarios (EPC) que restringen su resolución. Objetivo: analizar la evidencia científica que permita comprender la situación de salud de las PPL del país. Método: se realizó una revisión sistemática de las investigaciones en salud realizadas en las prisiones de Colombia, en algunas bases de datos y literatura gris, con los siguientes términos: “prisioneros”/“prisiones”, “salud”, “ituación de salud”, “condiciones de vida”, “problemas de salud”. Se abordan temas relacionados con la infraestructura, los principales problemas de salud (par población general y especial), así como sus determinantes cuando fueron explicados. Resultados: existe muy poca literatura científica que permita entender la situación de salud de las PPL. La mayoría de los estudios fueron referidos a problemas de salud mental y enfermedades infecciosas (TB e ITS). Los informes oficiales mostraron que las PPL experimentan condiciones desfavorables que limitan su salud. Conclusiones: en el país la escasa investigación científica limita la evidencia requerida para implementar políticas públicas apropiadas para mejorar la situación de salud, pero la información oficial no parece haber promovido un impacto positivo en la salud.
Industrial Sustainability: Reviewing the Past and Envisioning the Future
Authors: Sutherland John W. , Skerlos Steven J. , Haapala Karl R. , Cooper Daniel , Zhao Fu , Huang Aihua
Published: June 2020

Society's consumption of natural resources and the impact of industrial activities on the environment have gained increasing attention over the last several decades. This paper provides a historical perspective on the origins of the environmental movement and its connection to industrial systems. Then, recent research related to product design, process improvement and change, green manufacturing planning, and the circular economy are described. With respect to product design, topics such as material selection and component light-weighting are considered. For process-related research, efforts such as operation changes and equipment design for reduced energy consumption are discussed. For manufacturing planning, new developments in process planning and production scheduling are highlighted that consider environmental performance. The concept of circular economy is examined critically, with particular emphasis placed on closing materials loops via recycling and remanufacturing. The paper concludes with a discussion of challenges and opportunities to achieve the goal of industrial sustainability.
Combined Effects of Steam Wetness and Pressure on Characteristics of Acoustic Resonance Amplitude in Closed Side Branch
Authors: Uchiyama Yuta , Morita Ryo
Published: June 2020

Steam piping and components in many industrial applications such as power plants sometimes experience structural vibration and fatigue damage caused by flow-induced acoustic resonance in piping with closed side branches. The state of steam in the steam piping can be not only dry (superheated) steam but also wet steam (i.e., a two-phase flow comprising a mixture of saturated steam and saturated water). From our prior research on the general characteristics of acoustic resonance under wet steam flows, the maximum pressure amplitudes under low-pressure wet steam were significantly lower than those under dry steam, which is considered to be caused by the presence of a liquid phase. Here, we investigate how the steam wetness and steam pressure affect the maximum pressure amplitude since practical steam piping may be exposed to various conditions. Experiments on acoustic resonance in a single side branch were conducted under high-quality wet steam flows with a steam pressure of up to 0.8 MPa and a steam quality of 0.9 < x < 1.0 as parameters. For our experimental conditions, it was confirmed that the steam pressure and steam state had little impact on the critical Strouhal number, whereas the maximum amplitudes under wet steam were markedly lower than those under dry steam. Different dependences of the maximum amplitude on the Reynolds number were confirmed for dry steam and wet steam. Moreover, the reduction of the maximum pressure amplitude under wet steam was affected by both the void fraction and the density ratio.
Microwave ablation in the treatment of liver tumors. A better tool or simply more power?
Authors: Sparchez Zeno , Mocan Tudor , Radu Pompilia , Nenu Iuliana , Comsa Mihai , Hajjar Nadim Al , Mois Emil , Bartos Adrian , Kacso Gabriel , Sparchez Mihaela
Published: June 2020

It has been a long time since tumor ablation was first tested in patients with liver cancer, especially hepatocellular carcinoma. Since than it has become a first line treatment modality for hepatocellular carcinoma. Over the years, the indications of thermal ablation have expanded to colorectal cancer liver metastases and intrahepatic cholangiocarcinoma as well. Together with the new indication for ablation, new ablation devices have been developed as well. Among them microwave ablation shows potential in replacing radiofrequency ablation as the preferred method of thermal ablation in liver cancer. The debate whether radiofrequency or microwave ablation should be the preferred method of treatment in patients with liver cancer remains open. The main purpose of this review is to offer some answers to the question: Microwave ablation in liver tumors: a better tool or simply more power? Various clinical scenarios will be analyzed including small, medium, and intermediate size hepatocellular carcinoma, colorectal cancer liver metastases and intrahepatic cholangiocarcinoma. Furthermore, the advantages, limitations, and technical considerations of MWA treatment will be provided also.
Patterning nickel for extreme ultraviolet lithography mask application I. Atomic layer etch processing
Authors: Sang Xia , Chen Ernest , Chang Jane P.
Published: June 2020

The stringent requirement for patterning highly absorbing metal thin films as a mask for the next-generation extreme ultra-violet lithography system dictates the development of an atomic layer etching process to tailor the etch rate and the etch profile. A “plasma-thermal” atomic layer etching process is developed where an oxygen plasma is used to convert the metallic Ni layer into NiO, followed by formic acid vapor reacting with NiO to form nickel formate [Ni(COOH)2], thereby removing nickel. The directionality of the oxygen ions is used to create a directional chemical conversion of Ni into NiO, resulting in an anisotropic etch profile. Using the SiO2 patterned Ni thin film, a high etching selectivity to the mask (virtually no etching of SiO2) and a high etching anisotropy (a sidewall angle up to 87°) are achieved.
Loss of membrane asymmetry alters the interactions of erythrocytes with engineered silica nanoparticles
Authors: Bigdelou Parnian , Vahedi Amid , Kiosidou Evangelia , Farnoud Amir M.
Published: June 2020

Disruption of plasma membrane integrity is a primary mechanism of nanoparticle toxicity in cells. Mechanistic studies on nanoparticle-induced membrane damage have been commonly performed using model membranes with a focus on symmetric bilayers, overlooking the fact that the membrane has an asymmetric phospholipid composition. In this study, erythrocytes with normal and scrambled membrane asymmetry were utilized to examine how the loss of membrane asymmetry and the resulting alterations in the outer leaflet lipid composition affect nanoparticle-membrane interactions. Unmodified, amine-modified, and carboxyl-modified silica (30 nm) were used as nanoparticle models. Loss of membrane asymmetry was achieved by induction of eryptosis, using a calcium ionophore. Erythrocyte membrane disruption (hemolysis) by unmodified silica nanoparticles was significantly reduced in eryptotic compared to healthy cells. Amine- and carboxyl-modified particles did not cause hemolysis in either cell. In agreement, a significant reduction in the binding of unmodified silica nanoparticles to the membrane was observed upon loss of membrane asymmetry. Unmodified silica particles also caused significant cell deformation, changing healthy erythrocytes into a spheroid shape. In agreement with findings in the cells, unmodified particles disrupted vesicles mimicking the erythrocyte outer leaflet lipid composition. The degree of disruption and nanoparticle binding to the membrane was reduced in vesicles mimicking the composition of scrambled membranes. Cryo-electron microscopy revealed the presence of lipid layers on particle surfaces, pointing to lipid adsorption as the mechanism for vesicle damage. Together, findings indicate an important role for the lipid composition of the membrane outer leaflet in nanoparticle-induced membrane damage in both vesicles and erythrocytes.
Mode matching in axisymmetric fluid-filled pipes: Scattering by a flange
Authors: Williams Paul , Kirby Ray , Hill James
Published: June 2020

Long range ultrasonic testing of pipelines sends an ultrasonic wave along a pipe wall and then detects scattering from defects present. It is well known that scattering by pipe fixtures and fittings, such as a flange, can cause distortion and interfere with the ability to identify defects. This article develops a theoretical model to investigate scattering from a flange in a fluid-filled pipe with elastic walls. Mode matching is used as this is a computationally efficient way to examine long lengths of pipe and for enforcing the appropriate axial continuity conditions over area discontinuities. A recent article presented a mode matching approach for a similar problem, and it is demonstrated here that a re-casting of the equations is necessary to ensure all of the appropriate matching conditions are enforced. Mode matching predictions are also compared with an alternative point collocation approach in order to provide an independent benchmark. Excellent agreement between mode matching and point collocation is demonstrated, and reflection and transmission coefficients are generated in order to show the resonant behaviour of a flange and illustrate that its influence is significant and strongly frequency dependent.
Mate discrimination among subspecies through a conserved olfactory pathway
Authors: Khallaf Mohammed A. , Auer Thomas O. , Grabe Veit , Depetris-Chauvin Ana , Ammagarahalli Byrappa , Zhang Dan-Dan , Lavista-Llanos Sofía , Kaftan Filip , Weißflog Jerrit , Matzkin Luciano M. , Rollmann Stephanie M. , Löfstedt Christer , Svatoš Aleš , Dweck Hany K. M. , Sachse Silke , Benton Richard , Hansson Bill S. , Knaden Markus
Published: June 2020

Differential interpretation of a sex pheromone promotes formation of new species in
Drosophila
.
Phosphoregulation of a Conserved Herpesvirus Tegument Protein by a Virally Encoded Protein Kinase in Viral Pathogenicity and Potential Linkage between Its Evolution and Viral Phylogeny
Authors: Shibazaki Misato , Kato Akihisa , Takeshima Kosuke , Ito Jumpei , Suganami Mai , Koyanagi Naoto , Maruzuru Yuhei , Sato Kei , Kawaguchi Yasushi
Published: June 2020

It has been hypothesized that the evolution of protein phosphoregulation drives phenotypic diversity across species of organisms, which impacts fitness during their evolution. However, there is a lack of information regarding linkage between the evolution of viral phosphoregulation and the phylogeny of virus species. In this study, we clarified the novel HSV-2 Us3 phosphoregulation of UL7 in infected cells, which is important for viral replication and pathogenicity
in vivo
. We also showed that the evolution of Us3 phosphoregulation of UL7 was linked to the phylogeny of viruses that are phylogenetically close to HSV-2 and to the phosphorylation requirements for the efficient
in vivo
viral fitness of HSV-2 and HSV-1, which are representative of viruses that have and have not evolved phosphoregulation, respectively. This study reports the first evidence showing that evolution of viral phosphoregulation coincides with phylogeny of virus species and supports the hypothesis regarding the evolution of viral phosphoregulation during viral evolution.
Cell Division Protein FtsZ Is Unfolded for N-Terminal Degradation by Antibiotic-Activated ClpP
Authors: Silber Nadine , Pan Stefan , Schäkermann Sina , Mayer Christian , Brötz-Oesterhelt Heike , Sass Peter
Published: June 2020

Acyldepsipeptide (ADEP) antibiotics effectively kill multidrug-resistant Gram-positive pathogens, including vancomycin-resistant enterococcus, penicillin-resistant
Streptococcus pneumoniae
(PRSP), and methicillin-resistant
Staphylococcus aureus
(MRSA). The antibacterial activity of ADEP depends on a new mechanism of action, i.e., the deregulation of bacterial protease ClpP that leads to bacterial self-digestion. Our data allow new insights into the mode of ADEP action by providing a molecular explanation for the distinct bacterial phenotypes observed at low versus high ADEP concentrations. In addition, we show that ClpP alone, in the absence of any unfoldase or energy-consuming system, and only activated by the small molecule antibiotic ADEP, leads to the unfolding of the cell division protein FtsZ.
Temporal Control of the Helicobacter pylori Cag Type IV Secretion System in a Mongolian Gerbil Model of Gastric Carcinogenesis
Authors: Lin Aung Soe , McClain Mark S. , Beckett Amber C. , Caston Rhonda R. , Harvey M. Lorena , Dixon Beverly R. E. A. , Campbell Anne M. , Shuman Jennifer H. B. , Sawhney Neha , Delgado Alberto G. , Loh John T. , Piazuelo M. Blanca , Algood Holly M. Scott , Cover Timothy L.
Published: June 2020

The “hit-and-run model” of carcinogenesis proposes that an infectious agent triggers carcinogenesis during initial stages of infection and that the ongoing presence of the infectious agent is not required for development of cancer.H. pyloriinfection and actions of CagA (an effector protein designated a bacterial oncoprotein, secreted by the Cag T4SS) are proposed to constitute a paradigm for hit-and-run carcinogenesis. In this study, we report the development of methods for controllingH. pyloriCag T4SS activityin vivoand demonstrate that Cag T4SS activity contributes to gastric carcinogenesis. We also show that Cag T4SS activity during an early stage of infection is sufficient to initiate a cascade of cellular alterations leading to gastric inflammation and gastric cancer at later time points.
Berberine Chloride is an Alphavirus Inhibitor That Targets Nucleocapsid Assembly
Authors: Wan Judy J. , Brown Rebecca S. , Kielian Margaret
Published: June 2020

The alphavirus chikungunya virus (CHIKV) is an example of an emerging human pathogen with increased and rapid global spread. Although an acute CHIKV infection is rarely fatal, many patients suffer from debilitating chronic arthralgia for years. Antivirals against chikungunya and other alphaviruses have been identified
in vitro
, but to date none have been shown to be efficacious and have been licensed for human use. Here, we investigated a small molecule, berberine chloride (BBC), and showed that it inhibited infectious virus production by several alphaviruses including CHIKV. BBC acted on a late step in the alphavirus exit pathway, namely the formation of the nucleocapsid containing the infectious viral RNA. Better understanding of nucleocapsid formation and its inhibition by BBC will provide important information on the mechanisms of infectious alphavirus production and may enable their future targeting in antiviral strategies.
Genetic Variation Bias toward Noncoding Regions and Secreted Proteins in the Rice Blast Fungus Magnaporthe oryzae
Authors: Zhong Zhenhui , Chen Meilian , Lin Lianyu , Chen Ruiqi , Liu Dan , Norvienyeku Justice , Zheng Huakun , Wang Zonghua
Published: June 2020

Plants “lose” resistance toward pathogens shortly after their widespread emergence in the field because plant pathogens mutate and adapt rapidly under resistance selection. Thus, the rapid evolution of pathogens is a serious threat to plant health. Extensive studies have evaluated natural pathogen populations to understand their evolutionary effects; however, the study of the dynamic processes of the mutation and adaptation of plant pathogens to host plants remains limited. Here, by performing an experimental evolution study, we found a bias in genetic variation toward noncoding regions and SPs in the rice blast fungus
Magnaporthe oryzae
, which explains the ability of the rice blast fungus to maintain high virulence variation to overcome rice resistance in the field.
Siderophore-Mediated Interactions Determine the Disease Suppressiveness of Microbial Consortia
Authors: Gu Shaohua , Yang Tianjie , Shao Zhengying , Wang Tao , Cao Kehao , Jousset Alexandre , Friman Ville-Petri , Mallon Cyrus , Mei Xinlan , Wei Zhong , Xu Yangchun , Shen Qirong , Pommier Thomas
Published: June 2020

Soil-borne pathogens cause high losses in crop yields globally. The development of environmentally friendly approaches is urgently needed, but is often constrained by complex interactions between root-associated microbes and pathogens. Here, we demonstrate that the interactions within microbial consortia mediated by iron-scavenging siderophores play an important role in reducing pathogen infection and enhancing plant health. This study provides a promising and novel research direction for dealing with a wide range of microbial infections through iron exploitation, which is important for the colonization and infection of both plant and human hosts by pathogens.
Case of vago-glossopharyngeal neuralgia secondary to metastatic oropharyngeal cancer
Authors: Whitman Melissa Anne , Jefferson Artrish , Pincelli Thais , Sanghavi Devang K
Published: June 2020

Glossopharyngeal neuralgia (GN) is a rare pain syndrome caused by compression of the glossopharyngeal nerve. It is typically idiopathic and often goes misdiagnosed because of its similarities to trigeminal neuralgia. Vago-glossopharyngeal neuralgia, an even rarer subset of GN, occurs when the pain is accompanied by syncope and/or arrhythmia. Here, we present the case of a 54-year-old man with oropharyngeal cancer that metastasised to areas within his left carotid sheath. He presented with numerous intermittent episodes of pain, accompanied by vagal episodes. While this presentation is similarly described in prior case reports, our case is unique in that the syndrome occurred as a direct sequelae of a metastatic tumour completely encasing the left internal carotid artery.
Angiotensin II for the treatment of septic shock in a neutropenic patient with T-cell acute lymphoblastic leukaemia
Authors: Bui Albert D , Helgeson Scott A , Guru Pramod K , Sanghavi Devang K
Published: June 2020

Mortality remains high in septic shock with few new treatment options. Angiotensin II has been recently approved for use in septic shock due to promising results in the ATHOS-3 trial. However, patients with neutropenia were excluded in the trial. This patient population is becoming increasingly common in the intensive care unit as there is an increase in novel biologic therapies and stem cell transplantations for haematological and solid organ malignancies. We present a case of a patient with T-cell acute lymphoblastic leukaemia who received chemotherapy, resulting in neutropenia and septic shock. There was persistent hypotension despite initiating multiple conventional vasopressors. Angiotensin II was attempted with immediate improvement in the blood pressure which resulted in weaning of other vasopressors. This positive haemodynamic response suggests that angiotensin II can successfully be used in neutropenic patients without increasing the overall catecholamine burden of septic shock.
Light chain proximal tubulopathy with cast nephropathy in monoclonal gammopathy of renal significance
Authors: Chopra Rebaika , Santana de Roberts Rosalba , Batal Ibrahim , Batra Sachin , Jim Belinda
Published: June 2020

Kidney tubular disorders due to monoclonal immunoglobulin light chains are common manifestations of B-cell neoplasm. Cast nephropathy (CN) is the most frequent type of these disorders and may present with acute kidney injury (AKI) due to the presence of excess light chains in the distal tubules. Light chain proximal tubulopathy (LCPT) is an uncommon form of renal disease and may present as Fanconi syndrome due to proximal tubular cell damage by intracellular deposition of light chains. The concomitant disorder of both CN and LCPT is rare given the inherent differences in the biochemical properties of the immunoglobulin light chains of each disorder. We report a 64-year-old man who presented with AKI and Fanconi syndrome who was discovered to have both CN and LCPT due to the underlying disorder of monoclonal gammopathy of renal significance and who has responded favourably with conventional chemotherapy. We also review the existing literature on this interesting subject.
Novel accessory safety footswitch permitting dual control of surgical electrical diathermy: an asset in risk management in surgical training?
Authors: Eisawi Abdalla , Aung Myat , Canelo Ruben
Published: June 2020

Introduction

Human error contributes to the majority of adverse events in the operating theatre environment. Many processes exist to limit the incidence of such adverse events. However, the role of technology and device advancement has been limited in this respect.

Methods

A dual-controlled accessory electrical diathermy footswitch (abortive diathermy footswitch device or ADF) concept was developed in an attempt to improve patient safety in theatre. The activation of the ADF allows a senior surgeon to control the activation of diathermy devices by a junior surgeon by deactivating diathermy devices when the ADF footswitch is operated.

Results

The ADF device was constructed as a final working and tested prototype in association with the local medical engineering department at the Cumberland Infirmary in Carlisle. The device was clinically tested during two separate theatre sessions involving five elective laparoscopic cholecystectomies.

Conclusions

We demonstrated the feasibility and functionality of the ADF device and propose a role in surgical training through potentially limiting surgical errors associated with the use of electrical diathermy during training and expanding accessible surgical experience.
Implementation of interventions targeting the uptake of genetic testing services for breast cancer risk: protocol for a systematic review
Authors: Thapa Subash , Leppin Anja , Kristensen Rikke , Just Bonde Mette , Aro Arja R
Published: June 2020

Introduction

The timely identification of breast cancer-related pathogenic variants can help to identify the risk of potential disease development and determine healthcare choices. However, the uptake rate of genetic testing services for breast cancer risk remains low in many countries. Interventions targeting the uptake of these services among individuals potentially at risk for inherited breast cancer are often complex and have multiple components, and are therefore difficult to implement, replicate and disseminate to new contexts. Our aim is to systematically review studies targeting the uptake of genetic testing services for breast cancer risk and critically assess the quality of implementation outcomes and the reporting of intervention descriptions.

Methods and analysis

PubMed, CINAHL, PsycINFO, Embase, Cochrane Library and all Campbell Coordinating Group databases will be searched for intervention studies that target individuals' participation in breast cancer genetic testing programmes. Papers published in English within the time period from January 2005 until October 2019 will be considered for inclusion. Titles, abstracts and full papers will be screened for eligibility by two pairs of reviewers independently. For data analysis and synthesis, study-level and intervention-level characteristics will be abstracted. We will present all implementation outcomes that are mentioned in each of the studies and register the number of studies that do not at all look at or report implementation outcomes. The quality of implementation will be checked using a 5-point rubric item, and the quality and completeness of reporting of intervention description will be evaluated using the 12-item Template for Intervention Description and Replication (TIDieR).

Ethics and dissemination

Ethical approval is not required to conduct this review. Review findings will be disseminated to academic and non-specialist audiences via peer-reviewed academic journals and presented at appropriate conferences, workshops and meetings to policymakers, practitioners and organisations that work with our population of interest.

PROSPERO registration number

CRD42018105732.
The Problem-Solving Decision-Making scale—translation and validation for the Portuguese language: a cross-sectional study
Authors: Gregório Micaela , Teixeira Andreia , Páscoa Rosália , Baptista Sofia , Carvalho Rosa , Martins Carlos
Published: June 2020

Objectives

To translate and validate the Problem-Solving Decision-Making scale instrument into the Portuguese language.

Design

Cross-sectional study.

Setting: participants

The Problem-Solving Decision-Making scale was translated from English to Portuguese and then back-translated to obtain a final version. The questionnaire was then applied face-to-face from January to March 2019 in a representative sample of the Portuguese population (n=301 people aged 20 years or more) to validate the Problem-Solving Decision-Making scale in a Portuguese population.

Outcomes

Principal component analysis and Cronbach’s alpha.

Results

Principal component analysis was used to evaluate the validity of the internal structure of the scale. The results identified two components: problem-solving and decision-making with an explained variance of 65.9%. For internal consistency, three different techniques were used and applied to the two components. All of the items have very good internal consistency (problem-solving Cronbach’s alpha=0.931 and decision-making Cronbach’s alpha=0.951).

Conclusions

The validation of the Portuguese scale agreed well with the existing literature. The scale can be divided into two components: the problem-solving component and the decision-making component. The translated scale demonstrated good internal consistency and can therefore be used in future studies.
Mortality of ethnic minority groups in the UK: a systematic review protocol
Authors: Stanaway Fiona , Noguchi Naomi , Mathieu Erin , Khalatbari-Soltani Saman , Bhopal Raj
Published: June 2020

Introduction

Growing ethnic diversity in the UK has made it increasingly important to determine the presence of ethnic health inequalities. There has been no systematic review that has drawn together research on ethnic differences in mortality in the UK.

Methods

All types of observational studies that compare all-cause mortality between major ethnic groups and the white majority population in the UK will be included. We will search Medline (OvidSP), Embase (OvidSP), Scopus and Web of Science and search the grey literature through conference proceedings and online thesis registries. Searches will be carried out from inception to 2 August 2019 with no language or other restrictions. Database searches will be repeated prior to publication to identify new articles published since the initial search. We will conduct forward and backward citation tracking of identified references and consult with experts in the field to identify further publications and ongoing or unpublished studies. Two reviewers will independently screen studies and extract data. Two reviewers will independently assess the quality of included studies using the Newcastle-Ottawa Scale. If at least two studies are located for each ethnic group and studies are sufficiently homogeneous, we will conduct a meta-analysis. If insufficient studies are located or if there is high heterogeneity we will produce a narrative summary of results.

Ethics and dissemination

As no primary data will be collected, formal ethical approval is not required. The findings of this review will be disseminated through publication in peer reviewed journals and conference presentations.

PROSPERO registration number

CRD42019146143.
Social factors associated with chronic non-communicable disease and comorbidity with mental health problems in India: a scoping review
Authors: Madavanakadu Devassy Saju , Benny Anuja Maria , Scaria Lorane , Nannatt Anjana , Fendt-Newlin Meredith , Joubert Jacques , Joubert Lynette , Webber Martin
Published: June 2020

Objectives

The purpose of this study is to examine the existing literature of the major social risk factors which are associated with diabetes, hypertension and the comorbid conditions of depression and anxiety in India.

Design

Scoping review.

Data sources

Scopus, Embase, CINAHL Plus, PsycINFO, Web of Science and MEDLINE were searched for through September 2019.

Eligibility criteria for selecting studies

Studies reporting data on social risk factors for diabetes or hypertension and depression or anxiety in community-based samples of adults from India, published in English in the 10 years to 2019, were included. Studies that did not disaggregate pooled data from other countries were excluded.

Data extraction and synthesis

Two independent reviewers extracted study aims; methods; sample size and description; demographic, social and behavioural risk factors and a summary of findings from each paper. Risk factors were synthesised into six emergent themes.

Results

Ten studies were considered eligible and included in this review. Nine presented cross-sectional data and one was a qualitative case study. Six themes emerged, that is, demographic factors, economic aspects, social networks, life events, health barriers and health risk behaviours.

Conclusions

Literature relating to the major social risk factors associated with diabetes, hypertension and comorbid depression and anxiety in India is sparse. More research is required to better understand the interactions of social context and social risk factors with non-communicable diseases and comorbid mental health problems so as to better inform management of these in the Indian subcontinent.
Investigating foods and beverages sold and advertised in deprived urban neighbourhoods in Ghana and Kenya: a cross-sectional study
Authors: Green Mark Alan , Pradeilles Rebecca , Laar Amos , Osei-Kwasi Hibbah , Bricas Nicolas , Coleman Nathaniel , Klomegah Senam , Wanjohi Milka Njeri , Tandoh Akua , Akparibo Robert , Aryeetey Richmond Nii Okai , Griffiths Paula , Kimani-Murage Elizabeth W , Mensah Kobby , Muthuri Stella , Zotor Francis , Holdsworth Michelle
Published: June 2020

Objectives

The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods.

Design

Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability.

Setting

Three deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya).

Main outcome measure

Types of foods and beverages sold and/or advertised.

Results

Jamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets.

Conclusion

Our study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.
Service users’ experiences of contacting NHS patient medicines helpline services: a qualitative study
Authors: Williams Matt , Jordan Abbie , Scott Jennifer , Jones Matthew D
Published: June 2020

Objectives

Patient medicines helpline services (PMHS) are available from some National Health Service (NHS) Trusts in the UK to provide medicines information to hospital patients and carers. To date, studies of PMHS have examined the views of service users via satisfaction surveys. This study used qualitative methods to explore service users’ experiences of using a PMHS, including perceived benefits and areas for improvement.

Design

Qualitative, using semi-structured interviews.

Setting

This study was conducted across seven NHS Trusts in England.

Participants

Forty users of PMHS were individually interviewed over the telephone. Interviews were audio-recorded, transcribed verbatim and analysed using Braun and Clarke’s inductive reflexive thematic analysis. Ethical approval was obtained before study commencement.

Results

Participants predominantly called a PMHS for themselves (82%; carers: 18%). Two main themes were generated. Theme 1: timeliness—PMHS provide support during the uncertain transition of care period from hospital to home, when patients and carers often feel vulnerable because support is less available. PMHS met service users’ needs for timely and easily accessible support, and quick resolution of their issues. PMHS could be improved with staffing beyond typical work week hours, and by having staff available to answer calls instead of using an answerphone. Theme 2: PMHS are best-placed to help—PMHS were perceived as best-placed to answer enquiries that arose from hospital care. Service users felt reassured from speaking to pharmacy professionals, and PMHS were perceived as the optimal service in terms of knowledge and expertise regarding medicines-related questions. However, several participants were initially unaware that their PMHS existed.

Conclusions

PMHS are perceived to be a valuable means of accessing timely medicines-related support when patients and carers may be feeling particularly vulnerable. However, their availability and promotion could be improved. We recommend that providers of PMHS consider whether this is achievable, in order to better meet the needs of service users.
Systematic review protocol examining sex differences in survival among low birthweight newborns and infants in sub-Saharan Africa
Authors: Gebremeskel Akalewold T , Fantaye Arone W , Faust Lena E , Yaya Sanni
Published: June 2020

Introduction

In sub-Saharan African countries, low birthweight (LBW) accounts for three-quarters of under-five mortality and morbidity. However, there is no systematic evidence of sex differences in LBW survival risk. The aim of this protocol is to outline the methodological process of a systematic review that will gather qualitative and quantitative data on sex differences in survival among LBW newborns and infants in sub-Saharan Africa.

Methods

This protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols reporting guidelines. We will conduct a systematic review to retrieve all qualitative and quantitative studies. Electronic search strategies are being finalised on 24 February 2020 for Ovid Medline and EMBASE, and on 28 February 2020 for CINAHL, Scopus and Global Health in collaboration with a Health Sciences librarian. The primary outcome of interest is indicating sex differences in survival among LBW newborns and infants. Secondary outcomes are sex-disaggregated differences in morbidity among LBW newborns and infants. Screening, data extraction and assessments of risk of bias will be performed independently. Narrative synthesis and a meta-analysis will be conducted with studies that are compatible based on population and outcome. The systematic review is focused on the analysis of secondary data and does not require ethics approval.

Ethics and dissemination

As it will be a systematic review, without human participants’ involvement, there will be no requirement for ethical approval. The systematic review will present key evidence of sex-disaggregated differences in mortality and morbidity among LBW newborns and infants in sub-Saharan Africa. Programme managers, policy-makers and researchers can use the findings to evaluate LBW health outcomes in different sexes. The final manuscript will be disseminated through a peer-reviewed journal and scientific conferences.

PROSPERO registration number

CRD42020163470
Digital epidemiological and citizen science methodology to capture prospective physical activity in free-living conditions: a SMART Platform study
Authors: Katapally Tarun Reddy , Chu Luan Manh
Published: June 2020

Objectives

The purpose of this study was to develop a replicable methodology of mobile ecological momentary assessments (EMAs) to capture prospective physical activity (PA) within free-living social and physical contexts by leveraging citizen-owned smartphones running on both Android and iOS systems.

Design

Data were obtained from the cross-sectional pilots of the SMART Platform, a citizen science and mobile health initiative.

Setting

The cities of Regina and Saskatoon, Canada.

Participants

538 citizen scientists (≥18 years) provided PA data during eight consecutive days using a custom-built smartphone application, and after applying a rigid inclusion criteria, 89 were included in the final analysis.

Outcome measures

EMAs enabled reporting of light, moderate, and vigorous PA, as well as physical and social contexts of PA. Retrospective PA was reported using International Physical Activity Questionnaire (IPAQ). For both measures, PA intensities were categorised into mean minutes of light and moderate-to-vigorous PA per day. Wilcoxon signed ranks tests and Spearman correlation procedures were conducted to compare PA intensities reported via EMAs and IPAQ.

Results

Using EMAs, citizen scientists reported 140.91, 87.16 and 70.38 mean min/day of overall, light and moderate-to-vigorous PA, respectively, whereas using IPAQ they reported 194.39, 116.99 and 98.42 mean min/day of overall, light and moderate-to-vigorous PA, respectively. Overall (ρ=0.414, p<0.001), light (ρ=0.261, p=0.012) and moderate-to-vigorous PA (ρ=0.316, p=0.009) were fairly correlated between EMA and IPAQ. In comparison with EMAs, using IPAQ, citizen scientists reported significantly greater overall PA in active transportation (p=0.002) and recreation, sport and leisure-time domains (p=0.003).

Conclusions

This digital epidemiological and citizen science methodology adapted mobile EMAs to capture not only prospective PA, but also important physical and social contexts within which individuals accumulate PA. Ubiquitous tools can be leveraged via citizen science to capture accurate active living patterns of large populations in free-living conditions through innovative EMAs.
Generic outcome set for the international registry on Laser trEAtments in Dermatology (LEAD): a protocol for a Delphi study to achieve consensus on what to measure
Authors: Fransen Frederike , Spuls Phyllis , Alam Murad , Badawi Ashraf , Boixeda Pablo , Haedersdal Merete , Hamzavi Iltefat , Hedelund Lene , Kelly Kristen M , Kono Tara , Laubach Hans Joachim , Manuskiatti Woraphong , Marini Leonardo , Nouri Keyvan , Paasch Uwe , Passeron Thierry , Prinsen Cecilia A.C. (Sanna) , Verner Ines , Wolkerstorfer Albert
Published: June 2020

Introduction

While laser technology has expanded the armamentarium of treatment for various skin diseases during the past years, heterogeneity in study outcomes hampers comparability and appropriate evidence synthesis. Part of these issues can be addressed by developing a generic outcome set. Using the Delphi method, this study aims to seek consensus between key stakeholders on relevant generic outcomes (what to measure) for implementation in the international registry on Laser trEAtments in Dermatology (LEAD). The registry is focused on collecting research data on various laser treatments for skin disorders.

Methods and analysis

By reviewing the literature and involvement of key stakeholder groups and adult patients in need or after laser surgery and health professionals, a preliminary list of outcomes will be generated and categorised into domains. Using these outcomes, an international three-round Delphi study will be performed to rate the importance of outcomes in the selection of a generic outcome set. Participants are allowed to provide new outcomes to the preliminary list for revisions during the first Delphi round. Finally, results will be discussed during a consensus meeting to agree on generic outcomes to be used in the LEAD registry.

Ethics and dissemination

An ethics approval was not applicable (W19_290 # 18.336). The study is registered with the Cochrane Skin Core OUtcome Set INitiative) and the Core Outcome Measures in Effectiveness Trials initiative. Procedures will be conducted according to the Declaration of Helsinki. The findings will be disseminated through peer-reviewed publications and conference presentations.
Sevoflurane topical analgesia for intractable pain with suicidal ideation
Authors: Fernández-Ginés F Dámaso , Cortiñas-Sáenz Manuel , Selva-Sevilla Carmen , Gerónimo-Pardo Manuel
Published: June 2020

Proper symptom management to improve quality of dying is mandatory in palliative care patients. Home-based control of pain caused by leg ulcers is challenging, especially when the pain is severe and refractory to conventional analgesics, the patient is intolerant to opioids and refuses invasive measures. This was the case for an 87-year-old woman under oncological palliative care who suffered from a leg ulcer causing refractory pain, which produced suicidal ideation. Leg amputation was indicated, but she had signed a living will refusing any invasive measures. After obtaining written informed consent, sevoflurane was applied topically on the ulcer, which resulted in a rapid and long-lasting reduction of pain. Daily self-administration of sevoflurane successfully controlled the wound pain and the patient abandoned her suicidal ideation, the wound healed 35 days later, and her quality of dying improved remarkably. Topical sevoflurane deserves further research on ulcers of vascular and also neoplastic aetiology.
Parecoxib for opioid-induced hyperalgesia
Authors: Kellett Emily , Berman Richard , Morgan Helen , Collins Joanne
Published: June 2020

This paper describes the case report of a patient admitted to hospital with severe and complex pain and subacute bowel obstruction, who failed to respond to multiple analgesic regimens including ketamine burst and opioid rotation, and was subsequently successfully managed with a parecoxib infusion.
Prediction of adverse cardiac events in pregnant women with valvular rheumatic heart disease
Authors: Baghel Jyoti , Keepanasseril Anish , Pillai Ajith Ananthakrishna , Mondal Nivedita , Jeganathan Yavanasuriya , Kundra Pankaj
Published: June 2020

Objective

To assess the incidence of adverse cardiac events in pregnant women with rheumatic valvular heart disease (RHD) and to derive a clinical risk scoring for predicting it.

Methods

This is an observational study involving pregnant women with RHD, attending a tertiary centre in south India. Data regarding obstetric history, medical history, maternal complications and perinatal outcome till discharge were collected. Eight-hundred and twenty pregnancies among 681 women were included in the analysis. Primary outcome was composite adverse cardiac event defined as occurrence of one or more of complications such as death, cardiac arrest, heart failure, cerebrovascular accident from thromboembolism and new-onset arrhythmias.

Results

Of the 681 women with RHD, 180 (26.3%) were diagnosed during pregnancy. Composite adverse cardiac outcome during pregnancy/post partum occurred in 122 (14.9%) pregnancies, with 12 of them succumbed to the disease. In multivariate analysis, prior adverse cardiac events (OR=8.35, 95% CI 3.54 to 19.71), cardiac medications at booking (OR=0.53, 95% CI 0.32 to 0.86), mitral stenosis (mild OR=2.48, 95% CI 1.08 to 5.69; moderate OR=2.23, 95% CI 1.19 to 4.18; severe OR=7.72,95% 4.05 to 12.89), valve replacement (OR=2.53, 95% CI 1.28 to 5.02) and pulmonary hypertension (OR=6.90, 3.81 to 12.46) were predictive of composite adverse cardiac events with a good discrimination (area under the curve=0.803) and acceptable calibration. A predictive score combining these factors is proposed for clinical utility.

Conclusion

Heart failure remains the most common adverse cardiac event during pregnancy or puerperium. Combining the lesion-specific characteristics and clinical information into a predictive score, which is simple and effective, could be used in routine clinical practice.