bluuebunny/crossref_metadata_2025 huggingface dataset:
Recovery services and expectation of consumers and mental health professionals in community-based residential facilities of Ghana
Authors: Gyamfi Naomi , Badu Eric , Mprah Wisdom Kwadwo , Mensah Isaac
Published: July 2020

Background

In the past decades, considerable global attention has been drawn to recovery services that seek to promote the personal recovery journey of consumers with mental illness. However, in most settings, including Ghana, limited empirical studies have attempted to explore, from the perspectives of Mental Health Professionals (MHPs) and consumers, the effectiveness of recovery services and expectation towards the recovery. This study, therefore, explored consumers’ and MHPs perspectives concerning recovery services and expectations towards recovery in two community-based residential facilities in Ghana.

Methods

A qualitative method, involving in-depth interviews and observations, were used to collect data from 24 participants (5 MHPs and 19 consumers). Thematic analysis was used to analyze the data.

Results

The study identified three global themes and nine organizing themes. The global themes were recovery services offered to consumers, expectation regarding personal recovery and challenges in achieving recovery. The study found that recovery services were expected to improve the internal and external recovery processes of consumers. The internal recovery process was independent living whilst the external recovery process were management of illness, economic empowerment and social inclusion. Several systemic and consumer-related factors influenced consumers’ and MHPs expectation concerning the recovery journey.

Conclusion

The study concludes that the government should prioritize the use of recovery services through policies, financial incentives, infrastructure support, and adequate training of MHPs.
Design and psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services: a sequential exploratory study
Authors: Simbar Masoumeh , Rahmanian Fatemeh , Nazarpour Soheila , Ramezankhani Ali , Eskandari Narges , Zayeri Farid
Published: July 2020

Background

Providing gender sensitive reproductive health service is recently emphasized by health organizations. This study aims to develop and assess psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services (GS-PNCS) to be used by managers of perinatal services.

Methods

This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, 34 participants were interviewed and the items were generated. To evaluate the validity; face, content and construct validity were assessed. The reliability was assessed by internal consistency and stability calculation.

Results

The content validity and reliability were demonstrated by S-CVR = 0.92 and S-CVI = 0.98, Cronbach’s α = 0.880 and the ICC = 0.980 to 0.947. Exploratory factor analysis showed 8 factors which explained more than 52.53% of the variance.

Conclusion

GS-PNCS is a valid and reliable questionnaire, with 49 items to assess gender sensitivity of perinatal care services and helps health care managers and planners to improve the quality of the services.
A comparison of passive surveillance and active cluster-based surveillance for dengue fever in southern coastal Ecuador
Authors: Vitale Melissa , Lupone Christina D. , Kenneson-Adams Aileen , Ochoa Robinson Jaramillo , Ordoñez Tania , Beltran-Ayala Efráin , Endy Timothy P. , Rosenbaum Paula F. , Stewart-Ibarra Anna M.
Published: July 2020

Background

Dengue is a major emerging infectious disease, endemic throughout the tropics and subtropics, with approximately 2.5 billion people at risk globally. Active (AS) and passive surveillance (PS), when combined, can improve our understanding of dengue’s complex disease dynamics to guide effective, targeted public health interventions. The objective of this study was to compare findings from the Ministry of Health (MoH) PS to a prospective AS arbovirus research study in Machala, Ecuador in 2014 and 2015.

Methods

Dengue cases in the PS system were compared to laboratory confirmed acute dengue illness cases that entered the AS study during the study period. Variables of interest included age class and sex. Outbreak detection curves by epidemiologic week, overall cumulative incidence and age-specific incidence proportions were calculated. Descriptive statistics were tabulated for all variables of interest. Chi-square tests were performed to compare demographic characteristics between the AS and PS data sets in 2014 and 2015.

Results

177 and 245 cases were identified from 1/1/2014 to 12/31/2015 by PS and AS, respectively; nine cases appeared in both systems. AS identified a greater number of laboratory-confirmed cases in 2014, accounting for more than 60% of dengue cases in the study area. In 2015, the opposite trend was observed with PS identifying 60% of the dengue cases in the study area. Peak transmission time in laboratory confirmed dengue illness, as noted by AS and PS was similar in 2014, whereas earlier detection (7 weeks) was observed by AS in 2015. Younger patients were more frequently identified by PS, while older patients were identified more frequently by AS. The cumulative incidence proportion for laboratory confirmed dengue illness reported via PS to the MoH was 4.12 cases per 10,000 residents in 2014, and 2.21 cases per 10,000 residents in 2015.

Conclusions

Each surveillance system captured distinct demographic subgroups within the Machala population, possibly due to differences in healthcare seeking behaviors, access to care, emerging threats of other viruses transmitted by the same mosquito vector and/or differences in clinical presentation. Integrating AS with pre-existing PS can aid in identifying additional cases in previously underdiagnosed subpopulations, improving our understanding of disease dynamics, and facilitating the implementation of timely public health interventions.
Micronutrient-rich dietary intake is associated with a reduction in the effects of particulate matter on blood pressure among electronic waste recyclers at Agbogbloshie, Ghana
Authors: Takyi Sylvia A. , Basu Niladri , Arko-Mensah John , Botwe Paul , Amoabeng Nti Afua Asabea , Kwarteng Lawrencia , Acquah Augustine , Tettey Prudence , Dwomoh Duah , Batterman Stuart , Robins Thomas , Fobil Julius N.
Published: July 2020

Background

Informal recycling of electronic waste (e-waste) releases particulate matter (PM) into the ambient air. Human exposure to PM has been reported to induce adverse effects on cardiovascular health. However, the impact of PM on the cardiovascular health of e-waste recyclers in Ghana has not been studied. Although intake of micronutrient-rich diet is known to modify these PM-induced adverse health effects, no data are available on the relationship between micronutrient status of e-waste recyclers and the reported high-level exposure to PM. We therefore investigated whether the intake of micronutrient-rich diets ameliorates the adverse effects of ambient exposure to PM2.5 on blood pressure (BP).

Methods

This study was conducted among e-waste and non-e-waste recyclers from March 2017 to October 2018. Dietary micronutrient (Fe, Ca, Mg, Se, Zn, and Cu) intake was assessed using a 2-day 24-h recall. Breathing zone PM2.5 was measured with a real-time monitor. Cardiovascular indices such as systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were measured using a sphygmomanometer. Ordinary least-squares regression models were used to estimate the joint effects of ambient exposure to PM2.5 and dietary micronutrient intake on cardiovascular health outcomes.

Results

Fe was consumed in adequate quantities, while Ca, Se, Zn, Mg, and Cu were inadequately consumed among e-waste and non-e-waste recyclers. Dietary Ca, and Fe intake was associated with reduced SBP and PP of e-waste recyclers. Although PM2.5 levels were higher in e-waste recyclers, exposures in the control group also exceeded the WHO 24-h guideline value (25 μg/m3). Exposure to 1 μg/m3 of PM2.5 was associated with an increased heart rate (HR) among e-waste recyclers. Dietary Fe intake was associated with a reduction in systolic blood pressure levels of e-waste recyclers after PM exposure.

Conclusions

Consistent adequate dietary Fe intake was associated with reduced effects of PM2.5 on SBP of e-waste recyclers overtime. Nonetheless, given that all other micronutrients are necessary in ameliorating the adverse effects of PM on cardiovascular health, nutrition-related policy dialogues are required. Such initiatives would help educate informal e-waste recyclers and the general population on specific nutrients of concern and their impact on the exposure to ambient air pollutants.
Epidemiology of drug driving: protocol from a national Canadian study measuring levels of cannabis, alcohol and other substances in injured drivers
Authors: Masud Manal , Chan Herbert , Erdelyi Shannon , Yuan Yue , Brubacher Jeffrey R.
Published: July 2020

Background

Drug driving is an emerging global road safety problem. As the prevalence of alcohol-impaired driving decreases, and as more jurisdictions decriminalize or legalize cannabis, it is increasingly important for policy makers to have accurate information on the prevalence and pattern of drug driving. Unfortunately, this data is not widely available and the World Health Organization identifies lack of accurate data on the prevalence of drug driving as an important knowledge gap.

Methods

In this paper, we discuss the limitations of current methods of monitoring drug use in drivers. We then present a novel methodology from a multi-centre study that monitors the prevalence and pattern of drug use in injured drivers across Canada. This study uses “left-over” blood taken as part of routine medical care to quantify cannabis and other drugs in non-fatally injured drivers who present to participating emergency departments after a collision. Toxicology testing is done with waiver of consent as we have procedures that prevent results from being linked to any individual. These methods minimize non-response bias and have the advantages of measuring drug concentrations in blood obtained shortly after a collision.

Discussion

Our methods can be applied in other jurisdictions and provide a consistent approach to collect data on drug driving. Consistent methods allow comparison of drug driving prevalence from different regions. Data from this research can be used to inform policies designed to prevent driving under the influence of cannabis and other impairing drugs.
The occupational sitting and physical activity questionnaire (OSPAQ): a validation study with accelerometer-assessed measures
Authors: Maes Iris , Ketels Margo , Van Dyck Delfien , Clays Els
Published: July 2020

Background

The Occupational Sitting and Physical Activity Questionnaire (OSPAQ) was developed as an easy-to-use instrument for self-reported assessment of percentage sitting, standing, walking, and performing heavy labour in a workplace setting. This study aimed to evaluate the concurrent validity of all dimensions of the OSPAQ compared to accelerometer-assessed measures of occupational physical activities in a mixed sample of sedentary and physically active professions.

Methods

Data from the Flemish Employees’ Physical Activity (FEPA) study were used, including employees from the service and production sector. All participants filled in a questionnaire, underwent clinical measurements, and wore two Axivity AX3 accelerometers for at least 2 consecutive working days. Intraclass (ICC) and Spearman rho correlations (r) were analyzed to assess concurrent validity.

Results

The sample included 401 workers (16% sedentary profession) with a mean age of 39.2 (± 11) years. Concurrent validity was good and moderate for assessing percentage of sitting (ICC = 0.84;r = 0.53), and standing (ICC = 0.64;r = 0.53), respectively. The concurrent validity for walking was weak to moderate (ICC = 0.50;r = 0.49), and weak for performing heavy labour (ICC = 0.28;r = 0.35). Stronger validity scores were found in sedentary professions for occupational sitting and standing. In physically active professions, an underestimation of self-reported sitting and standing was found, and an overestimation of self-reported walking and heavy labour. No significant self-reported over- or underestimation was found for sitting and heavy labour in sedentary professions, but an underestimation of self-reported standing and an overestimation of self-reported walking was observed.

Conclusions

The OSPAQ has acceptable measurement properties for assessing occupational sitting and standing. Accelerometer-assessed measures of occupational walking and heavy labour are recommended, since a poor concurrent validity was found for both.
Antenatal dietary concordance among mothers and fathers and gestational weight gain: a longitudinal study
Authors: Figueroa Roger , Saltzman Jaclyn A. , Kang Augustine , Mini Fernanda Neri , Davison Kirsten K. , Taveras Elsie M.
Published: July 2020

Background

Parent-child dietary concordance is associated with child diet, but the clinical implications of mother-father dietary concordance during pregnancy are unknown. This study evaluates antenatal mother-father dietary concordance and associations with gestational weight gain (GWG).

Methods

Mother-father (n = 111) dyads with low income reported their fruit/vegetable (FV), fast food (FF), and sugar-sweetened beverage (SSB) consumption frequency during the first trimester of pregnancy. From electronic health records, we collected height and self-reported pre-pregnancy weight and calculated pre-pregnancy body mass index (BMI). The primary outcome was excessive GWG for pre-pregnancy BMI. Dyads were categorized as healthy or unhealthy concordant (consuming similarly high or low amounts of FV, FF, or SSB), or mother-healthy or father-healthy discordant (consuming different amounts of FV, FF, or SSB). Multivariable and logistic regressions analyzed associations between dietary concordance and GWG.

Results

Mothers were Hispanic (25%), 43% White, 6% Black, and 23% Asian or Other. Most mothers were employed (62%) making <$50,000/year (64%). Average maternal GWG was 11.6 kg (SD = 6.40), and 36% had excessive GWG. Mothers in the mother-healthy discordant FV group (OR = 4.84; 95% CI = 1.29, 18.22) and the unhealthy concordant FF group (OR = 7.08; 95% CI = 2.08, 24.12) had higher odds for excessive GWG, compared to healthy concordant dyads. SSB concordance was associated with higher GWG in unadjusted, but not adjusted models.

Conclusions

Mothers had higher risk for excessive GWG when both partners had unhealthy FF consumption frequency, and when fathers had unhealthy FV consumption frequency. These findings imply that fathers should be involved in educational opportunities regarding dietary intake during pregnancy.
Rapid disease progress in a PVOD patient carrying a novel EIF2AK4 mutation: a case report
Authors: Zeng Xiaofang , Chen Fan , Rathinasabapathy Anandharajan , Li Tangzhiming , Adnan Ali Mohammed Mohammed Agila , Yu Zaixin
Published: July 2020

Background

Pulmonary veno-occlusive disease (PVOD) and pulmonary arterial hypertension (PAH) share an overlapping disease phenotype. Hence it is necessary to distinguish them.

Case presentation

Our 14-year-old female patient admitted with progressive shortness of breath, dizziness, and fatigue even after minimal physical activity was clinically suspected for PAH, based on her previous history. Her chest computed tomography artery reported the presence of PVOD triad features - subpleural thickened septal lines, ground-glass nodules/opacities and mediastinal lymphadenopathy. Because of her weak physical stature, a lung biopsy was not performed; however, the genetic testing identified a novel heterozygous EIF2AK4 mutation at c.4833_4836dup (p.Q1613Kfs*10) - the dominant susceptible factor driving PVOD. Combination of genetic testing and computed tomography artery facilitated us to distinguish PVOD from PAH. Her disease symptoms advanced aggressively so that she died even before the lung transplantation, which was less than 6 months from the onset of disease symptoms.

Conclusion

This case report highlights that novel EIF2AK4 mutation at [c.4833_4836dup (p.Q1613Kfs*10)] would predict an aggressive phenotype of PVOD. Hence, we conclude that a genetic test identifying EIF2AK4 mutation would serve as a tool for the early diagnosis of PVOD, circumventing lung biopsy.
Augmented reality guided osteotomy in hallux Valgus correction
Authors: Viehöfer Arnd Fredrik , Wirth Stephan Hermann , Zimmermann Stefan Michael , Jaberg Laurenz , Dennler Cyrill , Fürnstahl Philipp , Farshad Mazda
Published: July 2020

Background

An optimal osteotomy angle avoids shortening of the first metatarsal bone after hallux valgus surgery and therefore reduces the risk of transfer-metatarsalgia. The purpose of the present ex-vivo study was to investigate whether augmented reality (AR) would improve accuracy of the distal osteotomy during hallux valgus surgery.

Methods

Distal osteotomies of the first metatarsals were performed on a foot model by two surgeons with different levels of surgical experience each with (AR, n = 15 × 2) or without (controls, n = 15 × 2) overlay of a hologram depicting an angle of osteotomy perpendicular to the second metatarsal. Subsequently, the deviation of the osteotomy angle in the transverse plane was analyzed.

Results

Overall, AR decreased the extent of deviation and the AR guided osteotomies were more accurate (4.9 ± 4.2°) compared to the freehand cuts (6.7 ± 6.1°) by tendency (p = 0.2). However, while the inexperienced surgeon performed more accurate osteotomies with AR with a mean angle of 6.4 ± 3.5° compared to freehand 10.5 ± 5.5° (p = 0.02), no significant difference was noticed for the experienced surgeon with an osteotomy angle of around 3° in both cases.

Conclusion

This pilot-study suggests that AR guided osteotomies can potentially improve accuracy during hallux valgus correction, particularly for less experienced surgeons.
Clinical outcome of arthroscopic internal drainage of popliteal cysts with or without cyst wall resection
Authors: Su Chao , Kuang Shi-da , Zhao Xin , Li Yu-sheng , Xiong Yi-lin , Gao Shu-guang
Published: July 2020

Background

This study aimed to compare the arthroscopic internal drainage of popliteal cysts alone or in combination with cyst wall resection in terms of clinical outcomes.

Methods

Forty-two consecutive patients with symptomatic popliteal cysts received arthroscopic treatment. Specifically, 20 of them received arthroscopic internal drainage (AI group) alone and 22 received arthroscopic internal drainage combined with cyst wall resection (AICR group) through double posteromedial portals. Magnetic resonance imaging (MRI) was performed to identify recurrence of popliteal cysts. The Lysholm score and Rauschning-Lindgren grade were used to assess the clinical outcomes. The median of the follow-up period was 24 months (12–48 months).

Results

The two groups (AI group and AICR group) were similar in age, gender, cyst diameter, associated joint disorder, preoperative Lysholm score, preoperative Rauschning-Lindgren grade and follow-up period (P > 0.05). Relative to the AI group, the AICR group had a significantly prolonged operation time (P < 0.05) and a higher incidence of complications (P < 0.05). In both groups, the Rauschning-Lindgren grade at the last follow-up significantly differed from the preoperative grade (P < 0.05) and the Lysholm knee score remarkably increased compared to the preoperative score (P < 0.05); however, there were no differences between the two groups at the last follow-up (P > 0.05). According to the MRI results, the cyst disappeared in 11 (55%), shrank in size in 6 (30%) and existed in 3 (15%) patients in the AI group, and was absent in 18 (81.8%) and shrank in size in 4 (18.2%) patients in the AICR group, suggesting a significant difference between the two (P < 0.05).

Conclusion

Additional resection of cyst wall can result in a lower recurrence rate of cysts but extend the operation time and increase the incidence of perioperative complications compared with arthroscopic internal drainage of popliteal cysts alone.
Clinical efficacy and radiographic K-rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis
Authors: Fu Chaohua , Chen Tianjun , Yang Yuhao , Yang Hua , Diao Maohui , Zhang Guowei , Ji Zhisheng , Lin Hongsheng
Published: July 2020

Background

This study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS).

Methods

A total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n = 25) and rigid systems (n = 15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system.

Results

JOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system.

Conclusions

Compared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.
Observation of intracellular bacterial communities in urinary sediment using brightfield microscopy; a case report
Authors: Martínez-Figueroa Carlos , Cortés-Sarabia Karen , del Carmen Alarcón-Romero Luz , Catalán-Nájera Hilda Guadalupe , Martínez-Alarcón Micaela , Vences-Velázquez Amalia
Published: July 2020

Background

Urinary tract infections (UTIs) are usually related to the presence of Escherichia coli, a microorganism that adopts an intracellular life-style during the pathogenesis of cystitis. Evidence of the underlying mechanism in urothelial cells from urine samples has been reported. However, intracellular communities have not yet been described in squamous cells in fresh samples stained with Sternheimer-Malbin method, thus, we have provided these descriptions in this case report.

Case presentation

Number 1 was a male patient with symptoms of UTI, his urinalysis revealed hematuria and nitrites. In the urine sediment, we found urothelial cells with internal endosomes filled with short rods. Case number 2, female patient with recurrent UTI by E. coli, her urinalysis showed positive nitrites, glycosuria, bacteriuria and squamous cells with endosomes filled with short rods. Both patients were positive for E. coli isolation.

Conclusions

These case reports provide evidence of the presence of intracellular bacterial communities in urothelial and squamous cells (not previously reported) in fresh urine samples stained with Sternheimer-Malbin using brightfield microscopy. The clinical impact and pathogenic mechanisms involved in the invasion of the squamous epithelium need further investigation.
Prognostic value of pretreatment neutrophil-to-lymphocyte ratio in renal cell carcinoma: a systematic review and meta-analysis
Authors: Shao Yuan , Wu Bo , Jia Wei , Zhang Zikuan , Chen Qian , Wang Dongwen
Published: July 2020

Background

Numerous studies show that the pretreatment neutrophil-to-lymphocyte ratio (NLR) is associated with the prognosis of patients with RCC. However, their findings are inconsistent, urging us to explore the prognostic value of NLR in RCC patients.

Methods

This study was pre-registered in PROSPERO (CRD42020167131). Two reviewers independently performed a systematical search of PubMed, Web of Science, EMBASE, and Cochrane Library databases for prospective or retrospective cohort studies investigating the prognostic value of pretreatment NLR. Hazard ratios with 95% confidence intervals for overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), cancer-specific survival (CSS), and other useful clinicopathological features were extracted and analyzed with fixed or random-effect models by using Review Manager 5.3 and Stata 12.0 software. Heterogeneity was estimated on the basis of Cochran’s Q test and I2 value. Sensitivity analyses and subgroup analyses were also performed to explore the potential sources of heterogeneity. Publication bias was assessed with funnel plots and precisely assessed by Egger’s tests. The quality of the evidence was evaluated in accordance with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results

Overall, 6461 RCC patients from 24 retrospective studies and 1 prospective study were included. In overall population, elevated pretreatment NLR was associated with poorer OS (pooled HR = 1.90, 95% CI = 1.56–2.30, p < 0.001; I2 = 87%), DFS/PFS (pooled HR = 2.09, 95% CI: 1.49–2.94, p < 0.001; I2 = 99%), and CSS (pooled HR = 2.31, 95% CI: 1.61–3.33, p < 0.001; I2 = 14%). Furthermore, this negative association was further confirmed in patients with nonmetastatic and metastatic RCC patients, respectively. We also investigated the predictive role of NLR in metastatic RCC patients treated with immune checkpoint inhibitors (ICIs). The results indicated that the level of NLR was significantly associated with OS (pooled HR = 3.92, 95% CI: 2.00–7.69, p < 0.001; I2 = 0%) and PFS (pooled HR = 2.20, 95% CI: 95% CI: 1.61–3.01, p < 0.001; I2 = 20%).

Conclusions

This study demonstrated that elevated pretreatment NLR was significantly associated with poor prognosis of RCC patients. NLR could be helpful as a potential prognostic biomarker to guide clinical decision-making and select individualized treatment strategies for RCC patients.
Weight management barriers and facilitators after breast cancer in Australian women: a national survey
Authors: Ee Carolyn , Cave Adele Elizabeth , Naidoo Dhevaksha , Bilinski Kellie , Boyages John
Published: July 2020

Background

Breast cancer is the most common cancer in women worldwide. Weight gain after breast cancer is associated with poorer health outcomes. The aim of this study was to describe how Australian breast cancer survivors are currently managing their weight.

Methods

Online cross-sectional survey open to any woman living in Australia who self-identified as having breast cancer, between November 2017 and January 2018.

Results

We received 309 responses. Most respondents described their diet as good/excellent and reported moderate-high levels of weight self-efficacy. Despite this, the proportion of overweight/obesity increased from 47% at time of diagnosis to 67% at time of survey. More than three quarters of respondents did not receive any advice on weight gain prevention at the time of diagnosis. 39% of women reported being less active after cancer diagnosis, and and few weight loss interventions were perceived to be effective. Facilitators were structured exercise programs, prescribed diets, and accountability to someone else, while commonly cited barriers were lack of motivation/willpower, fatigue, and difficulty maintaining weight. Women who cited fatigue as a barrier were almost twice as likely to be doing low levels of physical activity (PA) or no PA than women who did not cite fatigue as a barrier.

Conclusions

We report high levels of concern about weight gain after BC and significant gaps in service provision around weight gain prevention and weight management. Women with BC should be provided with support for weight gain prevention in the early survivorship phase, which should include structured PA and dietary changes in combination with behavioural change and social support. Weight gain prevention or weight loss programs should address barriers such as fatigue. More research is required on the effectiveness of diet and exercise interventions in BC survivors, particularly with regard to weight gain prevention.
The polysemy of psychotropic drugs: continuity and overlap between neuroenhancement, treatment, prevention, pain relief, and pleasure-seeking in a clinical setting
Authors: Sakakibara Eisuke
Published: July 2020

Background

Enhancement involves the use of biomedical technologies to improve human capacities beyond therapeutic purposes. It has been well documented that enhancement is sometimes difficult to distinguish from treatment. As a subtype of enhancement, neuroenhancement aims to improve one’s cognitive or emotional capacities.

Main body

This article proposes that the notion of neuroenhancement deserves special attention among enhancements in general, because apart from the notion of treatment, it also overlaps with other concepts such as prevention, pain relief, and pleasure seeking. Regarding prevention, patients’ mental endurance can be enhanced when a patient is prescribed a selective serotonin reuptake inhibitor for the purpose of preventing the relapse of depression following a stressful situation. As for pain relief, psychiatrists use medication to alleviate distress in patients who experience various types of anxiety; the alleviation of distress is equal to psychological pain relief, but is also an enhancement of the patient’s temperamental traits. Regarding pleasure seeking, insidious transition exists between neuroenhancement and pleasure seeking when using psychotropic drugs. It is well known that people use psychostimulants for recreational purposes and to induce overconfidence in one’s performance. The polysemy of psychotropics derives from their effects on human sensibility. Therefore, when using psychotropic agents, psychiatrists should pay close attention to what the agent is used for on each patient in each situation, and explicitly share the continuity and overlap in the purpose of prescribing a medication with the patients to make a better clinical decision.

Conclusions

The notion of neuroenhancement overlaps not only with the notion of treatment, but also with other concepts of prevention, pain relief, and pleasure seeking. The continuity between those concepts makes the issues concerning the prescription of psychotropic drugs subtler. Psychiatrists should explicitly share the continuity with the patients to make a better clinical decision.
Evaluation of decision-making capacity in patients with dementia: challenges and recommendations from a secondary analysis of qualitative interviews
Authors: Poppe Christopher , Elger Bernice S. , Wangmo Tenzin , Trachsel Manuel
Published: July 2020

Background

Evaluation of decision-making capacity to consent to medical treatment has proved to be difficult in patients with dementia. Studies showed that physicians are often insufficiently trained in the evaluation of decision-making capacity. In this study, we present findings from a secondary analysis of a qualitative interviews with physicians. These interviews were initially used to assess usability of an instrument for the evaluation of decision-making capacity. By looking at difficult cases of decision-making capacity evaluation in patients with dementia, we provide recommendations for such evaluations in clinical practice.

Methods

We used thematic coding to analyse physicians’ narratives of problematic decision-making capacity evaluations in patients with dementia to uncover challenging issues of decision-making capacity evaluation.

Results

In this study, decision-making capacity evaluations in patients with dementia were mainly perceived as challenging when they pertained to treatment refusals and treatment unrelated circumstances, such as psychiatric consultation, advance directives, and new living arrangements. Furthermore, the physicians reported training needs regarding situation-independent challenges with decision-making capacity evaluation.

Conclusions

Upon further examining self-reported training needs and challenging cases, we have developed recommendations to improve decision-making capacity evaluations in clinical practice. In these recommendations, we argue that being able to evaluate decision-making capacity is an integral part of the informed consent process.
The clinical learning environment, supervision and nurse teacher scale (CLES+T): psychometric properties measured in the context of postgraduate nursing education
Authors: Ozga Dorota , Gutysz-Wojnicka Aleksandra , Lewandowski Bogumił , Dobrowolska Beata
Published: July 2020

Background

The Clinical Learning Environment, Supervision and Nurse Teacher Scale(CLES+T) instrument is internationally used for the evaluation of clinical learning environment in undergraduate nursing education. However, no evidence is available on the possible applications of this instrument in the context of postgraduate nursing education.

Purpose

To examine the basic psychometric properties of CLES+T in the context of clinical postgraduate nursing education in Poland.

Methods

Study among a sample of 417 nurses participating in the clinical postgraduate training in Poland.

Results

Cronbach’s alpha for the total scale was 0.97. A five-factor structure was confirmed in accordance with the assumptions adopted by the authors of the original version of the scale. Cronbach’s alpha coefficient for the Polish version of the CLES+T subscales ranged from 0.83 (Nursing care on the ward) to 0.95 (The content of supervisory relationship). The mean results for individual subscales ranged from 4.52 ± 0.63 fornursing care on the wardto 4.73 ± 0.45 forrole of the nurse teacher.

Conclusions

Having shown satisfactory psychometric properties, CLES+T can be considered a useful instrument to assess those elements of clinical learning environment which are important for the assurance of education quality at the postgraduate level.
A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa
Authors: Lebina Limakatso , Oni Tolu , Alaba Olufunke A. , Kawonga Mary
Published: July 2020

Background

Chronic care models like the Integrated Chronic Disease Management (ICDM) model strive to improve the efficiency and quality of care for patients with chronic diseases. However, there is a dearth of studies assessing the moderating factors of fidelity during the implementation of the ICDM model. The aim of this study is to assess moderating factors of implementation fidelity of the ICDM model.

Methods

This was a cross-sectional mixed method study conducted in two health districts in South Africa. The process evaluation and implementation fidelity frameworks were used to guide the assessment of moderating factors influencing implementation fidelity of the ICDM model. We interviewed 30 purposively selected healthcare workers from four facilities (15 from each of the two facilities with lower and higher levels of implementation fidelity of the ICDM model). Data on facility characteristics were collected by observation and interviews. Linear regression and descriptive statistics were used to analyse quantitative data while qualitative data were analysed thematically.

Results

The median age of participants was 36.5 (IQR: 30.8–45.5) years, and they had been in their roles for a median of 4.0 (IQR: 1.0–7.3) years. The moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). One feature of the ICDM model that seemingly compromised fidelity was the inclusion of tuberculosis patients in the same stream (waiting areas, consultation rooms) as other patients with non-communicable diseases and those with HIV/AIDS with no clear infection control guidelines. Participants also suggested that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure, adequate staff, and balanced patient caseloads.

Conclusion

There are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors influencing implementation fidelity of the ICDM model. Augmenting facilitation strategies (training and clinical mentorship) could further improve the degree of fidelity during the implementation of the ICDM model.
Causes of maternal deaths and delays in care: comparison between routine maternal death surveillance and response system and an obstetrician expert panel in Tanzania
Authors: Said Ali , Malqvist Mats , Pembe Andrea B. , Massawe Siriel , Hanson Claudia
Published: July 2020

Background

To reduce maternal mortality Tanzania introduced Maternal Death Surveillance and Response (MDSR) system in 2015 as recommended by World Health Organization (WHO). All health facilities are to notify and review all maternal deaths inorder to recommend quality improvement actions to reduce deaths in future. The system relies on consistent and correct categorization of causes of maternal deaths and three phases of delays. To assess its adequacy we compared the routine MDSR categorization of causes of death and three phases of delays to those assigned by an independent expert panel with additional information from Verbal Autopsy (VA).

Methods

Our cross-sectional study included 109 reviewed maternal deaths from two regions in Tanzania for the year 2018. We abstracted the underlying medical causes of death and the three phases of delays from MDSR system records. We interviewed bereaved families using the standard WHO VA questionnaire. The obstetrician expert panel assigned underlying causes of death based on information from medical files and VA according to International Classification of Disease to Death in Pregnancy Childbirth and Puerperium (ICD-MM). They assigned causes to nine ICD-MM groups and identified the three phases of delays. We used Cohen’s K statistic to compare causes of deaths and delays categorization.

Results

Comparison of underlying causes was done for 99 deaths. While 109 and 84 deaths for expert panel and MDSR respectively were analyzed for delays because of missing data in MDSR system. Expert panel and MDSR system assigned the same underlying causes in 64(64.6%) deaths (K statistic 0.60). Agreement increased in 80 (80.8%) when causes were assigned by ICD-MM groups (K statistic 0.76). The obstetrician expert panel identified phase one delays in 74 (67.9%), phase two in 24 (22.0%) and phase three delays in all 101 (100%) deaths that were assessed for this delay while MDSR system identified delays in 42 (50.0%), 10 (11.9%) and 78 (92.9%).The expert panel found human errors in management in 94 (93.1%) while MDSR system reported in 53 (67.9%) deaths.

Conclusions

MDSR committees performed reasonably well in assigning underlying causes of death. The obstetrician expert panel found more delays than reported in MDSR system indicating difficulties within MDSR teams to critically review deaths.
What methods are used to promote patient and family involvement in healthcare regulation? A multiple case study across four countries
Authors: Wiig Siri , Rutz Suzanne , Boyd Alan , Churruca Kate , Kleefstra Sophia , Haraldseid-Driftland Cecilie , Braithwaite Jeffrey , O’Hara Jane , van de Bovenkamp Hester
Published: July 2020

Background

In the regulation of healthcare, the subject of patient and family involvement figures increasingly prominently on the agenda. However, the literature on involving patients and families in regulation is still in its infancy. A systematic analysis of how patient and family involvement in regulation is accomplished across different health systems is lacking. We provide such an overview by mapping and classifying methods of patient and family involvement in regulatory practice in four countries; Norway, England, the Netherlands, and Australia. We thus provide a knowledge base that enables discussions about possible types of involvement, and advantages and difficulties of involvement encountered in practice.

Methods

The research design was a multiple case study of patient and family involvement in regulation in four countries. The authors collected 1) academic literature if available and 2) documents of regulators that describe user involvement. Based on the data collected, the authors from each country completed a pre-agreed template to describe the involvement methods. The following information was extracted and included where available: 1) Method of involvement, 2) Type of regulatory activity, 3) Purpose of involvement, 4) Who is involved and 5) Lessons learnt.

Results

Our mapping of involvement strategies showed a range of methods being used in regulation, which we classified into four categories: individual proactive, individual reactive, collective proactive, and collective reactive methods. Reported advantages included: increased quality of regulation, increased legitimacy, perceived justice for those affected, and empowerment. Difficulties were also reported concerning: how to incorporate the input of users in decisions, the fact that not all users want to be involved, time and costs required, organizational procedures standing in the way of involvement, and dealing with emotions.

Conclusions

Our mapping of user involvement strategies establishes a broad variety of ways to involve patients and families. The four categories can serve as inspiration to regulators in healthcare. The paper shows that stimulating involvement in regulation is a challenging and complex task. The fact that regulators are experimenting with different methods can be viewed positively in this regard.
Comparative whole genome DNA methylation profiling across cattle tissues reveals global and tissue-specific methylation patterns
Authors: Zhou Yang , Liu Shuli , Hu Yan , Fang Lingzhao , Gao Yahui , Xia Han , Schroeder Steven G. , Rosen Benjamin D. , Connor Erin E. , Li Cong-jun , Baldwin Ransom L. , Cole John B. , Van Tassell Curtis P. , Yang Liguo , Ma Li , Liu George E.
Published: July 2020

Background

Efforts to improve animal health, and understand genetic bases for production, may benefit from a comprehensive analysis of animal genomes and epigenomes. Although DNA methylation has been well studied in humans and other model species, its distribution patterns and regulatory impacts in cattle are still largely unknown. Here, we present the largest collection of cattle DNA methylation epigenomic data to date.

Results

Using Holstein cattle, we generated 29 whole genome bisulfite sequencing (WGBS) datasets for 16 tissues, 47 corresponding RNA-seq datasets, and 2 whole genome sequencing datasets. We did read mapping and DNA methylation calling based on two different cattle assemblies, demonstrating the high quality of the long-read-based assembly markedly improved DNA methylation results. We observed large differences across cattle tissues in the methylation patterns of global CpG sites, partially methylated domains (PMDs), hypomethylated regions (HMRs), CG islands (CGIs), and common repeats. We detected that each tissue had a distinct set of PMDs, which showed tissue-specific patterns. Similar to human PMD, cattle PMDs were often linked to a general decrease of gene expression and a decrease in active histone marks and related to long-range chromatin organizations, like topologically associated domains (TADs). We tested a classification of the HMRs based on their distributions relative to transcription start sites (TSSs) and detected tissue-specific TSS-HMRs and genes that showed strong tissue effects. When performing cross-species comparisons of paired genes (two opposite strand genes with their TSS located in the same HMR), we found out they were more consistently co-expressed among human, mouse, sheep, goat, yak, pig, and chicken, but showed lower consistent ratios in more divergent species. We further used these WGBS data to detect 50,023 experimentally supported CGIs across bovine tissues and found that they might function as a guard against C-to-T mutations for TSS-HMRs. Although common repeats were often heavily methylated, some young Bov-A2 repeats were hypomethylated in sperm and could affect the promoter structures by exposing potential transcription factor binding sites.

Conclusions

This study provides a comprehensive resource for bovine epigenomic research and enables new discoveries about DNA methylation and its role in complex traits.
Effects of a physical activity program from diagnosis on cardiorespiratory fitness in children with cancer: a national non-randomized controlled trial
Authors: Nielsen Martin Kaj Fridh , Christensen Jesper Frank , Frandsen Thomas Leth , Thorsteinsson Troels , Andersen Lars Bo , Christensen Karl Bang , Wehner Peder Skov , Hasle Henrik , Adamsen Lis Ørgaard , Schmiegelow Kjeld , Larsen Hanne Bækgaard
Published: July 2020

Background

Children with cancer experience impaired cardiorespiratory fitness and physical function during and after treatment restricting their possibilities to engage in social activities including sport, leisure activities, and school. The objectives were to determine the effects of classmate-supported, controlled, supervised, in-hospital, physical activity program to preserve cardiorespiratory fitness and physical function from time of diagnosis in children with cancer.

Methods

National non-randomized controlled trial including schoolchildren aged 6–18 years at diagnosis treated with chemo-/radiotherapy. We included 120 of 128 eligible patients (94%) in the intervention group (62.5% boys, 11.2 ± 3.1 years) from East Denmark and 58 patients in the control group (57% boys, 11.0 ± 3.2 years) from West Denmark. Eight children from the control group withdrew from participation. The groups were comparable in anthropometrics and cancer diagnoses (p > 0.05). The intervention consisted of (i) supervised in-hospital physical activity from diagnosis and throughout intensive treatment, (ii) 90-min general educational session on cancer and therapy in the child’s school class, and (iii) selection of two classmates as ambassadors who took turns to support the child’s physical training during the daytime. The primary outcome was cardiorespiratory fitness (VO2peak, mL/min/kg) at 6 months after diagnosis (sex, age, diagnosis adjusted). Secondary outcomes were sit-to-stand, timed-up-and-go, handgrip strength, and balance test scores.

Results

Ambassadors were identified for all, and 2542 individual and 621 group training sessions were held. VO2peak deteriorated over time in the control group (− 0.17 [95% CI − 0.32 to − 0.02] per week, p = 0.02), but not in the intervention group (p = 0.14). At 6 months from diagnosis, VO2peak was higher in the intervention group (29.6 ± 5.6 mL/kg/min) than in the control group (22.1 ± 5.6 mL/kg/min) (p = 0.01), and the intervention group had a better physical function at 3 and 6 months (p < 0.0001).

Conclusions

Peer-supported, supervised, in-hospital, physical activity is safe and feasible in children with cancer during treatment. Further, the results suggest that the intervention might mitigate impairments in cardiorespiratory fitness during treatment in children with cancer.

Trial registration

The study was prospectively registered on the 11 January 2013. Clinicaltrial.gov NCT01772849 and NCT01772862.