bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of HBV infection among male and female first-time blood donors born before and after the July 1986 HBV vaccination program in Taiwan
Authors: Wang Hsuan-Hui , Sun Shu-Lung , Jau Rong-Chiou , Tantoh Disline Manli , Hsu Shu-Yi , Nfor Oswald Ndi , Chen Pei-Hsin , Liu Wen-Hsiu , Ko Jiunn-Liang , Liaw Yung-Po
Published: October 2021

Background

In July 1984, Taiwan officially began a nationwide hepatitis B virus (HBV) vaccination program where only infants born to HBsAg-positive mothers were vaccinated free of charge until June 1986. However, from July 1986, all infants were vaccinated against HBV. The impact of the July 1986 HBV vaccination program on first-time blood donors has not been exhaustively studied. We, therefore, determined the risk of HBV among male and female first-time blood donors born before and after the July 1986 HBV vaccination program in Taiwan.

Methods

Initially, we recruited 857,310 first-time blood donors whose data were collected between 2013 and 2018 from 5 blood donation centers in Taiwan. However, we excluded donors with incomplete and outlying data (n = 12,213) and those born between July 1984 and June 1986 (n = 21,054). The final study participants comprised 9118 HBV positive and 814,925 HBV negative individuals. We divided the participants into two birth cohorts (born before and after July 1986) and assumed that those born before July 1986 were not vaccinated at birth while those born after July 1986 were vaccinated.

Results

The prevalence of HBV among those born before and after July 1986 was 4.53 and 0.25%, respectively. Individuals born after July 1986 had a lower risk of HBV than those born before July 1986. The adjusted odds ratio (OR), 95% confidence interval (CI) was 0.16, 0.13–0.19. Men had a higher risk of HBV than women (OR = 1.40, 95% CI = 1.34–1.47). The interaction between sex and birth date was significant (p-value = 0.0067). Stratification of participants by birth date revealed a higher risk of HBV in men compared to women in both birth cohorts. The OR, 95% CI was 1.47, 1.40–1.55 for those born before July 1986 but declined to 1.15, 1.02–1.29 for those born after July 1986.

Conclusions

The risk of HBV was lower among those born after than those born before the July 1986 vaccination program. In both cohorts, the risk was high in men relative to women. The seemingly protective effect among those born after July 1986 was higher in women than men.
Road traffic noise and cognitive function in older adults: a cross-sectional investigation of The Irish Longitudinal Study on Ageing
Authors: Mac Domhnaill Ciarán , Douglas Owen , Lyons Seán , Murphy Enda , Nolan Anne
Published: October 2021

Background

The World Health Organization published updated Environmental Noise Guidelines in 2018. Included are recommended limit values for environmental noise exposure based on systematic reviews for a range of health outcomes, including cognitive impairment. There is emerging evidence in the literature that chronic exposure to road traffic noise may affect cognitive function in older adults, but this relationship is not well established. This study spatially linked nationally representative health microdata from The Irish Longitudinal Study on Ageing to building-level modelled noise data for two cities in the Republic of Ireland. This was used to investigate associations between exposure to road traffic noise and cognitive function in a sample of older adults, independent of a range of socio-demographic and behavioural characteristics, as well as exposure to air pollution.

Methods

We used the Predictor-LimA Advanced V2019.02 software package to estimate noise originating from road traffic for the cities of Dublin and Cork in Ireland according to the new common noise assessment methodology for the European Union (CNOSSOS-EU). Noise exposure values were calculated for each building and spatially linked with geo-coded TILDA microdata for 1706 individuals aged 54 and over in the two cities. Ordinary least squares linear regression models were estimated for eight standardised cognitive tests including noise exposure as an independent variable, with standard errors clustered at the household level. Models were adjusted for individual sociodemographic, behavioural and environmental characteristics.

Results

We find some evidence that road traffic noise exposure is negatively associated with executive function, as measured by the Animal Naming Test, among our sample of older adults. This association appears to be accounted for by exposure to air pollution when focusing on a sub-sample. We do not find evidence of an association between noise exposure and memory or processing speed.

Conclusions

Long term exposure to road traffic noise may be negatively associated with executive function among older adults.
Correlates of psychological intimate partner violence with HIV care outcomes on patients in HIV care
Authors: Fredericksen R. J. , Nance R. M. , Whitney B. M. , Harding B. N. , Fitzsimmons E. , Del Rio C. , Eron J. , Feaster D. J. , Kalokhe A. S. , Mathews W. C. , Mayer K. H. , Metsch L. R. , Mugavero M. J. , Potter J. , O’Cleirigh C. , Napravnik S. , Rodriguez B. , Ruderman S. , JAC Delaney , Crane H. M.
Published: October 2021

Background

Among people living with HIV (PLWH), physical intimate partner violence (IPV) is associated with poor virologic, psychiatric, and behavioral outcomes. We examined non-physical, psychological intimate partner violence (psy-IPV) and HIV care outcomes using data from two U.S. consortia.

Methods

We conducted multivariable analyses with robust standard errors to compare patients indicating/not indicating psy-IPV.

Results

Among PLWH (n = 5950), 9.5% indicated psy-IPV; these individuals were younger (− 3; 95% CI [− 2,-4], p-value < 0.001), less likely to be on antiretroviral treatment (ART) (0.73 [0.55,0.97], p = 0.03), less adherent to ART (− 4.2 [− 5.9,-2.4], p < 0.001), had higher odds of detectable viral load (1.43 [1.15,1.78], p = 0.001) and depression (2.63 [2.18,3.18], p < 0.001), and greater use of methamphetamines/crystal [2.98 (2.30,3.87),p < 0.001], cocaine/crack [1.57 (1.24,1.99),p < 0.001], illicit opioids [1.56 (1.13,2.16),p = 0.007], and marijuana [1.40 (1.15,1.70), p < 0.001].

Conclusion

Psychological IPV, even in the absence of physical or sexual IPV, appears to be associated with HIV care outcomes and should be included in IPV measures integrated into routine HIV care.
Public engagement in health technology assessment in Brazil: the case of the public consultation on National Clinical Guidelines for Care in Normal Birth
Authors: da Silva Carvalho Viviane Karoline , da Silva Everton Nunes , Barreto Jorge Otávio Maia
Published: October 2021

Background

There is a growing body of literature that recognizes the importance of public engagement in health technology assessment. However, there is still uncertainty regarding how the results should be recorded, analyzed, and used by decision makers.

Objective

Synthesize the contributions of the Brazilian public (women, health professionals, managers, educational institutions, and companies) about the implementation of the National Clinical Guidelines for Care in Normal Birth from the public consultation carried out in Brazil.

Method

IRaMuTeQ software was used to organize and summarize the corpus based on three types of analysis: descriptive statistics; descending hierarchical classification; and specificities analysis. The public consultation was conducted in 2016 by the National Committee for Health Technology Incorporation (CONITEC) in the Brazilian public health system as part of the guideline development process.

Results

The corpus consisted of 303 texts, separated into 1233 text segments, 1081 of which were used, corresponding to retention of 87.67%. Five classes emerged from our analyses: mandatory presence of an obstetrician during labor and delivery in hospital settings; barriers and facilitators for guideline implementation; use of evidence—based practices by health professionals; progression of labor and delivery and women’s rights; and mobilization to promote the guideline For each class, the most frequent words and sentences with the highest chi-squared scores were presented. Barriers were associated with lack of financial resources, training and professional motivation, and facilitators with training to change the practices of health professionals. Obstetric nurses emerged as an alternative for supervising normal births as well as the mandatory presence of an obstetrician during childbirth in hospital settings.

Conclusion

Our findings summarize the contributions provided by the Brazilian public and shed some light on the barriers and facilitators of clinical guidelines for care in normal birth. These topics are not typically explored by quantitative studies. Including this information in the decision-making process would not only increase public engagement, but provide greater evidence for implementing the clinical guidelines nationwide.
Factors influencing COVID-19 knowledge-gap: a cross-sectional study in China
Authors: Wang Han , Li Lina , Wu Jing , Gao Hao
Published: October 2021

Background

In the face of a sudden outbreak of COVID-19, it is essential to promote health communication, especially to reduce communication inequality. The paper targeted China to investigate whether social structural factors (education level and urban-rural differences) lead to the knowledge gap of COVID-19. Also, this paper examined whether media use, interpersonal communication, public communication, and perceived salience of information can influence the knowledge gap of COVID-19. Furthermore, this paper explored the strategies to promote communication equality.

Methods

An online survey on COVID-19 knowledge and its influencing factors was conducted in February 2020, with a valid sample of 981 participants. The dependent variable was the total score of knowledge related to COVID-19. In addition to demographic variables such as education level and residence, the main explanatory variables include four independent variables: the use of different media (print media, radio, television, Internet), interpersonal communication, public communication, and perceived salience of information. This paper utilized descriptive statistics, correlation analysis, and hierarchical multiple regression analysis for data processing.

Results

Descriptive statistics indicated that the Internet was the most frequent source of information for participants to obtain COVID-19 knowledge (M = 6.28, SD = 1.022). Bi-variate analysis and regression analysis presented that education level, Internet media use, and perceived salience of information predicted the difference in knowledge level. Hierarchical multiple regression showed that Internet media use significantly predicted differences in the level of knowledge related to COVID-19 among groups with different education levels.

Conclusions

This study found a COVID-19 knowledge gap among the Chinese public, especially the digital knowledge gap. Education level, perceived salience of information, and internet media use can significantly predict the difference in COVID-19 knowledge level. In contrast, the use of traditional media such as newspaper, radio, and television, public communication, and interpersonal communication did not improve knowledge level. Internet media use and education level have an interactive effect on the formation of a COVID-19 knowledge gap. That is, online media use will expand the COVID-19 knowledge gap between groups with different education levels.
Generalized anxiety disorder and resilience during the COVID-19 pandemic: evidence from China during the early rapid outbreak
Authors: Chen Hao , Gao Junling , Dai Junming , Mao Yimeng , Wang Yi , Chen Suhong , Xiao Qianyi , Jia Yingnan , Zheng Pinpin , Fu Hua
Published: October 2021

Background

Generalized Anxiety Disorder (GAD) is a common but urgent mental health problem during disease outbreaks. Resilience buffers against the negative impacts of life stressors on common internalizing psychopathology such as GAD. This study assesses the prevalence of GAD and examines the protective or compensatory effect of resilience against worry factors during the COVID-19 outbreak.

Methods

A cross-sectional online survey was conducted among Chinese citizens aged ≥18 years from January 31 to February 2, 2020. A total of 4827 participants across 31 provinces and autonomous regions of the mainland of China participated in this study. The Generalized Anxiety Disorder scale (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), and a self-designed worry questionnaire were used to asses anxiety disorder prevalence, resilience level, and anxiety risk factors. Multivariable logistic regression was used to identify the associations of resilience and worry factors with GAD prevalence after controlling for other covariates.

Results

The prevalence of anxiety disorder was 22.6% across the 31 areas, and the highest prevalence was 35.4% in Hubei province. After controlling for covariates, the results suggested a higher GAD prevalence among participants who were worried about themselves or family members being infected with COVID-19 (adjusted odds ratio, AOR 3.40, 95%CI 2.43–4.75), worried about difficulty obtaining masks (AOR 1.92, 95%CI 1.47–2.50), worried about difficulty of distinguishing true information (AOR 1.65, 95%CI 1.36–2.02), worried about the prognosis of COVID-19 (AOR 2.41, 95%CI 1.75–3.33), worried about delays in working (AOR 1.71, 95%CI 1.27–.31), or worried about decreased income (AOR 1.45, 95%CI 1.14–1.85) compared with those without such worries. Additionally, those with a higher resilience level had a lower prevalence of GAD (AOR 0.59, 95%CI 0.51–0.70). Resilience also showed a mediating effect, with a negative influence on worry factors and thereby a negative association with GAD prevalence.

Conclusion

It may be beneficial to promote public mental health during the COVID-19 outbreak through enhancing resilience, which may buffer against adverse psychological effects from worry factors.
Long working hours, poor sleep quality, and work-family conflict: determinant factors of fatigue among Indonesian tugboat crewmembers
Authors: Mansyur Muchtaruddin , Sagitasari Risna , Wangge Grace , Sulistomo Astrid B. , Kekalih Aria
Published: October 2021

Background

Tugboat crewmembers are susceptible to fatigue during their 24-h work shifts, despite the availability of rest time. The fatigue experienced by seafarers contributes to marine accidents and metabolic and cardiovascular diseases, which have long-term effects. This study aimed to analyse the association between working hours and fatigue and other possibly related factors in tugboat crewmembers.

Method

This comparative cross-sectional study included 127 tugboat crew members from 15 randomly chosen tugboats in Samarinda Harbor, Indonesia. Their fatigue levels while at work were measured using a reaction timer and standardised questionnaire. Personal and occupational data of crewmembers, including age, marital status, rating (job ranking), duration on board, length of seafaring experience, watch system, smoking status, coffee and alcohol consumption, and working hours, were collected. Moreover, sleep quality and stress levels related to work-family conflict were measured and analysed using the Pittsburgh Sleep Quality Index (PSQI) and Work-Family Conflict Scale (WCFS), respectively.

Results

The study found that 40.2% of the subjects were classified as having fatigue. The determinant factors were long working hours (> 72 h/week), poor sleep quality, and work-family conflict [adj. OR = 13.32; 95%-CI (4.78–31.23)] and p < 0.001, [adj. OR = 4.49 (1.39–14.52)] and p = 0.012, [adj. OR = 2.87 (1.12–7.33)] and p = 0.028, respectively. However, personal and occupational factors, including age, marital status, duration on board, length of seafaring experience, smoking status, and coffee and alcohol consumption, were not significantly associated with crewmember fatigue.

Conclusion

The incidence of fatigue among Indonesian tugboat crewmembers operating on the Mahakam River was considerably high. Working hours, sleep quality, and work-family conflict were strongly associated with fatigue in tugboat crewmembers; therefore, the working hours of tugboat crewmembers need to be improved. Crewmember lifestyle variables need to be studied further.
Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial
Authors: Wei Bo , Tang Cheng , Li Xuxiang , Lin Rongcai , Han Liu , Zheng Suyang , Xu Yan , Yao Qingqiang , Wang Liming
Published: October 2021

Background

Enhanced recovery after surgery (ERAS) protocols were rapidly adopted in many surgeries such as fast-track arthroplasty. The study aimed to investigate the impact of ERAS protocols on the clinical effect of total knee arthroplasty (TKA) via the midvastus approach.

Methods

A total of 69 patients who underwent primary unilateral TKA via the midvastus approach from October 2018 to June 2019 were enrolled and randomly divided into two groups: ERAS group and Control group. The ERAS protocols were adopted for the ERAS group and consisted of pure juice drinking 2 h before the surgery, optimization of the preoperative anesthesia plan, phased use of tourniquets, and the use of tranexamic acid as well as a drug cocktail. The operative time, first postoperative walking time, first straight leg elevation time, postoperative hospitalization time, visual analogue scale score (VAS score), Hospital for Special Surgery score (HSS score), conventional Knee Society score (KSS), and knee range of motion (ROM) were used to assess the clinical effects in the two groups. All the included patients were followed up for 12 months.

Results

There were no significant differences in the basic demographic information and operation time between the ERAS and Control groups (P > 0.05). The first postoperative walking time (2.11 ± 0.11 h) and first postoperative straight leg elevation time (6.14 ± 1.73 h) in the ERAS group were significantly earlier than those in the Control group (P < 0.001) and the postoperative hospitalization time was significantly shorter (3.11 ± 0.32 days). The postoperative mean VAS scores in both groups were significantly reduced compared with those before surgery (P < 0.001). The VAS scores for the ERAS group were significantly lower than those for the Control group at 1, 2, and 7 days after surgery (P < 0.001). The mean HSS scores, KSS, and knee ROM were significantly increased in both the ERAS and Control groups at 1, 3, 6, and 12 months after surgery (P < 0.001). In addition, the HSS scores, KSS, and knee ROM in the ERAS group were significantly higher than those in the Control group at 1 month after surgery (P < 0.001).

Conclusions

ERAS protocols improved the clinical effects of TKA via the midvastus approach, facilitating early out-of-bed activity and comfortable postoperative rehabilitation exercise, and further increasing patient satisfaction.

Trial registration

ClinicalTrials.gov Identifier: NCT04873544.
Association between clusters of back and joint pain with opioid use in middle-aged community-based women: a prospective cohort study
Authors: Hussain Sultana Monira , Wang Yuanyuan , Peeters Geeske , Wluka Anita E. , Mishra Gita D. , Teede Helena , Urquhart Donna , Brown Wendy J. , Cicuttini Flavia M.
Published: October 2021

Background

To determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing.

Methods

Of 11,221 middle-aged participants from the Australian Longitudinal Study of Women’s Health, clusters of back pain and joint pain from 2001 to 2013 were identified using group-based trajectory modelling. Prescription opioid dispensing from 2003 to 2015 was identified by linking the cohort to Pharmaceutical Benefit Scheme dispensing data. Multinomial logistic regression was used to examine the association between back pain and joint pain clusters and dispensing of prescription opioids. The proportion of opioids dispensed in the population attributable to back and join pain was calculated.

Results

Over 12 years, 68.5 and 72.0% women reported frequent or persistent back pain and joint pain, respectively. There were three clusters (‘none or infrequent’, ‘frequent’ and ‘persistent’) for both back pain and joint pain. Those in the persistent back pain cluster had a 6.33 (95%CI 4.38-9.16) times increased risk of having > 50 opioid prescriptions and those in persistent joint pain cluster had a 6.19 (95%CI 4.18-9.16) times increased risk of having > 50 opioid prescriptions. Frequent and persistent back and joint pain clusters together explained 41.7% (95%CI 34.9-47.8%) of prescription opioid dispensing. Women in the frequent and persistent back pain and joint pain clusters were less educated and reported more depression and physical inactivity.

Conclusion

Back pain and joint pain are major contributors to opioid prescription dispensing in community-based middle-aged women. Additional approaches to reduce opioid use, targeted at those with frequent and persistent back pain and joint pain, will be important in order to reduce the use of opioids and their consequent harm in this population.
Effective factors on Sharp Score in patients with rheumatoid arthritis: a retrospective study
Authors: Wen Jianting , Liu Jian , Xin Ling , Wan Lei , Jiang Hui , Sun Yue , Sun Yanqiu , Wang Xin , Wang Jie
Published: October 2021

Background

This study aims to describe the association between sharp score and clinical indexes, bone metabolism indexes, Disease Activity Score (DAS28) and sociodemographic factors in rheumatoid arthritis (RA).

Methods

Data were collected from the HIS (hospital information system), a national inpatient database in China, with information on the patients hospitalized during the period from 2012 to 2019. The association between sharp score and effective factors were identified using multinomial logistic regression and association rule mining (ARM).

Results

Three thousand eight hundred and forty patients were included: 82.66% males, 17.34% females, mean (SD) age 56.95 (12.68) years and symptom duration 3.45 (1.09) years. Spearman correlation analysis and Association rules analysis showed that there were significant positive correlations between sharp score and effective factors. Logistic regression analysis presented that erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (CRP), rheumatoid factor (RF) were risk factors of sharp score. In the analysis of individual outcomes, sex, age, symptom duration, DSA28 score, RF, ever drinker, and radiographic grading of hands were influence factors of sharp score.

Conclusion

Sharp score should be taken into consideration in formulating treatment strategies in RA.
The role of lymph node dissection in intrahepatic cholangiocarcinoma: a multicenter retrospective study
Authors: Hu Hanjie , Xu Gang , Du Shunda , Luo Zhiwen , Zhao Hong , Cai Jianqiang
Published: October 2021

Background

Lymph node dissection (LND) is of great significance in intrahepatic cholangiocarcinoma (ICC). Although the National Comprehensive Cancer Network (NCCN) guidelines recommend routine LND in ICC, the effects of LND remains controversial. This study aimed to explore the role of LND and some related issues and of in ICC.

Methods

Patients were identified in two Chinese academic centers. Inverse probability of treatment weighting (IPTW) was used to reduce bias. Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS) and disease-free survival (DFS).

Results

Of 232 patients, 177 (76.3%) underwent LND, and 71 (40.1%) had metastatic lymph nodes. A minimum of 6 lymph nodes were dissected in 66 patients (37.3%). LND did not improve the prognosis of ICC. LNM > 3 may have worse OS and DFS than LNM 1–3, especially in the LND >  = 6 group. For patients who did not underwent LND, the adjuvant treatment group had better OS and DFS.

Conclusions

The proportions of patients who underwent LND and removed >  = 6 lymph nodes were not high enough. LND has no definite predictive effect on prognosis. Patients with 4 or more LNMs may have a worse prognosis than patients with 1–3 LNMs. Adjuvant therapy may benefit patients of nLND.
Tanshinone IIA attenuates renal injury during hypothermic preservation via the MEK/ERK1/2/GSK-3β pathway
Authors: Xu Linhao , Xu Yizhou , Zhu Zhoujing , Gu Huiquan , Chen Chaofeng , Chen Jian
Published: October 2021

Background

Oxidative stress-induced injury during hypothermic preservation is a universal problem that delays graft function and decrease the success of organ transplantation. Tanshinone IIA (Tan IIA) was reported to exhibit a variety of biochemical activities, including protection against oxidative stress. Therefore, the specific molecular pathway by which Tan IIA protects renal tissues during preservation was investigated in this study.

Methods

In vivo study, Sprague-Dawley (SD) rats were divided into twelve groups and the kidneys were isolated and preserved in different solutions for 0, 24 or 48 h, respectively: control group (Celsior solution) and Tan II groups (Celsior solution containing 10, 50,100 μM). In vitro study, primary renal cell from SD rats was cultured which was treated H2O2 (800 μM) for 6 h to mimic oxidative stress injury. Four groups were finally divided: control group; H2O2 group; H2O2 + Tan IIA group; H2O2 + Tan IIA + G15 group.

Results

In present study, we demonstrate data indicating that a significant increase in the superoxide dismutase (SOD) activity and a decrease in the reactive oxygen species (ROS) content were observed in the kidneys and renal cells preserved with Tan IIA compared with those preserved with the Celsior solution alone after 24 h and 48 h of hypothermic preservation (P < 0.01). The expression of phosphorylated mitogen-activated protein kinase kinase (MEK), phosphorylated extracellular signal-regulated protein kinases 1/2 (ERK1/2), phosphorylated glycogen synthase kinase-3β (GSK-3β) and cleaved caspase-3 was lower in the kidneys and renal cells preserved with Tan IIA than in those preserved with the Celsior solution alone after 24 h and 48 h of hypothermic preservation (P < 0.01). The mitochondrial morphology was rescued and adenosine triphophate (ATP) production and mitochondrial membrane potential were increased in the Tan IIA groups. Finally, Tan IIA also decreased cell apoptosis.

Conclusion

It suggests that the supplementation of the standard Celsior solution with Tan IIA may significantly improve long-term kidney preservation. Tan IIA attenuated oxidative stress injury and decreased apoptosis levels via activation of the MEK/ERK1/2/GSK-3β signaling pathway during kidney hypothermic preservation.
Alexithymia, social support, depression, and burnout among emergency nurses in China: a structural equation model analysis
Authors: Pei Juhong , Wang Xinglei , Chen Haixia , Zhang Hongchen , Nan Ruiling , Zhang Jing , Dou Xinman
Published: October 2021

Background

Several factors are associated with the incidence of burnout, including alexithymia, social support, and depression. The relative importance of these three key parameters as mediators of burnout, however, is not well understood. In addition, there have been few studies to date specifically examining the association between alexithymia and burnout among nurses in China.

Purpose

To evaluate the relationship of burnout with alexithymia, social support, and depression across emergency department nurses in China.

Methods

This descriptive, cross-sectional survey was conducted using a convenience sampling methodology to survey nurses responsible for direct emergency care (n = 413) from 18 tertiary hospitals in Western, Eastern, Northern, and Southern China between May 2020 and June 2020. A structural equation modeling approach was then used to assess a hypothetical model wherein alexithymia both directly and indirectly affects burnout among emergency nurses via impacting the incidence of depression and perceived social support.

Results

Results supported all driving hypotheses. Alexithymia was positive direct correlated with burnout (β = 0.35; P < 0.001) and depression (β = 0.50; P < 0.001), and exhibited a negative direct effect on social support (β = − 0.14; P = 0.041). Depression was associated with burnout, both directly (β = 0.24; P < 0.001) and indirectly (β = 0.15; P < 0.001) through its relationship with social support. Alexithymia was the factor most strongly associated with burnout, and it was able to affect burnout indirectly through depression and social support.

Conclusions

We found that among emergency nurses in China, alexithymia was correlated with burnout, depression, and social support. Alexithymia was the factor most strongly associated with burnout. These data suggest that providing better social support and alleviating alexithymia may decrease rates of burnout among emergency nurses.
Awakening Canadians to ageism: a study protocol
Authors: Dahlke Sherry , Hunter Kathleen F. , Fox Mary T. , Davidson Sandra , Perry Nicole , Watts Laura Tamblyn , Martin Lori Schindel , Butler Jeffrey I. , Raymond Christy , Chasteen Alison L. , McCleary Lynn , Boscart Veronique , Moody Elaine
Published: October 2021

Background

Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses—the largest and most trusted group of healthcare professionals—to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies.

Methods

To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies.

Discussion

Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses’ perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging—older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts.
Quality of antenatal care and its sociodemographic determinants: results of the 2015 Pelotas birth cohort, Brazil
Authors: Morón-Duarte Lina Sofia , Varela Andrea Ramirez , Bertoldi Andrea Dâmaso , Domingues Marlos R. , Wehrmeister Fernando C. , Silveira Mariangela Freitas
Published: October 2021

Background

Inadequate antenatal care (ANC) has been associated with adverse pregnancy outcomes. ANC quality is considered a key component of the right to health and a route to equity and dignity for women and their children. Although ANC coverage is relatively high in Brazil, there are revealed some health disparities when coverage is examined by socio-demographic determinants. In this study we evaluated ANC quality and its socio-demographic determinants using data from the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil.

Methods

This study is part of the 2015 Pelotas population-based birth cohort (n = 3923 pregnant women) conducted in southern Brazil. ANC quality was assessed through 19 content and service utilization indicators recommended by the Brazilian Ministry of Health. Descriptive analyses and associations of each of the ANC indicators and independent variables were performed using the chi-square and linear trend test. ANC indicators were analyzed individually and aggregated as a score. Associations between ANC score quality and socio-demographic variables were assessed with ordinal regressions. Mediation analysis with G-computation was performed to estimate direct and indirect effect of mother’s level of education on ANC quality mediated by the number of consultations and timing of ANC initiation. Base and post confounders were included.

Results

The results showed that except for breast examination, height measurement, tetanus toxoid vaccination and ANC starting at the first trimester, all ANC indicators showed more than 80% coverage during ANC visits.

In the adjusted analysis, inadequate quality ANC was associated with lower maternal education level, not having a partner, being multiparous, being attended by a private provider and by the same professional in all consultations. In the mediation analyses, 6.8% of the association between ANC quality and mother’s education was mediated by the trimester in which ANC started, while 12.8% was mediated by the number of ANC visits.

Conclusions

ANC quality is associated with pregnant women’s socio-demographic characteristics. Significant efforts are needed to improve the quality of facility-based maternity care.
Translating evidence into policy: opinions and insights of Health Researchers and Policymakers in Nepal
Authors: Tiwari Biplav Babu , Ban Anusha , Gurung Sony , Karki Khem Bahadur
Published: October 2021

Background

The Evidence-Based Policymaking (EBP) process in Nepal is rife with poor practices where often policymakers are portrayed as perpetrators for such practices. However, we need to think of the EBP as a two-sided coin where both research pull and research push play equally significant roles. This study aimed to assess the perception of Nepalese health policymakers and researchers on EBP and identify appropriate mechanisms to integrate evidence into policies.

Methods

Following the constructivist philosophical paradigm, qualitative research design was used in the study with the grounded theory approach. Purposive sampling was performed, and the 12 in-depth interviews were conducted, where number of interviews was finalized using saturation theory. All interviews were audio-recorded, transcribed, translated to English, coded line by line, and then developed into themes. Thematic analysis technique was used to manually analyze the data.

Results

Study participants highlighted that evidence is being utilized during policy formulation but not in the amount it should be, with a preference for anecdotal evidence further reducing the chance. Apart from these barriers, poor credibility of information obtained, poorly targeted dissemination, inadequate policy-based researches, and policymakers and researchers operating within the spheres of their own with a feeble link to channel the flow of information between them were identified by participants. On the other hand, the publication of one-pager research brief, conduction of nationally representative surveys especially quantitative studies, the practice of cost-effectiveness study, and policymaker’s involvement during the research were some facilitators identified.

Conclusions

Moreover, the study accentuates that better communication strategies such as the establishment of formal forums with policymakers and researchers, better-targeted dissemination, and identification of priority areas have wide potential to promote a unified front of health policymakers and researchers for EBP.
Taxonomy-aware, sequence similarity ranking reliably predicts phage–host relationships
Authors: Zielezinski Andrzej , Barylski Jakub , Karlowski Wojciech M.
Published: October 2021

Background

Characterizing phage–host interactions is critical to understanding the ecological role of both partners and effective isolation of phage therapeuticals. Unfortunately, experimental methods for studying these interactions are markedly slow, low-throughput, and unsuitable for phages or hosts difficult to maintain in laboratory conditions. Therefore, a number of in silico methods emerged to predict prokaryotic hosts based on viral sequences. One of the leading approaches is the application of the BLAST tool that searches for local similarities between viral and microbial genomes. However, this prediction method has three major limitations: (i) top-scoring sequences do not always point to the actual host; (ii) mosaic virus genomes may match to many, typically related, bacteria; and (iii) viral and host sequences may diverge beyond the point where their relationship can be detected by a BLAST alignment.

Results

We created an extension to BLAST, named Phirbo, that improves host prediction quality beyond what is obtainable from standard BLAST searches. The tool harnesses information concerning sequence similarity and bacteria relatedness to predict phage–host interactions. Phirbo was evaluated on three benchmark sets of known virus–host pairs, and it improved precision and recall by 11–40 percentage points over currently available, state-of-the-art, alignment-based, alignment-free, and machine-learning host prediction tools. Moreover, the discriminatory power of Phirbo for the recognition of virus–host relationships surpassed the results of other tools by at least 10 percentage points (area under the curve = 0.95), yielding a mean host prediction accuracy of 57% and 68% at the genus and family levels, respectively, and drops by 12 percentage points when using only a fraction of viral genome sequences (3 kb). Finally, we provide insights into a repertoire of protein and ncRNA genes that are shared between phages and hosts and may be prone to horizontal transfer during infection.

Conclusions

Our results suggest that Phirbo is a simple and effective tool for predicting phage–host relationships.
Krüppel-homolog 1 exerts anti-metamorphic and vitellogenic functions in insects via phosphorylation-mediated recruitment of specific cofactors
Authors: Wu Zhongxia , Yang Libin , Li Huihui , Zhou Shutang
Published: October 2021

Background

The zinc-finger transcription factor Krüppel-homolog 1 (Kr-h1) exerts a dual regulatory role during insect development by preventing precocious larval/nymphal metamorphosis and in stimulating aspects of adult reproduction such as vitellogenesis. However, how Kr-h1 functions both as a transcriptional repressor in juvenile metamorphosis and an activator in adult reproduction remains elusive. Here, we use the insect Locusta migratoria to dissect the molecular mechanism by which Kr-h1 functions as activator and repressor at these distinct developmental stages.

Results

We report that the kinase PKCα triggers Kr-h1 phosphorylation at the amino acid residue Ser154, a step essential for its dual functions. During juvenile stage, phosphorylated Kr-h1 recruits a corepressor, C-terminal binding protein (CtBP). The complex of phosphorylated Kr-h1 and CtBP represses the transcription of Ecdysone induced protein 93F (E93) and consequently prevents the juvenile-to-adult transition. In adult insects, phosphorylated Kr-h1 recruits a coactivator, CREB-binding protein (CBP), and promotes vitellogenesis by inducing the expression of Ribosomal protein L36. Furthermore, Kr-h1 phosphorylation with the concomitant inhibition of E93 transcription is evolutionarily conserved across insect orders.

Conclusion

Our results suggest that Kr-h1 phosphorylation is indispensable for the recruitment of transcriptional cofactors, and for its anti-metamorphic and vitellogenic actions in insects. Our data shed new light on the understanding of Kr-h1 regulation and function in JH-regulated insect metamorphosis and reproduction.
Cost-effectiveness evaluation of add-on dapagliflozin for heart failure with reduced ejection fraction from perspective of healthcare systems in Asia–Pacific region
Authors: Liao Chia-Te , Yang Chun-Ting , Toh Han Siong , Chang Wei-Ting , Chang Hung-Yu , Kuo Fang-Hsiu , Lee Mei-Chuan , Hua Yi-Ming , Tang Hsin-Ju , Strong Carol , Ou Huang-Tz
Published: October 2021

Background

With emerging evidence on the efficacy of adding dapagliflozin to standard care for patients with heart failure with reduced ejection fraction (HFrEF), this study assessed the cost-effectiveness of add-on dapagliflozin to standard care versus standard care alone for HFrEF from the perspective of healthcare systems in the Asia–Pacific region.

Methods

A Markov model was applied to project the outcomes of treatment in terms of lifetime medical cost and quality-adjusted life-years. The transition probabilities between health states in the model were obtained from the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction trial. Country-specific costs and utilities were extracted for modeling. The incremental cost-effectiveness ratio against a country-specific willingness-to-pay threshold was applied to determine the cost-effectiveness of treatment. A series of sensitivity analyses were performed to ensure the robustness of the study results. Costs are presented in 2020 United States dollars.

Results

The incremental cost-effectiveness ratios for add-on dapagliflozin versus standard care alone were $5277, $9980, $12,305, $16,705, and $23,227 per quality-adjusted life-year gained in Korea, Australia, Taiwan, Japan, and Singapore, respectively. When using add-on dapagliflozin to standard care versus standard care alone, ~ 100% of simulations were cost-effective at a willingness-to-pay threshold of one gross domestic product per capita of the given Asia–Pacific country; however, the probability of being cost-effective for using add-on dapagliflozin decreased when the time horizon for simulation was restricted to 18 months and when the cardiovascular mortality for the two treatments (43.8% and 33.0%, respectively) was assumed to be the same. The cost-effectiveness results were most sensitive to cardiovascular mortality of treatment.

Conclusions

Adding dapagliflozin to standard care is cost-effective for HFrEF in healthcare systems in the Asia–Pacific region, which supports the rational use of dapagliflozin for HFrEF in this region.
Pathogenic fungi infection attributes of malarial vectors Anopheles maculipennis and Anopheles superpictus in central Iran
Authors: Moosa-Kazemi Seyed Hassan , Asgarian Tahereh Sadat , Sedaghat Mohammad Mehdi , Javar Saeedeh
Published: October 2021

Background

Due to the effect of synthetic and commercial insecticides on non-target organisms and the resistance of mosquitoes, non-chemical and environmentally friendly methods have become prevalent in recent years. The present study was to isolate entomopathogenic fungi with toxic effects on mosquitoes in natural larval habitats.

Methods

Larvae of mosquitoes were collected from Central, Qamsar, Niasar, and Barzok Districts in Kashan County, Central Iran by standard dipping method, from April to late December 2019. Dead larvae, live larvae showing signs of infection, and larvae and pupae with a white coating of fungal mycelium on the outer surface of their bodies were isolated from the rest of the larvae and sterilized with 10% sodium hypochlorite for 2 min, then washed twice with distilled water and transferred to potato-dextrose-agar (PDA) and water-agar (WA) media and incubated at 25 ± 2 °C for 3–4 days. Larvae and fungi were identified morphologically based on identification keys.

Results

A total of 9789 larvae were collected from urban and rural areas in Kashan County. Thirteen species were identified which were recognized to belong to three genera, including Anopheles (7.89%), Culiseta (17.42%) and Culex (74.69%). A total of 105 larvae, including Anopheles superpictus sensu lato (s.l), Anopheles maculipennis s.l., Culex deserticola, Culex perexiguus, and Culiseta longiareolata were found to be infected by Nattrassia mangiferae, Aspergillus niger, Aspergillus fumigatus, Trichoderma spp., and Penicillium spp. Of these, Penicillium spp. was the most abundant fungus isolated and identified from the larval habitats, while An. superpictus s.l. was the most infected mosquito species.

Conclusions

Based on the observations and results obtained of the study, isolated fungi had the potential efficacy for pathogenicity on mosquito larvae. It is suggested that their effects on mosquito larvae should be investigated in the laboratory. The most important point, however, is the proper way of exploiting these biocontrol agents to maximize their effect on reducing the population of vector mosquito larvae without any negative effect on non-target organisms.
Sharp loss: a new loss function for radiotherapy dose prediction based on fully convolutional networks
Authors: Bai Xue , Zhang Jie , Wang Binbing , Wang Shengye , Xiang Yida , Hou Qing
Published: October 2021

Background

Neural-network methods have been widely used for the prediction of dose distributions in radiotherapy. However, the prediction accuracy of existing methods may be degraded by the problem of dose imbalance. In this work, a new loss function is proposed to alleviate the dose imbalance and achieve more accurate prediction results. The U-Net architecture was employed to build a prediction model. Our study involved a total of 110 patients with left-breast cancer, who were previously treated by volumetric-modulated arc radiotherapy. The patient dataset was divided into training and test subsets of 100 and 10 cases, respectively. We proposed a novel ‘sharp loss’ function, and a parameter γ was used to adjust the loss properties. The mean square error (MSE) loss and the sharp loss with different γ values were tested and compared using the Wilcoxon signed-rank test.

Results

The sharp loss achieved superior dose prediction results compared to those of the MSE loss. The best performance with the MSE loss and the sharp loss was obtained when the parameter γ was set to 100. Specifically, the mean absolute difference values for the planning target volume were 318.87 ± 30.23 for the MSE loss versus 144.15 ± 16.27 for the sharp loss with γ = 100 (p < 0.05). The corresponding values for the ipsilateral lung, the heart, the contralateral lung, and the spinal cord were 278.99 ± 51.68 versus 198.75 ± 61.38 (p < 0.05), 216.99 ± 44.13 versus 144.86 ± 43.98 (p < 0.05), 125.96 ± 66.76 versus 111.86 ± 47.19 (p > 0.05), and 194.30 ± 14.51 versus 168.58 ± 25.97 (p < 0.05), respectively.

Conclusions

The sharp loss function could significantly improve the accuracy of radiotherapy dose prediction.