bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda
Authors: Tuyisenge David , Byiringiro Samuel , Manirakiza M. Louise , Mutsinzi Robert G. , Nshimyiryo Alphonse , Nyishime Merab , Hirschhorn Lisa R. , Biziyaremye Francois , Gitera Joseph , Beck Kathryn , Kirk Catherine M.
Published: February 2021

Background

Neonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. The All Babies Count (ABC) intervention was designed to reduce neonatal mortality through provision of equipment and supplies, training, mentorship, and data-driven quality improvement (QI) with peer-to-peer learning through learning collaborative sessions (LCS). We aim to describe the ABC scale-up in seven rural district hospitals from 2017 to 2019 focusing on the QI strategies implemented in hospital neonatal care units (NCUs) and the resultant neonatal care outcomes.

Methods

A pre-post quasi experimental study was conducted in 7 rural hospitals in Rwanda in two phases. The baseline periods were April-June 2017 for Phase I and July-September 2017 for Phase II; with end-line data collected during the same periods in 2019. Data included facility audits of supplies and staffing, LCS surveys of QI skills, and reports of implemented QI change ideas. Data on NCU admissions and deaths were extracted from Health Management Information System (HMIS). Facility-reported change ideas were coded into common themes. Changes in post-post neonatal mortality were measured using Chi-squared tests.

Results

NCUs were run by a median of 1 nurse [interquartile range (IQR):1–2] at baseline and endline. Median NCU admissions increased from 121 [IQR: 77–155] to 137 [IQR: 79–184]. Availability of advanced equipment improved (syringe pumps: 57–100 %, vital sign monitors: 51–100 % and CPAP machine: 14–100 %). There were significant improvements in QI skills among NCU staff. All 7 NCUs (100 %) addressed non-adherence to protocol as a priority gap, 5 NCUs (86 %) also improved communication with families. NCU case fatality rate declined from 12.4 to 7.8 % (p = 0.001).

Conclusions

The ABC package of interventions combining the provision of essential equipment to NCU, clinical training and strong mentorship, QI coaching, and the LCS approach for peer-to-peer learning was associated with significant neonatal mortality reduction and services utilization in the intervention hospitals.
Attainment of smiling and walking in infancy associates with developmental delays at school entry in moderately-late preterm children: a community-based cohort study
Authors: van Dokkum Nienke H. , Reijneveld Sijmen A. , Bos Arend F. , de Kroon Marlou L. A.
Published: February 2021

Background

Moderately-late preterm (MLP) children (gestational age [GA] 32–36 weeks) are followed-up within community services, which often use developmental milestones as indicators of delay. We aimed to examine associations of parental report of smiling-age and walking-age with developmental delay upon school entry for MLP and full-term children.

Methods

This study regards a community-based cohort study, including 1241 children. Parent-reported smiling-age (n = 514) and walking-age (n = 1210) were recorded in preventive child healthcare. To determine developmental delay at school entry (at age 4) we used the Ages and Stages Questionnaire (ASQ) total and domain scores. We assessed the association of smiling-age and walking-age with dichotomized ASQ-scores, using logistic regression analyses.

Results

For MLP children, each week later corrected smiling-age was associated with a relative increased likelihood of delays of 31, 43, 36 and 35% in the personal-social, problem-solving, gross motor and general developmental functioning, respectively. Each month later corrected walking-age was associated with a relative increased likelihood of delays of 10, 15 and 13% in the personal-social, gross motor and general developmental functioning, respectively. All corrected smiling-ages and walking-ages were within normal full-term ranges. For full-term children, we only found that later walking-age was associated with delays in the personal-social and gross motor domains.

Conclusions

Smiling-age and walking-age are associated with developmental delay in several domains for MLP and full-term children. Professionals could use these milestones to identify children that may benefit from closer monitoring of their development.

Trial registration

Clinical Trial Registry name and registration number: controlled-trials.com, ISRCTN80622320.
Bedside upper gastrointestinal series in the neonatal intensive care unit
Authors: Kang Choeum , Yoon Haesung , Shin Hyun Joo , Eun Ho Sun , In Park Kook , Lee Mi-Jung
Published: February 2021

Background

In neonatal intensive care unit (NICU) patients with intubation status, fluoroscopic evaluation for the bowel is limited. This study was to evaluate the utility of bedside upper gastrointestinal (UGI) series with delayed radiographs (DR) for assessing duodenojejunal junction (DJJ) and small bowel passage in NICU patients with nonspecific bowel ultrasonography and contrast enema findings.

Methods

We reviewed clinical and imaging data for bedside UGI with DR of NICU patients from 2014 to 2019. Five abdominal radiographs were obtained at fixed time intervals of immediately after, 1 min, 5 min, 1 h, and 2 h following the administration of 5 cc/kg isotonic water-soluble contrast agent via the nasogastric tube.

Results

Twenty bedside UGI with DR were performed in 17 patients (weight range: 520-3620 g, age range: 0–4 months). Confidence identifying the DJJ was either good (n = 7) or equivocal (n = 8) at immediate or 1 min radiographs. The DJJ could not be evaluated in five from four delayed passage (including two meconium plug syndrome and one gastric volvulus) and one inadequate timing. There was only one case of intestinal malrotation, which was not detected on ultrasonography, but detected at the first UGI examination with good DJJ confidence.

Conclusions

Bedside UGI with DR can evaluate intestinal malrotation using immediate and 1 min delay and small bowel passage using 1 and 2 h delay images in NICU patients with nonspecific ultrasonographic and contrast enema findings. The majority with delayed contrast passages can have bowel pathology. Because of a small number of patients in this study, further studies with more infants are needed.
Depressive symptoms among Peruvian adult residents amidst a National Lockdown during the COVID-19 pandemic
Authors: Antiporta Daniel A. , Cutipé Yuri L. , Mendoza Maria , Celentano David D. , Stuart Elizabeth A. , Bruni Andrea
Published: February 2021

Background

Population health and well-being in Latin America, the current epicenter of the COVID-19 pandemic, has been severely affected during the past semester. Despite the growing evidence about the link between the pandemic, its control measures, and mental health worldwide, there is still no regional evidence of the potential mental health impact. We describe the prevalence and distribution of depressive symptoms across demographic and socioeconomic risk factors in the Peruvian population amidst a national lockdown during the COVID-19 pandemic.

Methods

Cross-sectional study conducted during the community transmission phase and national lockdown in Peru (May 4th–16th, 2020). We recorded 64,493 responses from adult Peruvian residents through an opt-in online questionnaire. All analyses were weighted using raking based on proportions of sociodemographic variables from the last Peruvian census in 2017. The prevalence of depressive symptoms was calculated using the Patient Health Questionnaire (PHQ-9) score of 10 or more. We identified associated demographic and socioeconomic factors by prior mental health diagnosis. Sensitivity analysis considered an alternative cut-off point for depressive symptoms of PHQ-9 ≥ 14.

Results

A total of 57,446 participants were included in the analytical sample. A third of the participants (n = 23,526, unweighted) showed depressive symptoms in the 2 weeks prior to the study. Participants who reported a previous mental health diagnosis doubled the sample prevalence of depressive symptoms (59, 95%CI 56.7, 61.4%) of those without a prior diagnosis. Psychosocial and functioning reactions were largely more prevalent among females and young adults. A dose-response relationship was found between household income and depressive symptoms across previous mental health diagnosis strata, being as low as 32% less in the wealthiest than the most impoverished group (PR: 0.68, 95%CI 0.58,0.79). Other critical factors associated with a higher burden of depressive symptoms were lower education level, single, unemployed, and chronic comorbidity.

Conclusions

An increased burden of depressive symptoms and psychosocial reactions has emerged during the COVID-19 pandemic in Peru compared to previous years. The mental health burden disproportionately affects women, the younger population, and those with low income and education. As the country eases the social distancing measures, it is crucial to use local evidence to adjust public health policies and mental health services to the renewed population needs.
Psychological distress associated with the COVID-19 pandemic and suppression measures during the first wave in Belgium
Authors: Lorant Vincent , Smith Pierre , Van den Broeck Kris , Nicaise Pablo
Published: February 2021

Background

The COVID-19 pandemic and subsequent suppression measures have had health and social implications for billions of individuals. The aim of this paper is to investigate the risk of psychological distress associated with the COVID-19 pandemic and suppression measures during the early days of the lockdown. We compared the level of psychological distress at the beginning of that period with a pre-pandemic health survey and assessed the psychological effects of exposure to the COVID-19 pandemic and changes in social activity and support.

Methods

An online survey was distributed to the general population in Belgium 3 days after the beginning of the lockdown. 20,792 respondents participated. The psychological distress of the population was measured using the GHQ-12 scale. Social activities and support were assessed using the Social Participation Measure, the Short Loneliness Scale, and the Oslo Social Support Scale. An index of subjective exposure to the COVID-19 pandemic was constructed, as well as a measure of change in occupational status. Measurements were compared to a representative sample of individuals extracted from the Belgian Health Interview Survey of 2018. Bootstrapping was performed and analyses were reweighted to match the Belgian population in order to control for survey selection bias.

Results

Half of the respondents reported psychological distress in the early days of the lockdown. A longer period of confinement was associated with higher risk of distress. Women and younger age groups were more at risk than men and older age groups, as were respondents who had been exposed to COVID-19. Changes in occupational status and a decrease in social activity and support also increased the risk of psychological distress. Comparing the results with those of the 2018 Belgian Health Interview shows that the early period of the lockdown corresponded to a 2.3-fold increase in psychological distress (95% CI: 2.16–2.45).

Conclusions

Psychological distress is associated with the consequences of the COVID-19 pandemic and suppression measures. The association is measurable from the very earliest days of confinement and it affected specific at-risk groups. Authorities should consider ways of limiting the effect of confinement on the mental and social health of the population and developing strategies to mitigate the adverse consequences of suppression measures.
Goal management training for adults with ADHD – clients’ experiences with a group-based intervention
Authors: Nordby Emilie S. , Gilje Sigrid , Jensen Daniel A. , Sørensen Lin , Stige Signe H.
Published: February 2021

Background

There is growing evidence for the efficacy of group-based interventions for adults with ADHD. However, there is still a lack of research investigating how clients experience participating in such interventions. The aim of the current study was to explore how adults with ADHD experience participating in a group-based intervention (Goal Management Training) for ADHD.

Method

We conducted individual, semi-structured, interviews with ten adults with ADHD who had participated in Goal Management Training administered as a group intervention. The interviews were transcribed verbatim and analyzed using thematic analysis within a hermeneutic phenomenological framework.

Results

Our analysis identified three main themes. The participants’ starting point captured the participants’ motivation and expectations prior to treatment. The ambiguity of the group – the various meanings of the group consisted of three sub-themes (The group created a sense of belonging - “I am not alone”; The personal cost of participating in the group - “At times it was a hot mess”; and The group supported the learning experience - “We worked with it together”). The group promoted positive change – How the group affected the participants’ everyday lives consisted of two sub-themes (Managing ADHD in daily life - “It’s much easier to handle everyday life”, and Personal growth - “Gaining new perspectives”).

Conclusion

The group format was experienced as a valuable aspect of treatment. The structure provided by Goal Management Training allowed participants to expand their perspectives and experience improved management of ADHD, as well as personal growth. The opportunity to exchange experiences with others in similar situations was seen as particularly beneficial and brought feelings of recognition and belonging. However, some also experienced the group as a burden at times, for instance by stealing one’s focus. This study expands existing knowledge by exploring clients’ experiences of participating in group-based interventions for ADHD and shows how the group format provided participants with more than they had hoped for. While expecting a more instrumental outcome of treatment, such as tools to manage ADHD, participants also gained a welcomed, but unexpected outcome of personal growth.
Evaluating the independent influence of sexual transmission on HBV infection in China: a modeling study
Authors: Li Miaolei , Zu Jian , Shen Mingwang , Zhuang Guihua , Chen Siyuan , Wang Fuzhen , Zheng Hui , Zhang Guomin
Published: February 2021

Background

The long-term impact of sexual transmission on the hepatitis B virus (HBV) infection in China remains unclear. This study aims to estimate the independent influence of sexual transmission on HBV infection.

Methods

Based on the natural history of HBV infection and three national serosurvey data of hepatitis B in China, we developed an age- and sex-specific discrete model to describe the transmission dynamics of HBV. The initial conditions of the model were determined according to the age- and sex-specific national serosurvey data in 1992. Based on the national survey data of hepatitis B in 1992 and 2006, by using the Markov Chain Monte Carlo (MCMC) method, we estimated the age- and sex-specific seroclearance rates of hepatitis B surface antigen (HBsAg) and the horizontal transmission rates as well as their 95% confidence intervals (CI). Then we used the age- and sex-specific national serosurvey data of hepatitis B in 2014 to test the accuracy of our model-based estimation. Finally, we evaluated the independent impact of sexual transmission on HBV infection and discussed the long-term effect of promotion of condom use in China.

Results

We estimated that the annual rates of HBsAg seroclearance for males and females aged 1–59 years were respectively 1.04% (95% CI, 0.49–1.59%) and 1.92% (95% CI, 1.11–2.73%). Due to sexual transmission, in 2014, the total number of chronic HBV infections in people aged 0–100 years increased 292,581, of which males increased 189,200 and females increased 103,381. In 2006, the acute HBV infections due to sexual transmission accounted for 24.76% (male: 31.33%, female: 17.94%) and in 2014, which accounted for 34.59% (male: 42.93%, female: 25.73%). However, if the condom usage rate was increased by 10% annually starting in 2019, then compared with current practice, the total number of acute HBV infections from 2019 to 2035 would be reduced by 16.68% (male: 21.49%, female: 11.93%). The HBsAg prevalence in people aged 1–59 years in 2035 would be reduced to 2.01% (male: 2.40%, female: 1.58%).

Conclusions

Sexual transmission has become the predominant route of acute HBV infection in China, especially for men. The promotion of condom use plays a significant role in reducing the cases of acute HBV infection.
Leisure-time physical activity and its correlates in a multi-ethnic sample of adults over age 50 in Singapore
Authors: Fong Joelle H.
Published: February 2021

Background

To examine the prevalence and correlates of regular leisure-time physical activity (LTPA) among community-dwelling adults in Singapore.

Methods

Data was sourced from the 2018–2019 Singapore Life Panel, which asked respondents about their current LTPA participation at various time-points over a seven-month period. The final sample comprised 7684 subjects over age 50. We applied logistic regression models in our analysis.

Results

39.8% of the respondents engaged in regular LTPA, with significantly higher proportions of men than women doing so. Factors positively associated with regular LTPA in both genders were age, education, retired, income, and satisfaction with social life, whereas a negative association was found with self-rated health. The correlates of sustained LTPA participation were relatively consistent with factors predicting current participation.

Conclusions

Regular participation in recreational physical activities is important to promoting health and well-being among middle-aged and older adults as populations age. Our findings indicated that positive perceptions of social relationships and being retired are important supporting factors. The urgent development of physical activity promotion strategies and interventions are required to foster greater overall LTPA participation.
Correction to: Exploring expected and perceived facilitators and barriers of an indicated prevention strategy to prevent future longterm sickness absence; a qualitative study among employers and employees
Authors: Klasen Sophie H. , van Amelsvoort Ludovic G. P. M. , Houkes Inge , Jansen Nicole W. H. , Kant IJmert
Published: February 2021

An amendment to this paper has been published and can be accessed via the original article.
A hybrid approach for chronic pancreatitis: combination of laparoscopic assisted distal pancreatectomy and open Frey procedure
Authors: Saito Kenta , Matsuo Yoichi , Ueda Goro , Omi Kan , Hayashi Yuichi , Imafuji Hiroyuki , Tsuboi Ken , Morimoto Mamoru , Ogawa Ryo , Takahashi Hiroki , Naitoh Itaru , Hayashi Kazuki , Kataoka Hiromi , Takiguchi Shuji
Published: February 2021

Background

The treatment of chronic pancreatitis requires a surgical approach in patients who are refractory to medical therapy. During surgical treatment, ductal decompression is required, but a pancreatectomy is necessary for some patients, such as those with severe stenosis of the pancreatic duct. Indeed, suboptimal procedures lead to recurrent pancreatitis. We used a laparoscopic hybrid approach for patients with severe stenosis of the pancreatic duct. In this report, we present the feasibility and outcomes of our approach.

Methods

We selected a laparoscopic approach for the distal pancreatectomy, which is relatively safe and the effect of reducing the length of the wound is substantial. We selected an open approach for the Frey procedure because complete ductal compression has a high risk for injury to the vessels posterior to the pancreas. We recorded the operative outcomes, postoperative complications, and recurrence of pancreatitis.

Results

We performed the laparoscopic hybrid approach on 3patients between January and December 2018. There were no major intraoperative complications (Clavien-Dindo classification IIIa or more) and the postoperative course was uneventful in all patients. There were no recurrences of pancreatitis and no postoperative pain in all patients in > 2 years of follow-up.

Conclusion

Our hybrid method with a focus on complete ductal compression with safety and minimal invasiveness might be the optimal approach for the surgical treatment of chronic pancreatitis that requires a pancreatectomy with the Frey procedure.
Improved access in minimally invasive temporomandibular joint surgery through a novel endaural template
Authors: Krause Matthias , Kamal Mohammad , Kruber Daniel , Halama Dirk , Hierl Thomas , Lethaus Bernd , Bartella Alexander K.
Published: February 2021

Background

Digitally designed surgical templates for minimally invasive temporomandibular joint (TMJ) surgery (MITMJS) are a promising tool for improving the safety of these procedures. Given the TMJ anatomy, the template fitting and intraoperative overview are the most important issues for a safe surgery. This article is a technical advance article that aims to describe an endaural surgical template based on the Moses approach as a possible solution in TMJ surgery.

Methods

Three patients with internal derangement were treated with the guidance of a MITMJS template based on cone beam computed tomography (CBCT) and a surface imprint of the periauricular region. None of the patients needed an additional open surgical procedure. Fitting of the templates was judged in terms of position and rotational stability. Surgical side effects and complications were recorded for each patient.

Results

The template design and clinical use were satisfactory for MITMJS. The templates showed satisfying fit and good visibility. In the study cohort, no bleeding, facial nerve injury, or other complications occurred after the procedure, and no visible scars were noted postoperatively.

Conclusion

Our feasibility report on template-guided MITMJS shows a promising new application of templates. It points to improved access in arthroscopy or arthrocentesis of TMJ surgery through endaural access with an increased level of safety during surgery.
Low‐level laser therapy using laser diode 940 nm in the mandibular impacted third molar surgery: double-blind randomized clinical trial
Authors: Momeni Ehsan , Barati Hoda , Arbabi Melika Rajaei , Jalali Behrouz , Moosavi Mahdieh-Sadat
Published: February 2021

Background

The effect of low-level laser therapy (LLLT) on pain mitigation following the third molar surgery is still controversial. The absence of a standard method for using laser among the studies is related to the types of sample selection, sample size, control, and LLLT parameters, which make pain mitigation following surgery more controversial. Therefore, this study aimed to determine the effect of LLLT on reducing pain, swelling, and trismus following the mandibular impacted third molar surgery.

Methods

This study was performed on 25 healthy subjects. After the surgery, amoxicillin 500 mg was prescribed every 8 h for a 7-day period besides oral Ibuprofen (Gelofen) 400 mg every 12 h for a 3-day period. The intraoral Laser diode 940 nm was applied immediately after suture on the tested side, while on the placebo side, a fiber tip was used with no laser radiation following surgery. Eventually, the pain score was evaluated by VAS index from the 1st to the 7th-day post-surgery and then analyzed by SPSS 24.

Results

The results indicate that the mean swelling and trismus before, during, 2 days after, and 7 days after the intervention did not differ significantly between the two studied groups. However, the results show that on the sixth and seventh days, the pain was significantly lower in the intervention group compared to the control group.

Conclusions

The results suggest that although the pain, swelling, and trismus following surgery were lower on the radiated side, only pain was found to be significant on the radiated side (p < 0.05).

The registration number of the clinical trial in a Primary Registry in the WHO Registry Network is IRCT20141209020258N110 and the date of retrospective registration is 04/05/2019. The related URL ishttps://www.irct.ir/trial/36321.
Combination effect of laser diode for photodynamic therapy with doxycycline on a wistar rat model of periodontitis
Authors: Astuti Suryani Dyah , Utomo Irawan Budi , Setiawatie Ernie Maduratna , Khasanah Miratul , Purnobasuki Hery , Arifianto Deny , Alamsyah Kartika Anggraini
Published: February 2021

Background

Periodontitis is a chronic inflammatory disease characterized by progressive damage on the structure of tooth-supporting tissues. The aim of the study is determining the combination photodynamic effect of diode laser 405 nm treatments and the administration of doxycycline 0.1% within 1, 3, 5, and 7 days on a Wistar rat model of periodontitis.

Methods

Samples were induced with Porphyromonas gingivalis ATCC33277 to allow periodontitis development and were treated with combination of doxycycline and laser diode, then statistical analysis was carried out (One-Way ANOVA test and the post-hoc Duncan test; Kruskal–Wallis test and Mann–Whitney follow-up test for non-parametric data). Samples were divided into five groups, laser exposure used was 405-nm diode laser with energy density of 8 J/cm2. The expression level of histomorphometric was calculated by measuring the number of macrophages, lymphocytes, fibroblasts and the distance between the CEJ-AV.

Results

The results showed that the combination treatment of doxycycline and laser exposure yielded immunomodulatory effects. The expression level of fibroblast and the distance between CEJ-AV bone showed that the combination of doxycycline and laser therapy exerted healing effect in rat models of periodontitis on day 5 and 7.

Conclusion

The combination of doxycycline 0.1% and diode laser therapy provides a healing effect in rats models of periodontitis.
Challenges and opportunities associated with cervical cancer screening programs in a low income, high HIV prevalence context
Authors: Adedimeji Adebola , Ajeh Rogers , Pierz Amanda , Nkeng Relindis , Ndenkeh Jackson , Fuhngwa Norbert , Nsame Denis , Nji Miriam , Dzudie Anastase , Anastos Kathryn M. , Castle Philip E.
Published: February 2021

Background

Cervical cancer is a leading cause of death among Cameroon women. The burden of cervical cancer is in part traceable to the inadequate understanding of socio-contextual determinants of access to screening and prevention opportunities. We explored multilevel individual, community and structural factors that facilitate or inhibit cervical cancer prevention in women at risk in a low-income, high HIV prevalence context.

Methods

We utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews from May to August, 2018. A two-stage purposive sampling strategy was used to select 80 women and 20 men who participated in 8 focus group discussions and 8 in-depth interviews. The socio-ecological model guided data analyses to identify micro-, meso-, and macro-level determinants of cervical cancer screening.

Results

Micro-level factors including lack of awareness and knowledge about cervical cancer, lack of access to information, excessive cost of cervical cancer screening, low risk perceptions, and poor health seeking behaviors were major barriers for women seeking cervical cancer screening. Meso-level factors, such as social networks, socio-cultural norms, perceptions of the role of men and HIV-related stigma when screening is integrated into HIV care, also engender negative attitudes and behaviors. Macro-level barriers to cervical cancer screening included poorly equipped health facilities and a lack of national cancer prevention policies and programs.

Conclusion

In the context of the call for elimination of cervical cancer as a public health problem, our findings highlight challenges and opportunities that should be considered when implementing interventions to increase uptake of cervical cancer screening in low-middle income settings.
Perceptions of Ecuadorian indigenous healers on their relationship with the formal health care system: barriers and opportunities
Authors: Bautista-Valarezo Estefanía , Duque Víctor , Verhoeven Veronique , Mejia Chicaiza Jorge , Hendrickx Kristin , Maldonado-Rengel Ruth , Michels Nele R.M.
Published: February 2021

Background

The new paradigm of intercultural policies focuses on rethinking the common public culture. In Ecuador, the “Buen Vivir” plan seeks to incorporate the ancestral medical knowledge, experience and beliefs of traditional healers into the formal health services. This study explores views on the formal health system from the perspective of the healers belonging to the Kichwa and Shuar ethnicities in the South of Ecuador.

Methods

A qualitative study with a phenomenological approach was performed. Focus groups were conducted in three locations in Southern Ecuador. Shuar, Kichwa and Mestizo ethnic groups were included in the research.

Results

Eleven focus groups with a total of 110 participants belonging to the Shuar, Kichwa and Mestizo ethnic groups participated in the study. Six themes were created through analysis: 1) conflicts with health professionals, 2) acceptance of traditional healers, 3) respect, 4) work as a team, 5) environment and patient care, and 6) salary and recognition.

Conclusion

This study indicated the perceived barriers compromising respectful collaboration between health staff and traditional healers from an indigenous perspective. Power inequalities and a historically unidirectional relationship and, in addition, differences in health beliefs, seem to create misunderstandings regarding each other’s approach when faced with health and disease. However, insight in these barriers can create opportunities towards collaboration, which will have a positive effect on patient confidence in one or both systems and support continuity between traditional healers and the formal health system.
Health management students’ self-regulation and digital concept mapping in online learning environments
Authors: Alt Dorit , Naamati-Schneider Lior
Published: February 2021

Background

Self-regulation of learning is considered one of the key capabilities deemed essential for the healthcare system and its workers to cope successfully with the current challenges they are facing. Therefore, healthcare curricula are increasingly called upon to support self-regulation as a central learning outcome. With scant relevant publications describing how students of medicine and other healthcare professions regulate their learning, this study set out to design and assess a problem-based learning using digital concept mapping in an online course and to evaluate the set of connections between this intervention and Health Management students’ self-regulation of learning.

Method

Students of a Management of Health Service Organizations program (100) were presented with an ill-structured problem, relevant to their course content (accreditation process within hospitals) and were asked to argue for or against the implementation of the accreditation process. The participants were asked to detail five arguments to establish their decision by using Mindomo, a popular digital platform for designing concept maps. The students were given predefined criteria that allowed them to self-assess their maps. Data for the analysis were gathered by two measurements: Concept mapping for problem-based learning scale and the Online self-regulated learning scale and were analyzed by using Partial Least Squares - Structural Equation Modeling.

Results

The analyses showed that at the beginning of the process, students’ online self-regulation was found lower than at the end of the intervention, and only two self-regulation sub-factors: Goal setting and Task strategies, were positively linked to students’ perceptions of the intervention. After the intervention, the analyses showed that it increased the levels of four Online self-regulation sub-factors: Goal setting, Task strategies, Environment structuring, and Time management.

Conclusions

Teachers need to recognize and account for different types of learners and encourage and scaffold students’ effective use of self-regulation strategies. Low self-regulated learners might fail to see the advantages of concept mapping in problem-solving activities. Combining these teaching and learning tools together with the use of advanced technology in an online course that encourages active learning enables the development and acquisition of abilities of self-directed learning among students in the medical and health management professions.
Efficacy-specific herbal group detection from traditional Chinese medicine prescriptions via hierarchical attentive neural network model
Authors: Chen Li , Liu Xinglong , Zhang Siyuan , Yi Hong , Lu Yongmei , Yao Pan
Published: February 2021

Background

Mining massive prescriptions in Traditional Chinese Medicine (TCM) accumulated in the lengthy period of several thousand years to discover essential herbal groups for distinct efficacies is of significance for TCM modernization, thus starting to draw attentions recently. However, most existing methods for the task treat herbs with different surface forms orthogonally and determine efficacy-specific herbal groups based on the raw frequencies an herbal group occur in a collection of prescriptions. Such methods entirely overlook the fact that prescriptions in TCM are formed empirically by different people at different historical stages, and thus full of herbs with different surface forms expressing the same material, or even noisy and redundant herbs.

Methods

We propose a two-stage approach for efficacy-specific herbal group detection from prescriptions in TCM. For the first stage we devise a hierarchical attentive neural network model to capture essential herbs in a prescription for its efficacy, where herbs are encoded with dense real-valued vectors learned automatically to identify their differences on the semantical level. For the second stage, frequent patterns are mined to discover essential herbal groups for an efficacy from distilled prescriptions obtained in the first stage.

Results

We verify the effectiveness of our proposed approach from two aspects, the first one is the ability of the hierarchical attentive neural network model to distill a prescription, and the second one is the accuracy in discovering efficacy-specific herbal groups.

Conclusion

The experimental results demonstrate that the hierarchical attentive neural network model is capable to capture herbs in a prescription essential to its efficacy, and the distilled prescriptions significantly could improve the performance of efficacy-specific herbal group detection.
Benchmarking outcomes on multiple contextual levels in lean healthcare: a systematic review, development of a conceptual framework, and a research agenda
Authors: Reponen Elina , Rundall Thomas G. , Shortell Stephen M. , Blodgett Janet C. , Juarez Angelica , Jokela Ritva , Mäkijärvi Markku , Torkki Paulus
Published: February 2021

Background

Reliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists.

Methods

We systematically searched the Pubmed, Scopus, and Web of Science databases to identify original articles reporting benchmarking on different contextual levels in Lean healthcare and critically appraised the articles. Scarcity and heterogeneity of articles prevented quantitative meta-analyses. We developed a new, widely applicable conceptual framework for benchmarking drawing on the principles of ten commonly used healthcare quality frameworks and four value statements, and suggest an agenda for future research on benchmarking in Lean healthcare.

Results

We identified 22 articles on benchmarking in Lean healthcare on 4 contextual levels: intra-organizational (6 articles), regional (4), national (10), and international (2). We further categorized the articles by the domains in the proposed conceptual framework: patients (6), employed and affiliated staff (2), costs (2), and service provision (16). After critical appraisal, only one fifth of the articles were categorized as high quality.

Conclusions

When making evidence-informed decisions based on current scarce literature on benchmarking in healthcare, leaders and managers should carefully consider the influence of context. The proposed conceptual framework may facilitate performance benchmarking and spreading best practices in Lean healthcare. Future research on benchmarking in Lean healthcare should include international benchmarking, defining essential factors influencing Lean initiatives on different levels of context; patient-centered benchmarking; and system-level benchmarking with a balanced set of outcomes and quality measures.
Triglyceride-glucose index and the risk of stroke and its subtypes in the general population: an 11-year follow-up
Authors: Wang Anxin , Wang Guangyao , Liu Qian , Zuo Yingting , Chen Shuohua , Tao Boni , Tian Xue , Wang Penglian , Meng Xia , Wu Shouling , Wang Yongjun , Wang Yilong
Published: February 2021

Background

Triglyceride-glucose (TyG) index was recently suggested to be a reliable surrogate marker of insulin resistance. We aim to investigate the associations between baseline and long-term TyG index with subsequent stroke and its subtypes in a community-based cohort.

Methods

A total of 97,653 participants free of history of stroke in the Kailuan Study were included. TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). Baseline TyG index was measured during 2006–2007. Updated cumulative average TyG index used all available TyG index from baseline to the outcome events of interest or the end of follow up. The outcome was the first occurrence of stroke, including ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage. The associations of TyG index with outcomes were explored with Cox regression.

Results

During a median of 11.02 years of follow-up, 5122 participants developed stroke of whom 4277 were ischemic stroke, 880 intracerebral hemorrhage, and 144 subarachnoid hemorrhage. After adjusting for confounding variables, compared with participants in the lowest quartile of baseline TyG index, those in the third and fourth quartile were associated with an increased risk of stroke (adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.12–1.33, and adjusted HR 1.32, 95% CI 1.21–1.44, respectively,Pfor trend < 0.001). We also found a linear association between baseline TyG index with stroke. Similar results were found for ischemic stroke. However, no significant associations were observed between baseline TyG index and risk of intracranial hemorrhage. Parallel results were observed for the associations of updated cumulative average TyG index with outcomes.

Conclusions

Elevated levels of both baseline and long-term updated cumulative average TyG index can independently predict stroke and ischemic stroke but not intracerebral hemorrhage in the general population during an 11-year follow-up.
CALM1 promotes progression and dampens chemosensitivity to EGFR inhibitor in esophageal squamous cell carcinoma
Authors: Liu Tao , Han Xiujuan , Zheng Shutao , Liu Qing , Tuerxun Aerziguli , Zhang Qiqi , Yang Lifei , Lu Xiaomei
Published: February 2021

Background

Calmodulin1 (CALM1) has been identified as one of the overexpression genes in a variety of cancers and EGFR inhibitor have been widely used in clinical treatment but it is unknown whether CALM1 and epidermal growth factor receptor (EGFR) have a synergistic effect in esophageal squamous cell carcinoma (ESCC). The aim of the present study was to explore the synergistic effects of knock-out CALM1 combined with EGFR inhibitor (Afatinib) and to elucidate the role of CALM1 in sensitizing the resistance to Afatinib in ESCC.

Method

Immunohistochemistry (IHC) and qRT-PCR were used to examine the expression of CALM1 and EGFR in ESCC tissues. Kaplan–Meier survival analysis was used to analyze the clinical and prognostic significance of CALM1 and EGFR expression in ESCC. Furthermore, to evaluate the biological function of CALM1 in ESCC, the latest gene editing technique CRISPR/Cas9(Clustered regularly interspaced short palindromic repeats)was applied to knockout CALM1 in ESCC cell lines KYSE150, Eca109 and TE-1. MTT, flow cytometry, Transwell migration, scratch wound-healing and colony formation assays were performed to assay the combined effect of knock-out CALM1 and EGFR inhibitor on ESCC cell proliferation and migration. In addition, nude mice xenograft model was used to observe the synergistic inhibition of knock-out CALM1 and Afatinib.

Results

Both CALM1 and EGFR were found to be significantly over-expressed in ESCC compared with paired normal control. Over-expressed CALM1 and EGFR were significantly associated with clinical stage, T classification and poor overall prognosis, respectively. In vitro, the combined effect of knock-out CALM1 mediated by the lentivirus and EGFR inhibitor was shown to be capable of inhibiting the proliferation, inducing cell cycle arrest at G1/S stage and increasing apoptosis of KYSE-150 and Eca109 cells; invasion and migration were also suppressed. In vivo, the results of tumor weight and total fluorescence were markedly reduced compared with the sgCtrl-infected group and sgCAML1 group.

Conclusion

Our data demonstrated that knock-out of CALM1 could sensitize ESCC cells to EGFR inhibitor, and it may exert oncogenic role via promotion of EMT. Taken together, CALM1 may be a tempting target to overcome Afatinib resistance.
Curcumin anti‐tumor effects on endometrial cancer with focus on its molecular targets
Authors: Jahanbakhshi Fahime , Maleki Dana Parisa , Badehnoosh Bita , Yousefi Bahman , Mansournia Mohammad Ali , Jahanshahi Moghadeseh , Asemi Zatollah , Halajzadeh Jamal
Published: February 2021

Curcumin is extracted from turmeric and shows a variety of properties that make it a useful agent for treating diseases and targeting different biological mechanisms, including apoptosis, angiogenesis, inflammation, and oxidative stress. This phenolic compound is safe even at high doses. However, it has poor bioavailability. The incidence rates of endometrial cancer (EC) that is one of the most prevalent gynecological malignancies is increasing. Meanwhile, the onset age of EC has been decreased in past few years. Besides, EC does not show a convenient prognosis, particularly at advanced stages. Based on this information, discovering new approaches or enhancing the available ones is required to provide better care for EC patients. In this review, we cover studies concerned with the anti-tumor effects of curcumin on EC. We focus on molecular mechanisms that are targeted by curcumin treatment in different processes of cancer development and progression, such as apoptosis, inflammation, and migration. Furthermore, we present the role of curcumin in targeting some microRNAs (miRNAs) that may play a role in EC.
A model for malaria elimination based on learnings from the Malaria Elimination Demonstration Project, Mandla district, Madhya Pradesh
Authors: Rajvanshi Harsh , Bharti Praveen K. , Nisar Sekh , Jayswar Himanshu , Mishra Ashok K. , Sharma Ravendra K. , Saha Kalyan B. , Shukla Man Mohan , Wattal Suman L. , Das Aparup , Kaur Harpreet , Anvikar Anupkumar R. , Khan Azadar , Kshirsagar Nilima , Dash Aditya P. , Lal Altaf A.
Published: February 2021

Background

Malaria Elimination Demonstration Project (MEDP) was started as a Public-Private-Partnership between the Indian Council of Medical Research through National Institute of Research in Tribal Health, Govt. of Madhya Pradesh and Foundation of Disease Elimination and Control of India, which is a Corporate Social Responsibility (CSR) initiative of the Sun Pharmaceutical Industries Limited. The project’s goal was to demonstrate that malaria can be eliminated from a high malaria endemic district along with prevention of re-establishment of malaria and to develop a model for malaria elimination using the lessons learned and knowledge acquired from the demonstration project.

Methods

The project employed tested protocols of robust surveillance, case management, vector control, and capacity building through continuous evaluation and training.  The model was developed using the learnings from the operational plan, surveillance and case management, monitoring and feedback, entomological investigations and vector control, IEC and capacity building, supply chain management, mobile application (SOCH), and independent reviews of MEDP.

Results

The MEDP has been operational since April 2017 with field operations from August 2017, and has observed: (1) reduction in indigenous cases of malaria by about 91 %; (2) need for training and capacity building of field staff for diagnosis and treatment of malaria; (3) need for improvement insecticide spraying and for distribution and usage of bed-nets; (4) need for robust surveillance system that captures and documents information on febrile cases, RDT positive individuals, and treatments provided; (5) need for effective supervision of field staff based on advance tour plan; (6) accountability and controls from the highest level to field workers; and (7) need for context-specific IEC.

Conclusions

Malaria elimination is a high-priority public health goal of the Indian Government with a committed deadline of 2030. In order to achieve this goal, built-in systems of accountability, ownership, effective management, operational, technical, and financial controls will be crucial components for malaria elimination in India. This manuscript presents a model for malaria elimination with district as an operational unit, which may be considered for malaria elimination in India and other countries with similar geography, topography, climate, endemicity, health infrastructure, and socio-economic characteristics.
Diversity-oriented synthesis derived indole based spiro and fused small molecules kills artemisinin-resistant Plasmodium falciparum
Authors: Nayak Akshaykumar , Saxena Himani , Bathula Chandramohan , Kumar Tarkeshwar , Bhattacharjee Souvik , Sen Subhabrata , Gupta Ashish
Published: February 2021

Background

Despite numerous efforts to eradicate the disease, malaria continues to remain one of the most dangerous infectious diseases plaguing the world. In the absence of any effective vaccines and with emerging drug resistance in the parasite against the majority of anti-malarial drugs, the search for new drugs is urgently needed for effective malaria treatment.

Methods

The goal of the present study was to examine the compound library, based on indoles generated through diversity-oriented synthesis belonging to four different architecture, i.e., 1-aryltetrahydro/dihydro-β-carbolines and piperidine/pyrrolidine-fused indole derivatives, for their in vitro anti-plasmodial activity. Trifluoroacetic acid catalyzed transformation involving tryptamine and various aldehydes/ketones provided the library.

Results

Among all the compounds screened, 1-aryltetrahydro-β-carbolines 2 and 3 displayed significant anti-plasmodial activity against both the artemisinin-sensitive and artemisinin-resistant strain of Plasmodium falciparum. It was observed that these compounds inhibited the overall parasite growth in intra-erythrocytic developmental cycle (IDC) via reactive oxygen species-mediated parasitic death and thus could be potential anti-malarial compounds.

Conclusion

Overall the compounds 2 and 3 identified in this study shows promising anti-plasmodial activity that can kill both artemisinin-sensitive and artemisinin-resistant strains of P. falciparum.