bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility and acceptability of wearable devices and daily diaries to assess sleep and other health indicators among young women in the slums of Kampala, Uganda
Authors: Nielsen Karen , Mobley Kate , Culbreth Rachel , Palmier Jane , Nabulya Anna , Swahn Monica H.
Published: October 2024

Background

Individuals in Uganda's urban slums have unmet mental health needs due to limited healthcare infrastructure, poor environmental conditions, and extreme poverty. Researchers often use wearable devices to measure factors associated with mental health including sleep, physical activity, and exposure to environmental stressors. However, the use of wearables for research purposes in low-resource settings is limited. This pilot study investigated the feasibility and acceptability of wearables and accompanying daily diaries to assess sleep and other health indicators in young women living in Kampala's slums.

Methods

Women ( n = 60 total, two groups) aged 18–24 living in three urban slums participated in 5-day pilot protocols comprised of wearing Garmin vívoactive 3 smartwatches and completing daily diaries concerning sleep and physical activities. Participants completed surveys about their experiences. We based analyses on survey findings and data completeness.

Results

All participants responded to daily diaries. All but one reported wearing the device nonstop and 51 had recoverable heart rate data with median data coverage of 93.2%. Most devices (87.5%) recorded data for 5 days without running out of battery. Some participants (8.5%) found the wearable uncomfortable during the day, and 25% found it uncomfortable at night. Few participants (6.7%) reported feeling unsafe with the wearable, with most reports occurring prior to the availability of bracelet-like wearable covers.

Conclusions

Study protocols implementing wearables and complimentary daily diaries are feasible in this urban population. However, important contextual factors including participant and researcher training and safety concerns warrant additional considerations for acceptable utilization of wearable devices for research in other low-resource settings.
Corporate Demography and Wage Inequality: Revisited
Authors: Bomark Niklas , Carlberg Larsson Elis , Wennberg Karl
Published: October 2024

To further research how organizations influence workforce wage inequality, the authors replicate and extend Sorensen and Sorenson’s study on organizational demography and wage inequality in region-industries by (1) replicating original results from Danish regions from 1992 to 1998 using a close-to-identical dataset in Sweden during the same time period, (2) using multiverse analysis to gauge the effect of analytical choices on research results, and (3) expanding the scope of Sorensen and Sorenson’s model by two new measures of organizational diversity. The findings suggest strong to fair test-retest validity of the original model, but model extensions with nuanced measures of organization form diversity do not enhance the model’s explanatory power. The authors analyze and discuss replication anomalies and show how multiverse analysis can be gainfully used more generally in comparative organizational sociology.
Keeping Everyone Buoyant: The Care Work of Women Faculty and Research Staff during COVID-19
Authors: Gordon Loa , Christopher Gabriella , McNair Nicole , Young Marisa
Published: October 2024

The authors explore how the coronavirus disease 2019 (COVID-19) pandemic amplified a broad range of care practices for women in academia. Engaging the lived experiences of faculty and research staff members, the authors investigate the entangled impact of care on work-life productivity during the first year and a half of the global pandemic. Mixed-methods data include roundtable accounts focusing on the COVID-19 experiences of woman employees at a Canadian university with supplementary analyses from a related institutional survey. The findings demonstrate a triangulated configuration of care responsibilities: care directly associated with work, care outside of work without disruption to professional excellence, and pressures of self-care. The authors conclude by describing the “cruel optimism” of care that is at once rewarding but simultaneously diminishing to personal flourishing. This article contributes to analytical efforts to critically redefine care in higher education as an ambivalent set of laborious practices steeped in inequities.
Primary Arthrodesis or Open Reduction and Internal Fixation for Lisfranc Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Mactier Lachlan , Cox Genevieve , Mittal Rajat , Suthersan Mayuran
Published: October 2024

Background:

Lisfranc injuries are often managed surgically with primary arthrodesis (PA) or open reduction and internal fixation (ORIF); however, neither approach has been shown to be superior. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) to compare the functional and surgical outcomes of PA and ORIF in the treatment of Lisfranc injuries.

Methods:

This study was performed as per the PRISMA protocol. Database searches were conducted on Cochrane, Embase, and PubMed libraries. Five RCTs were identified for inclusion involving 241 patients, of which 121 underwent PA and 120 underwent ORIF.

Results:

Statistically significant differences in visual analog scale pain score at 2 years (mean difference 0.89, 95% CI 0.18-1.59), patient satisfaction (OR 10.04, 95% CI 1.78-56.76), and all-cause return to surgery (OR 27.31, 95% CI 12.72-58.63) were observed, all favoring PA. There were no statistically significant differences between PA and ORIF with regard to American Orthopaedic Foot & Ankle Society midfoot scores at 2 years, 36-Item Short Form Health Survey (SF-36) scores, and unplanned return to surgery.

Conclusion:

This study showed significant improvement in pain at 2 years, patient satisfaction, and all-cause return to surgery favoring PA in all instances. Given ORIF often necessitates a second operation for hardware removal, it is to be expected that all-cause return to surgery is higher in ORIF groups. Overall, these results do not have the power to confer an advantage to a particular approach because of significant heterogeneity. Further studies should focus on larger patient cohorts and longer follow-up, or analysis stratified by patient demographics and injury presentation. In the absence of clinically significant differences, cost-benefit analyses should be considered to answer the question of whether to “fix or fuse” for Lisfranc injuries.
Synergies Unveiled: Mapping the Intersection of Financial Well-being and Sustainable Development Goals through Bibliometric Insights
Authors: Biswas Bappaditya , Sharma Mantosh
Published: October 2024

Financial well-being is a state of being financially healthy and happy. Financial well-being plays an important role in achieving Sustainable Development Goals (SDGs). Increasing financial well-being helps to promote SDGs 1, 3, 10 and 16. SDGs and financial well-being are interconnected in several ways. This article presents a systematic review of the literature on financial well-being and tries to link it with some important SDGs. The study included the research article from the Web of Science and Scopus index database. The article suggests an organising framework to identify significant research gaps and suggests future research directions by critically analysing the existing findings and providing a comprehensive, up-to-date overview of financial well-being and its relationship with SGDs that scholars or researchers from different areas can use to position and design future research. Researchers used R Studio software for the bibliometric analysis.
Ambient air pollution and the lungs: what do clinicians need to know?
Authors: Limaye S. , Salvi S.
Published: October 2024

Educational aims

To provide physicians with knowledge of the common ambient air pollutants and their adverse effects on human lungs.

To emphasise the fact that neonates, children and adults with pre-existing lung diseases are a susceptible population that need to be protected from the harmful effects of ambient air pollution.

To educate physicians about the role of oxidative stress in mediating the harmful effects of ambient air pollution, and the consequences that individuals with inherent defects in antioxidant defence genes may be more vulnerable to the harmful effects.

To provide physicians with current knowledge on the available dietary and drug sources of antioxidants which have the potential to enhance lung defence mechanisms against the harmful effects of air pollution.

To encourage physicians to act as advocates to help reduce the levels of ambient air pollutants and to conduct research that will not only identify susceptible individuals by conducting genetic studies, but will also help in developing interventions that will reduce the harmful effects of ambient air pollutants.

Ozone, oxides of nitrogen, sulphur dioxide and particulate matter are the important ambient air pollutants associated with adverse health effects. A large number of ambient air pollutants have been isolated from the fetal cord blood indicating that babies are exposed to air pollutants even before they are born. Children and the elderly are most susceptible to the harmful effects of ambient air pollutants. High levels of ambient air pollutants are associated with increased incidence or worsening of asthma and increased risk of developing allergic diseases, respiratory symptoms and respiratory tract infections. Mortality rates also increase in individuals with pre-existing cardiorespiratory diseases. The underlying mechanism for the harmful effects is the generation of oxidative stress which induces a strong respiratory as well as systemic inflammatory response. Individuals with genetic defects in enzymes associated with antioxidant defences seem to be particularly vulnerable to the harmful effects of air pollutants. Supplementation with antioxidants such asN-acetyl cysteine and sulforaphene has shown some protective effects in preliminary studies. High doses of vitamin C and vitamin E have shown some benefit in genetically susceptible asthmatic children. Physicians should play an important role in advocating to governments for a reduction in ambient air pollutants using innovative strategies and stricter legislation. Clearly more research is required to better understand intervention strategies to reduce morbidity and mortality due to ambient air pollutants, but in the meantime, the least we can do is to supplement diets with rich sources of antioxidants.
Chili cultivars vulnerability: a multi-factorial examination of disease and pest-induced yield decline across different growing microclimates and watering regimens
Authors: Ahmad Farhan , Kusumiyati Kusumiyati , Soleh Mochamad Arief , Khan Muhammad Rabnawaz , Sundari Ristina Siti
Published: October 2024

Background

As identified by the research, it is imperative to develop effective ways to address the pressing problem of disease and pest susceptibility in chili agriculture and secure sustainable crop yield. The research examines the impact of various growing microclimates, watering regimens, and chili cultivars on disease incidence, pest attacks, and yield loss.

Results

The study, which took place over a season, used a randomized complete block design to evaluate how well Tanjung, Unpad, and Osaka cultivars performed in four different watering regimens (100, 75, 50, and 25% ETc) and different microclimates (greenhouse, rain shelter, screen house, and open field). The findings exhibited that watering regimens and microclimates greatly influenced disease and pest occurrence, but cultivars had a minimal effect on these variables. Disease and pest attack rates were highest in the open field and lowest in the screen house. A correlation was found between lower disease and pest incidence and optimal irrigation levels (75% and 100% ETc). At lower watering regimens of 25% ETc and in the open field, yield loss was the greatest.

Conclusion

The results emphasize how crucial controlled environments and appropriate irrigation techniques are to reducing crop loss and increasing production. Enhancing watering regimens and implementing screen house cultivation are two strategies for improving the productivity and sustainability of chili output.
Clinical characteristics of pregnant women with COVID-19 and infection outcomes in one of the largest cities in the Brazilian Amazon
Authors: de Montalvão França Ana Paula Figueiredo , Paixão Jenephy Thalita Rosa , de Souza Fonseca Ricardo Roberto , Laurentino Rogério Valois , de Montalvão Leite Luana Gabriella Figueiredo , Veras Amanda Souza França , Ribeiro Francisco Jordano da Silva Feitosa , das Neves Pablo Fabiano Moura , Falcão Luís Fábio Magno , de Montalvão Serrão Ana Carla Figueiredo , Oliveira-Filho Aldemir Branco , Machado Luiz Fernando Almeida
Published: October 2024

Background

Pregnancy can be a risk factor for the development of more severe COVID-19 with a possible increase in the risk of complications during pregnancy/birth and adverse neonatal outcomes. This study aimed to describe and analyze the clinical and epidemiological aspects of SARS-CoV-2 infection in women in the perinatal period attended in the city of Belém, northern region of Brazil.

Methods

This is a clinical, observational, analytical, and cross-sectional study with a quantitative approach, conducted at the Santa Casa de Misericórdia do Pará Foundation (FSCMPA). It included 230 pregnant women hospitalized at FSCMPA with a positive SARS-CoV-2 RT-PCR molecular test between April 2020 and June 2022. Clinical and epidemiological information (origin, gestational age, prenatal care, comorbidities, birth complications, and chest tomography) were obtained from medical records, and correlation was made between the types of cases (mild, moderate, and severe) and maternal outcome. The chi-square test and G test were used to assess the possibility of association between variables.

Results

Evidence of association was observed between the severity of COVID-19 and the following parameters: gestational age, specific pregnancy comorbidities, baby and maternal death, birth complications, and prematurity. Dyspnea, headache, anosmia, odynophagia, diarrhea, and chest pain were the symptoms most related to disease aggravation. The maternal mortality rate in the study was 8.7%.

Conclusion

Specific pregnancy-related and pre-existing comorbidities associated with SARS-CoV-2 infection directly contribute to the worsening clinical condition, leading to complications such as prematurity, fetal, and maternal death.
Epidemiology of pneumococcal meningitis in sentinel hospital surveillance of Viet Nam, 2015–2018
Authors: Nguyen Dac Trung , Nguyen Thi Loan , Olmsted Allison , Duong Thi Hong , Hoang Hong Mai , Nguyen Lien Huong , Ouattara Mahamoudou , Milucky Jennifer , Lessa Fernanda C. , Vo Thi Trang Dai , Phan Van Thanh , Nguyen Thi Hien Anh , Pham Nguyen My Nguyet , Truong Huu Khanh , Phan Thi Quynh Tram , Bui Thi Hong Hoa , Pham Van Khang , Iijima Makiko , Le Binh , Kim Lindsay , Farrar Jennifer Loo
Published: October 2024

Background

Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae), and Neisseria meningitidis (N. meningitidis) are leading causes of childhood bacterial meningitis and preventable by vaccines. The aim of this hospital-based sentinel surveillance is to describe the epidemiological characteristics of pneumococcal meningitis, including disease burden, and to provide baseline data on pneumococcal serotype distribution to support decision making for pneumococcal conjugate vaccine (PCV) introduction in Vietnam.

Methods

Surveillance for probable bacterial meningitis in children 1–59 months of age is conducted in three tertiary level pediatric hospitals: one in Hanoi and two in Ho Chi Minh City. Cerebrospinal fluid (CSF) specimens were collected via lumbar puncture from children with suspected meningitis. Specimens were transferred immediately to the laboratory department of the respective hospital for cytology, biochemistry, and microbiology testing, including culture. PCR testing was conducted on CSF specimens for bacterial detection (S. pneumoniae, H. influenzae, and N. meningitidis) and pneumococcal serotyping.

Results

During 2015–2018, a total of 1,803 children with probable bacterial meningitis were detected; 1,780 had CSF specimens available for testing. Of 245 laboratory-confirmed positive cases, the majority were caused by S. pneumoniae (229,93.5%). Of those with S. pneumoniae detected, over 70% were caused by serotypes included in currently available PCV products; serotypes 6 A/6B (27.1%), 14 (19.7%), and 23 F (16.2%) were the most common serotypes. Children with laboratory-confirmed pneumococcal meningitis were more likely to live in Hanoi (p < 0.0001) and children 12–23 months of age were at greater odds (OR = 1.65, 95% CI: 1.11, 2.43; p = 0.006) of having confirmed pneumococcal meningitis compared to children < 12 months of age when compared to those without laboratory-confirmed bacterial meningitis. Additionally, children with confirmed pneumococcal meningitis were more likely to exhibit signs and symptoms consistent with clinical meningitis compared to negative laboratory-confirmed meningitis cases (p < 0.0001) and had a greater odds of death (OR = 6.18, 95% CI: 2.98, 12.86; p < 0.0001).

Conclusions

Pneumococcal meningitis contributes to a large burden of bacterial meningitis in Vietnamese children. A large proportion are caused by serotypes covered by PCVs currently available. Introduction of PCV into the routine immunization program could reduce the burden of pneumococcal meningitis in Viet Nam.
Early Onset Pancreatic Adenocarcinoma (EOPAC): presentation, clinical course and treatment outcomes in comparison to Average Onset Pancreatic Adenocarcinoma (AOPAC): a retrospective cohort study
Authors: Rashad Noha , Gouda Abdelrahman , Sabra Esraa , Youssef Mohamed A. , Alshazly Hossam , Samir Sandra
Published: October 2024

Background

Pancreatic adenocarcinoma (PAC) is a disease of decimal prognosis, with around 50% of patients presenting with metastatic disease. Previous trials reported a high incidence of early onset pancreatic cancer (EOPAC) in Egypt, presenting about 25% of patients with PAC. The clinic-pathological features and prognosis of EOPAC needs more study.

Patients and methods

A retrospective analysis of patients’ records at Shefa Al-Orman comprehensive cancer center database. Patients with histo-pathologically confirmed diagnosis of PAC. We categorized patients according to the age at diagnosis into EOPAC (≤ 50 years) and average onset PAC (AOPAC). Data on risk factors, family history, presenting symptoms, clinic-pathological features, treatment, and prognosis were extracted. Patients with histopathologically confirmed diagnosis of pancreatic cancer diagnosed between December 2016-December 2022 were included.

Results

The study cohort consisted of 412 patients. EOPAC represented 20.3% of patients, with no significant differences in risk factors and family history compared to AOPAC. Duration of symptoms before diagnosis is longer in EOPAC, with the majority of EOPAC presenting with localized disease (23.8%) and locally advanced tumors (28.5%) compared to AOPAC. AOPAC presented more with metastatic disease (64% vs. 45.2%, p = 0.003). EOPAC are usually submitted to more aggressive treatment including radical surgery, neoadjuvant therapy, and aggressive chemotherapy regimens in metastatic disease. Disease free survival (DFS) of EOPAC was shorter than AOPAC (11 months vs. 17 months, p = 0.889), but overall survival OS was significantly longer in EOPAC (10 months vs. 6 months, p = 0.013).

Conclusion

Patients with EOPAC in Egypt represent around 25% of cases. EOPAC tend to have a shorter disease free survival (DFS) in patients presenting with localized disease. The overall survival (OS) is longer in EOPAC compared to AOPAC. Further studies are mandatory to identify the epidemiological and risk factors of EOPAC in Egypt.
An exploration of community food pantries in Scotland: strategic and operational perspectives on addressing food insecurity and health inequalities
Authors: Baillie Anna , Skivington Kathryn , Fergie Gillian
Published: October 2024

Introduction

: Food insecurity and health are inextricably linked. Since 2008, Scotland has witnessed a proliferation of both food insecurity and emergency food provision. There is a recognised commitment from Scottish Government to ‘end the need for food banks’, however, the food aid landscape was ‘turbo-charged’ during COVID-19 leading to intense expansion and diversification of food-based projects, including the development of community food pantries (CFPs). These ‘new’ models are relatively under-researched, meaning we do not adequately understand their potential or realised impacts on food insecurity and health. This study aims to fill that gap.

Methods

A qualitative methodology was used to collect and analyse data from in-depth interviews with 10 representatives from both operational and policy settings related to food insecurity in Scotland. In addition, we conducted an analysis of policy documentation from Scottish Government related to tackling food insecurity to understand how CFPs fit into its overall strategy to transition away from food bank use.

Results

We found there were variations in conceptualisations of CFPs and how they operate, challenges related to addressing food insecurity at a community level and varied narratives around the role of community level interventions in tackling health inequalities. Choice and access to services were viewed as central components to the pantry model. However, there were significant challenges faced by CFPs, including territorialism, funding and food supply. Articulations of health were often multi-layered and complicated with strong recognition of the social determinants as well as acknowledgement of the limitations of tackling food insecurity and health inequalities solely at the community level.

Conclusions

Despite a commitment to transition away from emergency food provision, CFPs in Scotland appear to face many of the same issues as food banks, particularly those which impact health. Urgent critique of their reliance on surplus food redistribution is required alongside investigation of how these ‘new’ models are experienced by the people who access them. Further expansion of these models should be viewed with caution and in the same vein as traditional emergency food provision: a symptom of, rather than a solution to, the problem of food insecurity.
Perioperative medication therapy for Muslim patients in Germany undergoing oncological surgery: a retrospective study
Authors: Tekbaş Aysun , von Lilienfeld-Toal M. , Sayrafi F. , Settmacher U.
Published: October 2024

Purpose

Engagement of healthcare professionals with patients from diverse cultural and religious backgrounds is crucial in our multicultural society, where miscommunication and errors in medical history taking can lead to incorrect treatment. In particular, Muslim patients may present unique considerations due to their specific cultural and religious beliefs, which can significantly impact treatment outcomes. This study focuses on perioperative medication therapy for patients undergoing upper and lower gastrointestinal tract and pancreatic tumor surgery, specifically examining whether Islamic beliefs were duly considered in medication selection compared to a matching patient cohort.

Materials and methods

Data from January 2004 to July 2023 were analyzed. Muslim patients were identified using the onomastic method and matched with non-Muslim patients at a 1:3 ratio based on age, gender, and procedure. Analysis included examination of subcutaneous, oral, and intravenous medications, with attention to ingredients and compatibility with Islamic principles.

Results

Among 5272 patients, only 5 met the study’s inclusion criteria as Muslim patients, undergoing procedures such as anterior rectum resection, gastrectomy, and pancreatic head resection. Their religious affiliations were not documented in the admission records. According to the matched-pair analysis, consistent treatment was performed regardless of religious beliefs. All patients received subcutaneous medication, primarily enoxaparin, instead of fondaparinux, an Islam-compliant alternative. Intravenous heparin was used once for short period. Contrary to Islamic dietary restrictions and the availability of alternatives, capsules containing animal-derived gelatin and other non-compliant medications were administered orally.

Conclusion

This study underscores the importance of acknowledging Muslim patients’ cultural and religious backgrounds in the perioperative setting, as failure to do so may lead healthcare professionals to overlook their potential alternative medication needs, which are essential for providing tailored medical care in modern societies. Integration of diversity-related topics into medical curricula is essential for better preparing physicians for clinical practice and ensuring patient-centered care.
Cross-cultural adaptation and reliability of the inventory of vicarious posttraumatic growth and research of its influencing factors: a cross-sectional study
Authors: Cai Yitong , Li Yifei , Zou Jie , Zhang Jie , Luo Weixiang , Zhang Jingping , Qu Chaoran
Published: October 2024

Objective

The purpose of this study was to translate the Vicarious Posttraumatic Growth Inventory (VPTGI) into Chinese and to assess its reliability and validity in Nurses, Additionally, it explored the correlations between vicarious posttraumatic growth (VPTG), Secondary Traumatic Stress (STS) and demographic variables.

Methods

The Brislin translation model was used to translate the VPTGI into Chinese. Validity analysis involved exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and assessments of convergent validity, discriminant validity, and content validity. Reliability analysis included split-half reliability, internal consistency reliability, and test-retest reliability. Item analysis employed the Critical Ratio Decision Value (CR) method, item-total correlation method, and reliability change method. Single-factor analysis was conducted to examine the relationship between demographic variables and VPTG, while correlation analysis explored the association between STS and VPTG.

Results

The Chinese version VPTGI demonstrated robust content validity (I-CVI: 0.83-1, S-CVI: 0.97), supported by EFA (KMO: 0.933) and significant Bartlett’s test (p < 0.001). Four factors explained 67.82% variance, CFA confirmed the model fit (χ2/df = 2.255, RMSEA = 0.079, IFI = 0.931, TLI = 0.914, CFI = 0.930, NFI = 0.882). The Chinese version VPTGI demonstrated high internal consistency (Cronbach’s α = 0.951), with dimensions’ Cronbach’s α ranging from 0.806 to 0.912. Overall, nurses demonstrated a moderate to low level of VPTG and a severe level of STS. Furthermore, there was a significant negative correlation between STS and VPTG.

Conclusion

The Chinese version of VPTGI demonstrated satisfactory reliability, validity, and factor structure, making it a reliable tool to assess VPTG in Chinese nurses. These findings underscore the importance of promoting VPTG and addressing STS among healthcare professionals. Further research in this area is warranted to better understand and support the psychological well-being of nurses.
“Do I feel safe here?” Organisational climate and mental health peer worker experience
Authors: Reeves Verity , Loughhead Mark , Halpin Matthew Anthony , Procter Nicholas
Published: October 2024

Background

In Australia, lived experience peer support workforces are expanding making it one of the fastest growing emerging disciplines in transdisciplinary mental health settings. This article provides insight for organisations on the contextual realities peer workers face, increases understanding of peer support services to improve service delivery environments and contributes to mental health systems reform. This study aimed to qualitatively explore peer support workers experience integrating into and working within transdisciplinary mental health service teams.

Method

Semi-structured interviews were undertaken with 18 peer support workers currently working in mental health services in Australia. The research was a qualitative descriptive study design. All data collected were analysed utilising thematic analysis.

Results

Peer workers found their experience in the workplace was influenced by their colleagues and the organisation’s understanding of the peer role. Factors relating to organisational culture and climate were a central theme throughout discussions noting that a negative climate was perceived as harmful to peer workers. Themes established through results include (1) the role of leadership, (2) attitudes and behaviours of colleagues, (3) provision of psychologically safe environments, (4) the organisations messaging and use of language and (5) organisational structures and policy.

Conclusion

This study contributes to evidence for the impact of organisational culture on integrating and supporting peer support workers in mental health service delivery. This study provides insights into peer worker experiences integrating into transdisciplinary teams, confirming findings established in previous studies, highlighting a lack of movement or change in workplace culture to support peer worker integration into mental healthcare settings.
Chemoprevention of malaria with long-acting oral and injectable drugs: an updated target product profile
Authors: El Gaaloul Myriam , Tchouatieu Andre Marie , Kayentao Kassoum , Campo Brice , Buffet Benedicte , Ramachandruni Hanu , Ndiaye Jean Louis , Wells Timothy N. C. , Audibert Celine , Achan Jane , Donini Cristina , Barsosio Hellen C. , Tinto Halidou
Published: October 2024

Malaria is preventable, but the burden of disease remains high with over 249 million cases and 608,000 deaths reported in 2022. Historically, the most important protective interventions have been vector control and chemopreventive medicines with over 50 million children receiving seasonal malaria chemoprevention in the year 2023. Two vaccines are approved and starting to be deployed, bringing additional protection for children up to 36 months. However, the impact of these currently available tools is somewhat limited on various fronts. Vaccines exhibit partial efficacy, are relatively costly, and not accessible in all settings. The challenges encountered with chemoprevention are barriers to acceptability and feasibility, including frequency of dosing, and the lack of options in the first trimester of pregnancy and for women living with HIV. Also, the emergence of resistance against chemopreventive medicines is concerning. To address these limitations, a target product profile (TPP) is proposed as a road map to guide innovation and to boost the quest for novel chemopreventive alternatives. This TPP describes the ideal product attributes, while acknowledging potential trade-offs that may be needed. Critically, it considers the target populations most at risk; primarily infants, children, and pregnant women. Malaria control and elimination requires appropriate chemoprevention, not only in areas of high endemicity and transmission, but also in lower transmission areas where immunity is declining, as well as for travellers from areas where malaria has been eliminated. New medicines should show acceptable safety and tolerability, with high and long protective efficacy. Formulations and costs need to support operational adherence, access, and effectiveness. Next generation long-acting oral and injectable drugs are likely to constitute the backbone of malaria prevention. Therefore, the perspectives of front-line experts in malaria prevention, researchers, and those involved in drug development are captured in the TPP. This inclusive approach aims at concentrating efforts and aligning responses across the community to develop new and transformative medicines.
An unbiased, sustainable, evidence-informed Universal Food Guide: a timely template for national food guides
Authors: Dean Elizabeth , Xu Jia , Jones Alice Yee-Men , Vongsirinavarat Mantana , Lomi Constantina , Kumar Pintu , Ngeh Etienne , Storz Maximilian A.
Published: October 2024

Background

Although national food guides are designed, ostensibly, to translate scientific evidence with respect to food, dietary patterns, and health, their development has increasingly become a corporate/political process as well as scientific one; often with corporate/political influences overriding science. Our aim was to construct an unbiased, sustainable, evidence-informed Universal Food Guide to serve as a template for countries to develop their unique guides, thereby, provide a valid resource for health professionals, health authorities, and the public.

Methods

To address our aim, we conducted an integrative review of multiple evidence-informed sources (e.g., established databases, evidence syntheses, scholarly treatises, and policy documents) related to four areas: 1. Food guides’ utility and conflicts of interest; 2. The evidence-based healthiest diet; 3. Constituents of the Universal Food Guide template; and 4. Implications for population health; regulation/governance; environment/climate/planetary health; and ethics.

Results

The eating pattern that is healthiest for humans (i.e., most natural, and associated with maximal health across the life cycle; reduced non-communicable disease (NCD) risk; and minimal end-of-life illness) is whole food, low fat, plant-based, especially vegan, with the absence of ultra-processed food. Disparities in national food guide recommendations can be explained by factors other than science, specifically, corporate/political interests reflected in heavily government-subsidized, animal-sourced products; and trends toward dominance of daily consumption of processed/ultra-processed foods. Both trends have well-documented adverse consequences, i.e., NCDs and endangered environmental/planetary health. Commitment to an evidence-informed plant-based eating pattern, particularly vegan, will reduce risks/manifestations of NCDs; inform healthy food and nutrition policy regulation/governance; support sustainable environment/climate and planetary health; and is ethical with respect to ‘best’ evidence-based practice, and human and animal welfare.

Conclusion

The Universal Food Guide that serves as a template for national food guides is both urgent and timely given the well-documented health-harming influences that corporate stakeholders/politicians and advisory committees with conflicts of interest, exert on national food guides. Such influence contributes to the largely-preventable NCDs and environmental issues. Policy makers, health professionals, and the public need unbiased, scientific evidence as informed by the Universal Food Guide, to inform their recommendations and choices.
Synergistic effects of rivaroxaban and hypothermia or acidosis on coagulation initiation measured with ROTEM®: a prospective observational study
Authors: Sunnersjö Lotta , Ymén Isak , Schött Ulf , Hillarp Andreas , Undén Johan , Kander Thomas
Published: October 2024

Background

Hypothermia and acidosis individually inhibit haemostasis. We designed this study with the aim to investigate whether rivaroxaban combined with hypothermia or acidosis exhibit synergistic inhibitory effects on haemostasis using ROTEM®.

Methods

Patients with a clinical indication to start rivaroxaban treatment were prospectively included. Blood samples were collected before initiation of treatment and the day after. All blood samples were in vitro modified with respect to temperature (incubated and analysed at 28, 33, 37 and 40 degrees Celsius (°C)) and pH (6.8, 7.0, 7.2 and 7.4). The temperature and acidosis effects on the ROTEM EXTEM variables clotting time (CT), clot formation time (CFT) and alpha-angle (AA) were measured along with the individual effect of rivaroxaban on the same variables. The additive effect was calculated. The observed (potential synergistic) effects for the temperature and pH modified rivaroxaban samples on the same ROTEM variables, were registered. Differences between the additive and observed (potential synergistic) effects were analysed using matched non-parametric hypothesis testing.

Results

In total, 13 patients were included. Hypothermia and rivaroxaban exhibited a synergistic effect on CT at 28 °C (p = 0.0002) and at 33 °C (p = 0.0007). The same applied for acidosis at pH 6.8 (p = 0.003) and pH 7.0 (p = 0.003). There were no signs of synergistic effects of rivaroxaban and temperature or acidosis on CFT. In AA there were signs of synergism at 28 °C (p = 0,001), but not at other tested temperatures or pH levels.

Conclusions

The combination rivaroxaban together with hypothermia or acidosis demonstrated inhibitory synergistic effects on haemostasis.

Trial registration

The study was retrospectively registered 2023-03-01 at ClinTrials.gov with NCT05669313.
Diurnal patterns of accelerometer-measured physical activity and sleep and risk of all-cause mortality: a follow-up of the National Health and Nutrition Examination Surveys (NHANES)
Authors: Zhang Yue , Kivimäki Mika , Carrillo-Larco Rodrigo M. , Cheng Yangyang , Zhou Yaguan , Wang Hui , Yuan Changzheng , Xu Xiaolin
Published: October 2024

Background

Physical activity and sleep are established modifiable lifestyle factors, but the optimal time of the day of these behaviours for health is unknown. This study examined the independent and joint associations of diurnal patterns of physical activity and sleep with all-cause mortality.

Methods

This prospective cohort study included 6,673 participants who have attended the accelerometer assessment in the 2011–2014 National Health and Nutrition Examination Surveys (NHANES). Diurnal patterns of accelerometer-measured physical activity and sleep were identified using K-means clustering analysis. All-cause mortality was ascertained from the accelerometer measurement to December 31, 2019 (median follow-up 6.8 years). Survey-weighted Cox proportional hazard models were performed to estimate the independent and joint associations of diurnal patterns of physical activity and sleep with all-cause mortality.

Results

Diurnal patterns identified were: early-morning (32.4%), midday (42.5%), and late-afternoon (25.1%) for physical activity; and irregular sleep (37.4%), morning lark (33.6%), and night owl (29.0%) for sleep. After adjusting for volume of physical activity, sleep duration and other potential covariates, the early-morning physical activity pattern (hazard ratio 1.36, 95% confidence interval 1.13–1.64) and irregular sleep pattern (1.42, 1.01–1.99) were independently associated with higher risk of all-cause mortality, compared with midday physical activity and morning lark sleep patterns, respectively. In addition, participants with the combined pattern of early-morning physical activity and irregular sleep had higher risk of all-cause mortality compared to those with midday physical activity combined with a morning lark sleep pattern (1.92, 1.33–2.78). Several sociodemographic differences were observed in the strength of these associations.

Conclusions

Wearable activity-rest monitoring data showed that peak physical activity in the early morning and irregular sleep diurnal patterns are associated with increased mortality risk, and the combination of these patterns further exaggerated the risk. Public health program should acknowledge that the diurnal patterns of physical activity and sleep, in addition to their duration and frequency, may play a crucial role in lifestyle-based health promotion and management strategies.
Breastfeeding frequency and incidence of type 2 diabetes among women with previous gestational diabetes compared to those without: a historical cohort study in the UK
Authors: Eades Claire , Hoddinott Pat , Cameron Dawn , Evans Josie
Published: October 2024

Background

There is a growing body of research to suggest that women with gestational diabetes are less likely to initiate and continue breastfeeding than those who have not had however findings are mixed. There is limited research in the UK assessing the frequency of breastfeeding in women with gestational diabetes, none reporting the association of breastfeeding with incidence of type 2 diabetes and existing research has not adequately adjusted for potential confounders. This study aims to assess frequency of breastfeeding among women with gestational diabetes compared to those without, and to explore how breastfeeding influences risk of future type 2 diabetes in women with gestational diabetes while adjusting for known confounders.

Methods

Historical cohort study using routinely collected health care data from Fife and Tayside Health Boards, Scotland, UK including all women diagnosed with gestational diabetes between 1993 and 2015 and a matched comparator cohort (n = 4,968). Women with gestational diabetes were followed up until a diagnosis of type 2 diabetes, the end of the study, or date of death. Multinomial logistic regression was used to estimate odds ratios for breastfeeding for the whole sample and the association between breastfeeding and development of type 2 diabetes in women with gestational diabetes was assessed by Cox regression.

Results

Women with a diagnosis of gestational diabetes, who were younger, overweight/obese or living in the most deprived areas were significantly less likely to exclusively breastfeed for a duration of longer than eight weeks. Risk of developing type 2 diabetes among women with gestational diabetes was significantly higher for those who exclusively breastfed less than 8 weeks, lived in the most deprived areas or had a family history of diabetes.

Conclusions

This study confirms the important role of a short duration of exclusive breastfeeding in protecting women with gestational diabetes against type 2 diabetes but highlights the challenges to breastfeeding in this group. Interventions are needed to support breastfeeding among women with gestational diabetes that are acceptable to younger, overweight/obese women living in deprived areas.
Toll-like receptors ligand immunomodulators for the treatment congenital diaphragmatic hernia
Authors: Vallejo-Cremades Mayte , Merino Javier , Carmona Rita , Córdoba Laura , Salvador Beatriz , Martínez Leopoldo , Tovar Juan Antonio , Llamas Miguel Ángel , Muñoz-Chápuli Ramón , Fresno Manuel
Published: October 2024

Background

Congenital diaphragmatic hernia (CDH) is a rare disease that affects the development of the diaphragm, leading to abnormal lung development. Unfortunately, there is no established therapy for CDH. Retinoic acid pathways are implicated in the ethology of CDH and macrophages are known to play a role in repairing organ damage.

Methods

We have analyzed the effect of several Toll like receptor (TLR) ligands in the nitrofen-induced CDH model in pregnant rats widely used to study this disease and in the G2-GATA4Cre;Wt1fl/fl CDH genetic mice model. Morphometric and histological studies were carried out. Immune cell infiltration was assayed by immunochemistry and immunofluorescence and retinoic pathway gene expression analyzed in vivo and in vitro in macrophages.

Results

We found that administering a single dose of atypical TLR2/4 ligands (CS1 or CS2), 3 days after nitrofen, cured diaphragmatic hernia in 73% of the fetuses and repaired the lesion with complete diaphragm closure being on the other hand nontoxic for the mothers or pups. Moreover, these immunomodulators also improved pulmonary hypoplasia and alveolar maturation and vessel hypertrophy, enhancing pulmonary maturity of fetuses. We also found that CS1 treatment rescued the CDH phenotype in the G2-GATA4Cre;Wt1fl/fl CDH genetic mice model. Only 1 out of 11 mutant embryos showed CDH after CS1 administration, whereas CDH prevalence was 70% in untreated mutant embryos. Mechanistically, CS1 stimulated the infiltration of repairing M2 macrophages (CD206+ and Arg1+) into the damaged diaphragm and reduced T cell infiltration. Additionally, those TLR ligands induced retinol pathway genes, including RBP1, RALDH2, RARα, and RARβ, in the affected lungs and the diaphragm and in macrophages in vitro.

Conclusions

Our research has shown that TLR ligand immunomodulators that influence anti-inflammatory macrophage activation can be effective in treating CDH, being nontoxic for the mothers or pups suggesting that those TLR ligands are a promising solution for CDH leading to orphan drug designation for CS1. The immune system of the fetus would be responsible for repairing the damage and closure of the hernia in the diaphragm and enhanced proper lung development after CS1 treatment.
Quality of life and unmet needs in patients with fabry disease: a qualitative study
Authors: Morales Montserrat , Cruz Jordi , Brignani Eduardo , Acuña Laura , Lázaro Esther , Soria Cristina
Published: October 2024

Background

Patients with Fabry disease (FD) consider their quality of life to be significantly affected. The majority of studies evaluate the quality of life using quantitative measures and standardised scales that offer relevant information about experience with the disease in multiple aspects. The main objective of the research was to examine in depth the quality of life and unmet needs of patients diagnosed with FD in relation to their disease and treatment. A qualitative and transversal study was carried out in two stages: (a) nine semi-structured qualitative interviews with patients and one representative of the patient association, conducted individually by phone; (b) a focus group was set up with three patients diagnosed with FD and one relative. A deductive, thematic analysis approach was used for data coding and analysis.

Results

The analysis of the interviews revealed various relevant themes: experience with the disease, impact on daily activities, experience of the family and work environment, experience related to treatment and healthcare professionals, and unmet support needs. Diagnosis has a significant impact on both those suffering from the disease and on the family environment. The symptoms and evolution of the disease are highly variable among the patients interviewed and depend on the years diagnosed as well as the time taken to receive the diagnosis. The families of the interviewees have to go through an adjustment process in light of the significant psychological impact brought about by the disease. Patients show various unmet needs. The need mentioned most is to have more information, support, and understanding from people around them and society, improving empathy and raising awareness about the difficulties faced by people with FD while giving the disease visibility. A lack of social understanding is highlighted as one of the main challenges, as this does not only affect the emotional management of the disease but also has repercussions on working life and social relationships.

Conclusions

It seems necessary to define possible strategies that help to improve the quality of life of patients and their experience with the disease. Some recommendations obtained from the study include: facilitate access to mental health professionals for patients and their families; improve training for specialists and coordination among them; and carry out actions to raise awareness of the disease that are aimed at the general public, the patients themselves, and the people around them.