bluuebunny/crossref_metadata_2025 huggingface dataset:
Moderate, Rather Than Vigorous Exercise Benefits Plasma Amino Acids Profile in Patients With Nonalcoholic Fatty Liver Disease
Authors: Li Jia , Shi Xiulin , Huang Yinxiang , Huang Caoxin , Chen Zhen , Zhao Yan , Chen Zhong , Li Xuejun
Published: May 2020

Backgrounds: Exercise benefits nonalcoholic fatty liver disease (NAFLD), and amino acids (AAs) are close associated with the development and progression of NAFLD. However, it is unclear whether AAs profile changes following long term exercise training.Methods: NAFLD participants (n=220) were recruited and randomly assigned to control group, moderate exercise group, and vigorous exercise group with a 6-month followed-up. Clinical characteristics were carefully calculated and plasma AAs concentrations were determined using a validated ultrahigh performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method. Results: At baseline, AAs concentrations were close associated with clinical characteristics in NAFLD, particularly, the sum of branched chain amino acids (BCAAs) were positively associated with intrahepatic triglyceride (IHTG) content (r=0.18, P=0.007). After 6 month exercise intervention, IHTG content was reduced by both exercise intensities without a significant difference (P=0.45). Compared to control, several AAs concentrations altered, and different exercise intensity showed inversely impact on histidine, serine, glutamine, valine, tyrosine and tryptophan concentrations changes, particularly, moderate exercise was much more efficient on BCAAs decreasing than vigorous exercise with a significant difference (P=0.0008). Conclusions: Several AAs were close associated with IHTG content in NAFLD patients, and 6 month moderate exercise was more efficient on AAs concentrations alteration, especially BCAAs decreasing than vigorous exercise. Trial registration number: NCT01418027
Sensory Gating and Suppression of Subjective Peripheral Sensations During Voluntary Muscle Contraction
Authors: Takahara Terumasa , Yamaguchi Hidetaka , Seki Kazutoshi , Onodera Sho
Published: May 2020

Background: During voluntary muscle contraction, sensory information induced by electrostimulation of the nerves supplying the contracting muscle is inhibited and the somatosensory evoked potential (SEP) amplitude decreases. This depression of sensory input during voluntary muscle contraction has been demonstrated by many studies using electrophysiological methods. However, the association between the electrophysiological response of the sensory system during exercise and subjective peripheral sensation (SPS) is still unclear. The aim of this study was to investigate changes in spinal excitability, SEP, and SPS during voluntary muscle contraction.Results: The appearance rate of the F-wave was significantly higher during muscle contraction than rest, whereas no significant difference was observed in F-wave latency between muscle contraction and rest. Furthermore, the P25 amplitude of SEP was significantly lower during muscle contraction than rest, whereas the N20 amplitude of SEP exhibited no significant differences. The SPS was significantly lower during muscle contraction than rest.Conclusions: We conclude that sensory gating, which is found in the P25 component of SEP during muscle contraction, is one of the neurophysiological mechanisms underlying the suppression of SPS.
The rs28757157 and rs59429575 polymorphisms in CYP19A1 are associated with lung cancer in Chinese Han population
Authors: Zhang Chan , Cheng Yujing , Chen Wanlu , Li Qi , Dai Run , Wang Yajie , Yang Tonghua
Published: May 2020

Background: Lung cancer is the leading cause of cancer death globally. Recent studies have revealed that the CYP19A1 gene played a crucial role in cancer initiation and development. Objectives: The aim of this study was to assess the association of CYP19A1 genetic polymorphisms with the risk of lung cancer in Chinese Han population. Method: This study randomly recruited 507 lung cancer patients and 505 healthy controls. The genotypes of four SNPs of CYP19A1 gene were identified by Agena MassARRY technique. Genetic model analysis was used to assess the association between genetic variation and lung cancer risk. Odds ratio (OR) values and 95% confidence intervals (CIs) were provided for the evaluation of the lung cancer risk effect. Results: Rs28757157 and rs59429575 polymorphisms of CYP19A1 were significantly correlated with the risk of lung cancer. In stratified analysis, rs28757157 was associated with increased cancer risk in males and smoker. Meanwhile, rs59429575 was identified as a risk biomarker in female and lung adenocarcinoma patients (p < 0.05). While rs28757157 exerted protective role among people with a BMI greater than 24 (p = 0.033). Conclusions: This study identified two new SNPs (rs28757157 and rs59429575) of CYP19A1 associated with lung cancer in Chinese Han population. These findings provide data support for further functional studies of CYP19A1 in lung cancer.
Immediate Postpartum Haemorrhage at the Libreville University Hospital Centre: Epidemiological Profile of Women
Authors: WOROMOGO SYLVAIN HONORE , Ledaga Nathalie Ambouda , Yagata-Moussa Felicite-Emma , Ossouka Liela Agnes Okoyi , Tekem Vicky Noel Simo , Ango Eliane Okira , Kouanang Alain Jepang
Published: May 2020

Introduction In Gabon, the frequency of maternal deaths directly related to Immediate PostPartum Haemorrhage (IPPH) is 15 to 25%, despite the different means that World Health Organization (WHO) has made available to the providers of the Emergency Obstetrical and Neonatal Care (EmONC). The objective of this study was to determine the prevalence and epidemiological characteristics of IPPH in order to improve its management and reduce the rate of maternal deaths.Methods An analytical retrospective study involved 42,728 records, whose data were collected using a chart collection form on the basis of information contained in partograms and other patient records. The description of the sample is made using numbers and proportions. The relationship between the etiologies of IPPH and certain characteristics of the women was established using the ORs with their 95% confidence interval. The difference was significant if p < 0.05.Results The prevalence of IPPH was 1.6%. The 20-39 age group was the most represented. Multiparous women accounted for 67.2%. Delivery hemorrhages accounted for 65.5% of IPPH. The main factors associated with delivery hemorrhages were multiparity (p<0.001), preterm and postterm (p<0.001), and child weight >4,000 g (p<0.001). Those associated with genital track injuries were young maternal age, multiparity (p<0.001).ConclusionsThe prevalence of IPPH was 1.6%. The most common etiology was hemorrhage from delivery. Multiparity remains the most common risk factor and the young age of the patients. It is important to improve management through better assessment of blood loss in the immediate postpartum as well as capacity building of health providers on EmONC.
Impact of a multimedia website with patient experiences of multiple sclerosis (PExMS) on immunotherapy decision-making: study protocol for a pilot randomised controlled trial in a mixed-methods design
Authors: Barabasch Anna , Riemann-Lorenz Karin , Kofahl Christopher , Scheiderbauer Jutta , Eklund Desiree , Kleiter Ingo , Kasper Jürgen , Köpke Sascha , Lezius Susanne , Zapf Antonia , Rahn Anne Christin , Heesen Christoph
Published: May 2020

Background: A variety of management options (e.g. immunotherapies, lifestyle interventions, and rehabilitation) are available for people with relapsing-remitting multiple sclerosis (RRMS). Besides coping with the diagnosis, people with MS (pwMS) have to make complex decisions such as deciding about immunotherapies. In addition to factual information, reports of patient experiences (PEx) may support patients in decision-making. The added value of PEx in decision-making is not clear and controlled studies are rare. Therefore, systematic methods are necessary to develop and analyse PEx. As there are no evaluated PEx for MS in Germany, we are currently creating a website presenting PEx structured according to topics and illustrated by video, audio and text files. We aim to determine the feasibility of an intervention using PEx and evaluate whether PEx may help pwMS in their immunotherapy decision-making processes as a supplement to evidence-based information.Methods: This project will follow the Medical Research Council framework for development and evaluation of complex interventions. After the development of a website with PEx, a randomised controlled pilot trial (pilot RCT) will be conducted in 2-3 MS centres, clinics or rehabilitation centres including 55 pwMS and accompanied by a process evaluation. Patients with a RRMS diagnosis considering immunotherapy are eligible. The primary outcome is decision self-efficacy. Secondary outcomes include preparation for decision-making, decisional conflict, risk knowledge, confidence in active participation, affective forecasting, social support and self-reported impact of eHealth on its users. Participants will be randomly assigned either to i) an intervention group with a four weeks access to an evidence-based patient information resource and the PExMS-website as an adjunct or to ii) the control group with access to evidence-based information alone. A 6-members advisory panel involving representatives of pwMS, researchers, and neurologists, who accompany the whole project will mentor this pilot RCT.Discussion: The intervention was developed with systematic methods, created with active patient involvement and in critical appraisal by an expert advisory panel. The study is innovative as it contributes to the controversial evidence on the use of PEx in the context of evidence-based patient information.Trial registration: ClinicalTrials.gov (Identifier: NCT04236544).
Does Teaching Clinical Ethics to Medical Students Improve Knowledge, Attitude, and Practice of Medical Ethics Among Clinicians? An Observational Study in a Tertiary Care Hospital in Nepal.
Authors: Shrestha Carmina , Joshi Jasmin , Shrestha Ashma , Karki Shuvechchha , Acharya Sajan , Joshi Suchita
Published: May 2020

Background: The importance of doctors being aware of medical ethics has been highlighted in a number of studies. Our first study (Study-1) aims to assess the knowledge, attitude, and practices of medical ethics among clinicians at Patan Academy of Health Sciences (PAHS). We then follow up with the effect of teaching clinical ethics to medical students (Study-2). The purpose of this study is to assess the awareness regarding appropriate ethical principles, application of medical ethics and the effect of teaching medical ethics to students. Methods: There are two studies presented: Study-1 is a cross-sectional questionnaire-based study. A total of 72 participants, selected by simple random sampling, included doctors working as interns, medical officers and consultants in six departments of PAHS. Study-2 was a follow-up, cross-sectional online questionnaire-based comparative study conducted at PAHS to compare KAP of medical ethics among medical officers with and without formal medical ethics training. We used the validated questionnaire from our previous study. All graduates of PAHS 2016 and all medical officers employed at PAHS at the time of study who had graduated from other medical schools that did not include Medical Ethics in their core curriculum were included. Results: Study-1: A positive correlation between Knowledge(p = 0.088), Attitude (p = 0.002), Practice of medical ethics(p = 0.000), and years of practice was found. No significant difference in KAP of medical ethics between MBBS graduates from Nepal and abroad (p = 0.190) was found. The majority scored poorly in issues concerning autonomy. The follow-up study found a statistically significant difference (p = 0.000) in the knowledge between the doctors who were taught medical ethics and those who were not. Conclusions: Doctors find it easier to discuss ethical dilemmas with their colleagues rather than department heads. The KAP of the consultants were found to be better than that of the interns and medical officers. Autonomy is the least understood ethical principle. ‘Medical Ethics’ as a part of the core curriculum in medical schools would improve ethical practice.
LIP4 gene expression from Candida viswanathii strain
Authors: Teixeira Ronan C. , Daude Matheus M. , Oliveira Nayra M. L. de , Almeida Alex Fernando , Barreto Horllys G.
Published: May 2020

Background : Lipases are hydrolases that catalyze the cleavage of triglyceride esters bonds, releasing glycerol and free fatty acids. Candida genus can produce distinct isoforms of lipase, among of them, Candida viswanathii strain is a potential lipase producer using hydrophobic carbons sources in which produced high level of enzyme under submerged cultivation using olive oil as carbon sources. This enzyme has commercially attractive due to characteristics desired in the industries processes. The genes responsible for encoding the lipases comprise a family called LIP gene. C. viswanathii not have its genome sequenced and are not available in annotated form through the GenBank nucleotide sequence database for lipase production. The aim of this work was understanding at molecular level the effect of carbon sources to lipase production, to identify and to analyses the gene expression of CvLIP4 from C. viswanathii on different culture media. Results : In silico analysis was carried out with LIP4 gene from Candida species. Degenerate primers were designed and evaluated for expression in different conditions. CvLIP4 expression was evaluated using carbon sources glucose, tributyrin, triolein and olive oil. Triolein and olive oil were strong inducer for CvLIP4 gene expression, while tributyrin was a weak inducer and glucose was strong repressor. Conclusions : These results will contribute to further studies about regulation of the lipase genes expression from C. viswanathii and heterologous expression of this enzyme to improve the catalytic conditions in industries processes.
Development and External Validation of a Nomogram for Early Predicting in-hospital Mortality of Patients with SARS-CoV-2 Pneumonia: A Two-Center, Retrospective Analysis
Authors: Luo Miao , Lu Junlin , Liu Jing , Xia Shuli , Wei Shuang
Published: May 2020

Background At present, the death cases with SARS-CoV-2 pneumonia are continuing to increase globally. However, the information on death cases and predictive methods are substantial lacking. We aimed to develop a nomogram, which was validated by both internal and external cohorts, for early predicting mortality in hospitalized patients with SARS-CoV-2 pneumonia.Methods We retrospectively collected data on 1,540 patients confirmed SARS-CoV-2 pneumonia from two hospitals. Multivariate logistic regression analysis was performed to examine factors associated with in-hospital mortality. We investigated the mortality related risk factors and their weights, thereafter designed and validated a predictive nomogram model to facilitate early discrimination of in-hospital death. We assessed the nomogram performance by examining calibration (calibration plots and Hosmer–Lemeshow calibration test) and discrimination (AUROC). We also plotted survival curves and decision curves to evaluate the clinical usefulness of the nomogram.Results In the 1,540 patients from two centers, 248 cases died (16.1%). In the predictive nomogram calculated by a multivariate logistic regression analysis, eight independent risk factors associated mortality included age ≥ 60 years (odd ratio(OR) = 2.840; 95%CI, 1.467–5.495; P = 0.002), respiratory rate ≥ 30 breaths per minute (OR = 3.308; 95%CI, 1.408–7.770; P = 0.006), neutrophil count ≥ 7 × 109/L (OR = 3.084; 95%CI, 1.667–5.707; P < 0.001), lymphocyte count ≤ 0.8 × 109/ L (OR = 4.688; 95%CI, 2.500-8.791; P < 0.001), d-dimer ≥ 1.5 µg/mL(OR = 2.159; 95%CI, 1.169–3.989; P = 0.014), lactate dehydrogenase ≥ 350U/L(OR = 4.385; 95%CI, 2.299–8.362; P < 0.001), procalcitonin ≥ 0.1 ng/mL(OR = 4.972; 95%CI, 2.537–9.746; P < 0.001), and presence of myocardial injury (OR = 2.289; 95%CI, 1.260–4.160; P = 0.007) on admission. Calibration curves showed good fitting of the nomogram model with no statistical significance (P = 0.740) by Hosmer-Lemeshow test. This predictive nomogram had better predictive ability than CURB-65 score in training set (AUROC = 0.956 vs 0.828,P < 0.001). The good predictive performance of the nomogram is suggested by calibration, discrimination, and survival curve analysis, whether in the training, internal or external validation set. The decision curve analysis showed that predicting mortality risk applying this nomogram would be better than having all patients or none patients.Conclusions This nomogram is a reliable prognostic method that can accurately and early predict in-hospital mortality in patients with SARS-CoV-2 pneumonia. It can guide clinicians to improve their abilities to evaluate patient prognosis, enhance patient stratification, make earlier and reasonable decisions.Trail registration: This is a retrospective observational study without a trial registration number.
Prognostic Value of Baseline Clinical and HRCT Findings in 101 Patients with Severe COVID-19 in Wuhan, China
Authors: Cao Yukun , Han Xiaoyu , Gu Jin , Li Yumin , Liu Jia , Alwalid Osamah , Cui Yue , Zhang Xin , Zheng Chuansheng , Fan Yanqing , Wu Hanping , Shi Heshui
Published: May 2020

Background It has been reported that patients with severe Coronavirus disease 2019 (COVID-19) had high mortality rate, but the information about prognostic factors for these patients is unknown. The aim of this study was to assess the prognostic value of baseline clinical and high resolution CT (HRCT) findings in patients with severe COVID-19.Methods In this retrospective, two-center study, we included two groups of inpatients with severe COVID-19 who had been discharged or had died in Jin Yin-tan hospital and Wuhan union hospital between January 5, 2020, and February 22, 2020. Cases were confirmed by real-time polymerase chain reaction. Demographic, clinical, laboratory data, and HRCT data were collected and compared between discharged and deceased patients. Univariable and multivariable logistic regression models were used to assess predictors of mortality risk in these patients.Results 101 patients were included in this study, of whom 66 were discharged and 35 died in the hospital. The mean age was 56.6 ± 15.1 years and 67 (66.3%)were men. Of the 101 patients, hypertension (38, 37.6%), cardiovascular disease (21,20.8%), diabetes (18,17.8%), and chronic pulmonary disease (16,15.8%) were the most common coexisting conditions. The multivariable regression analysis showed older age (OR:1.142, 95%CI:1.059–1.231, p༜0.001), acute respiratory distress syndrome (ARDS) (OR:10.142, 95%CI:1.611–63.853, p = 0.014), reduced lymphocyte count (OR:0.004, 95%CI: 0.001–0.306, p = 0.013), and elevated HRCT score (OR:1.276, 95%CI:1.002–1.625, p = 0.049) to be independent predictors of mortality risk on admission in severe COVID-19 patients.Conclusions These initial data indicate that older age, ARDS, lymphocytopenia and elevated HRCT score on admission were strong predictors of mortality risk in severe COVID-19 patients.
Clinical and Sociodemographic Profile of the First 33 COVID 19 Cases Treated at Dedicated Treatment Center in Ethiopia.
Authors: Waji Sisay Teklu , Sultan Menbeu , Azazh Aklilu Azazh , Worku Aschalew , Redae Berhane , Walelign Miraf , Tefera Muluwork , Argaw Rahel , Waganew Woldesenbet , Yifru Sisay , Amogne Wondwossen , Tessema Natnael , Bekele Abebaw , Gebreegziabher Yonas , Araya Hiruy , Birhanu Addisu , Demoz Getachew , Tadesse Bethelehem , Seman Yakob , Genetu Abebe , Abayneh Aschalew
Published: May 2020

Back ground: Severe respiratory tract infection caused by family of Corona viruses has become world pandemic and is claiming many lives. In this study we have described the first 33 cases diagnosed, admitted and treated in Ethiopia COVID treatment center with the aim of contributing some information to the local and global effort of controlling the pandemic.Method: Descriptive study was conducted on the first 33 consecutive RT-PCR confirmed COVID 19 cases diagnosed and managed at Ekka-Kotebe COVID treatment center in Addis Ababa, Ethiopia.Result: Data of the first 33 COVID 19 confirmed patients treated at Ekka-kotebe COVID treatment center was analyzed. The median age of the cases was 36 years. Cough, headache and fever were the most frequent symptoms in the firs 33 COVID 19 cases reported in this study. Diarrhea, sore throats, loss of taste and/or smell sensation were among the rare symptoms. Most (84.8%) had mild to moderate disease and 15.2%(n = 5) were critical at the time of admission. Among the five ICU admissions, four patients required invasive mechanical ventilation. Both mild and moderate cases were managed in the general ward with or without low flow oxygen treatment. Thirty cases were discharged after two pairs of nasopharyngeal and oropharyngeal samples turned negative for SARS CoV2. Three cases from the ICU died while on mechanical ventilator. Age of the two deaths was 65 years and one was 60 years. With the exception of three, all cases were either imported from abroad or had contact with confirmed case.
A Qualitative Study of Clinicians’ Perspectives on Independent Rights Advice for Involuntary Psychiatric Patients in British Columbia, Canada
Authors: Cheung Iva , Silva Diego S. , Miller Kimberly J. , Michalak Erin E. , Goldsmith Charles H.
Published: May 2020

Background: In British Columbia, Canada, clinicians are responsible for giving involuntary psychiatric patients rights information upon admission. Yet an investigation by the BC Office of the Ombudsperson found that clinicians are not always fulfilling this responsibility. The Ombudsperson recommended that the provincial government fund an independent body to give rights advice to patients.Methods: To understand how clinicians feel about this recommendation, focus groups of clinicians who may give psychiatric patients rights information (n = 81) were conducted in Vancouver, BC, to probe their attitudes toward independent rights advisors. The focus group transcripts were thematically analyzed.Results: Most clinicians believe that giving rights information is within their scope of practice, although some acknowledge that giving involuntary patients rights information presents a conflict of interest when the patient wishes to challenge the treatment team’s decisions. Participants’ chief concerns about an independent rights-advice service were that (a) patients may experience a delay in receiving their rights information, (b) integrating rights advisors into the workflow would complicate an already chaotic admission process, and (c) more patients would be counselled to challenge their hospitalization, leading to an increased administrative workload for clinical staff. However, many participants believed that independent rights advisors would be a positive addition to the admission process, both allowing clinicians to focus on treatment and serving as a resource for clinicians and patients who have rights-related questions.Conclusions: Participants were generally amenable to an independent rights-advice service, suggesting that the introduction of rights advisors need not result in an adversarial relationship between treatment team and patient, as opponents of the proposal fear. Clearly distinguishing between basic rights information and in-depth rights advice could address several of the clinicians’ concerns about the role that independent rights advisors would play in the involuntary admission process. Clinicians’ and other stakeholders’ concerns should be considered as the province develops its rights-advice service.
Comparison of percutaneous cross screw fixation versus open reduction and internal fixation for Day type II crescent fracture-dislocation: Case-control study
Authors: Xiang Guangheng , Dong Xiaoyu , Jiang Xingan , Cai Leyi , Wang Jianshun , Guo Xiaoshan , Xiao Jian , Feng Yongzeng
Published: May 2020

Objective: To investigate the clinical outcomes of percutaneous cross screws internal fixation (PCSIF) for Day type II crescent fracture-dislocation (CFD). Methods: We reviewed 66 consecutive patients undergoing surgical treatment for Day type II CFD from June 2005 to December 2017. PCSIF was performed in 40 patients, and open reduction and internal fixation (ORIF) was performed in 26 patients. The patient characteristics, surgical complications, radiographic and clinical outcomes and were compared. Results: There was no statistically difference on the mean time from injury to surgery between the two groups. The time of operation, the amount of blood loss, the length of incision and the hospital stay were significantly shorter in the PCSIF Group. No significant difference on Matta scores and Majeed scores between the two groups. The ORIF Group resulted in a higher rate of intraoperative hemorrhage, nerve injury, discomfort and pain. Conclusion: PCSIF for Day Ⅱ type pelvic CFD was safe and effective. Minimally invasive fixation had the advantages of short operation time and hospitalization time, less intraoperative bleeding and less surgical trauma.
Epidemiology of methicillin resistant Staphylococcus species carriage in companion animals in the Greater Brisbane Area, Australia
Authors: Rynhoud Hester , Meler Erika , Gibson Justine S , Price Rochelle , Maguire Tina , Farry Trisha , Bennett Emma , Hartono Josephine , Magalhães Ricardo J Soares
Published: May 2020

Background: Methicillin resistant Staphylococcus species such as S. aureus (MRSA) and S. pseudintermedius (MRSP) can be involved in life-threatening multidrug resistant infections in companion animals. Knowledge of methicillin resistant Staphylococcus (MRS) carriage and factors influencing carriage in companion animals from South East Queensland is limited. Nasal and rectal swab samples were collected from dogs, cats and horses upon admission or within 24 hours of hospitalisation to several primary accession and referral veterinary practices between November 2015 and December 2017. MRSA and MRSP were identified using standard microbiological (Brilliance selective medium) and molecular (mecA gene PCR) methods. Risk factors associated with methicillin resistant Staphylococcus (MRS) carriage were quantified using Bernoulli logistic regression models. A Bayesian geostatistical model was developed to predict the probability of MRS carriage in Brisbane and surrounding areas. Results: Our results indicated that while the prevalence of MRSP carriage in dogs was 8.7% (35/402) no MRSP was isolated from cats (0/69) and horses (0/60); no MRSA was isolated in any species. MRSP carriage in dogs was significantly associated with previous hospitalisation, previous bacterial infection, consultation type, average precipitation, and human population density. Our predictive map of MRSP carriage indicated that the probability of carriage was highest along the coastal areas of Greater Brisbane, particularly Brisbane city, Sunshine Coast and Gympie areas. Conclusions: This study determined that MRSP carriage in dog populations from South East Queensland is geographically clustered and associated with both clinical and environmental factors.
Role of Interprofessional Primary Care Teams in Preventing Avoidable Hospitalizations and Hospital Readmissions in Ontario, Canada: A Retrospective Cohort Study
Authors: Haj-Ali Wissam , Moineddin Rahim , Hutchison Brian , Wodchis Walter P , Glazier Richard H.
Published: May 2020

Background: Improving health system value and efficiency are considered major policy priorities internationally. Ontario has undergone a primary care reform that included introduction of interprofessional teams. The purpose of this study was to investigate the relationship between receiving care from interprofessional versus non-interprofessional primary care teams and ambulatory care sensitive condition (ACSC) hospitalizations and hospital readmissions.Methods: Population-based administrative databases were linked to form data extractions of interest between the years of 2003–2005 and 2015–2017 in Ontario, Canada. The data sources were available through ICES. The Study Design was a Retrospective longitudinal cohort. We used a “difference-in-differences” approach for evaluating changes in ACSC hospitalizations and hospital readmissions before and after the introduction of interprofessional team-based primary care while adjusting for physician group, physician and patient characteristics.Principle Findings: As of March 31st, 2017, there were a total of 778 physician groups, of which 465 were blended capitation Family Health Organization (FHOs); 177 FHOs (22.8%) were also interprofessional teams and 288 (37%) were more conventional group practices (“non-interprofessional teams”). In this period, there were a total of 13,480 primary care physicians in Ontario of whom 4,848 (36%) were affiliated with FHOs—2,311 (17.1%) practicing in interprofessional teams and 2,537 (18.8%) practicing in non-interprofessional teams. During that same period, there were 475,611 and 618,363 multi-morbid patients in interprofessional teams and non-interprofessional teams respectively out of a total of 2,920,990 multi-morbid adult patients in Ontario. There was no difference in change over time in ACSC admissions between interprofessional and non-interprofessional teams between the pre- and post intervention periods. There were no statistically significant changes in all cause hospital re-admissions between the post- and pre-intervention periods for interprofessional and non-interprofessional teams.Conclusion: Our study findings indicate that the introduction of interprofessional team-based primary care was not associated with changes in ACSC hospitalization or hospital readmissions. The findings point for the need to couple interprofessional team-based care with other enablers of a strong primary care system to improve health services utilization efficiency.
The Current Landscape of Pre-exposure Prophylaxis (PrEP) Service Delivery Models for Hiv Prevention: A Scoping Review
Authors: Vanhamel Jef , Rotsaert Anke , Reyniers Thijs , Nöstlinger Christiana , Laga Marie , Landeghem Ella Van , Vuylsteke Bea
Published: May 2020

Background: Strengthening HIV combination prevention is imperative given the continued high HIV incidence worldwide. The introduction of oral PrEP as a new biomedical HIV prevention tool can be a potential gamechanger because of its high clinical efficacy and the feasibility of making it available for different key populations.Experiences with different PrEP delivery models in a variety of settings and HIV epidemics will inform howits uptake and usage can be maximised.Methods: We conducted a scoping review using the five-step framework for conducting scoping studies provided by Arksey and O’Malley. We systematically searched the existing peer-reviewed international and grey literature describing four components of a PrEP service delivery model in real-world: the target population of PrEP services, the setting where PrEP was delivered, PrEP providers’ professionalisation and PrEP delivery channels. We restricted our search to English language articles. No geographical or time restrictions were set.Results: Following exclusion of ineligible records and removal of duplicates, 33 articles were retained for charting and analysing of the results. The target population of PrEP services was often described in terms of PrEP eligibility without targeting specific subgroups. If a specific target group was mentioned, PrEP was mainly offered to men who have sex with men (MSM). PrEP was often delivered centralisedin specialist clinics providing HIV, sexual health or STI care. Yet examples of de-centralised and community-based PrEP delivery have been reported. Health care providers delivering PrEP were mainly medical professionals, with task-shifting to non-traditional health professionals and lay providers identified in a minority of the studies. PrEP was mainly delivered through classic in-person visits. More innovative options using mHealth and telemedicine approaches to deliver specific parts of PrEP services are currently being applied.Conclusions: Within our scope for PrEP service delivery models, a range of possibilities was found for all components of such models. This reflects differentiation of care according to different contextual settings. More research is needed on how integration of services in these contexts could respond to the needs of different profiles of PrEPuserswithin a combination prevention approach.
A Systematic Analysis of Adolescents’ Physical Activity Level and Sedentary Behavior
Authors: Alshammari Salem , Boushehry Heyam Reda , Alsahli Sultan Mohammed
Published: May 2020

Physical activity (PA) promotion and sedentary behavior (SB) reduction are needed to address the increasing rates of noncommunicable diseases (World Health Organization. Noncommunicable diseases, 2018). In the last two decades, there has been an increase in the incidence of both overweight young people and diabetes. Many countries have been looking for solutions to help young people achieve well-being (Centers for Disease Control and Prevention, 2011). However, few studies have been conducted to examine PA levels among adolescents, which leaves gaps to be filled regarding the understanding of overall health in adolescents. The purpose of this study was to examine the extent to which adolescents engage in regular PA as opposed to sedentary activities, such as watching television and using the internet, after controlling for sex and age. Finally, this study helped address how adolescents spend their time engaging in PA. The data were obtained from the National Youth Risk Behavior Survey (NYRB-S) 2007 by the Centers for Disease Control (http://www.cdc.gov/HealthyYouth/yrbs/data/). The participants in this study consisted of (14041) adolescents ranging in age from 12 to 18 years old. The NYRB-S was an instrument used to assess risk factors that affect adolescents. We concluded that there were significant overall effects of daily time watching television and age on PA level. Subjects who spent 4 to 14 hours daily watching television had a significantly higher mean level of PA than subjects who watched television for 0 to 4 hours daily. The analysis also showed that the seven age groups differed significantly. There were significant correlations between time spent engaging in SB, age and PA levels. An increase in television viewing was related to a decrease in PA, and subjects between the ages of 13 and 16 tended to watch television more frequently.
Vaccine Hesitancy Among Pediatric Nurses: Prevalence and Associated Factors
Authors: Elizondo-Alzola Usue , Carrasco Mireia G. , Pinós Laia , Picchio Camila Andrea , Rius Cristina , Diez Elia
Published: May 2020

Background. Immunization rates of immuno-preventable diseases have declined in recent decades due to vaccine hesitancy. Primary care nurses play an essential role in promoting and maintaining vaccination coverage but may have doubts about or question the need to vaccinate. This study describes the prevalence of vaccine hesitancy and the associated factors among pediatric primary care nurses in Barcelona (Spain).Methods. Cross-sectional descriptive study. We invited the pediatric nurses (N = 165) working at all the Barcelona public primary health services (N = 41) to participate. They answered a questionnaire with sociodemographic and behavioral variables: severity and probability of contracting the diseases in the vaccination schedule; safety and protection of each vaccine; and beliefs, social norms, and knowledge about vaccines. Outcome variable was vaccine hesitancy, dichotomized into no hesitant (nurses who would vaccinate their own offspring), and hesitant (including those who would not vaccinate them, those who had doubts and those who would delay the administration of one or more vaccines).We performed bivariate analysis and adjusted logistic regression models.Results. 83% of pediatric nurses (N = 137) agreed to participate. A 32.1% of them reported vaccine hesitancy, especially about the HPV (21.9%) and varicella (17.5%) vaccines. In the multivariate analysis, hesitancy was associated with low perception of the severity of whooping cough [aOR: 3.88; (95%CI):1.32–11.4], low perception of safety of the HPV vaccine [aOR:8.5;(95%CI):1.24–57.8], the belief that vaccines are administered too early [aOR:6.09;(95%CI):1.98–18.8], and not having children [aOR:4.05;(95%CI):1.22–13.3].Conclusions. Although most pediatric nurses would vaccinate their own children, almost one third display some kind of vaccine hesitancy, mainly related with doubts about HPV and varicella vaccines, as well as some misconceptions. These factors should be addressed to enhance their fundamental role in promoting vaccination among families.
An assessment of a 'Training-of-trainers programme for clinic committees' in a South African district: A qualitative exploratory study
Authors: Esau Natasha , English René , King Maylene Shung
Published: May 2020

Background In South Africa (SA), clinics and community health centres are the predominant primary level health care facilities in the public health sector. As part of legislated health governance requirements, clinic committees (referring to those for clinics and community health centres) were established to provide management oversight and bring to bear the perspectives and participation of communities at Primary Health Care (PHC) facilities. In order for the committees to better understand their roles, they need training. Facilitators in a district of SA were trained through a designated programme, called the ‘PHC Facility Governance Structures Trainer-of-Facilitator (ToF) Learning Programme‘, in preparation for the training of clinic committees. This paper explores how the programme had evolved and was experienced by the trained facilitators, in a district in SA. Methods We employed a retrospective qualitative case study design, guided by the Illuminative Evaluation Framework, with the training programme in the selected district as the case. The study assessed whether the intended aims of the training programme were clearly conveyed by the trainers, and how participants understood and subsequently conveyed the training programme intentions to the clinic committees. Key informant interviews and focus group discussions were conducted with trainers and managers, complemented by a review of relevant policy and legislative documents, and published literature. Study participants were purposively selected based on their involvement in the development, facilitation or training of the programme. Thirteen individuals participated in the study, and 23 (national, provincial and partner) documents were reviewed. Results Despite the different perceptions and understandings of the ToF Learning Programme, its overall aims were achieved. Trainers’ capacity was strengthened and clinic committees were trained accordingly. The training programme holds promise for possible national scale-up. The high quality of the interactive posters can be considered equally valuable as a training tool as the training manuals. Conclusions Trainers’ capacity was strengthened and clinic committees were trained accordingly, despite deviations in implementation of the original training approach and plan.
Impacts of triglycerides-glucose index on prognosis of patients with type 2 diabetes mellitus and non-ST-segment elevation acute coronary syndrome: results from an observational cohort study in China
Authors: Zhao Qi , Zhang Ting-Yu , Cheng Yu-Jing , Ma Yue , Xu Ying-Kai , Yang Jia-Qi , Zhou Yujie
Published: May 2020

Background
The relationship between triglycerides-glucose index (TyG index) and the prevalence and prognosis of cardiovascular disease has been confirmed by former studies. However, it remains uncertain whether TyG index has a prognostic impact in patients with type 2 diabetes mellitus (T2DM) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).
Methods
The study retrospectively enrolled 832 patients (mean age: 60.7 ± 8.4 years; 68.1% men) with T2DM and NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. TyG index was calculated as previously reported: ln [fasting TGs (mg/dL) * FBG (mg/dL) / 2]. The primary endpoint was a composite of adverse events as follows: all-cause death, non-fatal myocardial infarction (MI) and ischemia-driven revascularization.
Results
TyG index were significantly higher in patients with a primary endpoint event compared with those without. Multivariate Cox analysis showed that 1-unit increase of TyG index was independently associated with higher risk of primary endpoint, independent of other risk factors [hazard ratio (HR) 2.644 per 1-unit increase, 95% confidence interval (CI) 2.086–3.352, P < 0.001]. The addition of TyG index to a baseline risk model had an incremental effect on the predictive value for adverse prognosis [AUC: baseline risk model, 0.748 vs. baseline risk model + TyG index, 0.860, P for comparison < 0.001; category-free net reclassification improvement (NRI) 0.378, P < 0.001; integrated discrimination improvement (IDI) 0.139, P < 0.001].
Conclusion
Increased TyG index is a significant predictor of adverse prognosis in patients with T2DM and NSTE-ACS undergoing PCI. Further studies need to be performed to determine whether interventions for TyG index have a positive impact on improving clinical prognosis.
The burden of overweight and its risk factors in urban Nepalese school adolescents: A cross-sectional study
Authors: Chaulagain Kamal
Published: May 2020

Introduction Adolescents overweight are rising in both developing and developed countries. Overweight and obese adolescents are more likely to become obese adults which stimulate the risk of Non-communicable diseases such as diabetes, cardiovascular diseases and so on. Adolescence is the critical period for development of unhealthy life styles and food choices which increases the risk of NCDs. The loss of productivity, premature deaths and disability has been associated with NCDs at younger ages. This study focuses on identifying the prevalence and associated risk factors with adolescents overweight. Methods A school based cross-sectional study was conducted in Gokarneshwor municipality of Nepal. A random sample of 558 students aged 10-19 years from nine schools was included in the study. A self-administered questionnaire was filled out by the study participants. Anthropometric indices were measured and categorized using BMI for age Z-score. Descriptive statistics were carried out. Variables were considered for multivariable logistic regression if a Wald test p-value was ≤0.25 during bivariate logistic regression. The odds ratio with a 95% CI was calculated and a p-value of ≤0.05 was considered to declare the statistical significance of variables after fitting into the multivariable logistic regression. Results The prevalence of overweight among school adolescents was 17.9% (95% CI 14.7 to 21.1). The female adolescents were more likely to get overweight as compared to male adolescents (AOR 1.53, 95% CI 0.97 to 2.39). Similarly, the adolescents staying with more than four family members were less likely to get overweight as compared to their counterparts (AOR 0.57, 95% CI 0.35 to 0.95). There was no statistical significant association between adolescent overweight and age group, family type, school type, mothers’ occupation or fruits consumption. Conclusion The study findings highlighted the accelerated increase in the prevalence of overweight among school adolescents in Nepal. Therefore, appropriate nutritional intervention focusing on tackling overweight should be formulated and implemented so that the prevalence of overweight-associated non-communicable diseases can be minimized.
Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis
Authors: Woo Sungmin , Ghafoor Soleen , Becker Anton S. , Han Sangwon , Wibmer Andreas , Hricak Hedvig , Burger Irene A. , Schöder Heiko , Vargas Hebert Alberto
Published: May 2020

Purpose: Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown promise for detecting nodal and distant prostate cancer (PCa) metastases. However, its performance for local tumor staging is not as well established. The purpose of this study was to review the diagnostic performance of PSMA-PET for determining seminal vesical invasion (SVI) and extraprostatic extension (EPE).Methods: Pubmed and Embase databases were searched until January 12, 2020. Studies assessing accuracy of PSMA-PET in determining SVI and EPE were included. Study quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity were calculated using hierarchical summary receiver operating characteristics modeling. Heterogeneity was explored using meta-regression analyses for anatomical imaging component (MRI vs CT) and by testing for a threshold effect.Results: 12 studies (615 patients) were included. Pooled sensitivity and specificity were 0.68 (95%CI 0.53-0.81) and 0.94 (95% CI 0.90-0.96) for SVI and 0.72 (95% CI 0.56-0.84) and 0.87 (95%CI 0.72-0.94) for EPE. Meta-regression analyses showed that for SVI, PET/MRI demonstrated greater sensitivity than PET/CT (0.87 [95%CI 0.75-0.98] vs 0.60 [95% CI 0.47-0.74]; p = 0.02 for joint model) while specificity was comparable (0.91 [95%CI 0.84-0.97] vs. 0.96 [95%CI 0.93-0.99]) but not for EPE (p = 0.08). A threshold effect was present for studies assessing EPE (correlation coefficient = 0.563 [95% CI, -0.234-0.908] between sensitivity and false-positive rate).Conclusion: PSMA-PET has moderate sensitivity and excellent specificity for assessing local tumor extent in patients with PCa. PET/MRI shows significantly greater sensitivity than PET/CT for assessing SVI.
A comparative clinicopathological study between ultrasonography, mammography, FNAC and core needle biopsy of breast lump
Authors: Mandal Arnab , Jana Pradipta , Bakshi Sabyasachi , Mandal Ram Krishna
Published: May 2020

BACKGROUND:Early presentation and prompt diagnosis is the essential key in treatment of different variety of neoplastic as well as non-neoplastic breast disease. In this study usefulness of HRUSG, Mammography, FNAC and Core Needle Biopsy in correlation with histopathological pattern, was assessed.METHODS:After matching the criteria, 212 cases, were taken for this prospective, single center, observational study. RESULTS:Out of 212 cases, 163(76.88 %%) were benign lesions, 49(23.11%) were malignant and 1(0.47%) were of inflammatory pathology. Benign to malignant breast disease ratio was 3.3:1. Out of 49 malignant cases, 45 (91.83%) were ductal cell carcinoma and 4 (8.16%) was apocrine carcinoma. Maximum numbers of cancer patients were found in the 51- 60 year age groups.The sensitivity, specificity, Positive predictive value and Negative Predictive value of mammography in detecting carcinoma breast were 87.76%, 64.71%, 87.76% and 64.71% respectively. The sensitivity, specificity, PPV and NPV of HRUSG in detecting carcinoma breast were 85.71%, 90.18%, 72.41% and 95.45% respectively.Among benign lesions, 47 (28.83) % were diagnosed by mammography and 147(90.18) % were diagnosed by HRUSG. When these modalities were combined, >95% of the lesions was diagnosed accurately.CONCLUSIONS:Ultra sound used liberally as an adjunct to mammography, increase the cancer detection rate. Core needle biopsy is found more accurate but FNAC have limited value in evaluation of benign breast lump. This study also proves that preoperative categorization of breast lesions is utmost important for management of the patient and this will help to avoid unnecessary surgical treatment.