bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical activity and associated factors among pregnant women in Ethiopia: facility-based cross-sectional study
Authors: Hailemariam Teklehaimanot Tekle , Gebregiorgis Yosef Sibhatu , Gebremeskel Berihu Fisseha , Haile Tsiwaye Gebreyesus , Spitznagle Theresa Monaco
Published: February 2020

Background

Regular physical activity (PA) has health benefits, including reducing the risk of complications during pregnancy. In Ethiopia, little is known about PA status and its determinants among pregnant women. The purpose of this study was to assess PA status and associated factors among pregnant women attending antenatal care at public and private health facilities in Mekelle, Ethiopia.

Methods

A facility-based cross-sectional study was conducted. Data was collected from 299 pregnant women using a structured questionnaire. Study participants were selected using a simple random sampling technique. A binary logistic regression was modeled to investigate the statistical significance of independent variables with PA status during pregnancy. Factors associated with PA status were estimated using adjusted odds ratios with 95% confidence intervals and statistical significance was declared at p-value < 0.05.

Results

79.3% of the study participants were classified as sedentary. The age group of 26–35 years (AOR: 2.69, 95% CI: 1.07–6.78), attending non-formal education (AOR: 13.50, 95% CI: 2.65–68.91), and women who did not work outside the home (AOR: 5.23, 95% CI: 1.34–20.38) were significantly associated with a higher risk of sedentary activity status. Pregnant women who were married (AOR: 0.26, 95% CI: 0.09–0.73), had two children (AOR: 0.13, 95% CI: 0.03–0.59), traveled an hour or more to health facilities (AOR: 0.31, 95% CI: 0.11–0.89) were protected from being sedentary.

Conclusion

Sedentary PA status was highly prevalent during pregnancy. Pregnant women in the age group of 26–35 years, with a non-formal education, and women who did not work outside the home had a greater risk of reporting being sedentary. Those who were married, had two children, and traveled an hour or more to health facilities were less likely to be sedentary. Stakeholders (Tigrai regional health bureau, Mekelle University, local NGOs working with pregnant women and societies at large) should give higher emphasis on designing appropriate strategies including educational interventions to overcome barriers to PA during pregnancy.
Linc01234 promotes cell proliferation and metastasis in oral squamous cell carcinoma via miR-433/PAK4 axis
Authors: Liu Deyu , Jian Xinchun , Xu Pu , Zhu Rong , Wang Yuan
Published: February 2020

Background

Increasing studies have demonstrated that long non-coding RNAs (lncRNAs) play an important role in tumor progression. However, the potential biological functions and clinical importance of Linc01234 in oral squamous cell carcinoma (OSCC) remain unclear.

Methods

We evaluated the expression profile and prognostic value of Linc01234 in OSCC tissues by RT-qPCR. Then, functional in vitro experiments were performed to investigate the effects of Linc01234 on tumor growth, migration and invasion in OSCC. Mechanistically, RT-qPCR, bioinformatic analysis and dual luciferase reporter assays were performed to identify a competitive endogenous RNA (ceRNA) mechanism involving Linc01234, miR-433-3p and PAK4.

Results

We found that Linc01234 was clearly upregulated in OSCC tissues and cell lines, and its level was positively associated with T stage, lymph node metastasis, differentiation and poor prognosis of patients with OSCC. Our results shown that Linc01234 inhibited cell proliferation and metastatic abilities in CAL27 and SCC25 cells following its knockdown. Mechanistic analysis indicated that Linc01234 may act as a ceRNA (competing endogenous RNA) of miR-433-3p to relieve the repressive effect of miR-433-3p on its target PAK4.

Conclusions

Our results indicated that Linc01234 promotes OSCC progression through the Linc01234/miR-433/PAK4 axis and might be a potential therapeutic target for OSCC.
Bidirectional treatment of peritoneal metastasis with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) and systemic chemotherapy: a systematic review
Authors: Ploug Magnus , Graversen Martin , Pfeiffer Per , Mortensen Michael Bau
Published: February 2020

Background

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is used in the palliative treatment of peritoneal metastasis. The combination of intraperitoneal and systemic chemotherapy seems rational, and the aim of this systematic review was to compare PIPAC directed monotherapy with a bidirectional treatment approach (PIPAC in combination with systemic chemotherapy). Main outcomes were survival and quality of life.

Methods

A systematic literature search in Medline, Embase, Cochrane and the “Pleura and Peritoneum” was conducted and analyzed according to PRISMA guidelines. Studies in English reporting on bidirectional treatment with PIPAC and systemic chemotherapy and published before April 2019 were included.

Results

Twelve studies with a total of 386 patients were included. None were specifically designed to compare mono- versus bidirectional treatment, but 44% of the patients received bidirectional treatment. This was more frequent in women (non-gynecological cancers) and one-third of the bidirectional treated patients had received no prior chemotherapy. Data from the included studies provided no conclusions regarding survival or quality of life.

Conclusion

Bidirectional treatment with PIPAC and systemic chemotherapy is practised and feasible, and some patients are enrolled having received no prior systemic chemotherapy for their PM.

The difficulty in drawing any conclusions based on this systematic review has highlighted the urgent need to improve and standardize reports on PIPAC directed therapy. We have, therefore, constructed a list of items to be considered when reporting on clinical PIPAC research.

Trial registration

International Prospective Register of Systematic Reviews, PROSPERO. Registration number: 90352, March 5, 2018.
Production of an anti-angiogenic factor sFLT1 is suppressed via promoter hypermethylation of FLT1 gene in choriocarcinoma cells
Authors: Sasagawa Tadashi , Jinno-Oue Atsushi , Nagamatsu Takeshi , Morita Kazuki , Tsuruga Tetsushi , Mori-Uchino Mayuyo , Fujii Tomoyuki , Shibuya Masabumi
Published: February 2020

Background

Soluble Fms-like tyrosine kinase-1 (sFLT1) as an anti-angiogenic factor is abundantly expressed in placental trophoblasts. Choriocarcinoma, a malignant tumor derived from trophoblasts, is known to be highly angiogenic and metastatic. However, the molecular mechanism underlying angiogenesis in choriocarcinoma pathogenesis remains unclear. We aimed to investigate the mRNA expression and DNA methylation status of the FLT1 gene in human choriocarcinoma cells and trophoblast cells.

Methods

qRT-PCR, Western blotting and ELISA were conducted to evaluate the mRNA and protein expression levels of sFLT1. 5-aza-2′-deoxycytidine (5azadC) treatment and bisulfite sequencing were used to study the FLT1 gene promoter methylation. The effect of sFLT1 on choriocarcinoma growth and angiogenesis was evaluated in a xenograft mouse model.

Results

Expression of the FLT1 gene was strongly suppressed in choriocarcinoma cell lines compared with that in the primary trophoblasts. Treatment of choriocarcinoma cell lines with 5azadC, a DNA methyltransferase inhibitor, markedly increased in mRNA expression of three FLT1 splice variants and secretion of sFLT1 proteins. Bisulfite sequencing revealed that the CpG hypermethylation was observed at the FLT1 promoter region in choriocarcinoma cell lines and a human primary choriocarcinoma tissue but not in human trophoblast cells. Interestingly, in 5azadC-treated choriocarcinoma cell lines, sFLT1 mRNA expression and sFLT1 production were further elevated by hypoxic stimulation. Finally, as expected, sFLT1-expressing choriocarcinoma cells implanted into nude mice showed significantly slower tumor growth and reduced microvessel formation compared with GFP-expressing control choriocarcinoma cells.

Conclusions

Inhibition of sFLT1 production by FLT1 silencing occurs via the hypermethylation of its promoter in choriocarcinoma cells. The stable expression of sFLT1 in choriocarcinoma cells resulted in the suppression of tumor growth and tumor vascularization in vivo. We suggest that the FLT1 gene may be a cell-type-specific tumor suppressor in choriocarcinoma cells.
Expression of p53 N-terminal isoforms in B-cell precursor acute lymphoblastic leukemia and its correlation with clinicopathological profiles
Authors: Oh Lixian , Hainaut Pierre , Blanchet Sandrine , Ariffin Hany
Published: February 2020

Background

TP53mutations occur in only about 3% of primary and 10–20% of relapse B-cell precursor acute lymphoblastic leukaemia (BCP-ALL). However, alternative mechanisms may contribute to functionally impairing the p53 pathway in the absence of a mutation. Candidate mechanisms include overexpression of p53 mRNA variants encoding either dominant-negative p53 protein isoforms such as Delta40p53 and Delta133p53, or modulatory isoforms such as p53beta, which counteract the effects of Delta133p53 on replicative senescence in T-lymphocytes.

Methods

We used semi-quantitative reverse-transcriptase PCR (RT-PCR) and Western blot to investigate the expression of full length p53 (TAp53), Delta40p53, Delta133p53 or p53beta in diagnostic marrow from a clinical cohort of 50 BCP-ALL patients withoutTP53mutation (29 males and 21 females, age range 2–14 years) and in the bone marrow cells of 4 healthy donors (used as controls).

Results

Irrespective of isoforms, levels of p53 mRNA were low in controls but were increased by 2 to 20-fold in primary or relapse BCP-ALL. TAp53 was increased in primary BCP-ALL, Delta40p53 was elevated in relapse BCP-ALL, whereas Delta133p53 and p53beta were increased in both. Next, mRNA levels were used as a basis to infer the ratio between protein isoform levels. This inference suggested that, in primary BCP-ALL, p53 was predominantly in active oligomeric conformations dominated by TAp53. In contrast, p53 mostly existed in inactive quaternary conformations containing ≥2 Delta40 or Delta133p53 in relapse BCP-ALL. Western blot analysis of blasts from BCP-ALL showed a complex pattern of N-terminally truncated p53 isoforms, whereas TAp53beta was detected as a major isoform. The hypothesis that p53 is in an active form in primary B-ALL was consistent with elevated level of p53 target genesCDKN1AandMDM2in primary cases, whereas in relapse BCP-ALL, onlyCDKN1Awas increased as compared to controls.

Conclusion

Expression of p53 isoforms is deregulated in BCP-ALL in the absence ofTP53mutation, with increased expression of alternative isoforms in relapse BCP-ALL. Variations in isoform expression may contribute to functional deregulation of the p53 pathway in BCP-ALL, specifically contributing to its down-regulation in relapse forms.
Association between stigma towards HIV and MSM and intimate partner violence among newly HIV-diagnosed Chinese men who have sex with men
Authors: Wang Na , Huang Bo , Ruan Yuhua , Amico K. Rivet , Vermund Sten H. , Zheng Shimin , Qian Han-Zhu
Published: February 2020

Background

HIV- and MSM-related stigma are well documented as common for Chinese men who have sex with men (MSM) living with HIV, yet there is sparse literature on intimate partner violence (IPV) and its relationship with stigma in this vulnerable population. To evaluate the association between HIV-stigma and stigma related to homosexuality and IPV among newly HIV-diagnosed MSM in China.

Methods

Data were collected in the baseline survey among newly HIV-diagnosed Chinese MSM in a randomized clinical trial via face-to-face interviews. Univariate logistic and multivariate logistic regression analyses were performed to assess the associations between IPV and HIV- and MSM-related stigma.

Results

Of 367 newly HIV-diagnosed Chinese MSM, 23.7% experienced any IPV, including 16.6% physical, 7.4% psychological and 5.2% sexual IPV. Positive associations were found between HIV- and MSM-related stigma and IPV. Men with high HIV-related stigma (score ≥ 27) were 1.67 times as likely to experience any IPV as those with low stigma (adjusted odds ratio [AOR]: 1.67, 95% confidence interval [CI]: 1.02–2.76). Men with high MSM-related stigma (score ≥ 6) were 1.99 times as likely to experience any IPV as those with low stigma (AOR: 1.99, 95% CI: 1.18–3.36).

Conclusions

HIV- and MSM-related stigmas was positively associated with IPV experiences among newly diagnosed MSM in China. The manner in which stigma may exacerbate IPV, and/or the influence of IPV on worsening stigma should be further evaluated. The high prevalence of IPV and stigma in this population suggests that interventions should be taken to reduce stigma and prevent this risky behavior among MSM.
Socioeconomic patterning of vaping by smoking status among UK adults and youth
Authors: Green Michael J. , Gray Linsay , Sweeting Helen , Benzeval Michaela
Published: February 2020

Background

Smoking contributes significantly to socioeconomic health inequalities. Vaping has captured much interest as a less harmful alternative to smoking, but may be harmful relative to non-smoking. Examining inequalities in vaping by smoking status, may offer insights into potential impacts of vaping on socioeconomic inequalities in health.

Methods

Data were from 3291 youth (aged 10–15) and 35,367 adults (aged 16+) from wave 7 (2015–17) of the UK Household Longitudinal Study. In order to adjust for biases that could be introduced by stratifying on smoking status, marginal structural models were used to estimate controlled direct effects of an index of socioeconomic disadvantage (incorporating household education, occupation and income) on vaping by smoking status (among adults and youth), adjusting for relevant confounders and for selection into smoking states. We also estimated controlled direct effects of socioeconomic disadvantage on being an ex-smoker by vaping status (among adult ever-smokers; n = 18,128).

Results

Socioeconomic disadvantage was associated with vaping among never smoking youth (OR for a unit increase in the socioeconomic index: 1.17; 95%: 1.03–1.34), and among ex-smoking adults (OR: 1.17; 95% CI: 1.09–1.26), with little to no association among never smoking (OR: 0.98; 95% CI: 0.91–1.07) and current smoking (OR: 1.00; 95% CI: 0.93–1.07) adults. Socioeconomic disadvantage was also associated with reduced odds of being an ex-smoker among adult ever-smokers, but this association was moderately weaker among those who vaped (OR: 0.88; 95% CI: 0.82–0.95) than those who did not (OR: 0.82; 95% CI: 0.80–0.84; p-value for difference = 0.081).

Conclusions

Inequalities in vaping among never smoking youth and adult ex-smokers, suggest potential to widen health inequalities, while weaker inequalities in smoking cessation among adult vapers indicate e-cigarettes could help narrow inequalities. Further research is needed to understand the balance of these opposing potential impacts, and how any benefits can be maximised whilst protecting the vulnerable.
Surgical outcomes of elderly patients aged more than 80 years with distal radius fracture: comparison of external fixation and locking plate
Authors: Huang Yu-Yi , Lin Tung-Yi , Chen Chien-Hao , Chou Ying-Chao , Su Chun-Yi
Published: February 2020

Background

To compare the outcomes after surgical intervention, including external fixation (EF) with the optional addition of K-pins or open reduction and internal fixation (ORIF) with a volar locking plate (VLP), in patients with distal radius fracture aged > 80 years.

Methods

We reviewed 69 patients with a distal radius fracture aged > 80 years who treated under surgical intervention from 2011 to 2017 retrospectively. Their demographic data and complications were recorded. Preoperative, postoperative, and last follow-up plain films were analyzed. The functional outcomes of wrist range of motion were also evaluated.

Results

41 patients were treated with EF with the optional addition of K-pins, while 28 patients were treated with ORIF with a VLP. The radiological parameters, including ulnar variance and radial inclination, at the last follow-up were significantly more acceptable in the VLP group (p = 0.01, p = 0.03, respectively). The forearm supination was significantly better in patients treated with VLP (p = 0.002). The overall incidence of complications was lower in the VLP group (p = 0.003).

Conclusion

VLP provides better radiological outcomes, wrist supination and lower complication rates than EF. Therefore, although EF is still widely used because of its acceptable results and easy application, we recommend VLP as a suitable treatment option for distal radius fracture in the geriatric population aged > 80 years.
Impact of mining on the floristic association of gold mined sites in Southwest Nigeria
Authors: Adesipo Adegbite A. , Akinbiola Sehinde , Awotoye Olusegun O. , Salami Ayobami T. , Freese Dirk
Published: February 2020

Background

Occurrences in land use, human activities and climate change have both direct and indirect influences on the environment. Of interest for this study is mining; a common activity in developing countries such as Nigeria which is endowed with over 34 solid minerals. The gold mining sites in the Southwest region of the country is predominantly by Artisanal and Small-Scale Mining (ASM). Though the benefits are known, its induced consequences are enormous. To understand its extent of floristic diversity, identification of functional plants and plant species surviving on the mined sites (despite its characterized mining and alteration level); this study compared the floristic composition of an abandoned mining site (Site 1), an active mining site (Site 2) and an undisturbed vegetation sites (Control) of similar vegetation zone.

Results

A total of 54, 28 and 37 species belonging to 31, 20 and 23 families were found on Site 1, Site 2 and the control site, respectively. It shows that the floristic composition of all the sites has been altered due to its past intense agricultural colonization and human activities, but severe on Site 1 and 2 due to mining. Lots of the identified species are functional species and stand as ecological indicators. Species such as Acanthus montanus and Icacina trichantha found on the Control sites are native and significance but species such as Capsicum frutescens and Crassocephalum crepidioides on Site 2 are due to human inference while most species on Site 1 shows both original and altered floristic composition (e.g. Adenia venenata and Grewia flavescens).

Conclusions

Apart from the on-going farming activities, ASM activities such as pollution, deforestation and exposure of the forest soils to direct sunlight has greatly stressed and disturbed the floristic composition, species richness, life form patterns, of the mined sites as well as introduction of non-native plant species. It is therefore necessary to develop effective approaches and policies to curb these illegal ASM activities, empower the community (especially youths), stabilize the economy and establish sustainable development strategies with adequate reclamation measures.
Efficiency of using electric toothbrush as an alternative to a tuning fork for artificial buzz pollination is independent of instrument buzzing frequency
Authors: Tayal Mandeep , Chavana Jesus , Kariyat Rupesh R.
Published: February 2020

Background

Breeding programs and research activities where artificial buzz-pollinations are required to have primarily relied upon using tuning forks, and bumble bees. However, these methods can be expensive, unreliable, and inefficient. To find an alternative, we tested the efficiency of pollen collection using electric toothbrushes and compared it with tuning forks at three vibration frequencies—low, medium, and high and two extraction times at 3 s and 16 s- from two buzz—pollinated species (Solanum lycopersicum and Solanum elaeagnifolium).

Results

Our results show that species, and extraction time significantly influenced pollen extraction, while there were no significant differences for the different vibration frequencies and more importantly, the use of a toothbrush over tuning fork. More pollen was extracted from S. elaeagnifolium when compared to S. lycopersicum, and at longer buzzing time regardless of the instrument used.

Conclusions

Our results suggest that electric toothbrushes can be a viable and inexpensive alternative to tuning forks, and regardless of the instrument used and buzzing frequency, length of buzzing time is also critical in pollen extraction.
Cost-effectiveness of child caries management: a randomised controlled trial (FiCTION trial)
Authors: Homer Tara , Maguire Anne , Douglas Gail V. A. , Innes Nicola P. , Clarkson Jan E. , Wilson Nina , Ryan Vicky , McColl Elaine , Robertson Mark , Vale Luke
Published: February 2020

Background

A three-arm parallel group, randomised controlled trial set in general dental practices in England, Scotland, and Wales was undertaken to evaluate three strategies to manage dental caries in primary teeth. Children, with at least one primary molar with caries into dentine, were randomised to receive Conventional with best practice prevention (C + P), Biological with best practice prevention (B + P), or best practice Prevention Alone (PA).

Methods

Data on costs were collected via case report forms completed by clinical staff at every visit. The co-primary outcomes were incidence of, and number of episodes of, dental pain and/or infection avoided. The three strategies were ranked in order of mean cost and a more costly strategy was compared with a less costly strategy in terms of incremental cost-effectiveness. Costs and outcomes were discounted at 3.5%.

Results

A total of 1144 children were randomised with data on 1058 children (C + Pn = 352, B + Pn = 352, PAn = 354) used in the analysis. On average, it costs £230 to manage dental caries in primary teeth over a period of up to 36 months. Managing children in PA was, on average, £19 (97.5% CI: -£18 to £55) less costly than managing those in B + P. In terms of effectiveness, on average, there were fewer incidences of, (− 0.06; 97.5% CI: − 0.14 to 0.02) and fewer episodes of dental pain and/or infection (− 0.14; 97.5% CI: − 0.29 to 0.71) in B + P compared to PA. C + P was unlikely to be considered cost-effective, as it was more costly and less effective than B + P.

Conclusions

The mean cost of a child avoiding any dental pain and/or infection (incidence) was £330 and the mean cost per episode of dental pain and/or infection avoided was £130. At these thresholds B + P has the highest probability of being considered cost-effective. Over the willingness to pay thresholds considered, the probability of B + P being considered cost-effective never exceeded 75%.

Trial registration

The trial was prospectively registered with the ISRCTN (reference numberISRCTN77044005) on the 26th January 2009 and East of Scotland Research Ethics Committee provided ethical approved (REC reference: 12/ES/0047).
Knowledge, dentist confidence and management of periodontal patients among general dentists from Belarus, Lithuania, Macedonia, Moldova and Romania
Authors: Aleksejūnienė Jolanta , Pūrienė Alina , Rimkervicius Arunas , Amariei Corneliu , Oancea Roxana , Porosencova Tatiana , Porosencov Egor , Nikolovska Julijana , Mirnaya Elena , Serova-Papakul Aleksandra , Eaton Kenneth A.
Published: February 2020

Background

Evidence concerning periodontal practice in Eastern European countries is scarce. The aim of the present study was to investigate periodontal risk knowledge, patient management and self-perceived confidence among General Dentists (GDs) from five Eastern European regarding their provision of periodontal care.

Methods

GDs from Belarus, Lithuania, Macedonia, Moldova and Romania participated in a questionnaire survey. Power calculations were used to identify the sample size for each country. The structured questionnaire included several domains of inquiry. The socio-demographic domain inquired about dentist’s age, gender and years of clinical experience. The dental practice domain inquired about practice location, practising or not practising in a group practice and having or not having a periodontist or a dental hygienist in the practice. The distributions of answers across-countries were compared employing one way ANOVA (comparison of means) or Chi square test (comparison of proportions). For each country, the predictors of the study outcomes: a summative knowledge score for periodontal risks and dentist’s confidence level were identified employing either linear or logistic multiple regression models.

Results

The sample comprised 390 Belarussian, 488 Lithuanian, 349 Macedonian, 316 Moldovan, and 401 Romanian GDs. The majority of GDs (~ 80%) practiced in urban areas. Age and gender distributions differed significantly among countries. Significant across-country differences were found regarding working/not working in a group practice, having/not having access to a periodontist/dental hygienist and in proportions of patients receiving periodontal treatments or being referred to specialists. None of Macedonian patients nor the majority of Moldovan patients (78%) were referred to periodontists. There were also significant across-country differences in diagnosis, patient management and periodontal knowledge. Only in the Lithuanian cohort were dentists’ confidence levels associated significantly with their knowledge. In all countries, taking a medical history was a consistent and significant predictor of having higher periodontal knowledge score. Except in Belarus, periodontal risk assessment was a significantly consistent predictor of certainty levels associated with the provision of periodontal treatments.

Conclusions

There were substantial differences among GDs in the five countries regarding diagnosis, dentist’s confidence and management of periodontal patients.
Scales to evaluate developmental stage and professional identity formation in medical students, residents, and experienced doctors
Authors: Tagawa Masami
Published: February 2020

Background

To respond to the growing need to cultivate medical trainees with professional identity, it is necessary to evaluate professional identity formation (PIF) in medical trainees to understand their state of PIF and apply this to medical education. Previous qualitative studies indicated that Kegan’s human development model could explain medical trainees’ PIF. I proposed a development scale (DS) to quantitatively evaluate the degree of maturation and socialization as a physician; however, one scale is not enough to illustrate the helical and complex process of development.

Methods

Using Kegan’s model as the conceptual framework, scales that evaluate stage 2, 3, and 4, and higher stage-specific attributes were developed using data collected in a self-administered questionnaire (322 respondents), reliability analysis, group comparison, and analysis of individual DS scores. The respondents were 4th- and 6th-year medical students and 2nd-year residents at Kagoshima University, and experienced medical doctors (instructors).

Results

In addition to the DS, one self-administered questionnaire consisting of 27 items for stage 2, 3, 4, and higher stage-specific attribute scales was created. Students had the highest mean score in stage 2, and instructors had the highest mean score in stage 4 and higher stage scales. Individual analysis indicated that there were respondents with varied attributes in each group, that the average medical student might have inclusion preference typically seen at stage 3, and that the average instructor might have independent preference typically seen at stage 4 more than inclusion preference.

Conclusions

Combining multiple stage attribute-specific scales and DS scores could quantify the complexity and divergent processes of PIF. These scales could provide meaningful information about individuals, groups, and education in terms of professional development that is different from assessment data of medical knowledge or professional skills.
Lessening barriers to healthcare in rural Ghana: providers and users’ perspectives on the role of mHealth technology. A qualitative exploration
Authors: Peprah Prince , Abalo Emmanuel Mawuli , Agyemang-Duah Williams , Budu Hayford Isaac , Appiah-Brempong Emmanuel , Morgan Anthony Kwame , Akwasi Adjei Gyimah
Published: February 2020

Background

Key barriers to healthcare use in rural Ghana include those of economic, social, cultural and institutional. Amid this, though rarely recognised in Ghanaian healthcare settings, mHealth technology has emerged as a viable tool for lessening most healthcare barriers in rural areas due to the high mobile phone penetration and possession rate. This qualitative study provides an exploratory assessment of the role of mHealth in reducing healthcare barriers in rural areas from the perspective of healthcare users and providers.

Method

Semi-structured interviews were conducted with 30 conveniently selected healthcare users and 15 purposively selected healthcare providers within the Birim South District in the Eastern Region of Ghana between June 2017 and April 2018. Data were thematically analysed and normative standpoints of participants were presented as quotations.

Results

The main findings were that all the healthcare users had functioning mobile phones, however, their knowledge and awareness about mHealth was low. Meanwhile, rural health care users and providers were willing to use mHealth services involving phone call in the future as they perceived the technology to play an important role in lessening healthcare barriers. Nevertheless, factors such as illiteracy, language barrier, trust, quality of care, and mobile network connectivity were perceived as barriers associated with using mHealth in rural Ghana.

Conclusion

The support for mHealth service is an opportunity for the development of synergistic relationship between health policy planners and mobile network companies in Ghana to design efficient communication and connectivity networks, accessible, localised, user-friendly and cost-effective mobile phone-based health programmes to assist in reducing healthcare barriers in rural Ghana.
A developmental evaluation of an intraprofessional Pharmacy Communication Partnership (PROMPT) to improve transitions in care from hospital to community: A mixed-methods study
Authors: Guilcher Sara J. T. , Fernandes Olavo , Luke Miles J. , Wong Gary , Lui Philip , Cameron Karen , Pariser Pauline , Raco Vanessa , Kak Karishma , Varghese Shawn , Papastergiou John , McCarthy Lisa M.
Published: February 2020

Background

People transitioning from hospital- to community-based care are at increased risk of experiencing medication problems that can lead to adverse drug events and poor health outcomes. Community pharmacists provide medication expertise and support during care transitions yet are not routinely included in communications between hospitals and other primary health care providers. The PhaRmacy COMmunication ParTnership (PROMPT) intervention facilitates medication management by optimizing information sharing between pharmacists across care settings. This developmental evaluation sought to assess the feasibility and acceptability of implementing the PROMPT intervention, and to explore how contextual factors influenced its implementation.

Methods

PROMPT was implemented for 14 weeks (January–April, 2018) in the general internal medicine units at two teaching hospitals in Toronto, Canada. PROMPT featured two contact points between hospital and community pharmacists around patient discharge: (1) faxing an enhanced discharge prescription and discharge summary to a patient’s community pharmacy and (2) a follow-up phone call from the hospital pharmacist to the community pharmacist. Our mixed-method evaluation involved electronic patient records, process measures using tracking forms, telephone surveys and semi-structured interviews with participating community and hospital pharmacists.

Results

The intervention involved 45 patients with communication between 12 hospital and 45 community pharmacists. Overall, the intervention had challenges with feasibility. Issues with fidelity included challenges with the medical discharge summary being available at the time of faxing and hospital pharmacists’ difficulties with incorporating novel elements of the program into their existing practices. However, both community and hospital pharmacists recognized the potential benefits to patient care that PROMPT offered, and both groups proposed recommendations for further improvements. Suggestions included enhancing hospital staffing and resources.

Conclusion

Improving intraprofessional collaboration, through interventions such as PROMPT, positions pharmacists as leaders of medication management services across care settings and has the potential to improve patient care; however, more co-design work is needed to enhance the intervention and its fidelity.
“You get exposed to a wider range of things and it can be challenging but very exciting at the same time”: enablers of and barriers to transition to rural practice by allied health professionals in Australia
Authors: Kumar Saravana , Tian Esther Jie , May Esther , Crouch Rosanne , McCulloch Mandy
Published: February 2020

Background

There is consistent evidence highlighting the mal-distribution of the health workforce between urban and rural and remote regions. To date, addressing this mal-distribution has focused on medicine and nursing with limited initiatives targeted at allied health. Therefore, the aim of this research was to explore the enablers of and barriers to transition to rural practice by allied health professionals across South Australia in Australia.

Method

Qualitative descriptive methodology was used to underpin this research. Individual, in-depth semi-structured interviews were conducted with employers, managers and allied health professionals from rural regions of South Australia who were identified using purposive maximum variation sampling strategy.

Results

A total 22 participants shared their perspectives on the enablers of and barriers to transition to rural practice by allied health professionals across South Australia. Thematic analysis of the interview data resulted in a number of key issues impacting transition to rural-based practice. These findings could be broadly categorised into three stages during the transition: ‘before’; ‘during’ and ‘after’.

Discussion

This study identified a range of enablers of and barriers to transition to rural practice by allied health professionals. Five overarching themes – nature of rural practice, exposure to rural ‘taster’, social/lifestyle, job availability/characteristics, and mentor and support were identified. In particular, exposure to rural ‘taster’, social/lifestyle, and mentor and support were the key themes reported by the stakeholders. The multifactorial nature of the barriers and enablers highlight the complexity underpinning how AHPs transition to rural-based practice. These barriers/ enablers are often inter-linked and continually evolving which pose significant challenges for health care stakeholders to successfully addressing these.

Conclusion

This research sheds light on the complexities that confront and successful strategies that are required for health care stakeholders when considering how best to support allied health professional transition to rural practice.
Assessing health system responsiveness in primary health care facilities in Tanzania
Authors: Kapologwe Ntuli A. , Kibusi Stephen M. , Borghi Josephine , Gwajima Dorothy O. , Kalolo Albino
Published: February 2020

Background

Health system performance is one of the important components of the health care delivery; its achievement depends on the quality of services rendered and the health system responsiveness of its beneficiaries. Health system responsiveness is a multi-dimensional concept and is usually measured through several domains. Health system responsiveness (HSR) remains to be a key indicator for evaluation of health system performance in any settings. This study aimed at assessing the situation of health system responsiveness in primary health facilities in Tanzania prior to introduction of the Direct Health Facility Financing (DHFF) program.

Methods

This was a cross sectional study conducted between January and February in 2018. We collected data from 42 primary health facilities (14 health centers and 28 dispensaries) where a questionnaire was administered to a total of 422 participants. The questionnaire collected information on attention, respect to dignity, clear communication, autonomy, access to care, respect to confidentiality and basic amenities. Descriptive analysis was done to determine the distribution of the variables whereas ANOVA and linear regression analysis was employed to discern the association between variables.

Results

More than 67% of participants had visited the same health facility more than 5 times. Sixty seven percent of the patients were residing within 5kms from the public primary health care facilities. The geographical access to health care scored the lowest (43.5% for Dispensaries and 36% for Health center) mean as compared to other domains of health system responsiveness. The highest score was in respect to confidentiality (86.7%) followed by respect to dignity (81.4%). Linear regression analysis revealed no statistical association between any of the social demographic features with the overall HSR performances. However, in post hoc analysis, Pwani and Shinyanga regions didn’t differ significantly in terms of their performances whereas those two regions differ from all other regions.

Conclusion

Based on the study findings health system responsiveness domains has performed relatively poor in many regions except for respect of dignity and confidentiality scored high of all the domains. Shinyanga and Pwani regions scored relatively well in all domains this could have been due to the effect of Results Based financing (RBF) in the respective regions. All in all the Government and other stakeholders in the health sector they should deliberately invest on the access to care domain as seem to be a challenge as compared to others.
Six years’ experience with LipidSeq: clinical and research learnings from a hybrid, targeted sequencing panel for dyslipidemias
Authors: Dron Jacqueline S. , Wang Jian , McIntyre Adam D. , Iacocca Michael A. , Robinson John F. , Ban Matthew R. , Cao Henian , Hegele Robert A.
Published: February 2020

Background

In 2013, our laboratory designed a targeted sequencing panel, “LipidSeq”, to study the genetic determinants of dyslipidemia and metabolic disorders. Over the last 6 years, we have analyzed 3262 patient samples obtained from our own Lipid Genetics Clinic and international colleagues. Here, we highlight our findings and discuss research benefits and clinical implications of our panel.

Methods

LipidSeq targets 69 genes and 185 single-nucleotide polymorphisms (SNPs) either causally related or associated with dyslipidemia and metabolic disorders. This design allows us to simultaneously evaluate monogenic—caused by rare single-nucleotide variants (SNVs) or copy-number variants (CNVs)—and polygenic forms of dyslipidemia. Polygenic determinants were assessed using three polygenic scores, one each for low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol.

Results

Among 3262 patient samples evaluated, the majority had hypertriglyceridemia (40.1%) and familial hypercholesterolemia (28.3%). Across all samples, we identified 24,931 unique SNVs, including 2205 rare variants predicted disruptive to protein function, and 77 unique CNVs. Considering our own 1466 clinic patients, LipidSeq results have helped in diagnosis and improving treatment options.

Conclusions

Our LipidSeq design based on ontology of lipid disorders has enabled robust detection of variants underlying monogenic and polygenic dyslipidemias. In more than 50 publications related to LipidSeq, we have described novel variants, the polygenic nature of many dyslipidemias—some previously thought to be primarily monogenic—and have uncovered novel mechanisms of disease. We further demonstrate several tangible clinical benefits of its use.
A dose-ranging study of the inhaled dual phosphodiesterase 3 and 4 inhibitor ensifentrine in COPD
Authors: Singh Dave , Martinez Fernando J. , Watz Henrik , Bengtsson Thomas , Maurer Brian T.
Published: February 2020

Background

Many patients with chronic obstructive pulmonary disease (COPD) still experience daily symptoms, exacerbations, and accelerated lung function decline, even when receiving maximal combined treatment with inhaled long-acting bronchodilators and corticosteroids. Novel treatment options are needed for these patients.

Phosphodiesterases (PDEs) are enzymes that impact a range of cellular functions by modulating levels of cyclic nucleotides, and there is evidence to suggest that combined inhibition of PDE3 and PDE4 can have additive (or perhaps synergistic) effects. This study investigated the efficacy and safety of ensifentrine, a first-in-class dual inhibitor of PDE 3 and 4, in patients with COPD.

Methods

This randomised, double-blind, placebo-controlled, parallel-group, dose-ranging study recruited patients with COPD, post-bronchodilator forced expiratory volume in 1 s (FEV1) 40–80% predicted and FEV1/forced vital capacity ratio ≤ 0.7. Patients were randomised equally to inhale nebulised ensifentrine 0.75, 1.5, 3 or 6 mg or placebo, all twice daily. Primary outcome: placebo-adjusted difference in peak FEV1 (assessed over 3 h) at Week 4.

Results

The study took place between July 2017 and February 2018. Of 405 patients randomly assigned to medication, 375 (92.6%) completed the study. For peak FEV1 at Week 4, all four ensifentrine doses were superior to placebo (p ≤ 0.0001) with least squares mean differences of 146 (95% CI 75–216), 153 (83–222), 200 (131–270) and 139 (69–210) mL for ensifentrine 0.75, 1.5, 3 and 6 mg, respectively. Respiratory symptoms (assessed using the Evaluating Respiratory Symptoms questionnaire) were also significantly improved with all ensifentrine doses at Week 4. Adverse events were reported by 33.3, 44.4, 35.4 and 36.3% patients with ensifentrine 0.75, 1.5, 3 and 6 mg, respectively, and 39.2% with placebo.

Conclusions

In this four-week Phase IIb study, all four ensifentrine doses significantly improved bronchodilation and symptoms, with a dose-ranging effect from 0.75 to 3 mg twice daily, and all doses well tolerated. The study supports the continuing development of ensifentrine in COPD.

Trial registration

EudraCT 2016–005205-40, registered 30 May 2017.
miR-450b-3p inhibited the proliferation of gastric cancer via regulating KLF7
Authors: Yao Juan , Zhang Hao , Liu Cheng , Chen Shuangshuang , Qian Rongyu , Zhao Kun
Published: February 2020

Background

This study aimed to investigate the clinical characteristics of miR-450b-3p in the patients of gastric cancer (GC), and further explore whether miR-450b-3p could inhibit the proliferation of GC cells via regulating KLF7.

Methods

Real-time quantitative PCR (qRT-PCR) was performed to detect the expression level of miR-450b-3p in 48 GC patients of tumor tissue and paracancerous tissue specimens collected, and the associations between miR-450b-3p and the clinical characteristics of GC patients were analyzed. Meanwhile, the expression of miR-450b-3p in GC cell lines was verified using qRT-PCR. miR-450b-3p overexpression vectors was constructed in GC cell lines including AGS and BGC-823, and then CCK-8 cell proliferation assay, Plate colony formation assay and EdU assay were applied to analyze the biological function of miR-450b-3p in GC cell lines.

Results

The results of qRT-PCR showed that the expression level of miR-450b-3p in GC tissues was lower than that in paracancerous tissues, and the difference was statistically significant. Compared with GC patients with high-miR-450b-3p expression, these GC patients with low-miR-450b-3p expression had a higher pathological stage and tumor size. Subsequently, the proliferation ability of GC cells in miR-450b-3p mimic was significantly decreased when comparing with the NC mimic. In addition, qRT-PCR indicated that the expression level of KLF7 significantly decreased after miR-450b-3p mimic. Therefore, it was demonstrated that miR-450b-3p might inhibit the malignant progression of GC via modulating KLF7. Bioinformatics analysis and dual luciferase reporter suggested miR-450b-3p was bound to KLF7. Finally, the results of the reverse experiment confirmed that overexpression of KLF7 could reverse miR-450b-3p mimic induced-inhibition of GC malignant progression.

Conclusions

Generally, miR-450b-3p significantly down-regulated in GC tissues and cell lines, and was associated with the pathological stage and tumor size of GC patients. Meanwhile, miR-450b-3p inhibited cell proliferation in GC via modulating KLF7.
Construction of a circRNA-miRNA-mRNA network based on competitive endogenous RNA reveals the function of circRNAs in osteosarcoma
Authors: Qiu Yu , Pu Chao , Li Yanchao , Qi Baochuang
Published: February 2020

Background

Osteosarcoma (OS) is a common primary malignant bone tumour. Growing evidence suggests that circular RNAs (circRNAs) are closely related to the development of tumours. However, the function of circRNAs in OS remains unknown. Here, we aimed to determine the regulatory mechanisms of circRNAs in OS.

Methods

The expression profiles of OS circRNA (GSE96964), microRNA (GSE65071) and mRNA (GSE33382) were downloaded from the Gene Expression Omnibus (GEO) database to identify differentially expressed circRNAs, miRNAs and mRNAs in OS. A ceRNA network was constructed based on circRNA-miRNA pairs and miRNA-mRNA pairs. MRNAs with significant prognostic differences were identified by the TARGET database in the network. Functional and pathway enrichment analyses were performed, and interactions between proteins were predicted using Cytoscape. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to elucidate the possible functions of these differentially expressed circRNAs.

Results

A total of 15 downregulated circRNAs, 136 upregulated miRNAs and 52 downregulated mRNAs were identified in OS. Finally, a circRNA-miRNA-mRNA network was constructed in OS based on 14 circRNAs, 24 miRNAs, and 52 mRNAs. GO and KEGG pathway analyses suggested that the mRNAs in the network may be involved in the pathogenesis and progression of OS. Four mRNAs identified by the TARGET database were significantly associated with OS survival prognosis. A circRNA-miRNA-mRNA subnetwork was constructed based on these four mRNAs.

Conclusion

Our results provide a deeper understanding of the regulatory mechanisms by which circRNAs compete for endogenous RNAs in OS.