bluuebunny/crossref_metadata_2025 huggingface dataset:
Remote maintenance cardiac rehabilitation (MAINTAIN): A protocol for a randomised feasibility study
Authors: Denton Francesca , Waddell Alexander , Kite Chris , Hesketh Katie , Atkinson Lou , Cocks Matthew , Jones Helen , Randeva Harpal , Davenport Nathan , Powell Richard , Clark Cain , Kyrou Ioannis , Harwood Amy E , McGregor Gordon
Published: February 2023

Background

Long-term adherence to exercise is often poor for people with coronary heart disease (CHD) who have completed supervised, centre-based cardiac rehabilitation. The aim of this study is to assess the feasibility of a remotely prescribed, delivered and monitored cardiac rehabilitation intervention using a wearable device to support long-term adherence to exercise and physical activity during maintenance of cardiac rehabilitation.

Methods

After completing cardiac rehabilitation, 30 participants with CHD, will be randomised (1:1) to an intervention ( n = 15) or a usual care group ( n = 15) in a 12-month feasibility randomised controlled trial (RCT). The intervention will comprise of an exercise consultation, personalised exercise prescription delivered via a wearable activity monitor using biometric feedback, regular monitoring via check-ins, and feedback text-messages for 6-months. Participants will be assessed at baseline (following completion of cardiac rehabilitation) and at three-, six-, and 12-months post-randomisation. The primary outcome will be feasibility, including assessment of eligibility, recruitment, adherence, and acceptability. Secondary outcomes will include exercise capacity, physical activity behaviours, cardiovascular disease risk and quality of life. Semi-structured interviews will be conducted at three-, six-, and 12-months post-randomisation (and with those who drop-out) to explore the acceptability of the study intervention and procedures. A questionnaire will be offered to those who decline participation.

Discussion

The MAINTAIN study will evaluate the feasibility of conducting a future definitive multi-centre RCT testing a remotely prescribed and monitored long-term mHealth maintenance exercise programme, versus usual care, for people with CHD who have completed cardiac rehabilitation.

Trial registration number

ClinicalTrials.gov, NCT05292287. Registered on 22/03/2022
Proportion and characteristics of secondary progressive multiple sclerosis in five European registries using objective classifiers
Authors: Forsberg Lars , Spelman Tim , Klyve Pernilla , Manouchehrinia Ali , Ramanujam Ryan , Mouresan Elena , Drahota Jiri , Horakova Dana , Joensen Hanna , Pontieri Luigi , Magyari Melinda , Ellenberger David , Stahmann Alexander , Rodgers Jeff , Witts James , Middleton Rod , Nicholas Richard , Bezlyak Vladimir , Adlard Nicholas , Hach Thomas , Lines Carol , Vukusic Sandra , Soilu-Hänninen Merja , van der Walt Anneke , Butzkueven Helmut , Iaffaldano Pietro , Trojano Maria , Glaser Anna , Hillert Jan ,   on behalf of the SPMS Research Collaboration Network
Published: February 2023

Background

To assign a course of secondary progressive multiple sclerosis (MS) (SPMS) may be difficult and the proportion of persons with SPMS varies between reports. An objective method for disease course classification may give a better estimation of the relative proportions of relapsing–remitting MS (RRMS) and SPMS and may identify situations where SPMS is under reported.

Materials and methods

Data were obtained for 61,900 MS patients from MS registries in the Czech Republic, Denmark, Germany, Sweden, and the United Kingdom (UK), including date of birth, sex, SP conversion year, visits with an Expanded Disability Status Scale (EDSS) score, MS onset and diagnosis date, relapses, and disease-modifying treatment (DMT) use. We included RRMS or SPMS patients with at least one visit between January 2017 and December 2019 if ≥ 18 years of age. We applied three objective methods: A set of SPMS clinical trial inclusion criteria (“EXPAND criteria”) modified for a real-world evidence setting, a modified version of the MSBase algorithm, and a decision tree-based algorithm recently published.

Results

The clinically assigned proportion of SPMS varied from 8.7% (Czechia) to 34.3% (UK). Objective classifiers estimated the proportion of SPMS from 15.1% (Germany by the EXPAND criteria) to 58.0% (UK by the decision tree method). Due to different requirements of number of EDSS scores, classifiers varied in the proportion they were able to classify; from 18% (UK by the MSBase algorithm) to 100% (the decision tree algorithm for all registries). Objectively classified SPMS patients were older, converted to SPMS later, had higher EDSS at index date and higher EDSS at conversion. More objectively classified SPMS were on DMTs compared to the clinically assigned.

Conclusion

SPMS appears to be systematically underdiagnosed in MS registries. Reclassified patients were more commonly on DMTs.
Blogosphere, vulnerability news and users’ engagement: The contribution of blogs in the reporting of internally displaced persons in Nigeria
Authors: Apuke Oberiri Destiny , Gever Celestine Verlumun , Alhaji Tukur Naziru
Published: February 2023

This study examines blog coverage (October 2018 to October 2019) and its engagement with citizens regarding internally displaced persons in Nigeria. Approximately 85 stories of internally displaced persons were covered on Naija.com . This study found a significant difference in the appearance of internally displaced persons’ stories on the blog, appearance of the stories in the headline, length of stories used in describing internally displaced persons and the tone used. Most of the internally displaced persons’ stories appeared in the blog’s headlines, suggesting that blogs in Nigeria give prominence and importance to the stories of internally displaced persons. A large number of the stories were described in 400–600 characters, and most of such stories described the internally displaced persons’ situations via a negative tone. Surprisingly, there were very few stories of governmental support, but stories that demonstrate the internally displaced persons in a vulnerable state and exposed to various diseases, prone to attacks, raped, fed inadequately and in need of humanitarian assistance were predominant. As such, a significant association between the frames used and users’ comments and views online was found. Stories that framed the internally displaced persons in a vulnerable state had a greater number of views and comments and those that had more realistic still/graphic images attracted more comments and views.
Social Innovation for Sustainability and Social Inclusion
Authors: Kumar Dinesh , Gupta Punam
Published: February 2023

Companies are realising now that business is not only about selling products to rich consumers but also to serve the underserved bottom-of-the-pyramid (BOP) markets. Serving these customers calls for innovative methods. This had led to reinventing business models to expand the nature of their businesses from mere commercial motives to social ones as well; the understanding that businesses succeed if they go beyond their mandate of making profits. The future rests on three paradigm shifts taking place in BOP approaches: innovation, transformation of companies into social enterprises and technological advancements that bring products closer to BOP consumers. That is to say, companies today re-invent their business models and their very approach of doing business. Such companies stand a greater chance of success and long-term survival.

This article describes the concepts of social business, social entrepreneurship and social innovation. We illustrate the concepts with mini case studies or examples of several companies that have achieved innovation in products, business models or processes to serve BOP markets. We describe efforts that solve problems of consumers who are disadvantaged because of distance, education or purchasing power. If this ‘social innovation’ betters the life of consumers, it could result in sustainability and inclusive development.

The world is slowly realising that the existing business models that place importance on relentless pursuit of profits are causing immense damage to our society and environment. The objectives of business must change. Milton Friedman’s famous saying, ‘the sole purpose of a business is to generate profits for its shareholders’ is no longer accepted today as businesses find that they must cater to social objectives as well. This article describes that this can well be achieved, as illustrated by several companies who achieve both—financial profits and social good.

Drawing from examples of successful initiatives, new business models are being created that provide affordable products and services for disadvantaged consumers. We have taken elements from the business models of these companies to figure out what the future looks like. These companies, we find, found solutions through an action-oriented mindset to solve long-standing problems. Firms that embrace experimentation and rapid prototyping stand to win huge new markets and profits. They invest in distribution and training of local resources, develop innovative products and processes, involve stakeholders and above all, build a social purpose in their objectives.

Social innovation and social entrepreneurship shift the focus of governments and companies towards neglected or BOP consumers who are otherwise unapproachable. Examples of social innovation show that it touches the lives of millions of people, empowers them and leads to sustainability. Investments in social innovation that are both sustainable and socially inclusive are the need of the hour.
Postoperative HbA1c Level as a Predictor of Rotator Cuff Integrity After Arthroscopic Rotator Cuff Repair in Patients With Type 2 Diabetes
Authors: Yeom Ji Woong , Kholinne Erica , Kim Dong Min , Lee Jun-Bum , Ben Hui , AlAhmadi Basim Masoud , Shin Myung Jin , Kim Minsoo , Park Jeong Hee , Koh Kyoung-Hwan , Jeon In-Ho
Published: February 2023

Background:

In patients with type 2 diabetes mellitus (DM), preoperative glycosylated hemoglobin (HbA1c) is associated with outcomes after arthroscopic rotator cuff repair (ARCR); however, the relationship between outcomes and postoperative serum glycosylated hemoglobin (HbA1c) after ARCR has not been investigated.

Purpose:

To evaluate outcomes after ARCR in patients (1) with and without DM and (2) with DM according to their pre- and postoperative HbA1c levels.

Study Design:

Cohort study; Level of evidence, 3.

Method:

Included in this study were 148 patients without DM and 35 patients with type 2 DM who underwent ARCR between January 1, 2017, and December 31, 2019. Clinical and radiological outcomes were evaluated preoperatively and at the latest clinical follow-up. Postoperative magnetic resonance imaging was performed after 12 months. In patients with type 2 DM, HbA1c levels were evaluated preoperatively as well as 6 and 12 months postoperatively; patients with an HbA1c level of ≥7% were defined as having uncontrolled DM. Multivariate logistic regression analyses were performed to determine the factors for retears after ARCR.

Results:

The retear rates after ARCR were 22.9% (8/35) and 16.9% (25/148) in patients with and without DM, respectively. The retear rates were significantly higher in the 6-month postoperative uncontrolled DM group than in the controlled DM and non-DM groups (50% vs 8.7% and 16.8%; P < .05). The odds ratio for retears in the postoperative uncontrolled DM group was 5.555 ( P =0.01) compared with the non-DM group. Among the patients with DM, in the uncontrolled DM group, 6-month postoperative hyperglycemia was superior in accuracy, sensitivity, and specificity for predicting retears after ARCR than preoperative hyperglycemia (77.1% vs 62.9%, 75% vs 37.5%, and 77.8% vs 70.4%, respectively).

Conclusion:

This study demonstrated the association between uncontrolled postoperative DM and an increased risk of retears compared with no DM or controlled DM. Furthermore, postoperative HbA1c values were correlated more closely with the risk of retears than preoperative HbA1c values.
The will to security: Law, order, and the shifting terrain of popular struggles
Authors: Samet Robert
Published: February 2023

Populism is a notoriously unstable phenomenon. This instability has been on full display in contemporary Latin America where the progressive gains of the Pink Tide have confronted a rightwing backlash. How do we understand the sudden shift of fortunes from left to right? What tilted the balance of power in the region? One familiar answer to these questions is the exploitation by rightwing actors of tough-on-crime or mano dura rhetoric, which scapegoats already vulnerable populations (minorities, the poor, the “deviant,” etc.) as the source of insecurity. In conversation with this collection of papers on revanchist populism in Brazil, I want to propose a subtle twist on the theme of security and its role in rightwing populist mobilization. It draws on my research in neighboring Venezuela. Specifically, it looks at the unraveling of the Bolivarian Revolution’s progressive promise to defend the urban popular sectors against death squads, torture, arbitrary detention and other oppressive forms of policing. Comparing Venezuela, the vanguard of Latin America’s left turn, to Jair Bolsonaro’s Brazil may seem scandalous at first blush, but doing so asks us to confront an inconvenient truth about what I call the will to security. Rather than imagining security as something imposed from above, the will to security reframes it as an articulation of demands that resonate, at least in part, with the popular sectors. Adding this perspective to our analysis of rightwing populism provides an alternative spatial paradigm to the conversations about security that lends it historical depth and policy relevant positioning.
Psychological status of infertile men during the Coronavirus Disease 2019 Pandemic in China: a cross-sectional investigation
Authors: Zhang Zhe , Yang Yu-Zhuo , Zhang Hai-Tao , Xi Yu , Wang Cun-Tong , Liu De-Feng , Mao Jia-Ming , Lin Hao-Cheng , Tang Wen-Hao , Zhao Lian-Ming , Zhang Xian-Sheng , Dai Yu-Tian , Jiang Hui
Published: February 2023

Background

The coronavirus disease 2019 (COVID-19) outbreak has had a widespread and profound impact on people’s mental health. The factors associated with mental symptoms among men diagnosed with infertility, a disease closely related to psychological conditions, remain unclear. The aim of this study is to investigate the risk factors associated with mental symptoms among infertile Chinese men during the pandemic.

Results

A total of 4,098 eligible participants were recruited in this cross-sectional, nationwide study, including 2,034 (49.6%) with primary infertility and 2,064 (50.4%) with secondary infertility. The prevalence of mental health conditions was 36.3%, 39.6%, and 6.7% for anxiety, depression, and post-pandemic stress, respectively. Sexual dysfunction is associated with a higher risk with adjusted odds ratios (ORs) of 1.40 for anxiety, 1.38 for depression, and 2.32 for stress. Men receiving infertility drug therapy displayed a higher risk for anxiety (adjusted OR, 1.31) and depression (adjusted OR, 1.28) symptoms, while those receiving intrauterine insemination had a lower risk of anxiety (adjusted OR, 0.56) and depression (adjusted OR, 0.55) symptoms.

Conclusion

The COVID-19 pandemic has had a significant psychological impact on infertile men. Several psychologically vulnerable populations were identified, including individuals with sexual dysfunction, respondents receiving infertility drug therapy, and those experiencing control measures for COVID-19. The findings provide a comprehensive profile of the mental health status of infertile Chinese men during the COVID-19 outbreak and provide potential psychological intervention strategies.
Identification of the global diurnal rhythmic transcripts, transcription factors and time-of-day specific cis elements in Chenopodium quinoa
Authors: Wu Qi , Bai Xue , Luo Yiming , Li Li , Nie Mengping , Liu Changying , Ye Xueling , Zou Liang , Xiang Dabing
Published: February 2023

Background

Photoperiod is an important environmental cue interacting with circadian clock pathway to optimize the local adaption and yield of crops. Quinoa (Chenopodium quinoa) in family Amaranthaceae has been known as superfood due to the nutritious elements. As quinoa was originated from the low-latitude Andes, most of the quinoa accessions are short-day type. Short-day type quinoa usually displays altered growth and yield status when introduced into higher latitude regions. Thus, deciphering the photoperiodic regulation on circadian clock pathway will help breed adaptable and high yielding quinoa cultivars.

Results

In this study, we conducted RNA-seq analysis of the diurnally collected leaves of quinoa plants treated by short-day (SD) and long-day conditions (LD), respectively. We identified 19,818 (44% of global genes) rhythmic genes in quinoa using HAYSTACK analysis. We identified the putative circadian clock architecture and investigated the photoperiodic regulatory effects on the expression phase and amplitude of global rhythmic genes, core clock components and transcription factors. The global rhythmic transcripts were involved in time-of-day specific biological processes. A higher percentage of rhythmic genes had advanced phases and strengthened amplitudes when switched from LD to SD. The transcription factors of CO-like, DBB, EIL, ERF, NAC, TALE and WRKY families were sensitive to the day length changes. We speculated that those transcription factors may function as key mediators for the circadian clock output in quinoa. Besides, we identified 15 novel time-of-day specific motifs that may be key cis elements for rhythm-keeping in quinoa.

Conclusions

Collectively, this study lays a foundation for understanding the circadian clock pathway and provides useful molecular resources for adaptable elites breeding in quinoa.
Predictive role of cardiac valvular calcification in all-cause mortality of Chinese initial haemodialysis patients: a follow-up study of 4 years
Authors: Cheng Yun , Lu Zhihui , Cao Xuesen , Ding Xiaoqiang , Zou Jianzhou , Jin Huimin
Published: February 2023

Background

Cardiac valvular calcification (CVC) is prevalent in haemodialysis (HD) patients. Its association with mortality in Chinese incident haemodialysis (IHD) patients remains unknown.

Methods

A total of 224 IHD patients who had just begun HD therapy at Zhongshan Hospital, Fudan University, were enrolled and divided into two groups according to the detection of cardiac valvular calcification (CVC) by echocardiography. The patients were followed for a median of 4 years for all-cause mortality and cardiovascular mortality.

Results

During follow-up, 56 (25.0%) patients died, including 29 (51.8%) of cardiovascular disease. The adjusted HR related to all-cause mortality was 2.14 (95% CI, 1.05–4.39) for patients with cardiac valvular calcification. However, CVC was not an independent risk factor for cardiovascular mortality in patients who had just begun HD therapy.

Conclusion

CVC at baseline is an independent risk factor for all-cause mortality in HD patients and makes an independent contribution to the prediction of all-cause mortality. These findings support the use of echocardiography at the beginning of HD.
Food taboos and their perceived reasons among pregnant women in Ethiopia: a systematic review, 2022
Authors: Gebregziabher Hadush , Kahsay Amaha , Gebrearegay Fereweini , Berhe Kidanemaryam , Gebremariam Alem , Gebretsadik Gebretsadkan Gebremedhin
Published: February 2023

Background

There are foods considered as taboo across different communities in the world and in Ethiopia in particular. Although food taboos exist across all ages or physiologic states, they are predominant among pregnant women and children. Identifying such foods among pregnant women is crucial in providing focused interventions and prevents their negative consequences. Therefore, the aim of this review was to review the available evidence on food taboos and their perceived reasons among pregnant women in Ethiopia to provide comprehensive and precise evidence for decision making.

Methods

Electronic search of the literature was made from Pub-Med, Google Scholar, Google Scopus, and Medline databases using search terms set based on the PICO/PS (Population, Intervention/exposure, Comparison, and Outcome) and PS (Population and Situation) search table. The search was made from December 05, 2020 – December, 29, 2021, and updated on January, 2022. All quantitative and qualitative studies published in English were included in the review. The systematic review protocol was registered at INPLASY (Registration number: INPLASY202310078). The outcome of interest was food taboo for pregnant women and its perceived reasons. The results of the review was narrated.

Results

After identifying eighty two articles, thirteen were found eligible for the review. Vegetables, fruits, and fatty foods like meat, and dairy products were considered as taboo for pregnant women in different parts of Ethiopia. The reasons stated for the food taboo vary from fear of having a big baby, obstructed labour, and abortion to evil eye and physical and aesthetic deformities in the newborn.

Conclusions

Though not uniform across the country, there are foods considered as taboo for pregnant women in Ethiopia due to several perceived reasons, misconceptions, and societal influences. This could increase the risk of malnutrition and could have short and long term consequences on both the mother and her growing foetus. Therefore, context specific nutritional counseling with emphasis during ante-natal care and post-natal service is important.
Expression of substance P, neurokinin 1 receptor, Ki-67 and pyruvate kinase M2 in hormone receptor negative breast cancer and evaluation of impact on overall survival
Authors: Al-Keilani Maha S. , Bdeir Roba , Elstaty Rana I. , Alqudah Mohammad A.
Published: February 2023

Background

Chronic inflammation is a hallmark of cancer, and it can be stimulated by many factors. Substance P (SP), through binding to neurokinin 1 receptor (NK1R), and pyruvate kinase M2 (PKM2) play critical roles in cancer development and progression via modulating the tumor microenvironment. This study aimed to investigate the prognostic significance of SP and PKM2 in combination with NK1R and Ki-67 in hormone receptor negative (HR-ve) breast cancer.

Methods

Immunohistochemical expression levels of SP, NK1R, PKM2, and Ki-67 were measured in 144 paraffin-embedded breast cancer tissues (77 h -ve and 67 h + ve). SP, NK1R, and PKM2 were scored semiquantitatively, while Ki-67 was obtained by the percentage of total number of tumor cells with nuclear staining. The optimal cutoff value for SP, NK1R, PKM2, and Ki-67 were assessed by Cutoff Finder.

Results

High SP expression in HR -ve breast cancer was associated with TNM stage (p = 0.020), pT stage (p = 0.035), pN stage (p = 0.002), axillary lymph node metastasis (p = 0.003), and NK1R expression level (p = 0.010). In HR + ve breast cancer, SP expression was associated with HER2 status (p = 0.001) and PKM2 expression level (p = 0.012). Regarding PKM2 expression level, it significantly associated with HER2 status (p = 0.001) and history of DCIS (p = 0.046) in HR-ve tumors, and with HER2 status (p < 0.001) and SP expression level (p = 0.012) in HR + ve tumors. Survival analysis revealed that high SP level negatively impacted overall survival in HR-ve tumors that had low NK1R level (p = 0.021). Moreover, high SP negatively impacted overall survival in HR-ve tumors that had low Ki-67 level (p = 0.005). High PKM2 negatively impacted overall survival in HR-ve cases with low SP (p = 0.047).

Conclusion

Combined expression levels of SP with NK1R or Ki-67, and PKM2 with SP could be used to predict survival in breast cancer patients with HR-ve tumors. Our findings suggest a role of SP/NK1R pathway and PKM2 in HR-ve breast cancer pathogenesis which should be further investigated to unveil the underlying molecular mechanisms.
OCTA biomarkers in adults aged 50 and above: a prospective and cross-sectional community-based study
Authors: Li Yan Kiu , Fung Nicholas Siu-Kay , Chan Jonathan C.H , Choy Bonnie N.K. , Chow Loraine L.W. , Shih Kendrick C. , Wong Jasper K.W. , Wong Ian Y.H.
Published: February 2023

Background/Aims

To assess the normative values and parameters of optical coherence tomography angiography (OCTA) influencing the best corrected visual acuity (BCVA) in adults aged 50 and above.

Methods

This was a prospective cross-sectional study from an eye screening programme in Hong Kong for 4188 citizens aged 50 and above. Images were analysed using a validated quantification software calculating vessel density and capillary perfusion density (CPD), along with other OCTA parameters, such as the foveal avascular zone area (FAZ) and circularity. OCTA data was collected from May 2019 to December 2020, including a total of 4188 healthy eyes from 4188 subjects.

Results

Mean superficial vessel density (MSVD) was 14.48 ± 3.60 mm− 1, while the mean capillary perfusion density (MCPD) was 0.41 ± 0.06. Multivariate analysis revealed ageing (β = 0.321, p < 0.001), being male (β=-0.089, p < 0.001), having a high body mass index (BMI) (β = 0.039, p = 0.006), high FAZ area and low FAZ circularity (β = 0.039 and − 0.034, p = 0.01 and 0.024 respectively), low MSVD in the outer ring (β=-0.513, p < 0.001), specifically in the nasal and temporal outer quadrants (β = -0.226 and − 0.259, p < 0.001 for both), and low MCPD in the outer superior quadrant (β= -0.123, p = 0.016) being independently associated with BCVA.

Conclusion

High FAZ area and low FAZ circularity, low MSVD in the outer ring, specifically the nasal and temporal outer quadrants, and low MCPD in the outer superior quadrant can be used as biomarkers in predicting a low visual acuity in adults aged 50 and above.
REACh for the preschoolers; a developmental assessment tool for 2–5 year old children in Sri Lanka
Authors: Caldera A.V , Wickremasinghe A. R , Muttiah N , Godamunne P. K. S , Jayasena B.N , Chathurika L. K. E , Perera K. M. N , Mendis M , Tilakarathne D , Peiris M. K. R.R , Wijesinghe T , Senarathna N.E , Saubhagya W. D. L , Chandraratne M , Sumanasena S.P
Published: February 2023

Background

Preschool children in low resource settings are at higher risk of missing developmental potential due to the lack of standardized and validated methods for the timely detection of children with developmental delays or neurodevelopmental disorders. The preschool teacher is a non-specialist resourceful link within the community to detect and offer interventions early. This paper discusses the preliminary iteration of designing and testing the psychometric properties of a developmental assessment for children aged 24 to 60 months in Sri Lanka. This assessment is designed to be conducted by preschool teachers in their preschool setting.

Methods

Three processes followed: 1. Designing and development of the Ragama Early Assessment for Children (REACh) complete preschool developmental assessment and a tool kit 2. Testing and training teachers on conducting the REACh assessment 3. Preliminary assessment of the psychometric properties including content validity, internal consistency, interrater reliability and concurrent validity.

Results

A literature search identified 11 assessments and 542 items representing cognitive, social-emotional and adaptive, language and motor domains. Content validity was assessed to select and adapt items. A complete assessment tool was designed to be administered in four settings within the preschool. This was further improved during pre and pilot testing and teacher training. Cronbach's alpha measuring internal consistency was > 0.70 for cognitive, language, social-emotional and adaptive domains across all three age groups in 1809 children. Interrater reliability was > 65% for age groups 36–47 and 47- 60 months. Concurrent validity using a clinical gold standard demonstrated sensitivity of more than 0.75 for all age groups with variable specificities (24–35 months: 0.71, 36- 47 months: 0.43 and 48–60 months: 0.67) assessed in 75 children.

Conclusions

This culturally and linguistically adapted tool was tested nationally in Sri Lanka. The inte-rrater reliability between teachers and research assistants was higher than 65% for all domains in children more than 36 months. The preliminary iteration confirms it as an acceptable screening assessment for all age groups but with significantly lower specificity in the 36-47 month age group. Further improvement in certain domains together with intense teacher training is likely to enhance the validity and reliability of the assessment.

Trial registration

Ethics clearance for the procedure was granted prospectively from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya (ERC no. P 131/06/2018).
Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study
Authors: Shezi Mirriam Hlelisani , Tlou Boikhutso , Naidoo Saloshni
Published: February 2023

Background

In countries such as Eswatini, where there is a high HIV prevalence and low male circumcision the World Health Organization and the Joint United Nations Programme for HIV/AIDS recommend infant and adult circumcision be implemented. The aim of this study was to assess the knowledge, attitudes and acceptability of voluntary medical male circumcision amongst males attending high school in Eswatini.

Methods

An observational cross-sectional study was conducted during February and March of 2018 amongst 407 young males (15–21 years) attending Form 4, in nine high schools in the Shiselweni region of Eswatini using a self-administered questionnaire of 42 close ended questions. Sociodemographic details, circumcision status, acceptance of voluntary medical male circumcision, knowledge and attitude scores analysed in Stata® 14 statistical software were described using frequencies, medians and ranges respectively. Bivariate and multivariate linear regression was used to assess the impact of independent variables on circumcision status and acceptance of voluntary medical male circumcision. The level of statistical significance was p < 0.05.

Results

Amongst the 407 high school-going males, 48.98% (n = 201) reported being circumcised. The majority of the adolescents (75.74%; n = 306) were knowledgeable about voluntary medical male circumcision. However, an even larger majority (84.90% (n = 343) had a negative attitude towards it. In the multivariate logistic regression analysis, having parented their own children (aOR: 3.55; 95%CI: 1.2–10.48), and having circumcised friends (aOR: 3.99; 95%CI: 1.81–8.84) were significantly associated with being circumcised. Neither knowledge nor attitude were associated with the acceptability of voluntary medical male circumcision.

Conclusion

In Eswatini male high school students are knowledgeable about voluntary medical male circumcision but have a negative attitude towards it. Having parented their own children, and having circumcised friends influenced being circumcised.
The impact of migration-related characteristics on the risk of TORCH infections among women of childbearing age: a population-based study in southern China
Authors: Li Rui , Han Lu , Xiong Wenxue , Wang Wenjuan , Fan Chaonan , Li Mingzhen , Liu Xiaohua , Ling Li
Published: February 2023

Background

TORCH infections are the most common prenatal infections causing congenital malformation and infant mortality, especially in developing countries. Migrant women might be vulnerable to TORCH infections, but little is known about the association between migration-related characteristics and TORCH infection risk. This study aimed to investigate the impact of migrant status, migration distance, and the spouse’s migrant status on the TORCH epidemic among women of childbearing age.

Methods

Based on the National Free Preconception Health Examination Project, we analyzed a representative dataset of TORCH infections among women of childbearing age (15–49 years old) in Guangdong Province of China (2014–2019, n = 2,451,297). The past and/or recent infection status of TORCH infections (Toxoplasma gondii [TOX], Cytomegalovirus [CMV], and Rubella virus [RV]) were identified. Demographic and migration-related characteristics were collected. We thoroughly assessed the prevalence of TORCH infections in both migrant and native women and estimated adjusted odd ratios (aOR) for migration-related characteristics using multivariable logistic regression after adjusting the other sociodemographic factors.

Results

Among all 2,451,297 participants, 443,725 (18.1%) were migrant women. Migrant women presented a lower risk of past TOX infection (aOR: 0.89, 0.88–0.91) suggesting a healthy migrant effect (HME), but a higher risk of recent TOX infection (aOR: 1.88, 1.77–1.99), past CMV infection (aOR: 1.26, 1.25–1.28) and RV infection in natural ways (aOR: 1.05, 1.04–1.06). Compared with intra-provincial migrants, inter-provincial migrants had a lower past TOX infection (aOR: 0.88, 0.85–0.91), but a higher risk of recent TOX infection (aOR: 1.16, 1.05–1.27) and RV infection (aOR: 1.33, 1.31–1.36). In addition, having a migrant spouse was associated with a higher risk for all types of infection.

Conclusion

This study reported the association of migrant status and migration distance with TORCH infections, although the significance and directionality of these associations varied between pathogens. The spouse’s migrant status further amplified the infection risk for all types of pathogens. Our findings suggested interventions for preventing the spread of CMV and RV infection and new acquisition of TOX infection for migrants in southern China, to narrow the native-migrant health inequity and decrease the incidence of prenatal infections and related adverse outcomes.
Healthcare-seeking behavior for respiratory illnesses in Kenya: implications for burden of disease estimation
Authors: Emukule Gideon O. , Osoro Eric , Nyawanda Bryan O. , Ngere Isaac , Macharia Daniel , Bigogo Godfrey , Otieno Nancy A. , Chaves Sandra S. , Njenga M. Kariuki , Widdowson Marc-Alain
Published: February 2023

Background

Understanding healthcare-seeking patterns for respiratory illness can help improve estimation of disease burden and target public health interventions to control acute respiratory disease in Kenya.

Methods

We conducted a cross-sectional survey to determine healthcare utilization patterns for acute respiratory illness (ARI) and severe pneumonia in four diverse counties representing urban, peri-urban, rural mixed farmers, and rural pastoralist communities in Kenya using a two-stage (sub-locations then households) cluster sampling procedure. Healthcare seeking behavior for ARI episodes in the last 14 days, and severe pneumonia in the last 12 months was evaluated. Severe pneumonia was defined as reported cough and difficulty breathing for > 2 days and report of hospitalization or recommendation for hospitalization, or a danger sign (unable to breastfeed/drink, vomiting everything, convulsions, unconscious) for children < 5 years, or report of inability to perform routine chores.

Results

From August through September 2018, we interviewed 28,072 individuals from 5,407 households. Of those surveyed, 9.2% (95% Confidence Interval [CI] 7.9–10.7) reported an episode of ARI, and 4.2% (95% CI 3.8–4.6) reported an episode of severe pneumonia. Of the reported ARI cases, 40.0% (95% CI 36.8–43.3) sought care at a health facility. Of the74.2% (95% CI 70.2–77.9) who reported severe pneumonia and visited a medical health facility, 28.9% (95% CI 25.6–32.6) were hospitalized and 7.0% (95% CI 5.4–9.1) were referred by a clinician to the hospital but not hospitalized. 21% (95% CI 18.2–23.6) of self-reported severe pneumonias were hospitalized. Children aged < 5 years and persons in households with a higher socio-economic status were more likely to seek care for respiratory illness at a health facility.

Conclusion

Our findings suggest that hospital-based surveillance captures less than one quarter of severe pneumonia in the community. Multipliers from community household surveys can account for underutilization of healthcare resources and under-ascertainment of severe pneumonia at hospitals.
Pitfalls in the diagnosis and treatment of a hypertensive patient with unilateral primary aldosteronism and contralateral pheochromocytoma: a case report
Authors: Miyamoto Shotaro , Yoshida Yuichi , Ozeki Yoshinori , Okamoto Mitsuhiro , Gotoh Koro , Masaki Takayuki , Nishida Haruto , Fujinami Hiroyuki , Shin Toshitaka , Daa Tsutomu , Asayama Yoshiki , Shibata Hirotaka
Published: February 2023

Background

Primary aldosteronism (PA) is a common cause of secondary hypertension, whereas pheochromocytoma is a rare cause of it. Thus, concomitant PA and pheochromocytoma is a very rare condition.

Case presentation

A 52-year-old woman was admitted to our hospital with suspected PA based on the presence of hypertension, spontaneous hypokalemia, and a high aldosterone-to-renin ratio. She had no catecholamine excess symptoms other than hypertension. Abdominal computed tomography (CT) showed a right lipid-rich adrenal mass and a left lipid-poor adrenal mass. PA was diagnosed by the captopril challenge test. The 24-h urinary fractionated metanephrines were slightly elevated. Adrenal vein sampling (AVS) confirmed that the right adrenal gland was responsible for aldosterone hypersecretion. Medical therapy with eplerenone was started because the patient refused surgery. Five years later, she requested surgery for PA. The second AVS confirmed right unilateral hyperaldosteronism, as expected. Repeated abdominal CT showed the enlargement of the left adrenal mass. The 24-h urinary fractionated metanephrines had risen to the diagnostic level. 123I- metaiodobenzylguanidine (MIBG) scintigraphy showed a marked tracer uptake in the left adrenal mass with no metastatic lesion. After preoperative management with α-blockade, laparoscopic left partial adrenalectomy was performed. Immunohistochemical examination of the tumor showed chromogranin A positivity leading to the diagnosis of left pheochromocytoma.

Conclusions

We report an extremely rare case of concomitant unilateral PA and contralateral pheochromocytoma. When diagnosing unilateral PA by AVS, especially in cases with a lipid-poor adrenal mass, clinicians should rule out the possibility of the presence of pheochromocytoma before proceeding to undergo unilateral adrenalectomy. Although there is no standard treatment for this rare condition, it is essential to select personalized treatment from the perspective of conserving the adrenal gland.
Perceptual difference of smile aesthetics between 2-dimensional photographs and 3-dimensional dentofacial images: a cross-sectional study
Authors: Xiao Zhuoxing , Chen Gui , Zhao Yijiao , Wang Yong , Gu Yan
Published: February 2023

Background

The aim of this study was to compare the perceptual difference of smile aesthetics between 2D photographs and 3D dentofacial images as perceived by orthodontists and graduate students.

Methods

Forty-eight subjects finished orthodontic treatment were recruited with 2D photographs of frontal, oblique and lateral views as well as 3D dentofacial images. Twelve senior orthodontists and 13 postgraduate students were asked to rate the 2D and 3D smile simulations based on visual analog scale (VAS) and to vote for smile features that affect the attractiveness of smile. At the end, they completed a questionnaire about their views on different smile simulations. Wilcoxon signed-rank, Bland–Altman analysis, and multiple linear regression were used to compare the ratings and votes of smile perception between raters and between records.

Results

Orthodontists and postgraduate students rated smile consistently with 2D photographs, while orthodontists tended to give a higher rate for unattractive smiles and a lower rate for attractive smiles with 3D dentofacial images. The 3D dentofacial images were rated significantly lower than 2D photographs and the voting of most of the smile features showed significant negative main effect on VAS scores, while the effect of demographic characteristics of raters, voting on visible width of upper dentition and buccal corridor was not significant. In addition, a significant negative main effect of commissure and facial profile was found on the rating discrepancy between 2D and 3D images.

Conclusions

Senior orthodontists tend to perceived 3D images more conservatively in smile evaluation. 3D dentofacial images were rated lower than 2D photographs and most of the smile features affect the aesthetic perception of smile. The perceptual difference of commissure and facial profile contributed to the lower ratings in 3D dentofacial images.
Pelvic floor disorder and relevant factors in Iranian women of reproductive age: a cross-sectional study
Authors: Rashidi Fatemeh , Mirghafourvand Mojgan
Published: February 2023

Background

With high severity and prevalence, pelvic floor disorder is a health issue that women face worldwide. Different demographic-obstetric factors are involved in the emergence of this dysfunction that can have many adverse effects on a woman’s quality of life. Hence, this study aimed to determine the prevalence of pelvic floor disorder and its related socio-demographic and obstetric factors among Iranian women of reproductive age.

Methods

The statistical population of this cross-sectional study included 400 woman of reproductive age (15–49 years) covered by the health centers of Tabriz, Iran in 2022. The cluster sampling method was employed to select the participants. The data collection tools were a socio-demographic and obstetric characteristics questionnaire and the PDFI-20 (Pelvic Floor Distress Inventory-20). The chi-squared test was conducted to determine the association between socio-demographic and obstetric characteristics and prevalence of pelvic floor disorder in a bivariate analysis, whereas the multivariate logistic regression test was used in a multivariate analysis.

Results

The general prevalence of pelvic floor disorder was 76%. The prevalence rates of pelvic organ prolapse distress 6 (POPDI-6), colorectal-anal distress 8 (CRAD-8), and urinary distress (UDI-6) were 54.3%, 61.8%, and 49.3%, respectively. The results of the multivariate logistic regression test indicated that constipation (odds ratio = 5.62; 95% CI 1.97 to 16.03; P = 0.001) increased the risk of pelvic floor disorder.

Conclusions

According to the findings, the prevalence of pelvic floor disorder is high among Iranian women of reproductive age. This condition is correlated with constipation. Therefore, screening is recommended through valid tools in addition to offering preventive measures such as preventing and curing constipation to reduce the risk of pelvic floor disorder.
Epidural lidocaine, butorphanol, and butorphanol – lidocaine combination in dromedary camels
Authors: Nahas Ayman El , Almubarak Adel Ibrahim , Hagag Usama
Published: February 2023

Background

The use of general anesthesia in dromedary camels is constrained by risks related to decubitus. Caudal epidural analgesia is an alternative convenient technique providing loco-regional analgesia for numerous invasive and noninvasive painful conditions. Lidocaine is probably the most commonly used local anesthetic in clinical practice, but has a relatively short duration and may not provide significant long term analgesic benefits. Epidural administration of an opioid-local anesthetic mixture would improve the quality and length of analgesia and minimizes the adverse motor effects provoked by local anesthetics. Butorphanol (potent agonist–antagonist opioid) has been used to improve the duration of epidural analgesia in some animal species, but not in camels. Therefore, our purpose was to investigate the onset and duration of analgesia as well as the clinical and hemato-biochemical effects produced by the epidural administration of butorphanol (0.04 mg/kg), lidocaine (0.22 mg/ kg), and butorphanol-lidocaine (0.04 mg/kg—0.22 mg/ kg) mixture in nine adult dromedary camels in a crossover experimental study.

Results

The onset of analgesia was not statistically different between lidocaine (6.5 ± 2.3 min) and butorphanol-lidocaine (7.3 ± 1.5 min) combination. Delayed onset of analgesia was reported after butorphanol administration (14.7 ± 3.5 min). Butorphanol-lidocaine combination produced marked longer duration (175 ± 8.7 min) than lidocaine (55 ± 6.8 min) and butorphanol (158 ± 5.3 min). Mild ataxia was observed in the butorphanol–lidocaine and lidocaine treated animals and slight sedation was reported after butorphanol and butorphanol-lidocaine administration. A transient significant increase in the glucose levels was recorded after all treatments.

Conclusions

Epidural administration of butorphanol augments the analgesic effects and duration of lidocaine with minimal adverse effects.
Genome-wide polygenic risk score for major osteoporotic fractures in postmenopausal women using associated single nucleotide polymorphisms
Authors: Wu Qing , Jung Jongyun
Published: February 2023

Background

Osteoporosis is highly polygenic and heritable, with heritability ranging from 50 to 80%; most inherited susceptibility is associated with the cumulative effect of many common genetic variants. However, existing genetic risk scores (GRS) only provide a few percent predictive power for osteoporotic fracture.

Methods

We derived and validated a novel genome-wide polygenic score (GPS) comprised of 103,155 common genetic variants to quantify this susceptibility and tested this GPS prediction ability in an independent dataset (n = 15,776).

Results

Among postmenopausal women, we found a fivefold gradient in the risk of major osteoporotic fracture (MOF) (p < 0.001) and a 15.25-fold increased risk of severe osteoporosis (p < 0.001) across the GPS deciles. Compared with the remainder of the GPS distribution, the top GPS decile was associated with a 3.59-, 2.48-, 1.92-, and 1.58-fold increased risk of any fracture, MOF, hip fracture, and spine fracture, respectively. The top GPS decile also identified nearly twofold more high-risk osteoporotic patients than the top decile of conventional GRS based on 1103 conditionally independent genome-wide significant SNPs. Although the relative risk of severe osteoporosis for postmenopausal women at around 50 is relatively similar, the cumulative incident at 20-year follow-up is significantly different between the top GPS decile (13.7%) and the bottom decile (< 1%). In the subgroup analysis, the GPS transferability in non-Hispanic White is better than in other racial/ethnic groups.

Conclusions

This new method to quantify inherited susceptibility to osteoporosis and osteoporotic fracture affords new opportunities for clinical prevention and risk assessment.