bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of the COVID-19 Pandemic Hiatus From Sports Activities on Injuries Observed Among Division I NCAA Athletes
Authors: Kremen Thomas J. , Wu Shannon Y. , Upfill-Brown Alexander , Bugarin Amador , Huang Julian , Jones Kristofer J. , Shi Brendan Y.
Published: May 2023

Background:

The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted athletic activities, including those in the Pacific 12 (Pac-12) Conference of the National Collegiate Athletic Association. It is currently unknown how the disruption in training and competition impacted athletes’ risk of injury upon resumption of activities.

Purpose:

To describe and compare the rate, timing, mechanism, and severity of injuries among collegiate athletes across multiple sports in the Pac-12 Conference before and after the COVID-19 pandemic–associated hiatus of intercollegiate athletic activities.

Study Design:

Descriptive epidemiology study.

Methods:

Descriptive and injury data among intercollegiate athletes from both the season before the hiatus and the season after the hiatus were acquired from the Pac-12 Health Analytics Program database. Injury elements (timing of injury onset, injury severity, mechanism, recurrence, outcome, need for procedural intervention, and event segment during which the injury took place) were compared by time using the chi-square test and a multivariate logistic regression model. Subgroup analyses were performed on knee and shoulder injuries among athletes participating in sports with traditionally high rates of knee and shoulder injuries.

Results:

A total of 12,319 sports-related injuries across 23 sports were identified, with 7869 pre-hiatus injuries and 4450 post-hiatus injuries. There was no difference in the overall incidence of injury between the pre-hiatus and post-hiatus seasons. However, the proportion of noncontact injuries was higher in the post-hiatus season for football, baseball, and softball players, and the proportion of nonacute injuries in the post-hiatus season was higher among football, basketball, and rowing athletes. Finally, the overall proportion of injuries sustained by football players in the final 25% of competition or practice was higher in the post-hiatus season.

Conclusion:

Athletes competing in the post-hiatus season were observed to have higher rates of noncontact injuries and injuries sustained in the final 25% of competition. This study demonstrates that the COVID-19 pandemic has had varied effects on athletes from different sports, suggesting that many factors must be considered when designing return-to-sports programs for athletes after an extended absence from organized training.
Ischaemic stroke despite antiplatelet therapy: Causes and outcomes
Authors: Silimon Norbert , Drop Boudewijn , Clénin Leander , Nedeltchev Krassen , Kahles Timo , Tarnutzer Alexander A , Katan Mira , Bonati Leo , Salmen Stephan , Albert Sylvan , Salerno Alexander , Carrera Emmanuel , Berger Christian , Peters Nils , Medlin Friedrich , Cereda Carlo , Bolognese Manuel , Kägi Georg , Renaud Susanne , Niederhauser Julien , Bonvin Christophe , Schärer Michael , Mono Marie-Luise , Luft Andreas , Rodic-Tatic Biljana , Fischer Urs , Jung Simon , Arnold Marcel , Meinel Thomas , Seiffge David
Published: May 2023

Background:

Ischaemic stroke may occur despite antiplatelet therapy (APT). We aimed to investigate frequency, potential causes and outcomes in patients with ischaemic stroke despite APT.

Methods:

In this cohort study, we enrolled patients with imaging-confirmed ischaemic stroke from the Swiss Stroke Registry (01/2014-07/2022). We determined the frequency of prior APT, assessed stroke aetiology (modified TOAST classification) and determined the association of prior APT with unfavourable functional outcome (modified Rankin Scale score 3–6) and recurrent ischaemic stroke at 3 months using regression models.

Results:

Among 53,352 patients, 27,484 (51.5%) had no prior antithrombotic treatment, 17,760 (33.3%) were on APT, 7039 (13.2%) on anticoagulation and 1069 (2.0%) were on APT + anticoagulation. In patients with a history of ischaemic stroke/TIA ( n = 11,948; 22.4%), 2401 (20.1%) had no prior antithrombotic therapy, 6594 (55.2%) were on APT, 2489 (20.8%) on anticoagulation and 464 (3.9%) on APT + anticoagulation. Amongst patients with ischaemic stroke despite APT, aetiology was large artery atherosclerosis in 19.8% ( n = 3416), cardiac embolism in 23.6% ( n = 4059), small vessel disease in 11.7% ( n = 2011), other causes in 7.4% ( n = 1267), more than one cause in 6.3% ( n = 1078) and unknown cause in 31.3% ( n = 5388). Prior APT was not independently associated with unfavourable outcome (aOR = 1.06; 95% CI: 0.98–1.14; p = 0.135) or death (aOR = 1.10; 95% CI: 0.99–1.21; p = 0.059) at 3-months but with increased odds of recurrent stroke (6.0% vs 4.3%; aOR 1.26; 95% CI: 1.11–1.44; p < 0.001).

Conclusions:

One-third of ischaemic strokes occurred despite APT and 20% of patients with a history of ischaemic stroke had no antithrombotic therapy when having stroke recurrence. Aetiology of breakthrough strokes despite APT is heterogeneous and these patients are at increased risk of recurrent stroke.
Fabrication and Characterization of Organo Modified Polysiloxane Softened Linen Fabrics by On-Loom Integrated Finishing
Authors: Vasu P , Dharmalingam K , Ramachandran T , Prakash C
Published: May 2023

In this study, the fabrication – that is, weaving and softening of linen fabric – was accomplished by on-loom integrated finishing on a handloom using a special attachment. The optimization of the process parameters (finish liquor concentration, temperature and curing time) for these on-loom integrated softening finished fabrics were investigated. The softened linen fabric was studied for their physical properties like softness, drapeability, wickability, water vapour permeability, air permeability, total crease recovery angle, tensile and tear strength against untreated fabric and also compared with similar finished market sample. Furthermore, chemical interaction of the softener with linen fabric and their morphology were studied by the Fourier transform infrared and scanning electron microscopy, respectively. The results showed that as the concentration of the finish liquor increased, the softening effect increased, while wickability decreased after the particular optimum point. It was observed that drapeability, total crease recovery angle, tensile and tear strength were increased till the optimum point with the increase in process parameters. However, water vapour permeability and air permeability were decreased. The Fourier transform infrared and scanning electron microscopy studies clearly proved the presence of softener chemical and a coating of a thin layer on the fabric. The optimum process parameters of concentration of the finish liquor, curing temperature and curing time were found to be 10 g/L, 60°C and 5 min, respectively, for softening of linen fabric using this integrated finishing method.
Persistent Inflammation Associated With HLA-B27 After Pars Plana Vitrectomy With Scleral Buckle Placement
Authors: Dean Jordan , McTavish Sloane , Feng Yilin , Hoyek Sandra , Patel Nimesh A.
Published: May 2023

Purpose: To report 2 cases of persistent inflammation associated with human leukocyte antigen-B27 (HLA-B27) after pars plana vitrectomy (PPV) with scleral buckling. Methods: Two cases were analyzed. Results: A 47-year-old man had pars plana vitrectomy (PPV), scleral buckle (SB) placement, and endolaser for a macula-on rhegmatogenous retinal detachment (RRD). A 61-year-old man also had uneventful PPV, SB placement, and endolaser for a macula-off RRD. Postoperatively, both patients reported eye pain and had persistent intraocular inflammation. Both were found to be HLA-B27 positive despite having no previous signs or symptoms that would warrant HLA-B27 testing. Conclusions: Discovering the source of prolonged postoperative inflammation is critical in initiating the correct treatment and removing suspicion of infection. Although intraocular inflammation associated with HLA-B27 does not often present initially after surgery, HLA-B27 testing should be considered in cases of persistent, unexpected postoperative inflammation.
Asymmetric Purtscher-Like Retinopathy Caused by a Hypertensive Emergency and Undiagnosed Type 2 Diabetes
Authors: Woodward Richmond , Zheng Yuxi , Fekrat Sharon
Published: May 2023

Purpose: To report a case of Purtscher-like retinopathy (PLR) in the setting of a hypertensive emergency and undiagnosed type 2 diabetes mellitus (DM). Methods: A case was analyzed. Results: A 29-year-old, obese, hypertensive man presented with a 10-day history of progressive vision loss in the left eye with no history of trauma. The visual acuity was 20/25 OD and hand motions OS. A fundus examination showed dilated, tortuous veins; dot-blot and flame hemorrhaging; numerous cotton-wool spots; and polygonal areas of retinal whitening consistent with Purtscher flecken in the right eye and a vitreous hemorrhage in the left eye. The blood pressure was 226/125 mm Hg, and the hemoglobin A1c was 11.6%. The patient’s presentation was concerning for a hypertensive emergency and type 2 DM as the etiology for the ocular findings. Conclusions: The presence of one condition in association with PLR does not exclude the presence of another concurrent etiology.
The Arctic Council, the International Maritime Organization, and the Polar Code
Authors: Odgaard Liselotte , Lavelle Kathryn C
Published: May 2023

Numerous scientific investigations and multilateral efforts have contributed to our understanding of environmental challenges and how to deal with them; yet little effective and coordinated action has been taken. We review existing literature on climate clubs and on international society in the English School of international relations in order to assess how environmental and security risks can result in the formation of international institutions that seek to transcend the free-rider problem. We then ask what factors explain the emergence of the International Code for Ships Operating in Polar Waters (Polar Code) adopted in 2014, and how powerful states worked through the Arctic Council (AC) and International Maritime Organization (IMO) to establish it. We identify three parameters with respect to the shipping industry and Arctic region that made this advance possible at the nexus of environment and security: the identification of culprits, great power interest, and the socio-economic context. We find a degree of success even when substantive differences exist both inside and outside of the region and industry. Thus, the case study points to important applications of these parameters for future environmental peacebuilding.
Iron removal from kaolin by oxalic acid using a novel pre-agitating and high-pressure washing technique
Authors: Taheri Bijan
Published: May 2023

This study reports a leaching process along with a novel physical pretreatment technique to remove iron impurities from kaolin using oxalic acid. A detailed examination of the physical properties of the minerals confirmed that almost none of the leaching-resistant iron oxides, specifically hematite, was completely interlocked with the clay minerals. Accordingly, a pre-agitating technique followed by high-pressure washing of the sample on a 600 μm sieve were applied. In this method, by discarding up to 20% of the raw material, >54% of the total iron content of the raw kaolin was removed, and the iron content was reduced from 9.75% in the initial sample to <6.00% in the passing fraction. Application of this pretreatment method rendered the leaching process successful at 97°C using 0.3 M oxalic acid solutions for 1 h under atmospheric pressure. Compared to the leaching of the raw material without pretreatment, which consumed at least 0.5 M oxalic acid over a minimum period of 2 h, the method used was very cost-effective and favourable, reducing the iron content of the product to <1% and producing high-quality kaolin.
Sedimentary architecture of shallow-water fan-delta front in a lacustrine basin: Sangyuan section of Lower Cretaceous Xiguayuan Formation, Luanping Basin, northeast China
Authors: Zhang Ke , Wu Shenghe , Wang Hehua , Mi Zhongrong , Qu Jianhua , Wang Zhikun , Wang Haonan
Published: May 2023

The sedimentary architecture of fan deltas, which commonly constitute reservoirs, is a primary control on distribution and recovery efficiency of oil and gas. Deep-water fan deltas have been extensively discussed in the literature, whereas the sedimentary architecture of shallow-water fan-delta fronts, especially the characterization of mouth bar, quantification of architectural elements, and factors controlling the various architectural elements, remain poorly understood. Here, based on the integration of field survey and unmanned aerial vehicle (UAV) observation, the sedimentary architecture of Sangyuan section of the Lower Cretaceous Xiguayuan Formation in the Luanping Basin to is qualitatively and quantitatively characterized. Furthermore, factors controlling the architecture of the shallow-water fan-delta front are highlighted. Five facies associations, which differ in both lithofacies and dimensions, were interpreted in gravel-sand deposits of Sangyuan section, and indicate variations in flow conditions during deposition. The width/thickness ratio of facies associations generally increases rapidly as the flow energy and flow concentration decreases from debris flow to traction currents during the evolution of shallow-water fan delta. Both distributary channels and mouth bars dominate facies associations in the shallow-water fan-delta front, accounting for 53.42% and 36.88% of gravel-sand deposits respectively in Sangyuan section. Mouth bar consists of gravel accretions and sand accretions. Grain size of sediments influences the relative strength of the inertial force and bed friction, which determine the effluent behavior in a river-mouth system and the vertical grain-size trend of mouth bar accretions. Gravel accretions are characterized by normal grading, and these are interpreted as the products of inertia-dominated effluent. Sand accretions exhibit coarsening-upward trends in the river-mouth systems where friction-dominated outflow occurred. The overall vertical grain-size trend of mouth bar depends on the stacking pattern of accretions rather than the grading of one accretion.
Genesis of host rock in the Tamusu Mudstone pre-selected area in Northwest China for high-level radioactive waste geological disposal purposes
Authors: Xiang Long , Liu Xiaodong , Liu Pinghui , Dai Chaocheng , Jiang Meixia
Published: May 2023

Mudstone characterized by typical structures and mineral assemblages in the Tamusu Mudstone pre-selected area, in Inner Mongolia, Northwest China, has been selected as a potential host rock for China’s high-level radioactive waste (HLW) repository purpose. Based on indications of petrological and geochemical characteristics, hydrothermal sedimentary geneses of host rock are well discussed from the perspectives of hydrothermal sedimentary structures, sedimentary environments, and the hydrothermal sedimentary model. The results show that host rocks have the characteristics of low-temperature "white smoke" hydrothermal sedimentary rocks. The rocks developed in a dry, anaerobic and reducing saline lake environment with transient oxidation and dry–wet evolution. The 100–120 Ma tectonic activity in the Altun fault may have been the main factor controlling the process of hydrothermal exhalative, which provided the migration pathway for water–rock reactions and contributed to the formation of typical structures and mineral assemblages. The hydrothermal sedimentary rock is a new kind of argillaceous rock that serves as a potential host rock, and will provide new insights into suitability evaluations of mudstone properties to promote the site screening of the Tamusu Mudstone pre-selected area for China’s HLW disposal purpose.
Male obesity is associated with sperm telomere shortening and aberrant mRNA expression of autophagy-related genes
Authors: Raee Pourya , Shams Mofarahe Zahra , Nazarian Hamid , Abdollahifar Mohammad-Amin , Ghaffari Novin Mahsa , Aghamiri Shahin , Ghaffari Novin Marefat
Published: May 2023

Background

Obesity is regarded a global public health crisis. It has been implicated in a variety of health problems, but when it comes to male fertility, how and to what extent obesity affects it are poorly understood.

Accordingly, semen samples from 32 individuals with obesity (body mass index (BMI) ≥ 30 kg/m2) and 32 individuals with normal weight (BMI: 18.5-25 kg/m2) were obtained. Here, for the first time, we examined the association between obesity, relative sperm telomere length (STL) and autophagy-related mRNA levels such as Beclin1, AMPKa1, ULK1, BAX, and BCL2. Each group was also evaluated for conventional semen parameters, sperm apoptotic changes, DNA fragmentation index (DFI), sperm chromatin maturation, and reactive oxygen species (ROS) levels.

Results

Based on our findings, there was a marked reduction in relative STL in individuals with obesity as compared to the normal-weight group. We also found a significant negative correlation between relative STL and age, BMI, DFI, percentage of sperm with immature chromatin, and intracellular ROS levels in patients with obesity. In the normal-weight group, relative STL was only negatively correlated with DFI and intracellular ROS levels. Regarding mRNA expression, there was considerable upregulation of Beclin1, ULK1, and BCL2 in the group with obesity compared to the normal-weight group. Obesity was also found to be associated with a considerable decline in semen volume, total sperm count, progressive motility, and viability in comparison to normal-weight individuals. Furthermore, obesity was associated with considerably higher percentages of DFI, sperm with immature chromatin, late-stage apoptosis, and elevated ROS levels.

Conclusion

According to our findings, obesity is associated with sperm telomere shortening and aberrant autophagy-related mRNA expression. It should be emphasized that telomere shortening in sperm may be an indirect consequence of obesity due to the oxidative stress associated with the condition. Nevertheless, further investigation is required for a more comprehensive understanding.
Employing computational tools to design a multi-epitope vaccine targeting human immunodeficiency virus-1 (HIV-1)
Authors: Sher Hamza , Sharif Hafsa , Zaheer Tahreem , Khan Sarmad Ahmad , Ali Amjad , Javed Hasnain , Javed Aneela
Published: May 2023

Background

Despite being in the 21stcentury, the world has still not been able to vanquish the global AIDS epidemic, and the only foreseeable solution seems to be a safe and effective vaccine. Unfortunately, vaccine trials so far have returned unfruitful results, possibly due to their inability to induce effective cellular, humoral and innate immune responses. The current study aims to tackle these limitations and propose the desired vaccine utilizing immunoinformatic approaches that have returned promising results in designing vaccines against various rapidly mutating organisms. For this, all polyprotein and protein sequences of HIV-1 were retrieved from the LANL (Los Alamos National Laboratory) database. The consensus sequence was generated after alignment and used to predict epitopes. Conserved, antigenic, non-allergenic, T-cell inducing, B-cell inducing, IFN-ɣ inducing, non-human homologous epitopes were selected and combined to propose two vaccine constructs i.e., HIV-1a (without adjuvant) and HIV-1b (with adjuvant).

Results

HIV-1a and HIV-1b were subjected to antigenicity, allergenicity, structural quality analysis, immune simulations, and MD (molecular dynamics) simulations. Both proposed multi-epitope vaccines were found to be antigenic, non-allergenic, stable, and induce cellular, humoral, and innate immune responses. TLR-3 docking andin-silicocloning of both constructs were also performed.

Conclusion

Our results indicate HIV-1b to be more promising than HIV-1a; experimental validations can confirm the efficacy and safety of both constructs andin-vivoefficacy in animal models.

Graphical Abstract
Association between intraoperative remifentanil use and postoperative hyperalgesia in adolescent idiopathic scoliosis surgery: a retrospective study
Authors: Hasan M. Shahnaz , Abdul Razak Norashekeen , Yip Hing Wa , Lee Zheng-Yii , Chan Chris Yin Wei , Kwan Mun Keong , Chiu Chee Kidd , Yunus Siti Nadzrah , Ng Ching Choe
Published: May 2023

Background

The liberal use of remifentanil in spine surgery has been associated with an increased incidence of postoperative hyperalgesia. Nevertheless, controversies remain as the existing evidence is inconclusive to determine the relationship between remifentanil use and the development of opioid-induced hyperalgesia. We hypothesized that intraoperative infusion of higher dose remifentanil during scoliosis surgery is associated with postoperative hyperalgesia, manifesting clinically as greater postoperative morphine consumption and pain scores.

Methods

Ninety-seven patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion surgery at a single tertiary institution from March 2019 until June 2020 were enrolled in this retrospective study. Anesthesia was maintained using a target-controlled infusion of remifentanil combined with volatile anesthetic desflurane in 92 patients, while five patients received it as part of total intravenous anesthesia. Intravenous ketamine, paracetamol, and fentanyl were administered as multimodal analgesia. All patients received patient-controlled analgesia (PCA) morphine postoperatively. Pain scores at rest and on movement, assessed using the numerical rating scale, and the cumulative PCA morphine consumption were collected at a six-hourly interval for up to 48 h. According to the median intraoperative remifentanil dose usage of 0.215 µg/kg/min, patients were divided into two groups: low dose and high dose group.

Results

There were no significant differences in the pain score and cumulative PCA morphine consumption between the low and high dose remifentanil group. The mean duration of remifentanil infusion was 134.9 ± 22.0 and 123.4 ± 23.7 min, respectively.

Conclusion

Intraoperative use of remifentanil as an adjuvant in AIS patients undergoing posterior spinal fusion surgery was not associated with postoperative hyperalgesia.
Physicians’ experiences and actions in making complex level-of-care decisions during acute situations within older patients’ homes: a critical incident study
Authors: Forsgärde Elin-Sofie , Rööst Mattias , Elmqvist Carina , Fridlund Bengt , Svensson Anders
Published: May 2023

Background

Complex level-of-care decisions involve uncertainty in which decisions are beneficial for older patients. Knowledge of physicians’ decision-making during acute situations in older patients’ homes is limited. Therefore, this study aimed to describe physicians’ experiences and actions in making complex level-of-care decisions during the assessment of older patients in acute situations within their own homes.

Methods

Individual interviews and analyses were performed according to the critical incident technique (CIT). In total, 14 physicians from Sweden were included.

Results

In making complex level-of-care decisions, physicians experienced collaborating with and including older patients, significant others and health care professionals to be essential for making individualized decisions regarding the patients’ and their significant others’ needs. During decision-making, physicians experienced difficulties when doubt or collaborative obstructions occurred. Physicians’ actions involved searching for an understanding of older patients’ and their significant others’ wishes and needs, considering their unique conditions, guiding them, and adjusting care according to their wishes. Actions further involved promoting collaboration and reaching a consensus with all persons involved.

Conclusion

Physicians strive to individualize complex level-of-care decisions based on older patients’ and their significant others’ wishes and needs. Furthermore, individualized decisions depend on successful collaboration and consensus among older patients, their significant others and other health care professionals. Therefore, to facilitate individualized level-of-care decisions, the health care organizations need to support physicians when they are making individualized decisions, provide sufficient resources and promote 24 − 7 collaboration between organizations and health care professionals.
Dolutegravir-associated resistance mutations after first-line treatment failure in Brazil
Authors: Diaz Ricardo Sobhie , Hunter James R. , Camargo Michelle , Dias Danilo , Galinskas Juliana , Nassar Isabela , de Lima Isaac Barbosa , Caldeira Debora Bellini , Sucupira Maria Cecilia , Schechter Mauro
Published: May 2023

Background

Since January 2017, the recommended first-line antiretroviral regimen in Brazil is the fixed-dose combination of tenofovir plus lamivudine with dolutegravir (TL + D). According to the literature, integrase resistance-associated mutations (INRAMs) are rarely found upon virologic failure to first-line dolutegravir plus two nucleoside reverse transcriptase inhibitors. We evaluated the HIV antiretroviral genotypic resistance profile of patients referred for genotyping in the public health system who failed first-line TL + D after at least six months of therapy on or before December 31, 2018.

Methods

HIV Sanger sequences of the pol gene were generated from plasma of patients with confirmed virologic failure to first-line TL + D in the Brazilian public health system before December 31, 2018.

Results

One hundred thirteen individuals were included in the analysis. Major INRAMs were detected in seven patients (6.19%), four with R263K, one with G118R, one with E138A, and one with G140R. Four patients with major INRAMs also had the K70E and M184V mutations in the RT gene. Sixteen (14.2%) additional individuals presented minor INRAMs, and five (4,42%) patients had both major and minor INRAMS. Thirteen (11.5%) patients also presented mutations in the RT gene selected by tenofovir and lamivudine, including four with both the K70E and M184V mutations and four with only M184V. The integrase mutations L101I and T124A, which are in the in vitro pathway for integrase inhibitor resistance, were found in 48 and 19 patients, respectively. Mutations not related to TL + D, thus probable transmitted resistance mutations (TDR), were present in 28 patients (24.8%): 25 (22.1%) to nucleoside reverse transcriptase inhibitors, 19 (16.8%) to non-nucleoside reverse transcriptase inhibitors, and 6 (5.31%) to protease inhibitors.

Conclusions

In marked contrast to previous reports, we report a relatively high frequency of INRAMs among selected patients failing first-line TL + D in the public health system in Brazil. Possible reasons for this discrepancy include delays in detecting virologic failure, patients inadvertently on dolutegravir monotherapy, TDR, and/or infecting subtype.
“I take it and give it to my partners who will give it to their partners”: Secondary distribution of HIV self-tests by key populations in Côte d’Ivoire, Mali, and Senegal
Authors: Ky-Zerbo Odette , Desclaux Alice , Boye Sokhna , Maheu-Giroux Mathieu , Rouveau Nicolas , Vautier Anthony , Camara Cheick Sidi , Kouadio Brou Alexis , Sow Souleymane , Doumenc-Aidara Clémence , Gueye Papa Alioune , Geoffroy Olivier , Kamemba Odé Kanku , Ehui Eboi , Ndour Cheick Tidiane , Keita Abdelaye , Larmarange Joseph ,   for the ATLAS team
Published: May 2023

Introduction

HIV epidemics in Western and Central Africa (WCA) remain concentrated among key populations, who are often unaware of their status. HIV self-testing (HIVST) and its secondary distribution among key populations, and their partners and relatives, could reduce gaps in diagnosis coverage.

We aimed to document and understand secondary HIVST distribution practices by men who have sex with men (MSM), female sex workers (FSW), people who use drugs (PWUD); and the use of HIVST by their networks in Côte d’Ivoire, Mali, and Senegal.

Methods

A qualitative study was conducted in 2021 involving (a) face-to-face interviews with MSM, FSW, and PWUD who received HIVST kits from peer educators (primary users) and (b) telephone interviews with people who received kits from primary contacts (secondary users). These individual interviews were audio-recorded, transcribed, and coded using Dedoose software. Thematic analysis was performed.

Results

A total of 89 participants, including 65 primary users and 24 secondary users were interviewed. Results showed that HIVST were effectively redistributed through peers and key populations networks. The main reported motivations for HIVST distribution included allowing others to access testing and protecting oneself by verifying the status of partners/clients. The main barrier to distribution was the fear of sexual partners’ reactions. Findings suggest that members of key populations raised awareness of HIVST and referred those in need of HIVST to peer educators. One FSW reported physical abuse.

Secondary users generally completed HIVST within two days of receiving the kit. The test was used half the times in the physical presence of another person, partly for psychological support need. Users who reported a reactive test sought confirmatory testing and were linked to care. Some participants mentioned difficulties in collecting the biological sample (2 participants) and interpreting the result (4 participants).

Conclusion

The redistribution of HIVST was common among key populations, with minor negative attitudes. Users encountered few difficulties using the kits. Reactive test cases were generally confirmed. These secondary distribution practices support the deployment of HIVST to key populations, their partners, and other relatives. In similar WCA countries, members of key populations can assist in the distribution of HIVST, contributing to closing HIV diagnosis gaps.
Prenatal care and infant outcomes of teenage births: a Project WATCH study
Authors: Gardner Madelin E. , Umer Amna , Rudisill Toni , Hendricks Brian , Lefeber Candice , John Collin , Lilly Christa
Published: May 2023

Introduction

Infants of teenage births are known to have increased risk of poor infant outcomes. Adequate prenatal care (PNC) is essential to the overall health of infants and their birthing persons. While teenage births continue to be of concern in rural areas, little is known about the association between inadequate PNC and poor infant outcomes in teenage populations.

Purpose

To determine the association between inadequate PNC (< 10 visits) and poor infant outcomes neonatal intensive care unit (NICU) stay, low APGAR score, small for gestational age (SGA) and length of stay (LOS).

Methods

The study used West Virginia (WV) Project WATCH population level data (May 2018-March 2022). Multiple logistic regressions and survival analysis were performed on infant outcomes; NICU stay, APGAR score, infant size, and infant length of stay (LOS) with PNC categories inadequate (< 10 PNC visits) vs adequate (10 or more) adjusting for covariates including maternal race, insurance status, parity, smoking status, substance use status, and diabetes status.

Results

Of births to teenagers, 14% received inadequate PNC. Teens who received inadequate PNC had increased odds of infant admitted to NICU (aOR: 1.84, CI:(1.41, 2.42), p < 0.0001), low 5- minute APGAR score (aOR: 3.26, CI:(2.03,5.22), p < 0.0001), and increased LOS (Est. = -0.33, HR: 0.72, CI:(0.65,0.81), p < 0.0001).

Conclusions

Results demonstrated that infants of teenagers who received inadequate PNC are at increased risk of requiring a NICU stay, having a low APGAR score and requiring an increased LOS. PNC is particularly important for these groups as they are at increased risk of poor birth outcomes.
Clinical response to varying pollen exposure in allergic rhinitis in children in The Netherlands
Authors: Tameeris Ellen , Bohnen Arthur M. , Bindels Patrick J. E. , Elshout Gijs
Published: May 2023

Background

Allergic rhinitis (AR) affects 10–15% of children. Symptoms in seasonal AR are influenced by pollen exposure. Pollen counts vary throughout the pollen season and therefore, symptom severity fluctuates. This study investigates the correlation between pollen concentration and symptom load in children with AR in The Netherlands.

Methods

A secondary analysis was performed in a study determining the most effective treatment for children with seasonal AR. Symptoms were measured during three months in 2013 and 2014 using a daily symptom diary. The pollen concentration was measured with a Hirst type volumetric spore trap sampler. A correlation coefficient was calculated for the correlation between the pollen concentration and the mean daily symptom score. The study protocol was approved by the medical ethical review committee of the Erasmus MC and is incorporated in the International Clinical Trials Registry Platform (EUCTR2012-001,591–11-NL).

Results

In 2014, the correlation coefficient for birch pollen concentration and symptom score was 0.423 (p = 0.000). The correlation coefficient for grass pollen concentration and symptom score was 0.413 (p = 0.000) and 0.655 (p = 0.000) in 2013 and 2014, respectively. A delayed correlation between the birch pollen concentration and the symptom scores was seen up to two days after the pollen measurement (0.151, p = 0.031). For grass pollen this effect lasted up to three days after the pollen measurement (0.194, p = 0.000).

Conclusion

We found comparable correlations between symptom score and pollen concentration as found by EAACI. Birch and grass pollen have an elongated influence on symptom score of several days. This implies patients need to continue on demand medication longer after a measured pollen peak.
Risk factors of persistent adolescent thinness: findings from the UK Millennium Cohort Study
Authors: Whitfield H. , Hargreaves D. , Nicholls D. , Watt H. C. , Creese H.
Published: May 2023

Background

Thinness during adolescence can increase the risk of adverse health outcomes across the life-course and impede development. There is limited research examining the prevalence and determinants of persistent adolescent thinness in the United Kingdom (UK). We used longitudinal cohort data to investigate determinants of persistent adolescent thinness.

Methods

We analyzed data from 7,740 participants in the UK Millennium Cohort Study at ages 9 months, 7, 11, 14 and 17 years. Persistent thinness was defined as thinness at ages 11, 14 and 17; thinness was defined as an age- and sex-adjusted Body Mass Index (BMI) of less than 18.5 kg/m2. In total, 4,036 participants, classified either as persistently thin or at a persistent healthy weight, were included in the analyses. Logistic regression analyses were conducted to examine associations between 16 risk factors and persistent adolescent thinness by sex.

Results

The prevalence of persistent thinness among adolescents was 3.1% (n = 231). Among males (n = 115), persistent adolescent thinness was significantly associated with non-white ethnicity, low parental BMI, low birthweight, low breastfeeding duration, unintended pregnancy, and low maternal education. Among females (n = 116), persistent adolescent thinness was significantly associated with non-white ethnicity, low birthweight, low self-esteem, and low physical activity. However, after adjusting for all risk factors, only low maternal BMI (OR: 3.44; 95% CI:1.13, 10.5), low paternal BMI (OR: 22.2; 95% CI: 2.35, 209.6), unintended pregnancy (OR: 2.49; 95% CI: 1.11, 5.57) and low self-esteem (OR: 6.57; 95% CI: 1.46,29.7) remained significantly associated with persistent adolescent thinness among males. After adjustment for all risk factors, not reaching the recommended physical activity levels (OR: 4.22; 95% CI: 1.82, 9.75) remained significantly associated with persistent adolescent thinness among females. No appreciable associations were found between persistent adolescent thinness and sex, premature birth, smoking during pregnancy, income, maternal postnatal depression, mother-infant attachment or socio-emotional difficulties (p > 0.05).

Conclusion

Persistent adolescent thinness is not rare and appears to be associated with both physical and mental health factors, with some sex specific differences. Healthy weight initiatives should consider the full weight spectrum. Further research is required to understand thinness at a population level, including among those whose BMI changes during child and adolescent development.
Experiences of participating in a problem-solving intervention with workplace involvement in Swedish primary health care: a qualitative study from rehabilitation coordinator's, employee's, and manager's perspectives
Authors: Karlsson Ida , Kwak Lydia , Axén Iben , Bergström Gunnar , Bültmann Ute , Holmgren Kristina , Björk Brämberg Elisabeth
Published: May 2023

Background

Work-directed interventions that include problem-solving can reduce the number of sickness absence days. The effect of combining a problem-solving intervention with involvement of the employer is currently being tested in primary care in Sweden for employees on sickness absence due to common mental disorders (PROSA trial). The current study is part of the PROSA trial and has a two-fold aim: 1) to explore the experiences of participating in a problem-solving intervention with workplace involvement aimed at reducing sickness absence in employees with common mental disorders, delivered in Swedish primary health care, and 2) to identify facilitators of and barriers to participate in the intervention. Both aims targeted rehabilitation coordinators, employees on sickness absence, and first-line managers.

Methods

Data were collected from semi-structured interviews with participants from the PROSA intervention group; rehabilitation coordinators (n = 8), employees (n = 13), and first-line managers (n = 8). Content analysis was used to analyse the data and the Consolidated Framework for Implementation Research was used to group the data according to four contextual domains. One theme describing the participation experiences was established for each domain. Facilitators and barriers for each domain and stakeholder group were identified.

Results

The stakeholders experienced the intervention as supportive in identifying problems and solutions and enabling a dialogue between them. However, the intervention was considered demanding and good relationships between the stakeholders were needed. Facilitating factors were the manual and work sheets which the coordinators were provided with, and the manager being involved early in the return-to-work process. Barriers were the number of on-site meetings, disagreements and conflicts between employees and first-line managers, and symptom severity.

Conclusions

Seeing the workplace as an integral part of the intervention by always conducting a three-part meeting enabled a dialogue that can be used to identify and address disagreements, to explain CMD symptoms, and how these can be handled at the workplace. We suggest allocating time towards developing good relationships, provide RCs with training in handling disagreements, and additional knowledge about factors in the employee’s psychosocial work environment that can impair or promote health to increase the RCs ability to support the employee and manager.
Developing and validating a national set of standards for undergraduate medical education using the WFME framework: the experience of an accreditation system in Iran
Authors: Gandomkar Roghayeh , Changiz Tahereh , Omid Athar , Alizadeh Mahasti , Khazaei Majid , Heidarzadah Abtin , Rouzrokh Pouria , Amini Mitra , Honarpisheh Hamid , Laripour Reza , Abedi Farshid , Sabet Babak , Mirzazadeh Azim
Published: May 2023

Background

Defining standards is the first step toward quality assurance and improvement of educational programs. This study aimed at developing and validating a set of national standards for the Undergraduate Medical Education (UME) program through an accreditation system in Iran using the World Federation for Medical Education (WFME) framework.

Methods

The first draft of standards was prepared through consultative workshops with the participation of different UME program stakeholders. Subsequently, standards were sent to medical schools and UME directors were asked to complete a web-based survey. The content validity index at the item level (I-CVI) was computed using criteria including clarity, relevance, optimization and evaluability for each standard. Afterward, a full-day consultative workshop was held and a wide range of UME stakeholders across the country (n = 150) discussed the survey results and made corrections to standards.

Results

Analysis of survey results showed that relevance criteria had the best CVI as only 15 (13%) standards demonstrated CVI < 0.78. More than two-thirds (71%) and a half (55%) of standards showed CVI < 0.78 for optimization and evaluability criteria. The final set of UME national standards was structured in 9 areas, 24 sub-areas, 82 basic and 40 quality development standards, and 84 annotations.

Conclusions

We developed and validated national standards as a framework to ensure the quality of UME training with input from UME stakeholders. We used WFME standards as a benchmark while addressing local requirements. The standards and participatory approach to developing standards may guide relevant institutions.
“I wish I had known what I was getting into”: a qualitative study exploring the experiences of Canadians who study medicine abroad
Authors: Mathews Maria , Ryan Dana , Bourgeault Ivy
Published: May 2023

Background

An increasing number of Canadians are choosing to study medicine abroad (CSA); however, many CSA are not fully informed of the challenges that exist in returning to Canada to practice and relatively little information is known on the topic. This study explores CSA experiences in choosing to study abroad and their attempts to navigate a return to Canada to practice medicine.

Methods

We conducted semi-structured qualitative interviews with CSA who were attending medical school abroad, waiting to obtain or in a post-graduate residency program, or practicing in Canada. We asked participants about their decision to study medicine abroad and choice of school, medical school experiences, activities they engaged in to increase their likelihood of returning to Canada, perceived barriers and facilitators, and alternative plans if they were unable to return to Canada to practice. Interviews were transcribed and analyzed using a thematic analysis approach.

Results

Fourteen CSA participated in an interview. Expedited timelines (i.e., direct entry from high school) and a lack of competitiveness for medical school in Canada were the main justifications for CSAs’ decision to study abroad and a number of key factors (e.g., location, reputation) influenced their choice of school. Participants reported not fully anticipating the challenges associated with obtaining residency in Canada. CSA relied upon a variety of informal and formal supports and employed numerous methods to increase their likelihood of returning to Canada.

Conclusions

Studying medicine abroad remains a popular choice for Canadians; however, many trainees are unaware of the challenges associated with returning to Canada to practice. More information on this process as well as the quality of these medical schools is needed for Canadians considering this option.
Development and validation of the interpersonal communication assessment tool for assessing the interpersonal communication skills of public health midwives
Authors: Prasanna S.A.S. , Abeysena H.T.C.S. , Alagiyawanna M.A.A.P.
Published: May 2023

Background

Interpersonal Communication Skills (IPCS) are one of the core clinical skills that should be developed by the Public Health Midwives (PHMs), who are grass-root level public healthcare providers in primary healthcare settings in Sri Lanka. This study aimed to develop and validate the Interpersonal Communication Assessment Tool (IPCAT), an observational rating scale, to assess the IPCS of PHMs.

Methods

Item generation, item reduction, instrument drafting, and development of the tool’s rating guide were made by an expert panel. A cross-sectional study was conducted in five randomly selected Medical Officer of Health (MOH) areas, the smallest public health administrative division in the district of Colombo, Sri Lanka, to identify the factor structure, which is the correlational relationship between a number of variables in the tool. A sample of 164 PHMs was recruited. The data on IPCS were collected by video-recording the provider-client interaction using simulated clients. All recorded videos were rated by a rater using the drafted IPCAT, which included a Likert scale of 1(poor) to 5 (excellent). Exploratory factor analysis was conducted using the Principal Axis Factoring extraction method and the Varimax rotation technique to explore the factors. Three independent raters were used to rate ten randomly selected videos to assess the tool’s internal consistency and inter-rater reliability.

Results

The IPCAT obtained a five-factor model with 22 items, and all five factors explained 65% of the total variance. The resulting factors were “Engaging” (six items on making rapport), “Delivering” (four items on paying respect), “Questioning” (four items on asking questions), “Responding” (four items on empathy), and “Ending” (four items to assess the skills of ending a conversation productively). The internal consistency, Cronbach’s Alpha value, for all five factors was above 0.8, and the inter-rater reliability (ICC) was excellent (0.95).

Conclusions

The Interpersonal Communication Assessment Tool is a valid and reliable tool for assessing the interpersonal communication skills of Public Health Midwives.

Trial registration

Clinical Trial Registry, Sri Lanka. Ref No, SLCTR/2020/006(February 4th,2020)
Impact of prescription length supply policy on patient medication adherence in Thailand
Authors: Jarujumrus Inthorn , Taychakhoonavudh Suthira
Published: May 2023

Background

Phramongkutklao Hospital is one of the largest military hospitals in Thailand. Beginning in 2016, an institutional policy was implemented in which medication prescription length was increased from 30 to 90 days. However, there have been no formal investigations into how this policy has impacted medication adherence among patients in hospitals. As such, this study evaluated how prescription length impacted medication adherence among dyslipidemia and type-2 diabetes patients who were treated at Phramongkutklao Hospital.

Methods

This pre-post implementation study compared patients who received prescription lengths of 30 and 90 days based on information recorded in the hospital database between 2014 and 2017. Therein, we used the medication possession ratio (MPR) to estimate patient adherence. Focusing on patients with universal coverage insurance, we employed the difference-in-difference method to examine changes in adherence from before and after policy implementation, then conducted a logistic regression to test for associations between the predictors and adherence.

Results

We analyzed data from a total of 2,046 patients, with equal amounts of 1,023 placed into the control group (no change to 90-day prescription length) and intervention group (change from 30 to 90-day prescription length). First, we found that increased prescription length was associated with 4% and 5% higher MPRs among dyslipidemia and diabetes patients in the intervention group, respectively. Second, we found that medication adherence was correlated with sex, comorbidities, history of hospitalization, and the number of prescribed medications.

Conclusion

Increasing the prescription length from 30 to 90 days improved medication adherence in both the dyslipidemia and type-2 diabetes patients. This shows that the policy change was successful for patients in the hospital considered for this study.