bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone Density of the First Metatarsal Head: Which is the Best Place to Put the Screws in MIS Hallux Valgus Surgery?
Authors: Mocoçain Mac-iver Pablo E. , Radkievich Ruben D. , Elgueta Stephane , Díaz Andres Keller , Zanolli de Solminihac Diego H. , Valderrama Carlos
Published: November 2022

Category:

Basic Sciences/Biologics; Bunion

Introduction/Purpose:

Hallux valgus minimally invasive surgery (MIS) is becoming more common due to its good clinical and functional results. Third-generation MIS surgery uses screw fixation that is dependent on the bone density of the first metatarsal head (FMH) for optimal screw purchase. There is no information regarding areas of higher bone density (BMD) in the FMH that suggest a stronger area of fixation, nor has it been described whether it varies between different age groups or with gender. The objective of this study is to determine the BMD within four quadrants of the FMH. This finding could lead to identifying the ideal trajectory for screw placement. In addition, we evaluate BMD variation by age and gender.

Methods:

Transversal study. From our CT scan database, we obtained 40 patients with no previous history of first metatarsal fractures, pre existing hardware, foot surgery or osteoporosis. We divided the patients into 4 groups, each group containing 5 male and 5 female patients: group 1: <30 years, group 2: 31-45 years, group 3: 46-60 years, group 4: > 60 years. The main outcome is to evaluate the association between BMD in each FMH quadrant. Secondary outcomes are to identify any differences in BMD between gender and age groups. According to what has been previously discussed in the literature, two evaluators measured the Hounsfield units (HU) of each quadrant on a coronal cut located 10 mm proximal to the metatarsophalangeal joint using the Merge PACS system. Measures were averaged. Statistical analysis was performed by measuring normality with the Shapiro-Wilks test, and the ANOVA, Student's t-test, and Mann-Whitney U test.

Results:

The dorsolateral (DL) quadrant had the highest BMD (353.9hu) of all quadrants, followed by the lateral plantar (LP: 302.4hu), medial plantar (MP: 264.1hu), and dorsomedial (DM: 247.6hu) (p=0.001).When comparing the groups by age, DL (p=0.01) and LP (p=0.01) quadrants had significantly greater BMD in groups 1 and 2 (< 45 years) than groups 3 and 4 (> 45 years).When comparing BMD by gender, differences were only obtained in the group 4, in which mens had greater BMD in the DM (p=0.03), DL (p=0.02), and LP (p=0.01) quadrants.An significant inverse association between age and BMD was obtained for the DL (P=0.004) and MP (P=0.03) quadrants.

Conclusion:

There are differences in BMD between the quadrants of the first metatarsal head, with the greatest BMD being in the dorsolateral region at any age. BMD decreased proportionally with increasing age in the DL and MP quadrants. At the same age, there are no significant differences between gender, except in patients >60 years, where women have lower BMD in almost all quadrants.
Low-Profile Modifications of the Losee Pivot Shift Test for Assessment of an ACL-Deficient Knee in the Awake Patient
Authors: Bates Brandon , Albright Jay , Methenitis Allison , Dibbern Kevin , Losee Ronald , Albright John
Published: November 2022

Background:

Pivot shift test results have demonstrated widely inconsistent sensitivities when used on awake clinic patients. We believe the painful valgus force applied during traditional pivot shift techniques is the primary culprit and can be circumvented with our novel examination technique.

Indications:

The reason for publishing this examination technique is to maximize the sensitivity and accuracy of the pivot shift examination in the awake patient.

Technique Description:

Four major modifications of Ronald Losee’s original valgus-based examination technique are introduced. These are the 4 general modifications: minimizing the sagittal plane arc of motion, avoiding applying valgus force to the knee, application of gentle anteriorly directed force to the lateral tibia, and performing the examination on the patient’s noninjured knee first. We also provide detailed description of the hand placement during the Albright-Losee pivot shift test. (1) Once the patient is relaxed, the examiner’s hands are placed as follows: (1) the ulnar side of the examiner’s thumb is applied to the posterior aspect of the fibular head. The fingers are placed above the patella on the distal femur as shown in the video. (2) With the examiner’s hands in the correct position, the knee is flexed to 20° to 30°. One-to-3 pounds of anterior translatory force is then applied by the side of the thumb to the fibular head while the knee is taken slowly toward extension. Pathological anterior tibial translation can be expected to begin in a 20° to 30° range short of the patient’s complete knee extension. The examiner must be conscious not to provide any valgus or additional internal or external rotation of the leg.

Results:

This examination is useful for reproducing the subluxation phenomenon in anterior cruciate ligament (ACL)-deficient knees. Our work has shown that these modifications yield an accuracy of 95.51% and a sensitivity of 94.7% in 353 knees examined by 71 clinicians.

Discussion/Conclusion:

The Albright-Losee pivot shift test is an easy to perform, highly sensitive, and highly specific test. In our recently submitted American Journal of Sports Medicine manuscript, the Albright-Losee pivot shift test suggested to be of greater value than Lachman test. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Myoepithelioma in the Buccal Mucosa: An Unprecedented Case Report
Authors: de Araujo Gomes Bruno , Candido Isabella Romão , Silva de Azevedo Felipe Augusto , Cappelletti Elise Fagundes , Borba Alexandre Meireles
Published: November 2022

Myoepithelioma is a benign salivary gland tumor that mainly occurs at the parotid gland and, less commonly, affect minor salivary glands. This case report described the first case of myoepithelioma occurring in the buccal mucosa of a 13-year-old adolescent. The patient’s complaint was a mass in the lower cheek that could be felt inside his mouth, with 7 years of evolution, showing a recent growth spurt. Clinically, a normal, painless nodular lesion, with a sessile base, easily mobilized, of softened consistency, and measuring about 3 cm in its largest diameter could be seen. The patient underwent excisional biopsy of the lesion, histopathological, and immunohistochemical analysis, with final diagnosis of myoepithelioma originated from minor salivary glands. This unprecedented case contributes to report a both unusual location and age group of a rare benign neoplasm in the buccal mucosa.
Effects of melatonin-pretreated adipose-derived mesenchymal stem cells (MSC) in an animal model of spinal cord injury
Authors: Naeimi Arvin , Zaminy Arash , Amini Naser , Balabandi Raziye , Golipoor Zoleikha
Published: November 2022

Background

One of the most serious nervous system diseases is spinal cord injury(SCI), which is increasing for various reasons. Although no definitive treatment has yet been identified for SCI, one possible treatment is adipose-derived stem cells(ADSCs). However, a key issue in transplantation is improving cells’ survival and function in the target tissue. Melatonin(MT) hormone with antioxidant properties can prolong cell survival and improve cell function. This study investigates the pre-conditioning of ADSCs with melatonin for enhancing the engraftment and neurological function of rats undergoing SCI.

Methods

42 male Sprague–Dawley rats were divided into six groups, including Control, Sham, Model, Vehicle, and Lesion treatments A and B. After acquiring white adipose tissue, stem cells were evaluated by flow cytometry. SCI was then applied in Model, Vehicle, A, and B groups. Group A and B received ADSCs and ADSCs + melatonin, respectively, 1 week after SCI, but the vehicle received only an intravenous injection for simulation; The other groups were recruited for the behavioral test. Immunohistochemistry(IHC) was used to assess the engraftment and differentiation of ADSCs in the SCI site. Basso, Beattie, and Bresnahan's score was used to evaluate motor function between the six groups.

Results

Histological studies and cell count confirmed ADSCs implantation at the injury site, which was higher in the MT-ADSCs (P < 0.001). IHC revealed the differentiation of ADSCs and MT-ADSCs into neurons, astrocytes, and oligodendrocyte lineage cells, which were higher in MT-ADSCs. Functional improvement was observed in SCI + ADSCs and SCI + MT-ADSCs groups.

Conclusion

The pre-conditioning of ADSCs with melatonin positively affects engraftment and neuronal differentiation in SCI but does not impact performance improvement compared to the ADSCs.
Frailty and solid-organ transplant candidates: a scoping review
Authors: Kao Jonathan , Reid Natasha , Hubbard Ruth E , Homes Ryan , Hanjani Leila Shafiee , Pearson Ella , Logan Benignus , King Shannon , Fox Sarah , Gordon Emily H
Published: November 2022

Background

There is currently no consensus as to a standardized tool for frailty measurement in any patient population. In the solid-organ transplantation population, routinely identifying and quantifying frailty in potential transplant candidates would support patients and the multidisciplinary team to make well-informed, individualized, management decisions. The aim of this scoping review was to synthesise the literature regarding frailty measurement in solid-organ transplant (SOT) candidates.

Methods

A search of four databases (Cochrane, Pubmed, EMBASE and CINAHL) yielded 3124 studies. 101 studies (including heart, kidney, liver, and lung transplant candidate populations) met the inclusion criteria.

Results

We found that studies used a wide range of frailty tools (N = 22), including four ‘established’ frailty tools. The most commonly used tools were the Fried Frailty Phenotype and the Liver Frailty Index. Frailty prevalence estimates for this middle-aged, predominantly male, population varied between 2.7% and 100%. In the SOT candidate population, frailty was found to be associated with a range of adverse outcomes, with most evidence for increased mortality (including post-transplant and wait-list mortality), post-operative complications and prolonged hospitalisation. There is currently insufficient data to compare the predictive validity of frailty tools in the SOT population.

Conclusion

Overall, there is great variability in the approach to frailty measurement in this population. Preferably, a validated frailty measurement tool would be incorporated into SOT eligibility assessments internationally with a view to facilitating comparisons between patient sub-groups and national and international transplant services with the ultimate goal of improved patient care.
Association of physical fitness with cognitive function in the community-dwelling older adults
Authors: Zhao Xiaoguang , Huang Huiming , Du Chenya
Published: November 2022

Background

Cognitive function generally declines with the aging process. Although the association of physical fitness with cognitive function has been proved, how many and how well the physical fitness components are linked to cognitive function is not clear. This study aimed to examine the association of physical fitness with cognitive function, and find out which aspects of physical fitness components are the most closely related to cognitive function in community-dwelling older adults.

Methods

This cross-sectional study was conducted from March to July 2019. The sample consisted of 107 older people in the community with a mean age of 71.7 ± 5.0 years. The cognitive function of the participants was measured by a Chinese version of the Mini-Mental State Examination (MMSE). Several physical fitness items including grip strength, 5-repetition sit-to-stand, timed up and go, sit and reach, one-leg balance with the eye open, and 6-min walk were measured to reflect muscle strength, muscle endurance, agility, flexibility, balance, and cardiopulmonary endurance, respectively.

Results

The correlation analysis showed that the grip strength and the 6-min walk were positively related to cognitive function (r = 0.42 and 0.35, P < 0.05), while the 5-repetition sit-to-stand was negatively associated with cognitive function (r = -0.43, P < 0.01) adjusting for sex, age and years of education. It was also found that the mean values of physical fitness items including grip strength and 6-min walk were significantly lower, and 5-repetition sit-to-stand and timed up and go were significantly greater in the older adults with cognitive impairment (MMSE score < 27) than those in the normal older adults (MMSE score ≥ 27) (P < 0.05). Stepwise regression analysis revealed that age, together with physical fitness items including grip strength and 6-min walk can explain the cognitive function in older adults.

Conclusion

The findings suggest that there is an association between physical fitness and cognitive function, and the grip strength and 6-min walk can help explain the cognitive function in community-dwelling older adults. More attention needs to be paid to the increase in physical fitness for preventing or improving the cognitive dysfunction of older persons in the community, and further longitudinal study is warranted.
Associations of poor sleep quality, chronic pain and depressive symptoms with frailty in older patients: is there a sex difference?
Authors: Shen Shanshan , Zeng Xingkun , Yang Yinghong , Guan Huilan , Chen Lingyan , Chen Xujiao
Published: November 2022

Background

Sleep disturbance, chronic pain and depressive symptoms later in life are modifiable risk factors and may contribute to frailty. However, much less is known about sex differences in the association between these concurrent symptoms and frailty in older patients. Therefore, we conducted this study to explore the associations of poor sleep quality, chronic pain, and depressive symptoms with frailty in older patients, and the sex-specific associations.

Methods

In an observational population-based study, 540 older hospitalized patients from Zhejiang Hospital in China were enrolled. We collected data on poor sleep quality, pain, depressive symptoms and frailty using the Pittsburgh Sleep Quality Index, the Numerical Rating Scale, the 15-item Geriatric Depression Scale, and the Clinical Frailty Scale. Multivariate logistic regression models were used to explore the total sample and sex-specific associations among symptom burdens, symptom combination patterns and symptom counts, and frailty.

Results

After adjusting for the potential covariates, concurrent poor sleep quality and depressive symptoms (OR = 4.02, 95% CI 1.57–10.26), concurrent poor sleep quality and chronic pain (OR = 2.05, 95% CI 1.04–4.05), and having three symptoms (OR = 3.52, 95% CI 1.19–10.44) were associated with a higher likelihood of frailty in older inpatients. In addition, older patients with 2 or 3 symptoms (2 and 3 vs. 0 symptoms) had a higher risk of frailty, and the odds ratios were 2.40 and 3.51, respectively. Interaction analysis and sex-stratified associations exhibited conflicting results. The nonsignificant effect of the interaction of sex and symptoms on frailty, but not the sex-stratified associations, showed that individual symptoms, symptom combination patterns, and symptom counts were associated with elevated risks of frailty in older male patients, but not in older female patients.

Conclusions

Increased symptom burdens were associated with a higher risk of frailty in older inpatients, especially in those with poor sleep quality concurrent with at least one of the other two symptoms. Thus, a multidisciplinary program addressing these common symptoms is required to reduce adverse outcomes.
Individual and community level determinants of iron intake among children 6–59 months old in Ethiopia: multilevel logistic regression analysis
Authors: Belay Daniel Gashaneh , Asratie Melaku Hunie , Kibret Anteneh Ayelign , Kegnie Shitu  , Fentie Dawit Tefera , Shiferaw Yalelet Fentaw , Amlak Baye Tsegaye
Published: November 2022

Background

Iron deficiency is one of the most important factors of anemia which is caused by poor iron intake. In addition, children need more iron because of their rapid growth. On the other side, daily intake of iron is also recommended as a standard approach for the treatment and prevention of iron deficiency anemia. In Ethiopia, although more than half of children 6–59 months of age were affected by anemia, the magnitude and factors associated with iron intake among them are understudied. Therefore this study aimed to assess the magnitude and community and individual level determinants of iron intake among 6–59 months children in Ethiopia.

Methods

Demographic and Health Survey datasets (EDHS) were used for this study. The data were weighted using sampling weight to get valid statistical estimates. The total weighted samples of 9,218 children aged 6–59 months were included. A multilevel binary logistic regression model was fitted to identify factors associated with iron intake among 6–59 months of children in Ethiopia. In the final model adjusted odds ratio with a 95% confidence interval and p-value < 0.05 was taken to declare statistical significance.

Results

The magnitude of iron intake among children 6–59 months in Ethiopia was 9.24% (95% CI: 8.31%, 10.15%). Individual level variables such as having at least one antenatal care visit (ANC) [AOR = 1.27; 95%CI; 1.01, 1.61], having health institution delivery [AOR = 1.46; 95%CI;1.04, 2.04], age of children ≥ 24 months [AOR = 1.82; 95%CI; 1.29, 2.57], being female child [AOR = 0.81; 95%CI; 0.67, 0.99], being greater than three birth order [AOR = 0.73, 95%CI: 0.55, 0.98], whereas community level variables such as living in large central regions [AOR = 3.68; 95%CI; 1.47, 9.21], and living in community with high women education [AOR = 1.96; 95%CI; 1.28, 2.98] have an association with iron supplements among children 6–59 months years old in Ethiopia.

Conclusion and recommendations

The magnitude of iron intake among children 6–59 months old in Ethiopia is relatively low. Individual level factors such as; ANC visit, institution delivery, age of children, sex of the child, and birth order as well as; community level variables such as regions, and community women's education have a significant association with iron intake among children 6–59 months in Ethiopia. Prior attention should be given for under two years old children, children greater than three birth orders, and children living in small peripheral regions. Moreover, policymakers and other stakeholders had better plan and implement programs that empower women, enhance ANC visits, and health institution delivery to have a sustainable increment in iron intake for children in Ethiopia.
Does sexual Intimate Partner Violence (IPV) increase risk of multiple high-risk fertility behaviours in India: evidence from National Family Health Survey 2015–16
Authors: Das Milan , Tóth Csaba G. , Shri Neha , Singh Mayank , Hossain Babul
Published: November 2022

Background

One in three women from lower and middle-income countries are subjected to physical and/or sexual intimate partner violence (IPV) in their life span. Prior studies have highlighted a range of adverse health impacts of sexual IPV. However, less is known about the link between multiple high-risk fertility behaviours and sexual intimate partner violence. The present study examines the statistical association between multiple high-risk fertility behaviours and sexual intimate partner violence among women in India.

Methods

The present study used a nationally representative dataset, the National Family Health Survey (NFHS-4) 2015–16. A total of 23,597 women were included in the study; a subsample of married women of reproductive age who have had at least one child 5 years prior to the survey and who had valid information about sexual IPV. Logistic regression models were employed alongside descriptive statistics.

Results

Approximately 7% of women who are or had been married face sexual IPV. The prevalence of sexual violence was higher among women who had short birth intervals and women who had given birth more than three times (12%). Around 11% of women who had experienced any high-risk fertility behaviours also experienced sexual violence. The unadjusted association suggested that multiple high-risk fertility behaviours were 32% (UORs = 1.32, 95% CI: 1.16–1.50) higher for those women who experienced sexual violence. After adjusting for other sociodemographic variables, except for women’s education and wealth quantile, the odds of multiple high-risk fertility behaviours were 16% (AOR = 1.16; 95% CI: 1.02–1.34) higher among women who faced sexual violence. The inclusion of women’s educational attainment and wealth status in the model made the association between sexual IPV and high-risk fertility behaviours insignificant.

Conclusion

Sexual intimate partner violence is statistically associated with high-risk fertility behaviours among women in India. Programs and strategies designed to improve women’s reproductive health should investigate the different dimensions of sexual IPV in India.
Gender operationalisation and stress measurement in research with adolescent males: a scoping review
Authors: Carmichael-Murphy Parise , Demkowicz Ola , Humphrey Neil
Published: November 2022

Aim

Stress measurement in adolescent males is in its relative infancy, which is likely to influence the effectiveness of mental health services for this heterogeneous population. Although evidence suggests the prevalence of mental health difficulties increases during adolescence, the relationship between gender and stress measurement is less explored or understood. This review summarizes findings on gender operationalisation and stress measurement in research with adolescent males.

Methods

For this scoping review, six electronic databases across social and life sciences were searched using terms linked to adolescence, male, stress and research design. Articles were screened, data were extracted, and a narrative synthesis used to characterise studies by research design, adaptation of method for participants’ cultural context, operationalisation of gender, and measurement of stress.

Results

Searches identified 3259 citations, 95 met inclusion criteria and were reviewed. Findings suggest that research on psychological stress in adolescence is a developing field, but one that is currently dominated by Western studies. Furthermore, the results indicate that stress measurement research with adolescent males tends not to make adaptations relative to participants' gender, age, or context.

Conclusions

Stress research with adolescent males is lacking in scope. This review highlights the need for researchers to consider stress responses as more than a biological response, as it has been conceptualised historically. Recommendations for researchers to report research design and protocol more clearly are made to support readers to understand how stress and gender have been operationalised and measured and how this may influence research methodology. Future research should avoid conflating biological differences with gendered experience and demonstrate greater sensitivity to how gender identity may intersect with age and location to perpetuate gendered inequalities.
The impact of Hurricane Maria on individuals living with non-communicable disease in Puerto Rico: the experience of 10 communities
Authors: Andrade Elizabeth L. , Cordova Amalis , Schagen Courtney Riggle-van , Jula Megan , Rodriguez-Diaz Carlos E. , Rivera M. Ivonne , Santos-Burgoa Carlos
Published: November 2022

Background

Coinciding with the rising non-communicable disease (NCD) prevalence worldwide is the increasing frequency and severity of natural hazards. Protecting populations with NCDs against natural hazards is ever more pressing given their increased risk of morbidity and mortality in disaster contexts. This investigation examined Hurricane Maria’s impacts across ten lower SES municipalities in Puerto Rico with varying community characteristics and hurricane impacts to understand experiences of supporting individuals with NCD management in the six-month period following the hurricane.

Methods

We conducted 40 qualitative interviews with mayors, first responders, faith leaders, community leaders, and municipal employees from 10 municipalities in Puerto Rico. Using QSR NVivo software, we deductively and inductively coded interview transcripts and undertook thematic analysis to characterize community-level hurricane impact and consequences for NCD management, and to identify convergent and divergent themes.

Results

Damages to infrastructure, including healthcare facilities and roadways, complicated the provision of timely health care for NCDs, patient transport, and pharmaceutical/medical supply chain continuity. Lengthy power outages at both healthcare facilities and private residences were barriers to healthcare service delivery, use of medical equipment, and storage of prescription medications with refrigeration, and led to a widespread mental health crisis. Cascading failures such as fuel shortages further compounded these challenges. The consequences of these impacts included the reported exacerbation of health conditions and loss of life among NCD patients.

Conclusions

Study findings identify contributors to morbidity and mortality among individuals with NCDs following Hurricane Maria. With the growing frequency of catastrophic disasters from natural hazards, the experiences of communities that endured these impacts offer important lessons regarding policies and practices to better support community disaster resilience and address the evolving preparedness needs of NCD patients.
A smartphone-based self-care application for patients with urinary tract stones: identification of information content and functional capabilities
Authors: Shahmoradi Leila , Azizpour Amin , Bejani Mahmud , Shadpour Pejman , Rezayi Sorayya , Farzi Jebraeil , Amanollahi Alireza
Published: November 2022

Purpose

This study aimed to identify and validate the information content and functional capabilities of a smartphone-based application for the self-care of patients with urinary tract stones.

Methods and materials

First, by reviewing studies and urology-oriented books, studying 214 medical records, and consulting with specialists, the information items and basic capabilities of the application were identified, and in the next stage, a researcher-made questionnaire was designed based on the information obtained from the previous step. Then, experts' opinions were considered to confirm the validity and reliability of the questionnaire; the designed questionnaire was distributed among various participants. Finally, the application's leading information elements, contents, and functional capabilities were explored by analyzing the questionnaire results.

Results

To conduct the survey, 101 patients with Urinary Stone Diseases (USD), 32 urologists and nephrologists, 11 nurses, and six other specialists were recruited. After analyzing the results of the filled questionnaire, 21 information elements and nine surveyed capabilities that were more important than others were selected to be used in designing the application. Some of the principal information elements that were used in the application design include: the cause of various stones in the body, clinical manifestations, laboratory results, treatments of various stones, the role of environmental factors in the treatment, the role of nutrition in the treatment and formation of stones, and different diagnostic methods. Some of the important features of the application include: medication and fluid intake reminders, laboratory test reminders, radiography and periodic examination reminders, surgical history, and easy access to medical centers for information. The mean score of information elements was 75.07 from the patients' perspective, 65.09 from the physicians' perspective, and 80.09 from the nurses' perspective. Also, the mean score of application capabilities was 31.89 from the patients' perspective, 30.37 from the physicians' perspective, and 35.09 from the nurses' perspective. The difference in the mean scores of the above variables was statistically significant (p < 0.05) in both layers.

Conclusion

In this study, informational and functional needs and capabilities were presented for designing a mobile-based application that helps in disease management in patients with urinary tract stones.
Myointimoma (angiocentric myofibroblastic tumor) of the glans penis in an adolescent: a case report and review of the literature
Authors: Drlík Marcel , Gregová Mária , Sedláček Josef , Kočvara Radim
Published: November 2022

Background

Soft tumors of the penis are extremely rare in childhood and adolescence. Because there are no guidelines, each such case raises embarrassment over the extent and degree of aggressiveness of the diagnostic and therapeutic procedures. Herein, we describe a case of a teenager with a penile myointimoma along with a review of the literature. So far, only 10 cases have been reported in this age group.

Case presentation

The 15-year-old boy presented with a 6-months history of a slowly growing, palpable firm nodule in glans penis. Physical examination revealed a palpable, well circumscribed, firm, whitish painless mass, around 1 cm in diameter within the glans. Ultrasound revealed hypoechogenic, hypoperfused poorly defined area inside the glans. MRI did not confirm any other pathologic mass inside the glans and corpora cavernosa. An excisional biopsy was performed; its immunohistological features indicated myointimoma.

Discussion and conclusion

Given the rarity of this benign entity, the main importance is to distinguish myointioma from more clinically aggressive neoplasms. The key to a correct diagnosis is a careful histological examination, including immunohistochemistry. Local excision is safe and effective treatment modality.
Semen parameter variability among users of at-home sperm testing kits
Authors: Aznavour Yana , Navarrete Felipe , Badreddine Jad , Simon Paul H. G. , Gowda Vrushab , Rhodes Stephen , Abou Ghayda Ramy
Published: November 2022

Background

Despite the generally accepted World Health Organization guidelines on semen analysis, an individual’s results can display significant variation when performed across time or in different laboratories. Semen parameters are in fact highly variable measures that can differ significantly between various analyses. Numerous researchers have discovered a wide range of semen parameters within each individual male, but only a few studies included the analysis of semen parameters variability in patients with infertility. The aim of this study was to evaluate the inter- and intra-individual variability of semen parameters in men of reproductive age with normozoospermia and those with oligozoospermia.

Methods

Five hundred and thirteen who provided ≥ 2 semen samples (798 samples in total) using an at-home mail-in kit over a period of about 2 years were enrolled in the study. Semen samples collection using Give Legacy at-home mail-in semen collection kit; semen analysis at a CLIA-certified laboratory.

Results

The degree of intra-subject variation across all semen parameters was lower in men with normozoospermia compared to men with oligozoospermia. Men with normozoospermia furthermore demonstrated a level of intra-subject variation that was lower than inter-subject variation across all measured parameters. No association was observed between intra-subject coefficients of variation in any of the semen parameters, including sperm concentration, sperm count, motile sperm count, total motility, progressive motility, the percentage of sperm with normal morphology, and the age, duration of abstinence, and BMI of the men.

Conclusion

The results of this observational study confirm the significant variability in semen parameters in men with normozoospermia and oligozoospermia, as measured from at-home semen collection kit samples. This further underscore the importance of securing multiple samples for analysis to provide a robust assessment of male fertility.
Simple versus cross-mattress sutures for nondisplaced flaps of the maxillary molar region: a randomized controlled trial
Authors: Babazade Hossein , Vossough Farshad , Maftouhi Nafise , Konarizadeh Shokoofeh
Published: November 2022

Background

The type of suture used in periodontal surgery can affect post-surgical complications. This study aimed to compare simple with cross-mattress sutures for nondisplaced flaps of the maxillary molar region.

Methods

This randomized controlled trial included 32 candidates of nondisplaced flap surgery of the maxillary molar region referred to the private office of a periodontist in Bandar Abbas, Iran from January 21 to May 4, 2020. First, the patients’ age, sex, and plaque index were recorded. Then, they were randomized into two equal groups. In the first group, the interdental suturing was done using simple sutures with 4–0 vicryl threads, and in the second group, interdental suturing was performed using cross-mattress sutures with the same threads. The primary outcome was suture time, including the duration of the first suture and the total duration of all sutures. The secondary outcomes were bleeding on probing and the requirement of supplementary sutures immediately after the surgery, as well as the gingival index (at suture removal and one month after surgery).

Results

The two groups were comparable regarding age, sex, and plaque index. The first suture duration was significantly longer in the simple group compared to the cross-mattress group (P < 0.001); however, the total suture time did not differ between groups. Moreover, a significantly higher number of patients in the simple group required supplementary sutures (50% vs. 6.3%, P = 0.006). There was no significant difference between groups regarding bleeding on probing and gingival index (at suture removal and one month after surgery).

Conclusions

Cross-mattress sutures were superior to simple sutures in terms of supplementary suture requirement for nondisplaced flaps of the maxillary molar region, while the two suturing techniques were alike regarding total suture time, gingival index, and probing on bleeding.

Trial registration

Iranian Registry of Clinical Trials (IRCT), IRCT20191224045882N1. Registered 08/02/2020. Registered while recruiting, https://www.irct.ir/trial/44754.
Development and evaluation of competency-based curriculum for continuing professional development among military nurses: a mixed methods study
Authors: Ma Huijuan , Niu Aifang , Sun Li , Luo Yu
Published: November 2022

Background

Continuing professional development (CPD) is essential for career progression and maintaining military nursing competency. A well-designed CPD programme can improve the effectiveness of transforming knowledge and skills in healthcare organisations. This study aimed to develop a competency-based CPD curriculum for military nurses in China and evaluate its effectiveness from a developmental pilot study.

Methods

In phase one, a two-round Delphi was conducted to design a competency-based curriculum of CPD based on a clinical ladder model among military nurses. In phase two, the curriculum of one CPD programme was redesigned, and a pilot quasi-experiment was conducted to evaluate the effectiveness of this programme.

Results

A competency-based curriculum was developed for primary, intermediate, and senior titles, respectively. The trainees’ overall satisfaction with the redesigned CPD programme was 100%. The four themes in the qualitative data were: 1) learning motivation and learning barriers; 2) professional growth; 3) role model promoted career planning; 4) learning environment mattered.

Conclusion

This study developed a competency-based curriculum for continuing professional development among military nurses that can be used in designing CPD programmes. Competency-based curriculum can be utilised in the CPD activities to facilitate the improvement of nursing competency.
Value co-creation with family caregivers to people with dementia through a tailor-made mHealth application: a qualitative study
Authors: Kagwa Aber Sharon , Konradsen Hanne , Kabir Zarina Nahar
Published: November 2022

Background

Digitalization has been recognized as an efficient and cost-effective solution to address the increasing need for care due to the ageing population and the rise in people with dementia. This has subsequently increased the need to also care for family caregivers in community settings. Another benefit of digitalization is the introduction of new service concepts within service-dominant logic namely, value co-creation, which is changing the dynamics in healthcare, transitioning from a provider-centric to a customer-centric approach. The literature indicates that this transition is a slow process in healthcare due to the complex service context consisting of multi-stakeholders, with a fragmented decision-making process. This has resulted in limited research on how individuals co-create value through technology. The study aimed to explore how family caregivers to people with dementia living at home, as consumers of healthcare services co-create value in a multi-stakeholder context through a tailormade mHealth application.

Methods

A qualitative explorative design was used. Data were collected through semi-structured interviews with 12 family caregivers of people with dementia living at home. The data were analyzed deductively using qualitative content analysis.

Results

The findings show how family caregivers to people with dementia as healthcare consumers, engaged with a mHealth application and other actors in their service network through different levels of value co-creation activities.

Conclusion

This paper showed a willingness among family caregivers to people with dementia living at home, who mostly consisted of older people, to implement new technology to assist them with their caregiving tasks. The different value co-creation activities adopted by the family caregivers generated different levels of experiential value such as support, knowledge, and increased access to healthcare.
How much does effective health facility inspection cost? An analysis of the economic costs of Kenya’s Joint Health Inspection innovations
Authors: Chege Timothy , Wafula Francis , Tama Eric , Khayoni Irene , Ogira Dosila , Gitau Njeri , Goodman Catherine
Published: November 2022

Background

In most low- and middle-income countries, health facility regulation is fragmented, ineffective and under-resourced. The Kenyan Government piloted an innovative regulatory regime involving Joint Health Inspections (JHI) which synthesized requirements across multiple regulatory agencies; increased inspection frequency; digitized inspection tools; and introduced public display of regulatory results. The pilot significantly improved regulatory compliance. We calculated the costs of the development and implementation of the JHI pilot and modelled the costs of national scale-up in Kenya.

Methods

We calculated the economic costs of three phases: JHI checklist development, start-up activities, and first year of implementation, from the providers’ perspective in three pilot counties. Data collection involved extraction from expenditure records and key informant interviews. The annualized costs of JHI were calculated by adding annualized development and start-up costs to annual implementation costs. National level scale-up costs were also modelled and compared to those of current standard inspections.

Results

The total economic cost of the JHI pilot was USD 1,125,600 (2017 USD), with the development phase accounting for 19%, start-up 43% and the first year of implementation 38%. The annualized economic cost was USD 519,287, equivalent to USD 206 per health facility visit and USD 311 per inspection completed. Scale up to the national level, while replacing international advisors with local staff, was estimated to cost approximately USD 4,823,728, equivalent to USD 103 per health facility visit and USD 155 per inspection completed. This compares to an estimated USD 86,997 per year (USD 113 per inspection completed) spent on a limited number of inspections prior to JHI.

Conclusion

Information on costs is essential to consider affordability and value for money of regulatory interventions. This is the first study we are aware of costing health facility inspections in sub-Saharan Africa. It has informed debates on appropriate inspection design and potential efficiency gains. It will also serve as an important benchmark for future studies, and a key input into cost-effectiveness analyses.
The experiences and perceptions of wellbeing provision among English ambulance services staff: a multi-method qualitative study
Authors: Phung Viet-Hai , Sanderson Kristy , Pritchard Gary , Bell Fiona , Hird Kelly , Wankhade Paresh , Asghar Zahid , Siriwardena Niro
Published: November 2022

Background

NHS ambulance service staff are at risk of poor physical and mental wellbeing because of the likelihood of encountering stressful and traumatic incidents. While reducing sickness absence and improving wellbeing support to ambulance staff is a key NHS priority, few studies have empirically documented a national picture to inform policy and service re-design. The study aimed to understand how ambulance service trusts in England deal with staff health and wellbeing, as well as how the staff perceive and use wellbeing services.

Methods

To achieve our aim, we undertook semi-structured telephone interviews with health and wellbeing leads and patient-facing ambulance staff, as well as undertaking documentary analysis of ambulance trust policies on wellbeing. The study was conducted both before and during the UK first COVID-19 pandemic wave. The University of Lincoln ethics committee and the Health Research Authority (HRA) granted ethical approval. Overall, we analysed 57 staff wellbeing policy documents across all Trusts. Additionally, we interviewed a Health and Wellbeing Lead in eight Trusts as well as 25 ambulance and control room staff across three Trusts.

Results

The study highlighted clear variations between organisational and individual actions to support wellbeing across Trust policies. Wellbeing leads acknowledged real ‘tensions’ between individual and organisational responsibility for wellbeing. Behaviour changes around diet and exercise were perceived to have a positive effect on the overall mental health of their workforce. Wellbeing leads generally agreed that mental health was given primacy over other wellbeing initiatives. Variable experiences of health and wellbeing support were partly contingent on the levels of management support, impacted by organisational culture and service delivery challenges for staff.

Conclusion

Ambulance service work can impact upon physical and mental health, which necessitates effective support for staff mental health and wellbeing. Increasing the knowledge of line managers around the availability of services could improve engagement.
The impact of COVID-19 on psychiatric and mental health services in Europe: suffering experienced by professionals
Authors: Kane Hélène , Baumgart Jade Gourret , Rusch Emmanuel , Deloyer Jocelyn , Fuenzalida Claudio , Kelemen Gabriela , Krzystanek Marek , Marazziti Donatella , Moraitou Margarita , Reunanen Merja , Shyhrete Rexhaj , Thome Johannes , Verwaest Wim , Fond-Harmant Laurence , Denis Frédéric
Published: November 2022

Background

The COVID-19 pandemic has not only impacted intensive care units, but all healthcare services generally. This PsyGipo2C project specifically investigates how psychiatry and mental health professionals have been affected by the reorganizations and constraints imposed, which have reshaped their often already difficult working conditions.

Methods

Our research combined quantitative and qualitative methods, surveying and interviewing health professionals of all occupations working in psychiatric and mental health services. A questionnaire was completed by 1241 professionals from 10 European countries, and 13 group interviews were conducted across 5 countries. In addition to this, 31 individual interviews were conducted in Belgium and France.

Results

Among the questionnaire respondents, 70.2% felt that their workload had increased, particularly due to their tasks being diversified and due to increased complexity in the provision of care. 48.9% felt that finding a work-life balance had become more difficult, and 59.5% felt their health had been affected by the crisis. The impact of the health crisis nevertheless varied across professions: our data provides insight into how the health measures have had a differential impact on professional tasks and roles across the various categories of occupations, obliging professionals to make various adaptations. The distress incurred has been linked not only to these new constraints in their work, but also to the combination of these with other pressures in their personal lives, which has consequently compromised their well-being and their ability to cope with multiple demands.

Discussion

The COVID-19 health crisis has had varying impacts depending on the profession and access to remote work, sometimes leading to conflicts within the teams. The suffering expressed by the professionals was tied to their values and patterns of investment in work. Our research also highlights how these professionals made little use of the psychological supports offered, probably due to a reluctance to acknowledge that their mental health was affected.
Mâmawihitowin (bringing the camps together): Perinatal healthcare provider and staff participation in an Indigenous-led experiential intervention for enhancing culturally informed care—a mixed methods study
Authors: Bruno Grant , Bell Rhonda Catherine , Parlee Brenda , Lightning Patrick , Bull Ida , Cutknife Bruce , Oster Richard Thomas
Published: November 2022

Background

In partnership with a Nehiyawak (Plains Cree) community of Maskwacîs,central Alberta (Canada), we implemented an Indigenous-led intervention to provide experiential learning opportunities for perinatal health care providers (HCPs) and staff. Our objective was to capture the impact of participating in cultural safety learning opportunities on perceived self-awareness for HCPs and staff to provide enhanced culturally informed care.

Methods

Perinatal HCPs and staff who work regularly with Indigenous women from our partnering community took part in a series of experiential learning activities designed by a Community Advisory Committee. We used an explanatory sequential mixed methods approach informed by community-based participatory research. We compared Cultural Intelligence Scale (CQS) and Maskwacîs-Specific Cultural Scale (MSCS) scores pre- and post-intervention using non-parametrical statistical analysis (Wilcoxon signed rank test). Post-intervention, we conducted a qualitative description study using semi-structured interviews. Qualitative data was analyzed using thematic analysis.

Results

A total of 17 participants completed pre- and post-intervention questionnaires. Responses indicated a shift in perceived cultural and community knowledge and comfort levels, with positive gains in overall mean scores for both the CQS (p = 0.01) and MSCS (p = 0.01). Nine participants completed qualitative interviews. Overall, participants felt better equipped to provide more culturally informed care to their patients post-intervention.

Conclusion

An Indigenous-led experiential learning intervention was effective in enhancing overall perceived cultural awareness and preparedness to provide culturally informed care for perinatal HCPs and staff. This study provides evidence for fostering relationships between Indigenous communities and health systems toward enhanced perinatal care.