bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Empathy in Medical Students of two Portuguese Medicine Schools
Authors: Coutinho Mona Lisa , Silva Inês Rosendo , Neto Isabel , Maurício Kati , Simões José Augusto , Santiago Luiz Miguel
Published: August 2019

Objectives

To evaluate differences in empathy between the Integrated Master’s degree in Medicine (MIM) students from the Faculty of Medicine - University of Coimbra (FMUC) and the Faculty of Health Sciences - University of Beira Interior (FCS-UBI).Methodology

Cross-sectional observational study with the Jefferson Scale of Physician Empathy – students’ Portuguese version (JSPE – spv) to 1st, 3rd and 6th year students of the 2017/2018 academic year with descriptive and inferential statistical analysis (p<0.05).Results

Size representative sample of 795 students. Higher total empathy score (TES) (p=0.008) and "Perspective taking" (p=0.001) in FCS-UBI were found. JSPE-TES was higher in FCS-UBI, 3rd year (p=0.038). Higher FCS-UBI "Perspective taking" in the 1st year (p=0.030) and 6th year (p=0.044), for "Compassionate care" in the 3rd (p=0.019) and for "Standing in the patient’s shoes" in the 1st year (p=0.018) and in FMUC for "Compassionate care" in the 1st year (p=0.037) and the "Standing in the patient’s shoes" in the 3rd year (p=0.002) were found. Higher levels of empathy were found in FCS-UBI female students, for JSPE-TES (p=0.045) and "Perspective taking" (p=0.001).Conclusion

Higher empathy levels in FCS-UBI were found, with different results in the third year suggesting influence of the medical course teaching characteristics.
Spatial analysis of confirmed Lassa fever cases in Edo State, Nigeria, 2008 – 2014
Authors: Owoicho Samuel Amifofum , Awosanya Emmanuel , Fadugba Dorcas , Balogun Muhammed Shakir , Nguku Patrick , Ajisegiri Simon , Eugene Odigie , Olugasa Babasola
Published: August 2019

Spatial analysis of confirmed Lassa fever cases in Edo State, Nigeria, 2008 – 2014 S. Owoicho 1 , E. Awosanya 2 , D. Fadugba 2 , M. S. Balogun 1 ,P. Nguku 1 , W. S. Ajisegiri 1 , O. Eugene 2 , B. Olugasa 2 1 Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria; 2 Centre for Control and Prevention of Zoonoses, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria . Background: Lassa fever (LF) is endemic and poses public health threats in Edo State. Identification of primary clusters will help prioritize public health interventions in the state. We investigated retrospective cases of LF to identify primary cluster of the disease for household exposure management. Method: We reviewed retrospective data (n = 1400) of LF case-patients at a referral hospital in Edo State from 2008 to 2014 based on World Health Organization case definition for LF. We determined primary cluster of confirmed cases on Bernoulli model and evaluated environmental factors in the primary cluster: presence of rodent deterrents, proximity of households at 2 km radius to rice farm, rice post-harvest storage facility, refuse dump, forest, hospital and main road using Multi-criteria analysis at p < 0.05. Results : Of the reviewed cases, 171 (12.2%) were confirmed case-patients. The median age of confirmed case-patients was 30 years (IQR: 27.5). Of the confirmed case-patients, 101 (59.1%) were male. A primary spatial cluster (4.45 km radius; geographic centre at 6.717900 o N, 6.243500 o E) was identified in Esan West LGA. Associated environmental factors included presence of rodent deterrents (p < 0.001), proximities of households to refuse dump (p < 0.001), rice post-harvest storage facility (p = 0.01) and rice farm (p = 0.03). Conclusion : Esan West LGA was identified as a primary cluster for Lassa fever. Presence of rodent deterrents, household proximity to refuse dump sites, rice storage facilities and rice farms were associated environmental factors. We recommend improved rice post-harvest storage and use of rodent deterrents in Edo State, Nigeria.
The independent effects of nausea and vomiting and social support on health-related quality of life during early pregnancy: A longitudinal study
Authors: Hirose Masami , Tamakoshi Koji , Takahashi Yuki , Mizuno Taeko , Yamada Akiko , Kato Noriko
Published: August 2019

Background: Previous studies that have examined the impact of nausea and vomiting (NV) on health-related quality of life (HR-QOL) among early pregnant women have collected data at a single time point, with the timing varying among studies, and even, in one study, among subjects. No previous study has examined the independent association NV and social support have with HR-QOL.

We conducted a longitudinal study from August 2018 to February 2019 to investigate the independent association NV and social support have with HR-QOL among early pregnant women using repeated-measurement data. Subjects were 153 pregnant women who were 20 years of age or older and at less than 20 weeks of gestation at their first prenatal visit. They were recruited from a perinatal outpatient unit of a general hospital.

Methods: Along with providing sociodemographic data, subjects were asked to complete three self-administered questionnaires: the Index of Nausea, Vomiting, and Retching (INVR); the Multidimensional Scale of Perceived Social Support (MSPSS); and the 12-item Short Form Health Survey (SF-12). Further, at every subsequent visit up to 20 weeks of gestation, they were asked to complete both the SF-12 and the INVR (giving a maximum of three survey completions).

Results: After controlling for internal correlations and confounding factors using a mixed model for longitudinal data, the INVR score was found to be significantly negatively associated with the physical component summary scale score of the SF-12; however, the MSPSS score showed no association with the physical component summary scale score. On the other hand, both the INVR score and the MSPSS score were negatively and positively, respectively, significantly associated with the mental component summary scale score of the SF-12, independently of each other.

Conclusions: The severity of NV significantly impacts physical quality of life during early pregnancy, but social support has no such impact. However, NV and social support independently and significantly affect mental quality of life, independently of each other. Health professionals should recognize the significant impact of NV on HR-QOL. Additionally, they should be aware that social support contributes to the improvement of mental quality of life, regardless of the degree of NV.
Transgenic aspens (Populus tremula) with the xyloglucanase gene from Penicillium canescens keep faster growth under semi-natural conditions
Authors: Vidyagina Elena O. , Subbotina Natalia M. , Belyi Vladimir A. , Lebedev Vadim G. , Krutovsky Konstantin V. , Shestibratov Konstantin A.
Published: August 2019

Background Recombinant carbohydrases genes are used to produce transgenic woody plants with improved phenotypic traits. However, cultivation of such plants in open field is challenged by a number of problems. Therefore, additional research is needed to alleviate them. Results Results of successful cultivation of the transgenic aspens (Populus tremula) carrying the recombinant xyloglucanase gene (sp-Xeg) from Penicillium canescens in semi-natural conditions are reported in this paper for the first time. Change of carbohydrate composition of wood was observed in transgenic aspens carrying the sp-Xeg gene. The transformed transgenic line PtXVXeg1b demonstrated accelerated growth and increased content of cellulose in wood of trees growing in both greenhouse and outside in comparison with the control untransformed line Pt. The accelerated growth was observed also in the transgenic line PtXIVXeg1c. Thicker cell-wall and longer xylem fiber were also observed in both these transgenic lines. Undescribed earlier considerable reduction in the wood decomposition rate of the transgenic aspen stems was also revealed for the transformed transgenic lines. The decomposition rate was approximately twice as lower for the transgenic line PtXVXeg3b in comparison with the control untransformedline Pt. Conclusion Our results showed that the plants carrying the recombinant sp-Xeg gene do not demonstrate a decrease in growth parameters in semi-natural conditions. However, in some transgenic lines, a change in the carbohydrate composition of the wood, an increase in the cell wall thickness and a decrease in the rate of decomposition of wood are observed.
L-3-n-butylphthalide protect the neuro by reducing inflammation and brain edema in rat intracerebral hemorrhage model
Authors: Zeng Zhou , Gong Xiyu , Hu Zhiping
Published: August 2019

Background：Previous studies have shown that L-3-n-butylphthalide(NBP), which is a compound found in Apium graveolens Linn seed extracts, could have neuroprotective effects on acute ischemic stroke through anti-inflammation and by reducing brain edema. The pathological inflammatory pathways and consequent brain edema in intracerebral hemorrhage (ICH) share some characteristics with ischemic stroke. Methods：We hypothesized that NBP has anti-inflammatory and therapeutic effects on rats with ICH. ICH was induced by an infusion of bacterial collagenase type IV into the unilateral striatum of anesthetized rats. The therapeutic effect of NBP was measured by assessing neurological function, brain water content, blood-brain barrier permeability, and expression of tumor necrosis factor-alpha (TNF-α) and matrix metalloproteinase-9 (MMP-9) around the hematoma 48 hours after surgery. Magnetic resonance imaging (MRI) was performed 4 and 48 hours after ICH induction, and ICH-induced injured area volumes were measured using T2-weighted images. Results： The NBP treatment group performed better in the neurological function test than the vehicle group. Moreover, in comparison with the vehicle group, NBP group showed a lower expanded hematoma volume, brain water content, blood-brain barrier permeability, and TNF-α/ MMP-9 expression level. Conclusions：Our results suggested that NBP have a neuroprotective effect by reducing inflammation and brain edema in rat ICH model. Therefore, our findings also show the potential for clinical application of NBP in the treatment of ICH.
Where have all the susceptible gonococci gone? A historical review of changes in MIC distribution over the past 75 years
Authors: Kenyon Chris , Laumen Jolein , Bossche Dorien Van Den , Dijck Christophe Van
Published: August 2019

Background Does the emergence of antimicrobial resistance in Neisseria gonorrhoeae include an elimination of highly susceptible strains or does it merely involve a stretching of the MIC distribution? If it was the former this would be important to know as it would increase the probability that the loss of susceptibility is irreversible.Methods We conducted a historical analysis based on a literature review of changes of N. gonorrhoeae MIC distribution over the past 75 years for 3 antimicrobials (benzylpenicillin, ceftriaxone and azithromycin) in five countries (Denmark, Japan, South Africa, the United Kingdom and the United States).Results Changes in MIC distribution were most marked for benzylpenicillin and showed evidence of a right shifting of MIC distribution that occurred in up to 3 stages and was associated with a reduction/elimination of susceptible strains in all countries. In the case of ceftriaxone and azithromycin, right shifting was also found in all countries but the extent of right shifting varied and the evidence for the elimination of susceptible strains was more mixed.Conclusions Further research is required to assess why some populations have undergone a stage 3 as opposed to a stage 1 or 2 transition, with the greater loss of susceptible isolates that this involves. If differential antimicrobial consumption was found to be responsible, then this would provide additional impetus to promote antimicrobial stewardship.
Antibiotic resistance of Streptococcus pneumonia serotypes in Kisii, Kenya
Authors: Orucho Vincent Obino , Ochoi Cyrus Orucho , Nyangau Maureen Kerubo
Published: August 2019

Background : Pneumonia remains the leading cause of death in children under five worldwide, accounting for about 1.6 million deaths a year. Streptococcus pneumonia , has proved to be the most competent bacterial pathogen causing pneumonia infections among the infants and the elderly, leading to great morbidity and mortality. Currently there are over 94 different serotypes of Streptococcus pneumonia , and quite a number have emerged as drug-resistant strains which introduce a twist to the current treatment strategies. Detailed information of current antibiotic susceptibilities, resistance and serotype distribution will be important in designing new strategies for treatment and management of pneumococcal infections. Methods: A total of 309 S. pneumoniae isolates were collected from patients attending the Kisii Teaching and Referral Hospital between 2017 and 2018. Nasopharyngeal samples collected and serotyped using PCR. The samples were cultured and their sensitivity to drugs tested using various concentrations of; Oxacilin, Erythromycin, Tetracycline, Ofloxacin, Trimethoprim/sulfamethoxazole and Chloramphenicol. Results: Out of the 309 samples collected, 235 were positive for S. pneumonia, although 10 of the samples had incomplete data. A total of 41 S. pneumonia serotypes isolated from the 309 samples with the most prevalent serotypes being; Non-typable (11%), 15B (7.6%), 19F (7.0%), 19A (6.7%), 23B (5.8%), 23F (5.3%), 6A (4.4%). All the serotypes were highly resistant to Oxacilin, and trimethoprim/sulfamethoxazole, while showing high sensitivity to Erythromycin, Ofloxacin and chloramphenicol. The rate of sensitivity to Tetracycline was 75% with the other 25% showing intermediate sensitivity. Conclusions: The data collected showed a high rate of S. pneumonia (76%) consisting of various serotypes for various ages. The various serotypes isolated showed a marked resistance routinely used antibiotics for patient samples of various ages. The isolated serotypes also consisted of serotypes 19A, 6A, and 5B that are lacking in the pneumococcal vaccine (PCV 10). This data will provide relevant information for a better approach to both clinical treatment, management and prevention of infections with S. pneumonia. Keywords: Streptococcus pneumonia, Antibiotic resistance, serotypes, Drug sensitivity
The 5S rDNA and their chromosomal loci in autotriploid Carassius auratus
Authors: Cao Liu , Zhao Chun , Qin Qinbo , Gu Qianhong , Zhou Yuwei , Wang Chongqing , Wang Yude , Qin Huan , Tao Min , Zhang Chun , Zhao Rurong , Liu ShaoJun
Published: August 2019

Background Polyploidization can induces a flurry of genetic events and plays an important role in speciation. In this study, we comparatively analyzed the molecular organization and chromosomal locus of 5S rDNA in natural autotriploid (3nCC, 3n=150) and artificial autotriploid gynogenetic (3nG, 3n=150) Carassius auratus as well as the related diploid ancestors, diploid Carassius auratus (2nCC, 2n=100) and Carassius auratus red var. (RCC, 2n=100), which provide a excellent model to ascertain the genomic changes in autotriploidization process.
Results The similarities of the 5S rDNA coding region (class I, class II and class III) between RCC and 3nG were 98.3%, 100% and 99.1%, respectively, and the similarities of the 5S rDNA coding region (class IV, class V and class VI) between 2nCC and 3nCC were 97.5%, 100% and 100%, respectively. Fluorescence in situ hybridization (FISH) with 5S rDNA as probe indicated that the expected numbers of maternal chromosomal loci were found in 3nG and 3nCC, respectively.
Conclusions These observations indicate that autotriploidization has little influence on the divergence of 5S rDNA family in Carassius auratus.
Association of rs780094 polymorphism of glucokinase regulatory protein with non-alcoholic fatty liver disease
Authors: Mohammadi Saba , Farajnia Safar , Mohseni Fatemeh , Baghban Roghayyeh , Shadmand Masoud
Published: August 2019

Objective GCK rs780094 polymorphism is a single nucleotide polymorphism that has been associated with obesity, type II diabetes and dyslipidemia in some populations, conditions that highly related to NAFL etiology. The present study aimed to evaluate the relationship between NAFLD and rs780094 polymorphism in patients with NAFLD in Tabriz city, northwest of Iran. The rs780094 polymorphism was determined in 74 patients with NAFLD by PCR-RFLP technique. Demographic information was collected using a questionnaire and biochemical analysis was performed using standard laboratory methods.Results There were a significant difference between case and control subjects for alanine aminotransferase, aspartate aminotransferase, HDL-C and triglycerides ( P <0.05). Analysis by PCR-RFLP method revealed that there were no significant differences between NAFLD and healthy subjects for rs780094 polymorphism in the study population. The results of this study indicated that rs780094 polymorphism is not associated with NAFLD in subjects from Tabriz city.
The association between denture satisfaction and OHRQoL - a follow-up study
Authors: Teng Chia-Jen , Lin Sheng-Che , Chen Jen-Hao , Chen Yi , Kuo Hsiao-Ching , Ho Pei-Shan
Published: August 2019

Backgroud: The objectives were to evaluate the association between edentate patients’ self-ratings satisfaction and OHRQoL and to identify the determinants of denture satisfaction that best predict OHRQoL. Methods: This prospective study was conducted in subjects aged 65 years and over. All subjects completed questionnaires before and approximately 6 months after receiving complete denture. Information obtained by questionnaire included demographic characteristics, patients’ satisfaction and OHRQoL. The six satisfaction dimensions were classified as five cluster groups by an analysis of PCA and CA. Multiple linear regression was adapted to estimate the association between satisfaction and the responsiveness of OHIP7T. Results: The satisfaction cluster group is an important factor of OHRQoL after adjusting for other confounders. When compared to the cluster “HDS”, the greatest improvement of OHRQoL after treatment was found in the group “HS” (β=7.31(6.26-8.36), followed by group “QS” (β=4.71(3.54-5.87)), group “AS”(β=4.33(2.92-5.74)) and group “SDG” (β=3.25(2.10-4.41)). A statistically significant trend was detected in patient-rating satisfaction and OHRQoL. Conclusion: Psychological value is the greatest impacting dimension on OHRQoL among denture wearers in Taiwan elderly.
The geography of evolutionary divergence in the highly endemic avifauna from the Sierra Madre del Sur, Mexico
Authors: Rocha-Méndez Alberto , SÁNCHEZ-GONZÁLEZ LUIS A. , GONZÁLEZ CLEMENTINA , NAVARRO-SIGÜENZA ADOLFO G.
Published: August 2019

Background Mesoamerica is a remarkable region with a high geological and ecological complexity. Within northern Mesoamerica, the biotic province of the Sierra Madre del Sur (SMS) in western Mexico harbors exceptionally high avian endemism and diversity. Herein, we searched for spatially and temporally concordant phylogeographic patterns, in four bird genera from three distinct avian orders co-distributed across Mesoamerica and investigated their causes through hypothesis testing regarding historical processes. Selected species include endemic and differentiated populations across the montane forests of Mesoamerica, and particularly within the SMS. Results We gathered mitochondrial DNA sequences for at least one locus from 177 individuals across all species. We assessed genetic structure, demographic history, and defined a framework for the coalescent simulations used in biogeographic hypothesis testing temporal and spatial co-variance. Our analyses suggested shared phylogeographic breaks in areas corresponding to the SMS populations, and between the main montane systems in Mesoamerica, where the Central Valley of Oaxaca and the Nicaragua Depression being the most frequently shared breaks among analyzed taxa. Nevertheless, dating analyses and divergence patterns observed were consistent with the hypothesis of broad vicariance across Mesoamerica derived from mechanisms operating at distinct times across taxa in the SMS. Conclusions Our study provides a framework for understanding the evolutionary origins and historical factors enhancing speciation in well-defined regions within Mesoamerica, indicating that the evolutionary history of extant biota inhabiting montane forests is complex and often idiosyncratic.
Pretreatment neutrophil-to-lymphocyte ratio and Mean Platelet Volume in castration-resistant prostate cancer patients treated with first-line docetaxel
Authors: Başeskioğlu Barbaros , Duman Berna Bozkurt , Yıldız Bülent , Çil Timuçin , Dinçer Murat , Bayram Ertuğrul
Published: August 2019

Background:Patients who have evidence of disease progression (eg, increase in serum prostate-specific antigen [PSA], new metastases, progression of existing metastases) while being managed with androgen deprivation therapy (ADT) are considered to have castration-resistant disease. Docetaxel (75 mg/m2) given every three weeks in combination with daily prednisone (5 mg twice a day) significantly prolonged overall survival compared with mitoxantrone plus prednisone in the TAX 327 phase III trial [3]. Based upon those results, docetaxel plus prednisone has become the standard initial regimen when chemotherapy is indicated for CRPC Methods: Inflammation-based markers, such as the Neutrophile/Lymphocyte Ratio (NLR), are widely available and inexpensive measurements that are easy to integrate into pretreatment evaluation. Mean platelet volume (MPV) is a marker of activated platelets is associated some types of cancer including ovarian, gastric cancer. We retrospectively evaluated the predictive impact of neutrophil-lymphocyte ratio (NLR) and MPV as a marker for in men with progressive metastatic castration resistant prostate cancer (mCRPC) following docetaxel.Results: A significant correlation was not observed between NLR and PSA response. A significant correlation was not also observed between MPV and PSA response.There no correlation was found between MPV and NLR with total PSA level and response (p:0.355, p:0.673 respectively)Conclusion: . In our study; We didn’t show any correlation between MWP level, NLR ratio and response to Docetaxel therapy A significant correlation was not also observed between NLR , MPV and PSA response.
A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design
Authors: Feeley Nancy , Robins Stephanie , Genest Christine , Stremler Robyn , Zelkowitz Phyllis , Charbonneau Lyne
Published: August 2019

Background: The well-being of mothers of infants requiring Neonatal Intensive Care Unit (NICU) hospitalization may be affected by the architectural design of the unit. A few recent studies suggest there may be some drawbacks of single-family rooms (SFRs) for infants and their mothers, such as isolation of mothers and reduced exposure to auditory stimulation for infants.
Purpose: To compare NICU-stress, symptoms of depression, perceptions of nurse-parent support and family-centered care, sleep disturbances, breastfeeding self-efficacy and readiness for discharge in mothers of infants cared for in an open ward (OW) to those cared for in a unit that includes both pods and SFRs.
Methods: A pre-post quasi-experimental study was conducted in a Canadian level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW data were collected in 2014 and pod/SFR data one year after the transition in 2017 to 2018. Mothers of infants hospitalized for at least 2 weeks completed questionnaires about stress, depressive symptoms, support, family-centered care, and sleep disturbances. In the week prior to discharge, they responded to breastfeeding self-efficacy and readiness for discharge questionnaires. They described their presence in the NICU at enrolment and again prior to discharge.
Results: Pod/SFR mothers reported significantly less NICU-stress compared to OW mothers. OW mothers had greater sights and sounds stress and felt more restricted in their parental role. Pod/SFR mothers reported greater respect from staff. Controlling for maternal education, pod/SFR mothers perceived their infant’s readiness for discharge to be greater than OW mothers. There were no significant differences between groups in depressive symptoms, nurse-parent support, sleep disturbances, and breastfeeding self-efficacy.
At enrolment and again in the weeks preceding discharge, pod/SFR mothers were present significantly more hours per week than OW mothers, controlling for maternal education.
Conclusions: Further study of small pods is indicated as these units may be less stressful for parents, and enhance family-centered care, as well as maternal presence, compared to OWs.
A Correlative Study of Hemodynamically Significant Patent Ductus Arteriosus and Platelets within 24 hours of Birth in Preterm Infants
Authors: Ren Yi , Gao Xiangyu , Wang Huiying , Yang Bo , Jin Bao , Lei Honglin , Zhao Dandan , Huang Di
Published: August 2019

Objective To investigate the correlation between the hemodynamically significant patent ductus arteriosus (hsPDA) of preterm infants and the platelet count (PLT), plateletocrit within 24 h of birth.Methods The clinical data of 1270 preterm infants were retrospectively studied. The patients were divided into the non-PDA group, no hsPDA group, and hsPDA group.Results The smaller gestational age and the lower birth weight, PLT, plateletocrit were associated with the greater likelihood of PDA ( P < 0.05). The receiver operating characteristic (ROC) curve showed that the predictive values of PLT and plateletocrit were 0.703 and 0.748, respectively, with the best critical values of 241.5 × 10 9 /L and 0.245%. For the preterm infants with PLT < 241.5 × 10 9 /L, < 150 × 10 9 /L and < 100 × 10 9 /L as well as plateletocrit < 0.245% and 0.09%, the risks of hsPDA were 1.876, 2.169, 6.216, 1.749 and 5.407 times of preterm infants with PLT ≥ 241.5 × 10 9 /L, ≥ 150 × 10 9 /L and ≥ 100 × 10 9 /L as well as plateletocrit ≥ 0.245% and ≥0.09%. The logistic regression analysis showed that plateletocrit was an independent risk factor for preterm infants with hsPDA ( P = 0.000).Conclusions The decrease in plateletocrit of the preterm infants within 24 h of birth was the independent risk factor of hsPDA on the 4th-7th day of birth.
Association between Severe Unaddressed Dental Needs and Developmental Health at School Entry in Canada: A Cross-sectional Study
Authors: Janus Magdalena , Reid-Westoby Caroline , Lee Catherine , Brownell Marni , Maguire Jonathon L.
Published: August 2019

Background and Objective
Dental problems are the most prevalent chronic disease worldwide, with up to half of all kindergarten children having tooth decay. However, there is a lack of evidence of whether unaddressed dental needs (UDNs) are associated with children’s developmental health, a concept reflecting holistic child development - encompassing physical, emotional, and cognitive development. The objective of the current study was to evaluate the relationship between UDNs and developmental health among kindergarten children using the Early Development Instrument (EDI).
Methods
We examined associations between teacher reported UDNs and developmental vulnerability on the EDI. Children were included in the study if they were enrolled in kindergarten in publicly-funded schools in Canada between 2010 and 2015, had been in the classroom for at least one month, and had no more than 25% of missing items on the questionnaire.
Results
Among 576,264 children who met inclusion criteria (95.4% of eligible children), 2,465 (0.4%) were identified as having UDNs by their teachers. Children with UDNs had 4.58 to 8.27 times higher odds of being vulnerable on any of the five developmental domains (physical health and well-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge), compared to children without UDNs.
Conclusion
In this study, teacher-reported UDNs were associated with developmental vulnerability in kindergarten children. Teacher reported unmet dental needs in kindergarten children may be a proxy for poor developmental health at school entry, and thus a marker for supporting both children’s oral health and early developmental needs.
Defining the short-term disease recurrence after Loop Electrosurgical Excision Procedure (LEEP)
Authors: Papalia Nicholas , Rohla Amanda , Tang Selphee , Nation Jill G. , Nelson Gregg
Published: August 2019

Purpose: The goal of cervical cancer screening is to identify dysplastic lesions for subsequent excision in order to prevent invasive disease. There is clinical equipoise, on how to best follow women for disease surveillance after treatment with some Canadian provinces exclusively performing colposcopy and some utilizing HPV testing in addition to cervical cytology. Loop Electrosurgical Excision Procedure (LEEP) is used to treat pre-invasive HPV-mediated disease and patients are typically followed for 12 months after disease excision. This study aims to quantify the prevalence of high-grade disease at the time of the second follow-up colposcopy visit, in a practice setting that utilizes laser ablation in addition to LEEP. Methods: In a retrospective cohort study, consecutive patient charts were accessed through the electronic medical record system, ARIA, at the Tom Baker Cancer Centre, in Calgary, Alberta, from January 2010 to December 2015. Data was extracted and a REDCap database was used to compile pertinent information from charts meeting inclusion criteria. Descriptive and analytic statistics were performed. Results: Of the 303 patients identified, 221 patients met inclusion criteria. 86% of these patients met discharge criteria from colposcopy after the second follow up visit. Of the 31 (14%) who were seen in a subsequent visit, 7 (3.2%) underwent further treatment for high-grade disease (CIN 2/3). The remaining 23 (10.6%) had a third – negative – visit, resulting in discharge from colposcopy. Conclusion: In summary, our data demonstrates a prevalence of 3.2% of high-grade disease at the time of a second colposcopic follow up visit after treatment, in a setting which frequently utilizes laser ablation in combination with LEEP, for large lesions. This recurrence rate is consistent with most published literature on recurrence rates of CIN2/3.
Osteoporosis Screening as a Model for Effective Preventive Healthcare in Concierge Medicine
Authors: Wheeless Caleb , Yates Scott W , Schrader M Keith
Published: August 2019

Background : Annually, 2 million osteoporosis-related fractures result in 400,000 deaths and cost $12-17 billion in the United States. We examined the rate of bone density screening in our concierge medicine practice and compared this with previously published data for other patient populations. Methods : Using our electronic medical record system, we conducted a retrospective review of all patients followed in our group practice to determine the proportion of eligible patients who have been screened for osteoporosis. We present these results along with data for comparator populations. Results : In our population of 112 women age 50 or greater, 106 (94.6%) had been screened and of 63 women age 65 or greater, 61 (96.8%) had been screened. Our screening rate in Medicare age women (96.8%) compares favorably with previously published screening rates for Medicare HMO, Medicare PPO and MDVIP patients (74.2, 78.5 and 90.3% respectively). Conclusions : These data support our notion that limiting patient population size and effectively using a comprehensive electronic medical record in a systematic approach to prevention results in higher rates of osteoporosis screening.
Which interactions matter in economic evaluations? A simulation study
Authors: Dakin Helen A , Gray Alastair
Published: August 2019

Background

We aimed to assess the magnitude of interactions in costs, quality-adjusted life-years (QALYs) and net benefits within a sample of published economic evaluations of factorial randomised controlled trials (RCTs), evaluate the impact that different analytical methods would have had on the results and compare the performance of different criteria for identifying which interactions should be taken into account.

Methods

We conducted a systematic review of full economic evaluations conducted alongside factorial RCTs and reviewed the methods used in different studies, as well as the incidence, magnitude, statistical significance, and type of interactions observed within the trials. We developed the interaction-effect ratio as a measure of the magnitude of interactions relative to main effects. For those studies reporting sufficient data, we assessed whether changing the form of analysis to ignore or include interactions would have changed the conclusions. We evaluated how well different criteria for identifying which interactions should be taken into account in the analysis would perform in practice, using simulated data drawn from the studies identified in the review.

Results and conclusions

Large interactions for economic endpoints occurred frequently within the 40 studies identified in the review, although interactions rarely changed the conclusions. Simulation work demonstrated that in analyses of factorial RCTs, taking account of all interactions or including interactions above a certain size (regardless of statistical significance) minimised the opportunity cost from adopting treatments that do not in fact have the highest true net benefit.
Determining Some Factors Affecting the Longevity of Hemodialysis Patients. Using Survival Analysis
Authors: Rafati Shideh , Hassani Laleh , Tamaddondar Mohamad , Sabili Abdolnabi
Published: August 2019

Background

Dialysis is a method for removing excess fluid and uremic waste from the body of chronic renal-failure patients. In patients with CRF, blood dialysis stops death. Hemodialysis prevents the death of patients with chronic renal failure. Various factors can affect the survival of patients undergoing dialysis treatment. The current study aimed to determine such factors.Methods

This descriptive-analytic study examined 252 patients undergoing dialysis from 2010 to 2016 in all of hospitals in Bandar Abbas- Iran, whose data had been recorded in the dialysis unit or it was possible to get their files. The study used Lasso Regression in Cox's proportional hazards model in case with multi variables, background diseases, Body Mass Index,…… The collected data was analyzed using SPSS software and through installing glmnet and survival packages in R software.Results

In this study, 35 (13.9%) death events and 217 (86.1%) censored events were observed. The mean survival time of 252 patients was equal to 10.93 ± 7.82 years and the median survival time of these patients was calculated to be ten years. Based on the results of the Cox model under the penalized method of Lasso, The risk of mortality for patients with diploma degree was by 49% lower than that of the illiterate group (HR = 0.51). The risk of death for unemployed patients and farmers was equal to 0.66 (HR = 1.66) and 0.29 (HR = 1.29), respectively, higher than that of employees. Another significant factor in this study is the duration of each dialysis session. The risk of mortality has been reduced by 0.34 (HR = 0.66) for a single increase during dialysis.Conclusions

Apart from congenital and underlying diseases which early diagnosis will prevent kidney failure, the risk of mortality will be reduced by training behavioral issues in patients undergoing dialysis such as dialysis at predetermined hours and times and appropriate nutritional behaviors.
Inclusion of non-inferiority analysis in superiority-based clinical trials with single-arm, two-stage Simon’s design
Authors: Sampayo-Cordero Miguel , Miguel-Huguet Bernat , Pérez-García José , Páez David , Guerrero-Zotano Ángel , Noguera Javier Garde , Aguirre Elena , Holgado Esther , López-Miranda Elena , Huang Xin , Llombart-Cussac Antonio , Malfettone Andrea , Cortés Javier
Published: August 2019

Background The non-inferiority (NI) hypothesis is not usually considered in the early phases of clinical development. A proof-of-concept phase II study that allows for the analysis of NI, if superiority criteria cannot be met, may balance between multiple endpoints and additional parameters, which will result in more informed decisions in regard to the therapeutics’ potential value. Methods A total of 12,768 two-stage Simon’s design trials were constructed based on different assumptions of rejection response probability, minimum desired response probability, type I and II errors, and NI margins. P-value and type II error were calculated with stochastic ordering using Uniformly Minimum Variance Unbiased Estimator. Type I and II errors were simulated using the Monte Carlo method. Agreement between calculated and simulated values was analyzed with Bland-Altman plots. Results The level of agreement was equivalent between calculated and simulated values in two-stage superiority designs and ones in which switching to NI was allowed. Conclusion Switching to NI analysis, when superiority criteria are not achieved, may be useful for weighing additional factors such as clinical benefit duration, safety, cost, or biomarker strategy while assessing activity and early efficacy rate. Implementation of this strategy can be achieved through simple adaptations to existing designs for one-arm phase II clinical trials.
Identifying solutions to bottlenecks in hypertension service delivery: Insights for improving case detection in Tajikistan
Authors: Chukwuma Adanna , Gong Estelle , Latypova Mutriba , Fraser-Hurt Nicole
Published: August 2019

Background

Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of bottlenecks in service delivery for hypertension within primary health care in Tajikistan and define appropriate solutions.Methods

Our study drew on the cascade of care framework to examine patient progression through the recommended stages of care. We triangulated data from household surveys and facility registries to describe the cascade. Focus group discussions with local stakeholders identified the determinants of discontinuities in care. Drawing on global empirical evidence on effective interventions and stakeholder judgments on the feasibility of implementation, we developed recommendations to improve hypertension service delivery.Results

We review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in either Oblast, about 10 percent have been diagnosed in Khatlon and only 5 percent in Sogd. Bottlenecks in case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, job aids for providers, and task-shifting to increase provider supply.Conclusions

Translating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery bottlenecks.
The need for home care physicians in Japan – 2020 to 2060
Authors: Iwata Hiroyoshi , Matsushima Masato , Watanabe Takamasa , Sugiyama Yoshifumi , Yokobayashi Kenichi , Son Daisuke , Satoi Yoshinao , Yoshida Eriko , Satake Sumiko , Hinata Yuki , Fujinuma Yasuki
Published: August 2019

Background Due to the fact that Japan faces the most elderly society in the world, the Japanese government has launched an unprecedented health plan to reinforce home care medicine and increase the number of home care physicians, which means that an understanding of future needs for geriatric home care is vital. However, little is known about the future need for home care physicians. We attempted to estimate the basic need for home care physicians from 2020 to 2060. Methods Our estimation is based on modification of major health work force analysis methods with previously reported official data. Two models were developed to estimate the necessary number of home care physicians: one based on home care patient mortality, the other using physician-patient ratio, working with estimated numbers of home and nursing home deaths from 2020 to 2060. Moreover, the final process considered and adjusted for future changes in the proportion of deaths occurring at home. Results Results were highly concordant between our two models. In every instance, the mortality method’s mid-range estimation was between the physician-patient ratio method’s high- and low-estimations. Furthermore, our estimation is in line with the current number of physicians which was calculated using a different method. Approximately 1.6 times the current 38,000 home care physicians will be needed in Japan in the mid 2030’s, peaking at just above 60,000. However, the need for home care physicians is anticipated to begin to decrease by 2040. Conclusion The results indicate that the importance of home care physicians will rise with the growing elderly population, and that improvements in home care could partially suppress the future need for physicians. After the mid 2030’s, the supply can be reduced gradually, accounting for the decreasing total number of deaths after 2040. In order to provide sufficient home care and terminal care at home, increasing the number of home care physicians is indispensable. However, the unregulated supply of home care physicians will require careful attention in the future.
Assessing health system challenges and opportunities for better noncommunicable disease outcomes: the case of Mauritius
Authors: Musango Laurent , TIMOL Maryam , BURHOO Premduth , SHAIKH Faisal , DONNEN Philippe , KIRIGIA Joses Muthuri
Published: August 2019

Background This study provides an overview of NCD mortality, morbidity and risk factors; rates coverage of core population NCD interventions and individual NCD services in Mauritius; assesses health systems challenges and opportunities for better NCD outcomes; and recommends priority action areas to accelerate gains in NCD outcomes in Mauritius. Methods The Mauritius country assessment applied the guidelines developed by the World Health Organization Regional Office for Europe for systematically assessing health system challenges and opportunities for improving NCD outcomes. The assessment used mixed approaches to provide a fuller picture of the health system. Results In 2016, Mauritius sustained a total of 10 022 deaths from all causes. About 8,893 (88.7%) were from NCDs. Of the deaths due to NCDS, 6,935 (78%) were caused by cardiovascular diseases (CVD), diabetes and malignant neoplasms (cancers). Majority of NCDs are attributed to alcohol abuse, tobacco use, physical inactivity, and unhealthy diet. Of the 24-core population-based interventions for addressing these risk factors, 16.7% were rated extensive, 37.5% moderate and 45.8% limited. Three (20%), 8 (53%) and 4 (27%) of the 15 individual/personal CVD, diabetes and cancer services were rated extensive, moderate and limited respectively. Some of the challenges hindering NCD intervention scale-up include: lack of a government-led coordination mechanism; limited community empowerment for behavioural change; inefficient primary health care; insufficiently integrated health management information system; lack of explicit processes for prioritizing public health expenditures; and weak health workforce management. Conclusion There is urgent need to establish a high-level multisectoral/multistakeholder committee to oversee implementation of multisectoral activities for strengthening national health systems and other systems that address NCD risk factors and social determinants of health.
Increased soil moisture aggravated the competitive effects of the invasive tree Rhus typhina on the native tree Cotinus coggygria
Authors: Guo Xiao , Xu Zhen-Wei , Li Ming-Yan , Ren Xiao-Huang , Liu Jian , Guo Weihua
Published: August 2019

Background: Invasive exotic species cause significant problems, and the effects of extreme precipitation and drought, which might occur more frequently under the global climate change scenarios, on interspecific relationship between invasive and native species remain unclear. Results: We conducted a greenhouse experiment with three soil water levels (30%–40%, 50%–60%, and 70%–80% of field capacity) and two cultivation treatments (monoculture pots, one seedling of either species and mixture pots, one seedling of each species) to investigate soil water content effects on the relationship between invasive Rhus typhina and native Cotinus coggygria. We found that in mixture pots, the leaf area index and total chlorophyll concentration of R. typhina were lower than those in monoculture pots; the biomass parameters were unaffected. The growth, biomass, and gas exchange parameters, and total chlorophyll concentration of C. coggygria in mixture pots were lower than those in monoculture pots. Drought decreased the growth parameters, total chlorophyll concentration, and leaf biomass, but did not change gas exchange and other biomass parameters in R. typhina. The growth parameters, leaf area index, biomass parameters, total chlorophyll concentration, and net photosynthetic rate of C. coggygria decreased under drought conditions. The log response ratio (lnRR), calculated as ln (total biomass of a target plant grown in monoculture / total biomass of a target plant grown in mixed culture), of R. typhina was lower than that of C. coggygria. The lnRR of R. typhina and C. coggygria decreased and increased with increase in soil water content, respectively. Conclusions: R. typhina has greater capacity to relatively stable growth in the drought condition than C. coggygria and has strong competition advantages in the mixture with C. coggygria, especially in the drought condition. Our study will help understand the causes of invasiveness and wide distribution of R. typhina under various moisture conditions and predict its expansion under climate change scenarios.