bluuebunny/crossref_metadata_2025 huggingface dataset:
Room 4 Birth - The effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden
Authors: Berg Marie , Goldkuhl Lisa , Nilsson Christina , Wijk Helle , Gyllensten Hanna , Lindahl Göran , Moberg Kerstin Uvnäs , Begley Cecily
Published: October 2019

Background: An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences, and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden.
Methods/Design: Following ethical approval, a study design was developed and tested for feasibility in a pilot study which led to some important improvements for the conduction of the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour, who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centered approach and physical aspects (such as: light, silencer, media installator offering programmed nature scenes with sound, bath tub, birth support tools) that are adaptable as a woman wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding <1000 ml.); and a positive overall childbirth experience (7-10 on a scale 1-10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome, other physical outcomes of labour and birth; women´s selfreported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life), and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms.
Discussion: The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care.
Trial registration: ClinicalTrials.gov. Identifier NCT03948815. Registered 13 May 2019 - retrospectively registrered. https://clinicaltrials.gov/ct2/results?cond=Room+4+Birth&draw=1&rank=1#rowId0.
Keywords: Birth environment, Birthing room, Person-Centered Care, Labour, Randomised Controlled Trial
Performance of family planning clinics in conducting recommended HIV counseling and testing in Mombasa County, Kenya: a cross-sectional study
Authors: Eastment McKenna , Wanje George , Richardson Barbra , Nassir Faiza , Mwaringa Emily , Barnabas Ruanne V. , Sherr Kenneth , Mandaliya Kishorchandra , Jaoko Walter , McClelland R. Scott
Published: October 2019

Background

A high proportion of African women utilize family planning (FP) services. Accordingly, incorporating HIV testing into FP services may strategically target the first WHO 90-90-90 goal of 90% of people living with HIV knowing their status.Methods

The objective of this analysis was to determine the proportion of new FP clients counseled and tested for HIV, as well as correlates of HIV testing, in a random sample of 58 FP clinics in Mombasa County, Kenya. Structured interviews of FP clinic managers collected data on characteristics of FP clinics and staff. Study staff performed a 3-month review of FP registers, summarizing new client HIV testing and counseling (HTC). Because overall rates of HTC were quite low, a binary variable was created comparing clinics performing any HIV counseling and/or testing to clinics performing none. Generalized linear models were used to calculate prevalence ratios (PR) and identify correlates of HTC. Factors associated with any HTC with a p-value <0.10 in univariate analysis were included in a multivariate analysis.Results

Of the 58 FP clinics, 26 (45%) performed any counseling for HIV testing, and 23 (40%) performed any HIV testing. Counseling for HIV testing was conducted for 815/4389 (19%) new clients, and HIV testing was performed for 420/4389 (10%). Clinics without trained HIV testing providers uniformly did not conduct HIV counseling and/or testing (0/12 [0%]), while 27/46 (59%) of clinics with ≥1 provider performed some HTC (p<0.001). In the subset of 46 clinics with ≥1 trained HIV testing provider, correlates of performing HTC included being a public versus non-public clinic (PR 1.70 95%CI 1.01-2.88), and having an HIV comprehensive care center (CCC) onsite (PR 2.05, 95%CI 1.04-4.06).Conclusion

Trained HIV testing providers are crucial for FP clinics to perform any HTC. Approaches are needed to increase routine HTC in FP clinics including staffing changes and/or linkages with other testing services (in standalone VCT services or labs) in order to improve the implementation of existing national guidelines. A cluster randomized trial is planned to test an implementation strategy, the Systems Analysis and Improvement Approach (SAIA) to increase HTC in FP clinics.Key words/phrases

HIV testing, family planning clinics,
Whole-genome bisulfite sequencing in systemic sclerosis provides novel targets to understand disease pathogenesis
Authors: Lu Tianyuan , Klein Kathleen Oros , Colmegna Inés , Lora Maximilien , Greenwood Celia M.T. , Hudson Marie
Published: October 2019

Background Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease whose pathogenesis remains incompletely understood. Increasing evidence suggests that both genetic susceptibilities and changes in DNA methylation influence pivotal biological pathways and thereby contribute to the disease. The role of DNA methylation in SSc has not been fully elucidated, because existing investigations of DNA methylation predominantly focused on nucleotide CpGs within restricted genic regions, and were performed on samples containing mixed cell types. Methods We performed whole-genome bisulfite sequencing on purified CD4+ T lymphocytes from nine SSc patients and nine controls in a pilot study, and then profiled genome-wide cytosine methylation as well as genetic variations. We adopted robust statistical methods to identify differentially methylated genomic regions (DMRs). We then examined pathway enrichment associated with genes located in these DMRs. We also tested whether changes in CpG methylation were associated with adjacent genetic variation. Results We profiled DNA methylation at more than three million CpG dinucleotides genome-wide. We identified 599 DMRs associated with 340 genes, among which 54 genes exhibited further associations with adjacent genetic variation. We also found these genes were associated with pathways and functions that are known to be abnormal in SSc, including Wnt/-catenin signaling pathway, skin lesion formation and progression, and angiogenesis. Conclusion The CD4+ T cell DNA cytosine methylation landscape in SSc involves crucial genes in disease pathogenesis. Some of the methylation patterns are also associated with genetic variation. These findings provide essential foundations for future studies of epigenetic regulation and genome-epigenome interaction in SSc.
Systematic review on HIV situation in Addis Ababa, Ethiopia
Authors: Adal Melaku
Published: October 2019

Background

HIV prevalence in the Addis Ababa is still higher in key and priority populations. Therefore, this systematic review was carried out aiming in determining the prevalence of HIV, mortality rate by HIV/AIDS and predisposing risk factors, identification of hotspot areas, key and priority populations, availability and utilization of services, and challenges and gaps to be addressed for prevention and control of HIV epidemic in Addis Ababa.Methods

The documents relevant to address the objectives were collected from online databases Google scholar and PubMed for published works. In addition, unpublished survey and surveillance reports, performance reports and project assessment findings, and mapping results were collected from partner organizations working on HIV/AIDS prevention and control.Results

It appears that the HIV prevalence stabilizes, but varies along areas and socio-demographic groups. The most common hot spots in Addis Ababa are areas where bars, groceries, pensions, guest houses, hotels, brothels, massage houses, khat houses, shisha houses, night clubs, drinking establishments and tourist frequented settings are concentrated. The recognized key population (KP) is the female sex workers (FSWs). There is sexual mixing of key and priority populations (KPPs) with the general population. There are various behavioural, biological and socio-economic predisposing risk factors that drive HIV epidemic, and respective behavioural, biomedical and structural intervention measures are identified in the presence of gaps and challenges to address the problem.Conclusions

HIV prevalence in Addis Ababa seems stabilized. However, it varies along different groups of the population. There are many behavioural, biological and socio-economic factors that predisposed to HIV/AIDS. Weak monitoring of the quality of interventions, limited linkage of positive clients, lost to follow up, financial shortage, limited man power and coordination, data quality and gaps in use of program data or research findings are some of the gaps and challenges. Therefore, prevention and control measures using behavioural, structural and biomedical interventions through filling of gaps and tackle challenges should be strengthened in order to prevent and control HIV/AIDS.
Pregnancy options counselling in Ghana: A case study of women with unintended pregnancies in Kumasi metropolis, Ghana
Authors: Agbeno Evans Kofi , Gbagbo Fred Yao , Morhe ESK , Maltima Soale Issah , Sarbeng Kwadwo
Published: October 2019

Background
Pregnancy crisis mismanagement has contributed to maternal deaths and illnesses globally and in Ghana due to absence/inadequate pregnancy options counselling for clients to make informed decisions.

Aim of the study
This study examines options counselling for abortion seekers in health facilities in Ghana.

Methods
Analytical cross-sectional study design was done in selected specialised public and NGO health facilities within Kumasi Metropolis of Ghana, using self-administered structured questionnaires for data collection from 1st January to 30th April, 2014. Participants were 442 women with unintended pregnancies seeking abortion services. Data was analysed using Epi-Info (7.1.1.14) and STATA 12 to generate descriptive statistics, Pearson chi-square and multivariable logistic regressions. The Kwame Nkrumah University of Science and Technology approved the study.

Results
Respondents had divergent reproductive and socio-demographic profiles. Majority (about 58%) of them had been pregnant more than twice, but about 53% of this population had no biological children. (Although about 90% of respondents held perceptions that the index and previous pregnancies were mistimed/unintended, the majority (72%) had no induced abortion history. Induced abortion (208, 49%) and parenting (216, 51%) were mentioned as the only available options to unintended pregnancy in hospitals. Exposure to options counselling was observed to be significantly associated with parity (P = <0.001), gestational age (P = <0.001), previous induced abortions (P = <0.001), perception of pregnancy at conception (P = <0.001) and level of education (P = 0.002). The logistic regression analysis also shows that higher education has statistically significant effect on being exposed to options counselling (P = <0.001). Majority of respondents (95%) were not aware that giving a child up for adoption is an option to abortion in Ghana.

Conclusions
Pregnancy options counselling remains a major challenge in comprehensive abortion care in Ghana. Although higher educational attainments significantly exposes women to options counselling for informed decisions, the less educated are disadvantaged in this regard. Further research on type and depth of counselling services provided to pregnant women in health facilities is required to inform health policy and program decisions.
Early intervention and follow-up programs among children with cerebral palsy in Moldova: Do they make a difference?
Authors: Bufteac Ecaterina Gincota , Andersen Guro L. , Spinei Larisa , Jahnsen Reidun
Published: October 2019

Abstract
Aim: To study whether early intervention services (EI) and a follow-up program (FU) influence outcomes of children with cerebral palsy (CP) in Moldova.
Methods: Records from 351 children with CP in Moldova born during 2009 and 2010 were retrieved from hospital and orphanage archives between 1 July 2016 and 30 September 2017. We investigated the proportion enrolled in EI and FU at the Early Intervention Centre Voinicel and at the Institute of Mother and Child in 2009-2012. Logistic regression analyses were applied to calculate crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) for outcomes in children enrolled and not enrolled.
Results: Among all children with CP, 166 (47%) were enrolled in EI and FU. Of the 51 children born extremely preterm (gestational age ≤31 weeks), 46 (90%) were enrolled, compared to 97 (39%) of the 250 children born at term. Among 110 non-walking children with CP, 82 (74%) were enrolled into EI and FU, compared to 84 (35%) of 241 able to walk.
There was no difference in outcomes of cognition, communication, vision and hearing impairments between those enrolled or not enrolled in EI and FU. However, the subgroup analyses showed that the risk of contractures was five times higher among those not enrolled, regardless of GMFCS level (OR = 5.474, 95% CI 3.306–9.063, p <0.000).
Conclusion: In Moldova, EI and FU seem to be offered mostly to extremely preterm and non-walking children with CP. The results indicate a decreased risk for contractures in these children.
Neuronal migration genes and a familial translocation t(3;17): Candidate genes implicated in the phenotype
Authors: AMOR Meriam HADJ , Dimassi Sarra , Hannachi Hanen , Taj Amel , Mlika Adnene , Helal Khaled Ben , Saad Ali , Mougou-Zerelli Soumaya
Published: October 2019

Background: While Miller-Dieker syndrome critical region deletions are well known delineated anomalies, submicroscopic duplications in this region have recently emerged as a new distinctive syndrome. So far, only few cases have been described overlapping 17p13.3 duplications.
Methods: In this study, we report on clinical and cytogenetic characterization of two new cases involving 17p13.3 and 3p26 chromosomal regions in two sisters with familial history of lissencephaly. Fluorescent In Situ Hybridization and array Comparative Genomic Hybridization were performed.
Results: A deletion including the critical region of the Miller-Dieker syndrome of at least 2,9 Mb and a duplication of at least 3,6 Mb on the short arm of chromosome 3 were highlighted in one case. The opposite rearrangements, 17p13.3 duplication and 3p deletion were observed in the second case. This double chromosomal aberration is the result of an adjacent 1:1 meiotic segregation of a maternal reciprocal translocation t(3;17)(p26.2;p13.3).
Conclusions: 17p13.3 and 3p26 deletions have a clear range of phenotypic features while duplications still have an uncertain clinical significance. However, we could suggest that regardless of the type of the rearrangement, the gene dosage and interactions of CNTN4, CNTN6 and CHL1 in the 3p26 and PAFAH1B1, YWHAE in 17p13.3 could result in different clinical spectrums.
Association of Cleft Lip and Palate on Mother-to-Infant Bonding: a Cross-Sectional Study in the Japan Environment and Children's Study (JECS).
Authors: Tsuchiya Shinobu , Tsuchiya Masahiro , Momma Haruki , Koseki Takeyoshi , Igarashi Kaoru , Nagatomi Ryoichi , Arima Takahiro , Yaegashi Nobuo
Published: October 2019

Background: Cleft lip and/or palate is among the most prevalent congenital birth defects, and negatively affects maternal psychological status and may consequently result in higher prevalence of child maltreatment. However, the association of cleft lip and/or palate childbirths with bonding disorders still remains unclear. We examined the association between cleft lip and/or palate childbirth and mother-to-infant bonding, using data from the Japan Environment and Children's Study, a nationwide birth cohort study.
Methods: A cross-sectional study using the jecs-an-20180131 dataset was performed. A total of 104,065 foetuses in 15 regional centres in Japan were enrolled after obtaining informed written consent. The Mother-to-Infant Bonding Scale, a self-report scale consisting of 10 items, was used to evaluate maternal bonding at 1 year after childbirth. Finally, the participants consisted of 79,140 mother-infant pairs, of which 211 mothers with cleft lip and/or palate infants were included in our analyses. Multivariable logistic regression analysis using multiple imputation for missing data was performed to calculate the odds ratio and 95% confidence interval in the estimation of the association between bonding disorders and childbirth with cleft lip and/or palate.
Results: No increased risk of bonding disorders was observed among all the mothers with cleft lip and/or palate childbirths (odds ratio [95% confidence interval]; 0.97 [0.63-1.48], p = 0.880), and advanced maternal age or multiple parity may adversely affect the associations between bonding disorders and cleft lip and/or palate childbirths, respectively. After stratification with a combination of maternal age and parity, a significant association of cleft lip and/or palate childbirth with bonding disorders was found only among advanced-age multiparae (odds ratio [95% confidence interval] = 2.51 [1.17-5.37], p = 0.018), but it was weakened after additional adjustment for maternal depression.
Conclusions: Cleft lip and/or palate childbirth may increase the risk of bonding disorders among advanced-age multiparae, possibly through maternal depression. This finding provides valuable information for the provision of multidisciplinary cleft care.
Utilization And Associated Factors Of Emergency Contraception Among Women Seeking Abortion Services In Health Institutions Of Dessie Town, North East Ethiopia,2018
Authors: Feleke Asres Eshetie , Nigussie Tewdros Seyoum , Debele Tibeb Zena
Published: October 2019

Objective

The aim of the study was to assess utilization and associated factors of emergency contraception among women seeking abortion services in Health Institutions of Dessie Town, North East Ethiopia, 2018.Results

Among the interviewed 784 women 400(51%) utilized emergency contraception. Women’s age [AOR: 2.10, (95% CI 1.200, 3.671)], residence [AOR: 2.02 (95% CI1.273, 3.218], marital status [AOR: 1.71, (95%CI: 1.176, 2.485)], knowledge of emergency contraception [AOR: 5.66, (95%CI: 3.976,8.070)], and attitude towards emergency contraception [AOR: 2.75(95%CI: 1.946, 3.881)] were significantly associated factors with the utilization of emergency contraceptives. The emphasis of health education on emergency contraceptives shall focus on those women who are from the rural area, older and married women.
Preterm Births and Associated Factors among Mothers Who Gave Birth in Axum and Adwa Town Public Hospitals, Northern Ethiopia, 2018.
Authors: Gebremeskel Gebrekiros Aregawi , kassa Nega Assefa , Mengistu Frehiwot mesfin , Welay Fisseha Tekulu , Hailu Tesfay Adhena , Gebremedhin Mussie Mulugeta , Assefa Guesh gebreayezgi
Published: October 2019

Objective: The objective of this study was to determine the prevalence and associated factors of preterm births among mothers who gave birth in Axum and Adwa public hospitals, North Ethiopia, 2018.
Result: This study showed that 13.3% from the total 472 mothers gave a preterm birth. Being a rural resident (AOR=2.13,95% CI:(1.07,4.22), short inter pregnancy interval (AOR= 5.4, 95% CI: (1.32, 22.05), previous preterm birth(AOR= 3.74, 95% CI: (1.03, 16.34), Premature rupture of membrane(AOR=4.14, 95% CI: (1.92, 8.89), induced onset of labor(AOR=2.49, 95% CI: (1.06, 5.85) multiple pregnancy(AOR= 5.69, 95% CI: (2.27, 14.28), malaria during pregnancy (AOR= 4.71, 95% CI: (1.98, 11.23), Presence of chronic illness (AOR= 4.55, 95% CI: (1.83, 11.26) were significantly associated with preterm birth.
Digital Postpartum Hemorrhage Management Device (DPHMD)
Authors: Dereje Derartu , Getachew Abeba , Meskelu Birhan , Adamu Christian , Dejene Kidst , Daba Hundessa , Simegn Gizeaddis Lamesgin
Published: October 2019

Background

Primary postpartum hemorrhage (PPH) is an obstetric emergency caused by excessive blood loss that occurs most commonly after the placenta is delivered. PPH can lead to volume depletion, hypovolemic shock, anemia, and it is the leading cause of maternal mortality worldwide. Maternal mortality ratio in Ethiopia is among the highest in the world with 470 deaths per 100,000 live births. 94% of births in Ethiopia are estimated to occur at home and 10% of maternal deaths are attributed to PPH. Currently, physicians use visual estimation to calculate blood loss and provide fluid during delivery. This traditional method is subjective and generally inaccurate.Method

In this project, after delivery blood loss measurement system integrated with fluid delivery and vital sign monitoring method is proposed. The collection and measurement system collects blood loss after delivery and measures the amount of blood loss. The management system continuously monitors the mother’s heart rate and blood pressure. These vital sign values are integrated with the measured blood loss to estimate the amount of IV fluid required to be delivered for the mother. The rate of IV fluid delivery is regulated by a flow rate sensor and solenoid valve.Results

The prototype was built and undergone through different tests and iterations. The proposed device was tested for accuracy, cost effectiveness and ease to use. 91.28% accuracy has been achieved and the prototype was built with less than 210 USD.Conclusion

The proposed design allows physicians, especially those in low resource setting, to estimate blood loss and deliver fluid accurately. This helps to reduce maternal mortality rate that may occur due to postpartum hemorrhage.
Nurses’ knowledge of pressure ulcer and its associated factors at Hawassa University Comprehensive Specialized Hospital Hawassa, Ethiopia, 2018.
Authors: Walle Tarkie Abebe , Muhammed Ezedin Molla , Bifftu Berhanu Boru , Temachu Yemataw Zewdu
Published: October 2019

Introduction

Pressure ulcer is largely avoidable, but its prevalence rate increased more than 80% in a thirteen years study. Nurses have a great position to advance best practices towards the prevention of pressure ulcers. Therefore they should be knowledgeable of the signs and symptoms of pressure ulcers, and preventive strategies to reduce its incidence, but there is limited evidence on nurses’ knowledge and its associated factors to prevent pressure ulcer in Ethiopia.Objectives

The study aimed to assess nurses' knowledge and associated factors towards pressure ulcer prevention at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia, 2018.Methods

A hospital-based cross-sectional study was conducted from March 25 – April 23/ 2018. A total of 356 nurses were selected by stratification with a simple random sampling technique. Pretested structured questionnaire with closed and open-ended questions was used to collect data. Frequency distribution and percentage were computed to describe each variable. Bivariate and multivariable logistic regression with a 95% confidence interval was also carried out to see the effect of each independent variable on the dependent variable and declared statistical significant association with P< 0.05.Result

The mean knowledge score of nurses was 25.22 out of 41 item questions. Fifty-two point five percent of nurses score above the mean. Males [AOR=0.44, 95% CI (0.26 – 0.73)], working a maximum of eight hours [AOR= 3.57, 95% CI (1.48 – 8.61), not having training [(AOR= 2.31, 95% CI (1.14 – 4.61)], Low salary [AOR= 3.47, 95% CI (1.03 – 11.67)] were significantly associated with inadequate knowledge.Conclusion

Generally a nurse's knowledge of pressure ulcer was inadequate. Being female, working less than or equal to eight hours, not having the training and low working salary are contributors to a low level of knowledge for pressure ulcer.
Labor pain control and associated factors among women who gave birth at Leku primary hospital, southern Ethiopia
Authors: Siyoum Melese , Mekonnen Shewangizaw
Published: October 2019

Objective: To assess Labor pain control and associated factors among women who give birth at Leku primary Hospital, Southern Ethiopia, 2018/19. A systematic random sampling technique was used to select 404 mothers who gave birth at Leku Hospital during the data collection period. Data were collected by two first degree midwives immediately after delivery using Labor Agentry Scale (LAS).
Results: In this study, 404 mothers were participated making the response rate of 100%. Among the participants, 104 (25.7%) of mothers reported Mild control of labor pain. Maternal age of 19 to 24year AOR=5.85(95%CI 2.14, 15.98), being farmer AOR=2.5(1.14, 5.57), primi-para AOR=0.13(0.06, 0.3), good family support AOR=2.8(1.49, 5.3), short duration of labor (<12hrs) AOR=3.2(1.65, 6.23) and history of pregnancy loss AOR=0.06(0.03, 0.14) were significantly associated with greater control of labor pain. In general, compared to other studies, the level of labor pain control is good in this study area. Enhancing factors of labor pain control have to be strengthened to increase greater control of labor pain. Qualitative research is highly recommended to identify cultural factors related to labor pain control and management.
Keywords: labor analgesia, labor pain, labor pain control, southern Ethiopia, Leku
Gun Violence Restraining Order Laws and Firearm Suicide among Older Adults: A Longitudinal State-Level Analysis
Authors: Saadi Altaf , Choi Kristen R , Takada Sae , Zimmerman Fred J.
Published: October 2019

Background: Older adults commit suicide at a disproportionately higher rate compared to the general population, with firearms the most common means of suicide. State gun laws may be a policy remedy. Less is known about Gun Violence Restricting Order (GVRO) laws, which allow for removal of firearms from people deemed to be a danger to themselves or others, and their effects on suicide rates among older adults. The purpose of this study was to examine the association of state firearm laws with the incidence of firearm, non-firearm-related, and total suicide among older adults, with a focus on GVRO laws. Methods: This is a longitudinal study of US states using data from 2012 to 2016. The outcome variables were firearm, non-firearm and total suicide rates among older adults. Predictor variables were (1) total number of gun laws to assess for impact of overall firearm legislation at the state level, and (2) GVRO laws. Results: The total number of firearm laws, as well as GVRO laws, were negatively associated with firearm-related suicide rate among older adults (p<0.001). There was a small but significant positive association of total number of firearm laws to non-firearm-related suicide rates and a negative association with total suicide rate. GVRO laws were not significantly associated with non-firearm-related suicide and were negatively associated with total suicide rate. Conclusion: Stricter firearm legislation, as well as GVRO laws, are protective against firearm-relate suicides among older adults.
An updated meta-analysis of XRCC4 rs1805377 polymorphism and the risk of cancer based on 23 case-control studies
Authors: Zhang Xin-yuan , Wei Xiao-han , Wang Bao-jie , Yao Jun
Published: October 2019

Background The growing studies reports that the genes participating in repairing of DNA double-strand breaks may be cancer-susceptibility genes. Rs1805377 (A>G) is a functional single nucleotide polymorphism (SNP) in the x-ray cross-complementing group 4 (XRCC4) gene that may be involved in the etiology of cancer. However, no conclusive results can be determined from individually published studies. Thus, we performed a meta-analysis to examine the association between XRCC4 rs1805377 polymorphism and cancer risk.Methods The potential literatures were searched using three online electronic databases (PubMed, Embase, and Web of Science). The available studies were included according to the inclusion criteria. The pooled analysis were performed to explore the association between XRCC4 rs1805377 locus and the risk of cancer. Additionally, we also performed subgroup analysis and sensitivity analysis.Results Twenty-three studies were included in our meta-analysis. It contained 9,433 cancer patients and 10,337 healthy controls. The pooled results showed that there was no association between rs1805377 and the risk of cancer. Under the dominant model, the final pooled odds ratios (ORs) was 1.115 (95% confidence intervals: 0.956-1.301; P = 0.165) in a random effects model without the statistical significance. The subgroup analysis by ethnicity and source of controls also didn’t find that rs1805377 polymorphism was related to cancer occurrence. In the subgroup by type of cancers, the significant association was only found in gastric antrum adenocarcinoma.Conclusions our meta-analysis suggested that there was no association between rs1805377 polymorphism and cancer occurrence. It may provide useful information for the relevant studies on the etiology of cancer in future.
A Transcriptomic Meta-Analysis Identifies Differentially Expressed Genes across Different Types of Cancer and Their Association with Checkpoint Inhibitor Immunotherapy
Authors: Al-Khudhair Ahmed , Dar Pervaiz , Imam Shahnawaz , SA Khuder , Jaume Juan C.
Published: October 2019

Background Checkpoint inhibitor, anti-Programmed cell death protein1/Ligand (PD1 / PDL1) immunotherapy achieved great success in modulating the immune system to reinvigorate targeted immune fight against several types of cancer. However, patients’ clinical response to this cancer immunotherapy varies widely. Biomarkers that can predict the greatest response to the anti-PD1 immunotherapy could help to personalize the maximum benefit for the right patient.Results This study explored transcriptomic biomarkers that were associated with the response (or no-response) to the anti-PD1/PDL1 immunotherapy in seven types of cancer [Malignant Pleural Mesothelioma (n=8), Head and Neck cancer (n=3), Lung Non-Squamous cancer (n=15), Squamous Lung cancer (n=8), Melanoma (n=23), Melanoma Skin Metastasis (n=10), and Renal Cell Carcinoma (n=11)]. The most common differentially expressed genes (105 genes) were between melanoma skin metastasis and renal cell carcinoma; followed by malignant pleural mesothelioma and renal cell carcinoma, which had 79 common differentially expressed genes; then malignant pleural mesothelioma and melanoma skin metastasis, which had 46 differentially expressed genes in common. Many similar (parallel) and dissimilar (anti-parallel) gene expression signatures were identified in this study. Parallel signature Differentially Expressed Genes (DEGs) are genes up-regulated together in either response or no-response group of different types of cancer, while the anti-parallel DEGs show up-regulation in the response group of one type of cancer while same genes are up-regulated in the no-response group of another different type of cancers. Target of Myb1 like 1 Membrane Trafficking Protein gene (TOM1L1) was found to be common among malignant pleural mesothelioma, melanoma skin metastasis, and renal cell carcinoma and was up-regulated in the cancer patients’ samples that did not respond to the anti-PD1/PDL1 immunotherapy. This study also found that differentially expressed Plasminogen Activator, Urokinase Receptor gene (PLAUR), was common among squamous lung cancer, melanoma and melanoma skin metastasis, and was up-regulated in the patients’ samples that responded to the anti-PD1/PDL1 immunotherapy.Conclusion In summary, this study identified DEGs biomarkers that can predict the response or no-response to the anti-PD1 immunotherapy across seven types of cancer. It also affirms the attention to important genes like TOM1L1 and PLAUR for their potential function in the cancer dissemination and metastasis.
Quality Use Of Medicines In Patients With Chronic Kidney Disease
Authors: Castelino Ronald L , Saunder Timothy , Kitsos Alex , Peterson Greg , Jose Matthew , Wimmer Barbara , Khanam Masuma , Bezabhe Woldesellassie , Stankovich Jim , Radford Jan
Published: October 2019

Objective: To determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures. Design: Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). Setting & Participants: All adults (aged ≥18 years) with chronic kidney disease (CKD) presenting to general practices across Australia. Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n=9,926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.
Measuring the effectiveness of digital nursing technologies: Development of a comprehensive digital nursing technology outcome framework based on a scoping review
Authors: Krick Tobias , Huter Kai , Seibert Kathrin , Domhoff Dominik , Wolf-Ostermann Karin
Published: October 2019

Background: Digital nursing technologies (DNT) comprise an expanding, highly diverse field of research, explored using a wide variety of methods and tools. Study results are therefore difficult to compare, which raises the question how effectiveness of DNT can be adequately measured. Methods currently used might not be sufficient for certain specific nursing contexts. A comprehensive outcome framework that shows the multitude of possible outcome areas could be useful to generate more comparable results. The aim of the present study is to develop an outcome framework for DNT and to indicate which outcome areas have been most frequently evaluated in previous studies and how this has been done.
Methods: A mixed method design was used to develop the DNT outcome framework. The numerical analysis is based on a scoping review focussing on the effectiveness of DNT for persons in need of care, formal or informal caregivers or care institutions. Nine databases were included in the screening: Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. Additional literature searches and expert interviews were included.
Results: The developed framework comprises four outcome target groups and 47 outcome areas. There are considerable differences in the researched outcome areas for the individual outcome target groups. Persons in need of care were by far the most frequently surveyed, particularly with respect to their psychological health. There are much fewer studies on formal and informal caregivers, and it is particularly noticeable that the quality of life of both groups has rarely been investigated. Care process quality was most frequently researched for organisations.
Conclusion: We were able to provide a comprehensive DNT outcome framework, thereby identifying the outcome tools used and the less researched outcome areas. We recommend a detailed investigation of all areas and tools in future research projects with a view to initiating a discussion on the differing importance of existing outcome areas and on a standardisation of outcome tools. We also recommend the development of outcome areas for the macro level of effectiveness assessment.
Keywords: Technology, Care, Nursing, Framework, Effectiveness, Effect, Digital, Outcome, Evidence
Evaluation of dialysis centres: Values and criteria of the stakeholders
Authors: Parra Eduardo , Arenas María Dolores , Luis María José Fernandez-Reyes , Forcén Angel Blasco , Alvarez-Ude Fernando , Joven Juan Aguarón , Casas Alfredo Altuzarra , Moreno-Jiménez José María
Published: October 2019

Bacground Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. However, the methods used have important epistemological limitations. The present study aimed to determine the opinions and preferences of stakeholders (patients, clinicians, and managers) and establish their relative importance to facilitating an adequate evaluation. Methods Successive working groups (WGs) were established using a multicriteria methodology. WG1 created a draft of criteria and sub-criteria, WG2 agreed, and WG3 was composed of three face-to-face subgroups (WG3-A, WG3-B, and WG3-C) that weighted them using two methodologies: weighting sum (WS) and analytic hierarchy process (AHP). Subsequently, they determined a preference for the WS or AHP results. Finally, via the Internet, WG4 weighted the criteria and sub-criteria by the method preferred by WG3, and WG5 analysed the results. Results WG1 and WG2 identified and agreed on the following evaluation criteria: evidence-based variables (EBVs), annual morbidity, annual mortality, PROMs, and PREMs. The EBVs consisted of five sub-criteria: type of vascular access, dialysis dose, haemoglobin concentration, ratio of catheter bacteraemia, and bone mineral disease. The patients rated the PROMs with greater weight than the other stakeholders in both face-to-face WG3 (WS and AHP) and WG4 via the Internet. The type of vascular access was the most valued sub-criterion. A performance matrix of each criterion and sub-criterion is presented as a reference for assessing the results based on the preferences of the stakeholders. Conclusions The use of a multicriteria methodology allows the relative importance of the indicators to be determined, reflecting the values of the different stakeholders. In a performance matrix, the inclusion of values and intangible aspects in the evaluation could help in making clinical and organizational decisions.
Progression of Endothelial Dysfunction, Atherosclerosis, and Arterial Stiffness in Stable Kidney Transplant Patients: A Pilot Study
Authors: Junarta Joey , Hojs Nina , Ramphul Robin , Lowe-Jones Racquel , Kaski Juan C , Banerjee Debasish
Published: October 2019

Background
Kidney transplant patients suffer from vascular abnormalities and high cardiovascular event rates, despite initial improvements post-transplantation. The nature of the progression of vascular abnormalities in the longer term is unknown. This pilot study investigated changes in vascular abnormalities over time in stable kidney transplant patients long after transplantation.
Methods
Brachial artery flow-mediated dilation (FMD), nitroglycerin-mediated dilation, carotid-femoral pulse wave velocity (cf-PWV), ankle-brachial pressure index, and common carotid artery intima-media thickness (CCA-IMT) were assessed in 18 kidney transplant patients and 17 controls at baseline and 3-6 months after.
Results
There was no difference in age (51±13 vs. 46±11; P=0.19), body mass index (26±5 vs. 25±3; P=0.49), serum cholesterol (4.54±0.96 vs. 5.14±1.13; P=0.10), systolic blood pressure (BP) (132±12 vs. 126±12; P=0.13), diastolic BP (82±9 vs. 77±8; P=0.10), or diabetes status (3 vs. 0; P=0.08) between transplant patients and controls. No difference existed in vascular markers between patients and controls at baseline. In transplant patients, FMD decreased (-1.52±2.74; P=0.03), cf-PWV increased (0.62±1.06; P=0.03), and CCA-IMT increased (0.35±0.53; P=0.02). No changes were observed in controls.
Conclusions
Markers of vascular structure and function worsen in the post-transplant period on long-term follow-up, which may explain the continued high cardiovascular event rates in this population.
Facilitators and barriers to advancing binational health coverage strategies for undocumented Mexican migrants in the United States of America
Authors: Arredondo Armando , Orozco Emanuel , Recaman Ana Lucia , Azar Alejandra
Published: October 2019

Background: Within the framework of a new national health program with emphasis on universal coverage strategies and in the context of revision/adjustments to the North American Free Trade Agreement (NAFTA/TEMEC), the present study aimed to identify barriers, facilitators and challenges for the development of strategies on social protection in the health of migrants and their families. Material and methods: Evaluative research based on a qualitative analysis with a cross-sectional design. The techniques of documentary analysis, applied political analysis (mapping of actors), in-depth interviews and case studies were used. In the first stage, key actors were mapped at the federal level and senior executives and health officials, federal deputies, senators and members of the Mexican foreign service were interviewed. In the second stage, field work was carried out in the state of Guanajuato and California; State health service officials, state government officials, municipal officials, health unit workers, representatives of CSOs and relatives of migrants were interviewed. The analysis of the interviews was carried out through the ATLAS-Ti software, as well as the mapping of actors and feasibility analysis through the POLICY MAKER software. Results: The main results allowed to identify indicators on barriers and facilitators regarding social actors, binational agreements under NAFTA/TEMEC, institutional spaces, interaction between social actors, as well as the impact and type of relations for a greater advance in binational health policies. Several obstacles were reported, including the fears that undocumented emigrants have in the U.S. of being arrested and deported if they use public health services in the U.S. The stakeholders also believed that many Mexican emigrants do not have a culture that values health insurance. Conclusions: In the context of reforms and adjustments of health systems that are being discussed in parallel in the revision and adjustments of NAFTA/TEMEC (United States of America, Mexico and Canada), the facilitators and barriers identified can be used to strengthen the development of bi-national strategies with different schemes of social protection in the health of undocumented migrants and their families on both sides of the border.
Effect and mechanism of YH0618 granule on chemotherapy- induced hair loss in patients with breast cancer: study protocol for a randomized, double-blind, multi-center clinical trial
Authors: You Jie-shu , Guo Li , Huang Mei , Shi Xin-lei , Lin Man-di , Guo Zhen , Cao Ya-li , Sun You-zhi , Xu Qian , Qu Wei-ling , Liu Huan-lan , Chen Jianping
Published: October 2019

Background: Hair loss is one of the most common side effects of chemotherapy, which can cause persistent negative emotions, further affecting therapeutic effects and reducing the quality of life. However, there is no clinically safe and effective methods to solve the problem at present. Our previous clinical and animal studies showed that a medicinal and edible decoction YH0618 could significantly promote hair growth in cancer patients after chemotherapy, without interfering with the anti-tumor effect of chemotherapy. Besides, the theory of Chinese Medicine believes “Essence of the kidney is reflected on the hair”. Therefore, this study will further explore the efficacy of YH0618 granule on chemotherapy-induced hair loss in patients with breast cancer by a randomized, double-blind, multi-center clinical trial and elucidate the potential mechanism from the aspect of kidney deficiency or renal dysfunction. Methods/Design: Eligible breast cancer patients who will start chemotherapy will be randomly divided into group A (YH0618 granule) and group B (placebo). The chemotherapeutic agents contains Taxanes or/and Anthracyclines, and chemotherapy regimen will last at least 6 cycles with every three weeks a cycle. Subjects assigned to group A will receive YH0618 granules two times a day (6 g each time), 6 days a week, mixing with 300 ml warm water from the first to the fourth chemotherapy cycle. Subjects in group B will receive the placebo granule in the same manner. The primary outcome is the time point of occurrence of hair loss reaching grade II assessed by WHO Toxicity Grading Scale, and objective indexes of hair quality and hair follicle recorded by a hair and scalp detector before the fifth chemotherapy. Secondary outcomes include changes of facial color and thumbnails color, grading of thumbnails ridging, assessment of quality life, fatigue, routine blood test, hepatic and renal function, and some medical indicators which can reflect kidney deficiency in Chinese Medicine. Discussion: This research is of great significance for the treatment of cancer and improving the quality of life of patients. The study may provide the most direct evidence for meeting clinical needs and lay a solid scientific foundation for later product development. Trial registration: The trial was registered on 14 December 2018 at Chinese Clinical Trial Registry: ChiCTR1800020107.