bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the size of reference population for expected accuracy of genomic prediction using simulated and real data in Japanese Black cattle
Authors: Takeda Masayuki , Inoue Keiichi , Oyama Hidemi , Uchiyama Katsuo , Yoshinari Kanako , Sasago Nanae , Kojima Takatoshi , Kashima Masashi , Suzuki Hiromi , Kamata Takehiro , Kumagai Masahiro , Takasugi Wataru , Aonuma Tatsuya , Soma Yuusuke , Konno Sachi , Saito Takaaki , Ishida Mana , Muraki Eiji , Inoue Yoshinobu , Takayama Megumi , Nariai Shota , Hideshima Ryoya , Nakamura Ryoichi , Nishikawa Sayuri , Kobayashi Hiroshi , Shibata Eri , Yamamoto Koji , Yoshimura Kenichi , Matsuda Hironori , Inoue Tetsuro , Fujita Atsumi , Terayama Shohei , Inoue Kazuya , Morita Sayuri , Nakashima Ryotaro , Suezawa Ryohei , Hanamure Takeshi , Zoda Atsushi , Uemoto Yoshinobu
Published: November 2021

Background

Size of reference population is a crucial factor affecting the accuracy of prediction of the genomic estimated breeding value (GEBV). There are few studies in beef cattle that have compared accuracies achieved using real data to that achieved with simulated data and deterministic predictions. Thus, extent to which traits of interest affect accuracy of genomic prediction in Japanese Black cattle remains obscure. This study aimed to explore the size of reference population for expected accuracy of genomic prediction for simulated and carcass traits in Japanese Black cattle using a large amount of samples.

Results

A simulation analysis showed that heritability and size of reference population substantially impacted the accuracy of GEBV, whereas the number of quantitative trait loci did not. The estimated numbers of independent chromosome segments (Me) and the related weighting factor (w) derived from simulation results and a maximum likelihood (ML) approach were 1900–3900 and 1, respectively. The expected accuracy for trait with heritability of 0.1–0.5 fitted well with empirical values when the reference population comprised > 5000 animals. The heritability for carcass traits was estimated to be 0.29–0.41 and the accuracy of GEBVs was relatively consistent with simulation results. When the reference population comprised 7000–11,000 animals, the accuracy of GEBV for carcass traits can range 0.73–0.79, which is comparable to estimated breeding value obtained in the progeny test.

Conclusion

Our simulation analysis demonstrated that the expected accuracy of GEBV for a polygenic trait with low-to-moderate heritability could be practical in Japanese Black cattle population. For carcass traits, a total of 7000–11,000 animals can be a sufficient size of reference population for genomic prediction.
Bovine milk somatic cell transcriptomic response to Staphylococcus aureus is dependent on strain genotype
Authors: Niedziela Dagmara A. , Cormican Paul , Foucras Gilles , Leonard Finola C. , Keane Orla M.
Published: November 2021

Background

Mastitis is an economically important disease of dairy cows with Staphylococcus aureus a major cause worldwide. Challenge of Holstein-Friesian cows demonstrated that S. aureus strain MOK124, which belongs to Clonal Complex (CC)151, caused clinical mastitis, while strain MOK023, belonging to CC97, caused mild or subclinical mastitis. The aim of this study was to elucidate the molecular mechanisms of the host immune response utilising a transcriptomic approach. Milk somatic cells were collected from cows infected with either S. aureus MOK023 or MOK124 at 0, 24, 48, 72 and 168 h post-infection (hpi) and analysed for differentially expressed (DE) genes in response to each strain.

Results

In response to MOK023, 1278, 2278, 1986 and 1750 DE genes were found at 24, 48, 72 and 168 hpi, respectively, while 2293, 1979, 1428 and 1544 DE genes were found in response to MOK124 at those time points. Genes involved in milk production (CSN1, CSN10, CSN1S2, CSN2, a-LACTA and PRLR) were downregulated in response to both strains, with a more pronounced decrease in the MOK124 group. Immune response pathways such as NF-κB and TNF signalling were overrepresented in response to both strains at 24 hpi. These immune pathways continued to be overrepresented in the MOK023 group at 48 and 72 hpi, while the Hippo signalling, extracellular matrix interaction (ECM) and tight junction pathways were overrepresented in the MOK124 group between 48 and 168 hpi. Cellular composition analysis demonstrated that a neutrophil response was predominant in response to MOK124, while M1 macrophages were the main milk cell type post-infection in the MOK023 group.

Conclusions

A switch from immune response pathways to pathways involved in maintaining the integrity of the epithelial cell layer was observed in the MOK124 group from 48 hpi, which coincided with the occurrence of clinical signs in the infected animals. The higher proportion of M1 macrophages in the MOK023 group and lack of substantial neutrophil recruitment in response to MOK023 may indicate immune evasion by this strain. The results of this study highlight that the somatic cell transcriptomic response to S. aureus is dependent on the genotype of the infecting strain.
Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review
Authors: Koh Justin Jek-Kahn , Malczewska Madeline , Doyle-Waters Mary M. , Moe Jessica
Published: November 2021

Background

Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19 pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome in the ED.

Methods

We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED.

Results

We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED.

Conclusions

Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings should be evaluated in the ED setting before routine use.
Analysis of multivariate longitudinal substance use outcomes using multivariate mixed cumulative logit model
Authors: Lin Xiaolei , Mermelstein Robin , Hedeker Donald
Published: November 2021

Background

Longitudinal assessments of usage are often conducted for multiple substances (e.g., cigarettes, alcohol and marijuana) and research interests are often focused on the inter-substance association. We propose a multivariate longitudinal modeling approach for jointly analyzing the ordinal multivariate substance use data.

Methods

We describe how the binary random slope logistic regression model can be extended to the multi-category ordinal outcomes. We also describe how the proportional odds assumption can be relaxed by allowing differential covariate effects on different cumulative logits for multiple outcomes. Data are analyzed from a P01 study that evaluates the usage levels of cigarettes, alcohol and marijuana repeatedly across 8 measurement waves during 7 consecutive years.

Results

1263 subjects participated in the study with informed consent, among whom 56.6% are females. Males and females show significant differences in terms of the time trend for substance use. Specifically, males showed steeper trends on cigarette and marijuana use over time compared to females, while less so for alcohol. For all three substances, age effects appear to be different for different cumulative logits, indicating the violation of proportional odds assumption.

Conclusions

The multivariate mixed cumulative logit model offers the most flexibility and allows one to examine the inter-substance association when proportional odds assumption is violated.
Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study
Authors: Batte Anthony , Murphy Kristin J. , Namazzi Ruth , Co Katrina , Opoka Robert O. , Ssenkusu John M. , John Chandy C. , Conroy Andrea L.
Published: November 2021

Background

Acute kidney injury (AKI) disproportionately affects individuals in low-and middle-income countries (LMIC). However, LMIC—particularly countries in sub-Saharan Africa— are under-represented in global AKI research. A critical barrier in diagnosing AKI is access to reliable serum creatinine results. We evaluated the utility of a point-of-care test to measure creatinine and diagnose AKI in Ugandan children with malaria.

Methods

Paired admission creatinine was assessed in 539 Ugandan children 6 months to 4 years of age hospitalized with severe malaria based on blood smear or rapid diagnostic test. Creatinine levels were measured using isotope dilution mass spectrometry (IDMS)-traceable methods. The reference creatinine was measured using the modified Jaffe method by a certified laboratory and the point-of-care testing was conducted using an i-STAT blood analyzer (i-STAT1, with and without adjustment for the partial pressure of carbon dioxide). AKI was defined and staged using the Kidney Disease: Improving Global Outcomes criteria.

Results

The mean age of children was 2.1 years, and 21.6% of children were stunted. Mortality was 7.6% in-hospital. Over the entire range of measured creatinine values (<0.20mg/dL-8.4mg/dL), the correlation between the reference creatinine and adjusted and unadjusted point-of-care creatinine was high with R2 values of 0.95 and 0.93 respectively; however, the correlation was significantly lower in children with creatinine values <1mg/dL (R2 of 0.44 between the reference and adjusted and unadjusted i-STAT creatinine). The prevalence of AKI was 45.5% using the reference creatinine, and 27.1 and 32.3% using the unadjusted and adjusted point-of-care creatinine values, respectively. There was a step-wise increase in mortality across AKI stages, and all methods were strongly associated with mortality (p<0.0001 for all). AKI defined using the reference creatinine measure was the most sensitive to predict mortality with a sensitivity of 85.4% compared to 70.7 and 63.4% with the adjusted and unadjusted point-of-care creatinine values, respectively.

Conclusions

Point-of-care assessment of creatinine in lean Ugandan children <4 years of age underestimated creatinine and AKI compared to the clinical reference. Additional studies are needed to evaluate other biomarkers of AKI in LMIC to ensure equitable access to AKI diagnostics globally.
The viral expression and immune status in human cancers and insights into novel biomarkers of immunotherapy
Authors: Chen Siyuan , Lai Hongyan , Zhao Jingjing , Chen Bing , Li Yan , Li Yuchen , Li Qin , Zheng Qiupeng , Huang Shenglin , Zhu Xiaodong
Published: November 2021

Background

Viral infections are prevalent in human cancers and they have great diagnostic and theranostic values in clinical practice. Recently, their potential of shaping the tumor immune microenvironment (TIME) has been related to the immunotherapy of human cancers. However, the landscape of viral expressions and immune status in human cancers remains incompletely understood.

Methods

We developed a next-generation sequencing (NGS)-based pipeline to detect viral sequences from the whole transcriptome and used machine learning algorithms to classify different TIME subtypes.

Results

We revealed a pan-cancer landscape of viral expressions in human cancers where 9 types of viruses were detected in 744 tumors of 25 cancer types. Viral infections showed different tissue tendencies and expression levels. Multi-omics analyses further revealed their distinct impacts on genomic, transcriptomic and immune responses. Epstein-Barr virus (EBV)-infected stomach adenocarcinoma (STAD) and Human Papillomavirus (HPV)-infected head and neck squamous cell carcinoma (HNSC) showed decreased genomic variations, significantly altered gene expressions, and effectively triggered anti-viral immune responses. We identified three TIME subtypes, in which the “Immune-Stimulation” subtype might be the promising candidate for immunotherapy. EBV-infected STAD and HPV-infected HNSC showed a higher frequency of the “Immune-Stimulation” subtype. Finally, we constructed the eVIIS pipeline to simultaneously evaluate viral infection and immune status in external datasets.

Conclusions

Viral infections are prevalent in human cancers and have distinct influences on hosts. EBV and HPV infections combined with the TIME subtype could be promising biomarkers of immunotherapy in STAD and HNSC, respectively. The eVIIS pipeline could be a practical tool to facilitate clinical practice and relevant studies.
A cross-sectional, exploratory survey on health-relevant free-time activities and body mass index in preschool children in urban and rural settings of Austria
Authors: Robatsch J. , Voitl P. , Diesner-Treiber Susanne C.
Published: November 2021

Background

The increasing prevalence of obesity is among the most relevant healthcare issues in Europe. The number of overweight people rises due to lifestyle changes, increased sitting activities, and less physical activity. Prevention in early childhood is paramount to stop this alarming trend.

Aim

This study primarily aimed to evaluate the average time children (3-5 years) from rural and urban Austrian regions spent engaging in physical activity and sedentary behaviors in their free-time. Additionally, we investigated the potential correlation between duration and habits of free-time activity or place of residence and age- and sex-specific body mass index (BMI). The potential impact of socio-economic factors on BMI was examined.

Methods

Urban (Vienna) and rural (Carinthia) regions of Austria were chosen for this observational cross-sectional study. Preschool children (n=130) attending nurseries in these regions were included. Weight and height were measured and BMI calculated. Free-time activity and socio-economic data were asked using a self-administered questionnaire. Data on sedentary behavior time (sedentary activity and media consumption) and physical activity time (defined as organized or spontaneous exercise) were analyzed using non-parametric tests.

Results

Preschool children spent approximately as many hours of their free-time engaged in physical activity as in sedentary behaviors. Time trend in media consumption amounts to one-third of the cumulative time spent engaging in sedentary behaviors. Preschoolers from the urban area spent fewer hours practicing organized exercise and more in sedentary behaviors than peers in the rural area. In the selected areas, 7 % of preschoolers were overweight, 3.9 % were obese. BMI was not associated with free-time activities but showed a trendwise negative correlation with organized exercise. A positive correlation of age and organized exercise was observed but not with physical activity per se.

Conclusions

Our results confirm the necessity of preventive interventions among Austrian preschoolers and lead to a better understanding of their free-time activities. Further investigations with larger study populations are needed to promote effective childhood obesity prevention and examine the differences regarding obesity prevalence and leisure-time activity between rural and urban areas.
Psychiatric symptoms and moral injury among US healthcare workers in the COVID-19 era
Authors: Amsalem Doron , Lazarov Amit , Markowitz John C. , Naiman Aliza , Smith Thomas E. , Dixon Lisa B. , Neria Yuval
Published: November 2021

Background

Emerging cross-sectional data indicate that healthcare workers (HCWs) in the COVID-19 era face particular mental health risks. Moral injury – a betrayal of one’s values and beliefs, is a potential concern for HCWs who witness the devastating impact of acute COVID-19 illness while too often feeling helpless to respond. This study longitudinally examined rates of depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and moral injury among United States HCWs in the COVID-19 era. We anticipated finding high levels of clinical symptoms and moral injury that would remain stable over time. We also expected to find positive correlations between clinical symptoms and moral injury.

Methods

This three-wave study assessed clinical symptoms and moral injury among 350 HCWs at baseline, 30, and 90 days between September and December 2020. Anxiety, depression, PTSD, and moral injury were measured using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Primary Care PTSD Screen (PC-PTSD), and Moral Injury Events Scale (MIES).

Results

Of the 350 HCWs, 72% reported probable anxiety, depression, and/or PTSD disorders at baseline, 62% at day 30, and 64% at day 90. High level of moral injury was associated with a range of psychopathology including suicidal ideation, especially among healthcare workers self-reporting COVID-19 exposure.

Conclusions

Findings demonstrate broad, persisting, and diverse mental health consequences of the COVID-19 pandemic among United States HCWs. This study is the first to longitudinally examine the relationships between moral injury and psychopathology among HCWs, emphasizing the need to increase HCWs’ access to mental healthcare.
Premenstrual dysphoric disorder and childhood maltreatment, adulthood stressful life events and depression among Lebanese university students: a structural equation modeling approach
Authors: Younes Yorgo , Hallit Souheil , Obeid Sahar
Published: November 2021

Background

Premenstrual Syndrome (PMS) is a cyclic sequence of physical and behavioral symptoms that arise in the second half of the menstrual cycle. The extreme type of PMS is Premenstrual Dysphoric Disorder (PMDD). The current study aims at examining 1) the effects of childhood maltreatment and current life’s stressful events on PMDD, and 2) the mediating role of depression in these associations among Lebanese university female students.

Methods

This cross-sectional study was conducted between February and March 2021 during the COVID-19 pandemic. Lebanese students were recruited using a snowball technique from all national universities in Lebanon via an auto-administrated online survey. Structural equation modeling was performed to examine the structural relationship between childhood maltreatment and life’s stressful events, depression and PMDD.

Results

Higher life’s stressful events (Beta = 0.18; p < 0.001), physical (Beta = 0.19; p < 0.001), sexual (Beta = 0.18; p < 0.001) and psychological (Beta = 0.33; p < 0.001) abuse were significantly associated with higher depression. Moreover, higher sexual (Beta = 0.11; p = 0.021) and psychological (Beta = 0.11; p = 0.040) abuse and higher depression (Beta = 0.37; p < 0.001) were significantly associated with higher PMDD. The indirect relationships between psychological abuse/sexual abuse, depression and PMDD showed that depression mediated the association between both psychological (Beta = 0.22; p = 0.001) and sexual (Beta = 0.38; p = 0.004) abuse and PMDD.

Conclusion

This work presents a unique analysis using the structural equation model that enlightens the effect of childhood maltreatment, particularly sexual and psychological abuse on PMMD symptoms, with depression playing the role of a mediating factor. It would be interesting to test, in future studies, whether there are other mediating factors besides depression that could be indirect indicators of PMDD.
Implementing food bank and healthcare partnerships: a pilot study of perspectives from charitable food systems in Texas
Authors: Poulos Natalie S. , Nehme Eileen K. , O’Neil Molly M. , Mandell Dorothy J.
Published: November 2021

Background

Partnerships between charitable food systems and healthcare systems have been forming across the country to support individuals and families experiencing food insecurity, yet little research has focused on these partnerships, particularly from a food bank perspective. The objective of this exploratory pilot study was to identify implementation challenges and facilitators of charitable food system and healthcare partnerships from the food bank perspective.

Method

Texas food banks with existing food bank/healthcare partnerships were identify through website review and support from Feeding Texas. Interview questions were tailored to each interview, but all focused on identify program components of the food bank/healthcare partnership and implementation barriers/facilitators of the partnership. In total, six interviews were conducted with food bank/healthcare partnership leaders (n = 4) and charitable food system experts (n = 2) about their experiences of working with food bank/healthcare partnerships. All interviews were completed via Zoom and took between 30 and 60 min to completed. Detailed notes were taking during each interview, and immediately discussed with the complete research time to formulate broad implementation themes.

Results

Interviews suggest unique implementation challenges exist at all levels of food bank/healthcare partnerships including the partnership, program, and system levels. Partnership-level implementation challenges focused on issues of partnership scale and data collection, sharing, and analysis. Program-level implementation challenges focused on food and produce expectations. Structural-level implementation challenges included issues of food safety, subsidized food regulations, and patient privacy. Implementation facilitators included leadership support, mission compatibility/organizational readiness, food insecurity training, and identify of partnership champions.

Conclusions

This study adds to the growing interest in food bank/healthcare partnership as it highlights unique implementation challenges and facilitators for cross-sector partnerships between healthcare systems and community-based charitable food systems. Ultimately, we believe that collaborative discussion among leaders of charitable food systems and healthcare systems is needed to overcome outlined implementation challenges to better facilitate sustainable, equitable implementation of food bank/healthcare partnerships.
Evaluation of the quality of COVID-19 prevention and control by a novel comprehensive evaluation model in a tertiary general hospital: a prospective observational study
Authors: Zhong Xiao , Wang Dong-Li , Mo Lan-Fang , Zhang Wen , Xiao Li-Hua , Wu Xiang-Lin , Chen Yan-Wei , Yang Lei
Published: November 2021

Background

Prevention and control (P&C) of Corona Virus Disease 2019 (COVID-19) is still a critical task in most countries and regions. However, there are many single evaluation indexes to assess the quality of COVID-19 P&C. It is necessary to synthesize the single evaluation indexes reasonably to obtain the overall evaluation results.

Methods

This study was divided into three steps. Step 1: In February 2020, the improved Delphi method was used to establish the quality evaluation indexes system for COVID-19 P&C. Step 2: in March 2020, the CRITIC method was used to adjust the Order Relation Analysis (G1) method to obtain the subjective and objective (S&O) combination weights. The comprehensive evaluation value was obtained using the weighted Efficacy Coefficient (EC) method, weighted TOPSIS method, weighted rank-sum ratio (RSR) method, and weighted Grey Relationship Analysis (GRA) method. Finally, the linear normalization method was used to synthesize the evaluation values of different evaluation methods. Step 3: From April 2020 to May 2021, this evaluation method was used to monitor and assess COVID-19 P&C quality in critical departments prospectively. The results were reported to the departments monthly.

Result

A quality evaluation indexes system for COVID-19 P&C was established. Kendall’s consistency test shows that the four evaluation method had good consistency (χ2 = 43.429, P<0.001, Kendall’s consistency coefficient = 0.835). The Spearman correlation test showed that the correlation between the combined evaluation results and the original method was statistically significant(P < 0.001). According to the Mann-Kendall test, from March 2020 to May 2021, the mean value of COVID-19 P&C quality in all critical departments showed an upward trend (P < 0.01).

Conclusions

The combined comprehensive evaluation method based on the S&O combined weight was more scientific and comprehensive than the single weighting and evaluation methods. In addition, monitoring and feedback of COVID-19 P&C quality were helpful for the improvement of P&C quality.
Predictors of late presentation and advanced HIV disease among people living with HIV in Oman (2000–2019)
Authors: Elgalib Ali , Shah Samir , Al-Wahaibi Adil , Al-Habsi Zeyana , Al-Fouri Maha , Lau Richard , Al-Kindi Hanan , Al-Rawahi Bader , Al-Abri Seif
Published: November 2021

Background

The aim of this study was to determine the proportions and predictors of late presentation (LP) and advanced HIV disease (AD) in Oman. LP and AD were defined as presenting with a baseline CD4 count of < 350 and < 200 cells/mm3, respectively.

Methods

We conducted a retrospective database analysis of the National HIV Surveillance System to identify Omani people (≥ 13 years old) who were diagnosed with HIV in the period between January 2000 and December 2019 and had a documented baseline CD4 cell count. We calculated the rates and trend over time of LP and AD. A logistic regression was carried out to determine the predictors of LP and AD.

Results

A total of 1418 patients, who were diagnosed with HIV in the period from January 2000 to December 2019, were included; 71% were male and 66% were heterosexuals. The median (IQR) age at diagnosis was 33 (25–39) years. Overall, 71% (95% CI: 68–73) and 46% (95% CI: 44–49) of patients had LP and AD at presentation, respectively. The LP percentage decreased from 76% in 2000–2004 to 69% in 2015–2019; AD percentage decreased from 57 to 46% over the same period. The proportions of men with LP and AD were higher than women (74% vs. 62 and 50% vs. 36%, respectively). The percentages of persons with LP among people aged 13–24, 25–49, and ≥ 50 years were 65, 71, and 84%, respectively. The proportions of persons with AD among people aged 13–24, 25–49, and ≥ 50 years were 39, 46, and 65%, respectively. Logistic regression showed that male sex, older age, having an “unknown” HIV risk factor, and living outside Muscat were independent predictors of AD. Male sex also independently predicted LP.

Conclusions

This analysis indicates that a significant proportion of new HIV cases in Oman continue to present late. This study identified patient subgroups at greatest risk of late HIV diagnosis such as men and older people. Targeted interventions and greater efforts to scale up HIV testing services in Oman are needed.
The role of food security in increasing adolescent girls’ agency towards sexual risk taking: qualitative findings from an income generating agricultural intervention in southwestern Kenya
Authors: Onono Maricianah A. , Odhiambo Gladys , Sheira Lila , Conroy Amy , Neilands Torsten B. , Bukusi Elizabeth A. , Weiser Sheri D.
Published: November 2021

Background

Food insecurity is an important underlying driver of HIV risk and vulnerability among adolescents in sub-Saharan Africa. In this region, adolescents account for 80% of all new HIV infections. The primary purpose of this analysis is to understand perceived mechanisms for how a multisectoral agricultural intervention influenced sexual risk taking among HIV-affected adolescents in southwestern Kenya.

Methods

We conducted semi-structured, individual interviews with 34 adolescent-caregiver dyads who were participants in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in the Shamba Maisha trial (NCT01548599), a multi-sectoral agricultural and microfinance intervention. Interviews were audiotaped, transcribed, translated, and analyzed using framework and interpretive description analysis methods.

Results

Adolescents receiving the Shamba Maisha intervention described no longer needing to engage in transactional sex or have multiple concurrent sexual partners as a way to meet their basic needs, including food. Key mechanisms for these effects include greater sexual agency among adolescent girls, and increased confidence and self-efficacy in overcoming existing reciprocity norms and sexual relationship power inequity; as well as staying in school. The intervention also increased caregiver confidence in talking about adolescent sexual reproductive health issues. In contrast, driven primarily by the need for food and basic needs, girls in the control arms described engaging in transactional sex, having multiple sexual partners, being unable to focus in school, getting pregnant or becoming HIV infected.

Conclusion

These findings emphasize the need to address food insecurity as a part of structural interventions targeting adolescent HIV risk in low-resource countries. We recommend that future interventions build upon the Shamba Maisha model by combining sustainable agricultural production, with household level interventions that deliberately target gender norms that contribute to unequal power dynamics.
Over-the-counter analgesics use is associated with pain and psychological distress among adolescents: a mixed effects approach in cross-sectional survey data from Norway
Authors: Jonassen Rune , Hilland Eva , Harmer Catherine J. , Abebe Dawit S. , Bergem Anne Kristine , Skarstein Siv
Published: November 2021

Background

Over-the-counter analgesics (OTCA) such as Paracetamol and Ibuprofen are frequently used by adolescents, and the route of administration and access at home allows unsupervised use. Psychological distress and pain occur simultaneously and are more common among females than among males. There is a dynamic interplay between on-label pain indications and psychological distress, and frequent OTCA use or misuse can exacerbate symptoms. No studies have to date provided an overview of frequent OTCA use in a larger population-based study. The current study used survey data to explore associations between and the relative predictive value of on-label pain indication and measures of psychological distress, together with sex differences for weekly OTCA use.

Methods

This study included 349,528 adolescents aged 13–19. The data was collected annually between January 2014 and December 2018 as part of the Norwegian Young Data survey. Performance analysis was conducted to explore the relative roles and associations between on-label pain indication and psychological distress in weekly OTCA use. A mixed-effects logistic regression model was used to explore the unique contributions from four domains of on-label pain indication and psychological distress as measured by a combined measure of anxiety and depression (HSCL-10) and peer-bullying involvement as victims or bullies.

Results

Thirty percent of females and 13 % of males use OTCA weekly. Headache is the strongest on-label pain predictor of weekly OTCA use, followed by abdominal pain. Depression and anxiety are the strongest psychological predictor of weekly OTCA use, and higher symptom levels and being female increase the strength of this association. Anxiety and depression also predict weekly OTCA use after controlling for physiological pain.

Conclusions

Sex, pain and anxiety and depression are inter-correlated and strong predictors of frequent OTCA use. Frequent OTCA use in the context of psychological distress may be a form of self-medication that can exacerbate symptoms and decrease psychosocial function. Longitudinal studies that explore causal trajectories between frequent on-label OTCA use and psychological distress are required. OTCA use among adolescents, and particularly among females, with anxiety and depression should be administered with caution and closely monitored.
Project SUMS (scaling up of mental health in schools): design and methods for a pragmatic, cluster randomised waitlist-controlled trial on integrated school mental health intervention for adolescents
Authors: Amudhan Senthil , Jangam Kavita , Mani Kalaivani , Murugappan Nithya Poornima , Sharma Eesha , Mahapatra Payel , Burma Ajit Deo , Tiwari Hemant Kumar , Ashok Ashi , Vaggar Sangappa , Rao Girish Nagaraja
Published: November 2021

Background

There is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health.

Methods

Schools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools.

Discussion

This is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India.

Trial registration

Clinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. (ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums).
A qualitative examination of substance use service needs among people who use drugs (PWUD) with treatment and service experience in Ontario, Canada
Authors: Russell Cayley , Ali Farihah , Nafeh Frishta , LeBlanc Sean , Imtiaz Sameer , Elton-Marshall Tara , Rehm Jürgen
Published: November 2021

Background

People who use drugs (PWUD) often have complex health and social support needs related to substance use, yet face numerous barriers to service access, resulting in unmet treatment needs and a corresponding gap in treatment. While initiatives to scale up substance use services for PWUD in Canada - and Ontario - have been undertaken, these have excluded PWUD’ perspectives, and their needs have largely been defined by other actors. As end-users of services, PWUD’ perspectives are vital to understanding what services are required, and whether existent services are adequate, appropriate and effective. Thus, the present study aimed to elicit in-depth knowledge from PWUD with lived experience of accessing services to better understand their unmet treatment and service needs, towards closing the service and treatment gap in Ontario.

Methods

This qualitative study included one-on-one interviews conducted with a cohort of n = 45 adult PWUD with substance use and treatment experience in Ontario, Canada. Participants were recruited from substance use services based on ConnexOntario’s directory of all provincial addiction services, as well as by word-of-mouth. Questions focused on participants’ experiences and perspectives on substance use services towards understanding their service needs. Data underwent an inductive thematic analysis based on key themes that emerged.

Results

Participants commonly engaged in polysubstance use, and identified a number of unmet substance use service needs including complex factors within the current service system that influenced access to available programs. Specifically, participants suggested the need to address stigmatization and system fragmentation, increase service provision and capacity, and scale up specific services and related supports such as harm reduction, counseling, treatment, and housing.

Conclusions

This study identified PWUD’ needs in relation to substance use service provision in Ontario, Canada, and highlighted important areas for policy change and program planning and implementation. Concrete recommendations include the development of a government-funded, low-barrier, comprehensive and integrated service delivery and referral models that include PWUD as collaborators and program facilitators to ensure that services are as accessible, effective, and cohesive as possible. Results from this study can be used to enhance provincial substance use treatment and service provision.
Describing the indirect impact of COVID-19 on healthcare utilisation using syndromic surveillance systems
Authors: Ferraro Claire F. , Findlater Lucy , Morbey Roger , Hughes Helen E. , Harcourt Sally , Hughes Thomas C. , Elliot Alex J. , Oliver Isabel , Smith Gillian E.
Published: November 2021

Background

Since the end of January 2020, the coronavirus (COVID-19) pandemic has been responsible for a global health crisis. In England a number of non-pharmaceutical interventions have been introduced throughout the pandemic, including guidelines on healthcare attendance (for example, promoting remote consultations), increased handwashing and social distancing. These interventions are likely to have impacted the incidence of non–COVID-19 conditions as well as healthcare seeking behaviour. Syndromic Surveillance Systems offer the ability to monitor trends in healthcare usage over time.

Methods

This study describes the indirect impact of COVID-19 on healthcare utilisation using a range of syndromic indicators including eye conditions, mumps, fractures, herpes zoster and cardiac conditions. Data from the syndromic surveillance systems monitored by Public Health England were used to describe the number of contacts with NHS 111, general practitioner (GP) In Hours (GPIH) and Out-of-Hours (GPOOH), Ambulance and Emergency Department (ED) services over comparable periods before and during the pandemic.

Results

The peak pandemic period in 2020 (weeks 13–20), compared to the same period in 2019, displayed on average a 12% increase in NHS 111 calls, an 11% decrease in GPOOH consultations, and a 49% decrease in ED attendances. In the GP In Hours system, conjunctivitis consultations decreased by 64% and mumps consultations by 31%. There was a 49% reduction in attendance at EDs for fractures, and there was no longer any weekend increase in ED fracture attendances, with similar attendance patterns observed across each day of the week. There was a decrease in the number of ED attendances with diagnoses of myocardial ischaemia.

Conclusion

The COVID-19 pandemic drastically impacted healthcare utilisation for non-COVID-19 conditions, due to a combination of a probable decrease in incidence of certain conditions and changes in healthcare seeking behaviour. Syndromic surveillance has a valuable role in describing and understanding these trends.
Risk factors at five-year survival in grade 3 breast cancer: a retrospective observational study of the New Zealand population
Authors: Meharry Sharita , Borotkanics Robert , Ramsaroop Reena , Merien Fabrice
Published: November 2021

Background

Breast cancer is the most common cancer in New Zealand, with approximately 3000 new registrations annually, affecting one in nine women and resulting in more than 600 deaths. This study analyzed data of patients with selected prognostic factors of Nottingham grade 3 tumors over a specified five-year period. The study aimed to identify factors that result in differential survival in the female, New Zealand population.

Method

This is an observational, retrospective cohort study of prospectively collected data from New Zealand Breast Cancer Register. The selected period of 1st January 2011 to 31st, December 2015 allowed a consistent overlap for a national five-year data of grade 3 breast cancer in New Zealand. Mortality was carried out using univariate Fine-Gray competing risk statistical models.

Results

This study showed that women in the older age group (> 70 years) had higher five-year mortality risk (HR: 1.7, 95% CI: 0.9–3.0, p = 0.053). Hormonal receptor analysis showed that ER positive, PR negative, and ER negative, PR negative subjects were at increased risk (HR = 3.5, 95% CI 2.3–5.4, p < 0.001) and (HR = 2.6, 95% CI, 1.8–3.9, p < 0.001) respectively. Molecular subtypes Triple Negative Breast Cancer and Luminal B subjects were at increased risk (HR = 3.0, 95% CI, 1.8–4.7, p < 0.001 and (HR = 3.3, 95% CI, 1.7–6.3, p < 0.001) respectively. HER2 enriched subjects were at a higher, but not significant, risk of five-year mortality compared to luminal A (HR = 1.6, 95% CI, 0.8–3.0, p = 0.10). NZ Europeans were at increased risk (HR = 1.7, 95% CI, 0.8–3.2, p = 0.11), with the highest Cumulative Incidence Function CIF, the largest proportion of HER2 enriched and TNBC across ethnicities.; however, Pacific Islanders experienced the highest HER2 CIF.

Conclusion

The survival rates for grade 3 breast cancer vary across the selected prognostic factors and ethnicity. The results of this study make an initial contribution to the understanding of grade 3 breast cancer in the New Zealand population.
The utilization of simulated patients for teaching and learning in the pharmacy curriculum: exploring pharmacy students’ and recent alumni’s perceptions using mixed-methods approach
Authors: ElGeed Hager , El Hajj Maguy Saffouh , Ali Raja , Awaisu Ahmed
Published: November 2021

Background

The use of simulated patients (SPs) is considered a significant resource for teaching and assessing clinical and communication skills in health professional education. We conducted this study to explore pharmacy students’ perspective towards the utilization of SPs in Qatar and to identify areas that require improvement.

Methods

An explanatory sequential mixed-methods design was used among students and recent graduates of the College of Pharmacy at Qatar University (QU-CPH). First, their perspectives toward the current utilization of SPs at QU-CPH was explored using a quantitative cross-sectional study design. Following this, we conducted six focus group discussions based on the analysis of the questionnaire results. The findings of the two phases were interpreted through integration of the quantitative and qualitative phases.

Results

The majority of the participants (> 90%) reported that interactions with SPs are important in building good communication and counseling skills during professional skills course activities. Similarly, most of the respondents (80%) indicated that interactions with SPs prepared them to apply the clinical skills gained during professional skills and patient assessment sessions in real-life. In addition, they reported that interactions with SPs during competency-based assessments were good experiences. The participants disagreed with the notion that interaction with SPs of opposite gender was uncomfortable for them. Themes identified from the focus groups include: interactions with trained SPs compared to faculty SPs, standardization and consistency of SPs’ roles, communication and language barriers, simulations of real-life case scenarios, SPs’ competence and preparedness, psychological impact associated with interaction with SPs, proposed strategies for improving the SP program. Identified areas for improvement include the need for strengthening the SP training and orientation program as well as the SP selection criteria.

Conclusion

This study showed a positive impact of the utilization of SPs in this pharmacy curriculum as perceived by students and alumni. However, the SP program needs to be optimized in terms of the training and orientation of SPs.