bluuebunny/crossref_metadata_2025 huggingface dataset:
Policy rules and political polarization
Authors: Hefeker Carsten , Neugart Michael
Published: August 2024

We develop a model to analyze policymakers' incentives to install policy rules, comparing the case of no rule with a binding and a contingent policy rule that allows policymakers to suspend the rule in response to a sufficiently large shock. First, abstracting from political polarization, we show that the choice of the policy rule depends on policymakers' policy targets. Depending on the policy target, there is an unambiguous ranking going from a no‐rule regime to a contingent rule to a binding rule. Next, allowing for political polarization, the incentive to install the different types of rules changes with political polarization between different policymakers and their probability of being elected into office. Increasing political polarization when there is a sufficiently high election probability for policymakers with a high policy target increases the preference for more binding policy rules. It also leads to stricter rules in a contingent rule regime.
Rural–urban disparities in cardiovascular disease mortality vary by poverty level and region
Authors: Sekkarie Ahlia , Woodruff Rebecca C. , Casper Michele , Thompson‐Paul Angela M , Vaughan Adam S.
Published: August 2024

Purpose

To examine rural and urban disparities in cardiovascular disease (CVD) death rates by poverty level and region.

Methods

Using 2021 county‐level population and mortality data for CVD deaths listed as the underlying cause among adults aged 35–64 years, we calculated age‐standardized CVD death rates and rate ratios (RR) for 4 categories of counties: high‐poverty rural, high‐poverty urban, low‐poverty rural, and low‐poverty urban (referent). Results are presented nationally and by US Census region.

Findings

Rural and urban disparities in CVD mortality varied markedly by poverty and region. Nationally, the CVD death rate was highest among high‐poverty rural areas (191 deaths per 100,000, RR: 1.76, CI: 1.73–1.78). By region, Southern high‐poverty rural areas had the highest CVD death rate (256 deaths per 100,000) and largest disparity relative to low‐poverty urban areas (RR: 2.05; CI: 2.01–2.09). In the Midwest and West, CVD death rates among high‐poverty areas were higher than low‐poverty areas, regardless of rural or urban classification.

Conclusions

Results reinforce the importance of prioritizing high‐poverty rural areas, especially in the South, in efforts to reduce CVD mortality. These efforts may need to consider socioeconomic conditions and region, in addition to rural and urban disparities.
Can Preferences for Redistribution Explain the Impact of Austerity on Political Participation? Evidence from the UK
Authors: Justino Patricia , Martorano Bruno , Metzger Laura
Published: August 2024

Many European countries introduced austerity policies to control rising debt in the wake of the Great Recession of the late 2000s. Recent research suggests that austerity fuelled political polarization, instability, and populism in Europe. However, the motives behind citizens' responses to austerity are not well understood. Using the case of the UK, we study whether preferences for redistribution drive the effect of austerity on political participation in the form of voting, appealing for reform with the government, and protesting. Based on experimental and observational data, we show that individual exposure to austerity increases voting and appealing for reform with the government but not protesting, and changes people's preferences for redistribution. The experimental data show that being exposed to austerity is associated with a 0.128 and a 0.096 unit increase in voting and appealing for reform, respectively. The data also show that exposure to austerity increases preferences for taxing higher incomes and spending more on welfare and social security. This change in preferences explains between 8% and 11% of the effect of exposure to austerity on political participation.
Metal‐free functionalized carbon nitride as a photocatalyst driven by sunlight for acetal synthesis and selective regeneration of NAD(P)H cofactor
Authors: Mishra Shaifali , Yadav Rajesh K. , Mishra Dinesh K. , Kumar Kuldeep , Gupta Navneet Kumar , Singh Kuldeep , Gothwal Satyaveer , Baeg Jin‐OoK
Published: August 2024

Nicotinamide Adenine Dinucleotide Phosphate (NAD(P)H) plays an important role in numerous biologically significant redox reactions. The photochemical restoration of its oxidized form (NAD(P)+) under physiological conditions is intriguing in the context of integrated photo and catalysis. Herein, we report the functionalized graphitic carbon‐based solar light active photocatalyst by doping boron and fluorine in the native graphitic carbon nitride (GCN) (nonfunctionalized) for the regeneration of enzymatically visible light active coenzyme and in photo‐acetalization reactions. The metal‐free functionalized photocatalyst systems such as BFGCN‐x leads to higher yield NADH and NADPH regeneration. They are also capable of catalyzing acetal reactions in the absence of any Lewis and Bronsted acids. The current research endeavor provides the advancement and the application of functionalized GCN‐based photocatalysts for NADH (61.89%), NADPH (59.84%) regeneration, and photo‐acetalization reactions.
The impact of acculturation and personal discrimination on Latinx public opinion
Authors: Pleites‐Hernandez Giovanny D. , Shrode J. Robert
Published: August 2024

Objective

To what extent does personal experience with discrimination moderate the effect of acculturation on policy preferences amongst Latinxs? Work on acculturation shows that acculturation is an important predictor of policy preferences in Latinxs—with more acculturated individuals generally holding attitudes closer to their non‐Latinx Anglo counterparts than less acculturated Latinxs. Substantively less is known about how personal experience with discrimination influences the extent to which Latinxs adopt more mainstream policy stances. This rings even more true for attitudes outside of immigration, an area that has been the primary focus of scholars for a long time. We begin that exploration here.

Methods

We use the 2020 Collaborative Multi‐Racial Post‐Election Survey to explore the moderating role of personal discrimination on acculturation and, by extension, police preferences. We do so in a variety of policy areas, including abortion, affirmative action, climate change, police reform, and immigration, among others.

Results

We find that personal experience with discrimination inhibits the expected attitudinal convergence of Latinxs with their Anglo counterparts on a number of issues.

Conclusion

The findings here demonstrate that migrant experiences need to be accounted for when trying to understand the political incorporation of the Latinx population in the United States.
Representations of shifted quantum affine algebras and cluster algebras I: The simply laced case
Authors: Geiss Christof , Hernandez David , Leclerc Bernard
Published: August 2024

We introduce a family of cluster algebras of infinite rank associated with root systems of type , , . We show that suitable completions of these cluster algebras are isomorphic to the Grothendieck rings of the categories of the corresponding shifted quantum affine algebras. The cluster variables of a class of distinguished initial seeds are certain formal power series defined by E. Frenkel and the second author, which satisfy a system of functional relations called ‐system. We conjecture that all cluster monomials are classes of simple objects of . In the final section, we show that these cluster algebras contain infinitely many cluster subalgebras isomorphic to the coordinate ring of the open double Bruhat cell of the corresponding simple simply connected algebraic group. This explains the similarity between ‐system relations and certain generalized minor identities discovered by Fomin and Zelevinsky.
Blood flow restriction: The acute effects of body tilting and reduced gravity analogues on limb occlusion pressure
Authors: Swain Patrick , Caplan Nick , Hughes Luke
Published: August 2024

Blood flow restriction (BFR) has been identified as a potential countermeasure to mitigate physiological deconditioning during spaceflight. Guidelines recommend that tourniquet pressure be prescribed relative to limb occlusion pressure (LOP); however, it is unclear whether body tilting or reduced gravity analogues influence LOP. We examined LOP at the leg and arm during supine bedrest and bodyweight suspension (BWS) at 6° head‐down tilt (HDT), horizontal (0°), and 9.5° head‐up tilt (HUT) positions. Twenty‐seven adults (age, 26 ± 5 years; height, 1.75 ± 0.08 m; body mass, 73 ± 12 kg) completed all tilts during bedrest. A subgroup (n = 15) additionally completed the tilts during BWS. In each position, LOP was measured twice in the leg and arm using the Delfi Personalized Tourniquet System after 5 min of rest and again after a further 5 min. The LOP at the leg increased significantly from 6° HDT to 9.5° HUT in bedrest and BWS by 9–15 mmHg (Cohen's d = 0.7–1.0). Leg LOP was significantly higher during BWS at horizontal and 9.5° HUT postures relative to the same angles during bedrest by 8 mmHg (Cohen's d = 0.6). Arm LOP remained unchanged between body tilts and analogues. Intraclass correlation coefficients for LOP measurements taken after an initial and subsequent 5 min rest period in all conditions ranged between 0.91–0.95 (leg) and 0.83–0.96 (arm). It is advised that LOP be measured before the application of a vascular occlusion in the same body tilt/setting to which it is applied to minimize discrepancies between the actual and prescribed tourniquet pressure.
Steady-State Rotary Periodic Solutions of Rigid and Flexible Mechanisms With Large Spatial Rotations Using the Incremental Harmonic Balance Method for Differential-Algebraic Equations
Authors: Ju R. , Yang S. M. , Ren H. , Fan W. , Ni R. C. , Gu P.
Published: August 2024

Steady-state rotary periodic responses of mechanisms lead to stress cycling in flexible structures or connecting joints, which in turn can result in structural fatigue. A general approach is developed to study rotary periodic solutions of rigid and flexible mechanisms with large spatial rotations based on the incremental harmonic balance (IHB) method. The challenge in analyzing such dynamic systems emanates from the noncommutativity of the spatial rotation and the nonsuperposition nature of the rotational coordinates. The generally used rotational coordinates, such as Euler angles, cannot be expanded into Fourier series, which prevents direct usage of the IHB method. To overcome the problem, the natural coordinates method and absolute nodal coordinate formulation (ANCF) are used herein for the dynamic modeling of the rigid and flexible bodies, respectively. The absolute positions and gradients are used as generalized coordinates, and rotational coordinates are naturally avoided. Equations of motions of the system are differential-algebraic equations (DAEs), and they are solved by the IHB method to obtain the steady-state rotary periodic solutions. The effectiveness of the proposed approach is verified by the simulation of rigid and flexible examples with spatial rotations. The approach is general and robust, and it has the potential to be further extended for other extensive multibody dynamic systems.
Sensor-Embedded Tissue Phantom for Magnetic Resonance Elastography Mechanical Failure Testing
Authors: Hong Charles P. , Vinodkumar Tarun , Nieves-Vazquez Heriberto Andres , Ueda Jun
Published: August 2024

Magnetic Resonance Elastography (MRE) is an imaging technique capable of quantifying the stiffness of in vivo tissue by applying and imaging shear waves produced by an MRE actuator. Poor image acquisition may result from the MRE procedure if there is insufficient contact between the MRE actuator and the patient. An experimental test setup outside of the clinic will aid in reducing the number of failed acquisitions by enabling the development of advanced actuators and actuator systems. This work presents the development and testing of a sensor-embedded tissue phantom setup paired with a support vector machine (SVM) classifier to automate the MRE actuator testing process. MRE actuation of soft tissue is simulated by utilizing a voice coil positioning stage that interfaces with a phantom. To capture the resulting vibrations, accelerometers are embedded inside the phantom. Subsequent characterization experiments verify the functionality of the developed phantoms to capture wave propagation. A secondary investigation was performed by utilizing the developed setup to collect acceleration measurements at varying contact distances. We provide an overview of feature analysis and selection to develop SVM models for contact detection. Multiple SVM models are reported, and the best-performing model displayed almost perfect validation (94.53%) and test (90.91%) accuracy. The pairing of sensor-embedded phantom with an SVM for detection demonstrates potential improvements to the MRE actuator developmental process by automatically assessing contact-related issues prior to clinical testing.
Effects of a live versus heat-inactivated probiotic
Bifidobacterium
spp in preterm infants: a randomised clinical trial
Authors: Athalye-Jape Gayatri , Esvaran Meera , Patole Sanjay , Nathan Elizabeth A , Doherty Dorota A , Sim Edric , Chandrasekaran Lakshmi , Kok Chooi , Schuster Stephan , Conway Patricia
Published: August 2024

Background

Heat-inactivated probiotics (HPs) may provide an effective alternative to live probiotics (P) by avoiding their risks (eg, probiotic sepsis) while retaining the benefits. We assessed the safety and efficacy of a HP in very preterm (VP: gestation <32 weeks) infants.

Methods

VP infants were randomly allocated to receive a HP or P mixture (
Bifidobacterium breve
M-16V,
Bifidobacterium longum
subsp.
infantis
M-63,
Bifidobacterium longum
subsp.
longum
BB536, total 3×10
9 
CFU/day) assuring blinding. Primary outcome was faecal calprotectin (FCP) levels were compared after 3 weeks of supplementation. Secondary outcomes included faecal microbiota and short chain fatty acid (SCFA) levels.

Results

86 VP infants were randomised to HP or P group (n=43 each). Total FCP and SCFA were comparable between HP and P groups within 7 days (T1) and between day 21 and 28 (T2) after supplementation. At T2, median (range) FCP was 75 (8–563) in the HP group and 80 (21–277) in the P group (p=0.71). Propionate was significantly raised in both groups, while butyrate was significantly raised in the HP group (all p<0.01). Bacterial richness and diversity increased but was comparable between HP and P (p>0.05). Beta diversity showed similar community structures in both groups (all p>0.05). Changes in faecal Actinobacteria, Bacteroidetes and Bifidobacteriacae levels were comparable in both groups at T1 and T2. There was no probiotic sepsis.

Conclusions

HP was safe and showed no significant difference in FCP as compared with a live probiotic. Adequately powered trials are needed to assess the effects of HP on clinically significant outcomes in preterm infants.

Trial registration number

ACTRN12618000489291.
Voices of experience: insights from Dutch parents on periviability guidelines and personalisation
Authors: De Proost Lien , de Boer Angret , Verhagen Eduard , Hogeveen Marije , Geurtzen Rosa , Verweij E J T (Joanne)
Published: August 2024

Objective

To investigate the perspectives of experienced parents regarding guidelines and personalisation for managing imminent extremely premature births (22–26 weeks gestational age (GA)) . The study examined four scenarios: no guideline, a guideline based on GA, a guideline based on GA plus other factors and a guideline based on a calculated prognosis.

Design

Nineteen semistructured qualitative interviews were conducted with Dutch parents who experienced (imminent) extremely premature births between 23+5 and 26+2 weeks of gestation. Diversity was aimed for through purposive sampling from a database created prior to this study. Four of the parents opted for palliative care. Among the parents who chose intensive care, in nine cases the infant(s) survived.

Results

All participants acknowledged the necessity of having a periviability guideline because it would provide valuable decision-making support, and counterbalance decisions solely based on parental instincts to save their infant. Parents preferred guidelines that considered multiple prognostic factors beyond GA alone, without overwhelming parents with information, because more information would not necessarily make the decision easier for parents. Personalisation was defined by parents mainly as ‘being seen and heard’ and associated with building relationships with healthcare professionals and effective communication between them and professionals.

Conclusions

The results underscore the importance of having a periviability guideline including multiple prognostic factors to assist parents in making decisions at the limit of viability, and the importance of a personalised care approach to meet parental needs in the context of imminent extremely preterm birth.
Granular cell tumour of the breast
Authors: James Nicole Ellen , Guan Yue , Musa Fawaz , Cuffolo Giulio
Published: August 2024

Granular cell tumours (GCT) of the breast have similar clinical and radiological features to breast carcinomas. We present a case of a female patient with a tender, palpable lump, and associated skin changes. Imaging of the lesion was suspicious of malignancy. Initial histological examination showed uniform sheets of polygonal cells with abundant granular cytoplasm, and follow-up immunohistochemistry showed strongly positive staining of tumour cells with S100 and CD68, confirming the diagnosis of GCT. Wide local excision with complete resection margins was performed as a curative treatment for this lesion. This case report highlights the importance of considering GCTs in the differential diagnoses of breast lesions suspicious of malignancy and emphasises the necessity of accurate diagnosis of GCT for proper treatment.
Diagnosis of dysferlinopathy masked by a superimposed hypothyroid myopathy
Authors: Benn Kieran W , Bhalala Oneil G , Day Timothy J , French Christopher R
Published: August 2024

We report a woman in her 30s with dysferlinopathy whose diagnosis was masked by superimposed hypothyroidism. Laboratory studies revealed Hashimoto’s thyroiditis and markedly raised serum creatine kinase (CK of 6255 U/L; reference range 0–170 U/L). Electromyography, nerve conduction studies and MRI of the hip and thigh were consistent with a diagnosis of hypothyroid myopathy, but thyroxine failed to resolve her clinical presentation or normalise the CK level. Immunohistochemical (IHC) staining of right vastus lateralis muscle biopsy revealed the selective absence of dysferlin leading to a diagnosis of limb-girdle muscular dystrophy type IIB. Dysferlinopathy is a challenging diagnosis due to a varied clinical picture and low incidence. Misdiagnosis is common even in uncomplicated presentations, and this case outlines the need for routine inclusion of IHC and a low threshold for genetic testing, in the workup of complex myopathy.
Rate and risk factors of kidney function decline among South Asians with type 2 diabetes: analysis of the CARRS Trial
Authors: Singh Kavita , Kondal Dimple , Jagannathan Ram , Ali Mohammed K , Prabhakaran Dorairaj , Narayan K M Venkat , Anand Shuchi , Tandon Nikhil
Published: August 2024

Introduction

People with diabetes are at risk of developing chronic kidney disease. However, limited data are available to quantify their risk of kidney function decline in South Asia. This study evaluates the rate and predictors of kidney function decline among people with type 2 diabetes in South Asia.

Research design and methods

We analyzed data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Trial to quantify the rate of decline in estimated glomerular filtration rate (eGFR) in people with type 2 diabetes (n=1146) over 2.5 years of follow-up. The CARRS Trial evaluated a multicomponent intervention of decision-supported electronic health records and non-physician care coordinator to improve diabetes management at 10 diabetes clinics in India and Pakistan. We used linear mixed models to estimate eGFR slope among all participants and tested the association of eGFR slope with demographic, disease-related, and self-care parameters, accounting for randomization and site.

Results

The mean age of participants was 54.2 years, with a median duration of diabetes of 7.0 years (IQR: 3.0 - 12.0) and median CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) eGFR of 83.6 (IQR: 67.7 to 97.9) mL/min/1.73 m2. The overall mean eGFR slope was −1.33/mL/min/1.73 m2/year. There were no differences in the eGFR slope by treatment assignment to intervention versus usual care. In the adjusted regression model, pre-existing diabetic retinopathy (slope difference: −2.11; 95% CI: −3.45 to –0.77), previous cardiovascular disease (−1.93; 95% CI: −3.45 to –0.40), and statins use (−0.87; 95% CI: −1.65 to –0.10) were associated with faster eGFR decline.

Conclusions

People with diabetes receiving care at urban diabetes clinics in South Asia experienced annual eGFR decline at two times higher rate than that reported from other contemporary international diabetes cohorts. Risk factors for faster decline were similar to those previously established, and thus care delivery models must put an additional emphasis on kidney protective therapies among subgroups with microvascular and macrovascular diabetes complications.

Trial registration number

NCT01212328.
Determinants of translating routine health information system data into action in Mozambique: a qualitative study
Authors: Kawakyu Nami , Inguane Celso , Fernandes Quinhas , Gremu Artur , Floriano Florencia , Manaca Nelia , Ramiro Isaías , Felimone Priscilla , Alfandega Jeremias Armindo Azevedo , Isidor Xavier Alcides , Missage Santana Mário , Wagenaar Bradley H , Sherr Kenneth , Gimbel Sarah
Published: August 2024

Introduction

Routine health information systems (RHISs) are an essential source of data to inform decisions and actions around health facility performance, but RHIS data use is often limited in low and middle-income country contexts. Determinants that influence RHIS data-informed decisions and actions are not well understood, and few studies have explored the relationship between RHIS data-informed decisions and actions.

Methods

This qualitative thematic analysis study explored the determinants and characteristics of successful RHIS data-informed actions at the health facility level in Mozambique and which determinants were influenced by the Integrated District Evidence to Action (IDEAs) strategy. Two rounds of qualitative data were collected in 2019 and 2020 through 27 in-depth interviews and 7 focus group discussions with provincial, district and health facility-level managers and frontline health workers who participated in the IDEAs enhanced audit and feedback strategy. The Performance of Routine Information System Management-Act framework guided the development of the data collection tools and thematic analysis.

Results

Key behavioural determinants of translating RHIS data into action included health worker understanding and awareness of health facility performance indicators coupled with health worker sense of ownership and responsibility to improve health facility performance. Supervision, on-the-job support and availability of financial and human resources were highlighted as essential organisational determinants in the development and implementation of action plans. The forum to regularly meet as a group to review, discuss and monitor health facility performance was emphasised as a critical determinant by study participants.

Conclusion

Future data-to-action interventions and research should consider contextually feasible ways to support health facility and district managers to hold regular meetings to review, discuss and monitor health facility performance as a way to promote translation of RHIS data to action.
User perceptions and utilisation of features of an AI-enabled workplace digital mental wellness platform ‘mindline at work’
Authors: Yoon Sungwon , Goh Hendra , Low Xinyi Casuarine , Weng Janice Huiqin , Heaukulani Creighton
Published: August 2024

Background

The working population encounters unique work-related stressors. Despite these challenges, accessibility to mental healthcare remains limited. Digital technology-enabled mental wellness tools can offer much-needed access to mental healthcare. However, existing literature has given limited attention to their relevance and user engagement, particularly for the working population.

Aim

This study aims to assess user perceptions and feature utilisation ofmindline at work, a nationally developed AI-enabled digital platform designed to improve mental wellness in the working population.

Methods

This study adopted a mixed-methods design comprising a survey (n=399) and semistructured interviews (n=40) with office-based working adults. Participants were asked to usemindline at workfor 4 weeks. We collected data about utilisation of the platform features, intention for sustained use and perceptions of specific features.

Results

Participants under 5 years of work experience reported lower utilisation of multimedia resources but higher utilisation of emotion self-assessment tools and the AI chatbot compared with their counterparts (p<0.001). The platform received a moderate level of satisfaction (57%) and positive intention for sustained use (58%). Participants regardedmindline at workas an ‘essential’ safeguard against workplace stress, valuing its secure and non-judgmental space and user anonymity. However, they wanted greater institutional support for office workers’ mental wellness to enhance the uptake. The AI chatbot was perceived as useful for self-reflection and problem-solving, despite limited maturity.

Conclusion

Identifying the unique benefits of specific features for different segments of working adults can foster a personalised user experience and promote mental well-being. Increasing workplace awareness is essential for platform adoption.
All cause and cause specific mortality in 15-24-year-olds in Denmark 2010 to 2022: nationwide study of socioeconomic predictors
Authors: Kruckow Sofie , Tolstrup Janne S
Published: August 2024

Objective

To assess inequalities in all cause and cause specific mortality in young people and if there are differences across gender and age groups.

Design

Nationwide cohort study of socioeconomic predictors.

Setting

Denmark, 1 January 2010 to 31 December 2022

Participants

All Danes of ages 15 to 24 years during the study period summing to a total of 9 314 807 person years and 2297 deaths. Participant and parental information were linked to obtain information on socioeconomic background to investigate differences in parents' educational level, employment status, and family's disposable income, using annually updated nationwide registers.

Main outcome measures

All cause and cause specific mortality including natural deaths (ie, medical conditions and diseases) and unnatural deaths (accidents, suicides, and homicides). Poisson regression was used to calculate incidence rate ratios and 95% confidence intervals (CI).

Results

Overall mortality rate was 24.7 (95% CI 23.7 to 25.7) and higher for men (33.2 (31.5 to 34.8)) compared with women (15.8 (14.6 to 16.9)). All cause and cause specific mortality were higher in financially disadvantaged groups compared with more affluent groups, and consistently so for all three measures of socioeconomic position. Results generally reflected a dose dependent association showing a higher mortality with lower levels of socioeconomic position. For instance, incidence rate ratios of all cause mortality related to parents' education was 2.3 (95% CI 2.0 to 2.7) for elementary level, 1.5 (1.3 to 1.6) for low, and 1.3 (1.1 to 1.4) for medium level as compared with high level. For deaths, incidence rate ratios of elementary education level compared with the most well educated group were 2.2 (1.5 to 3.2) for natural causes, 3.3 (2.5 to 4.4) for accidents, 1.6 (1.2 to 2.2) for suicides, and 3.1 (0.8 to 12) for homicides. Associations were similar in strata of men and women and by age group (15-17v18-24 years). Mortality in young men was considerably higher than in young women for all of the causes.

Conclusion

Young people from disadvantaged backgrounds have a markedly higher mortality from all causes than those from more affluent families. The socioeconomic position of their parents was associated with premature mortality in a dose dependent manner meaning that this effect is not only a concern for marginalised groups. Public health attention should be directed to respond to these inequities by strengthening advocacy for adolescent health, ensuring focus on adolescents in health policies and strategies, using the response to adolescent health as an indicator of equity, and prioritising research into the underlying mechanisms linking socioeconomic position in adolescence and mortality.
Deep brain stimulation for Parkinson’s disease: systematic review with meta-analysis and trial sequential analysis
Authors: Petersen Johanne Juul , Kamp Caroline Barkholt , Faltermeier Pascal , Juul Sophie , Løkkegaard Annemette , Gluud Christian , Jakobsen Janus C
Published: August 2024

Objective

To assess the benefits and harms of deep brain stimulation for Parkinson’s disease.

Design

Systematic review with meta-analysis and trial sequential analysis.

Data sources

Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), and other sources, from inception to 9 May 2023.

Eligibility criteria for selecting studies

Randomised clinical trials of deep brain stimulation with antiparkinsonian drug treatment use versus antiparkinsonian drugs only (primary comparison, seven trials) for Parkinson’s disease. Other comparisons were deep brain stimulation versus surgery with sham stimulation (three trials) and versus resective surgery (two trials).

Results

Primary outcomes were all cause mortality, serious adverse events, and disease specific symptoms. In seven trials, 1125 participants were randomised to receive deep brain stimulation with antiparkinsonian drugs versus antiparkinsonian drugs only. All results had a high risk of bias and the certainty of the evidence was very low for all primary outcomes. Information size was insufficient for assessing all cause mortality (risk ratio 2.69, 95% confidence interval (CI) 0.79 to 9.24; I2=0.0%; τ2=0.00; P=0.12; four trials). Meta-analysis showed that deep brain stimulation increased the risk of serious adverse events (risk ratio 2.36, 95% CI 1.37 to 4.09; I2=73.7%; τ2=0.24; P<0.01; six trials) mainly because of an increased risk of perioperative complications, such as cerebral haemorrhages and postoperative confusion, and hardware related events, such as infection at the stimulator site, dislocation of the device, or reoperations. Meta-analyses indicated that deep brain stimulation might reduce some symptoms specific to Parkinson's disease, but assessment of disease specific symptoms in these trials had methodological limitations, including not reporting overall symptom scores.

Conclusions

The certainty of evidence was very low for all primary outcomes, and based on the included evidence, the beneficial effects were questionable because of methodological limitations. Compared with only antiparkinsonian drug treatment, deep brain stimulation with antiparkinsonian drugs seemed to increase the risk of serious adverse events, mainly because of perioperative complications and hardware related events. Conducting randomised clinical trials of adequate methodological quality to effectively evaluate the effects of deep brain stimulation is crucial.

Systematic review registration

PROSPERO CRD42022306556.
COVID-19’s impact on food environment in the Indian states of Telangana, Maharashtra, West Bengal, Tamil Nadu and Punjab: a descriptive qualitative study to build further research in India’s food environment resilience building
Authors: Johnsen Jørgen Torgerstuen , Rafaela Lima do Vale Marjorie , Bhangaonkar Rekha , Nyaga Wanja , Ayyad Sally , Ray Sumantra
Published: August 2024

Background and aim

Globally, COVID-19 has had a profound impact on food and nutrition security. This paper aims to gather the perspective from Transforming India’s Green Revolution by Research and Empowerment for Sustainable food Supplies (TIGR2ESS) Flagship Project 6 (FP-6) team on the impact of COVID-19 on the food systems in India. The responses collected will be used for further research projects after TIGR2ESS ends in March 2022.

Method

Members of the TIGR2ESS FP-6 team in India were invited to complete an online open-ended questionnaire with 21 questions exploring the impact of the COVID-19 pandemic on food systems and environments in India. The questionnaire and data analysis were guided by the food environment framework developed by Turneret aland the adaptations proposed by the United Nations System Standing Committee on Nutrition. Discussions and organisation of codes under the respective themes and subthemes were held online using the virtual platform Miro. 35 individual codes and 65 subcodes were agreed on. Responses were collated and analysed using the template with support from NVivo software and synthesised the relevant themes under Turneret al’s framework.

Results

The organisation representatives from TIGR2ESS FP-6 (n=16) captured the perceived impact of the COVID-19 on food systems and the environment from the Indian states of Maharashtra, Punjab, Tamil Nadu, Telangana and West Bengal. Negative disruptions were caused by the COVID-19 restrictions across all the themes affecting food actors and consumers. Myths and misconception on dietary intake were reported across the state affecting especially the consumption of poultry. Positive aspects such as home cooking and awareness around healthy food emerged.

Conclusion

Potential research areas were identified and involve the effects of supply chain resilience buidling, farmers selling their produce directly to consumer and the revival of local and traditional food’s impact on diets, understanding the harm for consumers by implementing restrictions, how indigenous and local food may impact peoples’ diets, how to build on the encouragement of healthy home cooking during the pandemic, investigate the negative and positive effects of digital environments during the pandemic and dispelling myths and misconception while advocating for healthy diets.
Which factors affect post-transfer gaps in follow-up care? A qualitative study of the insights of healthcare providers in Sweden and Belgium
Authors: Skogby Sandra , Goossens Eva , Johansson Bengt , Moons Philip , Bratt Ewa-Lena
Published: August 2024

Background

Young people with congenital heart disease (CHD) are frequently affected by discontinued follow-up when transferring from paediatric to adult care. Identified predictors for discontinuation include mostly patient-related factors, and further knowledge of hospital and healthcare system factors is needed.

Aim

This study aims to explore patient-related, hospital-related and healthcare system-related factors affecting continued follow-up care after transfer, as perceived and experienced by paediatric cardiology and adult CHD (ACHD) healthcare providers (HCPs) in Sweden and Belgium.

Methods

This descriptive qualitative study included individual interviews with cardiologists, nurses and administrative staff, subjected to qualitative content analysis. A total of 30 HCPs from 13 specialist care outpatient clinics at 8 different centres in Sweden and Belgium were interviewed. HCPs were included if they had direct contact with patients and had at least 1 year of work experience.

Findings

The findings illuminate three main categories of factors perceived by HCPs to affect continued follow-up care after transfer, including ‘care structure’, ‘care processes’ and ‘patient characteristics and circumstances’. Success was described as multifactorial, emphasising processes and structures of care, with a focus on collaboration, organisation, joint responsibility, resources, care relationships and transitional care interventions. Few differences appeared between paediatric and ACHD HCPs and between Swedish and Belgian HCPs.

Conclusion

HCPs perceived factors on patient, hospital and healthcare system levels to influence continued follow-up. Process-related and structure-related aspects of care were perceived as more influential than individual patient characteristics. Hence, future research on discontinued follow-up care should focus on process-related and structure-related aspects of care delivery.
Learning environment and its relationship with quality of life and burn-out among undergraduate medical students in Pakistan: a cross-sectional study
Authors: Shahzad Saadia , Wajid Gohar
Published: August 2024

Objective

This study was conducted to determine the association between the learning environment, quality of life (QoL), and burn-out among students from selected public-sector and private-sector medical colleges in Lahore, Pakistan.

Design

This was a cross-sectional study.

Setting

The study was conducted at six public-sector and private-sector medical colleges, selected randomly from a total of 21 medical colleges located in Lahore, Pakistan.

Participants

Study participants included a sample of 3400 undergraduate medical students from both genders and from all five classes of the programme. Data were collected using Google Forms after necessary ethical approval. The learning environment was the predictor variable, and QoL and burn-out were the outcome variables. The learning environment was measured by the Johns Hopkins Learning Environment Scale (JHLES). Students’ QoL was measured using a validated linear analogue self-assessment question adopted from larger inventories for QoL, and student burn-out was measured using a validated single-item linear question (adopted from the Maslach Burnout Inventory) to measure the two parts (emotional exhaustion and depersonalisation) of burn-out. All undergraduate medical students currently enrolled in the graduation programme were included. Students in allied health sciences, dentistry and nursing programmes were excluded.

Results

The overall JHLES Score was 82.0 for men and 81.6 for women. The mean QoL score was 7.0±1.9; for burn-out, that is, emotional exhaustion and depersonalisation, the mean scores were 21.0±13.8 and 17.5±9.0, respectively. A significant correlation (p<0.05) was found between the overall JHLES mean score and QoL, emotional exhaustion, and depersonalisation. The logistic regression model showed that the odds of higher QoL were less with a higher level of class Adjusted Odd Ratio (AOR) 0.679 (0.51–0.91) (p<0.01) and with a higher JHLES Score AOR 0.9 (0.89–0.91) p<0.0001.

Conclusion

Students were less likely to have a high QoL, even if they rated JHLES score on a higher side. They were more likely to have higher emotional exhaustion with successive higher class and residential status (boarders). Also, students had minimally high depersonalisation even when they rated higher scores on the JHLES scale. Based on this study, policies can be developed to improve students’ well-being. Further studies are suggested postpandemic, with a bigger scope of intrinsic and extrinsic influencing factors for QoL and burn-out associated with the learning environment.
Risk perception regarding social determinants of health among women with breast cancer in Iran: a qualitative study
Authors: Ashari Arezou , SoleimanvandiAzar Neda , Nojomi Marzieh , Ranjbar Hadi , Mirzaei Kamran , Nafissi Nahid , Roohravan Benis Mahshid , Rampisheh Zahra
Published: August 2024

Objectives

Breast cancer is the most common cancer among women all around the world. Today, in addition to factors including hormones and genetics that are involved in the occurrence of breast cancer, special attention is paid to the role of social and non-medical determinants of health. This study aims to explore the perception of Social Determinants of Health (SDH) in women with breast cancer.

Design

Qualitative study design with a conventional thematic analysis approach.

Setting

The study was conducted in Tehran, Iran, between December 2021 and February 2023.

Participants

19 women with breast cancer were selected through purposeful and snowball sampling with maximum variation. Sampling continued until data saturation was reached.

Primary and secondary outcome measures

The study categorised the extracted codes from interviews into three main categories and 12 subcategories related to SDH in women with breast cancer.

Results

The study identified factors such as personal and family health records, health behaviours and lifestyles and medical screening and follow-up as key themes in the perception of SDH among women with breast cancer. The main categories were also categorised into 12 subcategories, ‘including family history’, ‘environmental factors’, ‘hormonal and medicinal changes’, ‘metaphysical factors’, ‘traditional medicine-related factors’, ‘stress’, ‘body weight’, ‘physical activity’, ‘nutrition’, ‘smoking and tobacco use’, ‘screening’, ‘self-examination’ and ‘barriers to medical follow-up’. ‘Near the telecommunications tower’, ‘Improper use of supplements’, ‘Being subjected to the evil eye regularly’, ‘Eating cold nature foods’, ‘Breast weight’ and ‘Being ashamed of the doctor’ were some examples of the codes.

Conclusions

Participants identified a number of environmental, personal and cultural factors as contributing to the disease. Woman’s screening behaviours were influenced by factors such as fear of disease and death, disbelief in getting sick and shame, depending on cultural context. The study suggests the need for further research to explore the impact of these factors on screening behaviours and outcomes in different cultural contexts.
Measuring the frequency and determinants of COVID-19 prevention behaviours: a cross-sectional assessment of large-scale programmes in seven countries, late 2020
Authors: Bick Sarah , White Sian , Hasund Thorseth Astrid , Friedrich Max N D , Gavin Ian , Prasad Gautam Om , Dreibelbis Robert
Published: August 2024

Objectives

This multicountry analysis aimed to assess the prevalence of key hygiene prevention behaviours and their determinants, associated with international non-governmental organisation (WaterAid) hygiene behaviour change programmes for COVID-19 prevention. The goal of this analysis is to inform future outbreak preparedness and pandemic response in low and middle-income countries.

Design

Cross-sectional study.

Setting

Households in seven countries where WaterAid implemented a first-phase COVID-19 response programme in 2020 (Ethiopia, Ghana, Nepal, Nigeria, Rwanda, Tanzania and Zambia).

Participants

3033 adults (1469 men and 1564 women, alternately sampled from one household to the next to maintain gender balance) in specific programme areas (211 villages) surveyed between October and November 2020.

Primary outcome measures

Self-reported primary outcomes were: a composite measure of HWWS for prevention of respiratory infection/COVID-19 (total of 5 key moments); respondent increased HWWS behaviour after the COVID-19 pandemic; respondent always wears a mask in public spaces; respondent always practices physical distancing in public spaces.

Results

Most respondents (80%) reported increasing their handwashing behaviour after the pandemic, but practice of HWWS at COVID-19-specific prevention moments was low. Mask wearing (58%) and physical distancing (29%) varied substantially between countries. Determinants of key behaviours were identified, including age and socioeconomic status, perceived norms, self-regulation and the motive of protecting others. Incidence rate ratios or odds ratios and 95% CIs for a range of psychosocial determinants for each of the four primary outcomes are reported.

Conclusions

These findings highlight that leveraging behaviour-specific emotional drivers and norms, reducing common barriers and promoting targeted messages about specific behaviours and actions individuals can take to reduce risk are necessary to support large-scale behaviour change. Learning from the COVID-19 response to more effectively integrate novel behaviours into existing health promotion will be vital for disease prevention and outbreak resilience.
Diagnostic performance of an albuminuria point-of-care test in screening for chronic kidney disease among young people living with HIV in Uganda: a cross-sectional study
Authors: Nasuuna Esther M , Kalyesubula Robert , Tomlinson Laurie A , Castelnuovo Barbara , Okello Emmy , Dziva Chikwari Chido , Weiss Helen A
Published: August 2024

Objectives

The main aim was to determine the diagnostic performance of an albuminuria point-of-care test (POC) for diagnosis of chronic kidney disease among young people living with HIV (YPLHIV) in Uganda.

Design

We conducted a cross-sectional study comparing the diagnostic performance of MicroalbuPHAN (Erba Lachema, Czech Republic), an albuminuria POC test against the laboratory-measured albumin and creatinine as the reference standard.

Setting

The study was set in seven HIV clinics in Kampala, Uganda that provide antiretroviral therapy to adults and children living with HIV. The study took place from April to August 2023.

Participants

497 YPLHIV aged 10–24 years who were diagnosed with HIV before 10 years of age were randomly selected from the HIV clinics. Pregnant YPLHIV were excluded.

Procedures

Participants provided a spot urine sample that was tested for albumin and creatinine using the POC and in the laboratory and proteinuria using urine dipstick. The sensitivity, specificity, negative and positive predictive values (NPV, PPV) of the POC versus the laboratory test were calculated, and factors associated with having a positive POC test were estimated using logistic regression.

Outcome measures

The primary outcome was a diagnosis of albuminuria defined as an albumin creatinine ratio above 30 mg/g.

Results

Of the 497 participants enrolled, 278 (55.9%) were female and 331 (66.8%) were aged 10–17 years. The POC test had a sensitivity of 74.5% (95% CI 70.6% to 78.4%) and specificity of 68.1% (95% CI 63.9% to 72.3%). The PPV was 21.5% (95% CI 17.8% to 25.1%) and the NPV was 95.8% (95% CI 94.0% to 97.6%), with an accuracy of 68.8%. There was strong evidence that a positive POC test was associated with having proteinuria (OR 2.82; 95% CI 1.89 to 4.22, p<0.001); body mass index <19.5 (OR 1.69 95% CI 1.17 to 2.45, p=0.005) and being male (OR 1.48; 95% CI 1.02 to 2.14, p=0.04).

Conclusions

The albuminuria POC test had low sensitivity and specificity. However, it can be used to exclude kidney disease given its high NPV. It should be validated against the 24-hour urinary excretion rate to further determine its diagnostic performance.