bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychosocial Support in Emergency Settings
Authors: Loughry Maryanne
Published: September 2024

The integration of psychosocial support into emergency responses is a recent development. In the 1990s, the need to address the mental health and psychosocial well-being of individuals and communities affected by emergencies became clear following the breakup of the former Yugoslavia (1991–1992) and the Rwandan genocide (1994). Prior to this, mental health in emergencies was primarily addressed in clinical settings. However, the humanitarian field was divided between the medical sector, which asserted that psychiatric clinical intervention was best, and many nonmedical actors, who preferred a person-in-environment approach. The need for consensus resulted in the Inter-Agency Standing Committee (IASC) working group’s establishment of the framework of Mental Health and Psychosocial Support (MHPSS), which combined both approaches. The IASC Guidelines on MHPSS in Emergency Settings, published in 2007, are widely recognized as explaining how best to administer psychosocial support in emergencies. This ended decades of tension between mental health and psychosocial experts in emergency and humanitarian settings.
Brown, William Neal
Authors: Edwards Richard L.
Published: September 2024

William Neal Brown (1919–2009) was a social work educator who began his professional career after service in World War II as a Tuskegee Airman. The son of an African American father and Native American mother, in 1956 he became the first black professor at Rutgers University, where he taught in the School of Social Work for the next 33 years.
Regulation of maize root growth by local phosphorus availability, sucrose metabolism, and partitioning
Authors: Sun Yan , Zhang Jinting , Li Weiwei , Xu Zikai , Wang Siji , Zhao Manli , Shen Jianbo , Cheng Lingyun
Published: September 2024

Background and Aims

Understanding how maize roots proliferate in phosphorus (P)-rich soil patches is critical for improving nutrient acquisition and crop productivity. This study explores the mechanisms of root adaptation to heterogeneous P availability, focusing on sucrose metabolism and the role of local P signals.

Methods

A split-root system with chambers of differing inorganic phosphate (Pi) concentrations (0 and 500 μm) was used to examine maize root responses. Various physiological and biochemical parameters, including root growth, sucrose partitioning, enzyme activities and gene expression, were measured to elucidate the underlying mechanisms.

Key Results

Root proliferation, particularly of second-order lateral roots, was markedly enhanced in P-rich patches. Sucrose was preferentially allocated to the Pi-supplied side, as confirmed by Fourier transform infrared microscopy. Sucrose content in these roots decreased, indicating active metabolism. Higher activities of cell-wall invertase and sucrose synthase were observed in the Pi-supplied roots, supporting enhanced carbohydrate utilization.

Conclusions

Local P availability triggers significant adjustments in sucrose metabolism and allocation, enhancing the sink capacity of maize roots in P-rich patches. These changes facilitate efficient lateral root proliferation and Pi utilization, highlighting the critical role of local P signals in nutrient acquisition strategies. This research provides deeper insights into the adaptive responses of maize to heterogeneous P environments, offering potential strategies for improving crop nutrient efficiency.
Inferring complex evolutionary history of the closely related East Asian wild roses in Rosa sect. Synstylae (Rosaceae) based on genomic evidence from conserved orthologues
Authors: Jeon Ji-Hyeon , Maki Masayuki , Chiang Yu-Chung , Kim Seung-Chul
Published: September 2024

Background and Aims

The section Synstylae in the genus Rosa (Rosaceae) comprises 25–36 species and includes several major progenitors of modern rose cultivars. East Asian Synstylae species have recently diverged and are closely related, but their phylogenetic relationships remain unclear. In the present study, we employed conserved orthologue set (COS) markers and genome-wide nuclear orthologues to elucidate their phylogenetic relationships and unravel their complex evolutionary history.

Methods

Utilizing eight Rosaceae COS (RosCOS) markers, we analysed a total of 137 accessions representing 15 East Asian Synstylae taxa to establish a robust phylogenetic framework and reconstruct ancestral areas. Furthermore, we constructed the species tree for eight representative species and estimated their divergence times based on 1683 genome-wide orthologues. The species tree–gene tree coalescence time comparison, Patterson’s D, f4-ratio and f-branch statistics were analysed to identify incomplete lineage sorting (ILS), genetic introgression and reticulation events using conserved orthologue data.

Key Results

RosCOS markers and genome-wide orthologues effectively resolved a robust phylogeny of East Asian Rosa sect. Synstylae. Species divergence times estimated with genome-wide orthologues indicated that East Asian Synstylae species have recently diverged, with an estimated crown age of ~2 Mya. The rampant gene tree discordance indicated the possibility of ILS and/or genetic introgression. In the section Synstylae, deeper coalescence in the gene trees compared to the species tree suggested ILS as a source of gene tree discordance. Further, Patterson’s D and f-branch statistics indicated that several lineages in the section were involved in genetic introgression.

Conclusions

We have unravelled the complex evolutionary history of East Asian Rosa sect. Synstylae, including recent species divergences, ILS and genetic introgression. Coupled with the geographical and ecological complexity of East Asia, ILS and genetic introgression may have contributed to the rapid diversification of East Asian Synstylae species by permitting adaptation to diverse environments.
The carbon footprint of a laparoscopic cholecystectomy
Authors: Comes Daan J , Bluiminck Stijn , Kooistra Emma J , de Nes Lindsey , van Workum Frans T W E , Touw Hugo , Eussen Myrthe M M , Bouvy Nicole D , Stobernack Tim , de Reuver Philip R
Published: September 2024

Lay Summary

Background

Gallbladder removal is one of the most common surgical procedures worldwide. The keyhole operation treats patients with symptomatic gallstones. This procedure uses many single-use tools and results in a lot of waste. Before we can make this operation more sustainable, we need to assess the amount of waste and CO2 emissions.

Aim

The aim of this study was to identify the types of waste and measure the CO2 emissions created by a gallbladder removal.

Method

We collected waste from 15 gallbladder operations at three hospitals. We noted the medications used and measured the surgery duration to estimate electricity consumption. We also asked all the staff how they travelled to the hospital that day.

Findings and Conclusion

The operation produces about 56.5 kg of CO2. The main sources of CO2 are single-use tools, packaging materials and disposable drapes and gowns. This study helps us understand where most CO2 is produced, so we can work on reducing it more effectively.
No Impact of Human Immunodeficiency Virus (HIV) Coinfection on Mortality in Patients With Hepatitis C Virus Infection After Sustained Virological Response
Authors: Martín-Carmona Jesica , Corma-Gómez Anaïs , Téllez Francisco , Arenga-Barrios Dolores , Serrano-Fuentes Miriam , Morano Luis , Corona-Mata Diana , Navarrete Lorite Miguel Nicolás , Vera-Méndez Francisco Jesús , Alados Juan Carlos , Palacios Rosario , de los Santos Ignacio , Geijo Paloma , Imaz Arkaitz , Merino Dolores , Reus-Bañuls Sergio Javier , Galindo Maria Jose , López-Ruz Miguel Ángel , Galera Carlos , Pineda Juan A , Macías Juan
Published: September 2024

Background

In patients with hepatitis C virus (HCV) chronic infection and advanced liver disease, the impact of human immunodeficiency virus (HIV) coinfection on the clinical outcome after sustained virological response (SVR) has not been sufficiently clarified. The aim of this study was to compare the mortality after SVR of patients bearing HCV chronic infection and advanced liver fibrosis, with and without HIV coinfection after a prolonged follow-up.

Methods

This was a prospective multicenter cohort study including individuals with HIV/HCV coinfection and patients with HCV monoinfection from Spain, fulfilling (1) liver stiffness (LS) ≥9.5 kPa before treatment, (2) SVR with a direct-acting antiviral–based regimen, and (3) LS measurement available at SVR. The main outcome was overall survival. Mortality attributable to liver disease and nonhepatic causes was also assessed.

Results

A total of 1118 patients were included, of whom 676 (60.5%) had HIV. The median (Q1–Q3) follow-up was 76 (57–83) months. After SVR, 46 (10%) HCV-monoinfected and 74 (11%) HIV/HCV-coinfected patients died. The overall mortality rate (95% CI) was 1.9 (1.6–2.2) per 100 person-years, 1.9 (1.4–2.5) per 100 person-years in patients with HCV monoinfection, and 1.8 (1.6–2.3) per 100 person-years in people with HIV. In the multivariable analysis, HIV coinfection was not associated with shorter survival (hazard ratio, .98; 95% CI, .61–1.58; P = .939).

Conclusions

In patients with HCV chronic infection and advanced fibrosis, HIV coinfection does not reduce the overall survival after SVR.

Clinical Trials Registration

Clinicaltrials.gov (NCT04460157).
Long-term prognostic characteristics of patients with clinical stage IA part-solid lung adenocarcinoma: a conditional survival analysis
Authors: Shen Xinchen , Zhao Mengmeng , Deng Jiajun , Chen Tao , Wen Jialiang , Xu Long , Huang Shenghao , Wu Junqi , Sun Weiyan , Ren Longbing , She Yunlang , Hou Likun , Chen Chang , Zhao Deping
Published: September 2024

OBJECTIVES

Despite excellent 5-year survival, there are limited data on the long-term prognostic characteristics of clinical stage IA part-solid lung adenocarcinoma. The objective was to elucidate the dynamics of prognostic characteristics through conditional survival analysis.

METHODS

Consecutive patients who underwent complete resection for clinical stage IA part-solid lung adenocarcinoma between 2011 and 2015 were retrospectively reviewed. Conditional survival is defined as the probability of surviving further y years, conditional on the patient has already survived x years. The conditional recurrence-free survival (CRFS) and conditional overall survival (COS) were analysed to evaluate prognosis over time, with conditional Cox regression analysis performed to identify time-dependent prognostic factors.

RESULTS

A total of 1539 patients were included with a median follow-up duration of 98.4 months, and 80 (5.2%) patients experienced recurrence. Among them, 20 (1.3%) recurrence cases occurred after 5 years of follow-up with 100% intrathoracic recurrence. The 5-year CRFS increased from 95.8% to 97.4%, while the 5-year COS maintained stable. Multivariable Cox analysis revealed that histologic subtype was always an independent prognostic factor for CRFS even after 5 years of follow-up, while the independent prognostic value of consolidation-to-tumour ratio, visceral pleural invasion and lymph node metastasis was observed only within 5 years. Besides, age, pathologic size and lymph node metastasis maintained independent predictive value for COS during long-term follow-up, while consolidation-to-tumour ratio was predictive for COS only within 5 years of follow-up.

CONCLUSIONS

The independent prognostic factors for clinical stage IA part-solid lung adenocarcinoma changed over time, along with gradually increasing 5-year CRFS and stable 5-year COS.
Anthropocentrism in Contemporary Chinese Dictionary: A Synergic Perspective of Critical Lexicographical Discourse Studies and Systemic Functional Linguistics
Authors: Chen Wenge
Published: September 2024

Critical Lexicographical Discourse Studies (CLDS) view the dictionary as a discourse and emphasize an ideological, ethico-political dimension to the lexicographical process. Combining CLDS with Systemic Functional Linguistics, this paper looks into how anthropocentrism is manifested linguistically in Contemporary Chinese Dictionary (Seventh Edition), the most influential authoritative general-purpose Chinese dictionary, by examining the transitivity and appraisal patterns in the definition texts concerning animals and plants. The analysis shows that animals and plants are seldom assigned agency in their own right and that the animals and plants are evaluated either positively or negatively according to whether they are useful to the human beings while their intrinsic value is ignored. In particular, animals are highlighted for their agricultural and medicinal use and plants for their medicinal and ornamental value. However, compared with its previous editions, the dictionary has shown an enhanced awareness of environmental protection by deleting the encyclopaedic information that describes the use of some rare animals’ meat, bones and fur. It is argued that, although modern general-purpose dictionaries are increasingly corpus-based and descriptive, their role in shaping social values and stances cannot be disregarded. Dictionary makers need to balance what words mean with what they can be said to mean or be allowed to mean (Moon, 2014). The study contributes to unmasking and denaturalizing the hidden ideology in colony texts such as the dictionary, enhances a critical use of dictionaries and helps develop the theory of critical lexicography and emerging ecolexicography.
Designing for Sustained Motivation: A Review of Self-Determination Theory in Behaviour Change Technologies
Authors: Alberts Lize , Lyngs Ulrik , Lukoff Kai
Published: September 2024

Recent years have seen a surge in applications and technologies aimed at motivating users to achieve personal goals and improve their wellbeing. However, these often fail to promote long-term behaviour change, and sometimes even backfire. We consider how self-determination theory (SDT), a metatheory of human motivation and wellbeing, can help explain why such technologies fail, and how they may better help users internalize the motivation behind their goals and make enduring changes in their behaviour. In this work, we systematically reviewed 15 papers in the ACM Digital Library that apply SDT to the design of behaviour change technologies (BCTs). We identified 50 suggestions for design features in BCTs, grounded in SDT, that researchers have applied to enhance user motivation. However, we find that SDT is often leveraged to optimize engagement with the technology itself rather than with the targeted behaviour change per se. When interpreted through the lens of SDT, the implication is that BCTs may fail to cultivate sustained changes in behaviour, as users’ motivation depends on their enjoyment of the intervention, which may wane over time. An underexplored opportunity remains for designers to leverage SDT to support users to internalize the ultimate goals and value of certain behaviour changes, enhancing their motivation to sustain these changes in the long term.
Integration of surface swab with optical microscopy for detection and quantification of bacterial cells from stainless-steel surfaces
Authors: Zhang Yuzhen , Gao Zili , He Lili
Published: September 2024

Swab sampling is a common method for recovering microbes on various environmental surfaces. Its successful application for a specific target depends on the proper swab method and the following detection assay. Herein, we evaluated critical factors influencing surface swab sampling, aiming to achieve the optimal detection and quantification performance of optical detection for bacterial cells on stainless-steel surfaces. Our results showed the recovery rate of Salmonella enterica (SE1045) cells from the 10 × 10 cm2 stainless-steel surface reached up to 92.71 ± 2.19% when using ammonia bicarbonate-moistened polyurethane foam swabs for gentle collection, followed by ultrasound-assisted release in NH4HCO3 solution. Among the six different foam swabs, the Puritan™ Sterile Large Foam Swab contributed the lowest background noise and highest recovery efficiency when integrated with the optical detection assay. Notably, our method exhibited a strong linear relationship (r2 = 0.9983) between the detected cell numbers and the theoretical number of SE1045 cells seeded on surfaces in the range of 104–107 Colony Forming Units (CFU), with a limit of detection of 7.2 × 104 CFU 100 cm−2. This integration was completed within 2 h, exhibiting the applicable potential in various settings.
Advances in the understanding of talaromycosis in HIV-negative patients (especially in children and patients with hematological malignancies): A comprehensive review
Authors: He Haiyang , Cai Liuyang , Lin Yusong , Zheng Fangwei , Liao Wanqing , Xue Xiaochun , Pan Weihua
Published: September 2024

Talaromyces marneffei (T. marneffei) stands out as the sole thermobiphasic fungus pathogenic to mammals, including humans, within the fungal community encompassing Ascomycota, Eurotium, Eurotiumles, Fungiaceae, and Cyanobacteria. Thriving as a saprophytic fungus in its natural habitat, it transitions into a pathogenic yeast phase at the mammalian physiological temperature of 37°C. Historically, talaromycosis has been predominantly associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), classified among the three primary opportunistic infections linked with AIDS, alongside tuberculosis and cryptococcosis. As advancements are made in HIV/AIDS treatment and control measures, the incidence of talaromycosis co-infection with HIV is declining annually, whereas the population of non-HIV-infected talaromycosis patients is steadily increasing. These patients exhibit diverse risk factors such as various types of immunodeficiency, malignant tumors, autoimmune diseases, and organ transplantation, among others. Yet, a limited number of retrospective studies have centered on the clinical characteristics and risk factors of HIV-negative talaromycosis patients, especially in children and patients with hematological malignancies, resulting in an inadequate understanding of this patient cohort. Consequently, we conducted a comprehensive review encompassing the epidemiology, pathogenesis, risk factors, clinical manifestations, diagnosis, treatment, and prognosis of HIV-negative talaromycosis patients, concluding with a prospectus of the disease’s frontier research direction. The aim is to enhance comprehension, leading to advancements in the diagnosis and treatment rates for these patients, ultimately improving their prognosis.
Predicting gravitational wave signals from BPASS white dwarf binary and black hole binary populations of a Milky Way-like galaxy model for LISA
Authors: Tang P , Eldridge J J , Meyer R , Lamberts A , Boileau G , van Zeist W G J
Published: September 2024

Galactic white dwarf binaries (WDBs) and black hole binaries (BHBs) will be gravitational wave (GW) sources for LISA. Their detection will provide insights into binary evolution and the evolution of our Galaxy through cosmic history. Here, we make predictions of the expected WDB and BHB population within our Galaxy. We combine predictions of the compact remnant binary populations expected by stellar evolution from the detailed Binary Population and Spectral Synthesis (BPASS) code, with a Milky Way analogue galaxy model from the Feedback in Realistic Environment (FIRE) simulations. We use PhenomA and legwork to simulate LISA observations. Both packages make similar predictions that on average four Galactic BHBs and 673 Galactic WDBs are above the signal-to-noise ratio (SNR) threshold of 7 after a four-year mission. We compare these predictions to earlier results using the binary star evolution (BSE) code with the same FIRE model galaxy. We find that BPASS predicts a few more LISA observable Galactic BHBs and a twentieth of the Galactic WDBs. The differences are due to the different physical assumptions that have gone into the binary evolution calculations. These results indicate that the expected population of compact binaries that LISA will detect depends very sensitively on the binary population synthesis models used and thus observations of the LISA population will provide tight constraints on our modelling of binary stars. Finally, from our synthetic populations, we have created mock LISA signals that can be used to test and refine data processing methods of the eventual LISA observations.
High-throughput single telomere analysis using DNA microarray and fluorescent in situ hybridization
Authors: Zheng Yun-Ling , Wu Xingjia , Williams Madeline , Verhulst Simon , Lin Jue , Takahashi Yusuke , Ma Jian-Xing , Wang Ying
Published: September 2024

The human telomere system is highly dynamic. Both short and long leucocyte average telomere lengths (aTL) are associated with an increased risk of cancer and early death, illustrating the complex relationship between TL and human health and the importance of assessing TL distributions with single TL analysis. A DNA microarray and telomere fluorescent in situ hybridization (DNA-array-FISH) approach was developed to measure the base-pair (bp) lengths of single telomeres. On average 32000 telomeres were measured per DNA sample with one microarray chip assaying 96 test DNA samples. Various telomere parameters, i.e. aTL and the frequency of short/long telomeres, were computed to delineate TL distribution. The intra-assay and inter-assay coefficient of variations of aTL ranged from 1.37% to 3.98%. The correlation coefficient (r) of aTL in repeated measurements ranged from 0.91 to 1.00, demonstrating high measurement precision. aTLs measured by DNA-array-FISH predicted aTLs measured by terminal restriction fragment (TRF) analysis with r ranging 0.87–0.99. A new accurate and high-throughput method has been developed to measure the bp lengths of single telomeres. The large number of single TL data provides an opportunity for an in-depth analysis of telomere dynamics and the complex relationship between telomere and age-related diseases.
The Value of Medical Chart Reviews: A Methodological Approach to Supplement Mortality Data During Pandemic Outbreaks
Authors: Boos Elizabeth M , Holtmann Maxwell , DeHovitz Jack , Tesoriero James M , Driver Redd , Gonzalez Charles J
Published: September 2024

Administrative data may provide incomplete understanding of pandemic disease impact. Medical record review–based assessments of COVID-19–related causes of death were conducted among people with diagnosed HIV in New York State, which identified more COVID-19–related causes of death than Vital Statistics, thereby offering a deeper understanding of the pandemic’s impact on this population.
Characterization of Laboratory-Confirmed Creutzfeldt-Jakob Disease From 3 Ontario Tertiary Care Centers Between 2012 and 2022: A Retrospective Cohort Study
Authors: Gaete Kayla , Dalai Soma , Cabrera Ana , Li Xena , Sheth Prameet M , Kozak Robert A , Biondi Mia J
Published: September 2024

Background

Globally, Creutzfeldt-Jakob disease (CJD) affects one in one million people annually, but there is a paucity of recent Canadian data. This study summarizes epidemiology trends and diagnostic timelines of laboratory-confirmed CJD cases in three tertiary Ontario hospitals.

Method

Using laboratory information systems, we identified 30 patients with a laboratory-confirmed CJD diagnosis between 2012 and 2022 at three major tertiary hospitals in Ontario. Retrospective chart reviews were then completed.

Results

Patients had a mean of 2.2 hospital visits (SD, 1.2) prior to being admitted for testing. The most common symptom presentations included loss of coordination (63.3%), behavioral changes (60%), progressive mobility loss (53.4%), memory loss (50.0%), and involuntary movements (50.0%). Magnetic resonance imaging findings showed potential CJD in 76.7% of cases, and 56.7% exhibited periodic sharp wave complexes characteristic of CJD on electroencephalogram. The mean duration from symptom onset to microbiologic testing was 91 days (SD, 90.7). End-point quaking-induced conversion (EP-QuIC) testing of cerebrospinal fluid was positive in 90.0% of patients, while 83.3% tested positive for 14-3-3 on enzyme-linked immunosorbent assay. Elevated cerebrospinal fluid 14-3-3 levels significantly correlated with shorter duration from symptom onset to death (R2 = 0.71, F = 19.55, P = .0022). Post-diagnosis, 46.7% of patients were discharged home, 16.6% were transferred to external palliative care or hospice facilities, and 36.7% died during admission. The mean time from symptom onset to death was 121 days (SD, 120.7), and from diagnosis to death 35 days (SD, 83.9).

Conclusions

This study highlights the importance of early CJD consideration and laboratory testing when appropriate neurologic symptoms are present.
Non-adherence to urate lowering therapy in gout after 5 years is related to poor outcomes: results from the NOR-Gout study
Authors: Uhlig Till , Karoliussen Lars F , Sexton Joe , Provan Sella A , Haavardsholm Espen A , Dalbeth Nicola , Hammer Hilde Berner
Published: September 2024

Objectives

Patients with gout need to adhere to medication over time to achieve good outcomes. We assessed self-reported adherence to medication with urate lowering therapy (ULT) 5 years after a treat-to-target intervention and studied how non-adherence was related to baseline demographic and disease variables.

Methods

Patients in the NOR-Gout observational study were included after a recent gout flare and serum urate >360 µmol/l. Patients [mean age 56.2 (S.D. 13.6), 94.5% males, 17.2% with tophi] attended tight-control visits over one year with escalating urate lowering therapy using a treat-to-target strategy. Five-year follow-up included the Medication Adherence Report Scale (MARS-5) questionnaire (range 5–25) for adherence. Flares and SUA target achievement were compared for 5-year adherence to medication.

Results

At 5 years most of the 163 patients used ULT (95.1%). MARS-5 adherence scores after 5 years were high (median 24, interquartile range 22–25). Patients in the lowest MARS-5 quartile had, compared with the highest quartile, more often a flare during the last year of follow-up (33.3% vs 9.5%, P = 0.004) and reached the 5-yr serum urate treatment target less frequently (45.2% vs 87.5%, P < 0.001). Baseline lower age (OR 0.56, 95%CI 0.39–0.79), non-European origin (OR 0.22, 95%CI 0.06–0.80), lower SF-36 mental health scores (OR 0.94, 95%CI 0.91–0.98) and less joint pain during last flare (OR 0.73, 95%CI 0.58–0.92) were independent risk factors for non-adherence to medication.

Conclusions

Patients reported high adherence to medication after 5 years. Non-adherence was related to more flares and less urate target achievement. Younger age and non-European origin were associated with non-adherence.
Immune checkpoint blockade lowers the threshold of naïve T-cell priming to drug-associated antigens in a dose-dependent fashion
Authors: Grice Sophie , Saide Katy , Farrell Liam , Wells Georgia , Betts Catherine , Hammond Sean , Naisbitt Dean J
Published: September 2024

A growing body of clinical and experimental evidence indicates that immune checkpoint blockade enhances patient susceptibility to hypersensitivity reactions to co-administered medications. In this study, we utilized an in vitro T-cell priming assay to demonstrate one of the mechanistic hypotheses on how this occurs; through lowering of the threshold in patients to elicit aberrant T-cell responses. We outline the dependency of de novo T-cell priming responses to drug-associated antigens on dose at initial exposure. Findings support the aforementioned hypothesis and offer an experimental representation of fundamental parameters at play in hypersensitivity reactions to low molecular weight compounds.
O22 MATERNAL AND FETAL OUTCOMES OF VARIOUS ANTIHYPERTENSIVE TREATMENT REGIMENS DURING PREGNANCY: INSIGHTS FROM THE CZECH NATIONAL REGISTRY 2012-2022
Authors: Vaclavik Jan , Ramik Zdenek , Jarkovsky Jiri , Pohlova Radka , Jirova Jitka , Zouharova Anna
Published: September 2024

Introduction:

Arterial hypertension affects about 5-10% of pregnancies and has detrimental effects on pregnancy outcomes in both the mother and fetus. This study aimed to analyze the outcomes of pregnancy in women treated with different antihypertensive drugs.

Methodology:

Nationwide data on all births and abortions in the period 2012-2022 in the Czech Republic were obtained from the National Registry of Reproductive Health (NRRZ) and the National Registry of Reimbursable Health Services (NRHZS). Women who had the diagnosis I10 within one year before pregnancy and were prescribed any antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09) were classified as pre-existing hypertension. Women diagnosed with O13 or I10 during pregnancy were classified as pregnancy-induced hypertension. Hypoxia in the newborn was defined as pH <7.1 or Apgar score <8 present after delivery. For all factors, univariate logistic regression was used to calculate the odds ratios (OR) of adverse outcomes.

Results:

There were a total of 1,154,648 deliveries in the 11-year period. 95,215 women (8.2%) had hypertension in pregnancy, out of these 21,094 (22.2%) were treated with antihypertensive drugs. Odds ratios for caesarean section, pre-term delivery, low birth weight, newborn hypoxia, and pre-eclampsia in women using different antihypertensive classes and drugs are shown in the Figure. The risk of maternal and fetal complications was higher with calcium channel blockers (mainly amlodipine) compared to methyldopa and beta-blockers. Among beta-blockers, bisoprolol had the most favorable safety profile. Although used in limited numbers, diuretics, verapamil, ACE-inhibitors and angiotensin receptor blockers (ARBs) appeared to be comparably safe to methyldopa. A combination of multiple antihypertensive drugs was associated with a higher risk of adverse outcomes.

Conclusion:

Bisoprolol, verapamil, and diuretics seem to have a risk of adverse maternal and fetal outcomes comparable to methyldopa. Amlodipine and multiple antihypertensive drug combinations are associated with increased risk.
O25 ARE COMMUNITY HEALTH WORKERS EFFECTIVE IN MANAGING HYPERTENSION AND DIABETES SIMULTANEOUSLY? A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Thapa Rajshree , Zaman Sojib Bin , Thrift Amanda , Mishra Shiva Raj , Zengim Ayse
Published: September 2024

Background and objective:

To evaluate and summarise the effectiveness of community health worker (CHW)-led interventions to manage risk factors for NCDs. We further assessed whether CHWs could simultaneously manage hypertension and diabetes.

Methods:

We searched six different databases for randomised controlled trials and cluster randomised trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. We used random effects models to assess the sample average mean difference between intervention and control groups. The primary outcomes for this review were net mean differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (HbA1c and fasting blood glucose), blood lipids (low-density lipoprotein (LDL) and triglycerides) and obesity (body mass index (BMI) ≥ 25 kg/m2).

Results:

Among 10,508 potential articles identified, 68 were included in the systematic review, and 43 for meta-analysis (11223 participants) after excluding studies not meeting the inclusion criteria. Interventions undertaken by CHWs were effective in reducing SBP [-2.94 mmHg (95% CI, -4.28 to -1.59); I2=73%], DBP [-1.63 mmHg (95% CI, -2.60 to -0.66); I2=81%], HbA1c% [-0.30 (95% CI, -0.45 to -0.16), I2=54%], and triglycerides [-8.32 mg/dl (95%. CI, -13.54 to -3.10)]. Greater reductions in SBP were observed in low- and middle-income countries (LMICs) than in high-income countries (HICs). No detectable difference was observed in the change in HbA1c% in LMICs (only three studies). Interventions targeting diabetes as the primary outcome not only reduced HbA1c% but were also effective in reducing SBP by -2.03 mmHg (95% CI, -3.85 to -0.21). There was no evidence that these interventions improved body mass index or LDL

Conclusions:

We demonstrate that CHW-led interventions are effective in reducing SBP, DBP, HbA1c% and triglycerides, thus reinforcing the importance of engaging CHWs in the management of NCDs. This study represents an important step towards expanding the role of CHWs in addressing multiple risk factors in LMICs and marginalised groups in HICs.

Figure 1: Effect of CHW-delivered intervention on primary and secondary outcomes of systolic blood pressure
O28 EVALUATE THE IMPACT OF STRUCTURED TRAINING COURSE ON HEALTHCARE PROVIDERS KNOWLEDGE AND AWARENESS OF LIFESTYLE MODIFICATIONS FOR HYPERTENSION MANAGEMENT
Authors: Patil Mansi , Patil Vishal
Published: September 2024

Background:

This study explores how structured training program enhances healthcare professionals’ awareness of lifestyle modifications for hypertension. Assessing its impact on both knowledge and patient guidance, with an aim to improve healthcare delivery by equipping professionals with informed strategies for lifestyle modification.

Design and Methods:

A quasi-experimental design was employed with sample size of 750 HCPs. The Hypertension Knowledge-Level Scale (HK-LS), a modified questionnaire based on guidelines from the World Health Organization (WHO), was utilized to assess participants’ understanding of hypertension, knowledge of lifestyle modification, and clinical practice. A 12-week online course comprising seven modules was delivered to the HCPs, followed by pre- and post-tests to measure changes in knowledge regarding lifestyle modifications.

Results:

The analysis revealed a substantial increase in HCPs knowledge levels post-intervention compared to pre-intervention regarding hypertension (t = 4.90, p = 0.001), lifestyle modification (t = 3.62, p = 0.001), and their proficiency in offering lifestyle advice to patients (t = 3.56, p = 0.001). In addition to these positive outcomes among HCPs, the intervention also highlighted significant gender disparities in attendance and outcomes among participants. Females exhibited a higher attendance rate of 75% compared to males, with consequent improvements in practice, while males showed a more substantial enhancement in knowledge levels post-intervention. These findings underscore the importance of addressing gender-specific barriers to improvement, such as socio-cultural factors for females and preconceived notions for males, to optimize the effectiveness of future interventions in promoting healthier behaviors and outcomes.

Conclusions:

Structured training programs are imperative for enhancing HCPs’ knowledge of lifestyle modification, particularly in the context of hypertension, as a crucial component of primary prevention strategies. This signifies the effectiveness of the structured training program in enhancing HCPs’ comprehension of hypertension management and their ability to guide patients toward adopting healthier lifestyles.
O63 SARS-CoV-2 S PROTEIN REDUCES CYTOPROTECTIVE DEFENSES AND PROMOTES HUMAN ENDOTHELIAL CELL DYSFUNCTION AND SENESCENCE: PROTECTION BY KLOTHO AND ANGIOTENSIN-(1-7)
Authors: Villacampa Alicia , Shamoon Licia , Valencia Inés , Morales Cristina , Figueiras Sofía , de la Cuesta Fernando , Sánchez-Niño Dolores , Díaz-Araya Guillermo , Lorenzo Óscar , Sánchez-Pérez Isabel , Sánchez-Ferrer Carlos F. , Peiró Concepción
Published: September 2024

Background and objective:

Premature vascular aging and endothelial cell senescence are major risk factors for cardiovascular diseases, including hypertension and atherothrombotic disturbances, which are main complications of both acute and long COVID-19. SARS-CoV-2 S protein, which forms the crown of the coronavirus, can induce endothelial cells inflammation and has been found as an isolated element in both the circulation and human tissues reservoirs months after infection. The aim of this study was to investigate whether S protein is able to directly induce endothelial cell senescence and endothelial dysfunction and to decipher some of the mechanisms involved in such deleterious effect.

Methods:

Using primary cultures of human umbilical vein endothelial cells (HUVEC), cellular senescence was assessed by senescence-associated-β galactosidase (SA-β-gal) staining and the quantification of DNA damage response markers (γH2AX) and growth-arrest effectors (p53, p21, p16) by Western blot. Cytoprotective proteins were equally determined by Western blot. In isolated murine mesenteric microvessel, myography was used to assess defective vascular relaxation, as a key marker of endothelial dysfunction.

Results:

In primary cultures of human umbilical vein endothelial cells (HUVEC), SARS-CoV-2 S protein enhanced in a concentration-dependent manner from a threshold of 35 nmol/L the cellular content of senescence and DNA damage response markers, as well as growth-arrest effectors. In parallel, the S protein reduced the availability of cytoprotective proteins, such as the anti-aging protein klotho, Nrf2 or heme oxygenase-1, and caused functional harm by impairing ex vivo endothelial-dependent vasorelaxation in murine microvessels. These effects were prevented by the pharmacological inhibition of the NLRP3 inflammasome with MCC950. Furthermore, the supplementation with either recombinant klotho or angiotensin-(1-7), equally protected against the pro-senescence, pro-inflammatory and pro-oxidant action of the S protein.

Conclusions:

Globally, this study proposes novel mechanisms of disease in the context of COVID-19 and its vascular sequelae and provides pharmacological clues in order to prevent such complications.
O46 PSYCHOSOCIAL STRESSORS AT WORK ARE ASSOCIATED WITH INCREASED BLOOD PRESSURE VARIABILITY
Authors: Bergeron Nicolas , Lavigne-Robichaud Mathilde , Trudel Xavier , Milot Alain
Published: September 2024

Background and Objectives:

Elevated blood pressure variability (BPV) is associated with an increased risk of cardiovascular morbidity and mortality, independently of blood pressure values. Psychosocial stressors at work are modifiable risk factors from the work environment, shown to increase the risk of hypertension and cardiovascular diseases. The present study aims to determine whether psychosocial stressors at work have a detrimental effect on BPV.

Methods:

The present study relied on a prospective cohort of 3 645 white-collar workers in Quebec City evaluated at three visits: at recruitment, 3 years, and 5 years. At each visit, participants wore an ambulatory blood pressure monitor during working hours and answered a questionnaire on psychosocial work stressors, as measured using validated instruments according to the demand-control (DC) and effort-reward imbalance (ERI) models. Working hours BPV was calculated using average real variability.

Results:

A total of 7 078 observations (n = 4 246 in women and n = 2 832 in men) were available. Using the DC model, systolic and diastolic BPV were higher in active (high psychological demands, high job control) when compared to non-exposed participants (low demands, high control). Using the ERI model, systolic and diastolic BPV were higher among participants exposed to an imbalance between efforts at work and rewards when compared to unexposed participants. These associations were robust to adjustment for socio-demographics, lifestyle-related risk factors and clinical risk factors.

Conclusions:

Participants exposed to psychosocial stressors at work showed higher BPV than non-exposed participants. Since these risk factors are amenable to appropriate preventive intervention in workplaces, they should be considered for the primordial prevention of hypertension and cardiovascular diseases.

Adjusted for age, education, body mass index, alcohol intake, smoking status, sedentary behaviors, family history of CVD and medication for hypertension (as well as for sex in analyses conducted in the total sample).
O54 THE EFFECT OF SACUBITRIL/VALSARTAN TREATMENT ON HYPERTENSIVE PATIENTS
Authors: Nozato Yoichi , Takami Yoichi , Takahashi Toshimasa , Fujimoto Taku , Yoshida Shino , Hongyo Kazuhiro , Koriyama Hiroshi , Akasaka Hiroshi , Rakugi Hiromi , Yamamoto Koichi
Published: September 2024

Background and Objective:

Sacubitril/Valsartan was approved in Japan in 2020 for the treatment of heart failure and subsequently for the treatment of hypertension. It is a drug with a novel mechanism of action that inhibits both angiotensin receptors and neprilysin. Besides its cardioprotective and antihypertensive effects, a subanalysis of previous clinical trials in heart failure patients has shown that it tends to slow the rate of decline in renal function, and is expected to have therapeutic effects against CKD. However, its effect on renal function in hypertensive patients is unknown. In this study, we examined renal prognosis in patients with essential hypertension.

Methods:

166 consecutive patients who received an initial dose of ARNI(Sacubitril/Valsartan) (N=104) or ARB (Azilsartan) (N=42) and had blood tests performed before and within 3 months after the first dose at Osaka University Hospital from June 2020 to April 2023 were analyzed retrospectively.

Results:

ARNI tended to be administered to elderly patients and patients with impaired renal function in both male and female patients. eGFR did not decrease in the ARNI group at either 3 or 12 months post-dose. eGFR decreased over time in the ARB group at 3 and 12 months post-dose. 5 patients on ARNI had drug discontinuations that were thought to be due to adverse drug events (hypotension in 2, numbness in 1, dizziness in 1, syncope in 1 patient).

Conclusions:

In this study, ARNI tended to be administered in more elderly hypertensive patients. Although there were a few treatment interruptions due to adverse drug events, the adverse effects on renal function were rather minor compared to ARBs, and under careful management, ARNI may be a useful antihypertensive treatment modality even in elderly patients and patients with impaired renal function.
O55 ETHNIC DISPARITY IN HYPERTENSION AMONG LIVING KIDNEY DONORS
Authors: Tantisattamo Ekamol , Rochanaroon Voramol , Phoonakh Thutpharritchn , Sinkajarern Varissara , Noree Wanprapit , Sodsri Tulaton , Mongkolporn Ariya , Prasitsumrit Vitchapong , Kanthajan Tatchaya , Ngaohirunpat Sorawis , Chuenchaem Urairat , Sripusanapan Adivitch , Siramongkholkarn Smuch , Rodsom Kamonluk , Kookanok Chutawat
Published: September 2024

Background and Objective:

Whether the disparity among different ethnicities in living kidney donors (LKD) exists is unknown. We aim to examine the association between ethnicity and the risk of developing hypertension in LKD.

Methods:

A retrospective cohort study using OPTN/SRTR included adult LKD, who underwent donation between 6/1972 and 9/2022. Systolic and diastolic hypertension (SHTN and DHTN) were defined by SBP ≥130 and DBP ≥80 mmHg, respectively. The association of different ethnicities with the time-to-event of developing SHTN and DHTN was examined by multiple Cox regression.

Results:

Of 174,311 adult LKD, the mean±SD age was 41±12 years and 60% were female. Hispanic patients account for 13%. Mean pre-donation BP of Hispanics and non-Hispanics were 120±13/73±9 and 122±13/74±9, respectively (mean(SBP difference) -2.1 mmHg, 95%CI -2.3, -1.9, P <0.001; mean(DBP difference) -1.4 mmHg, 95%CI -1.6, -1.3, P <0.001; Figure 1). The median follow-up times for developing SHTN and DHTN were 13.2 (IQR 6.8, 24.4) and 12.2 (IQR 6.3, 24.1) months, respectively and the corresponding incidence rates were 0.020 and 0.003 person-months. After adjusting for age, gender, race, U.S. citizenship, education level, history of pre-donation hypertension, diabetes, pre-donation BMI, SBP, DBP, eGFR, and urine protein:creatinine ratio, Hispanics had 28% significantly greater risk for SHTN (HR 1.28, 95%CI 1.00, 1.63, P 0.046). There were no statistically significant differences in DHTN between Hispanics and non-Hispanics (1.15, 95%CI 0.95, 1.39, P 0.150). Gender was an effect measured modifier with an increased risk of developing SHTN in male, but not female LKD (HR(male) 1.501128, 95%CI 1.082693, 2.081278, P 0.015; HR(female) 1.05, 95%CI 0.72, 1.51, P 0.81)

Conclusions:

Hispanic LKD, particularly male Hispanics, are at increased risk for developing SHTN compared to non-Hispanics. As the fastest-growing ethnic minority in the United States, strategies to mitigate the risk of developing post-donation HTN in Hispanics should be implemented to avoid long-term medical complications in this at-risk population.
O60 SURVIVAL DISPARITIES AMONG INDIGENOUS GROUPS WITH HTN LINKED TO THEIR POPULATION CONCENTRATION
Authors: Quintero Baiz Adalberto Elias , Herrera Parra Lina Johana , Urina Jassir Manuel , Valbuena García Ana María , Quintero Martínez Juan Andrés , Gómez Mesa Juan Esteban , Acuña Merchán Lizbeth Alexandra , Urina Triana Miguel Alberto
Published: September 2024

Background and objective:

The indigenous groups are considered minority populations, primarily residing in rural areas. Cardiovascular disease stands as the leading cause of mortality, affecting native populations as well. This study aims to compare the overall survival (OS) rates among patients diagnosed with hypertension (HTN) in four Colombian departments where the population concentration of indigenous groups is over 10% compared to departments where it is less than 1%.

Methods:

Longitudinal retrospective cohort study. Population: Indigenous adults diagnosed with HTN from July 1st, 2014, to June 30 th, 2015, from the National Registry of Chronic Kidney Disease (NRCKD). The follow-up period was until July 30, 2023. We grouped indigenous communities according to their population concentration calculated by the Observatory of the Colombian Presidential Program for Human Rights. The probability of global survival from the date of diagnosis was estimated using Kaplan-Meier analysis. An unadjusted Royston Parmar flexible regression model was fitted. Right-censoring was defined as abandonment or completion of follow-up without death occurring.

Results:

67,353 indigenous prevalent cases were identified from July 1st, 2022 to June 30th, 2023, representing an HTN prevalence of 2.76%. Among them, 48.90% are in Cauca, Nariño, La Guajira, and Córdoba. Natives of Nariño registered a higher proportion of GFR stages 3 and 4, calculated using the CKD-EPI formula, compared to departments with a concentration of less than 1% (48.30% and 3.15% vs. 8.08% and 0.45% respectively). 2.600 cases were included in the survival analysis. Natives residents from Nariño and Cauca had the highest risk of all-cause mortality (HR = 7.66; 95% CI 3.33 – 17.59 and HR = 7.36; 95% CI 3.26 – 16.61) compared to groups living in departments with <1% concentration.

Conclusions:

In the Colombian health system, the hazard of all-cause mortality is higher for indigenous individuals with HTN living in Nariño and Cauca compared to those living in departments with less than 1% of the indigenous population.