bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction to the Special Issue on "The World Health Organization Choosing Interventions That Are Cost-Effective (WHO-CHOICE) Update"
Authors: Bertram Melanie Y. , Edejer Tessa Tan Torres
Published: September 2021

The WHO-CHOICE (World Health Organization CHOosing Interventions that are Cost-Effective) approach is unique in the global health landscape, as it takes a "generalized" approach to cost-effectiveness analysis (CEA) that can be seen as a quantitative assessment of current and future efficiency within a health system. CEA is a critical contribution to the process of priority setting and decision-making in healthcare, contributing to deliberative dialogue processes to select services to be funded. WHO-CHOICE provides regional level estimates of cost-effectiveness, along with tools to support country level analyses. This series provides an update to the methodological approach used in WHO-CHOICE and presents updated cost-effectiveness estimates for 479 interventions. Five papers are presented, the first focusing on methodological updates, followed by three results papers on maternal, newborn and child health; HIV, tuberculosis and malaria; and non-communicable diseases and mental health. The final paper presents a set of example universal health coverage (UHC) benefit packages selected through only a value for money lens, showing that all disease areas have interventions which can fall on the efficiency frontier. Critical for all countries is institutionalizing decision-making processes. A UHC benefit package should not be static, as the countries needs and ability to pay change over time. Decisions will need to be continually revised and new interventions added to health benefit packages. This is a vital component of progressive realization, as the package is expanded over time. Developing an institutionalized process ensures this can be done consistently, fairly, and transparently, to ensure an equitable path to UHC.
Usefulness of Home Screening for Promoting Awareness of Impaired Glycemic Status and Utilization of Primary Care in a Low Socio-Economic Setting: A Follow-Up Study in Reunion Island
Authors: Fianu Adrian , Doussiet Éric , Naty Nadège , Porcherat Sylvaine , Mussard Corinne , Boussaïd Karim , Cogne Muriel , Gérardin Patrick , Favier François
Published: September 2021

Background: Low socio-economic settings are characterized by high prevalence of diabetes and difficulty in accessing healthcare. In these contexts, proximity health services could improve healthcare access for diabetes prevention. Our primary objective was to evaluate the usefulness of home screening for promoting awareness of impaired glycemic status and utilization of primary care among adults aged 18-79 in a low socio-economic setting. Methods: This follow-up study was conducted in 2015-2016 in Reunion Island, a French overseas department in the Indian Ocean. Enrollment and screening occurred on the same day at the home of participants (N=907). Impaired glycemic status was defined as [glycated hemoglobin (HbA1c) ≥5.7%] OR [fasting capillary blood glucose (FCBG) ≥1.10 g/L] OR [HbA1c=5.5-5.6% and FCBG=1.00-1.09 g/L]. Medical, socio-cultural, and socio-economic characteristics were collected via a face-to-face questionnaire. A one-month telephone follow-up survey was conducted to determine whether participants had consulted a general practitioner (GP) for confirmation of screening results. A multinomial polytomous logistic regression model was used to identify factors independently associated with non-use of GP consultation for confirmation of screening results and nonresponse to the telephone follow-up survey. Results: Prevalence of glycemic abnormalities was 46.0% (95% CI = 42.7-49.2%). Among participants with impaired glycemic status (N=417), 77.7% (95% CI=73.7-81.7%) consulted a GP for confirmation of screening results, 12.5% (95% CI=9.3-15.6%) did not, and 9.8% failed to respond to the follow-up survey. Factors independently associated with non-use of GP consultation for confirmation of screening results were self-reported unwillingness to consult a GP (adjusted odds ratio [OR]: 4.86, 95% CI=1.70-13.84), usual GP consultation frequency of less than once a year (adjusted OR: 4.13, 95% CI=1.56-10.97), and age 18-39 years (adjusted OR: 3.09, 95% CI=1.46-6.57). Conclusion: Home screening for glycemic abnormalities is a useful proximity health service for diabetes prevention in low socio-economic settings. Further efforts, including health literacy interventions, are needed to increase utilization of primary care.
The Effect of Governmental Health Measures on Public Behaviour During the COVID-19 Pandemic Outbreak
Authors: Wang Guoyan , Li Li , Wang Lingfei , Xu Zhi
Published: September 2021

Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in radical changes in many aspects of life. To deal with this, each country has implemented continuous health measures from the beginning of the outbreak. Discovering how governmental actions impacted public behaviour during the outbreak stage is the purpose of this study. Methods: This study uses a hybrid large-scale data visualisation method to analyse public behaviour (epidemic concerns, self-protection, and mobility trends), using the data provided by multiple authorities. Meanwhile, a content analysis method is used to qualitatively code the health measures of three countries with severe early epidemic outbreaks from different continents, namely China, Italy, and the United States. Eight dimensions are coded to rate the mobility restrictions implemented in the above countries. Results: (1) Governmental measures did not immediately persuade the public to change their behaviours during the COVID-19 epidemic. Instead, the public behaviour proceeded in a three-phase rule, which is typically witnessed in an epidemic outbreak, namely the wait-and-see phase, the surge phase and the slow-release phase. (2) The strictness of the mobility restrictions of the three countries can be ranked as follows: Hubei Province in China (with an average score of 8.5 out of 10), Lombardy in Italy (7.125), and New York State in the United States (5.375). Strict mobility restrictions are more likely to cause a surge of population outflow from the epidemic area in the short term, whereas the effect of mobility restrictions is positively related to the stringency of policies in the long term. Conclusion: The public showed generally lawful behaviour during regional epidemic outbreaks and blockades. Meanwhile public behaviour was deeply affected by the actions of local governments, rather than the global pandemic situation. The contextual differences between the various countries are important factors that influence the effects of the different governments’ health measures.
Commercial Influence on Political Declarations: The Crucial Distinction Between Consultation and Negotiation and the Need for Transparency in Lobbying Comment on "Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-Communicable Diseases"
Authors: Berner-Rodoreda Astrid , Jahn Albrecht
Published: September 2021

Suzuki and colleagues’ rare and elaborate analysis of the political processes behind the 2018 United Nations (UN) non-communicable diseases (NCD) Declaration discloses various pathways towards influencing global public health policies. Their study should be a wake-up call for further scientific political scrutiny and analysis, including clearly distinguishing between consultations such as UN multi-stakeholder hearings preceding high-level meetings and the actual negotiating and decision making process. While stakeholder positions at interactive hearings are documented and published and thus made transparent, the negotiating process among member states is not publicly known. The extent to which intergovernmental negotiations are influenced at country or regional levels by commercial interests through direct and indirect lobbying outside of public consultations should be given more attention. Lobby registers should be implemented more stringently and legislative footprints required and applied not only to legally binding but also to internationally important documents such as political declarations.
Bio-Politics and Calculative Technologies in COVID-19 Governance: Reflections From England
Authors: Jayasinghe Kelum , Jayasinghe Tarosha , Wijethilake Chaminda , Adhikari Pawan
Published: September 2021

Background: Through the extensive use of public media, the government of England was heavily involved in encouraging and instructing people on how to manage their life during coronavirus disease 2019 (COVID-19). This model of health emergency governance replicates the practice of ‘calculative technologies’ and ‘bio-politics’ embedded in population management. Previous research on COVID-19 governance both in the United Kingdom and beyond provides varied revelations on broader ‘technologies of government’ and bio-politics by numerous governments. However, rarely have any studies explicitly and distinctively highlighted the unique ‘calculative technologies’ mobilised by governments within their bio-politically designed "technologies of government" to compel the populations to manage their lives under their COVID-19 guidance. The paper therefor examines how the UK government deployed "calculative technologies," as part of its strategies of health governance and governmentality during the first wave of COVID-19 in England. Methods: This study uses document analysis as its data collection method. Its review includes documents, press releases, social media disclosures and health guidance issued by the UK government from March to December, 2020. The data are analysed employing the Foucault’s governmentality and bio-political scholarship. Results: The paper’s findings reveal the UK government’s use of integrated calculative technologies of self-governance in the form of risk calculations and metrices/statistics (eg, death tolls, infection rates), performance management (eg, two metre social distancing, and hand washing for twenty seconds) and discipline and control (eg, fourteen days self-isolation), in addition to a more conventional top-down, managerial decision-making process adopted in the past. By these newly initiated "calculative technologies," the government has "bio-politically" governed the behaviours and lifestyles of vulnerable community members, health workers and general public at a distance, inculcating self-management and individualisation of responsibility. Conclusion: The newly adopted calculative technologies used by the UK government created a multi-faceted discourse of obligations, entitlements and scale of engagement, and facilitated directions about what people should do to protect themselves and others from the spread of the virus. Overall, the overtly and idiosyncratically used calculative technologies resemble a unique ‘art of government’ and produce a set of ‘bio-political’ interventions enforcing the populations to manage their own wellbeing and governing them at a distance during COVID-19.
Financing Strategies to Facilitate Access to High-Cost Anticancer Drugs: A Systematic Review of the Literature
Authors: Patikorn Chanthawat , Taychakhoonavudh Suthira , Sakulbumrungsil Rungpetch , Ross-Degnan Dennis , Anantachoti Puree
Published: September 2021

Background: Each country manages access to anticancer drugs differently due to variations in the structure and financing of the health system, but a summary of the various strategies used is absent. This study aimed to review and summarize financing strategies implemented across countries to facilitate access to high-cost anticancer drugs. Methods: We conducted a systematic review of articles referenced in PubMed, Embase, and Web of Science through May 12, 2021. Articles published in the English language from 2000 that describe strategies implemented in different countries to facilitate access to high-cost anticancer drugs were included. Letters, news articles, and proposed strategies were excluded. Quality assessment was not performed as we aimed to summarize the strategies. Data were analyzed by thematic analysis. A review protocol was registered at PROSPERO (CRD42018068616). Results: The review included 204 studies from 176 countries. Three themes of financing strategies were identified: (1) Basic pharmaceutical reimbursement and pricing policies, (2) Alternative funding strategies specific to high-cost drugs, and (3) Financial assistance for individual patients. Access in most countries depends mainly on basic pharmaceutical reimbursement policies (165 of 176 countries). Apart from that, high-income countries (HICs) tended to use funding strategies targeting high-cost drugs (72% of HICs vs 0%-24% of the rest), such as managed entry agreements (MEAs) or dedicated funds for high-cost drugs. In contrast, lower-income countries tended to implement financial assistance programs for cancer patients as a tool to increase access (32% of HICs vs 62%-79% of the rest). Conclusion: Many countries have implemented a combination of strategies to increase access to high-cost anticancer drugs. Most low- and middle-income countries utilized placement of anticancer drugs on a national list of essential medicines and patient assistance programs (PAPs) to facilitate access, while many HICs implemented a broader range of strategies.
Recovered but Constrained: Narratives of Ghanaian COVID-19 Survivors Experiences and Coping Pathways of Stigma, Discrimination, Social Exclusion and Their Sequels
Authors: Atinga Roger A. , Alhassan Nafisa Mummy Issifu , Ayawine Alice
Published: September 2021

Background: Research about the coronavirus disease 2019 (COVID-19), its epidemiology and socio-economic impact on populations worldwide has gained attention. However, there is dearth of empirical knowledge in low- and middle-income settings about the pandemic’s impact on survivors, particularly the tension of their everyday life arising from the experiences and consequences of stigma, discrimination and social exclusion, and how they cope with these behavioral adversities. Methods: Realist qualitative approach drawing data from people clinically diagnosed positive of COVID-19, admitted into therapy in a designated treatment facility, and subsequently recovered and discharged for or without follow-up domiciliary care. In-depth interviews were conducted by maintaining a code book for identifying and documenting thematic categories in a progression leading to thematic saturation with 45 participants. Data were transcribed and coded deductively for broad themes at the start before systematically nesting emerging themes into the broad ones with the aid of NVivo 12 software. Results: Everyday lived experiences of the participants were disrupted with acts of indirect stigmatization (against relatives and family members), direct stigmatization (labeling, prejudices and stereotyping), barriers to realizing full social life and discriminatory behaviors across socio-ecological structures (workplace, community, family, and social institutions). These behavioral adversities were associated with self-reported poor health, anxiety and psychological disorders, and frustrations among others. Consequently, supplicatory prayers, societal and organizational withdrawal, aggressive behaviors, supportive counseling, and self-assertive behaviors were adopted to cope and modify the adverse behaviors driven by misinformation and fearful perceptions of the COVID-19 and its contagious proportions. Conclusion: In the face of the analysis, social campaigns and dissemination of toolkits that can trigger behavior change and responsible behaviors toward COVID-19 survivors are proposed to be implemented by health stakeholders, policy and decision makers in partnership with social influencers, the media, and telecoms.
Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?
Authors: Waitzberg Ruth , Gottlieb Nora , Quentin Wilm , Busse Reinhard , Greenberg Dan
Published: September 2021

Background: Hospital professionals are "dual agents" who may face dilemmas between their commitment to patients’ clinical needs and hospitals’ financial sustainability. This study examines whether and how hospital professionals balance or reconcile clinical and economic considerations in their decision-making in two countries with activity-based payment systems. Methods: We conducted 46 semi-structured interviews with hospital managers, chief physicians and practicing physicians in five German and five Israeli hospitals in 2018/2019. We used thematic analysis to identify common topics and patterns of meaning. Results: Hospital professionals report many situations in which activity-based payment incentivizes proper treatment, and clinical and economic considerations are aligned. This is the case when efficiency can be improved, eg, by curbing unnecessary expenditures or specializing in certain procedures. When considerations are misaligned, hospital professionals have developed a range of strategies that may contribute to balancing competing considerations. These include ‘reshaping management,’ such as better planning of the entire course of treatment and improvement of the coding; and ‘reframing decision-making,’ which involves working with averages and developing tool-kits for decision-making. Conclusion: Misalignment of economic and clinical considerations does not necessarily have negative implications, if professionals manage to balance and reconcile them. Context is important in determining if considerations can be reconciled or not. Reconciling strategies are fragile and can be easily disrupted depending on context. Creating tool-kits for better decision-making, planning the treatment course in advance, working with averages, and having interdisciplinary teams to think together about ways to improve efficiency can help mitigate dilemmas of hospital professionals.
Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study
Authors: Yuan Shasha , Fan Fengmei , Zhu Dawei
Published: September 2021

Background: Integrated care is a global trend in international healthcare reform, particularly for piloting vertical integration involving hospitals and primary healthcare institutions (PHIs). However, evidence regarding the impact of vertical integration on primary healthcare has been mixed and limited. Our study aims to evaluate the empirical effects of vertical integration reform on PHIs in China, and examines variations across integration intensity (tight integration vs. loose collaboration). Methods: This study used a longitudinal design. The time-varying difference-in-difference (DID) method with a fixed-effect model for panel data was adopted. A total of 370 PHIs in the eastern, central, and western areas of China from 2009 to 2018 were covered. Outcome measures included the indicators at three dimensions regarding inpatient and outpatient service volume, patient flow between PHIs and hospitals and quality of chronic disease care (hypertension and diabetes). Results: Significant increases in absolute (the number) and relative (the ratio between PHIs and hospitals) volume of inpatient admissions have been found after reform under tight integration, peaking at 183% and 15.0% respectively, in the third reform year. The quality of hypertension and diabetes care (by indicators of control rate of blood pressure and blood glucose) showed significant improvements under both types of vertical integration after reform. It was much more distinct for the PHIs under tight integration, which had the most significant increase of 34.0% and 22.8% under tight integration for the control rate of hypertension and diabetes compared to the peak of 21.2% and 22.1% respectively under loose collaboration. Conclusion: Our findings suggest that vertical integration (especially tight integration) in China significantly contributed to strengthening primary healthcare in terms of inpatient services and quality of hypertension and diabetes care, providing empirical evidence to other countries on integrating primary healthcare-based health systems.
Learning by Doing: Accelerate Towards the NCD Target in SDG Through Primary Healthcare Comment on "Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare"
Authors: Varghese Cherian , Nongkynrih Baridalyne , Mikkelsen Bente
Published: September 2021

Health systems built on the foundation of primary healthcare (PHC) are essential to achieve universal health coverage (UHC). To adequately respond to the needs of people with non-communicable diseases (NCDs) and enable optimal management in primary care settings, changes are needed at many levels. PHC levers recommended in the UHC framework as the cornerstone of achieving Sustainable Development Goal (SDG) goals by strengthening the primary care system include strategic and operational levers. Experience from hypertension control programs across 18 countries has shown that rapid scale-up can be achieved through systematic improvement of the PHC system brought about by political commitment, financial support, and high-quality people-centred primary care. As countries are gripped with the pandemic the importance of an appropriate and resilient health system fit for the country is emerging as a priority for building preparedness. While there are general principles, each country must learn by doing and scale up models relevant to the national context.
Molecular Detection of Virulence Factor Glycoprotein (Gp63) of Leishmania spp. in Phlebotomus Sand Flies
Authors: Al-Mayali Hadi M. Hamza , Alyasiri Ali Jawad Abdulaali
Published: September 2021

Introduction: Gp63 is the major surface glycoprotein of Leishmania which is prevalent in the promastigote stage of Phlebotomus sergenti. Glycoprotein 63 (gp63) or leishmanolysin is a zinc-dependent metalloprotease found on the surface of Leishmania. It was initially discovered in 1980and described biochemically and genetically as a surface antigen expressed in promastigotes of Leishmania species, having a range of substrates including casein, albumin, fibrinogen, haemoglobin, and gelatin. On the surface of amastigote, GP63 is present at a very low level. Glycoprotein 63 is a zinc-dependent metalloprotease that is active in the pH range of 7–10, which is neutral to alkaline. Materials and Methods: During the study, which was carried out in Al-Muthanna province from July 2017 to August 2018, about 2550 sand fly samples including 719 males and 1633 females were collected. Three species of sand flies were recorded according to morphological features which included Phlebotomus papatasi, Phlebotomus sergenti, and Sergentomyia sintoni. The caught specimens showed that P. papatasi was the most prevalent species. Two primers were used for the diagnosis of Leishmania spp. using a nested PCR technique, which was designed in a previous study for 1250 samples of sand flies from 25 locations in the study area. Results: Results showed that 13 samples were positive, containing DNA for the Leishmania parasite, and 12 samples were negative. Positive samples include 11 samples of L. major species and only 2 samples of L. tropica species. Additionally, the results showed that the L. major species was the dominant species in the study area. Positive samples (13) of sand flies had Leishmania parasite based on molecular diagnosis and virulence factor gene (Gp63) of Leishmania parasite was detected in sand flies using PCR method The results showed that virulence factor gene (Gp63) was detected on the surface of promastigote. This refers to the presence of Leishmania parasite in sand fly. The study is the first one which detected the presence of the virulence factors gene (GP63) of Leishmania in the body of sand flies. Conclusion: This study revealed the possibility of diagnosing leishmaniasis by virulence factor gene (Gp63) in leishmania promastigotes.
Barriers to Self-care Among Patients with Heart Failure: A Qualitative Study
Authors: Negarandeh Reza , Aghajanloo Ali , Seylani Khatereh
Published: September 2021

Introduction: Heart failure is the most prevalent cardiovascular disease. It is the end stage of most cardiovascular diseases and is characterized by the reduced ability of the heart to pump enough blood to fulfill the metabolic needs of the body. Self-care is the basis of the management of chronic diseases such as heart failure. The aim of this study was to explore the barriers to self-care among patients with heart failure. Methods: This was a qualitative content analysis. Participants were fourteen patients with heart failure and three healthcare providers who were purposively recruited from cardiac care centers in Zanjan, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional qualitative content analysis approach proposed by Elo and Kyngäs. Results: Self-care barriers -care among patients with HF were categorized into three main categories, namely personal factors, disease burden, and inefficient support system. Each category had three subcategories which were respectively lack of self-care knowledge, heart failure-related negative emotions, the difficulty of changing habits, progressive physical decline, comorbid conditions, financial strain, inadequate social support, healthcare providers’ inattention to self-care, and limited access to healthcare providers. Conclusion: Patients with heart failure face different personal, disease-related, and support-related barriers to self-care. Based on these barriers, healthcare providers can develop interventions for promoting self-care among patients with heart failure.
Translation, Cross-cultural Adaptation and Validation of the Neck Bournemouth Questionnaire: Persian Version
Authors: Salaree Mohammad  Mehdi , Sirati Nir Masoud , Sobhani Vahid , Delavari Abbas Ali , Mosavi Seyyed Ali Reza
Published: September 2021

Introduction: The Neck Bournemouth Questionnaire (NBQ) is being used widely in various countries. This study evaluated the validity and reliability of the Persian version of NBQ. Methods: This methodological study investigated 170 patients with chronic neck pain (NP). The psychometric properties of NBQ were evaluated in two stages. First, the standard scale was translated based on Guillemin’s guidelines for cross-cultural adaption and face validity tested in a pilot group (N=25). Second, it was conducted on a sample of 170 diverse chronic pain patients. Construct validity was determined with convergent validity by short-form McGill pain questionnaire. Then, the reliability was confirmed using Cronbach’s alpha and the intraclass correlation coefficient. Results: The instrument demonstrated a good face validity and the participants made minor changes. A slight change was applied on content validity. In construct validity, Pearson’s correlation coefficient was 0.85, which was statistically significant and showed strong correlation. A Cronbach’s alpha of 0.87 was obtained. This confirmed the remarkable internal consistency and stability (0.92). Conclusion: The Persian version of NBQ showed a good internal consistency and reliability and it could be considered as a valuable tool for assessing patients with cervical pain in Iranian population.
Effects of Reflexology on the Pain Intensity among Patients with Depression after Receiving Electroconvulsive Therapy: A Randomized Clinical Trial
Authors: Aliashraf Jodat Maryam , Alilu Leyla , Ahangarzadeh Rezayee Sohila , Gharaaghaji Asl Rasool
Published: September 2021

Introduction: High prevalence of psychiatric disorders and the high effectiveness of electroconvulsive therapy (ECT) have made this treatment a useful intervention. Memory impairment, headache, and muscle pain are the most important complications after ECT. This research aimed to determine the effect of reflexology on the headache and muscle pain intensity of patients after receiving ECT. Methods: This randomized controlled trial was conducted in Razi teaching hospital of Urmia, Iran. A total of 56 patients with depression receiving ECT were randomly assigned into two equal groups of control (n=28) and intervention (n=28). In the intervention group, reflexology was performed for 20 minutes at reflex points and, in the control group, only the conventional measures were taken. Pain intensity was measured with visual analogue scale (VAS) before and 1, 6, and 24 hours after the intervention. Data were analyzed using the SPSS software version 13. Furthermore, chi-square, Mann-Whitney, Wilcoxon, and repeated-measures tests were performed. Results: The mean difference in the severity of headache and muscle pain in the intervention group was significantly reduced compared to the control group. Moreover, the results demonstrated a significant difference between the mean headache and muscle pain in the two groups after the intervention. Conclusion: The results of this study showed the positive effect of reflexology on reducing the intensity of pain in patients receiving ECT. Thus, it is recommended that nurses, health care providers, and caregivers use reflexology to reduce pain in patients with depression receiving ECT.
Factors Involved in Praxis in Nursing Practice: A Qualitative Study
Authors: Rafii Forough , Nikbakht Nasrabadi Alireza , Javaheri Tehrani Fereshteh
Published: September 2021

Introduction: Praxis is a process of applying knowledge in nursing practice to advance emancipatory goals in society and in the world and to eliminate any injustice and discrimination in care. Praxis requires the coherent application of patterns of knowing in nursing practice; however, understanding nursing knowledge is complex and using experiential knowledge alone cannot help us achieve it. The aim of this study was to determine the factors involved in praxis in nursing practice. Methods: The method adopted was qualitative. The researcher interviewed 19 nurses and attended eight observation sessions in different hospital departments. The findings were analyzed using conventional content analysis. Results: Findings from analyzing interviews and observations indicated that desirable and humanistic attributes and effective nurse-patient communication are facilitators of praxis. In contrast, prejudice, occupational barriers, negative thoughts, and discriminatory beliefs are barriers of praxis in nursing practice. Conclusion: If we consider praxis as the simultaneous application of all patterns of knowing alongside efforts to create social justice, factors that drive nurse performance toward social justice, facilitate praxis, and factors that contribute to varied degrees of discrimination and injustice, inhibit praxis. By identifying these factors, nurses may identify and eliminate social justice barriers to care.
Mothers’ Breastfeeding Experiences of Emotional Support Needs: A Qualitative Study in Iran
Authors: Maleki Saghooni Nahid , Karshki Hossein , Esmaily Habibollah , Zaidi Feroz Fakhera , Mirzaii Najmabadi Khadigeh
Published: September 2021

Introduction: Breastfeeding is an important strategy to ensure health promotion and wellbeing. Since breastfeeding rates have consistently decreased around the world, protection, promotion, and supportive programs are considered as public health priorities. This study aims to explore breastfeeding mothers’ perceptions and experiences of emotional support needs. Methods: This study was performed in five health centers and four hospitals affiliated to Mashhad University of Medical Sciences, Iran. Using a qualitative approach, 36 breastfeeding mothers, family members, and health providers attended individual semi-structured in-depth interviews. Data were analyzed using directed content analysis based on the Elo and Kyngas approach, with MAXQDA software version 10. Results: Four categories of ‘need to tranquility and solace’, ‘sense of being loved and belongingness’, ‘creating hope, motivation, and confidence’, and ‘empathy and companionship’, and 12 subcategories including ‘not inducing stress’, ‘relieving the mother’s stress and worries’, ‘creating and maintaining tranquility’, ‘understanding and attention’, ‘receiving affection from significant others’, ‘being respected by others’, ‘ being inspired by significant others’, ‘being assured by family members’, ‘being motivated by significant others’, ‘interacting with others’, ‘having the companionship and presence of others’, and ‘receiving empathy from others’ were identified as the mothers’ emotional support needs. Conclusion: Mothers need emotional support to sustain breastfeeding. Significant others, such as the husband, family members, and health providers play an important role in meeting breastfeeding mothers’ emotional support needs.
The Effect of Probiotics or Synbiotics on the Hypertensive Disorders of Pregnant Women with Gestational Diabetes: A Systematic Review and Meta-analysis
Authors: Movaghar Rouhina , Farshbaf-Khalili Azizeh , Hajizade khadijeh , MirzaRezaei Mehdi Ebrahimpour , Shahnazi Mahnaz
Published: September 2021

Introduction: Antioxidants and anti-inflammatory drugs have been suggested to treat preeclampsia. This systematic review and meta-analysis was conducted to investigate the efficacy of probiotic or synbiotic supplementation on hypertensive disorders in women with gestational diabetes mellitus (GDM). Methods: The databases including Cochrane, Embase, Ovid, ProQuest, Scopus, Web of Science, and PubMed were systematically searched for collecting the randomized controlled trials (RCTs) investigating the efficacy of probiotic or synbiotic supplementation versus placebo on hypertensive disorders and pregnancy outcomes in GDM until July 2020. Results: Five RCTs with a total sample size of 402 women were included in the meta-analysis. There was no significant decline in systolic blood pressure (standardized mean difference [SMD]=-3.41, 95% confidence interval [CI]=-8.32 to 1.50, P=0.17), diastolic blood pressure (SMD=-5.11, 95% CI=-14.20 to -3.98, P=0.27), preeclampsia (odds ratio [OR]=1.56, 95% CI=0.61 to 3.98, P=0.35), cesarean section (OR=0.52, 95% CI=0.18 to 1.50, P=0.23), and macrosomia (OR=0.81, 95% CI=0.41 to 1.57, P=0.53). No significant increase was observed in terms of 5-minute Apgar (SMD=0.16, 95% CI=-0.06 to 0.39, P=0.15, I2=0%), birth weight (SMD=-0.18, 95% CI=-0.43 to 0.06, P=0.13, I2=0%), and gestational age (SMD=0.13, 95% CI=-0.11 to 0.37, P=0.28, I2=0%). Conclusion: Probiotic or synbiotic supplements are not associated with significant effects on pregnancy outcomes in GDM. However, due to the limited number of studies in this regard and heterogeneity between studies, future high-quality RCTs are recommended.
Capillary haemangioma of the heart presenting with pericardial effusion: A case report
Authors: Darbari Anshuman , Singh Devender , Gilbert Shegu , Kumar Barun , Singh Neha
Published: September 2021

Cardiac haemangiomas (CH) are rare benign primary tumours of the heart and constitute nearly 2.8% of primary cardiac tumours. In a-48-year-old female, a cardiac tumour mass over right ventricular out flow area and main pulmonary artery was detected during diagnostic workup for aetiology of recurrent pericardial effusion. Echocardiograhy and pericardial fluid findings were non conclusive. Contrast enhanced Computed tomography (CECT) and Positron emission tomography (PET) scan imaging found the exophytic, moderately hypermetabolic, heterogeneous mass lesion posterolateral to main pulmonary trunk. We did partial resection of lesion without cardiac reconstruction and open incisional biopsy through midline sternotomy incision. Histopathological analysis confirmed this as a case of Capillary type of haemangioma of heart.
A case of progressive dyspnea: Atrial septal device-related functional mitral regurgitation after myocardial infarction
Authors: Memic Sancar Kadriye , Isık Ayan , Aydın Unal , Kalkan Ali Kemal , Erturk Mehmet , Babur Guler Gamze
Published: September 2021

Transcatheter device closure is a common treatment option of atrial septal defect. Mitral regurgitation has been reported with comorbid mitral valve prolapse and atrial septal defect. However there is no consensus regarding the pathogenesis of mitral regurgitation after closure. We are reporting a patient with functional mitral regurgitation associated with both an oversize closure device and wall motion abnormality after inferior myocardial infarction.
Trans catheter device closure of a large azygos vein in adult patient with systemic venous collateral development after the bidirectional Glenn shunt
Authors: Khajali Zahra , Firouzi Ata , Pashapour Pooneh , Ghaderian Homa
Published: September 2021

Superior cavopulmonary anastomosis is a type of palliative cardiac surgeries that usually done in children with cyanotic and complex congenital heart disease who have single ventricle profile. BDG shunt is staged palliation procedure for single ventricle patients who are candidates for total cavopulmonary connection (TCPC). Sometimes the surgeon misses ligating or intentionally leaves the azygos vein as a fenestration or emergency exit. This allows an abnormal flow from the superior vena cava (SVC into azygos vein). These patients can present progressive desaturation, chest tightness, progressive dyspnea, edema and shortness of breath. Therapeutic options include observation, surgical ligation and trans catheter closure. Because of high risks and extra traumas of surgery and greater chance for difficulties and the feasibility of trans catheter therapy, it is done in some centers as a method of choice.
Pancreaticopleural fistula: An insidious cause of pleural effusion –case report
Authors: Murteira Fábio , Costa Tiago , Pinto Sara Barbosa , Francisco Elsa , Gomes Ana Catarina
Published: September 2021

Pancreaticopleural fistulas (PPF) are a rare etiology of pleural effusions. We describe a case of a 61-year-old man, with left chest pain with six months of progression who presented with a large volume unilateral pleural effusion. A thoracentesis was performed, which showed a dark reddish fluid(exudate) and high content of pancreatic amylase. After that an abdominal computed tomography (CT)and magnetic resonance cholangiopancreatography (MRCP) was done, revealing fistulous pathways that originated in the pancreas. The patient was admitted for conservative and endoscopic treatment by Endoscopic Retrograde Cholangiopancreatography (ERCP) and a prosthesis was placed on a fistulous path. He was discharged without complications, with the resolution of the pleural effusion and fistula.The interest of this case lies in the rarity of the event and absence of symptoms of the probable primary event (acute pancreatitis). The possible iatrogenic association with several drugs of his usual medication makes it even more complex.
The Effectiveness of Low-Level Laser Therapy in Pain Induced by Orthodontic Separator Placement: A Systematic Review
Authors: Farzan Arash , Khaleghi Katayoon
Published: September 2021

Introduction: This systematic review was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) in orthodontic separator pain. Methods: This article was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Electronically and manually 3 databases, namely PubMed, Scopus and Google Scholar, were searched by the keywords that were selected based on population, intervention, comparison and outcome (PICO) on October 10, 2020. Studies were appraised by Cochrane version 5.2.0 with 7 domains and were checked by these inclusion criteria: 1. Randomized clinical trial (RCT) that examined the efficacy of LLLT in separator pain, 2. Split-mouth design, 3. LLLT application in the first hours after separator placement, 4. LLLT application to both sides of the teeth, 5. Patients receiving elastomeric separators between the premolars and molars, 6. Lasers with a wavelength of 800-899 nm, 7. Studies conducted from 2010 to 2020, and 8. Participants who went through orthodontic treatment without limitation in gender, age and social-economic status. Results: 299 studies were screened. 34 full-text papers were read by 2 authors independently. In the end, 4 articles met the inclusion criteria. All 4 articles showed LLLT has a significant impact on pain reduction. Conclusion: The exact protocol for laser therapy is still not clear. Therefore, more studies with a meticulously designed method are needed.
Use of Blue and Blue-Violet Lasers in Dentistry: A Narrative Review
Authors: Fornaini Carlo , Fekrazad Reza , Rocca Jean-Paul , Zhang Shiying , Merigo Elisabetta
Published: September 2021

Introduction: Blue and blue-violet diode lasers (450 and 405 nm) seem to represent an interesting approach for several clinical treatments today. The aim of this narrative review is to describe and comment on the literature regarding the utilization of blue and blue-violet lasers in dentistry. Methods: A search for "blue laser AND dentistry" was conducted using the PubMed database, and all the papers referring to this topic, ranging from 1990 to April 2020, were analyzed in the review. All the original in vivo and in vitro studies using 450 nm or 405 nm lasers were included in this study. All the articles on the LED light, laser wavelengths other than 405 and 450 nm and using lasers in specialties other than dentistry, as well as case reports, guideline papers and reviews were excluded. Results: From a total of 519 results, 47 articles met the inclusion criteria and were divided into 8 groups based on their fields of application: disinfection (10), photobiomodulation (PBM) (4), bleaching (1), resin curing (20), surgery (7), periodontics (1), endodontics (1) and orthodontics (3). Conclusion: Blue and blue-violet diode lasers may represent new and effective devices to be used in a large number of applications in dentistry, even if further studies will be necessary to fully clarify the potentialities of these laser wavelengths.
Low Level Laser Therapy With an 810-nm Diode Laser Affects the Proliferation and Differentiation of Premature Osteoblasts and Human Gingival Fibroblasts In Vitro
Authors: Bourouni Ioanna , Kyriakidou Kyriaki , Fourmousis Ioannis , Vrotsos Ioannis A. , Karoussis Ioannis K.
Published: September 2021

Introduction: Photomodulation is a promising strategy for optimizing tissue healing, but its photomodulatory effects on the synergistic cellular metabolism of gingival and bony tissues remain largely unknown. The aim of the present study was to evaluate the photomodulatory effects of a diode laser (810 nm) on osteoblasts, HGFs and their co-cultures in vitro. Methods: Primary cultures of HGFs, cultures of immature osteoblastic cells (MG63) and their co-cultures were irradiated with a diode laser (810 nm), 15 J/cm2 . Cell cultures were examined for cellular proliferation (MTT assay), viability (FDA/PI staining) after 24, 48 and 72 hours and cell differentiation (qPCR of collagen type 1a – COL1a and alkaline phosphatase expressions - ALP) after 7 days. Results: Photomodulation with an 810-nm diode laser increased cell proliferation at all time points. COL1a gene expression increased both in HGF and co-cultures. ALP expression was up-regulated in osteoblastic cultures, but co-cultures with fibroblasts negated this response. Conclusion: The 810-nm diode laser positively affected cell proliferation and viability in all experimental groups. The statistically significant increased COL1a gene expression at 7 days after irradiation both in the irradiated HGF and co-cultures suggests that low-level laser therapy (LLLT) stimulated extracellular matrix (ECM) formation signaling in both cell types.
Combined Treatment of Photobiomodulation and Arginine on Chronic Wound Healing in an Animal Model
Authors: Mostafavinia Atarodsadat , Amini Abdollah , Ahmadi Houssein , Rezaei Fatemehalsadat , Ghoreishi Seyed Kamran , Chien Sufan , Bayat Mohammad
Published: September 2021

Introduction: Herein, the individual and combined effects of photobiomodulation (PBM) and arginine (ARG) on the wound healing course of an experimental model of a slow healing wound (ulcer) in rats were assessed. Methods: A total of 108 male rats were divided into 6 groups: control; lower energy density (low)-PBM; arginine ointment (ARG); low-PBM+ARG; high energy density (high)-PBM; and high-PBM+ARG. In each rat, one ischemic wound in the center of a bipedicle flap and one non-ischemic wound out of the flap were created. Both wounds were treated in the experimental groups. Microbial growth, wound area, and wound strength were assessed on days 0, 5, 10, 15, and 20 after wound infliction. Results: All non-ischemic wounds closed before day 15. High-PBM+ARG and ARG significantly increased wound closure rates compared to the control group (LSD test, P=0.000, and P=0.001, respectively) on day 10. All slow healing wounds were open on day 15 but closed completely before day 20. Low-PBM+ARG and high-PBM significantly increased wound strength (stress high load, SHL) on day 10 compared to the control group (LSD test, P=0.001, and P=0.000, respectively). ARG, high-PBM, and low-PBM+ARG significantly increased wound closure rates on day 15 relative to the control group (LSD test, P=0.000, P=0.000, and P=0.001, respectively). Conclusion: High-PBM and low-PBM+ARG have biostimulatory and antibacterial effects on slow-healing wounds, which were shown by significant increases in wound closure rates, wound strength, and inhibition of Staphylococcus aureus growth.
Effect of non-surgical periodontal therapy on serum ferritin levels in postmenopausal women with chronic periodontitis
Authors: Faramarzi Masoumeh , Shirmohammadi Adileh , Khorramdel Azin , Sadighi Mehrnoosh , Bargahi Elshan
Published: September 2021

Background. Ferritin is a positive acute phase protein (APP) in inflammation and chronic infections, including chronic periodontitis. Two key factors that can regulate ferritin expression are iron and pro-inflammatory cytokines. Serum ferritin levels increase after menopause, affecting women’s health. This study aimed to evaluate serum ferritin levels in postmenopausal women upon undertaking non-surgical periodontal treatment. Methods. In this cross-sectional study, blood samples of 38 postmenopausal women with chronic periodontitis were collected before any treatment. The serum ferritin levels and periodontal parameters, probing depth (PD), clinical attachment level (CAL), and gingival index (GI) were recorded at baseline and three months after non-surgical periodontal therapy. Wilcoxon test was used to compare serum ferritin levels before and after treatment. T-test was used for comparison of periodontal parameters, with a P value of ≤0.05 considered significant. Results. A decrease was observed in the serum ferritin level (from 108.55 mcg/L to 98.28 mcg/L) after treatment compared to baseline (P<0.001). Also, significant improvements in periodontal parameters were observed compared to the baseline (P<0.001). Conclusion. Based on the results, it can be concluded that non-surgical periodontal treatment significantly reduces serum ferritin levels in postmenopausal women with chronic periodontitis.