bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Asian dust-derived particulate matter on ST-elevation myocardial infarction: retrospective, time series study
Authors: Lee Suji , Lee Whanhee , Lee Eunil , Jeong Myung Ho , Rha Seung-Woon , Kim Chong-Jin , Chae Shung Chull , Kim Hyo-Soo , Gwon Hyeon-Cheol , Kim Ho
Published: January 2021

Background

Dust storms affect human health by impairing visibility and promoting interactions with microscopic organisms, such as bacteria and fungi. Although ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) differ mechanistically, few studies have investigated the incidence of cardiovascular diseases according to infarction type; these studies have yielded inconsistent findings. This study aimed to examine whether PM size (< 2.5 μm (PM2.5) and < 10 μm (PM10)) modifies the effect of Asian dust on acute myocardial infarction (AMI), with separate analyses for STEMI and NSTEMI.

Methods

MI-related data from 9934 emergency visits were collected from the Korea AMI Registry from 2005 to 2017. Asian dust events were defined as days with visibility of ≤10 km. Generalized linear models were used to analyze data with natural cubic splines. To examine potential modifiers, analyses were stratified by age, smoking status, and body mass index (BMI).

Results

No significant associations were observed between Asian dust and AMI. By adjusting for different lag structures, a significant effect was exclusively observed in STEMI. For moving average lags, the largest value at lag 5 (relative risk [RR] 1.083; 95% confidence interval [CI], 1.007–1.166) for single and lags 0–7 (RR 1.067; 95% CI: 1.002–1.136) was observed for PM2.5; for PM10, the largest significant effect was observed at lag 4 (RR 1.075; 95% CI: 1.010–1.144) for single and lags 0–7 (RR 1.067; 95% CI: 1.002–1.136). RRs were significantly higher in < 65-year-olds than in ≥65-year-olds. Additionally, RRs between the BMI < 25 and BMI ≥ 25 groups were not different; statistically significant effects were observed for concentration at lags 0–5 (RR: 1.073; 95% CI: 1.002–1.150) and lags 0–6 (RR: 1.071; 95% CI: 1.001–1.146) in the BMI < 25 group. A negative exposure-response association was observed between daily average visibility-adjusted PM and STEMI and daily average visibility-adjusted PM in < 65-year-olds.

Conclusions

Reducing PM2.5 and PM10 emissions, particularly during the days of Asian dust, may be crucial and reduce STEMI and AMI incidence among < 65-year-olds. These results indicate that the Asian dust alarm system needs revision to protect vulnerable populations.
Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study
Authors: Brandenberger Julia , Pohl Christian , Vogt Florian , Tylleskär Thorkild , Ritz Nicole
Published: January 2021

Background

Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital.

Methods

We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups.

Results

A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1–2) in the asylum-seeking and 2 (IQR 1–4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (> 15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients.

Conclusions

Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.
Trends of multimorbidity in 15 European countries: a population-based study in community-dwelling adults aged 50 and over
Authors: Souza Dyego L. B. , Oliveras-Fabregas Albert , Minobes-Molina Eduard , de Camargo Cancela Marianna , Galbany-Estragués Paola , Jerez-Roig Javier
Published: January 2021

Background

The objective of this work was to analyse the prevalence trends of multimorbidity among European community-dwelling adults.

Methods

A temporal series study based on waves 1, 2, 4, 5, 6 and 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 274,614) from 15 European countries were selected for the period 2004–2017. Prevalence, adjusted by age, Average Annual Percentage Change (APC) and 95% confidence interval (95% CI) were all calculated. Trend analyses were realised by period, age groups and groups of diseases.

Results

The results showed a large variability in the prevalence of multimorbidity in adults aged 50 and over among European countries. Increase in the prevalence of multimorbidity in the countries of central Europe (Austria, Belgium, Czech Republic, France, Germany and Switzerland) and Spain in both sexes, and in the Netherlands among men. Stability was observed in northern and eastern European countries. Musculoskeletal and neurodegenerative groups showed more significant changes in the trend analyses.

Conclusions

This information can be useful for policy makers when planning health promotion and prevention policies addressing modifiable risk factors in health.
Characteristics of SARS-CoV-2 positive cases beyond health-care professionals or social and health-care facilities
Authors: Deiana Giovanna , Azara Antonio , Dettori Marco , Delogu Fiorenzo , Vargiu Gavino , Gessa Isabella , Arghittu Antonella , Tidore Marcello , Steri Giorgio , Castiglia Paolo
Published: January 2021

Background

During the outbreak of SARS-CoV-2 in Italy, infection among health-care professionals and in the context of welfare and health-care facilities was a significant concern. It is known that the elderly or those with concomitant pathologies are at greater risk of a serious evolution of the disease if affected by COVID-19 and that health workers are a category with greater exposure to SARS-CoV-2 infection. Until now, there has been little information on the epidemiological features and transmission dynamics of the COVID-19 outbreak which did not involve health-care professionals or social and health-care facilities. For this reason, this paper aims to describe the epidemiological characteristics of SARS-CoV-2 infection in the general population outside these semi-closed communities.

Methods

The study was designed by analyzing the data of the 1371 SARS-CoV-2 positive subjects observed in Sardinia up to 9 July, 2020 and whose data were available in the public health department. Statistical analysis and graphic representation were performed using STATA and Adobe Illustrator, respectively.

Results

Of the positive cases analyzed, 323 (23.5%) are health-care workers and 563 (41.1%) reside in social or health-care facilities. The number of positive cases among the general population (subjects who do not belong to these semi-closed communities), is 399 (29.1%), 208 females and 191 males. The estimated Case Fatality Rate stands at 5.0%, which is almost half the rate reported for all the SARS-CoV-2 positive cases (9.8%). The geographical distribution of positive cases differs considerably from the distribution of the totality of cases in Sardinia.

Conclusions

This review provides an insight into the COVID-19 situation in the general community, ie not involving health-care professionals or social and health-care facilities. Understanding the evolving epidemiology and transmission dynamics of the outbreak outside of these semi-closed communities would provide appropriate information to guide intervention policy. The COVID-19 pandemic has exacerbated the vulnerability of our health-care system. Severe disruptions in care, medicine shortages and unequal access to health-care are but a few examples of the challenges faced by people living in Italy and Europe, highlighting the importance of evidence-based approaches in supporting the development of prevention and response strategies for future pandemics.
Recognizing the hidden: strengthening the HIV surveillance system among key and priority populations in Mozambique
Authors: Semá Baltazar Cynthia , Boothe Makini , Chitsondzo Langa Denise , Sathane Isabel , Horth Roberta , Young Peter , Schaad Nick , Raymond Henry F.
Published: January 2021

High quality, representative data from HIV surveillance systems that have country ownership and commitment are critical for guiding national HIV responses, especially among key and priority populations given their disproportionate role in the transmission of the virus. Between 2011 to 2013, the Mozambique Ministry of Health has conducted five Biobehavioral Surveillance Surveys among key populations (female sex workers, men who has sex with men and people who inject drugs) and priority populations (long distance truck drives and miners) as part of the national HIV surveillance system. We describe the experience of strengthening the HIV surveillance system among those populations through the implementation of these surveys in Mozambique. We document the lessons learned through the impact on coordination and collaboration; workforce development and institutional capacity building; data use and dissemination; advocacy and policy impact; financial sustainability and community impact. Key lessons learned include the importance of multisectoral collaboration, vital role of data to support key populations visibility and advocacy efforts, and institutional capacity building of government agencies and key populations organizations. Given that traditional surveillance methodologies from routine data often do not capture these hidden populations, it will be important to ensure that Biobehavioral Surveillance Surveys are an integral part of ongoing HIV surveillance activities in Mozambique.
Developing a comprehensive school-based physical activity program with flexible design – from pilot to national program
Authors: Mooses Kerli , Vihalemm Triin , Uibu Marko , Mägi Katrin , Korp Leene , Kalma Maarja , Mäestu Evelin , Kull Merike
Published: January 2021

This article focuses on the process of designing the vital, participatory school-based intervention program aiming to increase the physical activity in schools. The program analyzed is Estonian nationwide comprehensive physical activity program Schools in Motion (SiM) that recently received European Commission’s #BeActive Education Award. The program has a good performance in terms of willingness of schools to participate in co-creation of program development, the high interest to join the program and zero dropouts, and strong partnership with ministries which enables to actively participate in policy making. Authors analyze the key elements of the planning, piloting, implementation, and scaling phases of the SiM program and share their lessons learnt in co-working with schools. The difficulties faced during the development process, the strengths and challenges associated with an interdisciplinary approach, and involvement of schools as experts have been addressed.
What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation
Authors: Krishnaratne Shari , Hamon Jessie K. , Hoyt Jenna , Chantler Tracey , Landegger Justine , Spilotros Nathaly , Demissie Shiferaw Dechasa , Mohammed Siraj , Webster Jayne
Published: January 2021

Background

Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period.

Methods

A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. The methodological approach included the development of an initial programme theory and the selection of relevant, published implementation related theoretical frameworks to aid organisation and cumulation of findings. Data from 23 semi-structured interviews were then analysed to determine key empirical mechanisms and drivers and to test the initial programme theory. These mechanisms were mapped against published theoretical frameworks and a revised programme theory comprised of context-mechanism-outcome configurations was developed. A critique of theoretical frameworks for abstracting empirical mechanisms was also conducted.

Results

Key contextual factors identified were: the use of trained Health Extension Workers (HEWs) to deliver FP services; a strong belief in values that challenged FP among religious leaders and community members; and a lack of support for FP from male partners based on religious values. Within these contexts, empirical mechanisms of acceptability, access, and adoption of innovations that drove decision making and intervention outcomes among health workers, religious leaders, and community members were identified to describe intervention implementation.

Conclusions

Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for whom the intervention worked. Linking empirical mechanisms to constructs of implementation related theoretical frameworks provided a level of abstraction through which findings could be cumulated across time, space, and conditions by theorising middle-range mechanisms.
Knowledge of PEP and PrEP among people living with HIV/aids in Brazil
Authors: Sousa Laelson Rochelle Milanês , Elias Henrique Ciabotti , Fernandes Nilo Martinez , Gir Elucir , Reis Renata Karina
Published: January 2021

Background

Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are key to preventing sexual transmission of HIV, whose sexual partners are at high risk of acquiring HIV.

We aimed to determine the factors associated with PrEP and PEP’s knowledge as secondary prevention among people living with HIV/AIDS.

Method

Cross-sectional analytical study carried out among people living with HIV/AIDS treated at five specialized services in the city of Ribeirão Preto, São Paulo, Brazil. Data were collected from July 2016 to July 2017. Individual interviews were conducted. We used multivariable logistic regression to determine factors associated with knowing PrEP and PEP.

Results

Of the 397 participants, 140 (35.26%) were heterosexual women aged 40 to 49 years (36.2%).Participants with less than 11 years of study (adjusted odds: 0.29; 95% CI: 0.13–0.60); who did not have a low viral load or did not know their viral load (adjusted odds: 0.29; 95% CI: 0.09–0.83) and those with casual partners (adjusted odds: 0.29; 95% CI: 0.09–0.83) were less likely to know about the PrEP. MSM (adjusted odds: 2.88; 95% CI: 1.59–5.3) and those who used alcohol during sexual intercourse (adjusted odds: 1.7; 95% CI: 1.0–2.8) were more likely to know about the PEP.

Conclusions

The knowledge about PEP and PrEP is low in Brazil. This may undermine secondary prevention efforts. Educational interventions to raise awareness of these prevention methods are needed among people living with HIV and who have HIV-negative sexual partners.
Diagnostic yield, safety, and impact of transbronchial lung biopsy in mechanically ventilated, critically ill patients: a retrospective study
Authors: Ghiani Alessandro , Neurohr Claus
Published: January 2021

Background

Pulmonary infiltrates of variable etiology are one of the main reasons for hypoxemic respiratory failure leading to invasive mechanical ventilation. If pulmonary infiltrates remain unexplained or progress despite treatment, the histopathological result of a lung biopsy could have significant impact on change in therapy. Surgical lung biopsy is the commonly used technique, but due to its considerable morbidity and mortality, less invasive bronchoscopic transbronchial lung biopsy (TBLB) may be a valuable alternative.

Methods

Retrospective, monocentric, observational study in mechanically ventilated, critically ill patients, subjected to TBLB due to unexplained pulmonary infiltrates in the period January 2014 to July 2019. Patients’ medical records were reviewed to obtain data on baseline clinical characteristics, modality and adverse events (AE) of the TBLB, and impact of the histopathological results on treatment decisions. A multivariable binary logistic regression analysis was performed to identify predictors of AE and hospital mortality, and survival curves were generated using the Kaplan-Meier method.

Results

Forty-two patients with in total 42 TBLB procedures after a median of 12 days of mechanical ventilation were analyzed, of which 16.7% were immunosuppressed, but there was no patient with prior lung transplantation. Diagnostic yield of TBLB was 88.1%, with AE occurring in 11.9% (most common pneumothorax and minor bleeding). 92.9% of the procedures were performed as a forceps biopsy, with organizing pneumonia (OP) as the most common histological diagnosis (54.8%). Variables independently associated with hospital mortality were age (odds ratio 1.070, 95%CI 1.006–1.138; p = 0.031) and the presence of OP (0.182, [0.036–0.926]; p = 0.040), the latter being confirmed in the survival analysis (log-rank p = 0.040). In contrast, a change in therapy based on histopathology alone occurred in 40.5%, and there was no evidence of improved survival in those patients.

Conclusions

Transbronchial lung biopsy remains a valuable alternative to surgical lung biopsy in mechanically ventilated critically ill patients. However, the high diagnostic yield must be weighed against potential adverse events and limited consequence of the histopathological result regarding treatment decisions in such patients.
Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain
Authors: Suni J. H. , Virkkunen T. , Husu P. , Tokola K. , Parkkari J. , Kankaanpää M.
Published: January 2021

Background

Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP.

Methods

Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0–4 none, 5–9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined.

Results

The internal consistency of the PHQ-9-mFIN was high (Cronbach’s α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson’s correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, − 0.40 to − 0.67 and − 0.64) than for the Physical (range, − 0.08 to − 0.43 and − 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work.

Conclusions

The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work.

Trial registration

NCT01465698.
Patient-reported outcomes in young adults with osteonecrosis secondary to developmental dysplasia of the hip - a longitudinal and cross-sectional evaluation
Authors: Marks Avi , Cortina-Borja Mario , Maor Dror , Hashemi-Nejad Aresh , Roposch Andreas
Published: January 2021

Background

Osteonecrosis of the femoral head is a common complication in the treatment of developmental dysplasia of the hip (DDH). While functional outcomes of affected patients are good in childhood, it is not clear how they change during the transition to young adulthood. This study determined the relationship between osteonecrosis and hip function, physical function and health status in adolescents and young adults.

Methods

We performed a cross-sectional study of 169 patients with a mean age of 19.7 ± 3.8 years with and without osteonecrosis following an open or closed reduction (1995–2005). We also performed a separate longitudinal evaluation of an historical cohort of 54 patients with osteonecrosis, embedded in this sample. All completed patient-reported outcome measures in 2015/2016 to quantify hip function (maximum score 100); physical function (maximum score 100); and general health status (maximum score 1). We graded all radiographs for subtype of osteonecrosis (Bucholz-Ogden); acetabular dysplasia (centre-edge angle); subluxation (Shenton’s line); and osteoarthritis (Kellgren-Lawrence). Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.

Results

In 149 patients (186 hips) with and without osteonecrosis, the mean differences (95% confidence interval) in hip function, physical function and quality of life were − 4.7 (− 10.26, 0.81), − 1.03 (− 9.29, 7.23) and 0.10 (− 1.15, 1.18), respectively. Adjusted analyses stratified across types of osteonecrosis showed that only patients with Bucholz-Odgen grade III had reduced hip function (p < 0.01) and physical function (p < 0.05) but no difference in health-related quality of life when compared to no osteonecrosis.

Conclusion

Osteonecrosis secondary to DDH is a relatively benign disorder in adolescents and young adulthood. Affected patients demonstrated minimal physical disability, a normal quality of life but reduced hip function.
Associations of objectively measured total duration and maximum bout length of standing at work with lower-extremity pain intensity: a 2-year follow-up of construction and healthcare workers
Authors: Lunde Lars-Kristian , Merkus Suzanne , Koch Markus , Knardahl Stein , Wærsted Morten , Veiersted Kaj Bo
Published: January 2021

Background

Musculoskeletal disorders are among the major reasons for years lived with disability. Approximately one third of the European working population report lower-extremity discomfort and many attribute these discomforts to work-related factors. Employees in the healthcare and construction sectors reports high levels of lower-extremity pain and commonly relate the pain to their profession. These workers spend a large part of their workday standing. Periods of prolonged standing is suggested to increase lower-extremity symptoms, but this cannot be concluded on, since limited evidence is available from longitudinal studies using objective measures. This study aimed to determine possible associations between objectively measured total duration and maximum bout length of static- and dynamic standing at work and lower-extremity pain intensity (LEPi) among Norwegian construction- and healthcare workers.

Methods

One-hundred and twenty-three construction and healthcare workers wore two accelerometers for up to four consecutive days, to establish standing behavior at baseline. The participants reported LEPi (Likert scale 0–9) for the preceding 4 weeks at baseline and after 6, 12, 18, and 24 months. We investigated associations between standing at work and average and change in LEPi using linear mixed models with significance levelp ≤ 0.05.

Results

Total duration of static- and dynamic standing showed weak associations with average LEPi, for the total sample and for construction workers. Maximum bout of static- and dynamic standing was associated with average LEPi in construction workers, but not in healthcare workers. Furthermore, we found no associations between standing and change in LEPi over the 2-year follow-up in any of our analyses.

Conclusions

This study indicate that objectively measured standing is associated with average LEPi over 2-years follow-up in construction workers, and that maximal bout of standing have a stronger association to LEPi than total duration. For every 10 min added to the maximal length of continuous standing during an average workday, we found approximately one unit increase in pain on a 0–9 scale. The lack of significant findings in analyses on healthcare workers suggest that the association between standing and LEPi depend on work-tasks, gender and/or other sector-specific factors.
The association of acute hypercarbia and plasma potassium concentration during laparoscopic surgery: a retrospective observational study
Authors: Weinberg Laurence , Lee Dong-Kyu , Gan Chrisdan , Ianno Damian , Ho Alexander , Fletcher Luke , Banyasz Daniel , Tosif Shervin , Jones Daryl , Bellomo Rinaldo , Karalapillai Dharshi
Published: January 2021

Background

It is uncertain whether increases in PaCO2 during surgery lead to an increase in plasma potassium concentration and, if so, by how much. Hyperkalaemia may result in cardiac arrhythmias, muscle weakness or paralysis. The key objectives were to determine whether increases in PaCO2 during laparoscopic surgery induce increases in plasma potassium concentrations and, if so, to determine the magnitude of such changes.

Methods

A retrospective observational study of adult patients undergoing laparoscopic abdominal surgery was perfomed. The independent association between increases in PaCO2 and changes in plasma potassium concentration was assessed by performing arterial blood gases within 15 min of induction of anaesthesia and within 15 min of completion of surgery.

Results

289 patients were studied (mean age of 63.2 years; 176 [60.9%] male, and mean body mass index of 29.3 kg/m2). At the completion of the surgery, PaCO2 had increased by 5.18 mmHg (95% CI 4.27 mmHg to 6.09 mmHg) compared to baseline values (P < 0.001) with an associated increase in potassium concentration of 0.25 mmol/L (95% CI 0.20 mmol/L to 0.31 mmol/L, P < 0.001). On multiple regression analysis, PaCO2 changes significantly predicted immediate changes in plasma potassium concentration and could account for 33.1% of the variance (r2 = 0.331, f(3,259) = 38.915, P < 0.001). For each 10 mmHg increment of PaCO2 the plasma potassium concentration increased by 0.18 mmol/L.

Conclusion

In patients receiving laparoscopic abdominal surgery, there is an increase in PaCO2 at the end of surgery, which is independently associated with an increase in plasma potassium concentration. However, this effect is small and is mostly influenced by intravenous fluid therapy (Plasma-Lyte 148 solution) and the presence of diabetes.

Trial registration Retrospectively registered in the Australian New Zealand Clinical Trials Registry (Trial Number: ACTRN12619000716167).
Failure to maintain full-term pregnancies in pig carrying klotho monoallelic knockout fetuses
Authors: Lee Sanghoon , Jung Min Hee , Song Kilyoung , Jin Jun-Xue , Taweechaipaisankul Anukul , Kim Geon A. , Oh Hyun Ju , Koo Ok Jae , Park Se Chang , Lee Byeong Chun
Published: January 2021

Background

Small animals that show a deficiency in klotho exhibit extremely shortened life span with multiple aging-like phenotypes. However, limited information is available on the function of klotho in large animals such as pigs.

Results

In an attempt to produce klotho knockout pigs, an sgRNA specific for klotho (targeting exon 3) was designed and Cas9-sgRNA ribonucleoproteins were transfected into porcine fibroblasts. Transfected fibroblasts were cultured for one to 2 days and then directly used for nuclear transfer without selection. The cloned embryos were cultured in vitro for 7 days and analyzed to detect modifications of the klotho gene by both T7E1 and deep sequencing analysis. Modification succeeded in 13 of 20 blastocysts (65%), 8 of which (40.0%) were monoallelic modifications and 5 (25.0%) were biallelic modifications. Based on high mutation rates in blastocysts, we transferred the cloned embryos to 5 recipient pigs; 1 recipient was pregnant and 16 fetuses were recovered at Day 28 post transfer. Of the 16 fetuses, 9 were resorbing and 7 were viable. Four of 9 (44.4%) resorbing fetuses and 3 of the 7 (42.9%) viable fetuses had monoallelic modifications. Thus, 3 klotho monoallelic knockout cell lines were established by primary culture. A total of 2088 cloned embryos reconstructed with 2 frame-shifted cell lines were transferred to 11 synchronized recipients. Of the recipients, 7 of 11 eleven (63.6%) became pregnant. However, none of the pregnancies was maintained to term. To discover why klotho monoallelic knockout fetuses were aborted, expression of aging- and apoptosis-related genes and klotho protein in placentas from klotho monoallelic knockout and wild-type fetuses was investigated. Placentas from klotho monoallelic knockout fetuses showed negatively changed expression of aging- and apoptosis-related genes with lower relative expression of klotho protein. These results indicated that the reason why klotho monoallelic knockout fetuses were not maintained to term was possibly due to decreased klotho expression in placentas, negatively affecting aging- and apoptosis-related genes.

Conclusions

Klotho monoallelic knockout porcine fetal fibroblasts were successfully established. However, pigs carrying klotho monoallelic knockout fetuses failed to maintain full-term pregnancy and a decrease in klotho expression in placenta likely leads to pregnancy loss.
Symptomatic primary hyperparathyroidism in a young woman presenting with multiple skeletal destructions: a case report and review of literature
Authors: Lu Shuai , Gong Maoqi , Zha Yejun , Cui Aimin , Tian Wei , Jiang Xieyuan
Published: January 2021

Background

Multiple pathological manifestations are rarely present in patients with primary hyperparathyroidism (PHPT). Here we described a case of a young woman who presented with multiple skeletal destructions and received an unclear diagnosis at several hospitals.

Case presentation

A 30-year-old woman was admitted to our hospital due to pain in both knees and walking difficulty that lasted for 6 and 2 years, respectively. Her laboratory test results revealed a high parathyroid hormone level (822 pg/ml) and hypercalcemia (2.52 mmol/L) in the blood. Parathyroid imaging revealed a lumpy concentration of radioactive uptake detected at the lower pole in the right lobe of the thyroid, and was nearly 2.2 cm * 2.4 cm in size. Next, the patient was treated with parathyroidectomy that resulted in a significant improvement in physiological and clinical symptoms. Moreover, the skeletal destruction and bone mineral density were significantly improved after a 5-years follow-up period.

Conclusions

Multiple skeletal destructions can be caused by PHPT that should be taken into consideration in young patients with complex bone lesions.
Craniofacial morphology/phenotypes influence on mandibular range of movement in the design of a mandibular advancement device
Authors: Sanz P. Mayoral , Reyes M. Garcia , Torras A. Bataller , Castillo J. A. Cabrera , Vich M. O. Lagravère
Published: January 2021

Background

The mandibular opening path movements have different directions according to the craniofacial morphology of the patient but always downward and backward, therefore increasing the collapse of the upper airway. The aim of this work is to determine if there is a relationship between the craniofacial morphology and the mandibular movement to help understand the impact on the mandibular position.

Methods

52 students with full permanent dentition aged 19 to 23 years (mean 21.3 SD 1.7; 29 females and 23 males), participated in the study. Each subject had a lateral cephalometric radiograph taken. The opening angle was determined for two levels of vertical openings at 5 and 10 mm.

Results

The opening angle showed a greater variability between subjects ranging from 63.15 to 77.08 for 5 mm angle and from for 61.65 to 75.72 for the 10 mm angle. Differences of facial phenotypes was evident when comparing the individual dissoccluding angle of the low angle horizontal pattern and high angle vertical pattern.

Conclusions

The opening angle is related to craniofacial morphology with higher vertical anterior and shorter anteroposterior faces having a more horizontal path of mandibular movement than shorter vertical anterior and longer anteroposterior subjects who have a more vertical path.
Selected salivary parameters in children with idiopathic nephrotic syndrome: a preliminary study
Authors: Kaczmarek Urszula , Wrzyszcz-Kowalczyk Alina , Jankowska Katarzyna , Prościak Katarzyna , Mysiak-Dębska Monika , Przywitowska Iwona , Makulska Irena
Published: January 2021

Background

Disturbances in the levels of serum constituents occurring in chronic renal diseases can be reflected in the saliva composition. The aim of this study was to assess some selected salivary components in children suffering from idiopathic steroid-sensitive nephrotic syndrome (iNS).

Methods

A case–control study was performed on iNS and healthy participants. In unstimulated mixed saliva, pH, buffer capacity, total protein, α-amylase, peroxidase, calcium, magnesium, inorganic phosphate, fluoride, urea, uric acid and salivary flow rate were measured. Oral condition was assessed using dmft, DMFT, API and GI indices, usage of fluoride specimens and frequency of tooth brushing. Statistical analysis was performed by Shapiro–Wilk, Brown-Forsythe, Student’s t, ANOVA, Tukey’s and Pearson’s chi-square tests, Pearson’s and Spearman’s correlations, logistic regression and receiver operating characteristic (ROC) curve analysis.

Results

The study involved 94 participants of both genders aged 4–17 (47 cases in relapse or remission phase of iNS and 47 controls) who were treated in the clinic of pediatric nephrology or outpatient dental clinic. Neither group differed in the number of caries-affected primary and permanent teeth, gingival condition or use of fluoride specimens. The iNS group presented lower levels of magnesium (0.41 ± 0.34 vs. 0.60 ± 0.38 mg/dL, P < 0.05) and fluoride (0.15 ± 0.10 vs. 0.21 ± 0.10 ppm, P < 0.01) and higher contents of urea (35.19 ± 15.55 vs. 25.21 ± 10.78 mg/dL, P < 0.01) and uric acid (2.90 ± 1.23 vs. 2.34 ± 1.04 mg/dL, P < 0.05) than the controls. In the iNS participants with relapse, a higher peroxidase activity and lower magnesium content than in the remission phase were found. ROC analysis showed a weak discriminatory power of these salivary constituents for the differentiation of participants with and without disease (accuracy from 66.0 to 67.0%, area under the ROC curve (AUC) from 0.638 to 0.682) and the relapse and remission phases (accuracy 70.2% and 68.1% and AUC 0.717 and 0.675, respectively).

Conclusions

Levels of urea, uric acid, magnesium and fluoride in saliva can be associated with the course of iNS. Salivary levels of peroxidase and magnesium can be related to the phase of the disease. However, the measurements of these parameters cannot be useful as a noninvasive tool in diagnosing iNS and the phase of the disease.
An educational intervention for improving knowledge of Syrian school children about avulsion using the "save your tooth" poster
Authors: Al Zaher Nancy , Dashash Mayssoon
Published: January 2021

Background

The prognosis of replantation of an avulsed tooth is affected by the first aid management in the first 15 min after traumatic incident. Knowledge of the optimal management is crucial to successful replantation. The objective of this study was to investigate the effectiveness of educational intervention using the Arabic version of the "save your tooth" poster designed by the International Association of Dental Traumatology IADT, in improving the knowledge of schoolchildren about first aid management of avulsion of permanent teeth.

Methods

An interventional educational study was undertaken. A total of 550 schoolchildren aged 9–12 years participated in this study. Thirteen public primary schools in Damascus city were selected. A questionnaire was developed to measure the knowledge of schoolchildren about avulsion of permanent teeth. The translated IADT education poster about avulsion management was adopted.The content of this poster was explained to the children. Two months later, the subjects were re-evaluated using the same questionnaire. Paired sample t-test was used to test the differences existed between the two assessments.

Result

A total of 537 schoolchildren completed the questionnaires in which (n = 305) 57% were females and (n = 232) 43% were males. The findings demonstrated significant improvement in the participants’ responses after interventional education (P < 0.05). The mean score of knowledge increased significantly from 3.71 at the baseline to 4.03 after the intervention (P < 0.003).

Conclusion

The findings of the present study showed that the level of knowledge of Syrian schoolchildren regarding first-aid management of avulsion of permanent teeth was limited at the baseline. The follow-up results showed that the educational intervention based on the “save your tooth” poster was significantly effective in improving the knowledge of schoolchildren. Further interventions to educate all Syrian schoolchildren about avulsion could be of great value to prevent its negative aesthetic, functional, psychological, economic impacts.
Does burnout affect clinical reasoning? An observational study among residents in general practice
Authors: Guillou Philippe , Pelaccia Thierry , Bacqué Marie-Frédérique , Lorenzo Mathieu
Published: January 2021

Background

Burnout results from excessive demands at work. Caregivers suffering from burnout show a state of emotional exhaustion, leading them to distance themselves from their patients and to become less efficient in their work. While some studies have shown a negative impact of burnout on physicians’ clinical reasoning, others have failed to demonstrate any such impacts. To better understand the link between clinical reasoning and burnout, we carried out a study looking for an association between burnout and clinical reasoning in a population of general practice residents.

Methods

We conducted a cross-sectional observational study among residents in general practice in 2017 and 2019. Clinical reasoning performance was assessed using a script concordance test (SCT). The Maslach Burnout Inventory for Human Services Survey (MBI-HSS) was used to determine burnout status in both original standards of Maslach’s burnout inventory manual (conventional approach) and when individuals reported high emotional exhaustion in combination with high depersonalization or low personal accomplishment compared to a norm group (“emotional exhaustion +1” approach).

Results

One hundred ninety-nine residents were included. The participants’ mean SCT score was 76.44% (95% CI: 75.77–77.10). In the conventional approach, 126 residents (63.31%) had no burnout, 37 (18.59%) had mild burnout, 23 (11.56%) had moderate burnout, and 13 (6.53%) had severe burnout. In the “exhaustion + 1“ approach, 38 residents had a burnout status (19.10%). We found no significant correlation between burnout status and SCT scores either for conventional or “exhaustion + 1“ approaches.

Conclusions

Our data seem to indicate that burnout status has no significant impact on clinical reasoning. However, one speculation is that SCT mostly examines the clinical reasoning process’s analytical dimension, whereas emotions are conventionally associated with the intuitive dimension. We think future research might aim to explore the impact of burnout on intuitive clinical reasoning processes.
Adaptation and validation of a Korean-language version of the revised hospital survey on patient safety culture (K-HSOPSC 2.0)
Authors: Lee Seung Eun , Dahinten V. Susan
Published: January 2021

Background

To date, there has been no universal and validated tool for measuring safety culture in Korea. The Hospital Survey on Patient Safety Culture (HSOPSC), version 2.0 was released by the Agency for Healthcare Research and Quality in 2019, but it had not yet been translated and assessed for use in Korea. The aim of this study was to assess the content validity and other psychometric properties of the Korean-language version of the HSOPSC 2.0.

Methods

Instrument adaptation was performed using a committee-based translation, cognitive interviews, and expert panel reviews. Confirmatory factor analysis was conducted on data obtained through an online survey from 526 registered nurses who worked on medical-surgical units in three teaching hospitals in South Korea.

Results

One item was dropped during the translation and adaption phase of the study as being a poor fit for the Korean healthcare context, resulting in excellent content validity. Confirmatory factor analysis supported the factorial structure of the K-HSOPSC 2.0. Correlations with an overall measure of patient safety provided further evidence of construct validity. Additionally, in comparing the results of this current study to those from U.S. research using the HSOPSC 2.0, it was found that Korean nurses assigned less positive scores to all dimensions of patient safety culture.

Conclusion

Our findings provide evidence of the content validity, reliability, and construct validity of the K-HOSPSC 2.0 for measuring patient safety culture in South Korean hospitals.

Hospital administrators can use this tool to assess safety culture and identify areas for improvement to enhance patient safety and quality of care.
Cross-cultural adaptation and exploratory factor analysis of the Person-centred Practice Inventory - Staff (PCPI-S) questionnaire among Malaysian primary healthcare providers
Authors: Balqis-Ali Nur Zahirah , Saw Pui San , Jailani Anis Syakira , Fun Weng Hong , Mohd Saleh Noridah , Tengku Bahanuddin Tengku Putri Zaharah , Sararaks Sondi , Lee Shaun Wen Huey
Published: January 2021

Background

The Person-centred Practice Inventory-Staff (PCPI-S) instrument was developed to measure healthcare providers’ perception towards their person-centred practice. The study aimed to explore the influence of culture, context, language and local practice towards the PCPI-S instrument adaptation process for use among public primary care healthcare providers in Malaysia.

Methods

The original PCPI-S was reviewed and adapted for cultural suitability by an expert committee to ensure conceptual and item equivalence. The instrument was subsequently translated into the local Malay language using the forward-backward translation by two independent native speakers, and modified following pre-tests involving cognitive debriefing interviews. The psychometric properties of the corresponding instrument were determined by assessing the internal consistency, test-retest reliability, and correlation of the instrument, while the underlying structure was analysed using exploratory factor analysis.

Results

Review by expert committee found items applicable to local context. Pre-tests on the translated instrument found multiple domains and questions were misinterpreted. Many translations were heavily influenced by culture, context, and language discrepancies. Results of the subsequent pilot study found mean scores for all items ranged from 2.92 to 4.39. Notable ceiling effects were found. Internal consistency was high (Cronbach’s alpha > 0.9). Exploratory factor analysis found formation of 11 components as opposed to the original 17 constructs.

Conclusion

The results of this study provide evidence regarding the reliability and underlying structure of the PCPI-S instrument with regard to primary care practice. Culture, context, language and local practice heavily influenced the adaptation as well as interpretation of the underlying structure and should be given emphasis when translating person-centred into practice.
Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration
Authors: Pedersen Rune Aakvik , Petursson Halfdan , Hetlevik Irene , Thune Henriette
Published: January 2021

Background

The acute treatment for stroke takes place in hospitals and in Norway follow-up of stroke survivors residing in the communities largely takes place in general practice. In order to provide continuous post stroke care, these two levels of care must collaborate, and information and knowledge must be transferred between them. The discharge summary, a written report from the hospital, is central to this communication. Norwegian national guidelines for treatment of stroke, issued in 2010, therefore give recommendations on the content of the discharge summaries. One ambition is to achieve collaboration and knowledge transfer, contributing to integration of the health care services. However, studies suggest that adherence to guidelines in general practice is weak, that collaboration within the health care services does not work the way the authorities intend, and that health care services are fragmented.

This study aims to assess to what degree the discharge summaries adhere to the guideline recommendations on content and to what degree they are used as tools for knowledge transfer and collaboration between secondary and primary care.

Methods

The study was an analysis of 54 discharge summaries for home-dwelling stroke patients. The patients had been discharged from two Norwegian local hospitals in 2011 and 2012 and followed up in primary care. We examined whether content was according to guidelines’ recommendations and performed a descriptive and interpretative discourse analysis, using tools adapted from an established integrated approach to discourse analysis. 

Results

We found a varying degree of adherence to the different advice for the contents of the discharge summaries. One tendency was clear: topics relevant here and now, i.e. at the hospital, were included, while topics most relevant for the later follow-up in primary care were to a larger degree omitted. In most discharge summaries, we did not find anything indicating that the doctors at the hospital made themselves available for collaboration with primary care after dischargeof the patient.

Conclusions

The discharge summaries did not fulfill their potential to serve as tools for collaboration, knowledge transfer, and guideline implementation. Instead, they may contribute to sustain the gap between hospital medicine and general practice.