bluuebunny/crossref_metadata_2025 huggingface dataset:
Mesenchymal stem cells- derived exosomes inhibit the expression of Aquaporin-5 and EGFR in HCT-116 human colorectal carcinoma cell line
Authors: Mansourabadi Amir Hossein , Aghamajidi Azin , Faraji Fatemeh , Taghizadeh Shirin , Mohamed Khosroshahi Leila , Bahramkiya Mona , Azimi Maryam
Published: September 2022

Background

Aquaporins are channel proteins, form pores in the membrane of biological cells to facilitate the transcellular and transepithelial water movement. The role of Aquaporins in carcinogenesis has become an area of interest. In this study, we aimed to investigate the effects of adipose-derived mesenchymal stem cells secreted exosomes on the expression of aquaporin 5 and EGFR genes in the HCT-116 tumor cell line.

Methods and results

Surface antigenic profile of Ad-MSCs was evaluated using specific markers. Exosomes were purified from the Ad-MSc supernatant while the quality and the shape of isolated exosomes were assessed by western blot and transmission electron microscopy (TEM) respectively. HCT-116 cells were co-cultured with MSC-conditioned medium (MSC-CM) and/or with 100 μg/ml of MSC-derived exosomes for 48 h and. Real-time PCR was carried out to determine the expression of aquaporin5 and EGFR in HCT-116. Relative expression levels were calculated using the 2-ΔΔct method.

Our result showed that AQP5 and EGFR mRNA levels were significantly reduced in CM and/or exosomes treated HCT116 compare to the control group (P-value < 0.05).

Conclusion

The current study showed that MSC derived exosomes could inhibit expression of two important molecules involved in tumor progression. Hence it seems MSCs-derived exosomes may hold a hopeful future as drug delivery vehicles which need the furtherer investigation.
Bioinformatics analysis reveals the potential target of rosiglitazone as an antiangiogenic agent for breast cancer therapy
Authors: Hermawan Adam , Putri Herwandhani
Published: September 2022

Background

Several studies have demonstrated the antitumor activity of rosiglitazone (RGZ) in cancer cells, including breast cancer cells. However, the molecular targets of RGZ in the inhibition of angiogenesis in breast cancer cells remain unclear. This study aimed to explore the potential targets of RGZ in inhibiting breast cancer angiogenesis using bioinformatics-based analysis.

Results

Venn diagram analysis revealed 29 TR proteins. KEGG pathway enrichment analysis demonstrated that TR regulated the adipocytokine, AMPK, and PPAR signaling pathways. Oncoprint analysis showed genetic alterations inFABP4(14%),ADIPOQ(2.9%),PPARG(2.8%),PPARGC1A(1.5%),CD36(1.7%), andCREBBP(11%) in patients with breast cancer in a TCGA study. The mRNA levels ofFABP4,ADIPOQ,PPARG,CD36, andPPARGC1Awere significantly lower in patients with breast cancer than in those without breast cancer. Analysis of gene expression using bc-GenExMiner showed that the mRNA levels ofFABP,ADIPOQ,PPARG,CD36, PPARGC1A, andCREBBPwere significantly lower in basal-like and triple-negative breast cancer (TNBC) cells than in non-basal-like and non-TNBC cells. In general, the protein levels of these genes were low, except for that of CREBBP. Patients with breast cancer who had low mRNA levels ofFABP4,ADIPOQ,PPARG, andPPARGC1Ahad lower overall survival rates than those with high mRNA levels, which was supported by the overall survival related to DNA methylation. Correlation analysis of immune cell infiltration with TR showed a correlation between TR and immune cell infiltration, highlighting the potential of RGZ for immunotherapy.

Conclusion

This study explored the potential targets of RGZ as antiangiogenic agents in breast cancer therapy and highlighted FABP4, ADIPOQ, PPARG, PPARGC1A, CD36, and CREBBP as potential targets of RGZ. These findings require further validation to explore the potential of RGZ as an antiangiogenic agent.
Drugs utilization profile in England and Wales in the past 15 years: a secular trend analysis
Authors: Naser Abdallah Y. , Alwafi Hassan , Al-Daghastani Tamara , Hemmo Sara Ibrahim , Alrawashdeh Hamzeh Mohammad , Jalal Zahraa , Paudyal Vibhu , Alyamani Nawras , Almaghrabi Murouj , Shamieh Ahmad
Published: September 2022

Background

Medication use assessment has a critical role in promoting the effective and rational use of pharmaceutical medications. There are no studies that have explored the utilization of all medications in England and Wales in the past 15 years without restrictions in the age group being studied or class of medications.

Aim

To explore the medication utilization pattern of dispensed medications in England and Wales in the past 15 years.

Method

A secular trend analysis study using publically available dispensing data on the population level in England and Wales for the duration between 2004 and 2019. Medication dispensing data was extracted from the Prescription Cost Analysis database.

Results

Medication prescriptions rate increased by 42.6% [from 1,345,095.75 (95% CI 1,345,004.25 – 1,345,187.26) in 2004 to 1,918,138.48 (95% CI 1,918,038.38 – 1,918,238.57) in 2019 per 100,000 persons, trend test, p < 0.001]. During the study period, the most common medication prescriptions were for the cardiovascular system, central nervous system, and endocrine system, which accounted for 30.2%, 18.8%, and 9.4%, respectively. The rate of medication prescriptions for skin, immunological products and vaccines, infections, and musculoskeletal and joint diseases decreased by 18.4%, 15.8%, 9.8%, and 5.7%, respectively.

Conclusion

The last two decades have witnessed a remarkable rise in the quantity of medications dispensed in community settings. Utilization of chronic disease medications has increased in the past 15 years, specifically, dispensed medications for the cardiovascular system, central nervous system, and endocrine system. It is necessary to conduct additional cohort studies to investigate the clinical outcomes and prescribing safety of these medications.
Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local
Authors: Zhang Xiyu , Miao Wenqing , Wu Bing , Lai Yongqiang , Jiao Mingli , Xia Qi , Zhang Chenxi , Tian Wanxin , Song Zhe , Shan Linghan , Hu Lingqin , Han Xinhao , Yin Hui , Cheng Xiaonan , Li Ye , Shi Baoguo , Wu Qunhong
Published: September 2022

Background

The high incidence of catastrophic health expenditure (ICHE) among middle-aged and elderly population is a major deterrent for reducing the financial risk of disease. Current research is predominantly based on the assumption of spatial homogeneity of nationwide population characteristics, ignoring the differences in regional characteristics. Thus, our study aimed to explore the impact of various influencing factors on the ICHE from a spatiotemporal perspective.

Methods

We used data from the China Health and Retirement Longitudinal Study (waves 1 to 4), to conduct a retrospective cohort study across 28 provinces, from 2011 to 2018. We measured regional incidences of catastrophic health expenditure using methods recommended by the World Health Organization. Ordinary least squares (OLS) and geographical and temporal weighted regression (GTWR) were used as the global and local estimation models, respectively. The Fortheringham method was used to test the spatiotemporal non-stationarity.

Results

National ICHE showed a gradual increase from 2011 to 2015, but suddenly decreased from 2015 to 2018, also showing the spatial heterogeneity. And the southwest area and Hebei showed persistently high ICHE (Qinghai even reached the highest value of 27.5% in 2015). Out-of-pocket payment, gross domestic product, PM2.5, ageing, incidence of non-communicable diseases and disabilities, number of nurses, and health insurance coverage in the global estimation passed the significance test, and the GTWR model showed a better model fit (0.769) than the OLS model (0.388). Furthermore, except for health insurance coverage, all seven variables had spatiotemporal non-stationarity among their impacts on ICHE.

Conclusion

In this longitudinal study, we found spatiotemporal non-stationarity among the variable relationships, supporting regional governments’ adoption of regional-target policies. First, after the completion of universal health insurance coverage, the spatiotemporal non-stationarity of the prevalence of non-communicable diseases and disability and ageing should be the focus of the next phase of health insurance design, where improvements to compensation coverage and benefit packages are possible policy instruments. Second, the governance and causes of catastrophic health expenditure need to be laid out from a macro perspective rather than only from the individual/household perspective, especially for the potential impact of economic development, air pollution and nursing resources.
VEGFA promotes the occurrence of PLA2R-associated idiopathic membranous nephropathy by angiogenesis via the PI3K/AKT signalling pathway
Authors: Ke Ben , Huang Jinjing , Duan Zhibing , Shen Wen , Wu Yao , Tu Weiping , Fang Xiangdong
Published: September 2022

Background

The M-type phospholipase A2 receptor (PLA2R)-associated idiopathic membranous nephropathy (IMN) is a common immune-related disease in adults. Vascular endothelial growth factor A (VEGFA) is the key mediator of angiogenesis, which leads to numerous kidney diseases. However, the role of VEGFA in IMN is poorly understood.

Methods

In the present study, we downloaded the microarray data GSE115857 from Gene Expression Omnibus (GEO). The differentially expressed genes (DEGs) were identified with R software. The cytoHubba plug-in were used to identify hub genes from the protein–protein interaction network. Gene set enrichment analysis (GSEA) was used to identify signalling pathway in IMN. CCK8 was performed to assess the cell viability in human vascular endothelial cells (HVECs). Then, passive Heymann nephritis (PHN) was induced in rats by a single tail vein injection of anti-Fx1A antiserum. Animals treated with VEGFA inhibitor bevacizumab (BV), with saline as a positive control. Proteinuria was evaluated by biochemical measurements. Immunohistochemistry and immunofluorescence was used to evaluate relative proteins expression. Electron microscopy was performed to observe the thickness of the glomerular basement membrane (GBM).

Results

We revealed 3 hub genes, including one up-regulated gene VEGFA and two down-regulated genes JUN and FOS, which are closely related to the development of PLA2R-associated IMN. Pathway enrichment analysis found that the biological process induced by VEGFA is associated with PI3K/Akt signalling. GSEA showed that the signalling pathway of DEGs in GSE115857 was focused on angiogenesis, in which VEGFA acts as a core gene. We confirmed the high expression of VEGFA, PI3K, and AKT in IMN renal biopsy samples with immunohistochemistry. In HVECs, we found that BV suppresses cell viability in a time and dose dependent manner. In vivo, we found low dose of BV attenuates proteinuria via inhibiting VEGFA/PI3K/AKT signalling. Meanwhile, low dose of BV alleviates the thickening of the GBM.

Conclusion

VEGFA/PI3K/AKT signalling may play significant roles in the pathogenesis of IMN, which may provide new targets for the treatment of IMN.
The role of informational support from women’s social networks on antenatal care initiation: qualitative evidence from pregnant women in Uganda
Authors: Comfort Alison B. , El Ayadi Alison M. , Camlin Carol S. , Tsai Alexander C. , Nalubwama Hadija , Byamugisha Josaphat , Walker Dilys M. , Moody James , Roberts Tatyana , Senoga Umar , Krezanoski Paul J. , Harper Cynthia C.
Published: September 2022

Background

Early and appropriate use of antenatal care services is critical for reducing maternal and neonatal mortality and morbidity. Yet most women in sub-Saharan Africa, including Uganda, do not seek antenatal care until later during pregnancy. This qualitative study explored pregnant women’s reliance on social ties for information about initiation of antenatal care.

Methods

We conducted semi-structured, in-depth interviews with 30 pregnant women seeking their first antenatal care visit at Kawempe Referral Hospital in Kampala, Uganda. Recruitment was done purposively to obtain variation by parity and whether women currently had a male partner. Study recruitment occurred from August 25th 2020 – October 26th, 2020. We used thematic analysis following a two-stage coding process, with both deductive and inductive codes. Deductive codes followed the key domains of social network and social support theory.

Results

We found that the most important source of information about antenatal care initiation was these women’s mothers. Other sources included their mothers-in-law, female elders including grandmothers, and male partners. Sisters and female friends were less influential information sources about antenatal initiation. One of the primary reasons for relying on their own mothers, mothers-in-law, and elder women was due to these women’s lived experience with pregnancy and childbirth. Trust in the relationship was also an important factor. Some pregnant women were less likely to rely on their sisters or female friends, either due to lack of trust or these women’s lack of experience with pregnancy and childbirth. The advice that pregnant women received from their mothers and others on the ideal timing for antenatal care initiation varied significantly, including examples of misinformation about when to initiate antenatal care. Pregnant women seemed less likely to delay care when more than one social tie encouraged early antenatal care.

Conclusions

Educating women’s social networks, especially their mothers, mothers-in-law, and community elders, about the importance of early antenatal care initiation is a promising avenue for encouraging pregnant women to seek care earlier in pregnancy.
A combined spatial score of granzyme B and CD68 surpasses CD8 as an independent prognostic factor in TNM stage II colorectal cancer
Authors: Noti Luca , Galván José A. , Dawson Heather , Lugli Alessandro , Kirsch Richard , Assarzadegan Naziheh , Messenger David , Krebs Philippe , Berger Martin D. , Zlobec Inti
Published: September 2022

Background

Previous assessments of peritumoral inflammatory infiltrate in colorectal cancer (CRC) have focused on the role of CD8+ T lymphocytes. We sought to compare the prognostic value of CD8 with downstream indicators of active immune cell function, specifically granzyme B (GZMB) and CD68 in the tumour microenvironment.

Methods

Immunohistochemical (IHC) staining was performed for CD8, GZMB, CD68 and CD163 on next-generation tissue microarrays (ngTMAs) in a primary cohort (n = 107) and a TNM stage II validation cohort (n = 151). Using digital image analysis, frequency of distinct immune cell types was calculated for tumour proximity (TP) zones with varying radii (10 μm-100 μm) around tumour cells.

Results

Associations notably of advanced TNM stage were observed for low density of CD8 (p = 0.002), GZMB (p < 0.001), CD68 (p = 0.034) and CD163 (p = 0.011) in the primary cohort. In the validation cohort only low GZMB (p = 0.036) was associated with pT4 stage. Survival analysis showed strongest prognostic effects in the TP25μm zone at the tumour centre for CD8, GZMB and CD68 (all p < 0.001) in the primary cohort and for CD8 (p = 0.072), GZMB (p = 0.035) and CD68 (p = 0.004) in the validation cohort with inferior prognostic effects observed at the tumour invasive margin. In a multivariate survival analysis, joint analysis of GZMB and CD68 was similarly prognostic to CD8 in the primary cohort (p = 0.007 vs. p = 0.002) and superior to CD8 in the validation cohort (p = 0.005 vs. p = 0.142).

Conclusion

Combined high expression of GZMB and CD68 within 25 μm to tumour cells is an independent prognostic factor in CRC and of superior prognostic value to the well-established CD8 in TNM stage II cancers. Thus, assessment of antitumoral effect should consider the quality of immune activation in peritumoral inflammatory cells and their actual proximity to tumour cells.
Suicide attempt rate and the risk factors in young, first-episode and drug-naïve Chinese Han patients with major depressive disorder
Authors: Ye Gang , Li Zhe , Yue Yan , Wu Yuxuan , Yang Ruchang , Wang Haitao , Wu Siqi , Zhou Yue , Zhao Xueli , Lv Xiaoli , Yuan Nian , Li Ronghua , Zhang Guangya , Ganapathi Pallavi B. , Wu Hanjing Emily , Du Xiangdong , Zhang Xiang-Yang
Published: September 2022

Background

In recent years, the rates of suicide among young people have been increasing, and major depressive disorder (MDD) is regarded to be its main cause. Many factors such as thyroid dysfunction and metabolic abnormalities are thought to mediate this process, but the conclusions are inconsistent. This study investigated the rate of suicide attempts and associated risk factors among young, first-episode and drug-naïve Chinese Han patients with MDD.

Methods

A total of 917 patients with MDD (aged 18 ~ 35 years) were recruited. Demographic and clinical data were collected and thyroid function, fasting blood glucose and lipid profiles were measured. The Hamilton Depression Rating Scale-17 items (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), positive symptom subscale of Positive and Negative Syndrome Scale (PANSS) and clinical global impression of severity scale (CGI-S) were adopted to assess depression, anxiety, psychotic symptoms and disease severity respectively.

Results

The rate of suicide attempts was 19.5% in young MDD patients. There were significant differences in age (p = 0.003), education level (p = 0.001), age of onset (p = 0.004) and disease duration (p = 0.001) between patients with and without suicide attempts. Compared with patients without suicide attempts, patients with suicide attempts had significantly higher scores on the HAMD-17, HAMA, PANSS positive symptom subscale and CGI-S (all p < 0.001). Patients with suicide attempts had significantly higher levels of TSH (p < 0.001), TgAb (p = 0.004), TPOAb (p < 0.001), TG (p = 0.016), TC (p < 0.001), LDL (p < 0.001), and fasting glucose (p < 0.001), but significantly lower levels of HDL (p < 0.001). Logistic regression analysis showed that marital status (OR = 0.515, 95%CI: 0.280–0.950, p = 0.515), disease duration (OR = 1.100, 95%CI: 1.013–1.194, p = 0.024), HAMA score (OR = 1.313, 95%CI: 1.205–1.430, p < 0.001), CGI-S score (OR = 1.875, 95%CI: 1.339–2.624, p < 0.001), levels of FT3(OR = 0.717, 95%CI: 0.536–0.959, p = 0.025), TPOAb (OR = 1.004, 95%CI: 1.002–1.006, p < 0.001), TC (OR = 1.330, 95%CI: 1.011–1.750, p = 0.042) and LDL (OR = 0.736, 95%CI: 0.558–0.971, p = 0.030) were all independently associated with suicide attempts in young MDD patients.

Conclusions

In China, the rate of suicide attempts in young patients with MDD is quite high and thyroid dysfunction and metabolic abnormalities may be implicated in its pathogenesis.
Newspaper framing of food and beverage corporations’ sponsorship of sport: a content analysis
Authors: Carters-White L. E. , Patterson C. , Nimegeer A. , Hilton S. , Chambers S.
Published: September 2022

Background

Unhealthy diets are a leading contributor to obesity, disability and death worldwide. One factor cited as contributing to rises in obesity rates is the pervasive and ubiquitous marketing of unhealthy foods and beverages (F&Bs) across a variety of mediums, such as sport sponsorship at both professional and amateur levels. Despite increased academic attention on the detrimental impacts of sport sponsorship within the obesogenic environment, this has not been matched by legislative action. One explanation may be the way that F&B corporations’ sport sponsorship is framed within policy debates. Framing is the deliberate ways in which (often contested) issues are presented in communication. This paper examines how sport sponsorship by F&B corporations is framed through media reports.

Methods

This study employed a mixed methods content and framing analysis. First, we conducted a quantitative newsprint content analysis (n = 234). This then informed and directed a thematic framing analysis of a sub-set of articles (n = 54) that specifically associated sport sponsorship by F&B corporations with obesity and childhood obesity.

Results

The findings suggest that two competing frames are evident within newspaper coverage: 1) public health and 2) industry. The public health frame rejects the sponsorship of sport by High in Fat Sugar and Salt (HFSS) product corporations in particular, calling for such sponsorship to be restricted or banned. The industry frame characterises sponsorship of sport as a form of corporate social responsibility, positioning industry as good moral actors and part of the solution to childhood and adult obesity. These frames are evident across other Unhealthy Commodity Industries (UCIs) policy debates. However, the prominence of industry actors within the sample is potentially indicative of their discursive power within this space, particularly with their emphasis on the financial maintenance of sport as well as encouraging physical activity, contributing to the lack of regulatory development of sport sponsorship by F&B corporations.

Conclusions

The findings of this study are particularly useful for public health organisations who seek regulatory change, as it may provide further insight into countering industry framing practices, raising the salience of regulation of sport sponsorship and thus increasing the likelihood of regulatory development that seeks to improve population health.
InterMob: a 24-month randomised controlled trial comparing the effectiveness of an intervention including behavioural change techniques and free transport versus an intervention including air pollution awareness-raising on car use reduction among regular car users living in Grenoble, France
Authors: Teran-Escobar Claudia , Duché Sarah , Bouscasse Hélène , Isoard-Gatheur Sandrine , Juen Patrick , Lacoste Lilas , Lyon-Caen Sarah , Mathy Sandrine , Ployon Estelle , Risch Anna , Sarrazin Philippe , Slama Rémy , Tabaka Kamila , Treibich Carole , Chardonnel Sonia , Chalabaev Aïna
Published: September 2022

Background

Frequent car use contributes to health and environmental issues such as air pollution, climate change and obesity. Active and sustainable mobility (bike, walk, public transport, car sharing) may address these issues. Different strategies have been implemented in past research, involving hard levers, aimed at modifying the economical or geographical context (e.g., free public transport), and soft levers, aimed at modifying psychological processes (e.g., personalised transport advice). However, few studies have combined both hard and soft levers. In addition, few have used robust methodologies (e.g., randomised controlled trials), followed behavioural changes in the long-term, and been anchored in behaviour change theories. InterMob aims to address these limits by implementing a 24-month randomised controlled trial including hard and soft levers. The objectives of InterMob are to a) evaluate the effectiveness of an experimental arm versus an active controlled arm, and b) identify the processes of mobility change.

Methods

Regular car users living in Grenoble (N = 300) will be recruited and randomised to one of the two arms. The experimental arm consists in a six-month intervention combining hard levers (free access to transport/bikes), and soft levers (e.g., personalised transport advice). The control arm consists in a six-month intervention aimed at raising awareness on air pollution and its health effects. Both arms will include eight evaluation weeks (spread out over 24 months) based on a GPS, an accelerometer, and a pollution sensor. Moreover, participants will complete mobility logbooks and surveys measuring psychological constructs, socio-economical, and socio-spatial characteristics.

Discussion

InterMob will assess the effectiveness of two interventions aimed at reducing car use within regular car users in the short-, mid- and long-term. Moreover, InterMob will allow to better understand the psychological processes of behaviour change, and the socio-economical and geographical conditions under which the intervention is efficient in reducing car use. Finally, the benefits of mobility change in terms of physical activity, quality of life, and exposure to pollution will be quantified.

Trial registration

ClinicalTrials.gov: NCT05096000 on 27/10/2021 (retrospectively registered).
Non-uptake of HIV testing among trans men and trans women: cross-sectional study of client records from 2017 to 2019 in a community-based transgender health center in Metro Manila, Philippines
Authors: Regencia Zypher Jude G. , Castelo Aisia V. , Eustaquio Patrick C. , Araña Yanyan S. , Corciega John Oliver L. , Rosadiño John Danvic T. , Pagtakhan Ronivin G. , Baja Emmanuel S.
Published: September 2022

Background

Transgender individuals are considered at high risk of contracting HIV infection. Integrating HIV testing and counseling (HTC) services into current transgender health programs is necessary to increase its uptake. Our study aimed to describe the characteristics of trans men (TM) and trans women (TW) who accessed HTC services in a community-based transgender health center in Metro Manila, Philippines, and to examine the relationship between gender identity and their non-uptake of HIV testing. 

Methods

We conducted a cross-sectional study of TM and TW seeking care from 2017 to 2019. Medical records of clients were reviewed to ascertain their age, gender identity, year and frequency of clinic visits, lifestyle factors, and non-uptake of HIV testing. The effect of gender identity on the non-uptake of HIV testing was estimated using a generalized linear model with Poisson distribution, log link function, and a robust variance, adjusted for confounding variables. 

Results

Five hundred twenty-five clients were included in the study, of which about 82.3% (432/525) of the clients declined the HTC services being offered. In addition, the prevalence of non-uptake of HIV testing was 48% higher (Adjusted Prevalence Ratio: 1.48; 95% Confidence Interval: 1.31–1.67) among TM compared to TW. Approximately 3.7% (1/27) and 10.6% (7/66) of the TM and TW, respectively, who accessed the HTC services were reactive. Moreover, most reactive clients were on treatment 87.5% (7/8); three were already virally suppressed, four were on ART but not yet virally suppressed, and one TW client was lost to follow up.

Conclusion

The non-uptake of HTC service of TM and TW is high. HIV program implementers should strategize solutions to reach this vulnerable population for increased and better HTC service uptake and linkage to care.
“Respecting our patients’ choices”: making the organizational decision to participate in voluntary assisted dying provision: findings from semi-structured interviews with a rural community hospice board of management
Authors: Auret Kirsten , Pikora Terri J. , Gersbach Kate , Donovan Robert J.
Published: September 2022

Background

There is limited literature around how palliative care organizations determine the degree to which they will interface with voluntary assisted dying in jurisdictions where it is legal. The aim of this research was to describe the experience of the board of management of an Australian community-based hospice during their decision-making process around whether to support voluntary assisted dying in the facility, prior to the legislation coming into operation.

Methods

The Board considered this decision over ten meetings in 2020, during which time they received information on the legislation, relevant literature, feedback from workshops which included the community, comment from hospice founders, staff survey results and presentations by clinicians able to discuss the impact of voluntary assisted dying on palliative care services. Members were encouraged to make notes of their own experiences during this time. Following this, semi-structured interviews were conducted with seven of the nine board members. Interviews were audio-recorded and transcribed verbatim and analysed using conventional qualitative content analysis method.

Results

The board members experienced a sense of journey in reaching an overall decision, which was to allow full participation in voluntary assisted dying provision for inpatients. Themes based on the journey motif included: starting from a personal view; moving to a hospice perspective; exploring if voluntary assisted dying can be part of end-of-life care; awareness and assessment of risks to the Hospice; arriving at a common platform to vote on; factors facilitating a safe decision-making journey; and personal impact of the journey.

Conclusions

The group highlighted several facilitators of a successful outcome including having adequate time, the availability of useful resources, sound board processes and a trusting culture. The study may provide support to other healthcare organisations as they face similar decisions triggered by legislative change.
Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey
Authors: Sserwanja Quraish , Turimumahoro Patricia , Nuwabaine Lilian , Kamara Kassim , Musaba Milton W.
Published: September 2022

Background

Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone.

Methods

This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15–24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25.

Results

Out of 6055 young women, 1506 (24.9%, 95% CI 24.0–26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06–1.50) and mobile phones (AOR: 1.84, 95% CI 1.25–2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR: 1.45, 95% CI 1.19–1.78), working (AOR: 1.49, 95% CI 1.27–1.74), being older (20–24 years) (AOR: 1.75, 95% CI 1.46–2.10), being married (AOR: 0.33, 95% CI 0.26–0.42), having visited a health facility within the last 12 months (AOR: 1.34, 95% CI 1.10–1.63), having secondary (AOR: 2.83, 95% CI 2.20–3.64) and tertiary levels of education (AOR: 3.35, 95% CI 1.83–6.13), higher parity (having above one child) AOR: 1.57, 95% CI 1.19–2.08) and residing in the southern (AOR: 2.11, 95% CI 1.61–2.79), northwestern (AOR: 1.87, 95% CI 1.39–2.52), northern (AOR: 2.11, 95% CI 1.59–2.82) and eastern (AOR: 1.68, 95% CI 1.27–2.22) regions of residence were associated with higher odds of modern contraceptives utilization.

Conclusion

In Sierra Leon, only one in four young women were using modern contraception and more than half of them had not had any exposure to family planning messages on the different types of mass media channels. Behavior change communicators can prioritize family planning messages using radio, mobile phones and the internet. In order to publicize and encourage young women to adopt healthy behaviours and increase uptake of modern contraceptive.
Burnout among midwives—the factorial structure of the burnout assessment tool and an assessment of burnout levels in a Swedish national sample
Authors: Hadžibajramović Emina , Hansson Malin , Akerstrom Magnus , Dencker Anna , Hensing Gunnel
Published: September 2022

Background

Many workplaces, within the healthcare sector, experience high rates of mental health problems such as burnout, anxiety, and depression, due to poor psychosocial working conditions and midwives are not an exception. To develop preventive interventions, epidemiologic surveillance of burnout levels, and their relation to professional specific working conditions is needed. Aims of this study is to assess the construct validity of the Burnout Assessment Tool (BAT) in the context of Swedish midwives, to evaluate whether the item responses can be combined into a single score and differential item functioning regarding age. Another aim was to assess the burnout levels of Swedish midwives.

Methods

Data come from a national cohort of Swedish midwives (n = 1664). The construct validity was evaluated using Rasch analysis. Burnout levels were presented by median and first (Q1) and third (Q3) quartiles for the BAT total score and the four subscales (exhaustion, mental distance, cognitive and emotional impairment).

Results

In the analysis including all 23 items the fit to the Rasch model was not obtained. Items within each subscale clustered together in a residual correlation matrix in a pattern consistent with the underlying conceptualization of the BAT, indicating multidimensionality. The Rasch analysis was re-run using the four testlets as input variables which resulted in a good fit. The median burnout level was 2.0 (Q1 = 1.6, Q3 = 2.4). The four subscales differentiated the picture (elevated levels on exhaustion and low levels on the other three subscales).

Conclusions

The construct validity of the BAT for use in the context of Swedish midwives was confirmed. The results indicated a strong general factor, meaning that the responses can be combined into a single burnout score. The scale works invariantly for different age groups. The results of this study secure access to a validated instrument to be used for accurate assessment of the burnout levels among midwives in Sweden.
Dietary patterns before and during pregnancy and small for gestational age in Japan: a prospective birth cohort study
Authors: Yamashita Takahiro , Obara Taku , Yonezawa Yudai , Takahashi Ippei , Ishikuro Mami , Murakami Keiko , Ueno Fumihiko , Noda Aoi , Onuma Tomomi , Iwama Noriyuki , Hamada Hirotaka , Sugawara Junichi , Suzuki Shigenori , Suganuma Hiroyuki , Saito Masatoshi , Yaegashi Nobuo , Kuriyama Shinichi
Published: September 2022

Background

Although small for gestational age (SGA) is a serious problem worldwide, the association of dietary patterns before and during pregnancy with SGA risk is unclear. We evaluated this association among Japanese pregnant women using three methods: reduced rank regression (RRR) and partial least squares (PLS), methods for extracting dietary patterns that can explain the variation of response variables, and principal component analysis (PCA), a method for extracting dietary patterns of the population.

Methods

Between July 2013 and March 2017, 22,493 pregnant women were recruited to the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, a population-based prospective birth cohort study in Japan. Information on dietary intake was obtained using food frequency questionnaires, and dietary patterns were extracted using RRR, PLS, and PCA. Information on birth weight was obtained from obstetric records, and the birth weight SD score and SGA were defined by the method of the Japan Pediatric Society. The associations of dietary patterns with birth weight SD score and SGA risk were investigated using multiple linear regression and multiple logistic regression, respectively.

Results

A total of 17,728 mother-child pairs were included. The birth weight SD score was 0.15 ± 0.96, and the prevalence of SGA was 6.3%. The dietary patterns extracted by RRR and PLS were similar and characterized by a high intake of cereals and fruits and a low intake of alcoholic and non-alcoholic beverages in both pre- to early pregnancy and from early to mid-pregnancy. Higher adoption of the RRR and PLS patterns in both periods was associated with an increased birth weight SD score and lower risk of SGA. In contrast, the PCA1 pattern was not associated with birth weight SD score or SGA risk in either period. Although the PCA2 pattern was associated with increased birth weight SD score from early to mid-pregnancy, no other associations with birth weight SD score or SGA risk were observed.

Conclusions

The dietary pattern with a high intake of cereals and fruits and a low intake of alcoholic and non-alcoholic beverages before and during pregnancy was associated with a decreased SGA risk in Japan.
Medial tibial plateau sustaining higher physiological stress than the lateral plateau: based on 3D printing and finite element method
Authors: Zheng Liqin , Dai Yuexing , Zheng Yongze , He Xingpeng , Wu Minhui , Zheng Desheng , Li ChiHung , Fan Yueguang , Lin Ziling
Published: September 2022

Background

Medial compartment knee osteoarthritis (KOA) accounts for most KOA cases, and increased trabecular bone volume fraction (BV/TV) is one of the pathological changes in the tibial plateau of KOA. How BV/TV changes before and after the menopause and its effects on medial compartment KOA are yet to be clarified.

Methods

Twenty femurs from twenty 12-week-old rats were included. The operated group underwent ovariectomy (to represent the osteoporosis condition), called the O group, and the non-operated group was the normal control, called the N group. Micro-CT scans of the femoral condyles were acquired 12 weeks after the surgery, and the volume of interest (VOI) of medial-, inter-, and lateral-condyle trabeculae were three-dimensional (3D) printed for uniaxial compression mechanical test and simulated by the finite element (FE) method.

Results

The results demonstrated that the O group indicated poorer trabecular architecture than the N group in three parts of the femoral condyle, especially in the intercondyle. Within the group, the BV/TV, trabecular thickness (Tb.Th), and trabecular number (Tb.N) ratios between the medial and lateral condyles were greater than 1 in both N and O groups. The medial condyle trabeculae's mechanical properties were higher than those of the lateral condyle, and this superiority appears to be broadened under osteoporotic conditions. FE modelling well reproduced these mechanical differentiations.

Conclusions

According to Wolff's law, the higher BV/TV and mechanical properties of the medial femoral condyle may be due to inherent imbalanced loading on the knee component. Alterations in BV/TV and their corresponding mechanical properties may accompany KOA.
The use of legal empowerment to improve access to quality health services: a scoping review
Authors: Joshi Anuradha , Schaaf Marta , Zayed Dina
Published: September 2022

This paper presents the results of a scoping review that examines the extent to which legal empowerment has been used as a strategy in efforts to improve access to quality health services in low- and middle-income countries. The review identifies lessons learned regarding legal empowerment program strategy, as well as impact on health empowerment and health outcomes, research gaps, areas of consensus and tension in the field.

The review included three main sources of data: 1) peer-reviewed literature, 2) grey literature, and 3) interviews with key legal empowerment stakeholders. Peer-reviewed and grey literature were identified via keyword searches, and interviewees were identified by searching an organizational database and snowball sampling.

The key findings were: first, there is very limited documentation on the use of legal empowerment strategies for improving health services. Second, the legal empowerment approach tends to be focussed on issues that communities themselves prioritize, often narrowly defined local challenges. However, legal empowerment as a strategy that pursues collective and individual remedies has the potential to contribute to structural change. Third, for this potential to be realised, legal empowerment entails building capacity of service providers and other duty bearers on health and related rights. Finally, the review also highlights the importance of trust—trust in state institutions, trust in the paralegals who support the process and trust in the channels of engagement with public authorities for grievance redress.

Several gaps also became evident through the review, including lack of work on private health providers, lack of discussion of the ‘empowerment’ effects of legal empowerment programs, and limited exploration of risk and sustainability. The paper concludes with a caution that practitioners need to start with the health challenges they are trying to address, and then assess whether legal empowerment is an appropriate approach, rather than seeing it as a silver bullet.
Drinking water nitrate and risk of pregnancy loss: a nationwide cohort study
Authors: Ebdrup Ninna Hinchely , Schullehner Jörg , Knudsen Ulla Breth , Liew Zeyan , Thomsen Anne Marie Ladehoff , Lyngsø Julie , Bay Bjørn , Arendt Linn Håkonsen , Clemmensen Pernille Jul , Sigsgaard Torben , Hansen Birgitte , Ramlau-Hansen Cecilia Høst
Published: September 2022

Background

Nitrate contamination is seen in drinking water worldwide. Nitrate may pass the placental barrier. Despite suggestive evidence of fetal harm, the potential association between nitrate exposure from drinking water and pregnancy loss remains to be studied. We aimed to investigate if nitrate in drinking water was associated with the risk of pregnancy loss.

Methods

We conducted a nationwide cohort study of 100,410 pregnancies (enrolled around gestational week 11) in the Danish National Birth Cohort (DNBC) during 1996–2002. Spontaneous pregnancy losses before gestational week 22 were ascertained from the Danish National Patient Registry and DNBC pregnancy interviews. Using the national drinking water quality-monitoring database Jupiter, we estimated the individual and time-specific nitrate exposure by linking geocoded maternal residential addresses with water supply areas. The nitrate exposure was analyzed in spline models using a log-transformed continuous level or classified into five categories. We used Cox proportional hazards models to estimate associations between nitrate and pregnancy loss and used gestational age (days) as the time scale, adjusting for demographic, health, and lifestyle variables.

Results

No consistent associations were found when investigating the exposure as a categorical variable and null findings were also found in trimester specific analyses. In the spline model using the continuous exposure variable, a modestly increased hazard of pregnancy loss was observed for the first trimester at nitrate exposures between 1 and 10 mg/L, with the highest.

adjusted hazard ratio at 5 mg/L of nitrate of 1.16 (95% CI: 1.01, 1.34). This trend was attenuated in the higher exposure ranges.

Conclusion

No association was seen between drinking water nitrate and the risk of pregnancy loss when investigating the exposure as a categorical variable. When we modelled the exposure as a continuous variable, a dose-dependent association was found between drinking water nitrate exposure in the first trimester and the risk of pregnancy loss. Very early pregnancy losses were not considered in this study, and whether survival bias influenced the results should be further explored.
High incidence of sexual dysfunction and timed intercourse was found only in infertile males who with known impairment of sperm quality for a long period: evidence from a hospital-based cross-sectional study
Authors: Yu Xiaowei , Zhang Songling , Chen Linjiao , Zhang Xiao Yuan , Wang Qun
Published: September 2022

Background

Infertile men with higher sexual dysfunction risk and increased psychological burden, were also associated with more inclined to timed intercourse. Decreased semen quality may have adverse effects on male sexual function. However, it is also likely that many of these sequences do not play a direct role, those negative consequences may depend mainly on the later failed attempting pregnancy. Research is limited in this area.

Methods

This cross-sectional study was based on a group of 509 men who were assessed for couple’s infertility at the First Hospital of Jilin University between June 2021 and October 2021. All the men completed a comprehensive questionnaire, and then were divided in two groups. Group A included patients who either never received a routine infertility work-up or done so recently within the last 6 months. Group B included patients who previously received a sperm quality assessment at least 6 months or more prior. Patients were further categorized into three subgroups according to the severity of the decreases in their sperm parameters: severe, mild-moderate, and normozoospermic.

Results

The prevalence of erectile dysfunction was higher in Group B Mild-Moderate and Group B Severe in comparison to Group A (OR=1.86 [1.07–3.24], P = 0.027; OR=5.312 [2.69–10.49], P < 0.001, respectively). No significant differences were found between Group A and Group B-normozoospermic. Similar results were observed in the prevalence of premature ejaculation between the groups. Timed intercourse was seen in 11.8% (20/170) of men in Group A and 16.2% (19/117) in Group B-normozoospermic. It was more commonly practiced among infertile men in Group B-Mild-Moderate and Group B Severe, as 28.2% (44/156) and 25.7% (17/66) of these couples had attempted to conceive through timed intercourse (P < 0.001).

Conclusions

Our findings indicate that the severity of sperm quality impairment was negatively associated with sexual dysfunction only in infertile men who with known impairment of sperm quality for a long period. Timed intercourse was more common among these couples. For those individuals had never test their sperm quality, although more than half of these patients showed a decrease in sperm quality, the incidence of sexual dysfunction is relatively low and were comparable to those men examined previously known as normozoospermic.