bluuebunny/crossref_metadata_2025 huggingface dataset:
Age-specific association of stage of hypertension at diagnosis with cardiovascular and all-cause mortality among elderly patients with hypertension: a cohort study
Authors: Wu Jingyi , Han Xiaojie , Sun Di , Zhang Jie , Li Jiong , Qin Guoyou , Deng Wei , Yu Yongfu , Xu Huilin
Published: May 2023

Background

Hypertension affects 31.1% of adults worldwide, with higher prevalence of great than 60% in elderly. Advanced hypertension stage was associated with the higher risk of mortality. However, little is known about the age-specific association of stage of hypertension at diagnosis on cardiovascular mortality or all-cause mortality. Therefore, we aim to explore this age-specific association among the hypertensive elderly through stratified and interaction analyses.

Methods

This cohort study included 125,978 elderly hypertensive patients aged 60+ years from Shanghai of China. Cox regression was used to estimate the independent and joint effect of hypertension stage and age at diagnosis on cardiovascular and all-cause mortality. Interactions were evaluated both additively and multiplicatively. Multiplicative interaction was examined by the Wald test of the interaction term. Additive interaction was assessed by relative excess risk due to interaction (RERI). All analyses were performed stratified by sex.

Results

28,250 patients died during the follow-up up to 8.85 years, and 13,164 died of cardiovascular events. Older age and advanced hypertension stage were risk factors of cardiovascular mortality and all-cause mortality. Besides, smoking, rarely exercise, BMI < 18.5 and diabetes were also the risk factors. When we compared stage 3 hypertension with stage 1 hypertension, hazard ratios (95% confidence interval) of cardiovascular mortality and all-cause mortality were 1.56(1.41–1.72) and 1.29(1.21–1.37) for males aged 60–69 years, 1.25(1.14–1.36) and 1.13(1.06–1.20) for males aged 70–85 years, 1.48(1.32–1.67) and 1.29(1.19–1.40) for females aged 60–69 years, and 1.19(1.10–1.29) and 1.08(1.01–1.15) for females aged 70–85 years, respectively. Negative multiplicative interaction and positive additive interaction between age at diagnosis and stage of hypertension at diagnosis on cardiovascular mortality were observed in males (HR: 0.81, 95% CI: 0.71–0.93 RERI: 0.59, 95% CI: 0.09–1.07) and females (HR: 0.81, 95% CI: 0.70–0.93 RERI: 0.66, 95% CI: 0.10–1.23).

Conclusions

Diagnosed with stage 3 hypertension was associated with higher risks of cardiovascular mortality and all-cause mortality, which were stronger among patients with age at diagnosis of 60–69 years compared with those with age at diagnosis of 70–85 years. Therefore, for the younger part of the elderly, the Department of Health should pay more attention to treating patients with stage 3 hypertension.
Risk of lymph node metastasis and feasibility of endoscopic submucosal dissection in undifferentiated-type early gastric cancer
Authors: Zhang Pengyue , Xu Tingting , Feng Hui , Zhu Zhen , Wang Jingjing , Wang Yalei
Published: May 2023

Background

Whether endoscopic submucosal dissection (ESD) applies to undifferentiated-type early gastric cancer (UEGC) remains controversial. We aimed to analyze the risk factors for lymph node metastasis (LNM) in UEGC and evaluate the feasibility of ESD.

Methods

This study included 346 patients with UEGC who underwent curative gastrectomy between January 2014 and December 2021. Univariate and multivariate analyses of the correlation between clinicopathological features and LNM were conducted, and the risk factors for exceeding the expanded ESD indications were evaluated.

Results

The overall LNM rate in UEGC was 19.94%. Among the preoperatively assessable factors, submucosal invasion (odds ratio [OR] = 4.77, 95% confidence interval [CI]: 2.14–10.66) and > 2 cm(OR = 2.49, 95% CI: 1.20–5.15) were independent risk factors for LNM, while postoperative independent risk factors were > 2 cm (OR = 3.35, 95% CI: 1.02–5.40) and lymphovascular invasion(OR = 13.21, 95% CI: 5.18–33.70). Patients who met the expanded indications had a low LNM risk (4.1%). Additionally, tumors located in the cardia (P = 0.03), non-elevated type (P < 0.01) were independent risk factors for exceeding the expanded indications in UEGC.

Conclusions

ESD may be applicable for UEGC meeting the expanded indications, and preoperative evaluation should be cautious when the lesion is non-elevated type or located in the cardia.

Trial registration

Chinese Clinical Trial Registry (12/05/2022 ChiCTR2200059841).
A nomogram for predicting cause-specific mortality among patients with cecal carcinoma: a study based on SEER database
Authors: Zhou Qianru , Zhan Yan , Guo Jipeng
Published: May 2023

Objective

Classical Cox proportional hazard models tend to overestimate the event probability in a competing risk setup. Due to the lack of quantitative evaluation of competitive risk data for colon cancer (CC), the present study aims to evaluate the probability of CC-specific death and construct a nomogram to quantify survival differences among CC patients.

Methods

Data on patients diagnosed with CC between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database. Patients were divided into a training dataset for the establishment of the model and a validation dataset to evaluate the performance the model at a ratio of 7:3. To evaluate the ability of multiple variables to predict cause-specific death in CC patients, univariate and multivariate analyses with Fine-Gray models were performed to screen the predictors of cause-specific death, and a nomogram for predicting cause-specific mortality was constructed. Then, the receiver operating characteristic (ROC) curve and the calibration curve were plotted to evaluate the prognostic performance of the nomogram.

Results

The dataset was randomly divided into a training (n = 16,655) dataset and a validation (n = 7,139) dataset at a ratio of 7:3. In the training dataset, variables including pathological subtypes of tumors, pathological grading (degree of differentiation), AJCC staging, T-staging, surgical type, lymph node surgery, chemotherapy, tumor deposits, lymph node metastasis, liver metastasis, and lung metastasis were identified as independent risk factors for cause-specific death of CC patients. Among these factors, the AJCC stage had the strongest predictive ability, and these features were used to construct the final model. In the training dataset, the consistency index (C-index) of the model was 0.848, and the areas under the receiver operating characteristic curve (AUC) at 1, 3, and 5 years was 0.852, 0.861, and 0.856, respectively. In the validation dataset, the C-index of the model was 0.847, and the AUC at 1 year, 3 years, and 5 years was 0.841, 0.862, and 0.852, respectively, indicating that this nomogram had an excellent and robust predictive performance.

Conclusion

This study can help clinical doctors make better clinical decisions and provide better support for patients with CC.
Total cholesterol and mortality in peritoneal dialysis: a retrospective cohort study
Authors: Wu Junnan , Yang Ruifeng , Wang Xiaoyang , Zhan Xiaojiang , Wen Yueqiang , Feng Xiaoran , Wang Niansong , Peng Fenfen , Jian Guihua , Wu Xianfeng
Published: May 2023

Background

Total cholesterol is inversely associated with mortality in dialysis patients, which seems implausible in real-world clinical practice. May there be an optimal range of total cholesterol associated with a lower mortality risk? We aimed to evaluate the optimal range for peritoneal dialysis (PD) patients.

Methods

We conducted a retrospective real-world cohort study of 3565 incident PD patients from five PD centers between January 1, 2005, and May 31, 2020. Baseline variables were collected within one week before the start of PD. The associations between total cholesterol and mortality were examined using cause-specific hazard models.

Results

820 (23.0%) patients died, including 415 cardiovascular deaths, during the follow-up period. Restricted spline plots showed a U-curved association of total cholesterol with mortality. Compared with the reference range (4.10–4.50 mmol/L), high levels of total cholesterol (> 4.50 mmol/L) were associated with increased risks of all-cause (hazard ratio [HR] 1.35, 95% confidence index [CI] 1.08–1.67) and cardiovascular mortality (HR 1.38, 95% CI 1.09–1.87). Similarly, compared with the reference range, low levels of total cholesterol (< 4.10mmol/L) were also associated with high risks of all-cause (HR 1.62, 95% CI 1.31–1.95) and cardiovascular mortality (HR 1.72, 95% CI 1.27–2.34).

Conclusion

Total cholesterol levels at the start of PD between 4.10 and 4.50 mmol/L (158.5 to 174.0 mg/dL), an optimal range, were associated with lower risks of death than higher or lower levels, resulting in a U-shaped association.
Fusobacterium nucleatum-derived small extracellular vesicles facilitate tumor growth and metastasis via TLR4 in breast cancer
Authors: Li Guiqiu , Sun Yan , Huang Yu , Lian Jie , Wu Shaoyuan , Luo Dixian , Gong Hui
Published: May 2023

Background

The contributive role of the microbiome in tumor progression has been reported in multiple studies, such as the Fusobacterium nucleatum (F. nucleatum) in breast cancer (BC). This study aimed to explore the role of F. nucleatum-derived small extracellular vesicles (Fn-EVs) in BC and preliminarily uncover the mechanism.

Methods

Ten normal and 20 cancerous breast tissues were harvested to investigate the gDNA expression of F. nucleatum and its relation with the clinical characteristics of BC patients. After isolating Fn-EVs by ultracentrifugation from F. nucleatum (ATCC 25,586), both MDA-MB-231 and MCF-7 cells were treated with PBS, Fn, or Fn-EVs, followed by being subjected to CCK-8, Edu staining, wound healing, and Transwell assays to detect their cell viability, proliferation, migration, and invasion. TLR4 expression in BC cells with diverse treatments was assessed by western blot. In vivo experiments were performed to verify its role in tumor growth and liver metastasis.

Results

The F. nucleatum gDNA levels of breast tissues in BC patients were significantly higher than those in normal subjects, and positively associated with tumor size and metastasis. Fn-EVs administration significantly enhanced the cell viability, proliferation, migration, and invasion of BC cells, while knocking down TLR4 in BC cells could block these effects. Furthermore, in vivo study verified the contributive role of Fn-EVs in tumor growth and metastasis of BC, which might rely on its regulation of TLR4.

Conclusions

Collectively, our results suggest that F. nucleatum plays an important role in BC tumor growth and metastasis by regulating TLR4 through Fn-EVs. Thus, a better understanding of this process may aid in the development of novel therapeutic agents.
Aprepitant inhibits the development and metastasis of gallbladder cancer via ROS and MAPK activation
Authors: Cao Xueyan , Yang Yang , Zhou Wei , Wang Yue , Wang Xue , Ge Xianxiu , Wang Fei , Zhou Fangfang , Deng Xueting , Miao Lin
Published: May 2023

Background

Aprepitant, as a neurokinin-1 receptor (NK-1R) antagonist, originally applied for curing chemotherapy-induced nausea and vomiting, has been reported to have significant antitumor effect on several malignant tumors. However, the effect of aprepitant on gallbladder cancer (GBC) is not clear yet. This study aimed to investigate the anti-tumor activity of aprepitant on GBC and the potential mechanisms.

Methods

The NK-1R expression of gallbladder cancer cells were examined by immunofluorescence. MTT assay, wound healing and transwell migration assay were applied to detect the effect of aprepitant on cell proliferation, migration and invasion. Flow cytometry was used to detect the apoptosis rate. The effects of aprepitant on the expressions of cytokine were examined by real-time quantitative PCR and MAPK activation were detected via immunofluorescence and western blotting. Besides, xenograft model was established to investigate the effect of aprepitant in vivo.

Results

Our results indicated that NK‐1R was markedly expressed in gallbladder cancer cells and aprepitant effectively inhibited the proliferation, migration and invasion. Furthermore, the apoptosis, ROS and inflammation response were significantly boosted by aprepitant in GBC. Aprepitant induced NF‐κB p65 nuclear translocationin and increased the expressions of p-P65, p-Akt, p-JNK, p-ERK and p-P38, as well as the mRNA levels of inflammatory cytokines IL-1β, IL-6 and TNF-α. Consistently, aprepitant suppressed the growth of GBC in xenograft mice model.

Conclusion

Our study demonstrated that aprepitant could inhibit the development of gallbladder cancer via inducing ROS and MAPK activation, which suggested that aprepitant may become a promising therapeutic drug against GBC.
The effect of cognitive behavioral therapy on sexual function in reproductive aged women with hypothyroidism: a randomized controlled clinical trial
Authors: Sheikh Miri Azam , Iravani Mina , Boostani Hatam , Latifi Mahmoud
Published: May 2023

Background

Hypothyroidism is the most common clinical disorder of the thyroid gland which is associated with an increased prevalence of sexual dysfunction even if treated with medication.

Objective

The aim of this study was to determine the effect of cognitive-behavioral therapy (CBT) on sexual function in reproductive-aged women with hypothyroidism.

Materials and methods

This randomized clinical trial was performed on 66 reproductive-aged women with hypothyroidism referring to selected health centers in Izeh, Iran. Data collection tools included demographic information form and Female Sexual Function Index (FSFI). Eligible individuals were randomly assigned to case (n = 33) and control (n = 33) groups using block randomization with the block size of 4. In addition to standard hypothyroidism treatment, the case group received 8 sessions of cognitive-behavioral group therapy, while the control group received only standard treatment.

Results

Before of treatment, there was no significant difference between the mean score of sexual function and its dimensions between the case and control groups (p < 0.05). However, immediately and 4 weeks after completion of treatment, the mean total score of sexual function and its dimensions in the case group increased significantly compared to the control group (p < 0.001).

Conclusion

According to the results of this study, CBT can be effective in improving sexual dysfunction in reproductive-aged women with hypothyroidism. However, before recommending this therapy to women suffering from hypothyroidism, more detailed studies are needed to prove the effectiveness of this intervention, as an adjuvant treatment to the standard pharmacotherapy.
Spatio-temporal dynamic of the COVID-19 epidemic and the impact of imported cases in Rwanda
Authors: Semakula Muhammed , Niragire François , Nsanzimana Sabin , Remera Eric , Faes Christel
Published: May 2023

Introduction

Africa was threatened by the coronavirus disease 2019 (COVID-19) due to the limited health care infrastructure. Rwanda has consistently used non-pharmaceutical strategies, such as lockdown, curfew, and enforcement of prevention measures to control the spread of COVID-19. Despite the mitigation measures taken, the country has faced a series of outbreaks in 2020 and 2021.

In this paper, we investigate the nature of epidemic phenomena in Rwanda and the impact of imported cases on the spread of COVID-19 using endemic-epidemic spatio-temporal models. Our study provides a framework for understanding the dynamics of the epidemic in Rwanda and monitoring its phenomena to inform public health decision-makers for timely and targeted interventions.

Results

The findings provide insights into the effects of lockdown and imported infections in Rwanda’s COVID-19 outbreaks. The findings showed that imported infections are dominated by locally transmitted cases. The high incidence was predominant in urban areas and at the borders of Rwanda with its neighboring countries. The inter-district spread of COVID-19 was very limited due to mitigation measures taken in Rwanda.

Conclusion

The study recommends using evidence-based decisions in the management of epidemics and integrating statistical models in the analytics component of the health information system.
Determinants of spousal physical violence against women in Zambia: a multilevel analysis
Authors: Phiri Million , Namayawa Sibongile , Sianyeuka Bruce , Sikanyiti Palver , Lemba Musonda
Published: May 2023

Background

Violence against women and girls is a major public health issue, a violation of human rights, and is linked to a number of harmful effects on one’s physical, mental, sexual, and reproductive health. Studies conducted in other parts of sub-Saharan Africa (SSA) suggest that there is an association between contextual factors and experience of intimate partner violence. However, in Zambia, this association is not well documented. Thus, this study was conducted to examine how individual and community-level characteristics influence spousal violence against women in Zambia.

Methods

Data from the most recent Zambia Demographic and Health Survey conducted in 2018 was used. A sample of 7,358 ever-married women aged 15–49 years was used in the analysis. Two level multilevel binary logistic regression models were employed to examine the association between individual and contextual-level factors and experience of spousal violence.

Results

The prevalence of spousal physical violence against women in Zambia was 21.1% [95% CI, 19.8, 22.5]. Women aged 15–19 [aOR = 2.36, 95% CI = 1.34–4.14] and 20–24 [aOR = 2.11, 95% CI = 1.38–3.22], who did not own mobile phone [aOR = 1.36, 95% CI = 1.10–1.69], and had low decision making autonomy [aOR = 1.24, 95% CI = 1.01–1.54] were more likely experience spousal physical violence. Furthermore, communities which had a low proportion of women with decision making power [aOR = 1.66, 95% CI = 1.26–2.19] were more likely experience spousal physical violence. Additionally, women whose partners’ drank alcohol [aOR = 2.81, 95% CI = 2.30–3.45] and those whose partners exhibited jealous behaviour [aOR = 2.38, 95% CI = 1.88–3.21] were more likely to experience spousal physical violence.

Conclusion

Both individual and community-level factors influenced spousal physical violence in Zambia. Integrating community level factors when designing interventions to address gender-based would be key to reduce women’s vulnerability to gender based violence in the country. There is need to re-evaluate and re-strategize current strategies being implemented to address gender based violence in the country to make them context specific.
Characteristics of idiopathic pulmonary fibrosis -associated cough. a case-control study
Authors: Saari Eeva , Mononen Minna , Hasala Hannele , Lätti Anne , Kaulamo Johanna , Nurmi Hanna , Kaarteenaho Riitta , Purokivi Minna , Koskela Heikki O
Published: May 2023

Background

Most patients with idiopathic pulmonary fibrosis (IPF) complain of cough. IPF-associated cough is widely characterized as dry or non-productive. The aim of this study was to compare chronic cough in early stage IPF patients to cough in subjects with chronic cough from a community-based sample and, especially, to investigate whether cough in IPF is less productive than chronic cough in a community-based sample.

Methods

The IPF cough population consisted of 46 biopsy-confirmed patients who complained of chronic cough. Control population consisted of subjects with chronic cough, gathered by a community-based email survey sent to public service employees and the Finnish Pensioners’ Federation. A case-control setting was applied by having four age, gender, and smoking-status matched subjects from the community sample for each IPF cough patient. A cough specific quality of life questionnaire (Leicester Cough Questionnaire (LCQ)) was filled in by all subjects. The LCQ questionnaire contains 19 questions, each question is scored from 1 to 7 and total score from 3 to 21 with a smaller value indicating more severe impairment.

Results

The sputum production frequency, as assessed by LCQ question 2, was 5.0 (3.0-6.0) in the IPF chronic cough population and 5.0 (3.0–6.0) in the community-based chronic cough population (median and interquartile range p= 0.72). The LCQ total score was 14.8 (11.5-18.1) in the IPF chronic cough population and 15.4 (13.0–17.5) in the community-based chronic cough population (p=0.76). The domain impact scores were physical, 4.9 (3.9–6.1) vs. 5.1 (4.5–5.6) (p=0.80); psychological, 4.6 (3.7–5.9) vs. 4.7 (3.9–5.7) (p=0.90); and social, 5.5 (3.7–6.5) vs. 5.5 (4.5–6.3) (p=0.84), respectively. Furthermore, cough response to paint or fumes, cough disturbing sleep, and cough frequency per day did not differ between the groups.

Conclusion

Cough in early stage IPF patients was not distinguishable from chronic cough in the community-based population by LCQ. Especially, there was no difference in the self-reported frequency of cough-associated sputum production.
Research progress and hot spot analysis related to oxidative stress and osteoarthritis: a bibliometric analysis
Authors: Gu Jin-Yu , Han Fei , Chen Si-Yu , Zhang Qing
Published: May 2023

Background

Osteoarthritis, a common degenerative osteochondral disease, has a close relationship between its mechanism of occurrence and oxidative stress. However, there are relatively few relevant studies in this field, and a more mature research system has not yet been formed.

Methods

By searching the Web of Science (WOS) database, we obtained 1 412 publications in the field of osteoarthritis and oxidative stress. The search results were then analyzed bibliometrically using Citespace and VOSviewer, including a study of publication trends in the field, analysis of core authors, analysis of countries and institutions with high contributions, analysis of core journals, and to identify research trends and hot spots in the field, we performed keyword clustering.

Results

We collected 1 412 publications on the field of osteoarthritis and oxidative stress from 1998–2022. By analyzing the publication trends in the field, we noted an exponential increase in the number of publications per year since 2014. We then identified the core authors in the field (Blanco, Francisco J., Loeser, Richard F., Vaamonde-garcia, et.al) as well as the countries (China, USA, Italy et.al) and institutions (Xi An Jiao Tong Univ, Wenzhou Med Univ, Zhejiang Univ et.al). The OSTEOARTHRITIS AND CARTILAGE and INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES contain a large number of research papers in this field, and through keyword co-occurrence analysis, we counted 3 227 keywords appearing in the field of osteoarthritis and oxidative stress. These keywords were clustered into 9 groups, representing 9 different research hotspots.

Conclusions

Research in the field of osteoarthritis and oxidative stress has been developing since 1998 and is now maturing, but there is an urgent need to strengthen international academic exchanges and discuss the future focus of research development in the field of osteoarthritis and oxidative stress.
Comprehensive coordinated community based palliative care (C3PaC) model for cancer patients in North India: a mixed-method implementation research study protocol
Authors: Gupta Mayank , Kankaria Ankita , Sahoo Soumya Swaroop , Bhatnagar Sushma , Kakkar Rakesh , Grewal Anju , Pruthi Gegal , Goyal Lajya Devi
Published: May 2023

Background

Cancer remains an escalating and challenging public health issue. The management, especially palliative care (PC), is disintegrated and out of reach of in need patients. The overall aim of the project is to develop a feasible and scalable Comprehensive Coordinated Community based PC model for Cancer Patients (C3PaC); congruent with socio-cultural, context and unmet needs in north India.

Methods

A mixed method approach will be used for three-phased pre- and post-intervention study in one of the districts of North India, having a high incidence of cancer. During phase I, validated tools will be used for quantitative assessment of palliative needs among cancer patients and their caregivers. Barriers and challenges for provision of palliative care will be explored using in-depth interviews and focus group discussions among participants and health care workers. The findings of phase I along with inputs from national experts and literature review will provide inputs for the development of the C3PAC model in phase II. During phase III C3PAC model will be deployed over a period of 12 months and its impact assessed. Categorical and continuous variables will be depicted as frequency (percentages) and mean ± SD/median (IQR) respectively. Chi-square test/Fischer test, independent samples Student t-tests and Mann–Whitney U tests will be used for categorical, normally and non-normally distributed continuous variables, respectively. Qualitative data will be analyzed using thematic analysis using Atlas.ti 8 software.

Discussion

The proposed model is designed to address the unmet palliative care needs, to empower community-based healthcare providers in comprehensive home-based PC and to improve the quality of life of cancer patients and caregivers. This model will provide pragmatic scalable solutions in comparable health systems particularly in low- and lower-middle Income countries.

Trial registration

The study has been registered with the Clinical Trial Registry-India (CTRI/2023/04/051357).
Risk prediction of heart failure in patients with ischemic heart disease using network analytics and stacking ensemble learning
Authors: Zhou Dejia , Qiu Hang , Wang Liya , Shen Minghui
Published: May 2023

Background

Heart failure (HF) is a major complication following ischemic heart disease (IHD) and it adversely affects the outcome. Early prediction of HF risk in patients with IHD is beneficial for timely intervention and for reducing disease burden.

Methods

Two cohorts, cases for patients first diagnosed with IHD and then with HF (N = 11,862) and control IHD patients without HF (N = 25,652), were established from the hospital discharge records in Sichuan, China during 2015-2019. Directed personal disease network (PDN) was constructed for each patient, and then these PDNs were merged to generate the baseline disease network (BDN) for the two cohorts, respectively, which identifies the health trajectories of patients and the complex progression patterns. The differences between the BDNs of the two cohort was represented as disease-specific network (DSN). Three novel network features were exacted from PDN and DSN to represent the similarity of disease patterns and specificity trends from IHD to HF. A stacking-based ensemble model DXLR was proposed to predict HF risk in IHD patients using the novel network features and basic demographic features (i.e., age and sex). The Shapley Addictive exPlanations method was applied to analyze the feature importance of the DXLR model.

Results

Compared with the six traditional machine learning models, our DXLR model exhibited the highest AUC (0.934 ± 0.004), accuracy (0.857 ± 0.007), precision (0.723 ± 0.014), recall (0.892 ± 0.012) and F1score (0.798 ± 0.010). The feature importance showed that the novel network features ranked as the top three features, playing a notable role in predicting HF risk of IHD patient. The feature comparison experiment also indicated that our novel network features were superior to those proposed by the state-of-the-art study in improving the performance of the prediction model, with an increase in AUC by 19.9%, in accuracy by 18.7%, in precision by 30.7%, in recall by 37.4%, and in F1score by 33.7%.

Conclusions

Our proposed approach that combines network analytics and ensemble learning effectively predicts HF risk in patients with IHD. This highlights the potential value of network-based machine learning in disease risk prediction field using administrative data.
Estimation of health literacy levels in patients with cardiovascular diseases in a Gulf country
Authors: Nair Satish Chandrasekhar , Sreedharan Jayadevan , Vijayan Karthik , Ibrahim Halah
Published: May 2023

Introduction

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. In the United Arab Emirates (UAE), the prevalence of deaths associated with CVD is higher than the global average, and the incidence of premature coronary heart disease is 10–15 years earlier than in Western nations. In patients with CVD, inadequate health literacy (HL) is significantly associated with poor health outcomes. The goal of this study is to assess HL levels among patients with CVD in the UAE to develop effective health system strategies for disease prevention and management.

Methods

A nationwide cross-sectional survey to assess HL levels in patients with CVD was conducted between January 2019 and May 2020 in the UAE. The association between health literacy level with patient age, gender, nationality, and education was determined using the Chi-Square test. The significant variables were further analyzed by ordinal regression.

Results

Of 336 participants (86.5% response rate), approximately half 51.5% (173/336) of the respondents were women, and 46% (146/336) of them attained high school level of education. More than 75% (268/336) of the participants were above the age of 50 years. Overall, 39.3% (132/336) of respondents possessed inadequate HL, and 46.4% (156/336) and 14.3% (48/336) demonstrated marginal and adequate HL, respectively. Inadequate health literacy was more prevalent among women, as compared to men. Age was significantly associated with HL levels. Participants under age 50 had higher adequate HL levels 45.6% (31/68), (95% CI (3.8–57.4), P < 0.001). There was no correlation between education and health literacy levels.

Conclusion

The inadequate HL levels found in outpatients with CVD is a major health concern in the UAE. To improve population health outcomes, health system interventions, including targeted educational and behavioral programs for the older population are necessary.
Assessing the cost-effectiveness of waiting list reduction strategies for a breast radiology department: a real-life case study
Authors: Fanizzi Annarita , Graps Elisabetta , Bavaro Domenica Antonia , Farella Marco , Bove Samantha , Campobasso Francesco , Comes Maria Colomba , Cristofaro Cristian , Forgia Daniele La , Milella Martina , Iacovelli Serena , Villani Rossella , Signorile Rahel , De Bartolo Alessio , Lorusso Vito , Massafra Raffaella
Published: May 2023

Background

A timely diagnosis is essential for improving breast cancer patients’ survival and designing targeted therapeutic plans. For this purpose, the screening timing, as well as the related waiting lists, are decisive. Nonetheless, even in economically advanced countries, breast cancer radiology centres fail in providing effective screening programs. Actually, a careful hospital governance should encourage waiting lists reduction programs, not only for improving patients care, but also for minimizing costs associated with the treatment of advanced cancers. Thus, in this work, we proposed a model to evaluate several scenarios for an optimal distribution of the resources invested in a Department of Breast Radiodiagnosis.

Materials and methods

Particularly, we performed a cost-benefit analysis as a technology assessment method to estimate both costs and health effects of the screening program, to maximise both benefits related to the quality of care and resources employed by the Department of Breast Radiodiagnosis of Istituto Tumori “Giovanni Paolo II” of Bari in 2019. Specifically, we determined the Quality-Adjusted Life Year (QALY) for estimating health outcomes, in terms of usefulness of two hypothetical screening strategies with respect to the current one. While the first hypothetical strategy adds one team made up of a doctor, a technician and a nurse, along with an ultrasound and a mammograph, the second one adds two afternoon teams.

Results

This study showed that the most cost-effective incremental ratio could be achieved by reducing current waiting lists from 32 to 16 months. Finally, our analysis revealed that this strategy would also allow to include more people in the screening programs (60,000 patients in 3 years).
Health professionals’ preferences with the use of pegfilgrastim on-body injector at oncology centers in 8 cities in Colombia
Authors: Larrarte-González María Alejandra , Pineda-Posada Mariana , Gaitán Álvaro Andrés , Amaya-Amaya Jenny , Ojeda Kelman
Published: May 2023

Background

Febrile neutropenia associated with some chemotherapy regimens can lead to potentially fatal complications and high health care costs. Administration of pegfilgrastim using an On-Body Injector (OBI) may be more convenient for cancer patients and physicians in countries with limited access to high-complexity healthcare. This study aims to describe physician and nurse preferences regarding different options for administration of pegfilgrastim at cancer centers, the chemotherapy schemes for which pegfilgrastim is most frequently prescribed and how healthcare providers prioritize certain administration schemes according to patients’ access to healthcare services.

Methods

Observational, descriptive, cross-sectional study and survey, conducted between 2019 and 2020, to describe physician and nurse preferences regarding options for administration of pegfilgrastim at cancer centers, the demographics of the study population and characteristics of participating cancer centers. It included 60 healthcare professionals practicing at oncology centers from 8 cities in Colombia who were contacted and surveyed via telephone. Quantitative continuous variables were summarized using central tendency and dispersion measures.

Results

It was found that 35% of participants are haemato-oncologists, oncologists or hematologists, 30% are general practitioners, and 35% are other healthcare professionals (i.e., nurse, oncology nurse and head nurse). Our study shows that 48% of physicians prefer the use of OBI, particularly in the scheme of 24 h after myelosuppressive chemotherapy administrations. Regardless of patient frailty and travel time to the clinic, over 90% of healthcare providers (HCPs) prefer to prioritize preventing the patient from having to return to the clinic for pegfilgrastim administration as well as to increase healthcare staff availability through the use of OBI.

Conclusions

The present study is the first one in Colombia that sought the reasons behind HCPs’ choice to use OBI pegfilgrastim. Our results indicate that most professionals prefer to avoid the patient having to re-enter the care center for pegfilgrastim administration to facilitate access to healthcare for patients; patient characteristics and ease of transport are determining factors for respondents when choosing an option for drug administration. We found OBI is the preferred alternative by most HCPs and a good resource optimization strategy in the context of cancer patients’ health care in Colombia.
A survey of experts on personalized medicine landscape in European Union and China
Authors: Hoxhaj Ilda , Beccia Flavia , Morsella Alisha , Cadeddu Chiara , Ricciardi Walter , Boccia Stefania
Published: May 2023

Introduction

Personalized Medicine (PM) is one of the main priorities of the research agenda of the European Commission and the focus of the European Coordination and Support Action titled “Integrating China into the International Consortium for Personalized Medicine” (IC2PerMed). Similar to the European focus, PM is a current priority of the Chinese Government, through dedicated policies and its five-year investment plans. In the context of IC2PerMed, we implemented a survey to understand the state of the art of the implementation of PM related policies in EU and China, and to identify opportunities for future Sino-European collaborations.

Methods

The survey was elaborated by the IC2PerMed consortium and validated by a focus group of experts. The final version, in English and Chinese, was administered online to a pool of accurately selected experts. Participation was anonymous and voluntary. The survey consists of 19 questions in 3 sections: (1) personal information; (2) policy in PM; (3) facilitating and hindering factors for Sino-European collaboration in PM.

Results

Forty-seven experts completed the survey, 27 from Europe and 20 from China. Only four participants were aware of the implementation of PM-related policies in their working country. Expert reported that PM areas with greatest policy impact so far were: Big Data and digital solutions; citizen and patient literacy; and translational research. The main obstacles found were the lack of shared investment strategies and the limited application of scientific developments in clinical practice. Aligning European and Chinese efforts, finding common ground across cultural, social, and language barriers, were considered as actions needed to enhance efforts in applying PM strategies internationally.

Conclusion

To achieve efficiency and sustainability of health systems, it remains crucial to transform PM into an opportunity for all citizens and patients with the commitment of all the stakeholders involved. The results obtained aim to help define common research and development approaches, standards and priorities and increase collaboration at international level, as well as provide key solutions to enable convergence towards a common PM research, innovation, development and implementation approach between Europe and China.
Mapping emerging technologies in aged care: results from an in-depth online research
Authors: Fasoli Annachiara , Beretta Giorgia , Pravettoni Gabriella , Sanchini Virginia
Published: May 2023

Background

Emerging Technologies (ETs) have recently acquired great relevance in elderly care. The exceptional experience with SARS-CoV-2 pandemic has emphasized the usefulness of ETs in the assistance and remote monitoring of older adults. Technological devices have also contributed to the preservation of social interactions, thus reducing isolation and loneliness. The general purpose of this work is to provide a comprehensive and updated overview of the technologies currently employed in elderly care. This objective was achieved firstly, by mapping and classifying the ETs currently available on the market and, secondly, by assessing the impact of such ETs on elderly care, exploring the ethical values promoted, as well as potential ethical threats.

Methods

An in-depth search was carried out on Google search engine, by using specific keywords (e.g. technology, monitoring techniques, ambient intelligence; elderly, older adults; care and assistance). Three hundred and twenty-eight technologies were originally identified. Then, based on a predetermined set of inclusion-exclusion criteria, two hundreds and twenty-two technologies were selected.

Results

A comprehensive database was elaborated, where the two hundred and twenty-two ETs selected were classified as follows: category; developmental stage; companies and/or partners; functions; location of development; time of development; impact on elderly care; target; website. From an in-depth qualitative analysis, some ethically-related contents and themes emerged, namely: questions related to safety, independence and active aging, connectedness, empowerment and dignity, cost and efficiency. Although not reported by developers, a close analysis of website contents highlights that positive values are often associated with potential risks, notably privacy threats, deception, dehumanization of care.

Conclusions

Research findings may ultimately lead to a better understanding of the impact of ETs on elderly people.
Measurement of unmet healthcare needs to assess progress on universal health coverage - exploring a novel approach based on household surveys
Authors: Ranjan Alok , Thiagarajan Sundararaman , Garg Samir
Published: May 2023

Background

Universal Health Coverage (UHC) aims to ensure universal access to quality healthcare according to health needs. The extent to which population health needs are met should be a key measure for progress on UHC. The indicators in use for measuring access mostly relate to physical accessibility or insurance coverage. Or, utilization of services is taken as indirect measure for access but it is assessed against only the perceived healthcare needs. The unperceived needs do not get taken into account. The present study was aimed at demonstrating an approach for measuring the unmet healthcare needs using household survey data as an additional measure of UHC.

Methods

A household survey was conducted in Chhattisgarh state of India, covering a multi-stage sample of 3153 individuals. Healthcare need was measured in terms of perceived needs which would be self-reported and unperceived needs where clinical measurement supplemented the interview response. Estimation of unperceived healthcare needs was limited to three tracer conditions- hypertension, diabetes and depression. Multivariate analysis was conducted to find the determinants of the various measures of the perceived and unperceived needs.

Results

Of the surveyed individuals, 10.47% reported perceived healthcare needs for acute ailments in the last 15 days. 10.62% individuals self-reported suffering from chronic conditions. 12.75% of those with acute ailment and 18.40% with chronic ailments received no treatment, while 27.83% and 9.07% respectively received treatment from unqualified providers. On an average, patients with chronic ailments received only half the medication doses required annually. The latent need was very high for chronic ailments. 47.42% of individuals above 30 years age never had blood pressure measured. 95% of those identified with likelihood of depression had not sought any healthcare and they did not know they could be suffering from depression.

Conclusion

To assess progress on UHC more meaningfully, better methods are needed to measure unmet healthcare needs, taking into account both the perceived and unperceived needs, as well as incomplete care and inappropriate care. Appropriately designed household surveys offer a significant potential to allow its periodic measurement. Their limitations in measuring the ‘inappropriate care’ may necessitate supplementation with qualitative methods.
The Swedish childhood tumor biobank: systematic collection and molecular characterization of all pediatric CNS and other solid tumors in Sweden
Authors: Díaz de Ståhl Teresita , Shamikh Alia , Mayrhofer Markus , Juhos Szilvester , Basmaci Elisa , Prochazka Gabriela , Garcia Maxime , Somarajan Praveen Raj , Zielinska-Chomej Katarzyna , Illies Christopher , Øra Ingrid , Siesjö Peter , Sandström Per-Erik , Stenman Jakob , Sabel Magnus , Gustavsson Bengt , Kogner Per , Pfeifer Susan , Ljungman Gustaf , Sandgren Johanna , Nistér Monica
Published: May 2023

The Swedish Childhood Tumor Biobank (BTB) is a nonprofit national infrastructure for collecting tissue samples and genomic data from pediatric patients diagnosed with central nervous system (CNS) and other solid tumors. The BTB is built on a multidisciplinary network established to provide the scientific community with standardized biospecimens and genomic data, thereby improving knowledge of the biology, treatment and outcome of childhood tumors. As of 2022, over 1100 fresh-frozen tumor samples are available for researchers. We present the workflow of the BTB from sample collection and processing to the generation of genomic data and services offered. To determine the research and clinical utility of the data, we performed bioinformatics analyses on next-generation sequencing (NGS) data obtained from a subset of 82 brain tumors and patient blood-derived DNA combined with methylation profiling to enhance the diagnostic accuracy and identified germline and somatic alterations with potential biological or clinical significance. The BTB procedures for collection, processing, sequencing, and bioinformatics deliver high-quality data. We observed that the findings could impact patient management by confirming or clarifying the diagnosis in 79 of the 82 tumors and detecting known or likely driver mutations in 68 of 79 patients. In addition to revealing known mutations in a broad spectrum of genes implicated in pediatric cancer, we discovered numerous alterations that may represent novel driver events and specific tumor entities. In summary, these examples reveal the power of NGS to identify a wide number of actionable gene alterations. Making the power of NGS available in healthcare is a challenging task requiring the integration of the work of clinical specialists and cancer biologists; this approach requires a dedicated infrastructure, as exemplified here by the BTB.
Validation of circulating histone detection by mass spectrometry for early diagnosis, prognosis, and management of critically ill septic patients
Authors: García-Giménez José Luis , García-López Eva , Mena-Mollá Salvador , Beltrán-García Jesús , Osca-Verdegal Rebeca , Nacher-Sendra Elena , Aguado-Velasco Carmen , Casabó-Vallés Germán , Romá-Mateo Carlos , Rodriguez-Gimillo María , Antúnez Oreto , Ferreres José , Pallardó Federico V. , Carbonell Nieves
Published: May 2023

Background

As leading contributors to worldwide morbidity and mortality, sepsis and septic shock are considered a major global health concern. Proactive biomarker identification in patients with sepsis suspicion at any time remains a daunting challenge for hospitals. Despite great progress in the understanding of clinical and molecular aspects of sepsis, its definition, diagnosis, and treatment remain challenging, highlighting a need for new biomarkers with potential to improve critically ill patient management. In this study we validate a quantitative mass spectrometry method to measure circulating histone levels in plasma samples for the diagnosis and prognosis of sepsis and septic shock patients.

Methods

We used the mass spectrometry technique of multiple reaction monitoring to quantify circulating histones H2B and H3 in plasma from a monocenter cohort of critically ill patients admitted to an Intensive Care Unit (ICU) and evaluated its performance for the diagnosis and prognosis of sepsis and septic shock (SS).

Results

Our results highlight the potential of our test for early diagnosis of sepsis and SS. H2B levels above 121.40 ng/mL (IQR 446.70) were indicative of SS. The value of blood circulating histones to identify a subset of SS patients in a more severe stage with associated organ failure was also tested, revealing circulating levels of histones H2B above 435.61 ng/ml (IQR 2407.10) and H3 above 300.61 ng/ml (IQR 912.77) in septic shock patients with organ failure requiring invasive organ support therapies. Importantly, we found levels of H2B and H3 above 400.44 ng/mL (IQR 1335.54) and 258.25 (IQR 470.44), respectively in those patients who debut with disseminated intravascular coagulation (DIC). Finally, a receiver operating characteristic curve (ROC curve) demonstrated the prognostic value of circulating histone H3 to predict fatal outcomes and found for histone H3 an area under the curve (AUC) of 0.720 (CI 0.546–0.895) p < 0.016 on a positive test cut-off point at 486.84 ng/mL, showing a sensitivity of 66.7% and specificity of 73.9%.

Conclusions

Circulating histones analyzed by MS can be used to diagnose SS and identify patients at high risk of suffering DIC and fatal outcome.