bluuebunny/crossref_metadata_2025 huggingface dataset:
Accumulating evidence from meta-analyses of prognostic studies on oral cancer: towards biomarker-driven patient selection
Authors: Almangush Alhadi , Alabi Rasheed Omobolaji , Pirinen Matti , Mäkitie Antti , Leivo Ilmo
Published: December 2024

Background

Many histopathologic prognostic markers, identified by routine hematoxylin and eosin (HE) staining, have been proposed for predicting the survival of patients with oral squamous cell carcinoma (OSCC). Subsequently, several meta-analyses have been conducted on these prognostic markers. We sought to analyze the accumulated evidence from these meta-analyses.

Methods

An electronic database search of PubMed, Scopus, Ovid Medline, Web of Science, and Cochrane Library was conducted to retrieve all meta-analysis articles published on histopathologic prognostic markers of OSCC. The risk of bias of the included studies was analyzed using the Risk of Bias in Systematic Reviews (ROBIS) tool. The synthesis of the results was conducted following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results

There were 16 meta-analysis articles published on the histological prognostic markers of OSSC. The accumulated evidence from these meta-analyses highlighted the powerful prognostic value of depth of invasion, tumor thickness, perineural invasion, lymphovascular invasion, worst pattern of invasion, tumor budding, and tumor-stroma ratio. The highest odds ratio (OR) of a relationship between a histopathologic prognostic marker and outcome was for the depth of invasion (OR 10.16, 95% CI 5.05–20.46) and tumor thickness (OR 7.32, 95% CI 5.3–10.1) in predicting lymph node metastasis.

Conclusion

The published meta-analyses present robust evidence on the significance of emerging histopathologic markers, namely, worst pattern of invasion, tumor budding, and tumor-stroma ratio. It is time to consider such markers in daily pathology reporting and risk stratification of OSCC.
Association between cognitive function, antioxidants, and clinical variables in Chinese patients with schizophrenia
Authors: Li Dan , Huang Yuanyuan , Lu Hongxin , Zhou Sumiao , Feng Shixuan , Li Hehua , Li Xuejing , Guo Yi , Fu Chunlian , Chen Guiying , Ning Yuping , Wu Fengchun , Liu Lianqi
Published: December 2024

Objective

Cognitive dysfunction is a prevalent and intricate manifestation of schizophrenia (SCZ) that may be associated with distinct clinical factors and the presence of antioxidants, which relationship is unclear. The study aimed to investigate cognitive function and its influencing factors in Chinese patients with SCZ.

Methods

A group of 133 patients with SCZ and 120 healthy controls (HCs) were recruited. The MATRICS Consensus Cognitive Battery (MCCB) was utilized to evaluate cognitive ability, and the Positive and Negative Syndrome Scale (PANSS) was used to assess clinical symptoms. Levels of plasma superoxide dismutase (SOD), serum albumin (ALB) and uric acid (UA) were assessed.

Results

Compared with HCs, patients with SCZ exhibited lower cognitive performance as indicated by MCCB scores, including the dimensions of speed of processing, attention/vigilance, working memory, verbal learning, and visual learning. In the SCZ group, total PANSS scores were negatively associated with all MCCB dimensions (all p < 0.05), except for the attention/vigilance score. The PANSS-negative and PANSS-cognitive subscores were negatively associated with speed of processing, verbal learning, and visual learning scores (all p < 0.05). The PANSS-excited subscores showed a negative correlation with working memory and visual learning scores (all p < 0.05). ALB levels significantly decreased, and their UA and SOD levels were notably elevated compared to HCs (all p < 0.05). ALB levels and PANSS-negative factors were correlated with to speed of processing, working memory, and visual learning dimensions. SOD levels were independent contributors to the attention/vigilance dimension.

Conclusion

The cognitive function was decreased in SCZ. The degree of cognitive impairment was closely related to ALB, SOD levels and negative clinical symptoms.
Quantification and time course of subjective psychotropic and somatic effects of tetrahydrocannabinol – a prospective, single-blind, placebo-controlled exploratory trial in healthy volunteers
Authors: Kleine-Brueggeney Maren , Huber Markus , Theiler Lorenz , Priemer Fritz , Greif Robert
Published: December 2024

Background

Cannabis is increasingly used and debates about the legalisation of the recreational use of cannabis are ongoing. In this prospective, placebo-controlled study in healthy volunteers not regularly consuming cannabis, subjective psychotropic and somatic effects after a single dose of intravenous THC were assessed and quantified over 48 h.

Methods

Twenty-five healthy volunteers received a single IV bolus of THC and 6 received normal saline. Psychotropic and somatic effects of THC were assessed by two questionnaires that were completed at up to 14 timepoints from shortly before drug administration to 48 h later.

Results

Demographic data did not differ between groups. Differences between THC and placebo for all assessed effects, except for euphoria, irritation and headache, were clearly discernible. Subdimensions related to positive mood were less and those related to negative mood were more pronounced in the THC group. Peak plasma concentrations were observed at 1 to 5 min after THC administration while peak effects occurred between 45 and 60 min. Differences between THC and placebo were pronounced and seen for up to 90 to 120 min for most effects, except for “sleepiness” and “deactivation”, where the effect of THC was discernible for up to 5 h. At 24 and 48 h, there were no statistically significant difference between THC and placebo group.

Conclusions

THC triggers a large range of psychotropic and somatic effects with peak effects at 45 to 60 min after IV administration of THC, much later than plasma peak levels. Most effects are short-lasting with a duration of up to 2 h, but some effects like sleepiness and deactivation can be longer-lasting and persist for 5 h or longer in cannabis-naïve or cannabis-abstinent individuals. Since effects of THC demonstrate a time course that differs from the time course of plasma concentrations it might be important to base the judgment of a possible impairment related to THC consumption on clinical or behavioral tests in addition to THC plasma levels.

Trial registration

www.isrctn.com; registration number ISRCTN53019164.
“Are we genuinely going to have our voices heard?” The experience of co-producing a blended intervention to prevent relapse in obsessive-compulsive disorder: a qualitative study on the perspectives of experts by lived experience
Authors: Millar Josie F.A. , Higson-Sweeney Nina , Jenkins Tom A. , Waites Erin F. , Minns Sophie
Published: December 2024

Introduction

Co-production involves researchers, practitioners and people with lived experience working in a collaborative manner, with shared power. The potential benefits of co-production are well documented. However, there is little research describing the experience of having been involved in co-production from the perspective of Experts By Lived Experience (EBLE). The aim of the present study is to explore the experiences of EBLE of obsessive-compulsive disorder (OCD) on their involvement in co-producing a blended intervention to prevent relapse for OCD.

Methods

Five EBLE took part in semi-structured interviews enquiring about their experiences of co-producing a relapse prevention intervention. Reflexive thematic analysis was used to analyse the data.

Results

Four themes were developed: (1) Welcome but unexpected therapeutic benefits; (2) The parameters of a safe space; (3) Genuine co-production brings meaningful change; and (4) Navigating the challenging terrain of co-production.

Conclusions

Overall, EBLE reported their involvement in the co-production process to have had positive impacts on both the development of the intervention and their own personal recovery journey. EBLE valued the safety created within the group, and the importance this had for allowing them to speak open and honestly about their experiences and the difficulties that can arise with the nature of the work.
Emotional processing as mechanism of change in brief good psychiatric management for borderline personality disorder: results of a randomized controlled trial
Authors: Kramer Ueli , Grandjean Loris , Machinea José Blanco , Beuchat Hélène , Ranjbar Setareh , de Roten Yves , Despland Jean-Nicolas , Conus Philippe , Kolly Stéphane
Published: December 2024

Background

Borderline Personality Disorder (BPD) is one of the most frequent, severe, mental conditions and is associated with a serious burden of disease. Treatment for patients with BPD involves structured psychotherapy. In addition and in order to improve access to care, psychiatric treatments are available. So far, it remains unclear if brief psychiatric intervention according to Good Psychiatric Management (GPM) produces a reliable effect on a variety of clinical outcomes. The assessment of mechanisms of change contributes to focus the treatment on the essential ingredients of change. The current study aims to demonstrate the emotional processing as a mechanism of change, assessed in an ecologically valid experimental context, of brief GPM.

Methods

The present two-arm randomized controlled study aims at testing the effects (i.e., reduction in borderline symptoms) and emotional processing as mechanism of change of a brief psychiatric treatment (10 sessions over 4 months), compared with treatment as usual. Participants are N = 76 patients with BPD who are either randomized to a 4 month GPM or a 4 month TAU without any BPD-specific content. All patients undergo assessments of borderline symptoms using ZAN-BPD and experiential enactment for assessment of emotional processing, at intake, 2 months and 4 months (discharge).

Results

The effect of a brief version of GPM is not different from the effect of TAU on the total score of the ZAN-BPD at 4 month (d = 0.04). At the level of the secondary effects, GPM is more effective in reducing relationship problems on the ZAN-BPD sub-scale (F(1, 61) = 5.53; p = .022, d = 0.52), and in reducing impulsivity and social problems, and it increases treatment retention. Change in emotional processing between intake and month 2 mediates the reduction on the ZAN-BPD subscale relationship problems assessed between months 2 and 4, in an ecologically valid experimental context.

Conclusions

Overall, brief GPM is not different from TAU in terms of reduction in borderline symptoms, but it may produce reduction in relationship problems between months 2 and 4 into the brief intervention. Change in emotional processing in an experimental context may function as mechanism of change of brief GPM. This study is in line with the top priority of establishing efficacy of brief interventions for BPD and proposes an evidence-based explanation for efficacy. These results should help disseminate brief psychiatric treatments for BPD, which contribute to reduce the societal burden related with BPD.

Trial registration

Clinical Trials NCT03717818 (date of registration of Abstract October 24th, 2018). Protocol number 2 from February 9th, 2018.
Tailoring implementation of a youth-focused mental health intervention in Sierra Leone using an implementation blueprint methodology
Authors: Desrosiers Alethea , Carrol Bidemi , Hayes Jacqueline , Momoh Fatoma , Ritsema Haley , Frank Hannah E. , Jalloh Unisa
Published: December 2024

Background

Identifying contextual factors that might support or hinder implementation of evidence-based mental health interventions for youth in low- and middle- income countries may improve implementation success by increasing the alignment of intervention implementation with local needs and resources. This study engaged community partners in Sierra Leone to: (a) investigate barriers and facilitators to implementing a mental health intervention within Sierra Leone’s schools; (b) develop an implementation blueprint to address identified implementation barriers; (c) explore the feasibility of using the implementation blueprint methodology in Sierra Leone.

Methods

We recruited Ministry of Education Officials (n = 2), teachers (n = 15) and principals (n = 15) in Sierra Leone to participate in needs assessment qualitative interviews. We used a rapid qualitative analysis approach to analyze data. Three team members summarized transcripts based on domains aligned with the structured research questions, organized themes into a matrix, and identified and discussed key themes to arrive at consensus. We then reconvened community partners to discuss implementation strategies that could address identified barriers. Participants ranked barriers according to high/low feasibility and high/low importance and selected implementation strategies for the blueprint.

Results

Qualitative results revealed several implementation barriers: teacher/parent/student buy-in; teacher motivation; scheduling time; limited funding; waning interest; daily hardships outside of school. Strategies selected included: develop/distribute educational materials; conduct education meetings/outreach; identify and prepare champions; access new funding.

Conclusions

Engaging community partners to develop an implementation blueprint for integration of a mental health intervention within Sierra Leone’s schools was feasible and may increase implementation effectiveness.
A systematic analysis of the burden of disease attributable to occupational noise-induced hearing loss in China based on the 2019 global burden of disease study
Authors: Wang Sirui , Liu Shuhan , Li Kaijie , Tang Wei , Fan Xiaofeng , Cheng Yongran , Dai Lili
Published: December 2024

Background

Occupational noise has long been recognized as a significant risk factor for hearing loss, particularly among workers. This study aimed to assess the disease burden of hearing loss caused by occupational noise in China from 1990 to 2019, with a focus on differences across sex and age groups, so as to address the existing gaps in the Global Burden of Disease Study (GBD) reports. By analyzing changes in years lived with disability (YLDs) among different sex and age groups over the past 30 years, this study provides valuable insights for the development of occupational noise safety measures in China.

Methods

We extracted data on the burden of hearing loss attributable to occupational noise from the 2019 Global Burden of Disease study. R software (version 4.12) was used to calculate the YLDs, age-standardized rates (ASRs), and average annual percent change (AAPC), stratified by age and sex. The Joinpoint regression model was used to analyze the trends in the burden of disease attributable to occupational noise exposure from 1990 to 2019.

Results

In China, the YLDs attributable to occupational noise-induced hearing loss in 2019 were 2.3277 million [95% uncertainty interval (UI): 1.5779–3.3478 million, marking a 70.95% increase compared with that in 1990. Throughout the study period, YLD rates exhibited a declining trend, with rates of 127.7 per 100,000 (95% UI: 87.4–181.4) in 1990 and 119.8 per 100,000 (95% UI: 81.2–182.1) in 2019. Using the Joinpoint regression model, the annual percent change (APC) in age-standardized YLD rates for occupational noise-related hearing loss initially increased from 1990 to 2000, followed by a decline, reaching its lowest point in 2015. From a sex perspective, the burden of YLDs in Chinese males exceeded that in females, although the rate of decline was less pronounced in females. With regard to age, the number and rate of YLDs attributable to occupational noise-induced hearing loss generally increased with age, particularly among middle-aged individuals and older adults. However, from 1990 to 2019, the number of YLDs attributable to occupational noise-induced hearing loss decreased among young people aged 15–19 years, accompanied by a significant reduction in YLDs rates.

Conclusion

Hearing loss attributable to occupational noise represents a substantial public health concern, especially among middle-aged and older adult workers in China. These findings underscore the importance of implementing effective measures to mitigate occupational noise exposure.
Helpful or harmful? Navigating the impact of social media influencers’ health advice: insights from health expert content creators
Authors: Kaňková Jaroslava , Binder Alice , Matthes Jörg
Published: December 2024

Background

With the growing role of social media influencers (SMIs) in providing health advice, concerns arise regarding the usefulness and reliability of online health information. This exploratory research focuses on health expert content creators (HECCs), who offer a unique perspective due to their combined medical knowledge and social media expertise.

Methods

We conducted semi-structured in-depth qualitative interviews with HECCs to explore their views on SMI-driven health communication, their motivations for participating on social media, and the strategies they employ to counteract misleading health messages on the platforms. The study employed thematic qualitative text analysis to identify key themes and patterns.

Results

HECCs highlighted the complex role of SMIs in public health, acknowledging their potential to promote positive health behaviors while also noting the risks associated with the spread of inaccurate or oversimplified health messages. The findings emphasize the urgent need to broaden health communication research to address not only misinformation but also overgeneralized health messaging, which can be equally detrimental.

Conclusions

The findings underscore the importance of expanding health communication research to address both misinformation and overgeneralized health messaging. Practical recommendations are provided to mitigate the spread of misleading health information by SMIs, informed by the experiences and strategies of HECCs.
The effect of honey in oral care intervention against chemotherapy-induced mucositis in pediatric cancer patients: a pilot study
Authors: Nurhidayah Ikeu , Rustina Yeni , Hastono Sutanto Priyo , Mediani Henny Suzana
Published: December 2024

Objective

Mucositis is one of the common side effects of chemotherapy. This study aimed to identify the effects of honey on oral care interventions to reduce mucositis scores among children undergoing chemotherapy.

Methods

This pilot study was quasi-experimental with pre-post intervention with the control group. The study employed consecutive sampling, with 24 patients in the control and 24 in the intervention group. The intervention group received an oral care protocol using honey, whereas the control group received regular oral care. The data were collected using demographic information form and the Oral Assessment Guide (OAG) to assess mucositis. The intervention group received oral care intervention using honey (35 ml of honey applied topically in the oral cavity and 15 ml of honey used as a mouthwash and for lip care), which was given thrice daily for five days. The data were analyzed using percentage distributions, means, chi-square tests, dependent and independent t-tests, and multivariate analysis using analysis of covariance (ANCOVA).

Results

The findings of this study showed that the intervention group experienced a significant reduction (-0.51 ± 0.66) in the average mucositis score after the intervention, whereas the control group experienced an increase in the mucositis score (3.84 ± 1.28) after controlling for confounding variables (p = 0.000).

Conclusion

This study revealed that oral care with honey effectively reduced chemotherapy-induced mucositis in children with cancer. These findings suggest that oral care with honey should be used as a nursing intervention for chemotherapy patients.

Trial registration

This clinical trial was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) with registration number ACTRN12624001313527 (29/10/2024).
How to enhance the novices’ learning in ultrasound-guided procedures utilizing handmade phantoms?
Authors: Huang Sih‑Shiang , Lin Chih-Hsien , Lin Shao-Yung , Huang Chien-Tai , Lien Wan-Ching
Published: December 2024

Introduction

This prospective study aims to evaluate the learning effect of US-guided thoracocentesis and pericardiocentesis in novices through simulation training using handmade phantoms.

Methods

The novices included undergraduate-year (UGY) students and first postgraduate-year (PGY-1) residents. Handmade phantoms were utilized for training and immediate assessment. Novices were re-evaluated using high-fidelity phantoms three months after training, while experienced PGY-3 emergency medicine residents were recruited and evaluated with high-fidelity phantoms simultaneously. Data on their performance, puncture time, and number of attempts were collected.

Results

Thirty-six novices (18 PGY-1 and 18 UGYs) and 12 PGY-3 emergency medicine residents were recruited. Alongside clinical observation, novices demonstrated improved skill retention and performance at the 3-month assessment compared to the immediate assessment [5 (4–5) vs. 3.5 (3–4), p = 0.0005] in thoracocentesis, achieving a comparable level of proficiency with the PGY-3 emergency medicine residents [5 (4–5) vs. 5 (5), p = 0.105]. Without clinical observation, novices exhibited a decline in skill proficiency in pericardiocentesis at the 3-month assessment [3 (3–4) vs. 4 (4–4.5), p = 0.015]. The puncture time was comparable between novices and PGY-3 emergency medicine residents for both thoracocentesis and pericardiocentesis. However, novices required a greater number of puncture attempts for pericardiocentesis.

Conclusions

Novices showed superior performance in thoracocentesis but experienced skill decay in pericardiocentesis at the 3-month assessment following training with handmade phantoms. This decline may be attributed to the very low frequency of pericardiocentesis cases encountered by novices after training, as well as the higher-stakes nature of the procedure. Further investigation is needed to evaluate the long-term effects of training, skill retention, and transfer of skills to actual patient care. Additionally, research should focus on determining optimal retraining intervals for pericardiocentesis and evaluating the use of standardized pericardiocentesis videos as an alternative to clinical observation.

Trial registration

Registered at ClinicalTrials.gov (NCT04792203) on March 7, 2021.
Developing institution-specific admission competency criteria for prospective health sciences students
Authors: Kang Eunhee , Kim Ryan Jin Young , Park Young-Seok , Park Shin-Young , Lee Jihyun
Published: December 2024

Background

Given the critical role of health professionals in societal health, the development of robust and effective selection methods is of fundamental concern for educational institutions within the field of health sciences education. Conventionally, admission competencies have been determined by institutional authorities. Developing institution-specific competency criteria enables an admission process that is mission- and value-aware, evidence-based, and strategically adaptable. However, few schools have established their admission competency criteria, although the majority possess their own models of graduation competencies. This study reports the process of developing and validating an institution-specific admission competency model that addresses the need for evidence-based and mission-aligned selection processes that are distinct from standardized models.

Methods

This study was conducted in two phases, using both qualitative and quantitative analyses. Phase I involved constructing an admission competency model through a qualitative approach facilitated by workshops with 17 faculty members and 92 first-year pre-doctoral students of a dental school. Through constant comparative analysis, this phase focused on the extraction and refinement of competencies for entering dental students. In Phase II, a questionnaire developed from the workshops asked respondents to rate the importance of 47 attributes across 10 constructs on a 5-point Likert scale. A total of 301 individuals participated in the survey. Exploratory Factor Analysis (EFA) identified the factor structure, and Confirmatory Factor Analysis (CFA) examined construct validity and assessed the model fit with the data.

Results

The EFA of the 47 attributes identified 10 factors, and the CFA results indicated a good-to-acceptable level of fit for the ten-factor model. Aligned with the American Association of Medical Colleges Premed competencies, this study identified unique attributes specific to the institution, such as confidence, leadership, and entrepreneurship. These findings highlight the importance of developing tailored competencies reflecting the unique needs of institutions and their fields.

Conclusions

This study demonstrates the feasibility and value of creating institution-specific admission competency models, offering a methodology that aligns with evidence-based mission-driven selection processes. The distinct competencies identified emphasize the need for educational institutions to consider unique institutional and field-specific requirements and move beyond standardized models to enhance the selection of medical students.
Early prediction of mortality upon intensive care unit admission
Authors: Yeh Yu-Chang , Kuo Yu-Ting , Kuo Kuang-Cheng , Cheng Yi-Wei , Liu Ding-Shan , Lai Feipei , Kuo Lu-Cheng , Lee Tai-Ju , Chan Wing-Sum , Chiu Ching-Tang , Tsai Ming-Tao , Chao Anne , Chou Nai-Kuan , Yu Chong-Jen , Ku Shih-Chi
Published: December 2024

Background

We aimed to develop and validate models for predicting intensive care unit (ICU) mortality of critically ill adult patients as early as upon ICU admission.

Methods

Combined data of 79,657 admissions from two teaching hospitals’ ICU databases were used to train and validate the machine learning models to predict ICU mortality upon ICU admission and at 24 h after ICU admission by using logistic regression, gradient boosted trees (GBT), and deep learning algorithms.

Results

In the testing dataset for the admission models, the ICU mortality rate was 7%, and 38.4% of patients were discharged alive or dead within 1 day of ICU admission. The area under the receiver operating characteristic curve (0.856, 95% CI 0.845–0.867) and area under the precision-recall curve (0.331, 95% CI 0.323–0.339) were the highest for the admission GBT model. The ICU mortality rate was 17.4% in the 24-hour testing dataset, and the performance was the highest for the 24-hour GBT model.

Conclusion

The ADM models can provide crucial information on ICU mortality as early as upon ICU admission. 24 H models can be used to improve the prediction of ICU mortality for patients discharged more than 1 day after ICU admission.
Psychological distress, suicidality and resilience of Lithuanian nurses
Authors: Kavaliauskas Povilas , Kazlauskas Evaldas , Smailyte Giedre
Published: December 2024

Background

Nurses, like other healthcare workers, are prone to poorer mental health, increased burnout, and may have an increased risk of suicide.

Purpose

This study aimed to evaluate mental health problems among Lithuanian nurses and explore factors associated with them.

Method

The survey was completed by 533 nurses. Mental health was assessed using the Depression, Anxiety, and Stress Scale—21, and suicidal ideation was measured with the Suicidal Behaviours Questionnaire—Revised (SBQ-R).

Findings

A large proportion of nurses in the study had high psychological distress, with 18% having high depression, 29.3% - high anxiety, and 17.1% - high stress. 21.2% of the sample had an increased suicide risk. 64.9% of nurses considered changing their careers to a non-medical profession in the last 12 months.

Discussion

Addressing mental health issues in the national healthcare system is critical to avoiding the loss of valued medical community members and ensuring that patients do not lose their critical caretakers.
Burden of invasive pneumococcal disease, non-invasive all-cause pneumonia, and acute otitis media in hospitalized US children: a retrospective multi-center study from 2015 to 2020
Authors: Mohanty Salini , Cossrow Nicole , White Meghan , Yu Kalvin C. , Ye Gang , Feemster Kristen A. , Gupta Vikas
Published: December 2024

Background

Despite effective pneumococcal vaccines, pneumococcal disease (PD) exerts a substantial burden on children. This study explored the clinical and economic burden of invasive PD (IPD), non-invasive all-cause pneumonia (ACP), and acute otitis media (AOM) in hospitalized children.

Methods

Data from the BD Insights Research Database of hospitalized children (< 18 years, including infants and children) in the US were analyzed retrospectively. The study cohort included patients with an ICD10 code for IPD, ACP, or AOM and/or a positive culture for S. pneumoniae. Descriptive statistics and multivariable analyses evaluated the following outcomes: length of stay [LOS], hospital cost per admission, hospital margin per admission [costs – payments], and in-hospital mortality.

Results

The study included 4575 pediatric patients with IPD (n = 36), ACP (n = 3,329), or AOM (n = 1,210) admitted to 57 US hospitals from October 2015 to February 2020. Approximately half (50.7%) were under 2 years of age. The in-hospital mortality rate was 0.6% (n = 28). The observed median (interquartile range) LOS was 4 (3, 5) days, cost per admission was $4,240 ($2,434, $8,311) US dollars, and hospital margin per admission was -$63 ($2,118, $2,025). LOS and costs were highly variable according to clinical characteristics and hospital variables. Key variables associated with poor outcomes were having a moderate- or high-risk condition (chronic or immunocompromising), intensive care unit admission, and prior 90-day admission.

Conclusions

The burden of PD among hospitalized pediatric patients in the US remains substantial. Our study highlights the burden of PD among young children (< 2 years) and children with underlying medical conditions that put them at greater risk for PD. The results support the need for ongoing prevention efforts including vaccination and antimicrobial stewardship programs to reduce the burden of PD in children.
Utility of colposcopy for the screening and management of cervical cancer in Africa: a cross-sectional analysis of providers’ training and practices
Authors: Fokom Domgue Joël , Dille Issimouha , Gnangnon Freddy , Kapambwe Sharon , Bouchard Celine , Mbatani Nomonde , Gauroy Elodie , Ambounda Nathalie Ledaga , Yu Robert , Sidibe Fatoumata , Kamgno Joseph , Traore Bangaly , Tebeu Pierre-Marie , Halle-Ekane Gregory , Diomande Mohenou Isidore , Dangou Jean-Marie , Lecuru Fabrice , Adewole Isaac , Plante Marie , Basu Partha , Shete Sanjay
Published: December 2024

Introduction

Cervical cancer is a public health issue in Africa with devastating socioeconomic consequences due to the lack of organized screening programs. The success of screening programs depends on the appropriate investigation and management of women who test positive for screening. Colposcopic assessment following positive screening results is a noteworthy issue in Africa. This study aimed to assess the utilization of colposcopy by providers in the region.

Methods

A cross-sectional study was conducted in 2021–2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior colposcopy training, whether they performed colposcopy and the indications of colposcopy in their practice.

Results

Of the 130 providers from 23 African countries who responded to the survey (mean age [SD]: 39.0 years [9.4]), half were female (65 [50.0%]), and 90.7% reported working in urban areas. Overall, only 12.6% of respondents indicated having received prior training on colposcopy, and 11.7% reported that they were performing colposcopy in their current practice. Among the providers who reported performing colposcopy in their practice, colposcopy was indicated for routine cervical cancer screening in 21.2% of clinicians, to better visualize the transformation zone in 15.2% of respondents, to further assess the vascularization of cervical mucosa in 33.3% of respondents, and to determine the appropriate treatment modality in 12.1% of respondents. Providers who performed colposcopy in their practice reported a median number of 30 (interquartile range: 19-65) colposcopic procedures in the past 6 months.

Conclusion

Providers’ training and practice of colposcopy for cervical cancer screening remain suboptimal in Africa. To increase utilization of colposcopy in the region, further training is needed to improve providers’ knowledge and engagement. With the development of lower-cost and portable colposcopes, efforts to equip cervical cancer prevention programs and facilities with colposcopy should be enhanced to ensure that women can be screened and managed appropriately in the clinical setting and communities.
Defining the transition from new to normal: a qualitative investigation of the clinical change process
Authors: Silver Santana R. , Jones Kayla Christine , Hook Kimberly , Crable Erika L. , George Emily R. , Serwint Janet R. , Austad Kirsten , Walkey Allan , Drainoni Mari-Lynn
Published: December 2024

Background

Understanding how and when a new evidence-based clinical intervention becomes standard practice is crucial to ensure that healthcare is delivered in alignment with the most up-to-date knowledge. However, rigorous methods are needed to determine when a new clinical practice becomes normalized to the standard of care. To address this gap, this study qualitatively explores how, when, and why a clinical practice change becomes normalized within healthcare organizations.

Methods

We used purposive sampling to recruit clinical leaders who worked in quality improvement and/or implementation science in diverse health contexts. Enrolled participants completed semi-structured interviews around implementing evidence-based practices. Qualitative data was inductively and deductively analyzed, and was guided by a modified version of the Normalization Process Theory (NPT) framework to identify salient themes. Additionally, identified normalization strategies were mapped to the Expert Recommendations for Implementation Change (ERIC) project.

Results

A total of 17 individuals were interviewed. Two categories of themes emerged: 1) signals of when a new clinical practice is considered to be normalized within clinical care; and 2) strategies utilized to normalize new clinical innovations. Participants described four key signals for identifying when a novel clinical practice becomes the new normal: 1) integrated seamlessly into existing workflows; 2) scaled across the entire organizational unit; 3) has strong staff buy-in and ownership; and 4) no longer needs monitoring and evaluation to be sustained. Major strategies to normalize new clinical interventions included: 1) taking a patient approach that starts slow and gains momentum; 2) identifying and using methods to gain staff buy-in and ownership; and 3) conducting ongoing measurement of progress towards normalization.

Conclusions

The results offer valuable insight into the indicators that signify when a novel clinical practice becomes normalized, and the strategies employed to facilitate this transition. These findings can inform future research to develop instruments that implementation leaders can use to systematically measure the clinical change process.
Client experiences of a task-shifting supported self-management intervention for depression in Vietnam
Authors: Chau Leena W. , Lou Hayami , Murphy Jill K. , Nguyen Vu Cong , Small Will , Samji Hasina , O’Neil John
Published: December 2024

Background

The global burden of mental illness is substantial, with depression impacting close to 300 million people worldwide. This has been exacerbated within the context of the COVID-19 pandemic. Yet, in many low- and middle-income countries including Vietnam, there is a substantial treatment gap, with many requiring mental health care unable to access it. Task-shifting is an evidence-based approach that seeks to address this gap by utilizing non-specialist providers to provide care. While there is a large body of literature exploring task-shifting, there is little that explores the client experience. This paper describes the facilitators and barriers impacting the client experience of a task-shifting supported self-management (SSM) intervention for depression in Vietnam. SSM involves a client workbook and supportive coaching by non-specialist providers.

Methods

This paper is situated within a randomized controlled trial that demonstrated the effectiveness of the SSM intervention in adult populations across eight provinces in Vietnam. Semi-structured interviews were conducted with a convenience sample of clients (recipients of the intervention) with depression caseness as measured by the Self-Report Questionnaire-20 depression screening measure, and providers (non-specialist “social collaborators”) to explore SSM’s acceptability and factors influencing participation and adherence. This paper presents the qualitative findings from an analysis of the interviews, focusing on the client perspective. Qualitative descriptive methods and thematic analysis were used.

Results

Forty-five clients were interviewed. Sub-themes reported for the facilitators and benefits for the client experience of the SSM intervention were client-provider relationship building and family and community connections. Sub-themes reported for the barriers were clients’ responsibilities, clients’ health conditions, and consequences of stigma.

Conclusions

Due to challenges with sustaining and scaling up the in-person SSM intervention in Vietnam, the research team has pivoted to delivering the SSM intervention digitally through a smartphone-based app adapted from SSM, with direction from the Government of Vietnam. Findings from this study suggest that while digital interventions may support accessibility and convenience, they may neglect the critical human contact component of mental health care. Ultimately, a model that combines digital delivery with some form of human contact by a support person may be important.
CRISPR in mobile genetic elements: counter-defense, inter-element competition and RNA-guided transposition
Authors: Koonin Eugene V. , Makarova Kira S.
Published: December 2024

CRISPR are adaptive immunity systems that protect bacteria and archaea from viruses and other mobile genetic elements (MGE) via an RNA-guided interference mechanism. However, in the course of the host-parasite co-evolution, CRISPR systems have been recruited by MGE themselves for counter-defense or other functions. Some bacteriophages encode fully functional CRISPR systems that target host defense systems, and many others recruited individual components of CRISPR systems, such as single repeat units that inhibit host CRISPR systems and CRISPR mini-arrays that target related viruses contributing to inter-virus competition. Many plasmids carry type IV or subtype V-M CRISPR systems that appear to be involved in inter-plasmid competition. Numerous Tn7-like and Mu-like transposons encode CRISPR-associated transposases (CASTs) in which interference-defective CRISPR systems of type I or type V mediate RNA-guided, site-specific transposition. The recruitment of CRISPR systems and their components by MGE is a manifestation of extensive gene shuttling between host immune systems and MGE, a major trend in the coevolution of MGE with their hosts.
Sphingolipid profiling as a biomarker of type 2 diabetes risk: evidence from the MIDUS and PREDIMED studies
Authors: Berkowitz Loni , Razquin Cristina , Salazar Cristian , Biancardi Fiorella , Estruch Ramón , Ros Emilio , Fitó Montserrat , Corella Dolores , Coe Christopher L. , Ryff Carol D. , Ruiz-Canela Miguel , Salas-Salvado Jordi , Wang Daniel , Hu Frank B. , Deik Amy , Martínez-Gonzalez Miguel A. , Rigotti Attilio
Published: December 2024

Background

Type 2 diabetes (T2D) has become a worldwide pandemic. While ceramides may serve as intermediary between obesity-related lipotoxicity and T2D, the relationship with simple glycosphingolipids remains uncertain. The aim of this study was to characterize the associations between blood glycosphingolipid and ceramide species with T2D and to identify a circulating sphingolipid profile that could serve as novel biomarker for T2D risk.

Methods

Cross-sectional relationship between sphingolipid levels, insulin resistance, and T2D prevalence were evaluated in 2,072 American adults from MIDUS cohort. Prospectively, the association between sphingolipid species and the incidence of T2D was analyzed using a case-cohort design nested within the PREDIMED trial (250 cases and a random sample of 692 participants, with 3.8 years of median follow-up). Circulating levels of sphingolipid species in both populations were measured using LC/MS. Hazard ratios were estimated with weighted Cox regression models using Barlow weights.

Results

In American adults, only CER18:0 and CER22:0 were linked to insulin resistance and a higher prevalence of T2D. Conversely, three lactosylceramides (LCER 14:0, 16:0, and 24:1) showed a strong inverse relationship with both insulin resistance and T2D. These findings led to development of two sphingolipid scores. In the prospective analysis, these scores consistently predicted a reduced risk of T2D incidence in PREDIMED (HR: 0.64, 95% CI 0.44 to 0.94 and 0.58, 0.40 to 0.85 respectively) between extreme quartiles, with 5-year absolute risk differences of 9.6% (95% CI: 0.3–20.5%) and 11.4% (1.0–21.6%). They were validated in the same trial with samples obtained after 1 year of follow-up.

Conclusions

Our findings support the potential usefulness of circulating sphingolipid profiles as novel biomarkers for T2D risk. Moreover, this study opens the door for future research on the predictive value and possible protective roles of lactosylceramides in T2D.

Graphical abstract
Systematic review of evidence for the impact and effectiveness of the 1-3-7 strategy for malaria elimination
Authors: Sogandji Nihal , Stevenson Anna , Luo Michael Y. , Qi Gao , Maude Richard J.
Published: December 2024

Background

The 1-3-7 approach to eliminate malaria was first implemented in China in 2012. It has since been expanded to multiple countries, but no systematic review has examined the evidence for its use. A systematic review was conducted aiming to evaluate the impact and effectiveness of the strategy and identify key challenges and variations in its implementation across different countries.

Methods

PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CABS Abstracts, LILACS, Global Health, Medrxiv, Biorxiv were searched for all studies containing 1-3-7 and articles included if they contained information on 1-3-7 impact, effectiveness, challenges and/or adaptations for implementation in different countries.

Results

31 studies were included from China (19), Thailand (6), Myanmar (2), Tanzania (1), Cambodia (1), India (1) and Vietnam (1). During 1-3-7 implementation, malaria cases in China decreased by 99.1–99.9%, in Thailand by 66.9% during 2013–19, 65,1% in Cambodia during 2015–17 and 30.3% in India during 2015–16, with some differences in implementation. It was not possible to separate the impact of 1-3-7 from that due to other contemporaneous interventions. Implementing the 1-3-7 policy was largely effective, with reporting within 1 day in 99.8–100% of individuals in China and 36–100% in other countries, investigation within 3 days in 81.5–99.4% in China and 79.4–100% in other countries, and foci investigation within 7 days in 90.1–100% in China and 83.2–100% in other countries. Adaptations to 1-3-7 were described in 5 studies, mostly adjustment of the timing and/or definitions of each component. Key challenges identified included those related to staffing, equipment, process, and patient-provided information.

Conclusion

Overall, the 1-3-7 approach was effectively implemented with a concomitant decrease in cases in malaria elimination settings, however, it was not possible to quantify impact as it was not implemented in isolation. Implementing adequate measures for testing, reporting, treatment, and containment is crucial for its success, which is dependent on the availability of resources, infrastructure, staffing, and consistent compliance across regions and throughout the year. However, achieving this nationally and maintaining compliance, especially at borders with malaria-affected countries, poses significant challenges.
Access to health insurance amongst people with disabilities and its association with healthcare use, health status and financial protection in low- and middle-income countries: a systematic review
Authors: Azizatunnisa’ Luthfi , Kuper Hannah , Banks Lena Morgon
Published: December 2024

Background

People with disabilities often incur higher costs for healthcare, due to higher needs, greater indirect costs, and the need for services not offered by the public system. Yet, people with disabilities are more likely to experience poverty and so have reduced capacity to pay. Health insurance is an important social protection strategy to meet healthcare needs and avoid catastrophic expenditures for this group. This systematic review synthesized evidence on health insurance coverage and potential effects among people with disabilities in low- and middle-income countries (LMICs).

Methods

This systematic review followed PRISMA Guidelines. We searched English peer-reviewed articles from nine databases (Medline, Embase, CINAHL, Web of Science, Scopus, Cochrane Library, PsyInfo, Global Health, and Econlit) from January 2000 to 24 January 2023. Two independent reviewers conducted the article selection, data extraction, and risk of bias assessment using NIH Guidelines. Studies were eligible for inclusion if they quantitatively assessed at least one of four key outcomes amongst people with disabilities: health insurance coverage/access, the association between health insurance and health care utilization, financial protection, or health status/outcome. Narrative synthesis was deployed due to high variety of outcome measurements.

Results

Out of 8,545 records retrieved and three from hand search, 38 studies covering data from 51 countries met the eligibility criteria. Over two-thirds (68.4%) focused on access/coverage, which was generally limited amongst people with disabilities. Seventeen studies (44.7%) examined healthcare utilization, with a positive association (9/12) found between health insurance and the use of disability-related services. However, its association with general healthcare utilization (5 studies) remained inconclusive. Financial protection, explored by six studies (15.8%), similarly yielded inconclusive results. Only four studies (10.5%) reported on health status, and the findings suggest a favourable association of health insurance with self-reported health among people with disabilities (2/4), despite the limited number of high-quality studies.

Conclusions

There is considerable variability and limited evidence regarding health insurance coverage and its potential impact among individuals with disabilities in LMICs. This gap highlights the pressing need for further evaluations of health insurance, with a specific focus on people with disabilities, aligning with the broader goal of achieving Universal Health Coverage (UHC).

Trial registration

PROSPERO CRD42023389533.