bluuebunny/crossref_metadata_2025 huggingface dataset:
Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines
Authors: Albert Elizabeth L. , Rose Jeanmarie C. , Gill India J. , Flocke Susan A.
Published: July 2020

Background

The use of electronic referrals (eReferrals) to state quitlines (QLs) for tobacco-using patients is a promising approach for addressing smoking cessation on a large scale. However, QL contact, enrollment, and completion rates are low. The purpose of this study was to examine the eReferral to QL process from the patient’s perspective in order to inform strategies for improving QL engagement.

Methods

We conducted interviews with 55 patients who agreed to an eReferral at a primary care visit to 1 of 8 safety-net community health centers in Cuyahoga County, Ohio (September 2017–August 2018). Interviews were designed to explore the experiences of three subgroups of patients who subsequently: 1) declined participation in the QL; 2) were unreachable by the QL; or 3) were enrolled in or had completed the QL program. Analysis was guided by a phenomenological approach designed to identify emergent themes.

Results

Reasons for QL program non-completion included changing life circumstances and events making cessation unviable; misunderstandings about the QL; discomfort with telephonic counseling; perceived lack of time for counseling; cell phone barriers; and having already quit smoking. We found that some individuals who were no longer engaged with the QL still desired continued support from the QL.

Conclusions

Participants intentionally and unintentionally disengage from the QL for a wide variety of reasons, several of which are mediated by low socioeconomic status. Integrating QL care with community-based resources that address these mediators could be a promising strategy.
Correction to: The influence of corruption and governance in the delivery of frontline health care services in the public sector: a scoping review of current and future prospects in low and middle-income countries of south and south-east Asia
Authors: Naher Nahitun , Hoque Roksana , Hassan Muhammad Shaikh , Balabanova Dina , Adams Alayne M. , Ahmed Syed Masud
Published: July 2020

An amendment to this paper has been published and can be accessed via the original article.
Impact of comorbidity on the short- and medium-term risk of revision in total hip and knee arthroplasty
Authors: Arias-de la Torre Jorge , Smith Kayla , Dregan Alexandru , Valderas Jose M. , Evans Jonathan P. , Prieto-Alhambra Daniel , Lozano Luis , Molina Antonio J. , Martín Vicente , Domingo Laia , Muñoz Laura , Espallargues Mireia
Published: July 2020

Background

The impact of comorbidity on the risk of revision in patients undergoing Total Knee arthroplasty (TKA) and Total Hip Arthroplasty (THA) is not currently well known. The aim of this study was to analyze the impact of comorbidity on the risk of revision in TKA and THA.

Methods

Patients recorded in the Catalan Arthroplasty Register (RACat) between 01/01/2005 and 31/12/2016 undergoing TKA (n = 49,701) and THA (n = 17,923) caused by osteoarthritis were included. As main explanatory factors, comorbidity burden was assessed by the Elixhauser index, categorized, and specific comorbidities from the index were taken into account. Descriptive analyses for comorbidity burden and specific conditions were done. Additionally, incidence at 1 and 5 years’ follow-up was calculated, and adjusted Competing Risks models were fitted.

Results

A higher incidence of revision was observed when the number of comorbidities was high, both at 1 and 5 years for THA, but only at 1 year for TKA. Of the specific conditions, only obesity was related to the incidence of revision at 1 year in both joints, and at 5 years in TKA. The risk of revision was related to deficiency anemia and liver diseases in TKA, while in THA, it was related to peripheral vascular disorders, metastatic cancer and psychoses.

Conclusions

Different conditions, depending on the joint, might be related to higher revision rates. This information could be relevant for clinical decision-making, patient-specific information and improving the results of both TKA and THA.
Delayed gastric emptying after Pancreaticoduodenectomy: a propensity score-matched analysis and clinical Nomogram study
Authors: Cai Xianlei , Zhang Miaozun , Liang Chao , Xu Yuan , Yu Weiming
Published: July 2020

Background

Delayed gastric emptying (DGE) is a common and frustrating complication of pancreaticoduodenectomy (PD). Studies suggest that surgical methods and other clinical characteristics may affect the occurrence of DGE. Nevertheless, the results of such studies are conflicting. The objective of this work was to perform a propensity score matching analysis to compare the differences between pylorus-preserving pancreaticoduodenectomy (PPPD) and pylorus-removing pancreaticoduodenectomy (PrPD) and to develop and validate a nomogram to predict the probability of severe DGE (SDGE).

Methods

This retrospective study enrolled patients who underwent PD at our institution from December 2009 to December 2018. Propensity score matching was applied at a ratio of 1:1 to compare PPPD and PrPD groups. We compared incidence of complications, DGE, lengths of hospital stay, hospitalization costs, and mortality. Univariate and multivariate logistic regression analysis were performed to identify potential risk factors of severe DGE. Finally, a nomogram was developed and validated to predict severe DGE.

Results

The PPPD group had a significantly higher rate of postoperative pancreatic fistula (29.9% versus 17.4%, P < 0.05) and less blood loss (463.7 ml versus 694.9 ml, P < 0.05). After propensity score matching, the PPPD group had a significantly higher rate of postoperative DGE (19.2% versus 3.8%, P < 0.05), especially severe DGE (17.3% versus 0%) than the PrPD group. There were no significant differences in terms of lengths of hospital stay, hospitalization costs or mortality between the groups. Surgical method, biliary leakage, abdominal infection, and diabetes were independent risk factors for SDGE. The nomogram predicted SDGE with a training C - index of 0.798 and a validation C - index of 0.721.

Conclusion

PPPD increases the risk of DGE than PrPD, especially SDGE. Our prediction nomogram gives good prediction of SDGE after pancreaticoduodenectomy.
Healthcare knowledge of relationship between time series electrocardiogram and cigarette smoking using clinical records
Authors: Tseng Kuo-Kun , Li Jiaqian , Tang Yih-Jing , Yang Ching Wen , Lin Fang-Ying
Published: July 2020

Background

In the few studies of clinical experience available, cigarette smoking may be associated with ischemic heart disease and acute coronary events, which can be reflected in the electrocardiogram (ECG). However, there is no formal proof of a significant relationship between cigarette smoking and electrocardiogram results. In this study, we therefore investigate and prove the relationship between electrocardiogram and smoking using unsupervised neural network techniques.

Methods

In this research, a combination of two techniques of pattern recognition; feature extraction and clustering neural networks, is specifically investigated during the diagnostic classification of cigarette smoking based on different electrocardiogram feature extraction methods, such as the reduced binary pattern (RBP) and Wavelet features. In this diagnostic system, several neural network models have been obtained from the different training subsets by clustering analysis. Unsupervised neural network of clustering cigarette smoking was then implemented based on the self-organizing map (SOM) with the best performance.

Results

Two ECG datasets were investigated and analysed in this prospective study. One is the public PTB diagnostic ECG databset with 290 samples (age 17–87, mean 57.2; 209 men and 81 women; 73 smoking and 133 non-smoking). The other ECG database is from Taichung Veterans General Hospital (TVGH) and includes 480 samples (240 smoking, and 240 non-smoking). The diagnostic accuracy regarding smoking and non-smoking in the PTB dataset reaches 80.58% based on the RBP feature, and 75.63% in the second dataset based on Wavelet feature.

Conclusions

The electrocardiogram diagnostic system performs satisfactorily in the cigarette smoking habit analysis task, and demonstrates that cigarette smoking is significantly associated with the electrocardiogram.
A prognostic index based on a fourteen long non-coding RNA signature to predict the recurrence-free survival for muscle-invasive bladder cancer patients
Authors: Zhang Xiaolong , Zhang Meng , Zhang Xuanping , Zhu Xiaoyan , Wang Jiayin
Published: July 2020

Background

Bladder cancer (BC) is regarded as one of the most fatal cancer around the world. Nevertheless, there still lack of sufficient markers to predict the prognosis of BC patients. Herein, we aim to establish a prognosis predicting signature based on long-noncoding RNA (lncRNA) for the invasive BC patients.

Methods

The lncRNA expression profile was downloaded from The Cancer Genome Atlas (TCGA) database, along with the correlated clinicopathological information. The univariate Cox regression test was employed to screen out the recurrence-free survival (RFS)-related lncRNAs. Then, the LASSO method was conducted to construct the signature based on these RFS-related lncRNA candidates. Genes correlated with these fourteen lncRNAs were extracted from the mRNA expression profile, with the Pearson correlation coefficient > 0.60 or < − 0.40. Subsequently, the Proteomap pathway enrichment analyses were conducted to classify the function of these correlated genes. Furthermore, the multivariate analyses were executed to reveal the independent role of the proposed signature with the clinicopathological features.

Results

We established an lncRNA-based RFS predicting signature by the LASSO Cox regression test, and proved its usage and stability on both the training and validation cohorts by the Kaplan-Meier and receiver operating characteristic (ROC) curves. Notably, the multivariate Cox regression analysis found that our classifier was an independent indicator for muscle-invasive BC patients rather than sex, age and tumor grade, with higher predictive value than the existing ones. Besides, we did the pathway analyses for these genes that highly correlated with the proposed fourteen lncRNAs, as well as the differentially expressed genes (DEGs) derived from the high-risk vs. low-risk groups, and the recurrence vs. non-recurrence groups, respectively. Notably, these results were consistent, and these genes were mostly enriched in the transcription factors, G protein-coupled receptors, MAPK signaling pathways, which were proved significantly associated with tumor progression and drug resistance.

Conclusions

Our results suggested that the fourteen-lncRNA-based RFS predicting signature is an independent indicator for BC patients. Further prospective studies with more samples are needed to verify our findings.
Elicitation of preferences in the second half of the shared decision making process needs attention; a qualitative study
Authors: Savelberg W. , Smidt M. , Boersma L. J. , van der Weijden T.
Published: July 2020

Background

It is known that the use of a Patient Decision Aid (PtDA), combined with advice for professionals on how and when to use it, can enhance the involvement of patients in the treatment decision. However, we need more knowledge with respect to the intention-behaviour gap. This study aims to analyse patients’ experiences with the Shared Decision Making (SDM) process to find clues to close this gap.

Methods

This qualitative study was part of a pilot study aiming to implement SDM in early adopter breast cancer teams. Patients were given access to a personalised PtDA. Breast cancer teams were instructed on how and when to deliver the PtDA. We interviewed 20 patients about their experience with the PtDA and SDM in general.

Results

Most patients experienced SDM, though to a certain extent. Choice talk and option talk were commonly experienced, however the elicitation of preferences and decision talk was rare. The PtDA was used by the majority of patients (N = 13), all indicating that it was useful, especially to recall all the information given. Patients appreciated the contribution of breast cancer nurses in the SDM process. They considered them as true case managers, easy to approach and supportive.

Conclusion

Although patients felt well-informed and satisfied about risk-communication, the elicitation of preferences appeared very limited to non-existent. We recommend that breast cancer teams divide tasks in the SDM process and reallocate the elicitation of preferences to the nurses in a well-defined clinical pathway.
Model construction of medical endoscope service evaluation system-based on the analysis of Delphi method
Authors: Zheng Jun , Lou Ligang , Xie Ying , Chen Siyao , Li Jun , Wei Jingming , Feng Jingyi
Published: July 2020

Background

Medical endoscope is widely used in clinical practice for the purpose of diagnosis and treatment, occupying around 5% of the medical device market. Evaluating the true service level of medical endoscope is essential and necessary to improve overall performance of medical diagnosis and treatment, and to maintain competitiveness of endoscope manufacturers, however, such a tool is not available in the market. This study develops an Evaluation Index System (EIS) to assess service level of medical endoscope, and to provide suggestions for improving the service level through the Delphi method.

Methods

Firstly, the possible factors influencing the service level were identified from literature review. In parallel, the Delphi expert method questionnaire was designed and 25 experts were invited to conduct three rounds of questionnaire, to evaluate and rate the possible factors. Finally, we determined the weights associated with the factors, using the analytic hierarchy process (AHP) and percentage method, and developed the service level EIS.

Results

The EIS consists of 3 first-level indicators, 24 s-level indicators and 68 third-level indicators. According to the weights computed using AHP, first-level indicators are ranked as post-sale (0.62), in-sale (0.25) and pre-sale (0.13). Through case verification, the medical endoscope brand Olympus had a total score of 4.17, Shanghai Aohua had a total score of 3.71, and Shanghai Chengyun had a total score of 3.28, which matches its market popularity and ranking in terms of market share. The results obtained from the EIS are consistent with the reality.

Conclusions

The EIS established in this study is comprehensive, reliable and reasonable with strong practicality. The EIS can act as a tool for the endoscope users to evaluate potential products and make informed choices. It also provides a measurable basis for endoscope manufacturers and service providers to improve service quality.
Does health insurance impact health service utilization among older adults in urban China? A nationwide cross-sectional study
Authors: Mao Wenhui , Zhang Yaoguang , Xu Ling , Miao Zhiwen , Dong Di , Tang Shenglan
Published: July 2020

Background

China’s rapidly aging population has led to many challenges related to the health care delivery and financing. Since 2007, the Urban Residents Basic Medical Insurance (URBMI) program has provided financial protection for older adults living in urban areas not already covered by other health insurance schemes. We conducted a national level assessment on this population’s health needs and health service utilization.

Methods

Records for 9646 individuals over the age of 60 were extracted for analysis from two National Health Service Surveys conducted in 2008 and 2013. Multiple regression models were used to examine associations between socioeconomic factors, health needs and health service utilization while controlling for demographic characteristics and survey year.

Results

Self-reported illness, especially non-communicable diseases (NCDs) increased significantly between 2008 and 2013 regardless of insurance enrollment, age group or income level. In 2013, over 75% of individuals reported at least one NCD. Outpatient services decreased for the uninsured but increased for those with insurance. Middle- and high-income groups with insurance experienced a higher increase in outpatient visits and hospital admissions than the low-income group. Forgone hospital admissions (defined as an admission indicated by a doctor but which was declined or not followed through by the patient) decreased. However, over 20% of individuals had to forgo necessary hospital admissions, and 40% of these cases were due to financial barriers. Outpatient visits and hospital admissions increased between 2008 and 2013, and insured individuals utilized more services than those without insurance.

Conclusion

After the implementation of URBMI, health service utilization increased and forgone hospital admissions decreased, indicating the program helped to improve access to health services. However, there was still a marked difference in utilization among different income groups, with the high-income group experiencing the greatest increase. This factor calls for further attention to be given to issues related to equity. Prevalence of self-reported NCDs greatly increased among the study population between 2008 and 2013, suggesting that health insurance programs need to ensure they cover sufficient support for the treatment and prevention of NCDs.
LncRNA OIP5-AS1 promotes the malignancy of pancreatic ductal adenocarcinoma via regulating miR-429/FOXD1/ERK pathway
Authors: Wu Liping , Liu Yongcun , Guo Cheng , Shao Yuan
Published: July 2020

Background

Pancreatic ductal adenocarcinoma (PDAC), a subtype of pancreatic cancer, is a malignant tumor with unfavorable prognosis. Despite accumulating researches have made efforts on finding novel therapeutic methods for this disease, the underlying mechanism of long non-coding RNAs (lncRNAs) remains elusive. OIP5 antisense RNA 1 (OIP5-AS1) has been reported to play important role in the occurrence and development of multiple human cancers. This study was aimed at unveiling the regulatory role of OIP5-AS1 in PDAC.

Methods

RT-qPCR analysis revealed the OIP5-AS1 expression in PDAC tissues and adjacent normal ones. Kaplan–Meier method was applied to analyze the overall survival of patients with high or low level of OIP5-AS1. Gain- or loss-of function assays were performed to assess the effects of OIP5-AS1 knockdown on cell functions, including proliferation, migration and EMT process. Mechanism experiments, such as luciferase reporter and RNA pull-down assays proved the interaction between OIP5-AS1 and miR-429 as well as that between miR-429 and FOXD1.

Results

OIP5-AS1 was up-regulated in PDAC tissues and cell lines, and high level of OIP5-AS1 indicated poor prognosis in PDAC patients. OIP5-AS1 knockdown hindered cell proliferation, migration and epithelial-mesenchymal transition (EMT) process, while overexpression of OIP5-AS1 caused the opposite results. OIP5-AS1 activated ERK pathway through up-regulating forkhead box D1 (FOXD1) expression by sponging miR-429. Furthermore, OIP5-AS1 facilitated cell growth in vivo.

Conclusion

OIP5-AS1 exerted oncogenic function in PDAC cells through targeting miR-429/FOXD1/ERK pathway.
Spatiotemporal association of low birth weight with Cs-137 deposition at the prefecture level in Japan after the Fukushima nuclear power plant accidents: an analytical-ecologic epidemiological study
Authors: Scherb Hagen , Hayashi Keiji
Published: July 2020

Background

Perinatal mortality increased in contaminated prefectures after the Fukushima Daichi Nuclear Power Plant (FDNPP) accidents in Japan in 2011. Elevated counts of surgeries for cryptorchidism and congenital heart malformations were observed throughout Japan from 2012 onward. The thyroid cancer detection rate (2011 to 2016) was associated with the dose-rate at the municipality level in the Fukushima prefecture. Since the birth weight is a simple and objective indicator for gestational development and pregnancy outcome, the question arises whether the annual birth weight distribution was distorted in a dose-rate-dependent manner across Japan after Fukushima.

Methods

The Japanese Ministry of Health, Labour, and Welfare provides prefecture-specific annual counts for 26.158 million live births from 1995 to 2018, of which 2.366 million births (9.04%) with weights < 2500 g. Prefecture-specific spatiotemporal trends of the low birth weight proportions were analyzed. Logistic regression allowing for level-shifts from 2012 onward was employed to test whether those level-shifts were proportional to the prefecture-specific dose-rates derived from Cs-137 deposition in the 47 Japanese prefectures.

Results

The overall trend of the low birth weight prevalence (LBWp) in Japan discloses a jump in 2012 with a jump odds ratio (OR) 1.020, 95%-confidence interval (1.003,1.037), p-value 0.0246. A logistic regression of LBWp on the additional dose-rate after the FDNPP accidents adjusted for prefecture-specific spatiotemporal base-line trends yields an OR per μSv/h of 1.098 (1.058, 1.139), p-value < 0.0001. Further adjusting the logistic regression for the annual population size and physician density of the prefectures, as well as for the counts of the dead, the missing, and the evacuees due to earthquake and tsunami (as surrogate measures for medical infrastructure and stress) yields an OR per μSv/h of 1.109 (1.032, 1.191), p-value 0.0046.

Conclusions

This study shows increased low birth weight prevalence related to the Cs-137 deposition and the corresponding additional dose-rate in Japan from 2012 onward. Previous evidence suggesting compromised gestational development and pregnancy outcome under elevated environmental ionizing radiation exposure is corroborated.
The impact of long-term ventilator-use on health-related quality of life and the mental health of children with neuromuscular diseases and their families: need for a revised perspective?
Authors: Johannsen Jessika , Fuhrmann Lena , Grolle Benjamin , Morgenstern Lydia , Wiegand-Grefe Silke , Denecke Jonas
Published: July 2020

Background

Life extension by medical interventions and health-related quality of life (HRQOL) are sometimes conflicting aspects of medical care. Long-term ventilation in children with neuromuscular disease is a well-established life-extending procedure and often at the center of this conflict. HRQOL and the mental health of affected children and their families become even more important in respect to emerging therapies in neuromuscular diseases with longer life-expectancy of treated patients and considerable costs of medical treatment.

Methods

We performed a questionnaire survey in a total of forty-three families of children with neuromuscular disease treated in the University Medical Center Hamburg-Eppendorf and the Children’s Hospital Altona. We evaluated self- and proxy-reported HRQOL and mental health outcomes of affected children and their parents using validated and age-appropriate instruments.

Results

Compared to normative data, children with neuromuscular diseases and their families experienced a lower HRQOL and mental health. However, there was no additional negative influence on the overall HRQOL by ventilator use.

Conclusions

As ventilator use was not responsible for the reduction of HRQOL and mental health our data contributes an important aspect to the discussion about life-prolonging procedures, in particular mechanical ventilation, in severly disabled patients.
Comparative analysis of country-level enablers, barriers and recommendations to strengthen institutional capacity for evidence uptake in decision-making
Authors: Schleiff Meike J. , Kuan Alice , Ghaffar Abdul
Published: July 2020

Background

Evidence-based decision-making is crucial to leadership in the health sector to identify country-level priorities and generate solutions supported by rigorous research. Barriers and enablers have been explored, but limited evidence about what works to strengthening capacity at individual and institutional levels within countries has been reported, and inconsistent use of evidence to inform policy-making is a persistent challenge and concern.

Methods

We conducted a framework analysis comparing experiences of nine purposively selected countries (Chile, Ethiopia, Ghana, Kyrgyzstan, Lebanon, Mozambique, Rwanda, South Africa and Sri Lanka). We utilised qualitative case studies developed by in-country teams to explore enablers and barriers described across components of a predefined theory of change and then identified six cross-cutting themes and recommendations for relevant stakeholders associated with each theme.

Results

The cross-cutting themes included (1) leadership and political will, (2) incentives and resources, (3) infrastructure and access to health data, (4) designated structures and processes, (5) interaction and relationships, and (6) capacity strengthening and engagement. While each case country’s context and experience was different, common enablers and barriers surfaced across each of these themes, with Ministries of Health and other government agencies having strong roles to play, but also recognising the need for other stakeholders, including researchers, donors and civil society, to serve as essential collaborators in order to strengthen evidence uptake. Substantial and sustained investment in research capacities, able leaders and stronger engagement of civil servants are needed to further this progress and strengthen processes of health decision-making.

Conclusions

All countries represented in this study have made commendable progress in increasing evidence uptake and strengthening supportive systems. Establishing and strengthening necessary structures and the relationships that underpin them takes time as well as resources. Going forward, the findings from this study can help guide and support advocacy to increase domestic funding for health research, especially health policy and systems research, and ensure that civil servants as well as researchers have the capacity and support to collaborate and continue to bolster evidence uptake.
Sweetened beverage taxes and changes in beverage price, imports and manufacturing: interrupted time series analysis in a middle-income country
Authors: Teng Andrea , Puloka Viliami , Genç Murat , Filimoehala Ofeina , Latu Catherine , Lolomana’ia Mohulamu , Osornprasop Sutayut , Signal Louise , Wilson Nick
Published: July 2020

Background

The Pacific Island nation of Tonga (a middle-income country) introduced a sweetened beverage tax of T$0.50/L in 2013, with this increasing further in 2016 (to T$1.00/L), and in 2017 (T$1.50/L; US$0.02/oz). Given the potential importance of such types of fiscal intervention for preventing chronic disease, we aimed to evaluate the impact of these tax changes in Tonga.

Methods

Interrupted time series analysis was used to examine monthly import volumes and quarterly price and manufacturing 1 year after each tax change, compared with a counterfactual based on existing trends. Autocorrelation was adjusted for when present, and adjustments were made for changes in GDP per capita, visitor numbers, season and T$/US$ exchange rate.

Results

In the year after the 2013, 2016 and 2017 tax increases, the price of an indicator soft drink increased by 16.8% (95%CI: 6.3 to 29.6), 3.7% (− 0.6 to 8.3) and 17.6% (6.0 to 32.0) respectively. Imports of sweetened beverages decreased with changes of − 10.4% (− 23.6 to 9.0), − 30.3% (− 38.8 to − 20.5) and − 62.5% (− 73.1 to − 43.4) respectively. Juice imports changed by − 54.2% (− 93.2 to − 1.1), and sachet drinks by − 15.5% (− 67.8 to 88.3) after the 2017 tax increase. Tonga water bottling (T$) increased in value by 143% (69 to 334) after the 2016 tax increase and soft drink manufacturing increased by 20% (2 to 46, albeit 5% market share).

Conclusions

Consistent with international evaluations of sugar-sweetened beverage taxes, the taxes in Tonga were associated with increased prices, decreased taxed beverages imports, and increased locally bottled water.
Diurnal patterns of sedentary behavior and changes in physical function over time among older women: a prospective cohort study
Authors: Reuter Chase , Bellettiere John , Liles Sandy , Di Chongzhi , Sears Dorothy D. , LaMonte Michael J. , Stefanick Marcia L. , LaCroix Andrea Z. , Natarajan Loki
Published: July 2020

Background

Sedentary behavior (SB) is linked to negative health outcomes in older adults. Most studies use summary values, e.g., total sedentary minutes/day. Diurnal timing of SB accumulation may further elucidate SB-health associations.

Methods

Six thousand two hundred four US women (mean age = 79 ± 7; 50% White, 34% African-American) wore accelerometers for 7-days at baseline, yielding 41,356 person-days with > 600 min/day of data. Annual follow-up assessments of health, including physical functioning, were collected from participants for 6 years. A novel two-phase clustering procedure discriminated participants’ diurnal SB patterns: phase I grouped day-level SB trajectories using longitudinal k-means; phase II determined diurnal SB patterns based on proportion of phase I trajectories using hierarchical clustering. Mixed models tested associations between SB patterns and longitudinal physical functioning, adjusted for covariates including total sedentary time. Effect modification by moderate-vigorous-physical activity (MVPA) was tested.

Results

Four diurnal SB patterns were identified: p1 = high-SB-throughout-the-day; p2 = moderate-SB-with-lower-morning-SB; p3 = moderate-SB-with-higher-morning-SB; p4 = low-SB-throughout-the-day. High MVPA mitigated physical functioning decline and correlated with better baseline and 6-year trajectory of physical functioning across patterns. In low MVPA, p2 had worse 6-year physical functioning decline compared to p1 and p4. In high MVPA, p2 had similar 6-year physical functioning decline compared to p1, p3, and p4.

Conclusions

In a large cohort of older women, diurnal SB patterns were associated with rates of physical functioning decline, independent of total sedentary time. In particular, we identified a specific diurnal SB subtype defined by less SB earlier and more SB later in the day, which had the steepest decline in physical functioning among participants with low baseline MVPA. Thus, diurnal timing of SB, complementary to total sedentary time and MVPA, may offer additional insights into associations between SB and physical health, and provide physicians with early warning of patients at high-risk of physical function decline.
Psychological experiences of women with pregnancy termination due to fetal anomalies: a qualitative study from the perspective of women, their spouses, and healthcare providers in Iran
Authors: Kamranpour Bahareh , Noroozi Mahnaz , Bahrami Masoud
Published: July 2020

Background

Pregnancy termination due to fetal anomalies has many psychological consequences for women. Providing appropriate and desirable care to this group of women and their families plays an important role in the process of coping with this crisis. The aim of the present study was to explore the psychological experiences of women with pregnancy termination due to fetal anomalies.

Methods

This was a qualitative content analysis study. 40 participants were selected through purposeful sampling with maximum variation and data were collected through in-depth individual interviews, field notes, and analyzed using the conventional qualitative content analysis method simultaneously.

Results

After analyzing the interview transcripts, the psychological experiences of women with pregnancy termination due to fetal anomalies were classified into two main categories: “emotional reactions coinciding with the diagnosis of fetal anomalies” (consisting of two sub-categories of “disbelief and denial of fetal anomalies” and “feelings of sadness and anger”) and “ psychological problems following pregnancy termination” (consisting of two sub-categories of “ feeling helpless, fearful, anxious, and depressed” and “feeling conscience-stricken, and guilty”).

Conclusion

According to findings of the present study, exploring and highlighting the experiences of women with pregnancy termination due to fetal anomalies in the psychological dimension can provide a deeper understanding of the needs of these women for providing optimal care at different times and ultimately promote their psychological health.
Genotyping of 30 kinds of cutaneous human papillomaviruses by a multiplex microfluidic loop-mediated isothermal amplification and visual detection method
Authors: Wang Yining , Ge Ge , Mao Rui , Wang Zhuo , Sun Yu-Zhe , Du Yu-Guang , Gao Xing-Hua , Qi Rui-Qun , Chen Hong-Duo
Published: July 2020

Background

Human papillomaviruses (HPVs), a group of non-enveloped small viruses with double-stranded circular DNA which lead to multiple skin diseases such as benign warts, are commonly seen in clinics. The current HPV detection systems aim mainly at mucosal HPVs, however, an efficient clinical approach for cutaneous HPVs detection is lacking.

Objectives

To establish a rapid detection system for cutaneous HPVs using a colorimetric loop-mediated isothermal amplification (LAMP) with hydroxynaphthol blue (HNB) dye in combination with microfluidic technology.

Methods

L1 DNA sequences of the 30 cutaneous HPVs were chemically synthesized, and LAMP primers against L1 DNA were designed with use of an online LAMP designing tool. Isothermal amplification was performed with use of a water bath and the amplification results were inspected with the naked eye. Using PCR sequencing as a control method, the specificity and sensitivity of the new detection system were obtained by detecting clinical samples.

Results

The lower detection limit of the LAMP assay was 107 viral DNA copies/μl when tested on synthesized L1 DNA sequences, which was better than the conventional PCR. Compared to PCR sequencing, the sensitivity of HPV27, HPV2, HPV1, HPV57, HPV3, HPV4, HPV7 and HPV75 genotypes detections were 100%, whereas the specificity was 34.55, 45.12, 95.83, 98.59 and 97.62% respectively, when tested on clinical samples.

Conclusions

The new cutaneous type HPV detection system is characterized by both a good sensitivity and specificity compared to conventional methods.
Genetic determinants of obesity heterogeneity in type II diabetes
Authors: Hosseini Khorami Somayeh Alsadat , Mutalib Mohd Sokhini Abd , Feili Shiraz Mohammad , Abdullah Joseph Anthony , Rejali Zulida , Ali Razana Mohd , Khaza’ai Huzwah
Published: July 2020

Background

Although obesity is considered as the main cause of Type II diabetes (T2DM), non-obese individuals may still develop T2DM and obese individuals may not.

Method

The mRNA expression of PI3K/AKT axis from 100 non-obese and obese participants with insulin sensitivity and insulin resistance states were compared in this study toward the understanding of obesity heterogeneity molecular mechanism.

Result

In present study, there was no statistically significant difference in gene expression levels of IRS1 and PTEN between groups, whereas PI3K, AKT2 and GLUT4 genes were expressed at a lower level in obese diabetic group compared to other groups and were statistically significant. PDK1 gene was expressed at a higher level in non-obese diabetic group compared to obese diabetic and non-obese non-diabetics groups. No statistically significant difference was identified in gene expression pattern of PI3K/AKT pathway between obese non-diabetics and non-obese non-diabetics.

Conclusion

The components of PI3K/AKT pathway which is related to the fasting state, showed reduced expression in obese diabetic group due to the chronic over-nutrition which may induced insensitivity and reduced gene expression. The pathogenesis of insulin resistance in the absence of obesity in non-obese diabetic group could be due to disturbance in another pathway related to the non-fasting state like gluconeogenesis. Therefore, the molecular mechanism of insulin signalling in non-obese diabetic individuals is different from obese diabetics which more investigations are required to study insulin signalling pathways in greater depth, in order to assess nutritional factors, contribute to insulin resistance in obese diabetic and non-obese diabetic individuals.
‘It’s far too complicated’: why fragmentation persists in global health
Authors: Spicer Neil , Agyepong Irene , Ottersen Trygye , Jahn Albrecht , Ooms Gorik
Published: July 2020

Background

Despite many efforts to achieve better coordination, fragmentation is an enduring feature of the global health landscape that undermines the effectiveness of health programmes and threatens the attainment of the health-related Sustainable Development Goals. In this paper we identify and describe the multiple causes of fragmentation in development assistant for health at the global level. The study is of particular relevance since the emergence of new global health problems such as COVID-19 heightens the need for global health actors to work in coordinated ways. Our study is part of theLancet Commission on Synergies between Universal Health Coverage, Health Security and Health Promotion.

Methods

We used a mixed methods approach. This consisted of a non-systematic literature review of published papers in scientific journals, reports, books and websites. We also carried out twenty semi-structured expert interviews with individuals from bilateral and multilateral organisations, governments and academic and research institutions between April 2019 and December 2019.

Results

We identified five distinct yet interconnected sets of factors causing fragmentation: proliferation of global health actors; problems of global leadership; divergent interests; problems of accountability; problems of power relations. We explain why global health actors struggle to harmonise their approaches and priorities, fail to align their work with low- and middle-income countries’ needs and why they continue to embrace funding instruments that create fragmentation.

Conclusions

Many global actors are genuinely committed to addressing the problems of fragmentation, despite their complexity and interconnected nature. This paper aims to raise awareness and understanding of the causes of fragmentation and to help guide actors’ efforts in addressing the problems and moving to more synergistic approaches.
Deadly combination of Vaping-lnduced lung injury and Influenza: case report
Authors: Akkanti Bindu H. , Hussain Rahat , Patel Manish K. , Patel Jayeshkumar A. , Dinh Kha , Zhao Bihong , Elzamly Shaimaa , Pelicon Kevin , Petek Klemen , Salas de Armas Ismael A. , Akay Mehmet , Kar Biswajit , Gregoric Igor D. , Buja L. Maximilian
Published: July 2020

Background

E-cigarette and vaping use-associated acute lung injury (EVALI) has been recently recognized as a complication in individuals who use vaping devices. Another consideration is that EVALI may have an adverse influence on the outcome of intercurrent respiratory infections. We document this deadly combination in the case of a young man who had EVALI and simultaneous Influenza-A infection leading to severe Acute Respiratory Distress Syndrome (ARDS).

Case presentation

A 27-year-old male with a history of tobacco and vaping use was admitted to hospital after two weeks of flu-like symptoms, diarrhea and vomiting. A chest x-ray was consistent with multifocal pneumonia, and microbiological tests were positive for Influenza-A and methicillin-sensitive Staphalacoccus aureus (MSSA). Bronchoscopy provided evidence of acute inhalational injury. After admission, he acutely decompensated with severe hypoxia and hypotension; he required intubation, sedation and vasopressors. He developed sepsis with acute kidney failure, liver failure, biventricular systolic dysfunction and severe rhabdomyolysis. He was placed on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) initially and later changed to Veno-Arterial (VA) ECMO. Nevertheless, the patient continued to deteriorate, and he expired two weeks after admission.

Conclusion

This case documents that EVALI can act as a major factor leading a respiratory infection to progress into severe ARDS with a fatal outcome.
Metabolic engineering of phosphite metabolism in Synechococcus elongatus PCC 7942 as an effective measure to control biological contaminants in outdoor raceway ponds
Authors: González-Morales Sandra Isabel , Pacheco-Gutiérrez Navid Berenice , Ramírez-Rodríguez Carlos A. , Brito-Bello Alethia A. , Estrella-Hernández Priscila , Herrera-Estrella Luis , López-Arredondo Damar L.
Published: July 2020

Background

The use of cyanobacteria and microalgae as cell factories to produce biofuels and added-value bioproducts has received great attention during the last two decades. Important investments have been made by public and private sectors to develop this field. However, it has been a challenge to develop a viable and cost-effective platform for cultivation of cyanobacteria and microalgae under outdoor conditions. Dealing with contamination caused by bacteria, weedy algae/cyanobacteria and other organisms is a major constraint to establish effective cultivation processes.

Results

Here, we describe the implementation in the cyanobacterium Synechococcus elongatus PCC 7942 of a phosphorus selective nutrition system to control biological contamination during cultivation. The system is based on metabolic engineering of S. elongatus to metabolize phosphite, a phosphorus source not normally metabolized by most organisms, by expressing a bacterial phosphite oxidoreductase (PtxD). Engineered S. elongatus strains expressing PtxD grow at a similar rate on media supplemented with phosphite as the non-transformed control supplemented with phosphate. We show that when grown in media containing phosphite as the sole phosphorus source in glass flasks, the engineered strain was able to grow and outcompete biological contaminants even when the system was intentionally inoculated with natural competitors isolated from an irrigation canal. The PtxD/phosphite system was successfully used for outdoor cultivation of engineered S. elongatus in 100-L cylindrical reactors and 1000-L raceway ponds, under non-axenic conditions and without the need of sterilizing containers and media. Finally, we also show that the PtxD/phosphite system can be used as selectable marker for S. elongatus PCC 7942 transgenic strains selection, eliminating the need of antibiotic resistance genes.

Conclusions

Our results suggest that the PtxD/phosphite system is a stable and sufficiently robust strategy to control biological contaminants without the need of sterilization or other complex aseptic procedures. Our data show that the PtxD/phosphite system can be used as selectable marker and allows production of the cyanobacterium S. elongatus PCC 7942 in non-axenic outdoor reactors at lower cost, which in principle should be applicable to other cyanobacteria and microalgae engineered to metabolize phosphite.
Development of risk factor-based scoring system for detection of hypervirulent Klebsiella pneumoniae bloodstream infections
Authors: Togawa Atsushi , Yoshimura Michinobu , Tokushige Chiemi , Matsunaga Akira , Takata Tohru , Takamatsu Yasushi
Published: July 2020

Background

Hypervirulent Klebsiella pneumoniae (HVKp) infections have distinct clinical manifestations from classical K. pneumoniae infections. The hallmark of HVKp infections are liver abscess formation and metastatic infections. Due to the severe sequelae of these complications, method to identify patients at-risk of HVKp infections should be developed.

Results

A retrospective cohort study of 222 patients with K. pneumoniae bloodstream infections (BSIs) was performed. Patient demographics, clinical manifestations, and bacterial characteristics were investigated. Ten cases of liver abscesses were identified. Characteristics such as community-onset BSIs, hypermucoviscosity phenotype, and capsular serotype K1 were identified as risk factors for HVKp infections. A scoring system was developed based on the risk factors. The area under the receiver operating characteristic curve for the scoring system was 0.90. A score of ≥ 2 points provided sensitivity and specificity of 0.70 and 0.94, respectively.

Conclusions

Simple scoring system was developed for the diagnosis of HVKp infections. The system allows early identification of patients with K. pneumoniae BSIs in whom hypervirulent infections should be evaluated. Prospective evaluation is expected.
Fraud against businesses both online and offline: crime scripts, business characteristics, efforts, and benefits
Authors: Junger Marianne , Wang Victoria , Schlömer Marleen
Published: July 2020

This study analyses 300 cases of fraudulent activities against Dutch businesses, 100 from each of the following three categories: CEO-fraud, fraudulent contract, and ghost invoice. We examine crime scripts, key characteristics of targeted businesses, and the relationship between input criminal effort and output financial benefit. Results indicate that whilst all CEO-frauds are conducted online, most of the fraudulent contracts and ghost invoices are undertaken via offline means. Both Routine Activity Theory and Rational Choice Model are evidenced-fraudsters clearly take the business size and seasonality into account, and the input criminal effort and output criminal benefit are positively correlated. Having vigilant employees is evidenced as the most effective way of fraud prevention, both online and offline.
Eating disorder diagnostics in the digital era: validation of the Norwegian version of the Eating Disorder Assessment for DSM-5 (EDA-5)
Authors: Dahlgren Camilla Lindvall , Walsh B. Timothy , Vrabel Karianne , Siegwarth Cecilie , Rø Øyvind
Published: July 2020

Objective

The Eating Disorder Assessment for DSM-5 (EDA-5) is an electronic, semi-structured interview developed to assess feeding and eating disorders following DSM-5 criteria. The original English version has strong psychometric properties, and previous research has shown high rates of agreement between diagnoses generated by the Eating Disorder Examination (EDE) interview and the EDA-5. The current study aimed to validate the Norwegian version of the EDA-5, and is the first international validation of this diagnostic tool.

Method

A total of 91 (87 females and 4 males) adult in- and out-patients were recruited from two of the largest eating disorder clinics in Norway. Diagnoses assigned using the EDA-5 were compared to diagnoses from the EDE interview (v. 17.0D).

Results

Results showed that diagnoses assigned using EDE and EDA-5 were identical for 75 (82.4%) of the 91 cases. Among individual diagnostic categories, kappas ranged from moderate (.49) to perfect (1.00) agreement. The majority of discrepant cases occurred between full- and sub-threshold AN and BN. The EDA-5 was significantly quicker to administer compared to the EDE (22 vs. 54 min).

Conclusions

The Norwegian EDA-5 can quickly and efficiently generate DSM-5 diagnoses without compromising diagnostic accuracy. It is a promising alternative to existing diagnostic tools, and may help streamline the identification of feeding and eating disorders in clinical settings and in research.
A daily fever curve for the Swiss economy
Authors: Burri Marc , Kaufmann Daniel
Published: July 2020

Because macroeconomic data is published with a substantial delay, assessing the health of the economy during the rapidly evolving COVID-19 crisis is challenging. We develop a fever curve for the Swiss economy using publicly available daily financial market and news data. The indicator can be computed with a delay of 1 day. Moreover, it is highly correlated with macroeconomic data and survey indicators of Swiss economic activity. Therefore, it provides timely and reliable warning signals if the health of the economy takes a turn for the worse.