bluuebunny/crossref_metadata_2025 huggingface dataset:
Paper 03: Multimodal Pain Regimen is Equivalent to Opioid Analgesia Following Arthroscopic Rotator Cuff Surgery: A Prospective Randomized Controlled Trial
Authors: Abbas Muhammad , Okoroha Kelechi , Moutzouros Vasilios , Jildeh Toufic
Published: May 2022

Objectives:

To evaluate the efficacy of a multimodal non-opioid analgesic protocol in controlling postoperative pain compared to opioids following a primary arthroscopic rotator cuff repair.

Methods:

Seventy consecutive patients undergoing a primary rotator cuff repair were assessed eligibility. A prospective randomized controlled trial was designed in accordance with the Consolidated Standards of Reporting Trials 2010 (CONSORT) statement. The two arms of the study included a multimodal non-opioid pain regimen for the experimental group, and a standard of care narcotics for the control group. The primary outcome was visual analog scale (VAS) pain scores for the first ten postoperative days. Secondary outcomes included PROMIS-PI, patient satisfaction, and adverse drug events. Patients were randomized using a random number generator. Whiles patients were not blinded to their treatment group, all reported outcomes were collected by blinded observers.

Results:

Twenty-six patients either declined to participate or were excluded from the study. Forty-four patients were included in the final analysis. A total of 27 patients were in the traditional group and 17 patients were in the nonopioid group. Patients in the traditional pain control group reported a significantly lower VAS pain score on post-operative day 1 (opioid: 5.7 ± 2, nonopioid: 3.7 ± 2.2, p=0.011) and post-operative day 4 (opioid: 4.4 ± 2.7, nonopioid: 2.4 ± 2.2, p=0.023). No significant difference was seen on any other postoperative day. When mixed measured models were used to control for confounding factors the non-opioid group demonstrated significantly lower VAS and PROMIS-PI scores (p<0.01) at every time point. The most commonly reported side effects for patients in both groups were drowsiness (opioid: 2.7 ± 3.3 days, nonopioid: 1.9 ± 3.3 days) and constipation (opioid: 2.2 ± 2.9 days, nonopioid: 0.2 ± 0.6 days). Patients in the traditional analgesia group reported significantly greater average number of days with constipation (opioid: 2.2 ± 2.9, nonopioid: 0.2 ± 0.6, p=0.003) and days with upset stomach (opioid: 1.3 ± 2.5, nonopioid: 0.0 ± 0.0, p=0.020) than those in the nonopioid group.

Conclusions:

This study found that a multimodal nonopioid pain protocol provided at least equivalent pain control compared to traditional opioid analgesics in patients undergoing primary arthroscopic rotator cuff repair. Minimal side effects were noted with some improvement in the multimodal nonopioid pain cohort, and all patients reported satisfaction with their pain management.
Paper 13: None: Clinical Outcomes of Ulnar Collateral Ligament Surgery in Non-Throwing Athletes
Authors: Rothermich Marcus
Published: May 2022

Objectives:

Ulnar collateral ligament (UCL) surgery continues to improve since its inception by Dr. Frank Jobe in 1974. There is now ample data on the outcomes of surgery for throwing athletes, such as baseball players, who undergo either UCL reconstruction or UCL repair. In comparison, there is very little available data regarding outcomes of UCL surgery for non-throwing athletes who are seeking similar benefit from the procedure. The primary objective of this study is to provide clinical outcomes of UCL surgery performed in non-throwing athletes at a single institution with a minimum two-year follow-up.

Methods:

Forty non-throwing athletes who underwent UCL surgery (repair or reconstruction) between 2011 and 2019 were identified. All surgeries were performed by one of three fellowship-trained sports medicine surgeons at our institution utilizing a uniform technique for repair or reconstruction. Demographics were recorded including age, sex, laterality, arm dominance, sport, level of competition, and type of surgery (UCL repair or reconstruction). Outcomes included return to play (rate and average time), American Shoulder and Elbow Surgeons (ASES) scores, and complications.

Results:

Thirty-seven patients (92.5%) were available for evaluation with a minimum two-year follow-up consisting of 16 males (43%) and 21 females (57%). Mean age at the time of surgery was 18±3.7 years.28 UCL repairs (76%) and 9 UCL reconstructions (24%) were performed.Sports included football (n=11), gymnastics (11), cheerleading (7), wrestling (4), volleyball (2), basketball (1), and acrobatics (1). Quarterbacks were excluded from the football patients as quarterbacks are throwing athletes. Level of competition included youth (1), high school (26), college (8), and professional (2).Return to play rate was 93% (26 of 28) at a mean of 7.4 months for UCL repair, and 100% (9 of 9) at a mean of 10 months for UCL reconstruction.Mean ASES scores were 94.4 and 98.7 for UCL repair and reconstruction, respectively.Two Patients in the UCL repair group required ulnar neurolysis and revision ulnar nerve transposition.

Conclusions:

Both UCL reconstruction and UCL repair show favorable outcomes at minimum two-year follow-up in non-throwing athletes.93% or greater returned to play with good functional outcomes and minimal complications. [Table: see text][Table: see text]
Data-driven Product Functional Configuration: Patent Data and Hypergraph
Authors: Lin Wenguang , Liu Xiaodong , Xiao Renbin
Published: May 2022

The product functional configuration (PFC) is typically used by firms to satisfy the individual requirements of customers and is realized based on market analysis. This study aims to help firms analyze functions and realize functional configurations using patent data. This study first proposes a patent-data-driven PFC method based on a hypergraph network. It then constructs a weighted network model to optimize the combination of product function quantity and object from the perspective of big data, as follows: (1) The functional knowledge contained in the patent is extracted. (2) The functional hypergraph is constructed based on the co-occurrence relationship between patents and applicants. (3) The function and patent weight are calculated from the patent applicant’s perspective and patent value. (4) A weight calculation model of the PFC is developed. (5) The weighted frequent subgraph algorithm is used to obtain the optimal function combination list. This method is applied to an innovative design process of a bathroom shower. The results indicate that this method can help firms detach optimal function candidates and develop a multifunctional product.
Copula miss-specification in REML multivariate genetic animal model estimation
Authors: Rohmer Tom , Ricard Anne , David Ingrid
Published: May 2022

Background

In animal genetics, linear mixed models are used to deal with genetic and environmental effects. The variance and covariance terms of these models are usually estimated by restricted maximum likelihood (REML), which provides unbiased estimators. A strong hypothesis of REML estimation is the multi-normality of the response variables. However, in practice, even if the marginal distributions of each phenotype are normal, the multi-normality assumption may be violated by non-normality of the cross-sectional dependence structure, that is to say when the copula of the multivariate distribution is not Gaussian. This study uses simulations to evaluate the impact of copula miss-specification in a bivariate animal model on REML estimations of variance components.

Result

Bivariate phenotypes were simulated for populations undergoing selection, considering different copulas for the dependence structure between the error components. Two multi-trait situations were considered: two phenotypes were measured on the selection candidates, or only one phenotype was measured on the selection candidates. Three generations with random selection and five generations with truncation selection based on estimated breeding values were simulated. When selection was performed at random, no significant differences were observed between the REML estimations of variance components and the true parameters even for the non-Gaussian distributions. For the truncation selections, when two phenotypes were measured on candidates, biases were systematically observed in the variance components for high residual dependence in the case of non-Gaussian distributions, especially in the case of a heavy-tailed or asymmetric distribution when the two traits were measured. Conversely, when only one phenotype was measured on candidates, no difference was observed between the Gaussian and non-Gaussian distributions in REML estimations.

Conclusions

This study confirms that REML can be used by geneticists to evaluate breeding values in the multivariate case even if the multivariate phenotypes deviate from normality in the situation of random selection or if one trait is not measured for the candidate under selection. Nevertheless, when the two traits are measured, the violation of the normality assumption may lead to non-negligible biases in the REML estimations of the variance-covariance components.
A sequential allocation study to determine the ED50 of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia
Authors: Karam Cynthia , Al Assadi Sadek , Kanazi Ghassan , Zeeni Carine
Published: May 2022

Background

Intravenous regional anesthesia is an easy and reliable anesthetic technique, but its use is limited by tourniquet pain. Clonidine is effective in overcoming this shortcoming when used with intravenous regional anesthesia at a dose of 1 μg/kg. Dexmedetomidine has also been used successfully at a dose of 0.5 μg/kg.

Objective

Based on the potency ratios of clonidine and dexmedetomidine (8 to 1) we hypothesize that a lower dexmedetomidine dose would provide patients with 50 min of pain free tourniquet time.

Methods

After informed consent, patients received intravenous regional anesthesia with lidocaine and dexmedetomidine following a sequential allocation scheme. The first patient received a dose of 0.5 μg/kg of dexmedetomidine. The dose was then adjusted in 0.1 μg/kg gradients for the following patients depending on the success of the previous block. If a patient experienced tourniquet pain prior to 50 min, the next patient received a higher dose. If not, the dose was decreased. Recruitment continued until 6 independent crossovers were observed with a minimum of 20 patients. The median effective dose ED50 of dexmedetomidine was calculated using the modified up-and-down method.

Main outcome measures

The median effective dose of dexmedetomidine (ED50) that provides 50 min of tolerance to the tourniquet during a lidocaine intravenous regional anesthesia by a sequential Dixon up-and-down allocation study.

Results

The ED50 of dexmedetomidine that provided 50 min of tolerance to the tourniquet was 0.30 ± 0.06 μg/kg.

Conclusion

We determined that the dexmedetomidine dose necessary to provide 50 min of pain free tourniquet time during intravenous regional anesthesia was higher than expected based on the relative alpha-2 adrenergic receptor selectivity of dexmedetomidine compared to clonidine.

Trial registration

Clinicaltrials.gov: Retrospectively registered (NCT05342870; registration date: 25/04/2022).
How do general practitioners handle complexities? A team ethnographic study in Japan
Authors: Haruta Junji , Goto Ryohei , Sachiko Ozone , Kimura Shuhei , Teruyama Junko , Hama Yusuke , Maeno Tetsuhiro
Published: May 2022

Background

General practitioners (GPs) are often faced with complex problems, including patients with socio-economic and medical problems. However, the methods they use to approach these complexities are still not understood. We speculated that elucidating these methods using complex adaptive systems (CAS) methodology to comprehensively assess GPs’ daily activities would contribute to improving the professional development of GPs. This study aimed to clarify how expert GPs handle complex problems and adapt to their community context through the ethnography of GPs and other healthcare professionals in terms of CAS.

Methods

We adopted the interdisciplinary team-ethnographic research approach. Five hospitals and four clinics in Japan which were considered to employ expert GPs were selected by purposive sampling. 62 individuals of various backgrounds working in these nine facilities were interviewed. Using field notes and interview data, the researchers iteratively discussed the adequacy of our interpretations. The first author (JH) prepared a draft report, which was reviewed by the GPs at the participating facilities. Through critical and iterative consideration of the different insights obtained, the final findings emerged together with representative data.

Results

We identified four approaches used by GPs to deal with complexities. First, GPs treat patients with complex problems as a whole being and address their problems multi-directionally. Second, GPs build horizontal, trusting relationships with other healthcare professionals and stakeholders, and thereby reduce the degree of complexity of problems. Third, GPs change the learning climate while committing to their own growth based on societal needs and by acting as role models for other professionals through daily interpersonal facilitation. Fourth, GPs share community vision with multi-professionals and thereby act as a driving force for organizational change. These various interactions among GPs, healthcare professionals, organizations and communities resulted in systematization of the healthcare and welfare network in their community.

Conclusions

Expert GPs developed interconnected multidimensional systems in their community health and welfare networks to adapt to fluctuating social realities using four approaches. GPs’ work environment may be considered as a complex adaptive system (CAS) and the approach of GPs to complexities is CAS-based. Our findings are expected to have practical applications for GPs.
Stakeholder engagement in developing a father-inclusive early life obesity prevention intervention: First Heroes
Authors: Silver Santana R. , Whooten Rachel C. , Kwete Gracia M. , Farrar-Muir Haley , Cournoyer Rachel N. , Barth Elizabeth A. , Kotelchuck Milton , Taveras Elsie M.
Published: May 2022

Background

Although paternal involvement in the perinatal period is associated with benefits for maternal-child health and reduced obesity risk, fathers are seldom included in perinatal or obesity prevention efforts. Engaging community leaders and fathers as stakeholders in intervention development is a critical step in designing a father-inclusive intervention that is efficacious and responsive to their needs.

Methods

We conducted a structured engagement study, including community stakeholder engagement and qualitative interviews with new fathers, to inform the development of a prospective randomized controlled trial that includes mothers and fathers as equal partners in infant obesity prevention. We interpreted stakeholder feedback through the Consolidated Framework for Implementation Research (CFIR) framework.

Results

Between September 2019 and April 2020, we held a Community Engagement meeting, formed a Community Advisory Board, and conducted 16 qualitative interviews with new fathers. Stakeholder engagement revealed insights across CFIR domains including intervention characteristics (relative advantage, complexity, design quality & packaging), outer setting factors (cosmopolitanism and culture), individual characteristics (including self-efficacy, state of change, identification with the organization) and process (engagement and adaptation). Stakeholders discussed the diverse challenges and rewards of fatherhood, as well as the intrinsic paternal motivation to be a loving, supportive father and partner. Both community leaders and fathers emphasized the importance of tailoring program delivery and content to meet specific parental needs, including a focus on the social-emotional needs of new parents.

Conclusions

A structured process of multidimensional stakeholder engagement was successful in improving the design of a father-inclusive perinatal obesity prevention interventions. Father engagement was instrumental in both reinforcing community ties and increasing our understanding of fathers’ needs, resulting in improvements to program values, delivery strategies, personnel, and content. This study provides a practical approach for investigators looking to involve key stakeholders in the pre-implementation phase of intervention development.

Trial registration

ClinicalTrials.gov, NCT04477577. Registered 20 July 2020.
Effects of childhood obesity and related genetic factors on precocious puberty: protocol for a multi-center prospective cohort study
Authors: Yu Tingting , Yu Ying , Li Xiaoqing , Xue Peng , Yu Xiaodan , Chen Yao , Kong Huijun , Lin Cuilan , Wang Xiumin , Mei Hao , Wang Dan , Liu Shijian
Published: May 2022

Background

Childhood obesity has important effects on the onset and development of puberty. Although a number of studies have confirmed the relationship between obesity and precocious puberty, little is known about the pleiotropic genes of obesity and precocious puberty and the interaction between genes and environment. There are four objectives: (1) to analyze the incidence of precocious puberty in the general population in China; (2) to verify the direct effect of obesity on children’s precocious puberty using a variety of methods; (3) to verify the effect of obesity and its risk gene polymorphism on precocious puberty in a prospective cohort study; and (4) to analyze the interaction effect of genes and environment on pubertal development.

Methods

We will conduct a multi-center prospective cohort study in three cities, which are selected in southern, central, and northern China, respectively. Primary schools in these cities will be selected by a stratified cluster random sampling method. Primary school students from grade 1 to grade 3 (6 to 10 years old) will be selected for the cohort with extensive baseline data collection, including assessment of pubertal development, family demographic information, early development, sleep pattern, dietary pattern, and physical activity. Participants will be followed up for at least three years, and long-term follow-up will depend on future funding.

Discussion

The findings of this multicenter prospective population-based cohort study may expand previous related puberty development research as well as provide important information on the mechanism of early puberty. Targeted interventions can also be developed to improve adolescent health problems related to puberty development based on the available evidence.

Trial registration

ClinicalTrials.gov Identifier: NCT04113070, prospectively registered on October 2, 2019.
Oral versus intravenous sildenafil for pulmonary hypertension in neonates: a randomized trial
Authors: Chetan Chinmay , Suryawanshi Pradeep , Patnaik Suprabha , Soni Naharmal B. , Rath Chandra , Pareek Prince , Gupta Bhvya , Garegrat Reema , Verma Arjun , Singh Yogen
Published: May 2022

Background

Sildenafil is the drug of choice for neonatal pulmonary hypertension in developing countries where inhaled nitric oxide is not available. Available as oral and intravenous preparation – no study has been done in the past to compare the two forms. Each has its own benefits – but requires comparison in terms of efficacy and safety. This study was done to compare the efficacy of oral versus intravenous (IV) sildenafil in infants with mild to moderate pulmonary hypertension.

Methods

An open labelled randomized trial was conducted in a neonatal intensive care unit of urban tertiary hospital in western India between February 2019 to December 2020. Infants born after 34 weeks of gestation with Pulmonary arterial pressure (PAP) > 25 mm Hg measured by echocardiography, within 72 h of birth, were enrolled for the study. Participants were randomly assigned to receive sildenafil either orally or by intravenous route. Primary outcome was the time taken for PAP to decrease below 25 mm Hg. Secondary outcomes were time taken for oxygenation index to decrease by 25%, duration of invasive and non-invasive mechanical ventilation, nasal oxygen, hospital stay, time to achieve full feeds, mortality, and side effects.

Results

Forty patients were enrolled. The baseline characteristics of neonates in both groups were similar except for APGAR scores at 1 min and 5 min, with oral group having lower score [MEDIAN (IQR) 5.00 (4.00- 7.00) and 7.00 (6.00- 8.00)] compared to IV group [MEDIAN (IQR) 7.00 (6.00–8.00) and 9.00 (8.00–9.00)] respectively. Time taken for PAP to decrease below 25 mm was not statistically different between the oral and intravenous groups. Systemic hypotension occurred in 4 neonates of the intravenous group but none in the oral group.

Conclusion

Oral and intravenous sildenafil had equal efficacy at reducing PAP in neonatal pulmonary hypertension, albeit intravenous sildenafil use was associated with a greater complication rate.

Trial registration

Trial was registered in the clinical trials registry of India [CTRI/2019/04/018781][25/04/2019].
Parent-perceived neighbourhood environment, parenting practices and preschool-aged children physical activity and screen time: a cross-sectional study of two culturally and geographically diverse cities
Authors: Cerin Ester , Barnett Anthony , Baranowski Tom , Lee Rebecca E. , Mellecker Robin R. , Suen Yi Nam , Mendoza Jason A. , Thompson Deborah I. , O’Connor Teresia M.
Published: May 2022

Background

Preschool-aged children’s physical activity (PA) and screen time (ST) are important health-related behaviours likely influenced by PA opportunities, parental perceptions of neighbourhood safety and parenting practices pertaining to PA and ST. How these factors interact to impact on young children’s PA and ST, and whether their effects are generalisable across cultures and geographical location is not known. This study addressed these knowledge gaps by conducting pooled analyses of comparable data from two culturally and geographically diverse samples – Chinese parent-child dyads from an ultra-dense city (Hong Kong, China) and Latino parent-child dyads from a low-density city (Houston, USA).

Methods

The analytical sample consisted of 164 Hong Kong Chinese and 84 US Latino parent-child dyads with data on socio-demographic characteristics, parent-perceived neighbourhood destinations and facilities for children’s PA, physical and social safety-related neighbourhood attributes, PA-related parenting practices and child’s ST and accelerometer-assessed PA. Generalised linear models with robust standard errors accounting for neighbourhood-level clustering were used to estimate associations and interaction effects.

Results

Hong Kong Chinese children accumulated less PA than US Latino children, although the latter had more ST. Hong Kong Chinese parents reported more parenting practices promoting inactivity. Neighbourhood PA opportunities were positively related to children’s PA only if parental perceptions of neighbourhood safety were favourable, and the associations of physical neighbourhood environment characteristics with children’s PA and ST depended on PA-related parenting practices. Community cohesion was positively related to children’s PA and negatively related to ST, while parental promotion of ST was positively associated with children’s ST. Correlates of children’s PA and ST did not differ by city.

Conclusions

The substantial differences in activity patterns between Hong Kong Chinese and US Latino preschool-aged children observed in this study are likely due to a combination of cultural and built environmental factors. However, the fact that no between-city differences in correlates of PA and ST were detected indicates that both populations of children are equally affected by parent-perceived neighbourhood environmental characteristics and parenting practices. Overall, this study highlights the importance of considering how various individual-, home- and neighbourhood physical and social factors interact to influence young children’s health-promoting activity levels.
Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism
Authors: Choi Kristen R. , Lotfizadah Amin D. , Bhakta Bhumi , Pompa-Craven Paula , Coleman Karen J.
Published: May 2022

Background

Applied behavior analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown in clinical trials to improve child functional status. There is substantial focus in ABA on setting and tracking individualized goals that are patient-centered, but limited research on how to measure progress on such patient-centered outcomes.

Purpose

The purpose of this investigation was to assess concordance between patient-centered and standard outcome measures of treatment progress in a real-world clinical sample of children receiving ABA for autism spectrum disorder.

Methods

This observational study used a clinical sample of children ages 3 to 16 years (N = 154) who received 24 months of ABA from an integrated health system. Concordance between three outcome measures after ABA was assessed using a correlation matrix: (1) patient-centered measures of progress on individualized treatment goals, (2) caregiver-centered measure of progress on treatment participation goals, and (3) the Vineland Adaptive Behavior Scales adaptive behavior composite.

Results

There was limited concordance among measures at both 12 and 24 months of ABA. None of the patient-centered measures showed significant positive correlation with adaptive behavior composite difference scores at either 12 or 24 months, nor did the caregiver measure. The percentage of children achieving clinically meaningful gain on patient-centered goal measures increased between 12 and 24 months of ABA, while the percentage of children achieving clinically meaningful gains in adaptive behavior declined during the same time period.

Conclusions

In a health system implementation of ABA, there was limited concordance between patient-centered and standard measures of clinically meaningful treatment progress for children with ASD. Clinicians should have ongoing dialogue with patients and parents/caregivers to ensure that interventions for ASD are resulting in progress towards outcomes that are meaningful to patients and families.
Motivators of impulsivity to smoke waterpipe tobacco among Nigerian youth who smoke waterpipe tobacco: the moderating role of social media normalisation of waterpipe tobacco
Authors: Adu Agatha Oluwafunmilayo , Ismail Nurzali , Noor Shuhaida Md.
Published: May 2022

Background

Impulsivity is a formidable cause of waterpipe tobacco smoking among youth, however, it is understudied among African youth. Using PRIME behavioural theory, this study aimed to develop a model that examines the motivators of impulsivity to smoke waterpipe tobacco in linkage to the moderating role of social media normalisation of waterpipe tobacco, specifically among youth in Nigeria who smoke waterpipe tobacco.

Methods

Data were drawn from 695 respondents who smoke waterpipe tobacco across six Nigerian universities in the South-West zone using the chain-referral sampling procedure. Descriptive analyses of the obtained data were carried out using the Statistical Package for Social Sciences (SPSS) version 25. The constructs in the developed model were validated through Partial Least Squares Structural Equation Modelling (PLS-SEM) in SmartPLS version 3.

Results

Among Nigerian youth who smoke waterpipe tobacco, intention (β = 0.442,P < 0.001) was the strongest motivator of impulsivity to smoke waterpipe tobacco as compared to positive evaluations (β = 0.302,P < 0.001). In addition, social media normalisation of waterpipe tobacco acted as a moderator that strengthened the relationship between intention and impulsivity (β = 0.287,P < 0.01), as well as, between positive evaluations and impulsivity (β = 0.186,P < 0.01) among youth.

Conclusion

Intention greatly instigates Nigerian youth’s impulsivity to smoke waterpipe tobacco, and social media normalisation of waterpipe tobacco also considerably increases their impulsivity to smoke waterpipe tobacco. Youth-focused educational waterpipe tobacco cessation-oriented programmes that utilise diverse constructive-based learning approaches like illustrative learning and counselling, can help to enlighten and encourage Nigerian youth on the importance of shunning the desirability to smoke waterpipe tobacco.
Occupational stress and associated factors among general practitioners in China: a national cross-sectional study
Authors: Feng Jing , Jiang Heng , Shen Xin , Lei Zihui , Li Liqing , Zhu Yi , Zhang Mingye , Yang Tingting , Meng Xin , Di Hongkun , Xia Wenqi , Lu Zuxun , Gan Yong
Published: May 2022

Background

Occupational stress among general practitioners (GPs) is a public health concern. This study aimed to investigate the prevalence and factors associated with occupational stress among GPs in China.

Methods

A cross-sectional design was used. Data were collected from 3,236 GPs in eastern, central, and western China (response rate, 99.75%) between October 2017 and February 2018 using a structured self-administered questionnaire. An ordinal logistic regression model was used to identify the factors associated with occupational stress among GPs.

Results

Among these respondents, 313 (9.67%), 1,028 (31.77%), and 1,895 (58.56%) of GPs had a low, medium, and high level of occupational stress, respectively. GPs from central China, with temporary work contracts, without management responsibility, receiving a moderate level of income, and with moderate occupational development opportunities had a lower level of occupational stress. GPs with greater than 40 working hours per week and those who worked overtime occasionally or frequently had a higher level of occupational stress.

Conclusions

The prevalence of occupational stress among GPs is high in China. Substantial regional variation in determinants of occupational stress among GPs was observed. These findings should inform the design of policies to reduce the occupational stress of GPs.
Perceived return-to-work pressure following cardiovascular disease is associated with age, sex, and diagnosis: a nationwide combined survey- and register-based cohort study
Authors: Bernt Jørgensen Sidsel Marie , Johnsen Nina Føns , Gerds Thomas Alexander , Brøndum Stig , Maribo Thomas , Gislason Gunnar , Kristiansen Maria
Published: May 2022

Background

Return to work is a key rehabilitation goal for people with cardiovascular disease (CVD) because employment matters to individuals and societies. However, people recovering from CVD often struggle with returning to work and maintaining employment. To identify people in need of vocational counselling, we examined the probability of feeling under pressure to return to work following CVD.

Methods

We conducted a combined survey- and register-based study in a randomly selected, population-based cohort of 10,000 people diagnosed with atrial fibrillation, heart failure, heart valve disease, or ischaemic heart disease in 2018. The questionnaire covered return-to-work items, and we reported the probabilities of feeling under pressure to return to work with 95% confidence intervals (CIs) in categories defined by sex, age, and CVD diagnosis.

Results

The survey response rate was 51.1%. In this study, we included 842 respondents (79.7% men) aged 32–85 years, who had returned to work following a sick leave. Overall, 249 (29.7%) had felt pressure to return to work. The probability of feeling under pressure to return to work ranged from 18.3% (95% CI: 13.1–24.6) among men aged > 55 years with atrial fibrillation to 51.7% (95% CI: 32.5–70.6) among women aged ≤ 55 years with atrial fibrillation. In addition, 66.0% of all respondents had not been offered vocational rehabilitation, and 48.6% of those who reported a need for vocational counselling had unmet needs. Survey responses also indicated that many respondents had returned to work before feeling mentally and physically ready.

Conclusion

A substantial proportion of people with cardiovascular disease feel under pressure to return to work, and this pressure is associated with age, sex, and diagnosis. The results show that vocational rehabilitation must be improved and emphasize the importance of ensuring that cardiac rehabilitation programmes include all core rehabilitation components.
Development, validation, and implementation of a Short Breast Health Perception Questionnaire
Authors: Alipour Sadaf , Rashidi Hadi , Maajani Khadije , Orouji Marzieh , Eskandari Yas
Published: May 2022

Background

Health status and perception can be assessed by general or disease-specific questionnaires, and disease specific questionnaires are more specific than general questionnaires. Considering the importance of breast health perception (BHP) in women’s lives and the lack of any pertinent questionnaires, we performed this study to develop a valid and reliable short BHP questionnaire (BHPQ); and then used it to assess the participants’ BHP.

Methods

We first designed and developed the instrument and then measured its inter-rater agreement (IRA), content validity including content validity index (I-CVI) and scale content validity index (S-CVI), and reliability (through internal consistency and test–retest). We then evaluated the BHP of eligible women with normal breasts and benign breast disorders who attended our breast clinic.

Results

The IRA index (78.6%) showed the optimal relevance and clarity of the questionnaire. The content validity was acceptable; with S-CVIs of 87.35 and 84.42 for clarity and relevance, respectively. The internal reliability was high (Cronbach’s alpha = 0.93). Three questions were eliminated for internal consistency (intraclass correlation coefficient < 0.7) but the rest of the questions showed good and excellent reliability. In the next step, BHP in the 350 eligible participants showed an overall score of 43.89 ± 9.09.

Conclusion

This study introduces a valid and reliable 11-item BHPQ. We propose its use in various circumstances throughout breast cancer screening, diagnosis, and treatment; and in the assessment of BHP in various physiologic and reproductive situations.
Effect of pharmacist-led inhaler technique assessment service on readmissions in hospitalized COPD patients: a randomized, controlled pilot study
Authors: Kebede Adyam Tesfamariam , Trapnes Elin , Lea Marianne , Abrahamsen Bjørg , Mathiesen Liv
Published: May 2022

Objective

To investigate the effect of pharmacist-led inhaler technique assessment service on readmissions and CAT-score in hospitalized COPD patients. Furthermore, to provide an effect estimate for sample size calculations for future studies and to gain experience on the feasibility of such studies.

Methods

A randomized controlled pilot study. Patients were randomized 1:1 to intervention or standard care. The primary endpoint was the difference in time to first readmission after hospital discharge between the treatment groups.

Results

There was no statistically significant effect on the time to readmission (median 41 days in the intervention group (19 patients) and 95 days in the control group (20 patients), HR 1.74, 95% CI 0.81–3.75, p = 0.16). There was no statistically significant difference between the groups in CAT-score 2 months after discharge, median scores being 25.5 and 24 in the intervention and the control group, respectively (p = 0.29). There was, however, a reduction of 3.5 units in CAT-score from baseline to 2 months after discharge in the intervention group, compared to no change in the control group.

Conclusion

Pharmacist-led inhaler technique training had no effect on time to readmission or CAT-score. Future studies in larger populations should consider focusing on patients with less severe COPD, exploring CAT-score as a primary endpoint, consider stratifying for important baseline variables and evaluate the acceptability of the intervention.

Trial registration

Date of registration 01/10/2018. ClinicalTrials.gov identifier: NCT03691324.
Success and failure after surgery of degenerative disease of the lumbar spine: an operational definition based on satisfaction, pain, and disability from a prospective cohort
Authors: Brasil Albert V B , Floriani Maiara Anschau , Sfreddo Ericson , do Nascimento Tobias Ludwig , Castro Andriele Abreu , Pedrotti Luana Giongo , Bessel Marina , Maccari Juçara Gasparetto , Mutlaq Mohamed Parrini , Nasi Luiz Antonio
Published: May 2022

Background

To describe success and failure (S&F) after lumbar spine surgery in terms equally understandable across the entire health ecosystem.

Methods

Back and leg pain and disability were prospectively recorded before and up to 12 months after the procedure. Satisfaction was recorded using a Likert scale. Initially, patients were classified as satisfied or unsatisfied. Optimal satisfaction/unsatisfaction cutoff values for disability and pain were estimated with ROC curves. Satisfied and unsatisfied groups underwent a second subdivision into four subcategories: success (satisfied AND pain and disability concordant with cutoff values), incomplete success (satisfied AND pain and disability nonconformant with cutoff values), incomplete failure (unsatisfied AND pain and disability nonconformant with cutoff values), and failure (unsatisfied AND pain and disability concordant with cutoff values).

Results

A total of 486 consecutive patients were recruited from 2019–2021. The mean values of preoperative PROMs were ODI 42.2 (+ 16.4), NPRS back 6.6 (+ 2.6) and NPRS leg 6.2 points (+ 2.9). Of the total, 80.7% were classified as satisfied, and 19.3% were classified as unsatisfactory. The optimal disability and pain cutoff values for satisfaction/unsatisfaction (NPRS = 6, AND ODI = 27) defined a subdivision: 59.6% were classified as success, 20.4% as incomplete success, 7.1% as incomplete failure and 12.4% as failure. The descriptions of each group were translated to the following: success—all patients were satisfied and presented no or only mild to tolerable pain and no or borderline disability; incomplete success – all patients were satisfied despite levels of pain and/or disability worse than ideal for success; incomplete failure – all patients were not satisfied despite levels of pain and/or disability better than expected for failure; failure – all patients were unsatisfied and presented moderate to severe pain and disability.

Conclusion

It is possible to report S&F after surgery for DDL with precise and meaningful operational definitions focused on the experience of the patient.
Characterization of the bacterial microbiota in different gut and oral compartments of splendid japalure (Japalura sensu lato)
Authors: Tian Zhige , Pu Hongli , Cai Dongdong , Luo Guangmei , Zhao Lili , Li Ke , Zou Jie , Zhao Xiang , Yu Min , Wu Yayong , Yang Tiankuo , Guo Peng , Hu Xiaoliang
Published: May 2022

Background

Gut and oral microbes form complex communities and play key roles in co-evolution with their hosts. However, little is understood about the bacterial community in lizards.

Results

In this study, we investigated the gut and oral bacterial communities in Japalura sensu lato from Sichuan Province, China, using 16S rRNA gene sequencing. Results showed that Bacteroidota (36.5%) and Firmicutes (32.8%) were the main phyla in the gut, while Proteobacteria, Bacteroidota, Firmicutes, and Actinobacteriota were the dominant phyla in the oral cavity. 16 S rRNA sequencing analysis of fecal samples showed that: (1) Bacteroidota was the most abundant in Japalura sensu lato, which was different from the bacterial community of insectivorous animals; (2) Bacteroidota, Firmicutes, Actinobacteriota, Fusobacteriota, and Cyanobacteria were the most abundant phylum in Japalura sensu lato. (3) Proteobacteria was the dominant phylum in Japalura sensu lato and other domestic insectivorous lizards (Shinisaurus crocodilurus, Phrynocephalus vlangalii, and Takydromus septentrionalis); (4) Comparing with the bacterial community of Shinisaurus crocodilurus, Phrynocephalus vlangalii, Takydromus septentrionalis, Liolaemus parvus, L. ruibali, and Phymaturus williamsi, Desulfobacterota was uniquely present in the gut of Japalura sensu lato. 16 S rRNA sequencing of oral samples showed that Chloroflexi and Deinococcota phyla were enriched in the oral cavity, which may have a significant influence on living in extreme environments.

Conclusions

Thus, based on 16 S rRNA sequencing analysis of the community composition of the gut and oral microbiomes, this study firstly represents a foundation for understanding the gut and oral microbial ecology of Japalura sensu lato, and constitutes a detail account of the diversity of the microbiota inhabiting the gut and oral cavity of Japalura sensu lato. Further researches will continue to reveal how gut and oral microbial communities may be impacting the ecology and evolution of lizards.
Discovery of new therapeutic targets in ovarian cancer through identifying significantly non-mutated genes
Authors: Al-Farsi Halema , Al-Azwani Iman , Malek Joel A. , Chouchane Lotfi , Rafii Arash , Halabi Najeeb M.
Published: May 2022

Background

Mutated and non-mutated genes interact to drive cancer growth and metastasis. While research has focused on understanding the impact of mutated genes on cancer biology, understanding non-mutated genes that are essential to tumor development could lead to new therapeutic strategies. The recent advent of high-throughput whole genome sequencing being applied to many different samples has made it possible to calculate if genes are significantly non-mutated in a specific cancer patient cohort.

Methods

We carried out random mutagenesis simulations of the human genome approximating the regions sequenced in the publicly available Cancer Growth Atlas Project for ovarian cancer (TCGA-OV). Simulated mutations were compared to the observed mutations in the TCGA-OV cohort and genes with the largest deviations from simulation were identified. Pathway analysis was performed on the non-mutated genes to better understand their biological function. We then compared gene expression, methylation and copy number distributions of non-mutated and mutated genes in cell lines and patient data from the TCGA-OV project. To directly test if non-mutated genes can affect cell proliferation, we carried out proof-of-concept RNAi silencing experiments of a panel of nine selected non-mutated genes in three ovarian cancer cell lines and one primary ovarian epithelial cell line.

Results

We identified a set of genes that were mutated less than expected (non-mutated genes) and mutated more than expected (mutated genes). Pathway analysis revealed that non-mutated genes interact in cancer associated pathways. We found that non-mutated genes are expressed significantly more than mutated genes while also having lower methylation and higher copy number states indicating that they could be functionally important. RNAi silencing of the panel of non-mutated genes resulted in a greater significant reduction of cell viability in the cancer cell lines than in the non-cancer cell line. Finally, as a test case, silencing ANKLE2, a significantly non-mutated gene, affected the morphology, reduced migration, and increased the chemotherapeutic response of SKOV3 cells.

Conclusion

We show that we can identify significantly non-mutated genes in a large ovarian cancer cohort that are well-expressed in patient and cell line data and whose RNAi-induced silencing reduces viability in three ovarian cancer cell lines. Targeting non-mutated genes that are important for tumor growth and metastasis is a promising approach to expand cancer therapeutic options.
CXCL13 expressed on inflamed cerebral blood vessels recruit IL-21 producing TFH cells to damage neurons following stroke
Authors: Rayasam Aditya , Kijak Julie A. , Kissel Lee , Choi Yun Hwa , Kim Taehee , Hsu Martin , Joshi Dinesh , Laaker Collin J. , Cismaru Peter , Lindstedt Anders , Kovacs Krisztian , Vemuganti Raghu , Chiu Shing Yan , Priyathilaka Thanthrige Thiunuwan , Sandor Matyas , Fabry Zsuzsanna
Published: May 2022

Background

Ischemic stroke is a leading cause of mortality worldwide, largely due to the inflammatory response to brain ischemia during post-stroke reperfusion. Despite ongoing intensive research, there have not been any clinically approved drugs targeting the inflammatory component to stroke. Preclinical studies have identified T cells as pro-inflammatory mediators of ischemic brain damage, yet mechanisms that regulate the infiltration and phenotype of these cells are lacking. Further understanding of how T cells migrate to the ischemic brain and facilitate neuronal death during brain ischemia can reveal novel targets for post-stroke intervention.

Methods

To identify the population of T cells that produce IL-21 and contribute to stroke, we performed transient middle cerebral artery occlusion (tMCAO) in mice and performed flow cytometry on brain tissue. We also utilized immunohistochemistry in both mouse and human brain sections to identify cell types and inflammatory mediators related to stroke-induced IL-21 signaling. To mechanistically demonstrate our findings, we employed pharmacological inhibitor anti-CXCL13 and performed histological analyses to evaluate its effects on brain infarct damage. Finally, to evaluate cellular mechanisms of stroke, we exposed mouse primary neurons to oxygen glucose deprivation (OGD) conditions with or without IL-21 and measured cell viability, caspase activity and JAK/STAT signaling.

Results

Flow cytometry on brains from mice following tMCAO identified a novel population of cells IL-21 producing CXCR5+ CD4+ ICOS-1+ T follicular helper cells (TFH) in the ischemic brain early after injury. We observed augmented expression of CXCL13 on inflamed brain vascular cells and demonstrated that inhibition of CXCL13 protects mice from tMCAO by restricting the migration and influence of IL-21 producing TFH cells in the ischemic brain. We also illustrate that neurons express IL-21R in the peri-infarct regions of both mice and human stroke tissue in vivo. Lastly, we found that IL-21 acts on mouse primary ischemic neurons to activate the JAK/STAT pathway and induce caspase 3/7-mediated apoptosis in vitro.

Conclusion

These findings identify a novel mechanism for how pro-inflammatory T cells are recruited to the ischemic brain to propagate stroke damage and provide a potential new therapeutic target for stroke.
Finding the “Sweet Spot”: Sharing the decision-making in ADHD treatment selection
Authors: Tan Daniel , King Thomas R.
Published: May 2022

Background

Stimulants are often prescribed as first-line therapy for attention-deficit/hyperactivity disorder. Currently, there are many therapeutic options available for clinicians and families to consider when making the decision to use a medication. In practice, selection of a stimulant medication for ADHD is highly personalized and can be narrowed down to two major factors: finding the optimal duration of the medication effect, and then estimating a starting dose and subsequently “fine-tuning” the medication to the optimal dosage of the medication. With the possibility of titrating to an optimal stimulant dosage within one prescription of a liquid stimulant, prescribers can recruit the parent/caregiver to actively participate in managing the transition to medication, allowing for greater ownership and a sense of shared control over the process.

Case presentation

The short case series offers a communication method by which clinicians can apply the principles of shared decision-making in helping the parent or caregiver of a newly diagnosed patient with ADHD make informed decisions about medication selection, and to obtain a greater sense of comfort with the new medication regimen.

Conclusions

Much has been published on the importance of clinicians and their patients fostering an environment of clear and unrestricted information-sharing. This short case series illustrates the effectiveness of this approach. Once parents are comfortable with the decision to start drug treatment for ADHD, it is incumbent upon the healthcare provider to ensure that an open channel of communication is maintained, and that parent/caregivers are encouraged to raise concerns as soon as possible.