bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort.
Authors: Chotard Marlene Curien- , Jantchou Prévost
Published: March 2020

Background: Gastroesophageal reflux (GER) is common in infants. Gastroesophageal reflux disease (GERD) is defined as GER leading to troublesome symptoms that affect daily functioning and/or complications. This study is aimed at determining the prevalence and progression of GER and GERD in a cohort of healthy term infants from birth to 12 months old.Methods: We conducted a prospective cohort study including all full-term living neonates born at Besançon Teaching Hospital, France. Parents completed a clinical report form and the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R) at 1, 3, 6, 10, and 12 months of age. GER was defined as score ≥1 to the first question with I-GERQ-R score < 16, and GERD as score ≥1 to the first question with I-GERQ-R score ≥ 16. Regurgitation was based on the answer to the first question of the I-GERQ-R as anything coming out of the mouth daily.Results: 157/347 births were included (83 boys). The prevalence of regurgitation at least once a day was 45.7% overall. In total: 72%, 69%, 56%, 18%, and 13% of infants regurgitated at least once a day at 1, 3, 6, 10, and 12 months of age, respectively. Physiological GER affected 53%, 59%, 51%, 16%, and 12% of infants; GERD, 19%, 9%, 5%, 2%, and 2%, respectively. Two risk factors were identified: family history of GER and exposure to passive smoking. Treatment included dietary modification (14%) and pharmacotherapy (5%).Conclusion: Physiological GER peaked at 3 months, GERD at 1 month. Most cases resolved on their own. GER and GERD are very common in the infant’s population and parents should be reassured/educated regarding symptoms, warning signs, and generally favorable prognosis. I-GERQ-R is useful to the clinical screening and follow up for GER and GERD.
Single-stage treatment of chronic localized tibial osteomyelitis with local debridement and antibiotic-loaded calcium sulfate implantation:a retrospective study of 42 patients.
Authors: Zhou Chun-Hao , Ren Ying , Adem Abdulnassir , Meng Xiang-Qing , Zhang Hong-An , Fang Jia , Qin Cheng-He
Published: March 2020

Background: The management of chronic tibial osteomyelitis is still a challenge, even with various methods have been introduced. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis. Methods: 42 patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received above mentioned treatment method were included in the study. The infection remission rate, recurrence rate, complication rate and bone healing rate were respectively analyzed. Results: With a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients, pain, limitation of movement, sinus tracts, topical redness and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed slight but acceptable discomfort in affected limbs. 5 patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged aseptic drainage was the most frequent complication that was observed in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by surgical intervention, months later, in 3 patients. According to the final X-rays examination, bone losses caused by local debridement were generally repaired, though the shape of tibia was not well restored to its initial form in 17 limbs. No fracture was recorded during follow-up. Conclusion: Local debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.
Diversity of active root-associated methanotrophs of three emergent plants in a eutrophic wetland in northern China
Authors: Cui Jing , Zhao Ji , Wang Zheng , Cao Weiwei , Zhang Shaohua , Liu Jumei , Bao Zhihua
Published: March 2020

Root-associated aerobic methanotrophs play an important role in regulating methane emissions from the wetlands. However, the influences of the plant genotype on root-associated methanotrophic structures, especially on active flora, remain poorly understood. Transcription of the pmoA gene, encoding particulate methane monooxygenase in methanotrophs, was analyzed by reverse transcription PCR (RT-PCR) of mRNA isolated from root samples of three emergent macrophytes, including Phragmites australis, Typha angustifolia, and Schoenoplectus triqueter (syn. Scirpus triqueter L.) from a eutrophic wetland. High-throughput sequencing of pmoA based on DNA and cDNA was used to analyze the methanotrophic community. Sequencing of cDNA pmoA amplicons confirmed that the structure of active methanotrophic was not always consistent with DNA. A type I methanotroph, Methylomonas, was the most active group in P. australis, whereas Methylocystis, a type II methanotroph, was the dominant group in S. triqueter. In T. angustifolia, these two types of methanotroph existed in similar proportions. However, at the DNA level, Methylomonas was predominant in the roots of all three plants. In addition, vegetation type could have a profound impact on root-associated methanotrophic community at both DNA and cDNA levels. These results indicate that members of the genera Methylomonas (type I) and Methylocystis (type II) can significantly contribute to aerobic methane oxidation in a eutrophic wetland.Key points1. Root-associated Methylomonas was predominant in three macrophytes using DNA approach. 2. Active Methylocystis was dominant in genera Typha and Schoenoplectus, but not in Phragmites. 3. Plant species impact on methanotrophic communities in both DNA and cDNA levels.
HDL functions and their interaction in patients of ST Elevation MI Acute Coronary Syndrome: a case control study
Authors: Thakkar Himani , Vincent Vinnyfred , Roy Ambuj , Singh Sandeep , Ramakrishnan Lakshmy , Kalaivani Mani , Singh Archna
Published: March 2020

Background: Recent studies emphasize the importance of HDL function over HDL cholesterol measurement, as an important risk for cardiovascular diseases (CVD). We compared the HDL function of patients with Acute Coronary Syndrome (ACS) and healthy controls.Methods: We measured cholesterol efflux capacity of HDL using THP-1 macrophages labelled with fluorescently tagged (BODIPY) cholesterol. Paraoxonase and arylesterase activity of PON1 enzyme were assessed by spectrophotometric methods. Results: We recruited 151 ACS patients and 110 controls. The HDL function of all patients during acute phase and at six month follow-up was measured. The mean age of the patients and controls was 51.7 and 43.6 years respectively. The mean HDL cholesterol/apolipoprotein A-I levels (ratio) of patients during acute phase, follow-up and of controls were 40.2 mg/dl/ 112.5 mg/dl (ratio= 0.36), 38.3 mg/dl/ 127.2 mg/dl (ratio= 0.30) and 45.4 mg/dl/ 142.1 mg/dl (ratio=0.32) respectively. The cholesterol efflux capacity (CEC) of HDL was positively correlated with apolipoprotein A-I levels during acute phase (r = 0.19, p = 0.019), follow-up (r = 0.26, p = 0.007) and of controls (r = 0.3, p = 0.0012) but not with HDL-C levels (acute phase: r = 0.07, p = 0.47; follow-up: r = 0.1 , p = 0.2; control: r = 0.02, p = 0.82). Higher levels of cholesterol efflux capacity, PON1 activity and apolipoprotein A-I were associated with lower odds of development of ACS. We also observed that low CEC is associated with higher odds of having ACS if PON1 activity of HDL is also low and vice versa. Conclusion: ACS is associated with reduced HDL functions which improves at follow-up. The predicted probability of ACS depends upon individual HDL functions and the interactions between them.
MDC1 depletion promotes Cisplatin induced cell death in Cervical cancer cells
Authors: Singh Neeru , Bhakuni Rashmi , Chhabria Dimple , kirubakaran sivapriya
Published: March 2020

Objective: Cisplatin, the most common chemotherapeutic drug for the treatment of advanced stage cervical cancers has limitations in terms of drugs resistance observed in patients partly due to functional DNA damage repair (DDR) processes in the cell. Mediator of DNA damage checkpoint1 (MDC1) is an important protein in the Ataxia telangiectasia mutated (ATM) mediated double stranded DNA break (DSB) repair pathway. In this regard, we investigated the effect of MDC1change in expression on the cisplatin sensitivity in cervical cancer cells.
Results: Through modulation of MDC1 expression in the cervical cancer cell lines; Hela, SiHa and Caski, we found that all the three cell lines silenced for MDC1 exhibited higher sensitivity to cisplatin treatment with inefficiency in accumulation of p γH2AX, Ser 139 foci and increased accumulation of pChk2 Thr 68 at the damaged chromatin followed by enhanced apoptosis. Further, we observed the increased p53 Ser 15 phosphorylation in the MDC1 depleted cells. Our studies suggest that MDC1 expression could be a key determinant in cervical cancer prognosis and treatment and its depletion in combination with cisplatin has the potential to be explored for the sensitisation of chemo-resistant cervical cancer cells.
Evaluating Dosimetric Constraints for Carbon Ion Radiotherapy in the Treatment of Locally Advanced Pancreatic Cancer
Authors: Lin Lien-Chun , Jiang Guo-Liang , Ohri Nitin , Wang Zheng , Lu Jiade , Garg Madhur , Guha Chandan , Wu XIAODONG
Published: March 2020

Objective: To identify a safe carbon ion radiotherapy (CIRT) regimen for patients with locally advanced pancreatic cancer (LAPC).Methods: We generated treatment plans for 13 consecutive, unselected patients who were treated for LAPC with CIRT at our center using three dose and fractionation schedules: 4.6 GyRBE x 12, 4.0 GyRBE x 14, and 3.0 GyRBE x 17. We tested the ability to meet published dose constraints for the duodenum, stomach, and small bowel as a function of dose schedule and distance between the tumor and organs at risk.Results: Using 4.6 GyRBE x 12 and 4.0 GyRBE x 14, critical (high-dose) constraints could only reliably be achieved when target volumes were not immediately adjacent to organs at risk. Critical constraints could be met in all cases using 3.0 GyRBE x 17. Low-dose constraints could not uniformly be achieved using any dose schedule.Conclusion: While selected patients with LAPC may be treated safely with a CIRT regimen of 4.6 GyRBE x 12, our dosimetric analyses indicate that a more conservative schedule of 3.0 GyRBE x 17 may be required to safely treat a broader population of LAPC patients, including those with large tumors and tumors that approach gastrointestinal organs at risk. The result of this work was used to guide an ongoing clinical trial.
Tumor Sidedness Could be a Prognostic Factor in Patients with Stage II Colon Cancer
Authors: Iguchi Kenta , Mushiake Hiroyuki , Hasegawa Seiji , Inagaki Daisuke , Mikayama Yo , Fukushima Tadao , Numata Masakatsu , Tamagawa Hiroshi , Yukawa Norio , Rino Yasushi , Masuda Munetaka
Published: February 2020

Background : The search for high-risk factors in stage II colon cancer (CC) is ongoing and several high-risk factors for stage II CC have been identified; however, the effects of tumor sidedness on prognosis is not clear. This study aims to determine whether tumor sidedness could be identified as another high-risk factor for stage II CC. Methods : We retrospectively analyzed 189 patients with stage II CC, following consecutive curative resection surgery performed between 2008 and 2014. We compared clinicopathological findings and long-term outcomes between the patients with right colonic cancer (RCC) and patients with left colonic cancer (LCC). Prognostic factors for survival were determined using univariate and Cox proportional regression analyses. Results : A total of 72 patients were diagnosed with RCC and 117 patients were diagnosed with LCC. Patients with RCC were significantly older (p < 0.001) than those with LCC, and the number of harvested lymph nodes (HLNs) was greater in the RCC group (RCC: 25 vs. LCC: 19; p = 0.003). The overall survival (OS) was notably worse in the RCC group than the OS in the LCC group (5 year survival rate—RCC: 81.3% vs. LCC: 90.4%; p = 0.025), whereas no significant difference was observed in disease-free survival (5 year survival rate—RCC: 74.8% vs. LCC: 83.4%; p = 0.065). Cox proportional regression analysis showed that tumor sidedness (hazard ratio (HR): 3.78, 95% confidence interval (CI): 1.61–8.85, p = 0.022), gender (HR: 3.27, 95% CI: 1.27–8.47, p = 0.014), and the number of HLNs (HR: 4.58, 95% CI: 1.95–10.74, p < 0.001) were independent prognostic factors for OS. Conclusion : Patients with a right-sided primary tumor location have more negative prognostic factors and worse long-term outcomes than those with a left-sided primary tumor location in stage II CC.
Clinical outcomes of immune checkpoint inhibitors for patients with recurrent or metastatic head and neck cancer: real-world data in Korea
Authors: kim hyera , Kim Binnari , Jung Hyun-Ae , Sun Jong-Mu , Lee Se-Hoon , Park Keunchil , Ahn Myung-Ju
Published: February 2020

Purpose Anti-PD1 inhibitors have been approved for the treatment of recurrent or metastatic head and neck cancer (HNC), as a result of Global Phase III trials. However, the clinical outcomes of immune checkpoint inhibitors in patients who are not eligible for clinical trials or have various medical conditions have not been fully elucidated. Methods We retrospectively reviewed 46 patients with recurrent or metastatic HNC who received pembrolizumab or nivolumab between June 2016 and June 2019. Results Thirty-five patients had head and neck squamous cell cancer (HNSCC) affecting the oropharynx, oral cavity, hypopharynx, larynx, nasal cavity, or paranasal sinuses, and eleven patients had nasopharyngeal cancer (NPC). The median progression-free survival (PFS) and overall survival (OS) were 3.7 months and 6.8 months, respectively, for patients with HNSCC, and 4.3 months and 11.8 months, respectively, for patients with NPC. The overall response rate (ORR) in all patients was 21%. Of 30 patients with HNSCC, 5 patients achieved complete response and 2 achieved partial response (ORR = 23%); 1 of 8 NPC patients achieved partial response (13%). Patients who previously underwent radiotherapy had better OS than those who did not (median OS, 7.6 months vs. 2.3 months, p = 0.006). OS was longer in patients treated with pembrolizumab than in those treated with nivolumab (median OS, 11.8 months vs. 6.8 months, p = 0.017). Conclusion Consistent with previous reports, immune checkpoint inhibitors showed promising efficacy in patients with previously treated recurrent or metastatic HNC in a real-world setting.
Common pathways and functional profiles reveal underlying patterns in Breast, Kidney and Lung cancers
Authors: Romera-Giner Sergio , García-García Francisco , Hidalgo Marta
Published: February 2020

Background : Cancer is an extremely heterogeneous disease, both intra and inter cancer types. In this work we aim to establish common patterns in Breast, Kidney and Lung cancers at the signaling pathways and functional level which give rise to the generic microenvironment of cancer, as well as determine cancer-specific pathways and functions related to each disease. Results : After a tumor vs. normal tissue comparison of the levels of activation of the signaling pathways and cell functions, we found a significant number of common subpathways and functions related to the three studied tumors. Also common survival mechanisms were established. Cancer-specific features which are only significant in one of the tumors have been determined. Conclusions : The joint analysis of these different cancer datasets reported an appreciable number of common functional features, some of them related at the same time to survival in two of the three analyzed cancers. On the other hand, tumor-specific subpathways and functions have been determined, allowing a better understanding of the specificity of each cancer. Keywords : cancer, signaling, pathways, functional analysis, common
Use of digital periodontal software to compare periodontal treatment outcomes in a practice-based research network (PBRN) – a proof of concept
Authors: Peikert Stefanie Anna , Mittelhamm Felix , Frisch Eberhard , Vach Kirstin , Ratka-Krüger Petra , Wölber Johan Peter
Published: March 2020

Background: The aim of this non-interventional, observational study was to develop and evaluate a digital procedure to access, extract and analyse recorded clinical data in practices to assess periodontal treatment outcomes.Methods: Participating periodontists were former or active postgraduate students of a master’s course in periodontics in Freiburg who routinely used a digital periodontal diagnostic program. All available stored periodontal patient charts were extracted, anonymized and digitally sent to the study centre.Results: In this study, data were collected from 6401 patients from 9 different practices. Information such as probing depth (PD), bleeding on probing (BOP), mobility, furcation and gingival attachment for 153163 teeth at first visit were successfully transferred to the study centre. During the observational period, which was from 2.08 years to 18.35 years on average, only 2.8% of all teeth were lost. The number of visits was significantly negatively correlated with BOP (p<0.0001), and the number of BOP-positive sites was significantly correlated with deeper PDs (p<0.001).Conclusion: The presented procedure was able to gather a large amount of practice-based periodontal data, and thus this study may support practice-based research networks. The data indicate that systematic and supportive periodontal therapy is successful on a practice-based level.
Increased interleukin-6 levels in neuron-derived plasma small extracellular vesicles in patients with aneurysmal subarachnoid hemorrhage
Authors: Lai Niansheng , Yao Yang , Qin Feiyun , Yu Tao , Xia Dayong , Zhao Xintong , Wu Degang , Liu Jiaqiang , Yuan Jinlong , Fang Xinggen , Li Zhenbao
Published: February 2020

Background Aneurysmal subarachnoid hemorrhage (aSAH) is a severe type of stroke characterized by high rates of mortality and disability. Identifying circulating biomarkers is helpful to improve prognosis. In this study, for the first time, we identify circulating interleukin-6 (IL-6) levels in neuron-derived small extracellular vesicles (NDSEVs) as potential biomarkers in prognosis of aSAH.Methods We extracted small extracellular vesicles from the plasma of aSAH patients and healthy controls and enriched them using sequential precipitation and anti-L1CAM antibody immunoabsorption. Subsequently, we determined IL-6 levels using an enzyme-linked immunosorbent assay (ELISA).Results Plasma IL-6 NDSEVs showed distinct pattern differences between aSAH patients and healthy controls. There were significant correlations of IL-6concentrations in plasma with severity in aSAH. The AUCs of IL-6 for distinguishing the severe aSAH patients from mild aSAH patients were 0.961. After multivariate logistic regression analysis, only age, acute hydrocephalus,and the levels of IL-6 NDSEVs enabled prediction of neurological outcome at 1 year. The IL-6 NDSEVs levels were greater and positively associated with disease and prognosis of aSAH patients.Conclusions These data suggest a neuroinflammatory cascade in aSAH patients. IL-6 NDSEVs may be a biomarkers to monitor the progression of aSAH.
Whole genome sequencing of macrolide resistant Streptococcus pneumoniae serotype 19A sequence type 416
Authors: Spanelova Petra , Jakubu Vladislav , Malisova Lucia , Musilek Martin , Kozakova Jana , Papagiannitsis Costas C. , Bitar Ibrahim , Hrabak Jaroslav , Pantosti Annalisa , Grosso Maria del , Zemlickova Helena
Published: February 2020

Background: The resistance of Streptococcus pneumoniae to macrolides is becoming an increasingly important issue and thus it is important to understand the genetics related to adaptation of this species to the widespread use of antibiotics in Europe. The 58 isolates of S. pneumoniae belonging to sequence type 416 and serotype 19A and to several different phenotypes originated from Italy, Portugal and Czech Republic were thus sequenced on Illumina MiSeq. The aim of the study was to describe the relation between isolates in this collection and the Netherlands15B-37 clone, which belongs to serotype 15B and sequence type 199. The association of sequence type 416 with macrolide resistance was also investigated. Results: Investigation of genes associated with serotype confirmed common recent origin of inquired isolates in the serotype switch between 15B and 19A serotypes. The genes associated with the macrolide resistance are to be quite variable even within closely genetically relative isolates. Conclusions: This tendency to interchange and modification of genes associated with macrolide resistance and surrounding sequences could lead to adaptation to different circumstances and thus to accelerate spreading of this sequence type in regions with high macrolide consumption.
Analysis of Reference Genes stability and Histidine Kinase Expression under Cold Stress in Cordyceps militaris
Authors: Liu Yong-Nan , Liu Bi-Yang , Ma You-Chu , Yang Hai-Long , Liu Li-Ming , Liu Gao-Qiang
Published: February 2020

Background: The development of fungal fruiting bodies from a hyphal thallus represents a transition from simple to complex multicellularity that is inducible under low temperature (cold stress). The molecular mechanism has been subject to surprisingly few studies. Analysis of gene expression level has become an important means to study gene function and its regulation mechanism. But identification of reference genes (RGs) stability under cold stress have not been reported in famous medicinal mushroom-forming fungi Cordyceps militaris. Results: Herein, 12 candidate RGs had been systematically validated under cold stress in C. militaris. Three diﬀerent algorithms, geNorm, NormFinder and BestKeeper were applied to evaluate the expression stability of the RGs. Our results showed that UBC and UBQ were the most stable RGs for cold treatments in short and long time, respectively. 2 RGs (UBC and PP2A) and 3 RGs (UBQ, TUB and CYP) were the suitable housekeeping genes for cold treatments in short and long time, respectively. Moreover, target genes, two-component-system histidine kinase genes, were selected to validate the most and least stable RGs under cold treatment, which indicated that use of unstable expressed genes as housekeeping genes leads to biased results.Conclusions: Our results provide a good starting point for accurate reverse transcriptase quantitative polymerase chain reaction normalization by using UBC and UBQ in C. militaris under cold stress and better support for understanding the mechanism of response to cold stress and fruiting body formation in C. militaris and other mushroom-forming fungi in future research.
Unmasking Anxiety in Autism: Explicit and Implicit Threatening Faces Dissociate Amygdala-centered Functional Connectivity
Authors: Chen Yu-Chun , Chen Chenyi , Liu Chia-Chien , Martínez Róger Marcelo , Fan Yang-Teng , Cheng Yawei
Published: March 2020

Background: Anxiety is the most prevalent comorbidity in individuals diagnosed with autism spectrum disorder (ASD). Amygdala reactivity to explicit and implicit threat processing is predictive of anxiety-related symptomatology. The neural mechanisms underlying the link between anxiety and ASD remains elusive. Methods: In this fMRI study, we recruited young adults with ASD (N = 31) and matched them with controls, then proceeded to assess their autistic and anxiety traits by the use of the Autism-Spectrum Quotient (AQ) and the State-Trait Anxiety Inventory (STAI-S), respectively; and scanned their hemodynamic responses, including amygdala, in response to explicit and implicit (backwardly masked) perception of threatening faces. Results: As compared to controls, the amygdala reactivity in ASD subjects was significantly lower to explicit threat, but comparable for implicit threat. The correlations of the amygdala reactivity with the AQ and STAI-S were dissociated depending on threat processing (explicit or implicit). Furthermore, the amygdala in ASD relative to controls had a more negative functional connectivity with the superior parietal cortex, fusiform gyrus, and hippocampus for explicit threat, whereas a more positive connectivity with the medial prefrontal cortex, temporal pole, and hippocampus for implicit threat. Conclusion: In ASD, the transmission of socially relevant information along dorsal and ventral neural pathways centered on the amygdala is dissociated depending on explicit and implicit threat processing. This dissociation, ascribed to their failure to compromise pre-existing hyperarousal, might contribute to anxiety in ASD.
Quality of Life among Infertile Couples in Gaza City, Palestine
Authors: baloushah suha , barjasteh samira , elsous aymen , alderawi ali , eid soha abou , masad atef
Published: March 2020

Background: Infertility is an important health problem affecting the quality of life accompanied by significant emotional and psychological consequences. Infertile couples living with emotional disturbances face challenges with less success of infertility treatment. Purposes: This study aimed to investigate the quality of life of infertile couples who seek In-Vitro Fertilizations (IVFs) by gender in Gaza city, Palestinian. Methods and materials: A cross sectional study was conducted, from Feb 2018 to Nov 2018, among 383 infertile couples selected through convenient sampling. A valid and reliable Arabic version of the fertility quality of life questionnaire (FertiQoL) was used in data collection. One way ANOVA and independent t-test was applied to compare between males and females. P value less than 0.05% was considered statistical significance. Results: The mean age of males and females was 34.54±8.54 and 29.28±6.71 years respectively. More than half of them had university degree (64% and 60% respectively). The mean duration of infertility of couples was 5.66±3.54 years. The mean males' scores of FertiQoL and its subscales (emotion, mind/body, social, core, tolerability and treatment) were significantly higher than females' scores (p<0.05). Conclusion: The males' total scores of FertiQoL and its subscales were higher than females' scores. The mean total of FertiQoL increased with better education, however, decreased with increase of age, duration of marriage, duration of infertility and number of IVF attempts. Psychological assessment and Counseling are necessary for infertile women taking into considerations factors affecting their QoL.
Modifications in COPD Treatment According to GOLD Guideline Recommendations
Authors: turan muzaffer onur , Sahin Sezgi , Altunbey Sinem Agca , Ogan Nalan , Hoca Nevin Taci , Mirici Arzu
Published: March 2020

INTRODUCTION Polypharmacy of respiratory medications is commonly seen in COPD patients. Reduction of COPD therapy in patients with overtreatment may have benefits by providing adherence to the guideline recommendations. We aimed to investigate effects of treatment de-escalation in COPD. METHODS This multi-center, prospective study was carried out in four pulmonary outpatient clinics. Overtreated patients (according to GOLD 2017) were recommended to undergo de-escalation of treatment (reduction group I), and those who were under appropriate treatment were recommended a stepwise de-escalation (reduction group II). Patients who declined de-escalation were in non-reduction group I. Non-reduction group II consisted of patients under appropriate treatment. Inhalation device skill, symptom control and quality of life (QOL) were assessed at baseline and 6-month follow-up. RESULTS At baseline visit, 55.9% of participants (76/136) were overtreated. There were de-escalation in 54 patients (35: reduction group I, 19: reduction group II). Non- reduction groups I and II included 37 and 45 patients, respectively. FEV 1 of patients with appropriate treatment improved significantly (p=0.033). There was a significant improvement in QOL in reduction group I (p=0.005) and II (p=0.011). Patients who reduced/quitted smoking during follow-up recorded significant improvements in FEV 1 and drug inhalation skills score (p=0.034 and p=0.023, respectively). Overtreatment had an estimated additional cost of 119.57$/year for each patient. CONCLUSION Overtreatment is a common problem in COPD. De-escalation of inhaler medications can improve QOL. Appropriate treatment according to guidelines positively affects respiratory parameters. Reduction/discontinuation of smoking improves both inhaler adherence and spirometric measurements. De-escalation of inhaler treatment should be considered in overtreated patients.
CARTA Fellows’ Scientific Contribution to the African Public and Population Health Research Agenda (2011 to 2018)
Authors: Igumbor Jude , Bosire Edna N , Basera Tariro , Dieudonn Uwizeye , Fayehun Funke , Wao Hesborn , Ajuwon Ademola , Otukpa Emmanuel , Karimi Florah , Conco Daphney , Gitau Evelyn , Fonn Sharon
Published: March 2020

Background: Strengthening research capacity in African academic institutions is crucial to address the ever-increasing health challenges across the continent. Since its inception in 2009, the Consortium for Advanced Research Training in Africa (CARTA) program has focused on strengthening the capacity of nine African universities to produce skilled researchers and scholars able to improve public and population health on the continent. This study describes the alignment between CARTA-supported doctoral topics and publications with the priorities articulated by the African public and population health research agenda and the Sustainable Development Goals’ (SDGs). Methods: We reviewed the output from CARTA PhD fellows between 2011 and 2018 to establish the volume and scope of the publications, and the degree to which the research focus coincided with the SDGs, World Bank, and African Development Bank research priority areas. We identified nine key priority areas into which the topics were classified.Results: In total, 140 CARTA fellows published 806 articles in peer-reviewed journals over the 8 years up to 2018. The publications are available in over 6300 online versions and have been cited in over 5500 other publications. About 69% of the published papers addressed the nine African public and population health research agenda and SDG priority areas. Infectious diseases topped the list of publications (26.8%), followed by the health system and policy research (17.6%), maternal and child health (14.7%), sexual and reproductive health (14.3%). About 70% of the articles were published by fellows from or affiliated to universities in Kenya, Nigeria, and South Africa. Conclusions and recommendations: Investments by CARTA in supporting doctoral studies provides fellows with sufficient training and skills to publish their research in fields of public and population health. The number of publications is understandably uneven across Africa’s public and population priority areas. However, even while low in number, fellows are nonetheless publishing in areas such as non-communicable disease, health financing, neglected tropical diseases, and environmental health. Violence and injury is perhaps underrepresented. There is need to keep developing research capacity in partner institutions with low research output by training more PhDs in such institutions and by facilitating enabling environments for research.
Influence of snoring on in incidence of metabolic syndrome: a community-based prospective cohort study in rural Northeast China
Authors: Yu Shasha , Guo Xiaofan , Li GuangXiao , Yang Hongmei , Sun Guozhe , Sun Yingxian
Published: March 2020

Background: There is increasing trend of metabolic syndrome (MetS) in rural areas of China in recent years. It is necessary to figure out the possible risk factors of MetS for better intervention. This community-based prospective cohort study was performed to assess the relationship between snoring status and incidence of MetS.Methods: We conducted a cohort study among residents aged ≥ 35 years without MetS in 2012-2013. Among 5,691 residents who met the inclusion criteria, 4,980 residents (2,586 men and 2394 women; follow-up proportion: 87.5%) remained available for follow-up examinations during 2015-2017. The main outcome was the incidence of MetS, defined by the unify criteria in 2009. We divided residents by snoring status and compared outcome between groups. Using a logistic regression model, we estimated the odds ratio (OR) for incidence for MetS, adjusting for confounders, ages, gender, exercise habit, sleep duration, alcohol and smoke consumption. Results: With a median follow up of 4.6 years, incidence of MetS was higher in snorers (men 26.2%, women 33.5%) than in non-snorers (men 19.7%, women 23.2%). Diastolic blood pressure increased in follow-up compared with baseline in male snorers but decreased in male non-snorers. Similarly, fast blood glucose level increased in female snorers at follow-up but decreased in female non-snorers. We found a significant association between snoring and incidence of MetS (adjusted OR=1.51, 95%CI=1.32-1.74). Besides, as the degrees of the snoring increased, the incidence of MetS increased simultaneously. And the OR for the very severe snoring was double compared with non-snorers (adjusted OR=2.10, 95%CI=1.38-3.20). Conclusion: Snoring is associated with higher incidence of MetS in rural Northeast Chinese. More emphasis should be paid to residents with snoring problem.
Rising trends and persisting inequalities in cesarean section rates in Nepal: evidence from demographic and health surveys 2006-2016
Authors: Acharya Kiran , Paudel Yuba Raj , Dhungana Chandra Mani
Published: March 2020

BackgroundSustainable development goals require member countries to reduce maternal mortality below 70 per 100,000 live births by 2030. Addressing inequalities in access to emergency obstetric care is crucial for reducing the maternal mortality ratio. This study was done to examine the time trends and socio-demographic inequalities in the utilization of cesarean section (CS) in Nepal during 2006-2016.MethodsWe used data from the Nepal Demographic and Health Surveys (NDHS) conducted during 2006-2016. Women who had a live birth in the last five years of the survey (most recent birth if there were two or more child birth) were the unit of analysis for this study. Absolute and relative inequalities in CS rates by different characteristics were measured in-terms of rate difference and rate ratios, respectively. Bivariate analyses and multivariate logistic regression models were used to assess the rate of cesarean sections by background socio-demographic characteristics of women. ResultsAge and parity adjusted CS rates were found to have increased almost three-fold (from 3.2%,95% CI:2.1-4.3 in 2006 to 10.5%;95% CI:8.9-11.9 in 2016) over the decade. In 2016, women from Mountain region (3.0%;95% CI:1.1-4.9), those from poorest wealth quintile (2.4%,95% CI:(1.2-3.7) and those living in province 6(2.4%,95% CI:1.3-3.5) had CS rate below 5%. Whereas, women from the richest income quintile (25.1%,95% CI :20.2-30.1), with higher education (21.2%,95% CI:14.7-27.8) and those delivering in private facilities (37.1%,95% CI:30.5-43.7) had CS rate above 15%. The absolute inequality in CS rate increased for maternal educational status, income quintiles, ecological region, province and place of delivery over the period. Relative inequality increased for provinces and place of delivery. Women from the richest income quintile (OR-3.3,95% CI: 1.6-7.0) and those delivered in private/NGO-run facilities (OR-3.6;95% CI:2.7-4.9) were more than three times more likely to deliver by CS compared to women from the poorest income quintile and those delivering in public facilities, respectively. ConclusionTo improve maternal and newborn health, strategies need to be revised to address the underuse of C-section in poor, mountain region and province 6. Simultaneously, policies and guidelines are needed to reduce overuse in rich women, women with higher education and those delivered in private facilities.
Nutritional status and dietary diversity of school-age children living with HIV: a cross sectional study in Phnom Penh, Cambodia
Authors: Yasuoka Junko , Yi Siyan , Okawa Sumiyo , Tuot Sovannary , Murayama Makoto , Huot Chantheany , Chhoun Pheak , Yem Sokunthea , Yuzuriha Kazuki , Mizutani Tetsuya , Kikuchi Kimiyo
Published: March 2020

Background: HIV/AIDS continues to be a major public health concern for children. Each day, worldwide, approximately 440 children became newly infected with HIV, and 270 children died from AIDS-related causes in 2018. Poor nutrition has been associated with accelerated disease progression, and sufficient dietary diversity is considered a key to improve children’s nutritional status. Therefore, this study aims to 1) examine nutritional status of school-age children living with HIV in Phnom Penh, Cambodia, and 2) identify factors associated with their nutritional status, especially taking their dietary diversity into consideration.Methods: This cross-sectional study was conducted in May 2018 within the catchment area of the National Pediatric Hospital, Cambodia. Data from 298 children and their caregivers were included in the analyses. Using semi-structured questionnaires, face-to-face interviews were conducted to collect data regarding sociodemographic characteristics, quality of life, and dietary diversity. To assess children’s nutritional status, body weight and height were measured. Viral load and duration of antiretroviral therapy (ART) were collected from clinical records. Multiple logistic regression analyses were performed to identify factors associated with stunting and wasting.Results: Of 298 children, nearly half (46.6%) were stunted, and 13.1% were wasted. The mean number of food groups consumed by the children in the past 24 hours was 4.6 out of 7 groups. Factors associated with children’s stunting were age (adjusted odds ratio [AOR] 2.166, 95% confidence interval [CI]: 1.151, 4.077), household wealth (AOR 0.543, 95%CI: 0.299, 0.986), duration of receiving ART (AOR 0.510, 95%CI: 0.267, 0.974), and having disease symptoms during the past one year (AOR 1.871, 95%CI: 1.005, 3.480). The only factor associated with wasting was being male (AOR 5.304, 95%CI: 2.210, 12.728).Conclusions: Prevalence of stunting was more than double that of non-infected school-age children living in urban areas in Cambodia. This highlights the importance of conducting nutritional intervention programs, especially tailored for children living with HIV in the country. Although dietary diversity was not significantly associated with children’s nutritional status in this study, the findings will contribute to implementing future nutritional interventions more efficiently by indicating children who are most in need of such interventions in Cambodia.
Food insecurity and lipid profile abnormalities are associated with an increased risk of non- alcoholic fatty liver disease (NAFLD): a case-control study in northwest of Iran
Authors: Tutunchi Helda , Saghafi-Asl Maryam , Attar Mohammad-Javad Hosseinzadeh , Asghari-Jafarabadi Mohammad , Ostadrahimi Alireza
Published: March 2020

Background Non-alcoholic fatty liver disease (NAFLD) is an important public health problem and a significant cause of morbidity and mortality. Little is known about the relation between food insecurity and NAFLD. This study aimed to assess the relationship between food insecurity, risk factors associated with food insecurity, and NAFLD prevalence in a sample of Iranian adults.Methods In this age-matched and gender-matched case–control study, 210 subjects were recruited. NAFLD diagnosis was performed by a single expert radiologist using ultrasonography. The demographic and socioeconomic characteristics, anthropometric indices, body composition, along with food insecurity and depression status were assessed. Blood samples were collected to determine the lipid profile parameters. Chi-square, independent samples t-test, and uni-and multi-variate logistic regression tests were used. Data were analysed using SPSS V.23.0.Results The prevalence of food insecurity was 56.8% and 26.1% in cases and controls ( P<0.001 ), respectively. According to final analysis model, food insecurity, depression, number of children ≥ 4, overweight, and obesity were identified as significant independent risk factors for NAFLD. The chance of NAFLD in the food insecure, depressed, overweight, and obese subjects was 2.2 (95%CI: 1.12-3.43), 1.9 (95%CI: 1.02-3.62), 2.6 (95%CI: 1.81-3.92), and 2.9 (95%CI: 2.02- 5.34) times higher, respectively. Additionally, a higher waist circumference (men, OR = 2.9, P < 0.001 ; women, OR= 2.6, P< 0.001 ), an elevated waist-to-hip ratio (men, OR=2.3, P<0.001 ; women, OR=2.7, P<0.001 ), an increased waist-to-height ratio (OR=2.9, P<0.001 ), and a higher body fat percentage (men, OR=3.0, P<0.001 ; women, OR=3.3, P<0.001 ) were independently associated with an increased risk of NAFLD. The odds of NAFLD increased by increment in serum triglyceride (TG) levels (OR=2.6, P<0.001 ) and decreased by increase in serum high-density lipoprotein cholesterol (HDL-C) (OR=0.34, P<0.001 ). Compared to controls, NAFLD patients were more likely to have higher TG/HDL-C ratio (OR =3.3, P<0.001 ).Conclusions The prevalence of food insecurity in patients with NAFLD was significantly higher compared to controls. Food insecurity was associated with an increased risk of NAFLD, even after adjusting for potential confounding factors. Additionally, NAFLD was significantly related to some indicators of dyslipidemia.
Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi
Authors: Habonimana Desire , Batura Neha
Published: March 2020

Background Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distance to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite prenatal, childbirth and postanal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four antenatal care (ANC) visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.Methods We use data from the 2017 Burundian Demographic and Health Survey (DHS) collected from 8,941 women who reported a live birth in the five years preceding the survey. We use multiple regression analysis to explore the factors that determine the likelihood of seeking ANC services from a trained health professional, the number of ANC visits made and the choice of assisted childbirth.Results Occupation, marital status and wealth increase the likelihood of seeking ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than others. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are assisted during childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth.Conclusions In Burundi, utilisation of maternal health services is low. There is inequality in services utilisation among women based on wealth, parity, religion, and occupation. ANC is an important determinant of subsequent delivery care. There is a gap between married and unmarried women. This has a strong health policy implication to improve access to maternal health services for unmarried women.
Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands
Authors: Spruijt Ineke , Haile Dawit Tesfay , Hof Susan van den , Fiekert Kathy , Jansen Niesje , Jerene Degu , Klinkenberg Eveline , Leimane Ieva , Suurmond Jeanine
Published: March 2020

Background Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods We interviewed adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment. We used a thematic analysis to identify, analyse and report patterns in the data.Results Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment.Conclusion The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.
Opportunities for the development of drowning interventions in West Bengal, India: A review of policy and government programs
Authors: Gupta Medhavi , Zwi Anthony B , Jagnoor Jagnoor
Published: March 2020

Background: Four million people living in the Indian Sundarbans region in the state of West Bengal face a particularly high risk of drowning due to rurality, presence of open water, lack of accessible health systems and poor infrastructure. Although the World Health Organization has identified a number of interventions that may prevent drowning in rural low-and middle-income country contexts, no drowning interventions are currently implemented in this region. Interventions that build on existing policy targets or government programs are more likely to be sustainable and scalable.Methods: A detailed content review of national and state policy (West Bengal) was conducted to identify policy principles and/or specific government programs that may be leveraged for drowning interventions. The enablers and barriers of these programs as well as their implementation reach were assessed through a systematic literature review. Identified policies and programs were also assessed to understand how they catered for underserved groups and their implications for equity.Results: Three programs may be leveraged for drowning interventions: the Integrated Child Development Scheme (ICDS), Self-Help Group (SHG) and Accredited Social Health Activist (ASHA) programs. All three had high coverage in West Bengal and considered underserved groups such as women and rural populations.Conclusions: This is the first systematic analysis of both policy content and execution of government programs to provide comprehensive insights into possible implementation strategies for a health intervention, in this case drowning. Programs targeting specific health outcomes should consider interventions outside of the health sector that address social determinants of health. This may enable the program to better align with relevant government agendas and increase sustainability.