bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilizing machine learning dimensionality reduction for risk stratification of chest pain patients in the emergency department
Authors: Liu Nan , Chee Marcel Lucas , Koh Zhi Xiong , Leow Su Li , Ho Andrew Fu Wah , Guo Dagang , Ong Marcus Eng Hock
Published: April 2021

Background

Chest pain is among the most common presenting complaints in the emergency department (ED). Swift and accurate risk stratification of chest pain patients in the ED may improve patient outcomes and reduce unnecessary costs. Traditional logistic regression with stepwise variable selection has been used to build risk prediction models for ED chest pain patients. In this study, we aimed to investigate if machine learning dimensionality reduction methods can improve performance in deriving risk stratification models.

Methods

A retrospective analysis was conducted on the data of patients > 20 years old who presented to the ED of Singapore General Hospital with chest pain between September 2010 and July 2015. Variables used included demographics, medical history, laboratory findings, heart rate variability (HRV), and heart rate n-variability (HRnV) parameters calculated from five to six-minute electrocardiograms (ECGs). The primary outcome was 30-day major adverse cardiac events (MACE), which included death, acute myocardial infarction, and revascularization within 30 days of ED presentation. We used eight machine learning dimensionality reduction methods and logistic regression to create different prediction models. We further excluded cardiac troponin from candidate variables and derived a separate set of models to evaluate the performance of models without using laboratory tests. Receiver operating characteristic (ROC) and calibration analysis was used to compare model performance.

Results

Seven hundred ninety-five patients were included in the analysis, of which 247 (31%) met the primary outcome of 30-day MACE. Patients with MACE were older and more likely to be male. All eight dimensionality reduction methods achieved comparable performance with the traditional stepwise variable selection; The multidimensional scaling algorithm performed the best with an area under the curve of 0.901. All prediction models generated in this study outperformed several existing clinical scores in ROC analysis.

Conclusions

Dimensionality reduction models showed marginal value in improving the prediction of 30-day MACE for ED chest pain patients. Moreover, they are black box models, making them difficult to explain and interpret in clinical practice.
The performance of balance exercises during daily tooth brushing is not sufficient to improve balance and muscle strength in healthy older adults
Authors: Granacher Urs , Muehlbauer Thomas , Göstemeyer Gerd , Gruber Stefanie , Gruber Markus
Published: April 2021

Background

High prevalence rates have been reported for physical inactivity, mobility limitations, and falls in older adults. Home-based exercise might be an adequate means to increase physical activity by improving health- (i.e., muscle strength) and skill-related components of physical fitness (i.e., balance), particularly in times of restricted physical activity due to pandemics.

Objective

The objective of this study was to examine the effects of home-based balance exercises conducted during daily tooth brushing on measures of balance and muscle strength in healthy older adults.

Methods

Fifty-one older adults were randomly assigned to a balance exercise group (n = 27; age: 65.1 ± 1.1 years) or a passive control group (n = 24; age: 66.2 ± 3.3 years). The intervention group conducted balance exercises over a period of eight weeks twice daily for three minutes each during their daily tooth brushing routine. Pre- and post-intervention, tests were included for the assessment of static steady-state balance (i.e., Romberg test), dynamic steady-state balance (i.e., 10-m single and dual-task walk test using a cognitive and motor interference task), proactive balance (i.e., Timed-Up-and-Go Test [TUG], Functional-Reach-Test [FRT]), and muscle strength (i.e., Chair-Rise-Test [CRT]).

Results

Irrespective of group, the statistical analysis revealed significant main effects for time (pre vs. post) for dual-task gait speed (p < .001, 1.12 ≤ d ≤ 2.65), TUG (p < .001, d = 1.17), FRT (p = .002, d = 0.92), and CRT (p = .002, d = 0.94) but not for single-task gait speed and for the Romberg-Test. No significant group × time interactions were found for any of the investigated variables.

Conclusions

The applied lifestyle balance training program conducted twice daily during tooth brushing routines appears not to be sufficient in terms of exercise dosage and difficulty level to enhance balance and muscle strength in healthy adults aged 60–72 years. Consequently, structured balance training programs using higher exercise dosages and/or more difficult balance tasks are recommended for older adults to improve balance and muscle strength.
A systematic review of the evidence for deprescribing interventions among older people living with frailty
Authors: Ibrahim Kinda , Cox Natalie J. , Stevenson Jennifer M. , Lim Stephen , Fraser Simon D. S. , Roberts Helen C.
Published: April 2021

Background

Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty.

Methods

The literature was searched using Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library up to May 2020. Interventional studies with any design or setting were included if they reported deprescribing interventions among people aged 65+ who live with frailty identified using reliable measures. The primary outcome was safety of deprescribing; whereas secondary outcomes included clinical outcomes, medication-related outcomes, feasibility, acceptability and cost-related outcomes. Narrative synthesis was used to summarise findings and study quality was assessed using Joanna Briggs Institute checklists.

Results

Two thousand three hundred twenty-two articles were identified and six (two randomised controlled trials) were included with 657 participants in total (mean age range 79–87 years). Studies were heterogeneous in their designs, settings and outcomes. Deprescribing interventions were pharmacist-led (n = 3) or multidisciplinary team-led (n = 3). Frailty was identified using several measures and deprescribing was implemented using either explicit or implicit tools or both. Three studies reported safety outcomes and showed no significant changes in adverse events, hospitalisation or mortality rates. Three studies reported positive impact on clinical outcomes including depression, mental health status, function and frailty; with mixed findings on falls and cognition; and no significant impact on quality of life. All studies described medication-related outcomes and reported a reduction in potentially inappropriate medications and total number of medications per-patient. Feasibility of deprescribing was reported in four studies which showed that 72–91% of recommendations made were implemented. Two studies evaluated and reported the acceptability of their interventions and further two described cost saving.

Conclusion

There is a paucity of research about the impact of deprescribing in older people living with frailty. However, included studies suggest that deprescribing could be safe, feasible, well tolerated and can lead to important benefits. Research should now focus on understanding the impact of deprescribing on frailty status in high risk populations.

Trial registration

The review was registered on the international prospective register of systematic reviews (PROSPERO) ID number: CRD42019153367.
Comparison of clinical features on admission between coronavirus disease 2019 and influenza a among children: a retrospective study in China
Authors: Liang Feng , Wang Xianfeng , Shao Jianbo , Chen Jun , Liu Lei , Li Hui , Xu Yi , He Liya , Liang Huiying , Li Kuanrong , Gong Sitang , Xia Huimin
Published: April 2021

Background

Coronavirus disease 2019 (COVID-19) share similar symptoms with influenza A (IA), but it is more worthwhile to understand the disparities of the two infections regarding their clinical characteristics on admission.

Methods

A total of 71 age-matched pediatric IA and COVID-19 patient pairs were formed and their clinical data on admission were compared.

Results

Fever, cough, nasal congestion and nausea/vomiting were the most common symptoms on admission for both infections but occurred less often in COVID-19. The IA patients were more likely to have lower-than-normal levels of lymphocyte count and percentage and to have higher-than-normal levels of activated partial thromboplastin time, prothrombin time, serum C-reactive protein, and serum procalcitonin, while the COVID-19 patients had higher odds of having lower-than-normal levels of neutrophil count and percentage.

Conclusions

This study suggests that influenza A is more symptomatic than COVID-19 for children and might be an overall more severe infection at the time of admission.
Association between the frequency of surgeries for video-assisted thoracic surgery and the incidence of consequent surgical site infections: a retrospective observational study based on national surveillance data
Authors: Kajihara Toshiki , Yahara Koji , Hirabayashi Aki , Kurosu Hitomi , Sugai Motoyuki , Shibayama Keigo
Published: April 2021

Background

The association between the frequency of surgeries and the incidence of surgical site infections (SSIs) has been reported for various surgeries. However, no previous study has explored this association among video-assisted thoracic surgeries (VATS). Hence, we aimed to investigate the association between the frequency of surgeries and SSI in video-assisted thoracic surgeries.

Methods

We analyzed the data of 26,878 thoracic surgeries, including 21,154 VATS, which were collected during a national surveillance in Japan between 2014 and 2018. The frequency of surgeries per hospital department was categorized into low (< 50/year), moderate (50–100/ year), and high (> 100/year). Chi-squared test or Fisher’s exact test was used for discrete explanatory variables, whereas Wilcoxon’s rank-sum test or Kruskal-Wallis test was used for continuous explanatory variables. Univariate analysis of the department groups was conducted to explore confounding factors associated with both SSIs and the department groups. We used a multiple logistic regression model focusing on VATS and stratified by the National Nosocomial Infections Surveillance System (NNIS) risk index.

Results

The rates of SSIs in the hospital groups with low, moderate, and high frequency of surgeries were 1.39, 1.05, and 1.28%, respectively. In the NNIS risk index 1 stratum, the incidence of SSIs was significantly lower in the moderate-frequency of surgeries group than that in the other groups (odds ratio [OR]: vs. low-frequency of surgeries: 2.48 [95% confidence interval [CI]: 1.20–5.13], P = 0.0143; vs. high-frequency of surgeries: 2.43 [95% CI: 1.44–4.11], P = 0.0009). In the stratum of NNIS risk indices 2 and 3, the incidence of SSI was significantly higher in the low-frequency of surgeries group (OR: 4.83, 95% CI: 1.47–15.93; P = 0.0095).

Conclusion

The result suggests that for departments with low-frequency of surgeries, an increase in the frequency of surgeries to > 50 per department annually potentially leads to a decrease in the incidence of SSIs. This occurs through an increase in the experience of the departmental surgeons and contributes to the improvement of VATS outcomes in thoracic surgeries.
Severe pneumonia caused by Parvimonas micra: a case report
Authors: Yu Qing , Sun Lingling , Xu Zuqing , Fan Lumei , Du Yunbo
Published: April 2021

Background

Parvimonas micra (P. micra) is a gram-positive anaerobic coccus that is detected widely on the skin, in the oral mucosa and in the gastrointestinal tract. In certain circumstances, P. micra can cause abdominal abscesses, bacteraemia and other infections. To the best of our knowledge, there have been no case reports describing the biological characteristics of P. micra-related pneumonia. These bacteria do not always multiply in an aerobic organ, such as the lung, and they could be easily overlooked because of the clinical mindset.

Case presentation

A 35-year-old pregnant woman was admitted to the emergency department 4 weeks prior to her due date who was exhibiting 5 points on the Glasgow coma scale. A computed tomography (CT) scan showed a massive haemorrhage in her left basal ganglia. She underwent a caesarean section and brain surgery before being admitted to the ICU. She soon developed severe pneumonia and hypoxemia. Given that multiple sputum cultures were negative, the patient’s bronchoalveolar lavage fluid was submitted for next-generation sequencing (NGS) to determine the pathogen responsible for the pneumonia; as a result, P. micra was determined to be the causative pathogen. Accordingly the antibiotic therapy was altered and the pneumonia improved.

Conclusion

In this case, we demonstrated severe pneumonia caused by the anaerobic organism P. micra, and the patient benefited from receiving the correct antibiotic. NGS was used as a method of quick diagnosis when sputum culture failed to distinguish the pathogen.
Evaluation of pooling of samples for testing SARS-CoV- 2 for mass screening of COVID-19
Authors: Mahmoud Sally A. , Ibrahim Esra , Thakre Bhagyashree , Teddy Juliet G. , Raheja Preety , Ganesan Subhashini , Zaher Walid A.
Published: April 2021

Background

The current pandemic of the SARS-CoV-2 virus, widely known as COVID-19, has affected millions of people around the world. The World Health Organization (WHO) has recommended vigorous testing to differentiate SARS-CoV-2 from other respiratory infections to aid in guiding appropriate care and management. Situations like this have demanded robust testing strategies and pooled testing of samples for SARS-CoV-2 virus has provided the solution to mass screening of people for COVID-19. A pooled testing strategy can be very effective in testing when resources are limited, yet it comes with its own limitations. These benefits and limitations need critical consideration when it comes to testing highly infectious diseases like COVID-19.

Methods

This study evaluated the pooled testing of nasopharyngeal swabs for SARS-COV-2 by comparing the sensitivity of individual sample testing with 4-and 8-pool sample testing. Median cycle threshold (Ct) values were compared, and the precision of pooled testing was assessed through an inter- and intra-assay of pooled samples. Coefficient of variance was calculated for inter- and intra-assay variability.

Results

The sensitivity becomes considerably lower when the samples are pooled. There is a high percentage of false negative reports with larger sample pool size and when the patient viral load is low or weak positive samples. High variability was seen in the intra- and inter-assay, especially among weak positive samples and when more number of samples are pooled together.

Conclusion

As COVID − 19 infection numbers and need for testing remain high, we must meticulously evaluate the testing strategy for each country depending on its testing capacity, infrastructure, economic strength, and need to determine the optimal balance on the cost-effective strategy of resource saving and risk/ cost of missing positive patients.
Food-related taboos and misconceptions during pregnancy among rural communities of Illu Aba Bor zone, Southwest Ethiopia. A community based qualitative cross-sectional study
Authors: Tsegaye Dereje , Tamiru Dessalegn , Belachew Tefera
Published: April 2021

Background

Poor maternal nutrition adversely affects pregnancy and birth outcomes. In many societies, there are dietary restrictions due to misconceptions or food taboos during pregnancy which consequently results in the depletion of important nutrients. These cultural malpractices and beliefs can influence the dietary intake of pregnant women which subsequently affects the birth outcome. The study aimed at exploring the extent of food taboos and misconceptions during pregnancy in rural communities of Illu Aba Bor Zone, Southwest Ethiopia.

Methods

A qualitative study was conducted using an in-depth interviews of key informants and focus group discussions among purposively selected pregnant women and their husbands, health care workers, health extension workers, and elderly people. Data were transcribed verbatim, thematized; color-coded, and analyzed manually using the thematic framework method.

Result

Thorough reading and review of the transcripts generated three major themes. The primary theme was the belief and practice of taboos related to the intake of certain food items during pregnancy. Pregnant women, their husbands, and mothers-in-law believed that certain foods should be avoided during pregnancy. The second theme was foods that were held as taboo and the reason attached to it. The most common food items held as taboo were related to the consumption of vegetables like cabbage, pumpkin, milk and milk products, sugar cane, fruits like bananas and avocado and egg. The main reasons to avoid these foods were beliefs that it can be plastered on the fetal head, making fatty baby which is difficult for delivery. The third theme was the reasons underlying adherence to food taboos which is deeply embedded in the person’s believes and attitudes of the pregnant women, who were nested within the influence of the social environment surrounding them and the traditional beliefs and values of the society in general.

Conclusions

The results showed a widespread practice of food taboos during pregnancy in the study area. The finding suggested that there is a need for strengthening the nutrition counseling components of antenatal care follow-up and planning comprehensive nutrition education through involving important others to dispel such traditional beliefs and prevent food taboo practices in the study community.
Mitochondrial DNA abnormalities provide mechanistic insight and predict reactive oxygen species-stimulating drug efficacy
Authors: Zaidieh Tarek , Smith James R. , Ball Karen E. , An Qian
Published: April 2021

Background

Associations between mitochondrial genetic abnormalities (variations and copy number, i.e. mtDNAcn, change) and elevated ROS have been reported in cancer compared to normal cells. Since excessive levels of ROS can trigger apoptosis, treating cancer cells with ROS-stimulating agents may enhance their death. This study aimed to investigate the link between baseline ROS levels and mitochondrial genetic abnormalities, and how mtDNA abnormalities might be used to predict cancer cells’ response to ROS-stimulating therapy.

Methods

Intracellular and mitochondrial specific-ROS levels were measured using the DCFDA and MitoSOX probes, respectively, in four cancer and one non-cancerous cell lines. Cells were treated with ROS-stimulating agents (cisplatin and dequalinium) and the IC50s were determined using the MTS assay. Sanger sequencing and qPCR were conducted to screen the complete mitochondrial genome for variations and to relatively quantify mtDNAcn, respectively. Non-synonymous variations were subjected to 3-dimensional (3D) protein structural mapping and analysis.

Results

Our data revealed novel significant associations between the total number of variations in the mitochondrial respiratory chain (MRC) complex I and III genes, mtDNAcn, ROS levels, and ROS-associated drug response. Furthermore, functional variations in complexes I/III correlated significantly and positively with mtDNAcn, ROS levels and drug resistance, indicating they might mechanistically influence these parameters in cancer cells.

Conclusions

Our findings suggest that mtDNAcn and complexes I/III functional variations have the potential to be efficient biomarkers to predict ROS-stimulating therapy efficacy in the future.
The prognostic significance of survivin expression in patients with HNSCC: a systematic review and meta-analysis
Authors: Zhou Liu-qing , Hu Yao , Xiao Hong-jun
Published: April 2021

Background

Survivin has been recently identified as a promising novel therapeutic target and prognostic marker in different types of cancer. Here we conducted a comprehensive meta-analysis to better clarify they the precise prognostic and diagnostic value of survivin in head and neck squamous cell carcinoma (HNSCC).

Methods

Database of PubMed (Medline), Embase, and Web of Science were systematically searched for related published literature up to September 2020. Pooled hazards ratios (HR) and related 95% confidence intervals (CI) were used to estimate the association of survivin expression and survival outcomes in HNSCC patients.

Results

Twenty eight studies with 4891 patients were finally included in this meta-analysis, the pooled analysis indicated that the survivin expression was significantly correlated with poorer overall survival (OS) (HR, 2.02; 95% CI, 1.65–2.47,P < 0.001), and poorer disease-free survival (DFS)/ disease-specific survival (DSS) (HR = 2.03, 95%CI: 1.64–2.52,P < 0.001; HR = 1.92, 95%CI: 1.41–2.60,P < 0.001, receptively). Similar results were observed in subgroup analysis stratified by different cancer types, such as laryngeal squamous cell carcinoma (LSCC) (HR = 1.35, 95%CI: 1.05–1.74,P < 0.001), oral squamous cell carcinomas (OSCC) (HR = 2.45, 95%CI: 1.89–3.17,P < 0.001), nasopharyngeal carcinoma (NPC) (HR = 2.53, 95%CI: 1.76–3.62,P < 0.001) and HNSCC (HR = 1.52, 95%CI: 1.25–1.86,P < 0.001). Furthermore, ethnicity-stratified analysis indicated that survivin was significantly associated with poorer OS among both Asian and Non- Asian HNSCC patients (HR = 2.16, 95%CI: 1.76–2.66; HR = 1.56, 95%CI: 1.33–1.82, respectively).

Conclusions

Our results suggested that survivin is predictors of worse prognosis in HNSCC patients. Hence, survivin is a potential therapeutic target for HNSCC.
Early immune responses and prognostic factors in children with COVID-19: a single-center retrospective analysis
Authors: Lu Wenjie , Yang Li , Li Xiong , Sun Ming , Zhang Aiping , Qi Shanshan , Chen Zhi , Zhang Lannan , Li Jianxin , Xiong Hao
Published: April 2021

Background

Early diagnostic indicators and the identification of possible progression to severe or critical COVID-19 in children are unknown. To investigate the immune characteristics of early SARS-CoV-2 infection in children and possible key prognostic factors for early identification of critical COVID-19, a retrospective study including 121 children with COVID-19 was conducted. Peripheral blood lymphocyte subset counts, T cell-derived cytokine concentrations, inflammatory factor concentrations, and routine blood counts were analyzed statistically at the initial presentation.

Results

The T lymphocyte subset and natural killer cell counts decreased with increasing disease severity. Group III (critical cases) had a higher Th/Tc ratio than groups I and II (common and severe cases); group I had a higher B cell count than groups II and III. IL-6, IL-10, IFN-γ, SAA, and procalcitonin levels increased with increasing disease severity. Hemoglobin concentration, and RBC and eosinophil counts decreased with increasing disease severity. Groups II and III had significantly lower lymphocyte counts than group I. T, Th, Tc, IL-6, IL-10, RBC, and hemoglobin had relatively high contribution and area under the curve values.

Conclusions

Decreased T, Th, Tc, RBC, hemoglobin and increased IL-6 and IL-10 in early SARS-CoV-2 infection in children are valuable indices for early diagnosis of severe disease. The significantly reduced Th and Tc cells and significantly increased IL-6, IL-10, ferritin, procalcitonin, and SAA at this stage in children with critical COVID-19 may be closely associated with the systemic cytokine storm caused by immune dysregulation.
Accelerometer measured physical activity patterns of children during segmented school day in Abu Dhabi
Authors: Ajja Rahma , Wikkeling-Scott Ludmilla F. , Brazendale Keith , Hijazi Rafiq , Abdulle Abdishakur
Published: April 2021

Background

The overwhelming majority of United Arab Emirates (UAE) school-aged children do not meet the 60 min per day recommendation of moderate-to-vigorous physical activity (MVPA). Understanding the different school day segments contribution to children reaching this goal is a crucial step toward developing successful strategies to promote school day MVPA levels. This study aimed to objectively measure children’s’ physical activity levels and to examine the difference in physical activity levels between high active and low active children during the school day in Abu Dhabi.

Methods

A total of 133 school children (56% boys; mean age 10.5 years; grades 4–7) from two elementary schools in Abu Dhabi wore accelerometers (ActiGraph GT9X Link) for up to 5 non-consecutive days during spring 2019. Children’s’ MVPA was estimated during the following school segments: class time, lunch, recess, physical education (PE), and whole school day. Children were stratified as “high active” meeting the ≥30 min/day MVPA school time guideline or “low active” accumulating < 30 min/day MVPA.

Results

On average children accumulated 21.8 ± 22.6 min/day of MVPA on PE days and 22.4 ± 15.9 min/day of MVPA on non-PE days. Only 19% of children met the 30 min or more of school day MVPA recommendation, with higher proportion of boys (27%) meeting such recommendation compared to girls (8%). High active boys, spent the highest percent of time in MVPA during PE (28%), followed closely by lunch (27%). In compression, high active girls spent the highest percent of time in MVPA during lunch (14.2%) followed by recess (9.1%). High active children accumulated 15.06 more minutes of MVPA during PE (p < 0.001), 2 more minutes during recess (p < 0.001), 3 more minutes of MVPA during lunch (p < 0.001) and 5 more minutes of MVPA during class time (p < 0.001).

Conclusion

The overwhelming majority of school children did not meet the recommended 30 min /day MVPA during school time. Girls substantially accumulated less MVPA and more sedentary minutes across all segments during the school days compared to boys. Further research is needed to investigate school day segments contribution to children MVPA in the UAE.
Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China
Authors: Zheng Yucan , Zhang Zhihua , Yan Kunlong , Guo Hongmei , Li Mei , Lian Min , Liu Zhifeng
Published: April 2021

Background

The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm.

Methods

This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes.

Results

A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including 5(9.8%) cases by endoscopy and 22(43.1%) cases by surgery. Twenty-two (43.1%)cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the time of the surgical group from ingestion to arriving at the hospital was longer([80(5–336) vs 26(2–216)]hours, p < 0.001) while there was no significant difference in the mean age or the number of magnets swallowed.

Conclusions

Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 h, even in asymptomatic patients.
A risk model and nomogram for high-frequency hearing loss in noise-exposed workers
Authors: Sun Ruican , Shang Weiwei , Cao Yingqiong , Lan Yajia
Published: April 2021

Background

High-frequency hearing loss is a significant occupational health concern in many countries, and early identification can be effective for preventing hearing loss. The study aims to construct and validate a risk model for HFHL, and develop a nomogram for predicting the individual risk in noise-exposed workers.

Methods

The current research used archival data from the National Key Occupational Diseases Survey-Sichuan conducted in China from 2014 to 2017. A total of 32,121 noise-exposed workers completed the survey, of whom 80% workers (n = 25,732) comprised the training cohort for risk model development and 20% workers (n = 6389) constituted the validation cohort for model validation. The risk model and nomogram were constructed using binary logistic models. The effectiveness and calibration of the model were evaluated with the receiver operating characteristic curve and calibration plots, respectively.

Results

A total of 10.06% of noise-exposed workers had HFHL. Age (OR = 1.09, 95% CI: 1.083–1.104), male sex (OR = 3.25, 95% CI: 2.85–3.702), noise exposure duration (NED) (OR = 1.15, 95% CI: 1.093–1.201), and a history of working in manufacturing (OR = 1.50, 95% CI: 1.314–1.713), construction (OR = 2.29, 95% CI: 1.531–3.421), mining (OR = 2.63, 95% CI: 2.238–3.081), or for a private-owned enterprise (POE) (OR = 1.33, 95% CI: 1.202–1.476) were associated with an increased risk of HFHL (P < 0.05).

Conclusions

The risk model and nomogram for HFHL can be used in application-oriented research on the prevention and management of HFHL in workplaces with high levels of noise exposure.
Breastfeeding knowledge of mothers in protracted crises: the Gaza Strip example
Authors: Iellamo Alessandro , Monaghan Emily , Moghany Samar A. L. , Latham Jonathan , Nassereddin Nihal
Published: April 2021

The protection and support of breastfeeding is the most effective intervention to prevent child morbidity and mortality especially in humanitarian crisis.

During the Palestine-Israel conflict healthcare services are understaffed and lack basic resources, with frequent power cuts and stock-outs of essential drugs and equipment. This case study seeks to answer the questions: (1) How does the protracted crisis in Gaza affect the breastfeeding practices of the most vulnerable population; and (2) What is the role that midwives can play in improving breastfeeding practices?

The study was conducted using a mixed method approach with quantitative and qualitative methods. Purposeful selection of women and children was conducted utilising eligibility criteria, women with children less than 2 years of age were included. All the respondents were asked if they agreed to participate in the survey.

A total of 63% practice early initiation of breastfeeding and 42% confirmed that their new-borns were given liquids other than breast milk during the first 3 days of life. Fifty percent of mothers addressed breast milk insufficiency by drinking additional fluids and 40% by using infant formula. Only 18% of women said that they received breastfeeding information during contact with health professionals throughout labour, delivery, and subsequent post-natal care visits. Many mothers during the focus group discussions (FGDs) confirm using milk to top up or replace breast milk.

Myths and misconceptions around breastfeeding remain, while women do access antenatal care services and deliver in the health facilities. There is a need to a) adapt the recommendations of the operational guidance for infant and young child feeding in emergencies (IYCF-E) in the Gaza strip, to protect, promote and support breastfeeding and b) include skilled breastfeeding counselling in the pre-service and in-service training for midwives.

Lessons learned included the importance of a) allocating additional research time, to account for interruption b) daily coordination with security officers to ensure safe access to localities c) identification of extra sites, in case of conflict escalation d) training of additional enumerators in case conflict escalation e) negotiation with authorities to ensure compliance with requirements.
Understanding cardiovascular disease in day-to-day living for African people: a qualitative metasynthesis
Authors: Tulu Seifu Nigussie , Al Salmi Nasser , Jones Jacqueline
Published: April 2021

Background

Globally, cardiovascular disease (CVD) accounts for 45% of all chronic non-communicable disease deaths and 31% of all deaths. CVD has remained the primary cause of death in the world for the past fifteen years. Compared to other continents, CVD and its risk factors are highly prevalent in Africa, but the continent also displays a low-level of knowledge and awareness of CVD, and poor perception of its risk factors. Little research has been done on the connection between the daily lived experiences of African people and the high prevalence and poor perception of CVD and its risk factors on the African continent. The aim of this study is to provide an in-depth understanding of the daily, lived experiences of African people and the connections between these experiences and the prevention, control, and management of CVD and its risk factors.

Methods

A systematic search was performed in PubMed, CINAHL, EMBASE, Psych INFO, and Web of Science databases to identify published English qualitative studies of CVD and its risk factors. Qualitative metasynthesis included structured techniques of data immersion and quality appraisal, thematic synthesis, and reciprocal translation.

Results

Seven studies met the inclusion criteria. Four major themes were identified from the metasynthesis: 1) understanding and beliefs about CVD; 2) perceived causes/risk factors for CVD; 3) understanding and belief about obesity; 4) perceived treatment options for CVD. The metasynthesis identified a consistent disconnect among African people between seeing CVD as a deadly and chronic disease and their perceptions of the minimal signs and symptoms of the disease in the early stages. This was further compounded by the gap between traditional healers and health care professionals.

Conclusions

Perceptions of CVD, its risk factors, and treatments were influenced by religious and cultural factors. Given the minimal signs and symptoms experienced in the early stages of the disease, there was a consistent disconnect among African people between seeing CVD as a deadly and chronic illness. Further investigations of the religious and cultural influences and educational programs related to these areas of disconnect are needed to improve the knowledge, attitudes, and beliefs of African people.
Individual quality of life and the environment – towards a concept of livable areas for persons with disabilities in Poland
Authors: Grabowska Izabela , Antczak Radosław , Zwierzchowski Jan , Panek Tomasz
Published: April 2021

Background

The United Nations Convention on the Rights of Persons with Disabilities [1] highlights the need to create proper socioeconomic and political conditions for persons with disabilities, with a special focus on their immediate living conditions. According to the Convention, these conditions should be built to ensure that persons with disabilities have the potential to enjoy a high quality of life (QoL), and this principle is reflected in the notion of livable areas. The crucial aspect of this framework is the relationship between the individual QoL and the environment, broadly understood as the socioeconomic as well as the technical conditions in which persons with disabilities function.

Methods

The basic research problem was to assess the relationship between individual QoL for the population with disabilities as a dependent variable and livability indicators as independent variables, controlling for individual characteristics. The study used a dataset from the EU-SILC (European Union Statistics on Income and Living Conditions) survey carried out in 2015 in Poland. The research concept involved several steps. First, we created a variable measuring the QoL for the entire population with disabilities. To measure the multidimensional QoL, we used Sen’s capability approach as a general concept, which was operationalized by the MIMIC (multiple indicators multiple causes) model. In the second step, we identified the livability indicators available in the official statistics, and merged them with survey data. Finally, in the last step, we ran the regression analysis. We also checked the data for the nested structure.

Results

We confirmed that the general environmental conditions, focused on creating livable areas, played a significant role in shaping the QoL of persons with disabilities; i.e., we found that the higher the level of the local Human Development Index, the higher the quality of life of the individuals living in this area. This relationship held even after controlling for the demographic characteristics of the respondents. Moreover, we found that in addition to the general environmental conditions, the conditions created especially for persons with disabilities (i.e., services for this group and support for their living conditions) affected the QoL of these individuals.

Conclusions

The results illustrate the need to strengthen policies aimed at promoting the QoL of persons with disabilities by creating access to community assets and services that can contribute to improving the life chances of this population.
Awareness of predatory journals and open access publishing among orthopaedic and trauma surgeons – results from an online survey in Germany
Authors: Maurer Elke , Walter Nike , Histing Tina , Anastasopoulou Lydia , El Khassawna Thaqif , Wenzel Lisa , Alt Volker , Rupp Markus
Published: April 2021

Background

Along with emerging open access journals (OAJ) predatory journals increasingly appear. As they harm accurate and good scientific research, we aimed to examine the awareness of predatory journals and open access publishing among orthopaedic and trauma surgeons.

Methods

In an online survey between August and December 2019 the knowledge on predatory journals and OAJ was tested with a hyperlink made available to the participants via the German Society for Orthopaedics and Trauma Surgery (DGOU) email distributor.

Results

Three hundred fifty orthopaedic and trauma surgeons participated, of which 291 complete responses (231 males (79.4%), 54 females (18.6%) and 5 N/A (2.0%)) were obtained. 39.9% were aware of predatory journals. However, 21.0% knew about the “Directory of Open Access Journals” (DOAJ) as a register for non-predatory open access journals. The level of profession (e.g. clinic director, consultant) (p = 0.018) influenced the awareness of predatory journals. Interestingly, participants aware of predatory journals had more often been listed as corresponding authors (p < 0.001) and were well published as first or last author (p < 0.001). Awareness of OAJ was masked when journal selection options did not to provide any information on the editorial board, the peer review process or the publication costs.

Conclusion

The impending hazard of predatory journals is unknown to many orthopaedic and trauma surgeons. Early stage clinical researchers must be trained to differentiate between predatory and scientifically accurate journals.
Low serum vitamin B12 levels are associated with degenerative rotator cuff tear
Authors: Kim Jae Hwa , Kim Go-Tak , Yoon Siyeoung , Lee Hyun Il , Ko Kyung Rae , Lee Sang-Cheol , Kim Do Kyung , Shin Jaeyeon , Lee So-young , Lee Soonchul
Published: April 2021

Background

Vitamin B12 (Vit B12) deficiency results in elevated homocysteine levels and interference with collagen cross-linking, which may affect tendon integrity. The purpose of this study was to investigate whether serum Vit B12 levels were correlated with degenerative rotator cuff (RC) tear.

Methods

Eighty-seven consecutive patients with or without degenerative RC tear were enrolled as study participants. Possible risk factors (age, sex, medical history, bone mineral density, and serum chemistries including glucose, magnesium, calcium, phosphorus, zinc, homocysteine, Vitamin D, Vit B12, homocysteine, and folate) were assessed. Significant variables were selected based on the results of univariate analyses, and a logistic regression model (backward elimination) was constructed to predict the presence of degenerative RC tear.

Results

In the univariate analysis, the group of patients with degenerative RC tear had a mean concentration of 528.4 pg/mL Vit B12, which was significantly lower than the healthy control group (627.1 pg/mL). Logistic regression analysis using Vit B12 as an independent variable revealed that Vit B12 concentrations were significantly correlated with degenerative RC tear (p = 0.044). However, Vit B12 levels were not associated with tear size.

Conclusion

Low serum levels of Vit B12 were independently related to degenerative RC tear. Further investigations are warranted to determine if Vit B12 supplementation can decrease the risk of this condition.
Identification and functional study of GATA4 gene regulatory variants in type 2 diabetes mellitus
Authors: Ding Liangcai , Cai Mengdi , Chen Lu , Yan Han , Lu Shicheng , Pang Shuchao , Yan Bo
Published: April 2021

Background

Type 2 diabetes mellitus (T2D) is a common and complex disease. Dysfunction of pancreatic β cells, which cannot release sufficient insulin, plays a central role in T2D. Genetics plays a critical role in T2D etiology. Transcription factor GATA4 is required for the pancreatic development, and GATA4 gene mutations are implicated in neonatal or childhood-onset diabetes. In this study, we aimed to investigate whether regulatory variants in GATA4 gene may change GATA4 levels, conferring susceptibility to T2D development.

Methods

The promoter region of GATA4 gene was analyzed by targeted sequencing in T2D patients (n = 255) and ethnic-matched controls (n = 371). Dual luciferase activity assay was used for functional study, and EMSA (electrophoretic mobility shift assay) was performed for detecting transcription factor binding.

Results

Thirteen regulatory variants including 5 SNPs were identified. A novel heterozygous variant (32124C > T) and one SNP [31487C > G (rs1053351749)] were only identified in T2D. Both regulatory variants significantly affected GATA4 gene promoter activity in cultured HEK-293 and INS-1 cells. Furthermore, the variant (32124C > T) evidently enhanced the binding of unknown transcriptional activator.

Conclusions

Our data suggested that GATA4 gene regulatory variants may contribute to T2D development as a rare risk factor.
Heterogeneity among women with stroke: health, demographic and healthcare utilization differentials
Authors: Jacobs Molly M. , Ellis Charles
Published: April 2021

Background

Although age specific stroke rates are higher in men, women have a higher lifetime risk and are more likely to die from a stroke. Despite this increased severity, most studies focus on male/female differences in stroke onset, patterns of care and stroke-related outcomes. Given that stroke presents differently in men and women, mixed sex studies fail to fully capture heterogeneity among women with stroke and the subsequent impact on their outcomes. This study examined the sociodemographic characteristics, factors related to stroke incidence and post-stroke functional status between young (< 60) and old (≥ 60) women with stroke.

Methods

Using 5 years of data from the National Health Interview Survey (NHIS), a nationally representative sample of US adults, cohorts of young and old women with stroke were identified. A set of demographic/lifestyle, health services utilization and health status characteristics were used evaluate within gender heterogeneity in three ways. First, disparities in population characteristics were assessed using Chi-Square and t tests. Second, young and old women with stroke were matched with women without stroke in their respective cohorts to determine differences in factors related to stroke incidence. Finally, the determinants of post-stroke functional limitation for the two cohorts were determined.

Results

Young women with stroke were more likely to be Black, smoke regularly and frequently consume alcohol than older women. Young women were also less likely to engage with their health provider regularly or receive preventative health screenings. Diabetes, high blood pressure, high cholesterol and high BMI were correlated with an increased relative likelihood of stroke among older women. In contrast, family size, smoking frequency, alcohol consumption and sleep were correlated with an increased prevalence of stroke among young women. Although factors correlated with stroke varied between young and old women, health status and receipt of healthcare were the most significant determinants of post-stroke functional status for both cohorts.

Conclusions

Health related characteristics were the primary correlates of stroke in older women, whereas post-stroke lifestyle and behaviors are the most significant correlates for younger stroke survivors. These findings suggest that while receipt of health services is essential for preventing stroke in both young and old women, providers should stress the importance of post-stoke lifestyle and behaviors to younger women at risk of stroke using approaches that may be different from older stroke women.
Experiences and perceptions of referrals to a community-based physical activity program for cancer survivors: a qualitative exploration
Authors: Faro Jamie M. , Mattocks Kristin M. , Mourao Dalton , Nagawa Catherine S. , Lemon Stephenie C. , Wang Bo , Cutrona Sarah L. , Sadasivam Rajani S.
Published: April 2021

Background

Physical activity rates in cancer survivors continue to be low despite the known benefits and availability of evidence-based programs. LIVESTRONG at the Y is a national community-based physical activity program offered cost-free to cancer survivors, though is underutilized. We explored perceptions and experiences of staff and participating survivors to better understand program awareness, referrals and participation.

Methods

LIVESTRONG at the Y program staff [directors (n = 16), instructors (n = 4)] and survivors (n = 8) from 8 United States YMCAs took part in 30-min semi-structured phone interviews between March–May 2019. Interviews were digitally recorded, transcribed, and evaluated using a thematic analysis approach.

Results

Program staff themes included: 1) Program awareness should be further developed for both the general public and medical providers; 2) Strong relationships with medical providers increased program referrals; 3) Electronic referral systems between providers and LIVESTRONG would help to streamline the referral process; and 4) Bi-directional communication between program staff and medical providers is key to providing patient progress updates. Survivor themes included: 1) Survivors trust their medical team and the information they provide about physical activity; 2) Providers need to incorporate an action plan and referrals for survivors to be active once treatments are completed; and 3) Personal experiences of those who participated in LIVESTRONG resonate with survivors and increase participation.

Conclusions

LIVESTRONG staff reported the need for an integrated electronic referral system and bi-directional communication with providers about participant progress. Survivors want physical activity education, electronic referrals and follow-up from their healthcare team, coupled with peer support from other survivors. Cancer care provider knowledge and electronic referrals during and after treatment may expedite and increase participation in this community-based program.