bluuebunny/crossref_metadata_2025 huggingface dataset:
An Investigation Into Local Infusion Site Pain After Infusion of Ultra Rapid Lispro Excipients Across Sites and Depths
Authors: Ignaut Debra , Fukuda Tsuyoshi , Bandi Ramanjineyulu , Ermer Marcel , Stoffel Marc S. , Zijlstra Eric , Paavola Chad
Published: November 2022

Background:

This phase 1, randomized, one-day, five-period crossover study in adults with type 1 diabetes on continuous subcutaneous insulin infusion investigated local infusion site pain following infusion of the excipients of ultra rapid lispro (URLi; without insulin) across infusion sites and depths.

Methods:

Forty participants (mean age, 40.5 years; body mass index [BMI], 27.5) were randomized to one of five infusion site sequences consisting of the arm, thigh, buttock (6 mm cannula depth), and abdomen (6 and 9 mm depth). Basal infusion of sodium citrate and treprostinil in diluent with magnesium chloride was initiated (10 μL/h) and at three, six, and nine hours after basal initiation, 15 unit-equivalent boluses (150 μL) were given. Participants rated their pain on a 0 to 100 mm validated visual analog scale (VAS) at 5 minutes pre-bolus and 1 and 15 minutes post-bolus.

Results:

At one minute post-bolus, increased VAS scores were occasionally reported. Most one minute post-bolus scores were ≤10 mm (little to no discomfort) while 7 of 577 were >45 mm (generally considered clinically meaningful pain). Painful infusions were reported more frequently for the arm, and mean VAS scores were higher for the arm compared with the thigh and abdomen. The VAS score distributions were similar between cannula depths. By 15 minutes post-bolus, VAS scores returned to pre-bolus levels.

Conclusions:

Local infusion site discomfort after infusion of URLi excipients was reported by a small subset of participants; it was transient, tolerable, and dependent on infusion site but not infusion depth. Given differences within individuals, patients may consider using a different infusion site if they experience discomfort.

Clinicaltrial.gov identifier:

NCT05067270.
Pursuing multiple goals during the commute: A dynamic self-regulatory perspective
Authors: Nolan Megan T. , Diefendorff James M. , Thornton-Lugo Meghan , Hynes Daniel , Prezuhy Margaret , Schreiber Jenna
Published: November 2022

The current review theorizes that self-regulatory principles can be applied to the commute experience to better understand how spatial navigation and role transition processes interface with each other. Using a multiple goal framework, spatial navigation and role transitions are conceptualized as simultaneous goals, each with their own set of effort allocation processes. Furthermore, the review describes how dynamic and stable features of the commute and of the different roles individuals enact come together to impact spatial navigation and role transition effectiveness, along with well-being and effectiveness in individuals’ “home” and “workplace” roles. The proposed framework offers novel predictions about how and why these two activities impact each other in different ways, providing testable propositions that will help researchers begin to better understand the commute as a time for multiple goal regulation. The review concludes with suggestions for future research aimed at investigating these processes.
Evaluation of Program Costs for Implementing a Self-Determination Intervention Using the Ingredients Method
Authors: Rifenbark Graham G. , Hicks Tyler A. , Burke Kathryn M. , Swinburne Romine Rebecca E. , Fleming Kandace K. , Shogren Karrie A.
Published: November 2022

In this study, we estimated the cost of implementing the Self-Determined Learning Model of Instruction (SDLMI), an evidence-based practice in secondary transition, at scale in 17 U.S. school districts to enhance self-determination and transition goal attainment outcomes among 340 transition-age adolescents with intellectual disability. An advantage of the SDLMI is that it can be overlaid upon any curriculum and, therefore, can minimize opportunity costs for self-determination instruction. Using the ingredients method, the current study: (a) identified and described the essential ingredients of SDLMI implementation in typical high school settings, (b) assigned and described the cost of needed ingredients, and (c) calculated a generalizable estimate of the average cost of using the SDLMI with 340 students for one school year across 17 school districts to be $40,221.26 (or $118.30 per student). We discuss how decision-makers considering using the SDLMI in their context can minimize costs while maximizing effects on transition goal attainment outcomes. Several implications of these findings for the field of transition are also described.
From Colonial to Neoliberal Regime: Understanding the Paradigms of Land Dispossession in India
Authors: Roy Animesh
Published: November 2022

The article attempts to understand and illustrate why state-mediated land dispossession in India on a large-scale under the colonial, post-colonial and neoliberal regimes became inevitably necessary, and how dispossession under these politico-economic regimes broadly metamorphosed the structure of dispossessed labour force. It, however, argues that the colonial regime dispossessed peasants and tribals from their means of subsistence primarily to exploit and extract resources in order to expand its unabated political power and retain its industrial growth trajectory in England while the post-colonial regime embarked on massive dispossession to obviate acute indigence of the Indian citizenries by building state-controlled dams and industries for production, and institutions for developing knowledge. The neoliberal regime contrarily aimed to accelerate economic growth largely on capitalist lines. Both colonial and post-colonial regimes partly absorbed the dispossessed labour force in the production processes, whereas neoliberal regime deprioritized its absorption, exemplifying therefore an ‘exclusionary’, non-labour intensive growth model.
Effect of Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma Augmentation on the Rate of Revision Rotator Cuff Repair
Authors: Schoch Bradley S. , Werner Brian C. , Shapiro Shane A. , Camp Christopher L. , Chalmers Peter N. , Cancienne Jourdan M.
Published: November 2022

Background:

The application of orthobiologics at the time of arthroscopic rotator cuff repair (RCR) has received an increasing amount of clinical interest despite a relative scarcity of human clinical studies on their efficacy.

Purpose:

To utilize a national administrative database to determine the association of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) applied at the time of RCR with revision surgery rates.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The Mariner data set from the PearlDiver patient records repository was utilized to identify patients undergoing RCR using Current Procedural Terminology (CPT) code 29827. Patients receiving BMAC or PRP at the time of RCR were then identified using CPT coding. For comparison purposes, a matched cohort was created consisting of patients who underwent RCR without biologic augmentation in a 5:1 fashion for each biologic separately. Cases were matched according to age, sex, tobacco use, biceps tenodesis, distal clavicle excision, and subacromial decompression. All groups were then queried for revision RCR or conversion to reverse shoulder arthroplasty. Revision rates were compared utilizing a multivariate binomial logistic regression analysis. Adjusted odds ratios (ORs) and 95% CIs were calculated.

Results:

A total of 760 patients who underwent biologic augmentation during RCR were identified, including 646 patients in the PRP group and 114 patients in the BMAC group. They were compared with 3800 matched controls without documented biologic application at the time of surgery. Compared with matched controls, patients who received BMAC at the time of surgery experienced a significantly lower incidence of revision surgery at 2 years (OR, 0.36; 95% CI, 0.15-0.82; P = .015). There was no significant difference in revision rates between PRP and matched controls (OR, 0.87; 95% CI, 0.62-1.23; P = .183).

Conclusion:

The application of BMAC at the time of RCR was associated with a significant decrease in the incidence of revision surgery. There was no apparent effect of PRP on the incidence of revision surgery after primary RCR. Higher-level clinical studies considering surgical factors are needed to more clearly define the role of biologic adjuvants in RCR.
Regular-Season Injury Rates in the National Football League After an Attenuated Preseason Due to COVID-19
Authors: Volpi Alexander , Haselman William , Photopoulos Christos , Banffy Michael
Published: November 2022

Background:

The preseason is a crucial time period for professional athletes to prepare for the upcoming season. However, due to the coronavirus 2019 (COVID-19) pandemic, the 2020 National Football League (NFL) preseason was canceled. As the regular season progressed, an increased number of injuries became apparent.

Purpose/Hypothesis:

The purpose of this study was to compare injury rates between the 2019 and 2020 NFL regular seasons after the canceled 2020 preseason. It was hypothesized that injury rates in the 2020 season would be the same or higher compared with 2019.

Study Design:

Descriptive epidemiology study.

Methods:

A public database of all 32 NFL teams was used to examine the movement of all players to injured reserve status as well as every player who missed a regular-season game due to injury for both the 2019 and the 2020 NFL regular seasons. Data collection consisted of tallying the total number of reported musculoskeletal injuries for each team. Comparisons of injury rates between the 2 seasons were made using a Wilcoxon signed-rank statistical analysis.

Results:

The total number of musculoskeletal injuries was 632 for the 2019 regular season and 765 for the 2020 regular season ( P = .0324). Compared with 2019, statistically significant increases in injury rates in 2020 were seen for calf or Achilles tendon strain (17 vs 39; P = .009), groin injury (25 vs 46; P = .018), and anterior cruciate ligament tear (14 vs 29; P = .016). There were several other increased trends in soft tissue injury rates in the 2020 season (eg, hamstring injury [87 vs 114; P = .085]); however, these did not reach statistical significance.

Conclusion:

This study showed a significant increase in total injuries during the 2020 COVID-19-affected NFL regular season compared with 2019. Several major soft tissue injuries reached statistical significance in their increase from 2019 to 2020 after the cancellation of the 2020 preseason due to COVID-19. These findings suggest that organized team preseason training and conditioning could have an effect on the prevention of sport-related injury at the highest level.
Patient and physician factors associated with symptomatic undiagnosed asthma or COPD
Authors: Cherian Mathew , Magner Kate M.A. , Whitmore G.A. , Vandemheen Katherine L. , FitzGerald J. Mark , Bergeron Celine , Boulet Louis-Philippe , Cote Andreanne , Field Stephen K. , Penz Erika , McIvor R. Andrew , Lemière Catherine , Gupta Samir , Mayers Irvin , Bhutani Mohit , Hernandez Paul , Lougheed M. Diane , Licskai Christopher J. , Azher Tanweer , Ainslie Martha , Ezer Nicole , Mulpuru Sunita , Aaron Shawn D.
Published: November 2022

Background

It remains unclear why some symptomatic individuals with asthma or COPD remain undiagnosed. Here, we compare patient and physician characteristics between symptomatic individuals with obstructive lung disease (OLD) who are undiagnosed and individuals with physician-diagnosed OLD.

Methods

Using random-digit dialling and population-based case finding, we recruited 451 participants with symptomatic undiagnosed OLD and 205 symptomatic control participants with physician-diagnosed OLD. Data on symptoms, quality of life and healthcare utilisation were analysed. We surveyed family physicians of participants in both groups to elucidate differences in physician practices that could contribute to undiagnosed OLD.

Results

Participants with undiagnosed OLD had lower mean pre-bronchodilator forced expiratory volume in 1 s percentage predicted compared with those who were diagnosed (75.2%versus80.8%; OR 0.975, 95% CI 0.963–0.987). They reported greater psychosocial impacts due to symptoms and worse energy and fatigue than those with diagnosed OLD. Undiagnosed OLD was more common in participants whose family physicians were practising for >15 years and in those whose physicians reported that they were likely to prescribe respiratory medications without doing spirometry. Undiagnosed OLD was more common among participants who had never undergone spirometry (OR 10.83, 95% CI 6.18–18.98) or who were never referred to a specialist (OR 5.92, 95% CI 3.58–9.77). Undiagnosed OLD was less common among participants who had required emergency department care (OR 0.44, 95% CI 0.20–0.97).

Conclusions

Individuals with symptomatic undiagnosed OLD have worse pre-bronchodilator lung function and present with greater psychosocial impacts on quality of life compared with their diagnosed counterparts. They were less likely to have received appropriate investigations and specialist referral for their respiratory symptoms.
Multidrug-resistant tuberculosis in Finland: treatment outcome and the role of whole-genome sequencing
Authors: Korhonen Virve , Kivelä Pia , Haanperä Marjo , Soini Hanna , Vasankari Tuula
Published: November 2022

Treatment of multidrug-resistant tuberculosis (MDR-TB) is a global challenge requiring long treatment with costly drugs. We assessed treatment combinations, outcome and the utility of whole-genome sequencing (WGS) in MDR-TB cases.

Clinical, demographic and microbiological data were obtained of all patients with MDR-TB who started treatment in Finland in 2007–2016. Definitions of MDR, pre-extensively drug-resistant (pre-XDR) and XDR tuberculosis were those applicable at the study period. Treatment outcome was defined according to World Health Organization (WHO) guidelines.Mycobacterium tuberculosisisolates were analysed by WGS in addition to routinely performed phenotypic drug susceptibility testing and genotyping.

Among the 47 cases, 35 (74%) had a successful treatment outcome. Risk factors for non-successful outcome were Finnish origin and XDR. Almost 90% of our cases had an adverse event for at least one drug. Phenotypic and WGS drug resistance results were fully concordant for isoniazid, fluoroquinolones and amikacin, and >90% concordant for rifampicin, pyrazinamide, kanamycin and capreomycin. >60% of phenotypically ethambutol-susceptible isolates were genotypically resistant. The results of the rifampicin and isoniazid nucleic acid amplification tests (NAATs) performed for the isolates were identical to the WGS results except for three isolates having uncommon resistance mutations not included in the NAATs. WGS did not reveal unexpected clustering.

More training is needed for physicians treating MDR-TB, and especially XDR-TB, to improve treatment outcome. Phenotypic drug susceptibility testing was shown to be unreliable for ethambutol. WGS could aid in the selection of optimal treatment regimen in the future.
Artificial intelligence based software facilitates spirometry quality control in asthma and COPD clinical trials
Authors: Topole Eva , Biondaro Sonia , Montagna Isabella , Corre Sandrine , Corradi Massimo , Stanojevic Sanja , Graham Brian , Das Nilakash , Ray Kevin , Topalovic Marko
Published: November 2022

Rationale

Acquiring high-quality spirometry data in clinical trials is important, particularly when using forced expiratory volume in 1 s or forced vital capacity as primary end-points. In addition to quantitative criteria, the American Thoracic Society (ATS)/European Respiratory Society (ERS) standards include subjective evaluation which introduces inter-rater variability and potential mistakes. We explored the value of artificial intelligence (AI)-based software (ArtiQ.QC) to assess spirometry quality and compared it to traditional over-reading control.

Methods

A random sample of 2000 sessions (8258 curves) was selected from Chiesi COPD and asthma trials (n=1000 per disease). Acceptability using the 2005 ATS/ERS standards was determined by over-reader review and by ArtiQ.QC. Additionally, three respiratory physicians jointly reviewed a subset of curves (n=150).

Results

The majority of curves (n=7267, 88%) were of good quality. The AI agreed with over-readers in 91% of cases, with 97% sensitivity and 93% positive predictive value. Performance was significantly better in the asthma group. In the revised subset, n=50 curves were repeated to assess intra-rater reliability (κ=0.83, 0.86 and 0.80 for each of the three reviewers). All reviewers agreed on 63% of 100 unique tests (κ=0.5). When reviewers set the consensus (gold standard), individual agreement with it was 88%, 94% and 70%. The agreement between AI and “gold-standard” was 73%; over-reader agreement was 46%.

Conclusion

AI-based software can be used to measure spirometry data quality with comparable accuracy as experts. The assessment is a subjective exercise, with intra- and inter-rater variability even when the criteria are defined very precisely and objectively. By providing consistent results and immediate feedback to the sites, AI may benefit clinical trial conduct and variability reduction.
Incorporation of biomarkers into a prediction model for paediatric radiographic pneumonia
Authors: Ramgopal Sriram , Ambroggio Lilliam , Lorenz Douglas , Shah Samir S. , Ruddy Richard M. , Florin Todd A.
Published: November 2022

Objective

The aim of this study was to evaluate biomarkers to predict radiographic pneumonia among children with suspected lower respiratory tract infections (LRTI).

Methods

We performed a single-centre prospective cohort study of children 3 months to 18 years evaluated in the emergency department with signs and symptoms of LRTI. We evaluated the incorporation of four biomarkers (white blood cell count, absolute neutrophil count, C-reactive protein (CRP) and procalcitonin), in isolation and in combination, with a previously developed clinical model (which included focal decreased breath sounds, age and fever duration) for an outcome of radiographic pneumonia using multivariable logistic regression. We evaluated the improvement in performance of each model with the concordance (c-) index.

Results

Of 580 included children, 213 (36.7%) had radiographic pneumonia. In multivariable analysis, all biomarkers were statistically associated with radiographic pneumonia, with CRP having the greatest adjusted odds ratio of 1.79 (95% CI 1.47–2.18). As an isolated predictor, CRP at a cut-off of 3.72 mg·dL
−1
demonstrated a sensitivity of 60% and a specificity of 75%. The model incorporating CRP demonstrated improved sensitivity (70.0%
versus
57.7%) and similar specificity (85.3%
versus
88.3%) compared to the clinical model when using a statistically derived cutpoint. In addition, the multivariable CRP model demonstrated the greatest improvement in concordance index (0.780 to 0.812) compared with a model including only clinical variables.

Conclusion

A model consisting of three clinical variables and CRP demonstrated improved performance for the identification of paediatric radiographic pneumonia compared with a model with clinical variables alone.
Lung diffusing capacities for nitric oxide and carbon monoxide at rest and post-walking in long COVID
Authors: Barisione Giovanni , Brusasco Vito
Published: November 2022

Background

Approximately one-third of long coronavirus disease 2019 (long COVID) patients report breathlessness and fatigue even during activities of daily living. We hypothesised that abnormalities of combined diffusing capacity of the lung for nitric oxide (DLNO) and carbon monoxide (DLCO) at rest or after mild exercise are associated with breathlessness in patients with long COVID.

Methods

Single-breath combinedDLNOandDLCOwere measured at rest and immediately after a short bout of treadmill exercise simulating ordinary walking in 32 Caucasian patients with long COVID and dyspnoea at rest. 20 subjects served as a control group.

Results

At rest, combinedDLNO,DLCOand alveolar volume (VA) were significantly lower in long COVID than in controls, withDLNOandDLCObeing below the limits of normal in 69% and 41% of cases, respectively. Mean values ofDLNO/VAandDLCO/VAin long COVID patients were less than controls, yet, in only 22% and 12% of long COVID patients were the values ofDLNO/VAandDLCO/VAbelow the limits of normal. After treadmill exercise,DLNO,DLNO/DLCO,VAand heart rate increased significantly without differences between groups.DLNOremained below the limit of normal in 47% of long COVID patients.

Conclusion

These data suggest localised discrete loss of lung units in approximately half of long COVID patients, not completely explained by loss ofVAor of alveolar–capillary recruitment during exercise.
Adverse perception of cough in patients with severe asthma: a discrete choice experiment
Authors: Holmes Joshua , O'Neill Vikki , McGarvey Lorcan P. , Heaney Liam G.
Published: November 2022

Background

Asthma symptoms adversely impact quality of life in particular in those with poor disease control. Commonly used patient-reported measures for asthma used to assess asthma control often inadequately capture the impact of cough, despite evidence that cough is one of the most bothersome symptoms for patients with asthma. This study aims to improve our understanding of how patients with asthma perceive cough to better understand its clinical impact.

Methods

A discrete choice experiment (DCE) was performed in two distinct adult asthma populations; those with severe asthma as defined by Global Initiative for Asthma (GINA) step 4/5 classification and those with moderate asthma (a GINA steps 2 or 3 classification of asthma severity).

Results

Choices were highly dominated by the cough attribute in the symptoms complexes; 48.4% of patients with severe asthma and 31.3% with moderate asthma consistently chose the alternative with the lowest level of cough. Furthermore, cough predominance was found to be significantly associated with severity of asthma (p=0.047). Patients with moderate asthma were not willing to accept any additional symptoms to reduce cough from severe to mild. However, these patients were willing to accept mild breathlessness, mild sleep disturbance, severe chest tightness and severe wheezing to remove coughing altogether.

Conclusions

Patients with asthma prefer to have less cough and are willing to accept greater levels of other symptoms to achieve this. Additionally, asthma severity may influence an individual's perception of their symptoms; cough is a more important symptom for patients with severe asthma than those with a milder disease.
Complete mitochondrial genomes and updated divergence time of the two freshwater clupeids endemic to Lake Tanganyika (Africa) suggest intralacustrine speciation
Authors: Milec Leona J. M. , Vanhove Maarten P. M. , Bukinga Fidel Muterezi , De Keyzer Els L. R. , Kapepula Vercus Lumami , Masilya Pascal Mulungula , Mulimbwa N’Sibula , Wagner Catherine E. , Raeymaekers Joost A. M.
Published: November 2022

Background

The hydrogeological history of Lake Tanganyika paints a complex image of several colonization and adaptive radiation events. The initial basin was formed around 9–12 million years ago (MYA) from the predecessor of the Malagarasi–Congo River and only 5–6 MYA, its sub-basins fused to produce the clear, deep waters of today. Next to the well-known radiations of cichlid fishes, the lake also harbours a modest clade of only two clupeid species,StolothrissatanganicaeandLimnothrissamiodon.They are members of Pellonulini, a tribe of clupeid fishes that mostly occur in freshwater and that colonized West and Central-Africa during a period of high sea levels during the Cenozoic. There is no consensus on the phylogenetic relationships between members of Pellonulini and the timing of the colonization of Lake Tanganyika by clupeids.

Results

We use short-read next generation sequencing of 10X Chromium libraries to sequence and assemble the full mitochondrial genomes ofS.tanganicaeandL.miodon.We then use Maximum likelihood and Bayesian inference to place them into the phylogeny of Pellonulini and other clupeiforms, taking advantage of all available full mitochondrial clupeiform genomes. We identifyPotamothrissaobtusirostrisas the closest living relative of the Tanganyika sardines and confirm paraphyly forMicrothrissa.We estimate the divergence of the Tanganyika sardines around 3.64 MYA [95% CI: 0.99, 6.29], and fromP.obtusirostrisaround 10.92 MYA [95% CI: 6.37–15.48].

Conclusions

These estimates imply that the ancestor of the Tanganyika sardines diverged from a riverine ancestor and entered the proto-lake Tanganyika around the time of its formation from the Malagarasi–Congo River, and diverged into the two extant species at the onset of deep clearwater conditions. Our results prompt a more thorough examination of the relationships within Pellonulini, and the new mitochondrial genomes provide an important resource for the future study of this tribe,e.g. as a reference for species identification, genetic diversity, and macroevolutionary studies.
Global abundance of short tandem repeats is non-random in rodents and primates
Authors: Arabfard Masoud , Salesi Mahmood , Nourian Yazdan Hassani , Arabipour Iman , Maddi AliMohammad Ali , Kavousi Kaveh , Ohadi Mina
Published: November 2022

Background

While of predominant abundance across vertebrate genomes and significant biological implications, the relevance of short tandem repeats (STRs) (also known as microsatellites) to speciation remains largely elusive and attributed to random coincidence for the most part. Here we collected data on the whole-genome abundance of mono-, di-, and trinucleotide STRs in nine species, encompassing rodents and primates, including rat, mouse, olive baboon, gelada, macaque, gorilla, chimpanzee, bonobo, and human. The collected data were used to analyze hierarchical clustering of the STR abundances in the selected species.

Results

We found massive differential STR abundances between the rodent and primate orders. In addition, while numerous STRs had random abundance across the nine selected species, the global abundance conformed to three consistent < clusters>, as follows: , , and , which coincided with the phylogenetic distances of the selected species (p < 4E-05). Exceptionally, in the trinucleotide STR compartment, human was significantly distant from all other species.

Conclusion

Based on hierarchical clustering, we propose that the global abundance of STRs is non-random in rodents and primates, and probably had a determining impact on the speciation of the two orders. We also propose the STRs and STR lengths, which predominantly conformed to the phylogeny of the selected species, exemplified by (t)10, (ct)6, and (taa4). Phylogenetic and experimental platforms are warranted to further examine the observed patterns and the biological mechanisms associated with those STRs.
Health management of malnourished elderly in primary health care: a scoping review
Authors: Taveira Adriana , Sousa Bárbara , Costa Patrício , Macedo Ana Paula
Published: November 2022

Objectives

The aim of this study, as the first review directed at Primary Health Care, is to identify the screening practices and health outcomes related to the care provided by Family Health Teams to the malnourished elderly people/population.

Methods

Following PRISMA and PICO strategies, searches were conducted in four electronic databases (PubMed, Web of Science, Scopus & EMBASE) on observational, qualitative, quantitative, or mixed studies, written in Portuguese, Spanish and English language, with participants of 65 years old or older at a community setting. The literature selected for this study ranges from the period 2011 to 2021; additional articles were included through reference lists.

Results

From the 483 studies identified, 16 were considered eligible to use in this work. The Mini Nutritional Assessment (MNA) score appears as the main criteria of choice, however, a standardized practice in the health systems regarding the use of screening methods has not been demonstrated. Studies are more oriented towards the analysis of the relationship of mortality/morbidity and malnutrition than towards the relationship of the cost and quality of life and malnutrition of the elderly.

Discussion

Malnutrition is one of the modifiable risk factors which contributes to the vulnerable condition of the elderly, with serious effects, especially when related to other comorbidities. Yet, several authors argue that the Primary Health Care intervention can minimize the negative impacts and improve the health outcomes.
The effectiveness of postpartum interventions aimed at improving women’s mental health after medical complications of pregnancy: a systematic review and meta-analysis
Authors: Shang Jie , Dolikun Nadila , Tao Xuanchen , Zhang Puhong , Woodward Mark , Hackett Maree L. , Henry Amanda
Published: November 2022

Background

Postpartum mental disorders including depression and anxiety are common. Medical complications of pregnancy, such as preeclampsia and gestational diabetes, are thought to increase the risk of mental disorders postpartum. However, it is unclear which interventions may be effective for preventing and/or treating postpartum mental disorders following a medically complicated pregnancy. We aimed to systematically review published literature on the effectiveness of postpartum interventions to improve women’s mental health after medical complications of pregnancy.

Methods

Systematic review (PROSPERO: CRD42021220030) was performed. Eligibility criteria: (1) randomized controlled trials (RCTs), published 1st Jan 2001-12th August 2021 (2) outcome measures reported on postpartum mental disorders (3) participants had ≥ 1 medical complication during pregnancy (4) intervention entirely postpartum or contained a postpartum component (5) full-text available in English or Chinese. Risk of bias was assessed using the Revised Cochrane Criteria Risk of Bias. Random effects inverse-variance weighted meta-analysis was used to pool the individual standardized mean differences (SMD) in depression or anxiety scores between intervention and control groups.

Results

Of 5928 studies screened, 9 met inclusion criteria, and were based on non-pharmaceutical, combined lifestyle interventions that began shortly after childbirth, or as part of extended care packages beginning during pregnancy. Of these, 2 were rated as low risk of bias, 1 with some concerns, and 6 were at high risk. Meta-analysis was performed for 8 studies using standardized measures of depression and 7 for anxiety. There were statistically significant reductions in depression (SMD − 1.48; 95%CI: -2.41 to -0.55), and anxiety scores (SMD − 1.98; 95%CI: -3.03 to -0.94) in intervention versus control groups. Considerable heterogeneity was noted for pooled depression (I2 = 97.9%, p < 0.05), and anxiety (I2 = 96.8%, p < 0.05) results.

Conclusion

Limited intervention studies aimed at improving postpartum mental disorders after medically complicated pregnancy were found, most with a high risk of bias. There was some evidence to suggest that postpartum depression and anxiety scores improved after early intervention. However, in general the current quality of evidence is low. Further, high-quality, interventional research is required in this understudied field.
Associations of impulsivity, hyperactivity, and inattention with nonsuicidal self-injury and suicidal behavior: longitudinal cohort study following children at risk for neurodevelopmental disorders into mid-adolescence
Authors: Ojala Olivia , Kuja-Halkola Ralf , Bjureberg Johan , Ohlis Anna , Cederlöf Martin , Norén Selinus Eva , Lichtenstein Paul , Larsson Henrik , Lundström Sebastian , Hellner Clara
Published: November 2022

Background

The knowledge of how the separate Attention-Deficit/Hyperactivity Disorder (ADHD) subdimensions (impulsivity, hyperactivity, and inattention) are associated with nonsuicidal self-injury (NSSI) and suicidal behavior (SB) is limited. The objective of this study was to investigate the associations of childhood ADHD subdimensions with NSSI and SB in children at risk of neurodevelopmental disorders (NDDs; including ADHD).

Methods

The sample (N = 391) included twin pairs where at least one twin screened positive for at least one NDD or common comorbidity at age 9 or 12. Data on ADHD subdimensions was collected through a telephone interview with a caregiver/legal guardian at age 9 or 12, and data on NSSI and SB was collected through an in-person clinical assessment at age 15. The associations between the ADHD subdimensions and NSSI or SB were tested in three different models: (1) univariable, (2) together with the other ADHD subdimensions, and (3) in a confounder-adjusted model including other NDD symptoms in addition to ADHD subdimensions, for NSSI and SB separately.

Results

A total of 32 (8.2%) adolescents reported life-time engagement of NSSI, and 18 (4.6%) SB. Childhood impulsivity was associated with SB and childhood inattention with NSSI, in all models. Hyperactivity was not meaningfully associated with any of the outcomes.

Conclusion

Impulsivity and inattention, but not hyperactivity, may be of particular importance in understanding SB and NSSI. Brief screening for impulsivity and inattention in childhood could facilitate detection of children vulnerable to NSSI and SB and indicate valuable information for preventive and intervention strategies.
Risk indicators for dental caries, and gingivitis among 6–11-year-old children in Nigeria: a household-based survey
Authors: Folayan Morenike Oluwatoyin , Adeniyi Abiola Adetokunbo , Arowolo Olaniyi , Maureen Chukwumah Nneka , Alade Micheal Abimbola , Tantawi Maha El
Published: November 2022

Background

There is little is known about the factors associated with caries experience and gingivitis among 6–11-year-old children in Nigeria. The aim of the study was to determine the prevalence and preventive oral health behaviors associated with caries and gingivitis among 6–11-year-old children in Nigeria.

Methods

A cross-sectional questionnaire-based survey was conducted in Ile-Ife, Nigeria. The dependent variables were caries and gingivitis. The dmft/DMFT index was used to assess dental caries experience (present or absent) and caries severity. The gingival index was used to assess the prevalence (present or absent) and severity of gingivitis (healthy gingiva/mild gingivitis versus moderate/severe gingivitis). The independent variables were preventive oral health behaviors (frequency of daily tooth brushing, frequency of consumption of refined carbohydrates in-between-meals, use of fluoridated toothpaste, and use of dental floss, history of dental service utilization). A series of logistic regression analysis models were constructed to determine the associations between the dependent and independent variables after adjusting for confounders (age, sex, and socioeconomic status).

Results

There were 69 (5.2%) children with caries. The mean (standard deviation) dmft was 0.08 (0.457) and the mean DMFT was 0.02 (0.159). There were 839 (63.3%) children with gingivitis with a mean (SD) gingival index score of 0.503 (0.453). Children who seldom or never used fluoride toothpaste had significantly higher odds of developing moderate to severe gingivitis (AOR; 1.671; 95% CI: 1.003–2.786; p = 0.049). Children with middle socio-economic status had significantly lower odds of developing moderate to severe gingivitis (AOR: 0.573; 95%CI: 0.330–0.994; p = 0.048). There were no risk indicators identified for caries.

Conclusion

The prevalence of dental caries was low while the prevalence of gingivitis was high in the study population. The daily used of fluoridated toothpaste seem to reduce the risk for moderate/severe gingivitis. Further studies are needed to understand these findings.
The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study
Authors: Emary Peter C. , Brown Amy L. , Oremus Mark , Mbuagbaw Lawrence , Cameron Douglas F. , DiDonato Jenna , Busse Jason W.
Published: November 2022

Background:

Emerging evidence suggests that access to chiropractic care may reduce the likelihood of initiating an opioid prescription for spinal pain; however, the impact of chiropractic care for patients already prescribed opioids is uncertain. We undertook a sequential explanatory mixed methods study to evaluate the association between initiating chiropractic care and continued opioid use among adult patients attending an Ontario community health centre (CHC) and receiving opioid therapy for chronic non-cancer spinal pain.

Methods:

We conducted a retrospective cohort study of 210 patient records between January 1, 2014 and December 31, 2020. We used generalized estimating equations, adjusted for patient demographics, co-morbidities, visit frequency, and calendar year, to evaluate the association between receipt versus non-receipt of chiropractic services and continued opioid use (e.g., unique opioid fills, number of refills, and dosages) up to one year following the index chiropractic visit. We also completed follow-up interviews with 14 patients and nine general practitioners from the CHC and integrated these data with our quantitative findings.

Results:

Over 12-month follow-up, there were lower rates of opioid fills (incidence rate ratio [IRR] = 0.66; 95% confidence interval [CI], 0.52–0.83) and refills (IRR = 0.27; 95% CI, 0.17–0.42) among chiropractic recipients (n = 49) versus non-recipients (n = 161). Although patients who did and did not receive chiropractic care began the study with the same dose of opioids, recipients were less likely to be prescribed higher-dose opioids (i.e., ≥ 50 mg morphine equivalents daily) compared to non-recipients at three months (odds ratio [OR] = 0.14; 95% CI, 0.04–0.47), six months (OR = 0.14; 95% CI, 0.05–0.40), nine months (OR = 0.19; 95% CI, 0.07–0.57), and 12 months (OR = 0.22; 95% CI, 0.08–0.62). Interviews suggested that patient self-efficacy, limited effectiveness of opioids for chronic pain, stigma regarding use of opioids, and access to chiropractic treatment were important influencing factors.

Conclusion:

We found that continued prescription opioid use among patients with chronic non-cancer spinal pain who received chiropractic care was lower than in patients who did not receive chiropractic care. Four themes emerged in our qualitative interviews to help provide a richer understanding of this association. Randomized controlled trials are needed to establish the effect of chiropractic care on opioid use for chronic spinal pain.
The feasibility and acceptability of implementing video reflexive ethnography (VRE) as an improvement tool in acute maternity services
Authors: McHugh Siobhan , Sheard Laura , O’Hara Jane , Lawton Rebecca
Published: November 2022

Background

Video-reflexive ethnography (VRE) has been argued to be an alternative approach to collaborative learning in healthcare teams, more able to capture the complexities of the healthcare environment than simulation. This study aims to explore the feasibility and acceptability of employing VRE as an improvement tool in acute maternity services.

Method

Focused ethnography and semi-structured interviews (n = 17) explored the feasibility of employing VRE from the perspective of the researcher-facilitator, and that of the healthcare staff participants. Reflexive thematic analysis was used to generate key themes.

Results

We identified four themes related to feasibility of employing VRE as an improvement approach: laying the groundwork; challenges of capturing in-situ video footage; effective facilitation of reflexive feedback; and, power to change. Of note was the central role of the facilitator in building and maintaining staff trust in the process, particularly in being able to guide collaborative, non-punitive discussion during reflexive feedback sessions. Interestingly, when considering implementation of change, structural hierarchies were evident with more senior staff better able to develop and effect ideas.

Two themes related to acceptability of VRE among healthcare staff were identified: staff response to the role of VRE in improvement; and the power of a different perspective. Staff were overwhelmingly positive about their experience of VRE, particularly appreciating the time, space and autonomy it afforded them to navigate and articulate ideas for change and improvement.

Conclusion

VRE is both feasible and acceptable as an improvement tool with acute, multi-disciplinary maternity staff teams. It is an important healthcare improvement tool that could prompt the development and maintenance of team resilience factors in the face of increasing stress and burn-out of healthcare staff in maternity services.
Donor age effects on in vitro chondrogenic and osteogenic differentiation performance of equine bone marrow- and adipose tissue-derived mesenchymal stromal cells
Authors: Bagge Jasmin , Berg Lise Charlotte , Janes Jennifer , MacLeod James N.
Published: November 2022

Background

Bone marrow (BM)- and adipose tissue (AT)-derived mesenchymal stromal cells (MSCs) have shown potential as cell-based therapies for cartilage and bone injuries and are used increasingly in human and veterinary practice to facilitate the treatment of orthopedic conditions. However, human and rodent studies have documented a sharp decline in chondrogenic and osteogenic differentiation potential with increasing donor age, which may be problematic for the important demographic of older orthopedic patients. The aim of this study was to identify the effect of donor age on the chondrogenic and osteogenic differentiation performance of equine BM- and AT-MSCs in vitro.

BM- and AT-MSCs and dermal fibroblasts (biological negative control) were harvested from horses in five different age groups (n = 4,N = 60); newborn (0 days), yearling (15–17 months), adult (5–8 years), middle-aged (12–18 years), and geriatric (≥ 22 years). Chondrogenic differentiation performance was assessed quantitatively by measuring pellet size, matrix proteoglycan levels, and gene expression of articular cartilage biomarkers. Osteogenic differentiation performance was assessed quantitatively by measuring alkaline phosphatase activity, calcium deposition, and gene expression of bone biomarkers.

Results

Chondrogenic and osteogenic differentiation performance of equine BM- and AT-MSCs declined with increasing donor age. BM-MSCs had a higher chondrogenic differentiation performance. AT-MSCs showed minimal chondrogenic differentiation performance in all age groups. For osteogenesis, alkaline phosphatase activity was also higher in BM-MSCs, but BM-MSCs calcium deposition was affected by donor age earlier than AT-MSCs. Chondrogenic and osteogenic differentiation performance of BM-MSCs exhibited a decline as early as between the newborn and yearling samples. Steady state levels of mRNA encoding growth factors, chondrogenic, and osteogenic biomarkers were lower with increasing donor age in both MSC types.

Conclusions

The data showed that chondrogenic and osteogenic differentiation performance of equine BM-MSCs declined already in yearlings, and that AT-MSCs showed minimal chondrogenic potential, but were affected later by donor age with regards to osteogenesis (calcium deposition). The results highlight the importance of donor age considerations and MSC selection for cell-based treatment of orthopedic injuries and will help inform clinicians on when to implement or potentially cryopreserve cells. Moreover, the study provides molecular targets affected by donor age.
Dynamic alteration in the gut microbiota and metabolome of Huanjiang mini-pigs during pregnancy
Authors: Xie Peifeng , Hu Chengjun , Azad Md. Abul Kalam , He Qinghua , Zhu Qian , Kong Xiangfeng
Published: November 2022

Background

Maternal gut microbiota and metabolites are associated with their offspring’s health. Our previous study showed that maternal body fat percentage increased from days 45 to 110 of gestation in a Huanjiang mini-pig model. Thus, this study aimed to investigate the changes in gut microbiota composition and microbial metabolite profile of sows from days 45 to 110 of gestation.

Results

Twenty-four Huanjiang mini-pigs with average body weight were assigned for sample collection during early- (day 45 of pregnancy), mid- (day 75 of pregnancy), and late-pregnancy (day 110 of pregnancy). The results showed that the relative abundances of Clostridium_sensu_stricto_1, Romboutsia, Turicibacter, and Streptococcus in jejunal contents were higher at day 110 than those at day 45 or 75 of gestation. In the ileum, the relative abundance of Streptococcus was higher (P < 0.05) at day 110 of gestation, as well as the metabolism function of the jejunal and ileal microbiota. The ileal butyrate and acetate concentrations were higher at days 45 and 110 of gestation, respectively. In the colon, the concentrations of cadaverine and spermine were higher (P < 0.05) at days 45 and 110 of gestation, respectively. Metabolomic analyses demonstrated that the metabolic pathways, including D-glutamine and D-glutamate metabolism, phenylalanine/tyrosine/tryptophan biosynthesis, and alanine/aspartate/glutamate metabolism changed during gestation.

Conclusion

Collectively, our results showed that gut microbiota composition and microbial metabolites changed dramatically from early to late pregnancy in a Huanjiang mini-pig model. These findings will provide new targets in formulating maternal nutritional interventions to alleviate the adverse effects during pregnancy on offspring health outcomes.
Triglyceride-glucose index and the risk of heart failure: Evidence from two large cohorts and a mendelian randomization analysis
Authors: Li Xintao , Chan Jeffrey Shi Kai , Guan Bo , Peng Shi , Wu Xiaoyu , Lu Xiaofeng , Zhou Jiandong , Hui Jeremy Man Ho , Lee Yan Hiu Athena , Satti Danish Iltaf , Tsang Shek Long , Wu Shouling , Chen Songwen , Tse Gary , Liu Shaowen
Published: November 2022

Background

The relationship between triglyceride-glucose (TyG) index, an emerging marker of insulin resistance, and the risk of incident heart failure (HF) was unclear. This study thus aimed to investigate this relationship.

Methods

Subjects without prevalent cardiovascular diseases from the prospective Kailuan cohort (recruited during 2006–2007) and a retrospective cohort of family medicine patients from Hong Kong (recruited during 2000–2003) were followed up until December 31st, 2019 for the outcome of incident HF. Separate adjusted hazard ratios (aHRs) summarizing the relationship between TyG index and HF risk in the two cohorts were combined using a random-effect meta-analysis. Additionally, a two-sample Mendelian randomization (MR) of published genome-wide association study data was performed to assess the causality of observed associations.

Results

In total, 95,996 and 19,345 subjects from the Kailuan and Hong Kong cohorts were analyzed, respectively, with 2,726 cases of incident HF in the former and 1,709 in the latter. Subjects in the highest quartile of TyG index had the highest risk of incident HF in both cohorts (Kailuan: aHR 1.23 (95% confidence interval: 1.09–1.39), PTrend <0.001; Hong Kong: aHR 1.21 (1.04–1.40), PTrend =0.007; both compared with the lowest quartile). Meta-analysis showed similar results (highest versus lowest quartile: HR 1.22 (1.11–1.34), P < 0.001). Findings from MR analysis, which included 47,309 cases and 930,014 controls, supported a causal relationship between higher TyG index and increased risk of HF (odds ratio 1.27 (1.15–1.40), P < 0.001).

Conclusion

A higher TyG index is an independent and causal risk factor for incident HF in the general population.

Clinical Trial Registration

URL: https://www.chictr.org.cn; Unique identifier: ChiCTR-TNRC-11,001,489.