bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal risk factors for congenital vertebral formation and mixed defects: A population-based case–control study
Authors: Heiskanen Susanna , Helenius Ilkka , Syvänen Johanna , Kemppainen Teemu , Löyttyniemi Eliisa , Ahonen Matti , Gissler Mika , Raitio Arimatias
Published: March 2024

Background:

The etiology and risk factors of congenital vertebral anomalies are mainly unclear in isolated cases. Also, there are no reports on the risk factors for different subgroups of vertebral anomalies. Therefore, we assessed and identified potential maternal risk factors for these anomalies and hypothesized that diabetes, other chronic diseases, smoking, obesity, and medication in early pregnancy would increase the risk of congenital vertebral anomalies.

Methods:

All cases with congenital vertebral anomalies were identified in the Finnish Register of Congenital Malformations from 1997 to 2016 for this nationwide register-based case–control study. Five matched controls without vertebral malformations were randomly selected. Analyzed maternal risk factors included maternal age, body mass index, parity, smoking, history of miscarriages, chronic diseases, and prescription drug purchases in early pregnancy.

Results:

The register search identified 256 cases with congenital vertebral malformations. After excluding 66 syndromic cases, 190 non-syndromic malformations (74 formation defects, 4 segmentation defects, and 112 mixed anomalies) were included in the study. Maternal smoking was a significant risk factor for formation defects (adjusted odds ratio 2.33, 95% confidence interval 1.21–4.47). Also, pregestational diabetes (adjusted odds ratio 8.53, 95% confidence interval 2.33–31.20) and rheumatoid arthritis (adjusted odds ratio 13.19, 95% confidence interval 1.31–132.95) were associated with mixed vertebral anomalies.

Conclusion:

Maternal pregestational diabetes and rheumatoid arthritis were associated with an increased risk of mixed vertebral anomalies. Maternal smoking increases the risk of formation defects and represents an avoidable risk factor for congenital scoliosis.

Level of evidence:

III
How Does the Breastfeeding Environment Affect Satisfaction? A Scale Development Study
Authors: Reyhan Feyza Aktaş , Yeşildere Sağlam Havva , Sayiner Fatma Deniz
Published: March 2024

Background:

Women need a safe and comfortable environment to breastfeed their babies. The quality of breastfeeding environments in social areas is important for women’s breastfeeding satisfaction.

Aim:

The aim of this study was to develop a measurement tool for the evaluation of breastfeeding environments and to examine the impact of the quality of breastfeeding environments in social areas on breastfeeding satisfaction.

Method:

The first phase of the study was conducted in methodological design and the second phase in cross-sectional design. The draft scale was applied to 365 women who had breastfeeding experiences in social environments during the postpartum 6 months–3 years period. In the first stage, scale development analyses were applied. In the second stage, the developed scale was applied to 255 women. Frequency, percentage, Cronbach’s α coefficient, and correlation analysis were used in the analysis of the data.

Results:

The Ideal Breastfeeding Environment Assessment Scale, consisting of 23 items and four subdimensions, was obtained in the study. As a result of the application of the scale in the second stage, the mean score of the breastfeeding environments evaluated by the women was 23.43 ± 8.36. A statistically significant moderate–weak correlation was found between the ideality of breastfeeding environments and the satisfaction levels of women ( p < .001).

Conclusion:

It was determined that the developed scale is a valid and reliable measurement tool that can be used to evaluate breastfeeding environments. As the quality of breastfeeding environments increases, women’s breastfeeding satisfaction increases.
Influence of Teaching Approaches on Senior High School Students’ Mathematical Mindset
Authors: Asante Britwum Bright , Ntow Forster D. , Smith Joseph Andam
Published: March 2024

Reviewing bodies have shown that a high percentage of SHS students tend to underperform in mathematics examinations. In that respect, we examined the influence of two teaching approaches on Ghanaian public Senior High School students’ mathematical mindsets. A quantitative research design was used, that is, an ex post facto research design was used for this study. A total sample of 366 respondents was involved in this study. Two sets of questionnaires were employed for the study which are the students’ perceptions of teaching approaches and mathematical mindset questionnaires. Descriptive analysis such as means and frequencies were used to analyze the data. The results revealed a possible influence of the teaching approaches students experienced and their mathematical mindset. That is, students taught with a student-centered approach were found to generally possess a growth mindset while those identified as possessing a more fixed mindset were mostly students taught using a more teacher-centered approach. The study recommended that teachers should adopt a student-centered approach to teaching since it has the potential to shape students’ mindset toward a strong growth mindset, as students who have a growth mindset are more likely to succeed in school and beyond.
Resection of Calcaneonavicular and Talocalcaneal Coalitions With Surgical Correction of the Hindfoot Valgus Deformity in One Step
Authors: De Pellegrin Maurizio , Marcucci Lorenzo , Brogioni Lorenzo , Fracassetti Dario
Published: March 2024

Background:

Calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions are the most common cause of rigid flatfoot in children. After resection, correction of the most frequent valgus-hindfoot deformity usually requires a second-step surgery. We report results of a retrospective study of patients treated with a one-step correction.

Methods:

Between 2008 and 2019, data were collected on 26 patients (19 male, 7 female) affected by CNC (n = 18) and TCC (n = 13), all with rigid symptomatic flatfeet. Average age at surgery was 12.5 ± 1.1 (SD) years (range, 9.8-15.2). All patients (26/26) underwent resection, 20 of 26 underwent at the same time subtalar extraarticular screw arthroereisis (SESA) for correction of residual hindfoot valgus deformity. Pre- and postoperative talocalcaneal angle according to Costa Bartani and Talar inclination angle in weightbearing were measured. Twenty-five of 26 patients had postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score.

Results:

Pre- and postoperative talocalcaneal average angle for CNC was respectively 141.5 ± 7.7 degrees and 130.5 ± 5.2 degrees ( P < .0001) and 143.7 ± 7.7 degrees and 129.7 ± 7.0 degrees ( P < .0001) for TCC. Talar inclination average angle for CNC was 29.2 ± 5.3 degrees and 19.3 ± 1.6 degrees ( P < .0001) and 31.2 ± 6.4 degrees and 21.4 ± 3.4 degrees ( P < .0001) for TCC. Average follow-up (FU) was 4.7 ± 3.0 years (range, 6 months–11.9 years, median 4.9 years), with a mean age at FU of 17.2 ± 5.8 (SD) years (min 12.1, max 25.3, median 16.8 years). The mean AOFAS ankle-hindfoot score for CNC and for TCC was 96.6 (range 83-100) for resection and valgus correction as one-step procedure with no statistical difference ( P = .5) between CNC and TCC. No patients had additional surgery for complications or recurrence.

Conclusion:

Symptomatic rigid flatfeet affected by CNC and TCC treated with coalition resection and minimally invasive subtalar arthroereisis (SESA) for residual hindfoot valgus correction in one step in adolescent age achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided.

Level of Evidence:

Level IV, retrospective study.
Keratoconus: exploring fundamentals and future perspectives – a comprehensive systematic review
Authors: Niazi Sana , Gatzioufas Zisis , Doroodgar Farideh , Findl Oliver , Baradaran-Rafii Alireza , Liechty Jacob , Moshirfar Majid
Published: March 2024

Background:

New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way.

Objectives:

This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies.

Design:

A multidimensional comprehensive systematic narrative review.

Data sources and methods:

A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed.

Results:

Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes.

Conclusion:

The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients.

Trial registration:

The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338
Healthcare workers’ safety and emotional exhaustion: Exploring the impact of violence and trust in emergency departments
Authors: Özel Mehmet , Balsak Habip , Yıldız Talat
Published: March 2024

Background

In the challenging and often high-stress environment of emergency departments (EDs), healthcare workers (HCWs) frequently encounter a concerning issue of workplace violence (WPV). This study delves into the effects of WPV management and safety on the emotional well-being of ED HCWs.

Methods

Data collected between 15 March 2023 and 15 May 2023 from 186 HCWs across Obstetrics and Gynecology, Pediatrics, and Adult EDs are analyzed. The survey includes the Safety and Confidence Scale (SCS) to gauge HCWs' perceptions of violence and the Job-Related Emotional Exhaustion Scale (JREES).

Results

Key findings highlight the prevalence of various forms of WPV in the ED, such as verbal violence (77.4%), threats, and insults (68.8%), with patients and their relatives identified as the primary perpetrators. Male HCWs scored significantly higher on the Violence Management and Safety (VMS) scale compared to their female counterparts.

Conclusions

In summary, within the demanding ED setting, this study sheds light on the profound impact of WPV on HCWs' emotional exhaustion and their overall sense of safety. It underscores the urgent need to build trust and bolster support mechanisms to alleviate emotional exhaustion among HCWs. Addressing WPV in the ED is paramount for the mental well-being of healthcare workers, particularly when faced with violence from patients and their families.
Endoscopic Repair of Ischial Tuberosity Avulsion Fracture
Authors: Bond Elizabeth C. , Scott Elizabeth J. , Mather Richard C.
Published: March 2024

Background:

The ischial tuberosity apophysis serves as an attachment site for the hamstring muscle complex in the pediatric pelvis. Once the apophysis begins to ossify around age 13 to 15 years, decreasing elasticity makes the physis the weakest part of the hamstring attachment to the pelvis. An avulsion injury of the hamstring muscle group in the adolescent therefore results in a fracture in the adolescent and is the functional equivalent to a 3-tendon proximal hamstring injury in an adult. Ischial tuberosity fractures have a higher rate of non-union than other pelvic apophyseal injuries. Endoscopic surgery offers the advantage of smaller incisions, reduced wound complications, and expedited recovery compared with an open procedure.

Indications:

Controversy exists over which fractures benefit from surgical fixation. Patients with an ischial tuberosity avulsion fracture that is displaced more than 20 mm or that remains symptomatic despite at least 3 months of conservative management are common indications for surgery.

Technique Description:

The patient is positioned in the prone position and under fluoroscopic guidance 2 endoscopic portals are created. The sciatic nerve is visualized, neurolysis performed, and then protected throughout the remainder of the case. The ischial tuberosity is located along with the avulsed apophysis and hamstring tendon. The bony surfaces are prepared. The fracture fragment is reduced and 3 partially threaded cannulated screws are percutaneously passed across the fracture. The interval between the semimembranosus and conjoined tendons was closed with a suture.

Results:

There are no results published specific to this technique. Outcome papers are lacking, but cohort studies show significant displacement increases risk for non-union. Displaced ischial tuberosity fractures are also thought to risk sciatic nerve irritation and decreased hamstring strength.

Discussion/Conclusion:

Recent advancements in periarticular endoscopic surgery of the hip have enabled this historically open procedure to be performed in a minimally invasive fashion. This technique achieves robust fixation of the avulsed fragment and the benefits of anatomic repair of the hamstring origin while avoiding the larger incision and soft tissue dissection required for an open procedure. In time, this technique may become standard of care much like other sports medicine procedures which have transitioned from open to arthroscopic with the development of suitable tools and techniques.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Misinformation and Literacies in the Era of Generative Artificial Intelligence: A Brief Overview and a Call for Future Research
Authors: Chu-Ke Chun , Dong Yujie
Published: March 2024

Misinformation constitutes a societal practice and challenge that necessitates unwavering attention worldwide. In this essay, we discussed the theoretical advancement and empirical evidence in misinformation research, encompassing a review of definitions of misinformation, research orientations, research perspectives, and vulnerable groups. We then reviewed the misinformation fueled by generative artificial intelligence (AI) and the evolving conceptualization of literacy. To counter AI-fueled misinformation, we argue that the development of ethical AI necessitates regulations from AI practitioners and legislation, and ethical uses of AI require efforts in AI literacy education and research. The AI literacy should include (a) users’ understanding and critical evaluation of knowledge, values, and cultures within which AI systems function, and their implications on the AI-generated content, (b) users’ strategic interpretation and proper use of AI-generated content, and (c) users’ utilization of feedback mechanisms to promote institutional management of the AI power.
Perceptions of Communication and Mobility Recovery Among Stroke Survivors With and Without Aphasia
Authors: Smith Rhiannon M. , Schliep Megan E. , Plummer Prudence
Published: March 2024

Self-perceived recovery after stroke can substantially impact quality of life. Yet, a disability paradox exists whereby disability and perceived recovery do not align. This study explored stroke survivors’ perceptions of their communication and mobility recovery, including perceived facilitators and barriers. Potential differences between the experiences of participants with aphasia (PWA) and participants without aphasia (PWOA) were also examined to explore the impact of communication disability on recovery experience. Semi-structured interviews were conducted with 17 adults with stroke 3 months after discharge from inpatient rehabilitation. Qualitative data in the form of interview transcripts were analyzed using thematic content analysis. Participants described their communication recovery primarily in terms of word-finding difficulty and slowed language formulation; they described their mobility recovery in terms of their ability to walk, their use of an assistive device, or their ability to participate in pre-stroke activities. Facilitators to recovery were described in the areas of (1) family involvement, (2) rehabilitation services and professionals, (3) personal factors, and (4) the need for self-reliance. Barriers were expressed in the domains of (1) physical difficulties, (2) communication difficulties, and (3) psychological difficulties. Key findings from this study include perceived needs for a high intensity of rehabilitation, earlier implementation of communication partner training for families of stroke survivors with communication impairments, and consideration of factors outside of stroke when tailoring intervention to the individual. Overall, these findings suggest a continued need for individuation rather than standardization of care, with an eye to both impairment and broader quality of life factors.
The circus of liberation: Clowning as social creativity in insane clown posse's dark carnival
Authors: Begg Nat
Published: March 2024

The Detroit band Insane Clown Posse (ICP) and their fan subculture of ‘Juggalos’ have created an alternative culture with its own symbolism, rituals, and forms of kinship, called the ‘Dark Carnival’. This article connects ICP and the Juggalo subculture to the cross-cultural study of clowning in European and Indigenous North American and Oceanian societies. It is argued that ICP and the Juggalos use clowning as a creative method to develop new ways of living and being and mount liberatory political challenges within an egalitarian counter-cultural space. ICP's clowning is situated within the post-industrial Rust Belt and is posed in relation to economic grievances, masculinity, class, Whiteness, and intergenerational violence. Clowned forms of performative violence are used in lyrics and rituals to create a communitarian ethos of ‘Juggalo family’ which accepts participants unconditionally, rejects actual violence, and eschews social taboos in favour of creating its own symbols and norms.
Factors most strongly associated with breathlessness in a population aged 50–64 years
Authors: Olsson Max , Björkelund Anders J. , Sandberg Jacob , Blomberg Anders , Börjesson Mats , Currow David , Malinovschi Andrei , Sköld Magnus , Wollmer Per , Torén Kjell , Östgren Carl Johan , Engström Gunnar , Ekström Magnus
Published: March 2024

Background

Breathlessness is a troublesome and prevalent symptom in the population, but knowledge of related factors is scarce. The aim of this study was to identify the factors most strongly associated with breathlessness in the general population and to describe the shapes of the associations between the main factors and breathlessness.

Methods

A cross-sectional analysis was carried out of the multicentre population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) of adults aged 50 to 64 years. Breathlessness was defined as a modified Medical Research Council breathlessness rating ≥2. The machine learning algorithm extreme gradient boosting (XGBoost) was used to classify participants as either breathless or nonbreathless using 449 factors, including physiological measurements, blood samples, computed tomography cardiac and lung measurements, lifestyle, health conditions and socioeconomics. The strength of the associations between the factors and breathlessness were measured by SHapley Additive exPlanations (SHAP), with higher scores reflecting stronger associations.

Results

A total of 28 730 participants (52% women) were included in the study. The strongest associated factors for breathlessness were (in order of magnitude): body mass index ( SHAP score 0.39), forced expiratory volume in 1 s (0.32), physical activity measured by accelerometery (0.27), sleep apnoea (0.22), diffusing lung capacity for carbon monoxide (0.21), self-reported physical activity (0.17), chest pain when hurrying (0.17), high-sensitivity C-reactive protein (0.17), recent weight change (0.14) and cough (0.13).

Conclusion

This large population-based study of men and women aged 50–64 years identified the main factors related to breathlessness that may be prevented or amenable to public health interventions.
START CARE: a protocol for a randomised controlled trial of step-wise budesonide–formoterol reliever-based treatment in children
Authors: Barry Tasmin , Holliday Mark , Sparks Jenny , Biggs Rowan , Colman Atalie , Lamb Rebekah , Oldfield Karen , Shortt Nick , Kerse Kyley , Martindale John , Eathorne Allie , Walton Michaela , Black Bianca , Harwood Matire , Bruce Pepa , Semprini Ruth , Bush Andrew , Fleming Louise , Byrnes Catherine A. , McNamara David , Hatter Lee , Dalziel Stuart R. , Weatherall Mark , Beasley Richard
Published: March 2024

Background

Asthma is the most common chronic childhood respiratory condition globally. Inhaled corticosteroid (ICS)–formoterol reliever-based regimens reduce the risk of asthma exacerbations compared with conventional short-acting β2-agonist (SABA) reliever-based regimens in adults and adolescents. The current limited evidence for anti-inflammatory reliever therapy in children means it is unknown whether these findings are also applicable to children. High-quality randomised controlled trials (RCTs) are needed.

Objective

The study aim is to determine the efficacy and safety of budesonide–formoterol reliever alone or maintenance and reliever therapy (MART) compared with standard therapy: budesonide or budesonide–formoterol maintenance, both with terbutaline reliever, in children aged 5 to 11 years with mild, moderate and severe asthma.

Methods

A 52-week, multicentre, open-label, parallel group, phase III, two-sided superiority RCT will recruit 400 children aged 5 to 11 years with asthma. Participants will be randomised 1:1 to either budesonide–formoterol 100/6 µg Turbuhaler reliever alone or MART; or budesonide or budesonide–formoterol Turbuhaler maintenance, with terbutaline Turbuhaler reliever. The primary outcome is moderate and severe asthma exacerbations as rate per participant per year. Secondary outcomes are asthma control, lung function, exhaled nitric oxide and treatment step change. Assessment of Turbuhaler technique and cost-effectiveness analysis are also planned.

Conclusion

This will be the first RCT to compare the efficacy and safety of a step-wise budesonide–formoterol reliever alone or MART regimen with conventional inhaled ICS or ICS–long-acting β-agonist maintenance plus SABA reliever in children. The results will provide a much-needed evidence base for the treatment of asthma in children.
Enhancing COPD classification using combined quantitative computed tomography and texture-based radiomics: a CanCOLD cohort study
Authors: Makimoto Kalysta , Hogg James C. , Bourbeau Jean , Tan Wan C. , Kirby Miranda ,   the CanCOLD Collaborative Research Group
Published: March 2024

Background

Recent advances in texture-based computed tomography (CT) radiomics have demonstrated its potential for classifying COPD.

Methods

Participants from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study were evaluated. A total of 108 features were included: eight quantitative CT (qCT), 95 texture-based radiomic and five demographic features. Machine-learning models included demographics along with texture-based radiomics and/or qCT. Combinations of five feature selection and five classification methods were evaluated; a training dataset was used for feature selection and to train the models, and a testing dataset was used for model evaluation. Models for classifying COPD status and severity were evaluated using the area under the receiver operating characteristic curve (AUC) with DeLong's test for comparison. SHapely Additive exPlanations (SHAP) analysis was used to investigate the features selected.

Results

A total of 1204 participants were evaluated (n=602 no COPD; n=602 COPD). There were no differences between the groups for sex (p=0.77) or body mass index (p=0.21). For classifying COPD status, the combination of demographics, texture-based radiomics and qCT performed better (AUC=0.87) than the combination of demographics and texture-based radiomics (AUC=0.81, p<0.05) or qCT alone (AUC=0.84, p<0.05). Similarly, for classifying COPD severity, the combination of demographics, texture-based radiomics and qCT performed better (AUC=0.81) than demographics and texture-based radiomics (AUC=0.72, p<0.05) or qCT alone (AUC=0.79, p<0.05). Texture-based radiomics and qCT features were among the top five features selected (15th percentile of the CT density histogram, CT total airway count, pack-years, CT grey-level distance zone matrix zone distance entropy, CT low-attenuation clusters) for classifying COPD status.

Conclusion

Texture-based radiomics and conventional qCT features in combination improve machine‑learning models for classification of COPD status and severity.
RNA-seq analysis reveals changes in mRNA expression during development in Daphnia mitsukuri
Authors: Zhang Xiuping , Yang Wenwu , Blair David , Hu Wei , Yin Mingbo
Published: March 2024

Temporal transcriptional variation is a major contributor to functional evolution and the developmental process. Parthenogenetic water fleas of the genus Daphnia (Cladocera) provide an ideal model to characterize gene expression patterns across distinct developmental stages. Herein, we report RNA-seq data for female Daphnia mitsukuri at three developmental stages: the embryo, juvenile (three timepoints) and adult. Comparisons of gene expression patterns among these three developmental stages and weighted gene co-expression network analysis based on expression data across developmental stages identified sets of genes underpinning each of the developmental stages of D. mitsukuri. Specifically, highly expressed genes (HEGs) at the embryonic developmental stage were associated with cell proliferation, ensuring the necessary foundation for subsequent development; HEGs at the juvenile stages were associated with chemosensory perception, visual perception and neurotransmission, allowing individuals to enhance detection of potential environmental risks; HEGs at the adult stage were associated with antioxidative defensive systems, enabling adults to mount an efficient response to perceived environmental risks. Additionally, we found a significant overlap between expanded gene families of Daphnia species and HEGs at the juvenile stages, and these genes were associated with visual perception and neurotransmission. Our work provides a resource of developmental transcriptomes, and comparative analyses that characterize gene expression dynamics throughout development of Daphnia.
Characteristics of infections with ancestral, Beta and Delta variants of SARS-CoV-2 in the PHIRST-C community cohort study, South Africa, 2020-2021
Authors: Cohen Cheryl , Kleynhans Jackie , von Gottberg Anne , McMorrow Meredith L. , Wolter Nicole , Bhiman Jinal N. , Moyes Jocelyn , du Plessis Mignon , Carrim Maimuna , Buys Amelia , Martinson Neil A. , Kahn Kathleen , Tollman Stephen , Lebina Limakatso , Wafawanaka Floidy , du Toit Jacques , Gómez-Olivé Francesc Xavier , Dawood Fatimah S. , Mkhencele Thulisa ,   for the PHIRST group, Tempia Stefano
Published: March 2024

Background

Data on the characteristics of individuals with mild and asymptomatic infections with different SARS-CoV-2 variants are limited. We therefore compared the characteristics of individuals infected with ancestral, Beta and Delta SARS-CoV-2 variants in South Africa.

Methods

We conducted a prospective cohort study in a rural and an urban site during July 2020-August 2021. Mid-turbinate nasal swabs were collected twice-weekly from household members irrespective of symptoms and tested for SARS-CoV-2 using real-time reverse transcription polymerase chain reaction (rRT-PCR). Differences in demographic and clinical characteristics, shedding and cycle threshold (Ct) value of infection episodes by variant were evaluated using multinomial regression. Overall and age-specific incidence rates of infection were compared by variant.

Results

We included 1200 individuals from 222 households and 648 rRT-PCR-confirmed infection episodes (66, 10% ancestral, 260, 40% Beta, 322, 50% Delta). Symptomatic proportion was similar for ancestral (7, 11%), Beta (44, 17%), and Delta (46, 14%) infections (p=0.4). After accounting for previous infection, peak incidence shifted to younger age groups in successive waves (40-59 years ancestral, 19-39 years Beta, 13-18 years Delta). On multivariable analysis, compared to ancestral, Beta infection was more common in individuals aged 5-12 years (vs 19-39)(adjusted odds ratio (aOR) 2.6, 95% confidence interval (CI)1.1-6.6) and PCR cycle threshold (Ct) value <30 (vs >35)(aOR 3.2, 95%CI 1.3-7.9), while Delta was more common in individuals aged <5 (aOR 6.7, 95%CI1.4-31.2) and 5-12 years (aOR 6.6 95%CI2.6-16.7)(vs 19-39) and Ct value <30 (aOR 4.5, 95%CI 1.3-15.5) and 30-35 (aOR 6.0, 95%CI 2.3-15.7)(vs >35).

Conclusions

Consecutive SARS-CoV-2 waves with Beta and Delta variants were associated with a shift to younger individuals. Beta and Delta infections were associated with higher peak viral loads, potentially increasing infectiousness.
The kidney histopathological spectrum of patients with kidney injury following snakebite envenomation in India: scoping review of five decades
Authors: Meena Priti , Bhargava Vinant , Gupta Pallav , Panda Sandip , Bhaumik Soumyadeep
Published: March 2024

Introduction

Snakebite is a public health problem leading to about 58,000 deaths every year in India. Kidney injury subsequent to snakebite envenomation is common with a reported prevalence of up to 32%. The current study aims to elucidate the spectrum of kidney histopathology in acute kidney injury (AKI) cases associated with snake bites.

Methods

We searched seven electronic database studies to identify studies describing the histopathological findings in the kidney with snakebite envenomation. Two reviewers independently conducted titles and abstract screening as well as full-text evaluation for the final inclusion decision. Data were extracted as per the standardized form. We conducted narrative synthesis. Studies done exclusively on autopsy findings, in vitro studies, and case reports were excluded.

Results

We retrieved 1464 studies and finally included 28 studies which met the eligibility criteria in the analysis. Most studies were single-centre and the majority were cross-sectional. Overall we included a total of 534 renal biopsies. Russell’s viper bite was the most common cause related to AKI. Acute tubular necrosis was the most common finding followed by acute interstitial nephritis, acute cortical necrosis (ACN), and thrombotic microangiopathy (TMA). Vasculitis changes in vessels were rarely reported. Lesions such as ACN and TMA were associated with poor outcomes.

Conclusion

This analysis supports the notion that renal biopsies are important to guide prognosis and increase our knowledge about post-snake bite AKI pathophysiology.
Can low-dose intravenous immunoglobulin be an alternative to high-dose intravenous immunoglobulin in the treatment of children with newly diagnosed immune thrombocytopenia: a systematic review and meta-analysis
Authors: Ren Xiangge , Zhang Miaomiao , Zhang Xiaohan , Zhao Peidong , Zhai Wensheng
Published: March 2024

Intravenous immunoglobulin (IVIg) is a first-line treatment for children with newly diagnosed immune thrombocytopenia (ITP). Higher doses of IVIg are associated with a more insupportable financial burden to pediatric patients’ families and may produce more adverse reactions. Whether low-dose IVIg (LD-IVIg) can replace high-dose IVIg (HD-IVIg) has yet to be established. We conducted a comprehensive literature search from the establishment of the database to May 1, 2023, and eventually included 22 RCTs and 3 cohort studies compared different dosages of IVIg. A total of 1989 patients were included, with 991 patients in the LD-IVIg group and 998 patients in the HD-IVIg group. Our results showed no significant differences between the two groups in the effective rate (LD-IVIg: 91% vs. HD-IVIg: 93%; RR: 0.99; 95%CI: 0.96–1.02) and the durable remission rate (LD-IVIg: 65% vs. HD-IVIg: 67%; RR: 0.97; 95%CI: 0.89–1.07). Similar results were also found in the time of platelet counts (PC) starting to rise (MD: 0.01, 95%CI: -0.06–0.09), rising to normal (MD: 0.16, 95%CI: -0.03–0.35), and achieving hemostasis (MD: 0.11, 95%CI: -0.02–0.23) between the two groups. Subgroup analysis showed the effective rate of 0.6 g/kg was equal to 1 g/kg subgroup (91%) but higher than 0.8 g/kg subgroup (82%), and a combination with glucocorticoid may contribute to effect enhancement (combined with glucocorticoid: 91% vs. IVIg alone: 86%) whether combined with dexamethasone (92%) or methylprednisolone (91%). Besides, the incidence rate of adverse reactions in the LD-IVIg group (3%) was significantly lower than the HD-IVIg group (6%) (RR: 0.61; 95%CI: 0.38–0.98). So low-dose IVIg (≤ 1 g/kg) is effective, safe, and economical, which can replace high-dose IVIg (2 g/kg) as an initial treatment. This systematic review was registered in PROSPERO (CRD42022384604).
A review of the current policies and guidance regarding Apgar scoring and the detection of jaundice and cyanosis concerning Black, Asian and ethnic minority neonates
Authors: Furness Amy , Fair Frankie , Higginbottom Gina , Oddie Sam , Soltani Hora
Published: March 2024

Background

Ethnic inequalities in maternal and neonatal health in the UK are well documented. Concerns exist regarding the use of skin colour in neonatal assessments. Healthcare professionals should be trained to recognise symptoms of diverse skin tones, and comprehensive, and inclusive guidance is necessary for the safe assessment of all infants. Disparities in healthcare provision have been emphasised during the COVID-19 pandemic, and additional research is needed to determine whether such policies adequately address ethnic minority neonates.

Methods

A desktop search included searches of guidance produced for the United Kingdom (UK). Further searches of the Cochrane and World Health Organization (WHO) were used to identify any international guidance applicable in the UK context.

Results

Several policies and one training resource used descriptors ‘pink,’ ‘pale,’ ‘pallor,’ and ‘blue’ about neonatal skin and mucous membrane colour. No policies provided specific guidance on how these colour descriptors may appear in neonates with different skin pigmentation. Only the NICE guidance and HEE e-learning resource acknowledged the challenges of assessing jaundice in infants with diverse skin tones, while another guideline noted differences in the accuracy of bilirubin measurements for the assessment of jaundice. Three policies and one training resource advised against relying on visual observation of skin colour when diagnosing neonatal conditions. The training resource included images of ethnic minority neonates, although most images included white infants.

Conclusions

Inadequate consideration of ethnicity in UK policy and training perpetuates disparities, leading to inaccurate assessments. A review is needed for inclusivity in neonatal care, regardless of skin pigmentation.
A qualitative study about explanatory models of alcohol use disorder among patients and relatives in a Ugandan mental hospital
Authors: Rudenstrand Hanna , Bäärnhielm Sofie
Published: March 2024

Background

Alcohol use disorder (AUD) is a major clinical problem in Uganda. Explanatory models (EMs) of illness are important as they have consequences for treatment. Clinicians´ knowledge about patients´ EMs can improve understanding of the latter´s perspectives and adapting treatments. There is a lack of African studies about EMs of AUD. The aim of this study was to explore EMs for AUD among hospitalized patients and their relatives at the alcohol and drug unit (ADU) at Butabika hospital in Uganda.

Methods

An adapted version of the Explanatory Model Interview Catalogue (EMIC) was used for interviews with ten patients and five relatives to investigate how both hospitalized patients with AUD and their relatives understand the disease. Data were analysed for themes with a qualitative content analysis and support of the software program, OpenCode 4.03.

Results

Five major themes were identified from the patient interviews: “Context promotes AUD”; “Alcohol is part of culture”; “Spiritual causes of AUD in the community”; “Help through Western medicine and religious sources is preferred” and “Social problems and stigmatization”. Six major themes identified from the interviews with relatives were: “Numerous causes of drinking alcohol”; “Devastating consequences of drinking alcohol”; “Exploiting persons with AUD”; “Others’ suffering”; “Relatives struggling for help” and “Suggested solutions”.

Conclusions

Patients’ EMs of AUD included social and spiritual explanations. Alcohol is seen as an important part of the Ugandan culture among both patients and their relatives. The results indicate it is important in clinical contexts to investigate the EMs of the patients and relatives to individually tailor treatment interventions.
Prevalence and correlates of hazardous alcohol drinking and drug use among female sex workers and men who have sex with men in Mozambique
Authors: Semá Baltazar Cynthia , Muleia Rachid , Ribeiro Banze Auria , Boothe Makini
Published: March 2024

Background

Hazardous drinking and drug consumption are associated with an increased risk of HIV due to the complex interplay of factors influencing decision-making capability, stigma and social marginalization. In this study, we explore the patterns of hazardous alcohol and drug use and correlates of risk factors among female sex workers (FSW) and men who as sex with men (MSM) in Mozambique.

Methods

We conducted a secondary data analysis of bio-behavioral surveys (BBS) among FSW and MSM using a respondent-driven sampling methodology conducted in five main urban areas of Mozambique from 2019 to 20. The survey included a standardized questionnaire, where hazardous drinking was assessed (using AUDIT-C scores ≥ 4 for men, ≥ 3 for women) and drug use in the last year (FSW). Chi-squared test was used to analyze the association between socio-demographic and behavioral variables, and multivariate logistic regression measured the impact of the associated factors.

Results

The prevalence of hazardous alcohol drinking was 47.1% (95% CI:44.8–49.5) for FSW and 46.5 (95% CI: 44.0–49.0) for MSM. Current drug use was reported in 13.3% of FSW. FSW engaging in hazardous alcohol drinking reported more sexual partners in the last month than those no reporting hazardous alcohol use (55.3% vs. 47,1%, p < 0.001), higher rates of self-reported STIs in the last year (62,5% vs. 48,2%, p < 0.001), physical (53.5% vs. 46.7%, p < 0.0001) and sexual violence (54.7% vs. 44.2%, p < 0.001), and HIV prevalence (55.2% vs. 44.2 p < 0.001). Among MSM with hazardous alcohol drinking, there was a higher prevalence of self-reported STIs (52.8% vs. 45.4%, p < 0.001), experiences of sexual violence (18.0% vs. 8.3%, p < 0.001), and HIV prevalence (53.0% vs. 46.3%, p < 0.001). In addition, FSW who reported illicit drug use were more likely to self-reported HIV own risk (14.2% vs. 9.7%), early start sexual activity (15.4% vs. 5.3%), self-reported STIs (17.9% vs. 10.2%), and experiences of both physical (17.4% vs. 7.0%) and sexual violence (18.6% vs. 8.9%).

Conclusion

There is an immediate need for the introduction and integration of comprehensive substance use harm mitigation and mental health interventions into HIV prevention programs, particularly those targeting key populations in Mozambique.
The burden of Cardiovascular diseases in Jordan: a longitudinal analysis from the global burden of disease study, 1990–2019
Authors: Al-Ajlouni Yazan A. , Al Ta’ani Omar , Shamaileh Ghaith , Nagi Yazan , Tanashat Mohammad , Al-Bitar Farah , Duncan Dustin T. , Makarem Nour
Published: March 2024

Background

Cardiovascular Disease (CVD) is the leading cause of mortality worldwide. While countries in the Arab world continue to lack public health data and be severely understudied in health research, previous research has shown that compared to 1990, CVDs had a higher burden of disease in the Arab World in 2010. Jordan, a middle-income Arab country, is profiled with unique attributes such as a dual-sector healthcare system, political stability, and its role as a haven for refugees and migrants. These distinctive factors emphasize Jordan’s suitability as a case study. This investigation aims to quantify CVD burden in Jordan and identify risk factors, contributing to a broader understanding of health challenges in the Arab region and beyond.

Methods

The Global Burden of Disease (GBD) dataset was used to estimate prevalence, death, and disability-adjusted life-years (DALYs) as age-standardized rates from 1990 to 2019. We calculated percentage change for nine specific CVDs and reported trends by gender and age groups. Additionally, data on twelve a priori selected behavioral, clinical, and environmental risk factors attributing to overall age-standardized CVDs DALY were reported per 100,00 population.

Results

In 2019, the age-standardized CVD prevalence, death, and DALYs rates in Jordan were 7980 (95% uncertainty interval [UI] 7629, 8360), 248 (95% UI 211, 288), and 4647 (95% UI 4028, 5388), respectively. Despite an increase in the absolute number of mortality and prevalence, between 1990 and 2019, the age-standardized prevalence, death, and DALYs rates all decreased by 5.5%, 45.1%, and 46.7%, respectively. In 2019, the leading risk factors contributing to overall age-standardized CVDs DALY per 100,000 population were high systolic blood pressure, high BMI, dietary risks, and high LDL cholesterol.

Conclusion

Despite decreasing burden rate of CVDs in Jordan between 1990 and 2019, CVDs remain the leading cause of mortality in Jordan, with an increase in the total number of prevalence and mortality. Overall, this contributes to increased healthcare costs. Further research is required to quantify the burden of CVDs and understand it better. Intervention measures and policies tailored to specific CVDs should be designed to reduce the burden of CVDs in Jordan.
Risk of diabetes and hypertension in a population with alcohol use disorders
Authors: Tseng Pei-Ying , Sung Fung-Chang , Muo Chih-Hsin , Lan Yu-Ching , Hser Yih-Ing , Chien Sarina Hui-Lin , Wang Jong-Yi
Published: March 2024

Background

A population-based follow-up study assessing the risk of developing hypertension and diabetes associated with alcohol use disorder (AUD) is crucial. We investigated this relationship by using insurance claims data from Taiwan.

Methods

From the claims data, an AUD cohort (N = 60,590) diagnosed between 2000 and 2006 and a non-AUD comparison cohort (N = 60,590) without the diagnosis of hypertension or diabetes at baseline were established and matched by propensity scores estimated by baseline demographic status and the Charlson comorbidity index (CCI). We assessed the incidence rates of hypertension and/or diabetes at the end of 2016 and used Cox’s method to estimate the related hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

Relative to the comparison cohort, the AUD cohort had an approximately 1.70-fold higher incidence of hypertension (35.1 vs. 20.7 per 1,000 person-years), with an adjusted HR (aHR) of 1.72 (95% CI: 1.68–1.76), 2.16-fold higher incidence of diabetes (20.2 vs. 9.36 per 1,000 person-years), with an aHR of 2.18 (95% CI: 2.11–2.24), and 1.91-fold higher incidence of both diabetes and hypertension (10.3 vs. 5.38 per 1,000 person-years) with an aHR of 2.02 (95% CI: 1.94–2.10). The incidence rates of all outcomes were greater in men than in women, whereas the HRs were greater for AUD in women than for AUD in men relative to the respective comparison patients. The risk increased further for subjects with CCI ≥ 1, which was higher in the AUD cohort.

Conclusions

The increased risk of developing diabetes and hypertension in patients with AUD, especially the differences noted according to gender, indicates that clinicians should address potential comorbidities in these patients.
The role of collectivism, liberty, COVID fatigue, and fatalism in public support for the zero-COVID policy and relaxing restrictions in China
Authors: Wang Xiao
Published: March 2024

Background

China was the last country in the world to relax COVID-19 restrictions. A successful public health policy requires public support. This analysis examined the factors associated with Chinese support for zero-COVID and relaxing COVID-19 restrictions in China.

Method

Two online surveys were conducted among Chinese participants in mainland China on June 10–13 (N = 460) and December 2, 2022 (N = 450). These two samples were similar based on the participants’ demographics.

Results

The results revealed that the perceived health consequences of a COVID-19 policy, perceived norms of approving a COVID-19 policy, and hope positively predicted the participants’ support for the COVID-19 policy. The results further showed that collectivism and fatalism positively predicted support for zero-COVID and negatively predicted support for relaxing restrictions. COVID fatigue was negatively associated with support for zero-COVID and positively associated with support for relaxing restrictions. Liberty positively predicted support for relaxing restrictions in June and negatively predicted zero-COVID in December 2023. It did not positively or negatively predict support for the policy adopted by the government.

Conclusion

Collectivism, liberty, COVID fatigue, and fatalistic beliefs are important considerations connected to public support for a COVID-19 policy. The role of liberty was more nuanced and depended on the survey’s time and whether the government adopted the policy.