bluuebunny/crossref_metadata_2025 huggingface dataset:
Aboriginal Community Controlled Health Organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia.
Authors: Pearson Odette , Schwartzkopff Kate , Dawson Anna , Hagger Christina , Karagi Agape , Davy Carol , Brown Alex , Braunack-Mayer Annette
Published: November 2020

Background: Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented. Methods: The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health was developed . A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings. Results: Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes. Conclusions: This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.
Qualitative views of Nigerian School Principals and Teachers on the barriers and opportunities for promoting students’ physical activity behaviour within the school settings
Authors: Oluwasanu Mojisola , Oladepo Oladimeji , Ibitoye Segun Emmanuel
Published: November 2020

Background: Insufficient physical activity is a growing public health challenge among Nigerian adolescents. Significant information gap exists on the school-related factors and its implication on the school-based physical activity participation of adolescents in Nigeria. This study was conducted to document the qualitative views of school principals and teachers on the barriers and opportunities for promoting the physical activity behaviours of adolescents within the school settings in light of the socio-ecological model. Methods: This was a qualitative study conducted in 12 public and private schools in two local government areas of Oyo state, Nigeria. Two key sources and data collection methods (i.e key informant interviews and focus group discussions) were used. Six key informant interviews were held with school principals and six focus group discussions with classroom teachers using pre-tested guides. Data was analysed using thematic analysis. Results: Fourteen sub-themes were identified as barriers to PA and linked to different levels of the socio-ecological model. Three themes were categorized as parental factors, three themes as socio-cultural and religious factors while the school-related factors had eight sub-themes. Specifically, the school related barriers were the declining number of trained physical health education teachers, limited opportunities for continuing education and low prioritisation of physical health education. Other school-related factors such as increasing demand for classroom academic time, negative attitudinal dispositions of other teachers and inadequate funding for schools which hampered the provision of facilities and equipment were identified as factors that limit the effective implementation of policies and programs for physical activity in schools. Opportunities to promote PA within the school settings during assemblies, breaktime, after-school and inter house sports competition exists. However; these opportunities are hampered by competing academic time, security threats, fear of causalities to students due to poor supervision after school, poor funding and brawling associated with competitive school-based sporting events. Conclusions: Factors that contribute to insufficient physical activity among in-school adolescents in the school settings are multifactorial. Implementation of holistic, multi-component interventions which address the social-cultural and school-level factors and enhance students’ opportunities for physical activity in schools are recommended.
Patterns and Correlates of Mis-implementation in State Chronic Disease Public Health Practice in the United States
Authors: Padek Margaret , Mazzucca Stephanie , Allen Peg , Weno Emily Rodriguez , Tsai Edward , Luke Douglas A. , Brownson Ross C.
Published: November 2020

Background: Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Methods: A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman’s correlation and multinomial logistic regression were used to assess factors in mis-implementation. Results: Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40). Conclusion: The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.
Snapshot of narcotic drugs and psychoactive substances in Kuwait: a qualitative analysis of illicit drugs and their associated mortality in Kuwait from 2015 to 2018
Authors: Al-Matrouk Abdullah , Al-Hasan Mohammed , Naqi Husain A , Al-Abkal Neamat , Mohammed Hanan , Haider Meshaal , Al-Shammeri Dalal , Bojbarah Haider
Published: November 2020

Background: The misuse of illicit substances is associated with increased morbidity and mortality; thus, substance abuse is a global health concern. However, a lack of laboratory-based research has limited the scientific assessment of drug misuse in the Arabian Gulf region. Thus, the primary aim of this study was to assess the problem of illicit drugs in Kuwait using laboratory-based analyses. Methods: We investigated the type and quantity of detained narcotic drugs and psychotropic substances from 2015 to 2018, number of abusers, and mortality among abusers. In total, 6220 cases from the Narcotic and Psychotropic Laboratory and 17,755 cases from the Forensic Toxicology Laboratory were reviewed and analyzed. Substances were identified and documented using gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry. Results: Cannabis, including marijuana, was the most seized substance, followed by heroin, opium, and cocaine. Amphetamines, including methamphetamine, in the form of powder or pills, were seized in larger quantities than other psychoactive substances. Benzodiazepines, tramadol, Khat, synthetic cannabinoids, and psilocin were also seized. The most consumed substances were, in order, amphetamines (including methamphetamine), benzodiazepines, cannabis, and heroin. Drug misuse was considerably higher among men than among women. We report the death rate associated with the abuse of various illegal drugs according to sex. The mortality rate associated with single-drug use was the highest among abusers of heroin, benzodiazepines, and methamphetamine. The mortality rate asscoaited with multiple-drug use was the highest among abusers of heroin–benzodiazepines, cannabis–benzodiazepines, and cannabis–amphetamines. Conclusions: Our study shows the changing trends in quantity and variety of substances illegally abused and marketed in Kuwait. Additionally, we report a direct gender-based association between mortality and consumption of certain substances. These findings suggest that there is a growing need to conduct larger scale studies to implement new strategies, policies, and interventions in populations affected by illicit drugs.
Effectiveness of a Breastfeeding Program for Mothers Returning to Work in Japan: a quasi-experiment study
Authors: Nakada Kaori
Published: November 2020

Background: Maternal employment has been described as a barrier to breastfeeding in many countries. In Japan, many mothers quit breastfeeding after returning to work because they do not know how to continue breastfeeding. The primary objective of this study was to investigate the effectiveness of a breastfeeding support program for mothers. The secondary objective was to explore the effectiveness of a pamphlet for mothers returning to work.Methods: This was a quasi-experimental design study with a program group (n=48), pamphlet group (n=46) and comparison group (n=47) that took place from February 2017 to August 2018. Participants in the program and pamphlet groups were women who planned to return to work within 4–12 months after giving birth, while the comparison group included women who had been back at work for at least 3 months. The program involved a 90-min breastfeeding class, a pamphlet, a newsletter, and email consultation. The pamphlet group was sent only the pamphlet, while the comparison group received no intervention. The outcome was breastfeeding continuation rate at 3 months after returning to work.Results: The breastfeeding continuation rate 3 months after returning to work was significantly higher in the program group than in the comparison group (79.2% vs. 51.1%, p=0.004). After adjusting for background factors, the program intervention had an effect on breastfeeding rates (adjusted odds ratio=4.68, 95% confidence interval: 1.57, 13.96; p=0.006). However, comparing the pamphlet and comparison groups revealed no significant differences in breastfeeding continuation rates at 3 months after returning to work (69.6% vs. 51.1%, p=0.07).Conclusions: Program intervention was associated with a significant increase in breastfeeding continuation rates 3 months after returning to work. Randomized controlled trials are needed to make this program applicable in practice. Pamphlet intervention resulted in no significant difference. Further study is necessary after examining the contents of the pamphlet.
Screening and selection strategy for the establishment of biosimilar to trastuzumab-expressing CHO-K1 cell lines
Authors: Lao-González Thailín , Soler Alexi Bueno , Hernandez Arnelys Duran , Aguiar Katya Sosa , Puerta Luis Eduardo Hinojosa , Garcia Tays Hernandez , Hernandez Kathya Rashida de la Luz , Oliva Julio Palacios , Ayo Tammy Boggiano
Published: November 2020

The high prices of biopharmaceuticals or biologics used in the treatment of many diseases limit the access of patients to these novel therapies. One example is the monoclonal antibody trastuzumab, successfully used for breast cancer treatment. An economic alternative is the generation of biosimilars to these expensive biopharmaceuticals. Since antibody therapies may require large doses over a long period of time, robust platforms and strategies for cell line development are essential for the generation of recombinant cell lines with higher levels of expression. Here, we obtained trastuzumab-expressing CHO-K1 cells through a screening and selection strategy that combined the use of host cells pre-adapted to protein-free media and suspension culture and lentiviral vectors. The results demonstrated that the early screening strategy obtained recombinant CHO-K1 cell populations with higher enrichment of IgG-expressing cells. Moreover, the measurement of intracellular heavy chain polypeptide by flow cytometry was a useful metric to characterize the homogeneity of cell population, and our results suggest this could be used to predict the expression levels of monoclonal antibodies in early stages of cell line development. Additionally, we propose an approach using 25cm2 T-flasks in suspension and shaking culture conditions as a screening tool to identify high producing cell lines. Finally, trastuzumab-expressing CHO-K1 clones were generated and characterized by batch culture, and preliminary results related to HER2-recognition capacity were successful. Further optimization of elements such as gene optimization, vector selection, type of amplification/selection system, cell culture media composition, in combination with this strategy will allow obtaining high producing clones.
Phenotypic characterization of X-linked hypophosphatemia in pediatric Spanish population.
Authors: Rodríguez-Rubio Enrique , Gil-Peña Helena , Chocrón Sara , Madariaga Leire , Cerda-Ojeda Francisco De la , Fernández-Fernández Marta , de Lucas-Collantes Carmen , Gil Marta , Luis-Yanes Mª Isabel , Vergara Inés , González-Rodríguez Juan David , Ferrando Susana , Gamero Montserrat Antón , Hidalgo-Barquero Marta Carrasco , Fernández-Escribano Angustias , Fernández-Maseda Mª Ángeles , Espinosa Laura , Oliet Aniana , Vicente Antonio , Ariceta Gema , Santos Fernando
Published: November 2020

BACKGROUNDX-Linked hypophosphatemia (XLH) is a hereditary rare disease caused by loss-of-function mutations in PHEX gene leading tohypophosphatemia and high renal loss of phosphate. Rickets and growth retardation are the major manifestations of XLH in children, but there is a broad phenotypic variability. Few publications have reported large series of patients. Current data on the clinical spectrum of the disease, the correlation with the underlying gene mutations, and the long-term outcome of patients on conventional treatment are needed, particularly because of the recent availability of new specific medications to treat XLH. RESULTSThe RenalTube database was used to retrospectively analyze 48 Spanish patients (15 men) from 39 different families, ranging from 3 months to 8 years and 2 months of age at the time of diagnosis (median age of 2.0 years), and with XLH confirmed by genetic analysis. Bone deformities, radiological signs of active rickets and growth retardation were the most common findings at diagnosis. Mean (±SEM) height was -1.89 ± 0.19 SDS and 55% (22/40) of patients had height SDS below - 2. All cases had hypophosphatemia, serum phosphate being -2.81 ± 0.11 SDS. Clinical manifestations and severity of the disease were similar in both genders. No genotype – phenotype correlation was found. Conventional treatment did not attenuate growth retardation after a median follow up of 7.42 years (IQR = 11.26; n=26 patients) and failed to normalize serum concentrations of phosphate. Eleven patients had mild hyperparathyroidism and 8 patients nephrocalcinosis.CONCLUSIONSThis study shows that growth retardation and rickets were the most prevalent clinical manifestations at diagnosis in a large series of Spanish pediatric patients with XLH confirmed by mutations in the PHEX gene. Traditional treatment with phosphate and vitamin D supplements did not improve height or corrected hypophosphatemia and was associated with a risk of hyperparathyroidism and nephrocalcinosis. The severity of the disease was similar in males and females.
Identification of a cytosine methyltransferase that improves transformation efficiency in Methylomonas sp. DH-1
Authors: Ren Jun , Lee Hyang-Mi , Thi Thai Duc , Na Dokyun
Published: November 2020

Background: Industrial biofuels and other value-added products can be produced from metabolically engineered microorganisms. Methylomonas sp. DH-1 is a candidate platform for bioconversion that uses methane as a carbon source. Although several genetic engineering techniques have been developed to work with Methylomonas sp. DH-1, the genetic manipulation of plasmids remains difficult because of the restriction-modification (RM) system present in the bacteria. Therefore, the RM system in Methylomonas sp. DH-1 must be identified to improve the genetic engineering prospects of this microorganism.Results: We identified a DNA methylation site, TGGCCA, and its corresponding cytosine methyltransferase for the first time in Methylomonas sp. DH-1 through whole-genome bisulfite sequencing. The methyltransferase was confirmed to methylate the fourth nucleotide of TGGCCA. In general, methylated plasmids exhibited better transformation efficiency under the protection of the RM system than non-methylated plasmids did. As expected, when we transformed Methylomonas sp. DH-1 with plasmid DNA harboring the psy gene, the metabolic flux towards carotenoid increased. The methyltransferase-treated plasmid exhibited an increase in transformation efficiency of 2.5 × 103 CFU/μg (124 %). The introduced gene increased the production of carotenoid by 26 %. In addition, the methyltransferase-treated plasmid harboring anti-psy sRNA gene exhibited an increase in transformation efficiency by 70 % as well. The production of carotenoid was decreased by 40 % when the psy gene was translationally repressed by anti-psy sRNA. Conclusions: Plasmid DNA methylated by the discovered cytosine methyltransferase from Methylomonas sp. DH-1 had a higher transformation efficiency than non-treated plasmid DNA. The RM system identified in this study may facilitate the plasmid-based genetic manipulation of methanotrophs.
Revisiting the continuum of resistance model in the digital age: A comparison of early and delayed respondents to the Norwegian Counties Public Health Survey
Authors: Clarsen Benjamin , Skogen Jens Christoffer , Nilsen Thomas Severinus , Aarø Leif Edvard
Published: November 2020

BackgroundThe continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has not been assessed in a large online population health survey.MethodsRespondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n =4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension.ResultsThe overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%).ConclusionsThere appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.
Continuous glucose monitoring in older people with diabetes receiving home care - A feasibility study
Authors: Larsen Annette Bævre , Hermann Monica , Graue Marit
Published: November 2020

BackgroundHypoglycemic incidents in older people can cause severe health problems, enhance general age-related disabilities and cause frailty. Little is known about incidences of hypoglycemia in older home-dwelling people with diabetes. Thus, the aim of this study was to examine the feasibility of capturing hypoglycemia and issues associated with increased risk of hypoglycemia by use of continuous glucose monitoring (CGM) and standardized questionnaires among older home dwelling individuals with diabetes type 2 receiving home care.MethodsCGM with the Ipro2 blinded monitoring system were performed for five days in six home-dwelling individuals ≥ 75 years diagnosed with diabetes and receiving home care. Demographic (age, gender, living arrangements) and clinical data (diabetes diagnoses and duration, diabetes medication, documented treatment goal, available glycosylated hemoglobin (HbA1c),) were collected from electronic patient records in home care services. Feasibility (ease of use, quality of data, time spent) of standardized questionnaires to identify the risk of hypoglycemia (the McKellar Risk Assessment Tool), risk of malnutrition (the Mini Nutritional Assessment (MNA)), functional status (the Individual-based Statistics for Nursing and Care Services (IPLOS)) and cognitive status (the Mini Mental Status Exam (MMSE)) was also assessed. Questionnaire data was collected by a study nurse in the individuals’ home.ResultsThe practical use of CGM was satisfactory, with no major remarks about discomfort or technical errors, except for one participant with skin reaction (redness). Collecting data with the McKellar Risk Assessment Tool, MNA and IPLOS worked well according to quality of data, time spent and ease of use. The MMSE survey required extensive training of personnel to be conducted.ConclusionThe feasibility study informs an upcoming study on the incidence and risk factors of hypoglycemia in home dwelling older individuals. We will ascertain that personnel who will use the MMSE questionnaire to collect cognitive status and skills are familiar with the tool and adequately educated and trained before study start. The use of blinded CGM in this population was well tolerated and can be used ‘as is’ for future studies.
A qualitative exploration of the factors associated with initiation to methamphetamine use in Iran.
Authors: Sighaldeh Shirin Shahbazi , Zarghami Fatemeh , Shahryari Ali , Mohammadinia Ali , Ebrahimi Mohsen , Jorjani Teimoor , Hamrah Mohammad Shoaib , Charkazi Abdurrahman
Published: November 2020

Background: Crystal (methamphetamine) is a strong stimulant of addictive substances that affects the central nervous system. The consumption of this substance is increasing among teenagers and adult young people in the country. In this matter, one of the practical and important ways to its control is to identify the factors leading to its first use. Thus this paper, explores the factors related to the first crystal use in Golestan province, Iran. Methods: In a qualitative study, 19 crystal users were recruited in the study conducted in Golestan province by snowball sampling from DIC (Drop-In Center) in addiction treatment centers. The interviews were mostly carried out individually with the participants; only one interview was conducted in an addiction treatment camp in the form of a group-focused discussion. Data analysis was implemented through content analysis in MAXQDA 10 software.Results: The mean age of the participants was 35.05± 6.06 years with a range of 23-46 years. Meanwhile, the mean of crystal use period was 7.42 (SD: 3.61) and a range of 1-14 years. Based on the obtained data, the reasons for first crystal use could be categorized in six; 1: "crystal use to other drugs rehabilitation"; 2: "Lack of awareness of the addictive nature of crystal"; 3: “stimulating curiosity in public with crystal-use friends” , 4: affordable and convenient use”, 5: "anti-sleeping effects and increasing work efficiency", and 6: "therapeutic and other misconceptions”". Conclusions: The results indicated that crystal is mostly abused to opium rehabilitation. The lack of awareness and misconceptions about this substance can lead people to crystal use. Therefore, designing public health interventions to increase awareness about negative consequences of crystal use is fundamental to prevent people from abusing it. We suggest designing public health program to promote awareness about health risks of crystal and modifying related misconceptions. Finally, the government can establish policies to mandate sale tax for crystal producers and reduce easy access to crystal especially among youth.
SARS-CoV-2 infection in an advanced Rheumatoid Arthritis patient
Authors: Bazmjoo Ahmadreza , Bagherzadeh Mohammad Aref , Farahmandpoor Farida , Raoofi Rahim , Abdoli Amir
Published: November 2020

Rheumatoid Arthritis (RA) patients usually managed with immunosuppressive agents and they are at a higher risk of infections. There are limited data regarding RA patients with COVID-19. This article reports a RA patient with an acute SARS‐CoV‐2 infection that successfully managed by dose reduction of immunosuppressive medication.
An Approach to Assessing Patient Satisfaction in HCAHPS Databases by Analyses Using Distances.
Authors: Okuda Masumi , Yasuda Akira , Tsumoto Shusaku
Published: November 2020

Background: Patient satisfaction studies have explored domains of patient satisfaction, the determinants of domains, and score differences of domains by patient/hospital characteristics but reports on the structure of patient satisfaction with respect to similarities among domains are scarce.Objective: To explore whether similarities among patient-satisfaction domains are influenced by hospital characteristics by analyses using distances, and to design a model evaluating relationships between the structure of patient satisfaction and hospital characteristics.Methods: Hospital Consumer Assessment of Healthcare Providers and Systems 2012 survey scores and their structural measures from the Hospital Compare website reported the adjusted percentages of scale for each hospital. Contingency tables of nine measures and their ratings were designed based on hospital characteristics, followed by three different analyses using distances - clustering, correspondence analysis and ordinal multidimensional scaling – for robustness to identify homogenous groups with respect to similarities.Results: Of 4,677 hospitals, 3,711 (79.3%) met the inclusion criteria and were analyzed. The measures were divided into three groups plus cleanliness. Certain combinations of these groups were shown to be dependent on hospital characteristics. High value ratings for communication and low value ratings for medication explanation, quietness and staff responsiveness were not influenced by hospital characteristics, but the varied-ratings domain group similarities, including items such as global evaluation and pain management, were affected by hospital characteristics.Conclusions: Analyses using distances can reveal the hidden structure of patient satisfaction. This study suggests that hospital characteristics including hospital size, the ability to provide acute surgical treatment, and hospital interest in improving medical care quality are factors which may influence the structure of patient satisfaction.
Maternal health among Venezuelan women migrants at the border of Brazil 
Authors: Bahamondes Luis , Laporte Montas , Margatho Deborah , de Amorin Helder , Brasil Cinthia , Charles Charles Mpoca , Becerra Alejandra , Hidalgo Maria Margarethe
Published: November 2020

Background: Guaranteeing the sexual and reproductive health and rights (SRHR) of populations living in fragile and humanitarian settings is essential and constitutes a basic human right. Compounded by the inherent vulnerabilities of women in crises, substantial complications are directly associated with increased risks of poor SRHR outcomes for displaced populations. The migration of Venezuelans, displaced due to current economic circumstances, is one of the largest in Latin America’s history. This study aims to provide an overview of the sexual and reproductive health (SRH) issues affecting migrant Venezuelan women in the state of Roraima, Brazil.Methods: Face-to-face interviews were conducted from 24 to 30 November 2019. Data collection covered various issues involving access to and use of SRH services by 405 migrant Venezuelan women aged 18-49 years. The Minimum Initial Service Package readiness assessment tools, available from the Inter-Agency Working Group on Reproductive Health in Crises, were used in the data collection.Results: Most commonly, the women reported unmet family planning needs. Of these, a significant proportion reported being unable to obtain contraceptive methods, particularly long-acting reversible contraceptives, either due to the woman’s inability to access them or their unavailability at healthcare centres. Although a significant proportion of women were largely satisfied with the attention received at the maternity hospital, both before and during childbirth, 24.0% of pregnant or postpartum women failed to receive any prenatal or postnatal care. Conclusion: Meeting the essential SRHR needs of migrant Venezuelan women in Roraima, Brazil is a challenge that has yet to be fully addressed. Given the size of this migrant population, the Brazilian healthcare system has failed to adapt sufficiently to meet their needs; however, problems with healthcare provision are similar for migrants and Brazilian citizens. Efforts need to be encouraged not only in governmental health sectors, but also with academic, non-governmental and international organisations, including a coordinated approach to ensure a comprehensive SRHR response. Given the current high risks associated with the SARS-CoV-2 pandemic, meeting the SRHR needs of migrant populations has become more critical than ever.
The spread of COVID-19 outbreak in the first 120 days: A comparison between Nigeria and seven other countries
Authors: Adebowale Ayo Stephen , Fagbamigbe Adeniyi Francis , Akinyemi Joshua Odunayo , Obisesan Olalekan K , Awosanya Emmanuel J , Afolabi Rotimi Felix , Alarape Selim A , Obabiyi Sunday O
Published: November 2020

Background: COVID-19 is an emerging global public health crisis. The increase in the daily COVID-19 confirmed cases in Nigeria is worrisome vis-a-vis its large and dense population. This study aims at assessing the pattern of spread in the first 120 days of COVID-19 case confirmation in Nigeria, and its comparison with seven other countries. Methods: Data extracted from the World Bank’s website were used for the descriptive assessment and modelling of COVID-19 disease using the first 120 days of the index case in Nigeria and seven other countries. Linear, quadratic, cubic and exponential methods of regression model were used to fit the data (α=0.05). Results: The COVID-19 growth pattern in Nigeria was similar to that of Egypt, Ghana and Cameroun; Nigeria’s COVID-19 daily death distribution was comparable to six of the other seven countries considered. There was an increasing trend in the daily COVID-19 confirmed cases in Nigeria. During the lockdown, the growth rate of COVID-19 in Nigeria was 5.85 (R2=0.728, p<0.001); however, it was 8.42 (R2=0.625, p<0.001) after the lockdown relaxation. Across all the countries investigated, the cubic polynomial model (CPM) provided the best fit for predicting COVID-19 cumulative cases and there was a clear deviation from the exponential growth model. Using the CPM, all things being equal, a 3-month (30 September 2020) prediction of COVID-19 cases in Nigeria was 155,467 (95% CI:151,111-159,824, p<0.001). Conclusions: An improvement in COVID-19 control measures and strict compliance with the COVID-19 recommended protocols are essential. A contingency plan is needed to provide care for the active cases in case the predicted target is realised.
Enhanced xylitol production using non-detoxified xylose rich pre-hydrolysate from sugarcane bagasse by newly isolated Pichia fermentans
Authors: Prabhu Ashish A , Bosakornranut Ekkarin , Amraoui Yassin , Agarwal Deepti , Coulon Frederic , Vivekanand Vivekanand , Thakur Vijay Kumar , Kumar Vinod
Published: November 2020

Background: Integrated management of hemicellulosic fraction and its economical transformation to value-added products is the key driver towards sustainable lignocellulosic biorefineries. In this aspect, microbial cell factories are harnessed for the sustainable production of commercially viable biochemicals by valorising C5 and C6 sugars generated from agro-industrial waste. However, in the terrestrial ecosystem, microbial systems can efficiently consume glucose. On the contrary, pentose sugars are less preferred carbon source as most of the microbes lack metabolic pathway for their utilization. The effective utilization of both pentose and hexose sugars is key for economical biorefinery. Results: Bioprospecting the food waste and selective enrichment on xylose-rich medium led to isolation and purification of yeast which was phylogenetically identified as Pichia fermentans. The newly isolated xylose assimilating yeast was explored for xylitol production. The wild type strain robustly grew on xylose and produced xylitol with >40% conversion yield. Chemical mutagenesis of isolated yeast with ethyl methanesulphonate (EMS) yielded seven mutants. The mutant obtained after 15 min exposure, exhibited best xylose bioconversion efficiency. This mutant under shake flask conditions produced maximum xylitol titer and yield of 34.0 g/L and 0.68 g/g, respectively. oweverHoHHHoHowever, under same conditions, the control wild type strain accumulated 27.0 g/L xylitol with a conversion yield of 0.45 g/g. Improved performance of the mutant was attributed to 34.6% activity enhancement in xylose reductase with simultaneous reduction of xylitol dehydrogenase activity by 22.9%. Later, the culture medium was optimized using statistical design and validated at shake flask and bioreactor level. Bioreactor studies affirmed the competence of mutant for xylitol accumulation. The xylitol titer and yield obtained with pure xylose were 98.9 g/L and 0.67 g/g, respectively. In comparison, xylitol produced using non-detoxified xylose rich pre-hydrolysate from sugarcane bagasse was 79.0 g/L with an overall yield of 0.54 g/g. Conclusion: This study demonstrates the potential of newly isolated P. fermentans in successfully valorising the hemicellulosic fraction for sustainable xylitol production.
Association of genetic variation with disproportionate vitamin A deficiency in pregnant women of certain ethnicities in the United States.
Authors: Suzuki Masako , Wang Tao , Garretto Diana J , Isasi Carmen R. , Cardoso Wellington V , Greally John M. , Quadro Loredana
Published: November 2020

Vitamin A is an essential micronutrient that plays critical roles in many biological functions of the body. Limited access to vitamin A-rich food or supplements severely affects tissue and blood levels of vitamin A. Therefore, low serum vitamin A and poverty levels are strongly associated in vitamin A deficiency (VAD) studies that have focused mainly on developing countries. The current national prevalence rate of vitamin A deficiency in the United States is reported to be very low (<1%). However, several studies, including ours, have suggested that people from certain ethnic groups still face a higher proportion of vitamin A deficiency. We hypothesize that the genetic variations between ethnic groups may associate to the VAD proportional differences between women of different ancestries. To assess the associations, we re-analyzed two independent datasets of serum retinol levels of pregnant women in the United States and three datasets of genotypic information of different ancestries. We found that pregnant women with non-Hispanic Black and with Latin American/Afro-Caribbean ancestry have strikingly high proportions of VAD compared to non-Hispanic White and Latin American/Mexican ancestry. Genotypic analyses showed that the minor allele frequencis of genetic variants that associate to serum retinol levels have significantly higher variations between these different ancestries. Our study revealed that VAD rates in the pregnant women differ between different ancestries and that ancestry-dependent genetic variations might contribute to the differences.
Homebound by COVID19: The Benefits and Consequences of Non-Pharmaceutical Intervention Strategies
Authors: Oruc Buse Eylul , Baxter Arden , Keskinocak Pinar , Asplund John , Serban Nicoleta
Published: November 2020

Background. Recent research has been conducted by various countries and regions on the impact of non-pharmaceutical interventions (NPIs) on reducing the spread of COVID19. This study evaluates the tradeoffs between potential benefits (e.g., reduction in infection spread and deaths) of NPIs for COVID19 and being homebound (i.e., refraining from interactions outside of the household).Methods. An agent-based simulation model, which captures the natural history of the disease at the individual level, and the infection spread via a contact network assuming heterogeneous population mixing in households, peer groups (workplaces, schools), and communities, is adapted to project the disease spread and estimate the number of homebound people and person-days under multiple scenarios, including combinations of shelter-in-place, voluntary quarantine, and school closure in Georgia from March 1 to September 1, 2020.Results. Compared to no intervention, under voluntary quarantine, voluntary quarantine with school closure, and shelter-in-place with school closure scenarios 4.5, 23.1, and 200+ homebound adult-days were required to prevent one infection, with the maximum number of adults homebound on a given day in the range of 119K-248K, 465K-499K, 5,388K-5,389K, respectively. Compared to no intervention, school closure only reduced the percentage of the population infected by less than 16% while more than doubling the peak number of adults homebound.Conclusions. Voluntary quarantine combined with school closure significantly reduced the number of infections and deaths with a considerably smaller number of homebound person-days compared to shelter-in-place.
Understanding demand for, and feasibility of, centre-based child-care for poor urban households: A mixed methods study in Dhaka, Bangladesh.
Authors: Elsey Helen , Fieroze Fariza , Shawon Riffat Ara , Nasreen Shammi , Hicks Joseph Paul , Das Mahua , Huque Rumana , Hirano Izumi , Wallace Hilary Jane , Mashreky Saidur
Published: November 2020

Background: Centre-based child-care has potential to provide multiple health and development benefits to children, families and societies. With rapid urbanisation, increasing numbers of low-income women work with reduced support from extended family, leaving a child-care vacuum in many low- and middle-income countries. We aimed to understand perceptions of, and demand for, centre-based child-care in Dhaka, Bangladesh among poor, urban households, and test the feasibility of delivering sustainable centre-based child-care. Methods: We used sequential mixed methods including a household survey (n=222) and qualitative interviews with care-givers (n=16), community leaders (n=5) and policy-makers (n=5). We co-produced and piloted a centre-based child-care model over ten-months, documenting implementation. A co-design focus group with mothers, parents’ meetings, and qualitative interviews with child-care centre users (n=5), non-users (n=3), ex-users (n=3) and staff (2) were used to refine the model and identify implementation issues. Results: We found 24% (95% CI: 16%,37%) of care-givers reported turning-down paid work due to lack of child-care and 84% (95% CI:74%, 91%) reported wishing to use centre-based child-care and were willing to pay up to 283 Takka (~$3.30) per month. Adjusted odds of reported need for child-care among slum households were 3.8 times those of non-slum households (95% CI: 1.4, 10). Implementation highlighted that poor households needed free child-care with food provided, presenting feasibility challenges. Meta-inference across quantitative and qualitative findings identified the impact of the urban environment on child-care through long working hours, low social capital and fears for child safety. These influences interacted with religious and social norms resulting in caution in using centre-based child-care despite evident need. Conclusion: Sustainable provision of centre-based care that focuses on early childhood development requires subsidy and careful design sensitive to the working lives of poor families, particularly women and must respond to the dynamics of the urban environment and community values. We recommend increased research and policy focus on the evaluation and scale-up of quality centre-based child-care, emphasising early-childhood development, to support low-income working families in urban areas.
Survival among patients with severe high cervical spine injuries – A TraumaRegister DGU® database study
Authors: Kamp Oliver , Jansen O. , Lefering R. , Aach M. , Waydhas C. , Dudda M. , Schildhauer T. A. , Hamsen U.
Published: November 2020

BackgroundTrauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. While the majority of patients do not survive injuries which are coded with an AIS 6, there are several patients with a severe high cervical spinal cord injury that could be discharged from hospital despite the prognosis of trauma scores. We estimate that the trauma scores and prediction models miscalculate these injuries. For this reason, we evaluated these findings in a larger control group.MethodsIn a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group.ResultsSix hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 hours. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%.ConclusionsAn AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality prognosis based on the RISC II score, they survived much more often than expected.
Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation
Authors: Fadiga Lúcia , Saraiva Joana , Catarino Diana , Frade João , Melo Miguel , Paiva Isabel
Published: November 2020

Introduction: Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA.Methods: We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results: We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR – 15) for T1DM and 42 years (IQR – 15) for LADA (p=0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p<0.001). The mean BMI at diagnosis was 24.1Kg/m2 in T1DM group and 26.1Kg/m2 in LADA group (p=0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p=0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p<0.001). The median daily insulin dose was 40IU for T1DM (0.58IU/Kg) and 33.5IU for LADA (0.57IU/Kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p=0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p=0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p=0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome and this difference was independent of diabetes duration. Conclusion: Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome.