bluuebunny/crossref_metadata_2025 huggingface dataset:
Online-Group Intervention after Suicide Bereavement through the Use of Webinars: Study Protocol for a randomized controlled Trial
Authors: Wagner Birgit , Hofmann Laura , Maaß Ulrike
Published: November 2019

Introduction The death of a significant person through suicide is a very difficult experience and can have long-term impact on an individual’s psychosocial and physical functioning. However, there are only few studies which have examined the effects of interventions in suicide survivors. In the present study, we examined an online-group intervention for people bereaved by suicide using a group-webinar. Methods The intervention was developed based on focus groups with the target group. The cognitive-behavioral 12-module webinar-based group intervention focuses on suicide bereavement related themes such as feelings of guilt, stigmatization, meaning reconstruction and the relationship to the deceased. Further, the webinar includes testimonial videos and psychoeducation. The suicide survivors are randomized to the intervention or the waiting- list in a group cluster randomized controlled trial. Primary outcome were suicidality (BSSI) and depression (BDI-II), secondary outcomes are symptoms of prolonged grief disorder (ICG-D), PTSD (IES-R), stigmatization (STOSASS) and posttraumatic cognitions (PTCI). Discussion Previous studies of internet-based interventions for the bereaved were writing interventions showing large treatment effects. Little is known about the use of webinars as group interventions. Advantages and challenges of this novel approach of psychological interventions will be discussed.
Danish Evaluation of Your Heart Forecast (DANY) - Study Protocol for a Cluster Randomised Controlled Trial on an Interactive Risk-communication Tool aimed at improving High Blood Pressure Patients’ adherence.
Authors: Jensen Anders Elkær , Søndergaard Jens , Kjær Niels Kristian , Jackson Rod , Nielsen Jesper Bo
Published: November 2019

Background To improve communication of risk messages, they must be communicated in a way that is understandable and relevant to the patient. Communicating risk of cardio-vascular-disease is a complex and individualised task, since the risk itself is a combination of multiple personal risk factors. Raised blood pressure is but one of these risk factors. In Denmark, one third of hypertensive patients are adequately treated, with regards to national guidelines. One reason for this meagre status is low treatment adherence, and tools with documented effects for increasing patient adherence are limited. Our objective is to evaluate the effect of a personalised, interactive and dynamic risk-assessment and risk-communication tool: “Your Heart Forecast” on blood pressure control, primary non-compliance, health literacy and patient empowerment.Methods Cluster-randomised controlled trial in general practice. Effect measures are adherence, blood pressure, lipid levels and empowerment at inclusion and after 6 and 12 months. To identify other benefits or possible adverse effects of the intervention, qualitative interviews will be conducted with a subgroup of patients. Discussion The investigators will explore effects of Your Heart Forecast on patients’ health literacy, adherence, empowerment and blood pressure control. The DANish evaluation of Your heart forecast (DANY) project will be the first to rigorously evaluate effects of YHF in Denmark and to link adherence of hypertensive patients exposed to Your Heart Forecast with the national databases of prescriptions and health services provided.
Factors associated with contracted services of Chinese family doctors from the perspective of medical staff and consumers: A cross-sectional study
Authors: Wang Huanyan , Shi Lei , Han Xuanye , Zhang Jinchan , Ma Yuanshuo , Yang Xi , Liu Ming , Fan Lihua , Lou Fengge
Published: November 2019

Background: The family doctor system has developed rapidly all over the world, and in the past few years, China has actively explored family doctor-type contracted services. The purpose of this study is to explore the related factors of Contracted Family Doctors Services (CFDS) from the perspectives of medical staff and consumers, and to provide a stronger basis for the development and promotion of CFDS.Methods: A combination of quantitative and qualitative methods were used in this study. A self-reported questionnaire was designed through a literature analysis, group discussions, expert consultations and a pre-investigation, and conducted among community health service providers in 12 community health service centres across four provinces of China. A total of 389 participants participated, and 320 valid questionnaires were obtained, with an effective response rate of 82.3%. A total of 36 consumers participated in in-depth interviews, and the effective rate was 100.0%. An exploratory factor analysis, a confirmatory factor analysis, inductive methods, and expert consultations were used to analyse the related CFDS factors.Results: A total of 320 respondents met the inclusion criteria. Most of the participants were women, 56.6% of them had received undergraduate education, and they held mainly middle-level professional positions. The related CFDS factors from the perspectives of medical staff were divided into four dimensions, with the following weighting coefficients: national government factors (31.87%), community health service agency factors (24.73%), consumer-related factors (22.58%), and contracted doctor-related factors (20.82%). The related CFDS factors from the perspectives of consumers were divided into four dimensions, with the following frequency sequence: national government factors, contract doctor- related factors, community health service agency factors, and consumers-related factors. National government factors played an important role in CFDS from the perspectives of medical staff and consumers.Conclusions: The related CFDS factors were the same from the perspective of medical staff and consumers, but the weight of each factor was different. The development of CFDS is inseparable from the support of policies. It is suggested that the government should strengthen the publicity of CFDS, expand the coverage, introduce personalised contract programs that meet the needs of different groups, and promote the rapid development of CFDS.
Birth order is associated with caries development in young children: a register-based cohort study
Authors: Julihn Annika , Soares Fernanda Cunha , Hammarfjord Ulrika , Hjern Anders , Dahllöf Göran
Published: November 2019

Background Birth order has been shown to affect the health of the child; less is known, however, about how birth order affects caries development in children. Thus, the present study investigated the association between birth order and dental caries development in young children. Methods This retrospective registry-based cohort study included all children born in 2000–2003 who were residing in Stockholm County, Sweden, at age 3 years (n = 83,147). The study followed the cohort until subjects reached 7 years of age. Children with registry data on dental examinations and sociodemographic characteristics at ages 3- and 7 years constituted the final study cohort (n = 65,259). The outcome variable was “caries increment from age 3- to 7 years” (Δdeft > 0) and the key exposure, “birth order”, was divided into five groups. A forward stepwise logistic binary regression was done for the multivariate analysis with adjustments for sociodemographic factors. Results At age 3 years, 94% had no fillings or manifest caries lesions. During the study period, 22.5% (n = 14,711) developed dental caries. The final logistic regression analysis found a statistically significant positive association between birth order and caries increment. Further, excess risk increased with higher birth order; with the mother’s first-born child as reference, risk for the second-born child was OR 1.17, 95% CI=1.12–1.23; for the third-born child, OR 1.47, 95% CI=1.38–1.56; for the fourth-born child, OR 1.69, 95% CI=1.52–1.88; and for the fifth-born or higher birth-order child, OR 1.84, 95% CI=1.58–2.14. Conclusions These findings show that birth order influences caries development in siblings, suggesting that birth order can be regarded as a predictor for caries development in young children. This factor may be helpful in assessing caries risk in preschool children and should be considered in caries prevention work in young children with older siblings.
Bilateral simultaneous total hip arthroplasty: comparison of treatment outcome between the direct anterior approach and the posterolateral approach
Authors: Feng Shuo , Sun Ning Jian , Zhang Yu , Zhang Ye , Chen Yang Xiang , Zha Guo-Chun
Published: November 2019

Background There are many surgical approaches for total hip arthroplasty. In recent years, direct anterior approach (DAA) has been highly praised by many scholars, and it has been widely reported that it has a good curative effect, such as fast recovery. Whether the surgical results and patient satisfaction can reach or exceed the traditional posterolateral approach has been controversial. We hypothesized that the treatment outcome of the direct anterior approach (DAA) approach is superior to the traditional posterolateral approach (PLA). Methods From January 2015 to April 2017, 20 patients (40 hips) were randomly divided into posterolateral approach (PLA) group and direct anterior approach (DAA) group. Record the operation time on both sides, postoperative drainage, prosthesis position, and complications, the functional recovery of hip joint was evaluated by D'Aubigne-Postel score, and the postoperative pain was evaluated by VAS score. Gait parameters were measured before surgery and at 3 and 6 months after surgery, and the patients were asked which side they preferred subjectively after surgery. Results When compared with the PLA group, the DAA group had a shorter incision length (11.4 vs 14.72 cm, P<0.001), shorter intraoperative blood loss (184.05vs 219.00 mL, P<0.001), shorter postoperative drainage volume (105.35 vs 154.10 mL, P<0.001), and lower VAS scores. However, the PLA had shorter operative times (82.20 vs 67.3 min, P<0.001). There was no significant difference in acetabular inclination (39.72 vs 40.92 °, P=0.069), and acetabular anteversion (17.41 vs 17.69°, P=0.663) between the two groups. Joint function recovery: The D'Aubigne-Postel scores of the hip joints in the DAA group vs PLA group at 1, 3, and 6 months after surgery were (8.2, 11.5, 16.5) vs (7.65, 11.45, 16.9). The difference in the 1, 3month was statistically significant (P=0.012, P=0.038), however, this difference disappeared in the 6th month(P=0.072). Conclusions Compared with the PLA, the DAA has the advantages of shorter operation time, smaller incision, less bleeding, less pain, better gait performance and faster recovery of joint function, but patients subjectively preferred the traditional PLA.
The Effects of Different Antiseptic Mouthwash On Microbiota Around Orthodontic Mini-Screw
Authors: AKBULUT Yasin
Published: November 2019

Objektives: This study aims to investigate the effects of different antiseptic mouthwash on microbiota around the mini-screw applied to patients undergoing fixed orthodontic treatment. Materials and methods: From patients who have been undergoing fixed orthodontic treatment and who have mini-screws in their mouth, a total of 38 patients were selected for the study consisting of 4 groups, each of which has 15 mini-screws. The patients were selected from the following groups: no use of mouthwash (Group 1), use of 0.12% Chlorhexidine gluconate-containing mouthwash (Group 2), use of Essential oils-containing mouthwash (Group 3) and use of 7.5% Povidone-iodine-containing mouthwash (Group 4). Plaque indices and gingival indices of the patients were measured at the beginning (T 0 ) and at their appointments three weeks later (T 1 ). In addition, biological samples were collected from the sulcus around the mini-screw with the help of sterile paper point. Results: The total number of microorganisms around the mini-screw in Group 2, Group 3 and Group 4 decreased significantly compared to Group 1. A significant decrease in Streptococcus oralis , Streptococcus mitis , Candida parapsilosis, total bacteria, plaque index and gingival index count was observed in T 1 compared to T 0. Conclusion: Antiseptic mouthwash in Group 2, Group 3 and Group 4 can be used to reduce the number of microbial microbiota around the mini-screw and to improve oral hygiene.
 Tuberculosis Treatment Outcome In Patients With Tb-Hiv Co-Infection In Kuala Lumpur, Malaysia
Authors: Selimin Diana Safraa , Ismail Aniza , Ahmad Norfazilah , Ismail Rohani , Azman Nurul Farhana Mohd , Azman Amaleena
Published: November 2019

Background Tuberculosis (TB) is a serious health threat to people living with human immunodeficiency virus (HIV). This study aimed to identify the characteristics, unsuccessful TB treatment rate and determinants of unsuccessful TB treatment outcome among patients with TB-HIV co-infection in Kuala Lumpur.Methods This was a cross-sectional study. The data of all patients with TB-HIV in the federal territory of Kuala Lumpur from 2013 to 2017 were collected and reviewed. The data were retrieved from the national database (TB Information System) at the Kuala Lumpur Health Department from 1 March 2018 to 31 May 2018.Results Out of 235 randomly selected patients with TB-HIV, TB treatment outcome was successful in 57.9% (cured and completed treatment) and unsuccessful in 42.1% (died, failed or defaulted treatment). Patients who did not receive DOTS (directly observed treatment, short course) (adjusted odds ratio [aOR] 21.71; 95% confidence interval [CI]: 5.36–87.94) and those who received shorter treatment duration of <6 months (aOR 34.54; 95% CI: 5.97–199.93) had higher odds for unsuccessful TB treatment outcome.Conclusions Nearly half of the patients with TB-HIV had unsuccessful TB treatment outcome. Therefore, it is important to ensure that such patients receive DOTS and continuous TB treatment of >6 months. It is crucial to strengthen and widen the coverage of DOTS, especially among high-risk groups, in healthcare settings. Strict follow-up by healthcare providers is needed for patients with TB-HIV to gain treatment adherence and for better rates of successful TB treatment.
Factors Related to Health Civic Engagement: Results from the 2018 National Survey of Health Attitudes to Understand Progress towards a Culture of Health
Authors: Dubowitz Tamara , Nelson Christopher , Weilant Sarah , Sloan Jennifer C. , Bogart Andrew , Miller Carolyn , Chandra Anita
Published: November 2019

Objectives Civic engagement, including voting, volunteering, and participating in civic organizations, is associated with better psychological, physical and behavioral health and well-being. In addition, civic engagement is increasingly viewed (e.g., in Robert Wood Johnson Foundation’s Culture of Health framework) as an important driver for raising awareness of and addressing unhealthy conditions in communities. As such, it is important to understand the factors that may promote civic engagement, with a particular focus on the less-understood, health civic engagement, or civic engagement in health-related and health-specific activities. Using data from a nationally representative sample of adults in the United States, we examined whether the extent to which individuals feel they belong in their community (i.e., perceived sense of community) and the value they placed on investing in community health were associated with individuals’ health civic engagement.Methods Using data collected on 7187 nationally representative respondents from the 2018 National Survey of Health Attitudes, we examined associations between sense of community, valued investment in community health, and perceived barriers to taking action to invest in community health, with health civic engagement. We constructed scales for each of these constructs and employed multiple linear regressions adjusting for multiple covariates.Results Participants who endorsed (i.e., responded with mostly or completely) all 16 sense of community scale items endorsed an average of 22.8% (95%CI: 19.8 - 25.7%) more of the health civic engagement scale items compared with respondents who did not endorse any of the sense of community items. Those who endorsed (responded that it was an important or top priority) for all items capturing valued investment in community health endorsed 14.0% (95%CI: 11.2 – 16.8%) more of the health civic engagement items than those who did not endorse any valued investment in community health items.Conclusions Health civic engagement, including voting and volunteering to ultimately influence government decisions about health issues, may help improve conditions that influence health and well-being for all. Focusing on individuals’ sense of community and highlighting investments in community health may concurrently increase health civic engagement and improve community and population health.
Tobacco and electronic cigarette cues for smoking and vaping: an online experimental study
Authors: Blackwell Anna K M , De-loyde Katie , Brocklebank Laura A , Maynard Olivia M , Marteau Theresa M , Hollands Gareth J , Fletcher Paul C , Attwood Angela S , Morris Richard W , Munafò Marcus R
Published: November 2019

Objective This study examined whether exposure to smoking and vaping cues the urge to smoke or vape. It extends previous studies on first-generation cigalikes (visually similar to cigarettes) and second-generation devices (visually similar to pens) by including third-generation tank system devices (larger bulky units). In an online experiment, participants were randomly assigned to view one of four videos, which included smoking, vaping (cigalike or tank system), or neutral cues. The primary outcome was urge to smoke. Secondary outcomes were urge to vape, desire to smoke and vape, and intention to quit or remain abstinent from smoking.Results UK adults varying in smoking (current or former) and vaping (user or non-user) status (n=1120) completed the study: 184 (16%) failed study attention checks meaning 936 were included in the final analysis. Urges to smoke were similar across cue groups. Urges to vape were higher following exposure to vaping compared to neutral cues. There was no clear evidence of an interaction between cue group and smoking or vaping status. The lack of cueing effects on smoking urges is inconsistent with previous research, raising questions about the ability to assess craving in online settings.
Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis.
Authors: Shi Yonghong , Luo Wen , Lin Yihua , Li Zhibin , Wang Wanyu
Published: November 2019

Background and Objectives: Pulmonary tuberculosis is one of the most common infectious diseases worldwide. Patients with suspected pulmonary tuberculosis with negative smear are recommended to undergo further tests including sputum induction and bronchoscopy. Our study is aimed to compare sputum induction and bronchoscopic specimens in the diagnosis of sputum smear-negative pulmonary tuberculosis. Method: PubMed, Web of Science, Cochrane Library and Embase were searched for eligible studies. The pooled sensitivities (SEN), specificities (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and 95% confidence interval (CIs) were constructed, and the areas under the curves (AUCs) were calculated.Results: Five studies with a total number of 586 cases were included. For mycobacterial culture, the SEN and SPE of sputum induction were 0.72(95% CI, 0.66-0.77) and 1.00 (95%CI, 0.99-1.000) respectively, whereas the SEN and SPE of bronchoscopy were 0.70(95%CI, 0.64-0.75) and 1.00 (95%CI, 0.99-1.00) respectively. Sputum induction had a similar AUC(0.9564, SE=0.0749) with bronchoscopy (0.8618, SE=0.1652) ( P =0.602). For specimen of acid-fast bacilli smear, the SEN and SPE of sputum induction were 0.35 (95% CI, 0.29-0.42) and 0.99(95% CI, 0.96-1.00) respectively, whereas the SEN and SPE of bronchoscopy were 0.38 (95% CI, 0.32-0.45) and 0.99 (95% CI, 0.96-1.00) respectively. Sputum induction had a familiar AUC (0.6016) with bronchoscopy (0.8163) ( P =0.792).Conclusions: For the diagnosis of sputum smear-negative pulmonary tuberculosis, the diagnosis yield of sputum induction and bronchoscopy is similar.
Different profiles of body mass index evolutions among patients with multidrug-resistant tuberculosis: a retrospective cohort study.
Authors: Diallo Alhassane , Diallo Boubacar Djelo , Camara Lansana Mady , Kounoudji Lucrèce Ahouéfa Nadège , Bah Boubacar , N’Zabintawali Fulgence , Carlos-Bolumbu Miguel , Diallo Mamadou Hassimiou , Sow Oumou Younoussa
Published: November 2019

Background Despite the predictor role of the body weight variation on multidrug-resistant tuberculosis (MDR-TB) treatment outcome, little data are available to corroborate this finding. We aimed to study the course of weight in patients with MDR-TB, to identify subgroups of weight evolutions, and to determine factors that influence these evolutions.Methods Patients treated with a shorter MDR-TB treatment regimen between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had rifampicin resistance, and who were cured or died were analysed. Patients were seen monthly until the end of treatment. Clinical outcome was the Body Mass Index (BMI). We used a linear mixed model to analyze the course of BMI and a latent class mixed model to identify subgroup of BMI evolutions.Results Of 232 patients treated for MDR-TB during the study period, 165 (71%) were analysed. These patients had a total of 1387 visits, with a median of 5 visits (interquartile range, 3 – 8 visits). Monthly BMI increase was 0.24 (SE 0.02) per kg/m 2 . Factors that associated with faster BMI progression were cured to MDR-TB treatment (0.24 [SE 0.09] per kg/m 2 ; p = 0.0205), and the absence of lung cavities on X-ray (0.18 [0.06] per kg/m 2 ; p = 0.0068). Two subgroups of BMI evolution were identified: “Rapid BMI (n = 121; 85%) and “Slow BMI evolution (n = 22; 15%). Patients in the slow increasing BMI group were mostly female (68%) without history of TB treatment (41%) with most severe clinical condition at baseline, characterized by a higher frequency of symptoms including HIV infection (59%), depression (18%), dyspnea (68%), poor adherence to MDR-TB treatment (64%), lower platelets count, and higher liver SGOT count. These patients had also a longer time to-initial culture conversion delay (log-rank test: p = 0.0087).Conclusion The available data provide quantitative information on BMI progression of patients with MDR-TB treated with a shorter regimen, and allowed the identification of the subgroup of patients with different BMI evolutions. Furthermore, they emphasize the usefulness of BMI as biomarker to monitor MDR-TB treatment outcome.
Serum level of vitamin D, CRP and biochemical parameter in acute and chronic brucellosis treated with doxycycline-loaded solid lipid nanoparticles
Authors: Hosserini Seyed Mostafa , Farmani Abbas , Arabestani Mohammad Reza
Published: November 2019

Background Brucellosis is a common disease between humans and livestock, and treatment and relapse of this disease is one of the major challenges. The aim of this study was to evaluate the therapeutic effect of doxycycline-loaded solid lipid nanoparticles (DOX-SLN) on acute and chronic brucellosis and its effect on serum level of 25-OH-Vitamin D, C-reactive protein (CRP) and biochemical parameters. Methods Double emulsion method was used for synthesis of nanoparticles. Serum levels of vitamin D, CRP, total protein, albumin and globulin were measured in rats with brucellosis. The therapeutic effect of DOX-SLN was compared with that of free doxycycline. Results The mean size, Zeta potential, PDI, drug loading and encapsulation efficiency of the synthesized nanoparticles were 299±34 nm, -28.7±3.2 mV, 0.29±0.027, 11.2±1.3%, and 94.9±3.2%, respectively. Serum vitamin D levels in rats with chronic brucellosis decreased compared to healthy rats. CRP increased in the acute and chronic stages of brucellosis. Serum levels of total protein and albumin were similar in both stages of the disease but serum globulin levels was increased. Conclusion According to the results, serum level of vitamin D was increased in rats after treatment with DOX-SLN. The use of DOX-SLN as an alternative drug for the treatment of chronic brucellosis is recommended.
Development of a non-invasive lung oximeter
Authors: Dixon Barry , Gibson Elizabeth
Published: November 2019

Objective: Monitoring of regional lung ventilation and perfusion in critically ill patients may assist in detection and management of lung injury. We developed a non-invasive oximeter that uses the principles of pulse oximetry to measure lung microvascular oxygen levels and a lung pulse waveform. The oximeter was tested in a healthy volunteer. Lung oxygen levels and the pulse waveforms were assessed in 2 lung regions; the apex (matched ventilation and perfusion) and the base (low ventilation relative to perfusion). Simultaneous conventional skin pulse oximetry was also recorded. Results: At the lung apex, oxygen saturation fell markedly during systole to ~60%, but rapidly recovered and peaked at 100% by the end of diastole. The lung pulse waveform was similar in shape and timing to a pulmonary artery pressure trace. At the lung base, oxygen saturation remained low ~ 80% throughout systole and diastole. The lung pulse was similar in shape and timing to a left atrial pressure trace. Skin oxygen levels remained at 100% throughout the pulse. The lung oximeter recordings were consistent with the expected regional changes in ventilation and perfusion at the apex and base. The lung oximeter could assist clinicians in the management of critically ill patients.
A comparison of erythrocyte sedimentation rate between blood anticoagulated with sodium citrate and EDTA among Tuberculosis suspected patients at University of Gondar Hospital, North West Ethiopia
Authors: Getaneh Zegeye , Ayelgn Fekadu , Asemahegn Geletaw , Geleta Habtamu , Yalew Aregawi , Melak Tadele
Published: November 2019

Objective: The main aim of this study was comparison of erythrocyte sedimentation rate results of sodium citrate and ethylene diamine tetra-acetic acid anticoagulant. A comparative cross-sectional study was conducted at University of Gondar Referral Hospital, Northwest, Ethiopia. A total of 70 TB suspected study participants were recruited. From each study participants, 3ml blood was collected in to EDTA tube and 1.6ml blood was collected in to a test tube containing 0.4ml Sodium Citrate anticoagulant. Results: The mean ± SD values for ESR were 57.9 ± 41.45 in EDTA and 50.99 ± 43.5 in citrate anticoagulated blood. The mean difference of ESR values between EDTA and citrated blood was 6.91 ± 13.66 mm/hr with a significant difference. The mean ± SD of ESR for EDTA and citrate blood was 59.57 ± 42.31 and 54.71 ± 40.44 mm/hr for males and 53.57 ± 44.61 and 46.04 ± 41.82 mm/hr for females, respectively. This study indicated that there was a significant difference between ESR values with EDTA and tri-sodium citrate anticoagulants.
Acid Experimental Evolution of the Extremely Halophilic Archaeon Halobacterium sp. NRC-1 Selects Mutations Affecting Arginine Transport and Catabolism
Authors: Kunka Karina S , Griffith Jessie M , Holdener Chase , Bischof Katarina M , Li Haofan , DasSarma Priya , DasSarma Shiladitya , Slonczewski Joan L
Published: November 2019

Background Halobacterium sp. NRC-1 (NRC-1) is an extremely halophilic archaeon that is adapted to multiple stressors such as UV, ionizing radiation and arsenic exposure. We conducted experimental evolution of NRC-1 under acid stress. NRC-1 was serially cultured in CM+ medium modified by four conditions: optimal pH (pH 7.5), acid stress (pH 6.3), iron amendment (600 μM ferrous sulfate, pH 7.5), and acid plus iron (pH 6.3, with 600 μM ferrous sulfate). For each condition, four independent lineages of evolving populations were propagated. After 500 generations, 16 clones were isolated for phenotypic characterization and genomic sequencing. Results Genome sequences of all 16 clones revealed 378 mutations, of which 90% were haloarchaeal insertion sequences (ISH) and ISH-mediated large deletions. This proportion of ISH events in NRC-1 was five-fold greater than that reported for comparable evolution of E. coli. One acid-evolved clone had increased fitness compared to the ancestral strain when cultured at low pH. Seven of eight acid-evolved clones had a mutation within or upstream of arcD, which encodes an arginine-ornithine antiporter; no non-acid adapted strains had arcD mutations. Mutations also affected the arcR regulator of arginine catabolism, which protects bacteria from acid stress by release of ammonia. Two acid-adapted strains shared a common mutation in bop, which encodes the bacteriorhodopsin light-driven proton pump. Unrelated to pH, one NRC-1 minichromosome (megaplasmid) pNRC100 had increased copy number, and we observed several mutations that eliminate gas vesicles and arsenic resistance. Thus, in the haloarchaeon NRC-1, as in bacteria, pH adaptation was associated with genes involved in arginine catabolism and proton transport. Conclusions Our study is among the first to report experimental evolution with multiple resequenced genomes of an archaeon. Haloarchaea are polyextremophiles capable of growth under environmental conditions such as concentrated NaCl and desiccation, but little is known about pH stress. Halobacterium sp. NRC-1 (NRC-1) is considered a model organism for the feasibility of microbial life in iron-rich brine on Mars. Interesting parallels appear between the molecular basis of pH adaptation in NRC-1 and in bacteria, particularly the acid-responsive arginine-ornithine system found in oral streptococci.
Dysbiosis of saliva microbiome in patients with oral lichen planus
Authors: Yu FeiYan , Wang QianQian , Li Miao , Cheng Ya-Hsin , Cheng Yi-Shing Lisa , Zhou Yu , Yang Xi , Zhang Fang , Ge XueJun , Zhao Bin , Ren XiuYun
Published: November 2019

Background : Oral microbiota is not only important for maintaining oral health but also plays a role in oral diseases. However, studies regarding microbiome changes in oral lichen planus(OLP)are very limited. Therefore, the purpose of this study was to identify the characteristic microbial profile in the saliva of OLP patients, with or without erosive lesions, and compare that with recurrent aphthous ulcer (RAU), a common oral immunological disorder that also shows multiple erosive/ulcerative lesions. Methods : Whole saliva samples were collected from 20 patients with OLP (10 each for erosive (E) and non-erosive (NE) groups), 10 patients with RAU (U group), and 10 healthy controls (C). DNA was extracted from the saliva samples, and the 16S rDNA gene V4 hypervariable region was analyzed using Illumina sequencing. Results were assessed with alpha- and beta-diversity, linear discriminant analysis (LDA) effect size, and the data was analyzed by Spearman’s rank correlation,Wilcoxon and Kruskal test. Results: We obtained 4949 operational taxonomic units from the V4 region in all saliva samples. Community composition analysis showed a clear decreased relative abundance of genera Streptococcus and Sphingomonas in saliva from RAU patients when compared to the other three groups. Relative abundance of Lautropia and Gemella were higher in E group,whereas relative abundance of Haemophilus and Neisseria were higher in NE group when compared to C group. Abiotrophia and Oribacterium were higher in OLP (combining E and NE groups), while Eikenella and Aggregatibacter were lower when compared to C group. There was statistically significance in α-diversity between E and RAU groups( p <0.05). Significant differences in β-diversity were detected in bacteria between E and C; NE and C; as well as E and NE groups. Conclusion： We found that salivary microbiome in OLP was significantly different from that found in RAU; and these changes may be related to the underlying disease process rather than presence of ulcerative/erosive lesions clinically. In addition, our findings in bacterial relative abundance in OLP were significantly different from the previously reported findings, which points to the need for further research in salivary microbiome of OLP.
Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: A qualitative study
Authors: Goodman Helena Mary , Brooks Cat Papastavrou , Price Owen , Barley Elizabeth Alexandra
Published: November 2019

Background: Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a potentially safer alternative first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings, and none which consider the patient or carer perspective. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours. Methods: Semi-structured individual interviews (n=12) and focus groups (n=3) were conducted with eight patients, four carers and twenty-five staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results: Four themes and 15 sub-themes (barrier and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: high-security as an inherently deprived environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff-patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions: This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The different factors which promote fear in each group should be addressed in de-escalation training.
The Fair Decision-making of Children and Adolescents with High-functioning Autism Spectrum Disorder from the Perspective of Dual-process Theories
Authors: Jin Peiying , Wang Yao , LI Yun , Xiao Yunhua , Li Chunyan , Qiu Nana , Weng Jiao , Fang Hui , Ke Xiaoyan
Published: November 2019

Background: Fairness, as a core component of moral society, has received much attention. At present, there are inconsistencies in the findings regarding the fair decision-making of high-functioning autism spectrum disorder (HF-ASD). Previous studies have shown that the fair decision-making of typically developing children is influenced by theory of mind(ToM) and executive function(EF).Dual-process theories propose that both intuitive processes and reasoning processes participate in fair decision-making. As those with HF-ASD have defects in both domains, this study aims to explore the differences in fair decision-making between children and adolescents with HF-ASD and those with typical development (TD). Methods: We used a mini ultimatum game (mini-UG) to explore 31 children and adolescents with HF-ASD and 38 children and adolescents with TD. Ttests and chi-square tests are used to compare group differences, Pearson correlation analysis and stepwise regression analysis was used to analyse the influencing mechanism of the two groups' unfair acceptance rates. Results: The results showed that children with HF-ASD were more likely to accept unfair offers, but when it came to adolescents, the difference was no longer significant. Regression analysis showed that the interaction between the Behavioral Regulation Index(BRI) and age could negatively predict the unfair acceptance rate of children and adolescents with HF-ASD. Working memory and ToM can negatively predict the unfair acceptance rate of those with TD. Conclusion: This study concluded that the development of fair decision-making by children and adolescents with HF-ASD fell far behind that of those with TD. Intuition processes play a dominant role in the fair decision-making processes of children and adolescents with HF-ASD, and we believe that comorbidity, age, experience and emotional management are important factors influencing the fair decision-making of individuals with HF-ASD.
Dimensions of leisure-time physical activity and risk of depression in the “SEGUIMIENTO UNIVERSIDAD DE NAVARRA” (SUN) prospective cohort
Authors: Montero Alejandro Fernández , Moreno-Galarraga Laura , Sánchez-Villegas Almudena , Lahortiga-Ramos Francisca , Ruiz-Canela Miguel , Martínez-González Miguel Ángel , Molero Patricio
Published: November 2019

Background An inverse association between total leisure-time physical activity (LTPA) and depression has been previously documented in the scientific literature. Our objective was to prospectively assess the association of LTPA with the risk of depression, focusing on several dimensions of LTPA (intensity, duration and type). Methods The SUN (Seguimiento Universidad de Navarra) project is a prospective cohort study formed by Spanish university graduates. A total of 15,488 adults (40.2% men, mean age 37±12 years) initially free of depression were assessed. A report of a validated medical diagnosis of depression or the habitual use of antidepressants (any of both) were considered as incident cases of depression. LTPA was estimated through previously validated self-reported questionnaires. Participants were classified following Physical Activity recommendations from the World Health Organization, and according to the intensity, duration and type of LTPA. Cox proportional hazards regression models were run, adjusted for demographic, lifestyle, and dietary factors, to estimate adjusted hazard ratios (HR) of depression and 95% confidence intervals (CI). Results During 163,059 person-years of follow-up we registered 870 incident cases of depression. Participants with higher total LTPA (METs-h/week) and higher duration of LTPA (hours/week) exhibited a lower risk of depression HR=0.84 (95% CI: 0.72-0.99) and HR=0.83 (0.70-0.99) respectively, whereas intensity of LTPA (MET) did not show any association with depression. Conclusion Participants with higher LTPA had a lower risk of depression. The inverse association was stronger for total LPTA time than for its intensity. Higher duration of LTPA should be encouraged to prevent depression.
Low sense of coherence in long-term follow up of adolescents with anorexia nervosa
Authors: Vagedes Jan , Kleih Theresa , Simmance Cara , Svaldi Jenifer , Hautzinger Martin , von Schoen-Angerer Tido
Published: November 2019

Background: Sense of coherence is a personal resource known to be low in eating disorders. We wanted to know if sense of coherence is still correlated to anorexia symptoms several years after initial hospitalisation for anorexia. Methods: 86 former female patients diagnosed with anorexia were contacted 5-11 years after hospitalisation in a German hospital; 68 of 149 women (46%) could be contacted and agreed to participate in a survey with the Eating Disorder Inventory (EDI-2) and the Sense of Coherence Questionnaire (SOC-13). Results: 17.6% of participants stated that they suffered from an eating disorder currently, with 7.4% having anorexia nervosa. Mean EDI-2 subscales (except for the bulimia sub-scale) were in the <40th percentile for women with anorexia. Sense of coherence was low (percentile rank 20). All EDI-2 subscales correlated negatively with the SOC-13 score (p<0.01). Conclusions: The sense of coherence is low in long-term follow up of anorexia nervosa and is correlated with on-going anorexia symptoms.
Tumor Characteristics and Treatment Outcomes of Older Women with Breast Cancer in a Developing Country
Authors: Abdel-Razeq Hikmat , Rahman Fadwa Abdel , Al-Masri Hanan , Abdelelah Hazem , Nasser Mahmoud Abu , Salam Mourad , Taqash Ayat
Published: November 2019

Background Less than 10% of newly diagnosed breast cancer in our region are diagnosed in women 70 years or older. Treatment plans of such patients is less clear and have poor outcomes. In this paper, we describe clinical presentation, tumor characteristics and treatment outcomes in such patients.Patients and methods Consecutive patients aged 65 years or older with pathologically-confirmed diagnosis of breast cancer were included. Medical records and hospital databases were searched for patients’ characteristics and treatment outcomes.Results A total of 553 patients, median age 70 (range: 65-91) years, were included. On presentation, 114 (20.6%) patients had metastatic disease and was mostly visceral (81; 71.1%). Patients with non-metastatic disease had poor pathological features including node-positive in 244 (55.6%), GIII in 170 (38.7%) and lymphovascular invasion in 173 (39.4%). Patients were treated less aggressively; 144 (34.0%) patients with early-stage disease and 98 (86.0%) with metastatic disease never had chemotherapy. After a median follow up of 45 months, 5-year overall survival for the whole group was 67.6%. Survival was better for patients with non-metastatic disease (78.8% vs. 25.4%, P<0.0001) and for those with node-negative compared to node-positive disease; 85.4% vs. 74.1%, P=0.0024. On Cox regression, only positive lymph nodes were associated with poor outcome in patients with non-metastatic disease (Hazard Ratio [HR], 1.75; 95% CI: 1.006-3.034, P=0.0476).Conclusions Older Jordanian women with breast cancer present with more aggressive features and advanced-stage disease that reflect poorly on treatment outcomes. Because of comorbidities and poor performance status, some patients were not aggressively treated.
Perinatal Mood and Anxiety Disorders, Serious Mental Illness, and Delivery-Related Health Outcomes, United States, 2006-2015
Authors: McKee Kimberly Schmitt , Admon Lindsay K. , Winkelman Tyler N. A. , Muzik Maria , Hall Stephanie , Dalton Vanessa K. , Zivin Kara
Published: November 2019

Purpose: National estimates of perinatal mood and anxiety disorders (PMAD) and serious mental illness (SMI) among delivering women over time, as well as associated outcomes and costs, are lacking. We examined the prevalence of perinatal mood and anxiety disorders and serious mental illness, from 2006-2015 and associated risk of adverse obstetric outcomes, including severe maternal morbidity and mortality (SMMM), and delivery costs. Methods: We conducted a serial, cross-sectional analysis using National Inpatient Sample data. We estimated the prevalence of PMAD and SMI among delivering women as well as obstetric outcomes, healthcare utilization, and delivery costs using adjusted weighted logistic with predictive margins and generalized linear regression models, respectively. Results : We identified an estimated 39,025,974 delivery hospitalizations from 2006-2015 in the U.S. PMAD increased from 18.4 (95% CI 16.4-20.0) to 40.4 (95% CI 39.3-41.6) per 1,000 deliveries. SMI also increased among delivering women over time, from 4.2 (95% CI 3.9-4.6) to 8.1 (95% CI 7.9-8.4) per 1,000 deliveries. Medicaid covered 72% (95% CI 71.2-72.9) of deliveries complicated by SMI compared to 44% (95% CI 43.1-45.0) and 43.5% (95% CI 42.5-44.5) among PMAD and all other deliveries, respectively. Women with PMAD and SMI experienced higher incidence of SMMM, and increased hospital transfers, lengths of stay, and delivery-related costs compared to other deliveries ( P <.001 for all). Conclusion : Over the past decade, the prevalence of both PMAD and SMI among delivering women increased substantially across the United States, and affected women had more adverse obstetric outcomes and delivery-related costs compared to other deliveries.
Effectiveness of spiritual care training to enhance spiritual health and spiritual care competency among oncology nurses
Authors: Hu Yanli , Jiao Miaorui , Li Fan
Published: November 2019

Background: Although spiritual care is a basic element of holistic nursing, nurses' spiritual care knowledge and abilities are often unable to satisfy patients' spiritual care needs. Therefore, nurses are in urgent need of relevant training to enhance their abilities to provide patients with spiritual care.
Design: A non-randomized controlled trial.
Objective : To establish a spiritual care training protocol and verify its effectiveness.
Methods: This study recruited 92 nurses at a cancer-treatment hospital in a certain province via voluntary sign-up. The nurses were divided into two groups: the experimental group (45 people) and the control (wait-listed) group (47 people) using a coin-toss method. The experimental group received one spiritual care group training session each six months based on their routine nursing education; this training chiefly consisted of lectures by experts, group interventions, clinical practice, and case sharing. The control group participated in monthly nursing education sessions organized by the hospital for 12 continuous months.
Results : After 12 months of intervention, the nurses in the experimental group had significantly higher overall spiritual health and spiritual care competency scores as well as significantly higher scores on all individual dimensions compared with those in the control group ( P <0.01).
Conclusions: A spiritual care training protocol for nurses based on the concept of mutual growth with patients enhances nurses' spiritual well-being, spiritual care competencies.Trial registration: ChiCTR1900020930. Registered 22 January 2019.