bluuebunny/crossref_metadata_2025 huggingface dataset:
Crimes Against Morality: Unintended Consequences of Criminalizing Sex Work*
Authors: Cameron Lisa , Seager Jennifer , Shah Manisha
Published: September 2020

We examine the impact of criminalizing sex work, exploiting an event in which local officials unexpectedly criminalized sex work in one district in East Java, Indonesia, but not in neighboring districts. We collect data from female sex workers and their clients before and after the change. We find that criminalization increases sexually transmitted infections among female sex workers by 58 percent, measured by biological tests. This is driven by decreased condom access and use. We also find evidence that criminalization decreases earnings among women who left sex work due to criminalization and decreases their ability to meet their children’s school expenses while increasing the likelihood that children begin working to supplement household income. Although criminalization has the potential to improve population STI outcomes if the market shrinks permanently, we show that five years postcriminalization the market has rebounded and the probability of STI transmission in the general population is likely to have increased.
More is Less: Publicizing Information and Market Feedback*
Authors: Bird Andrew , Karolyi Stephen A , Ruchti Thomas G , Truong Phong
Published: September 2020

We study whether and how publicizing internal information affects the value of financial markets to the real economy. By publicizing corporate filings, the Securities and Exchange Commission’s EDGAR (Electronic Data Gathering, Analysis, and Retrieval) web platform reduces the cost of acquiring internal information for outsiders and so makes it relatively less attractive to gather external information. We find that the staggered introduction of EDGAR reduced the sensitivity of firm investment to prices, consistent with prices being less informative to managers due to the crowding out of external information gathering. This crowding out effect is stronger when outsiders’ incentives for gathering information are stronger and for firms that rely more on external information. Our findings suggest that policies designed to “level the playing field” by publicizing internal information can have significant unintended consequences by reducing the informativeness of prices for real decisions.
PREHISTORY OF THE CZECH RADON PROGRAM
Authors: Thomas Josef Jiří
Published: September 2020

In the Czech Republic, the program managing high radon levels in dwellings has existed for nearly 30 years. Although the recent history of radiation protection from naturally radioactive gas is quite well known, prior radon management is less understood. This article describes the history of natural radioactivity and its management from the Middle Ages, showing that Czech countries have a much longer and abundant history related to natural radioactivity.
The Law on the Books Versus the Law in Action: Muslim Women in Polygamous Marriages under the Jewish State
Authors: Aburabia Rawia
Published: September 2020

Based on empirical evidence from the Shari’a court in Beersheba of the ratification of customary polygamous marriages, the article examines the complexity of legal recognition of second marriages and the structural conditions under which polygamy is possible in the plural legal orders that exist in Israel. Although polygamy is criminally prohibited by the state of Israel, this prohibition is not enforced among the Bedouin in Israel, where 18.5 percent of Bedouin households are polygamous. This article demonstrates how these conditions perpetuate patriarchal norms among the Bedouin under the auspices of colonial legal structures.
Phylogenomics of Parasitic and Nonparasitic Lice (Insecta: Psocodea): Combining Sequence Data and Exploring Compositional Bias Solutions in Next Generation Data Sets
Authors: de Moya Robert S , Yoshizawa Kazunori , Walden Kimberly K O , Sweet Andrew D , Dietrich Christopher H , Kevin P Johnson
Published: September 2020

The insect order Psocodea is a diverse lineage comprising both parasitic (Phthiraptera) and nonparasitic members (Psocoptera). The extreme age and ecological diversity of the group may be associated with major genomic changes, such as base compositional biases expected to affect phylogenetic inference. Divergent morphology between parasitic and nonparasitic members has also obscured the origins of parasitism within the order. We conducted a phylogenomic analysis on the order Psocodea utilizing both transcriptome and genome sequencing to obtain a data set of 2370 orthologous genes. All phylogenomic analyses, including both concatenated and coalescent methods suggest a single origin of parasitism within the order Psocodea, resolving conflicting results from previous studies. This phylogeny allows us to propose a stable ordinal level classification scheme that retains significant taxonomic names present in historical scientific literature and reflects the evolution of the group as a whole. A dating analysis, with internal nodes calibrated by fossil evidence, suggests an origin of parasitism that predates the K-Pg boundary. Nucleotide compositional biases are detected in third and first codon positions and result in the anomalous placement of the Amphientometae as sister to Psocomorpha when all nucleotide sites are analyzed. Likelihood-mapping and quartet sampling methods demonstrate that base compositional biases can also have an effect on quartet-based methods.[Illumina; Phthiraptera; Psocoptera; quartet sampling; recoding methods.]
The virome from a collection of endomycorrhizal fungi reveals new viral taxa with unprecedented genome organization
Authors: Sutela Suvi , Forgia Marco , Vainio Eeva J , Chiapello Marco , Daghino Stefania , Vallino Marta , Martino Elena , Girlanda Mariangela , Perotto Silvia , Turina Massimo
Published: September 2020

Mutualistic plant-associated fungi are recognized as important drivers in plant evolution, diversity, and health. The discovery that mycoviruses can take part and play important roles in symbiotic tripartite interactions has prompted us to study the viromes associated with a collection of ericoid and orchid mycorrhizal (ERM and ORM, respectively) fungi. Our study, based on high-throughput sequencing of transcriptomes (RNAseq) from fungal isolates grown in axenic cultures, revealed in both ERM and ORM fungi the presence of new mycoviruses closely related to already classified virus taxa, but also new viruses that expand the boundaries of characterized RNA virus diversity to previously undescribed evolutionary trajectories. In ERM fungi, we provide first evidence of a bipartite virus, distantly related to narnaviruses, that splits the RNA-dependent RNA polymerase (RdRP) palm domain into two distinct proteins, encoded by each of the two segments. Furthermore, in one isolate of the ORM fungus Tulasnella spp. we detected a 12 kb genomic fragment coding for an RdRP with features of bunyavirus-like RdRPs. However, this 12 kb genomic RNA has the unique features, for Bunyavirales members, of being tri-cistronic and carrying ORFs for the putative RdRP and putative nucleocapsid in ambisense orientation on the same genomic RNA. Finally, a number of ORM fungal isolates harbored a group of ambisense bicistronic viruses with a genomic size of around 5 kb, where we could identify a putative RdRP palm domain that has some features of plus strand RNA viruses; these new viruses may represent a new lineage in the Riboviria, as they could not be reliably assigned to any of the branches in the recently derived monophyletic tree that includes most viruses with an RNA genome.
Anatomy, taxonomy and phylogeny of the Eocene guitarfishes from the Bolca Lagerstätten, Italy, provide new insights into the relationships of the Rhinopristiformes (Elasmobranchii: Batomorphii)
Authors: Marramà Giuseppe , Carnevale Giorgio , Naylor Gavin J P , Varese Massimo , Giusberti Luca , Kriwet Jürgen
Published: September 2020

We here re-evaluate the skeletal anatomy and the systematic position of the two Eocene guitarfish species represented by almost complete and articulated material from the Konservat-Lagerstätten of Bolca in Italy. The analyses of morphometric, skeletal and dental features of ‘Rhinobatos’ dezignii and ‘R.’ primaevus allow them to be excluded from the living guitarfish genus Rhinobatos and assigned to the new genera †Pseudorhinobatos gen. nov. and †Eorhinobatos gen. nov., respectively. The placement of these new genera within the rhinopristiform family Rhinobatidae is based on the possession of a series of morphological features (e.g. pectoral fins fused to head forming a wedge-shaped pectoral disc; rostral cartilage extending to the tip of the snout; nuchal cartilages and horn-like processes of nasal capsules absent; teeth with Rhinobatos-like morphology displaying smooth enameloid, central uvula and two lateral uvulae) that unambiguously exclude their assignment to any other rhinopristiform family. A new morphology-based phylogenetic analysis that includes the two new fossil genera, described herein, provides novel insights into the relationships of the Batoidea and recovers the Rhinopristiformes as a paraphyletic group. This indicates that the monophyly of extant taxa could be the result of the extinction of crucial taxa.
What Influences Choice of Continuing Medical Education Modalities and Providers? A National Survey of U.S. Physicians, Nurse Practitioners, and Physician Assistants
Authors: O’Brien Pott Maureen , Blanshan Anissa S. , Huneke Kelly M. , Baasch Thomas Barbara L. , Cook David A.
Published: September 2020

Purpose

To explore what influences clinicians in selecting continuing medical education (CME) activities in the United States.

Method

In August 2018, the authors conducted an Internet-based national survey, sampling 100 respondents from each of 5 groups: family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants. In total, 1,895 clinicians were invited and 500 (26%) responded. Questions addressed the selection and anticipated use of CME delivery modalities and perceived characteristics of specific CME providers. Response formats used best–worst scaling or 5-point ordinal response options.

Results

The factors identified as most important in selecting CME activities were topic (best–worst scaling net positivity 0.54), quality of content (0.51), availability of CME credit (0.43), and clinical practice focus (0.41), while referral frequency (−0.57) ranked lowest. The activities that the respondents anticipated using most in the future were live (mean 3.8 [1 = not likely, 5 = very likely]), online (mean 3.5), point-of-care (mean 3.5), and print-based (mean 3.5) activities. For online CME, the features of greatest appeal were that learning could be done when clinicians had time (mean 4.4), at their own pace (mean 4.2), and at lower cost (mean 4.2). For live CME, the features of greatest appeal were that the subject was best taught using this modality (mean 4.0), or the activity was located in a destination spot (mean 4.0) or a regional location (mean 3.9). When rating specific CME providers, most academic institutions received relatively high ratings for research focus and clinical practice focus, whereas commercial providers had slightly higher ratings for ease of access. Responses were generally similar across clinician types and age groups.

Conclusions

Physicians, nurse practitioners, and physician assistants are interested in using a variety of CME delivery modalities. Appealing features of online and live CME were different.
Early diagnosis and population prevention of coronavirus disease 2019
Authors: Su Ying-Ying , Zhang Shi-Yin , Li Ting-Dong , Xia Ning-Shao
Published: September 2020

Purpose of review

To discuss the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by nucleic acid and antibody testing as well as its contribution to mitigating the spread of coronavirus disease 2019.

Recent findings

Nucleic acid testing (NAT) is the firstly developed and most widely used diagnostic technique for SARS-CoV-2 infection. However, the sensitivity of SARS-CoV-2 RNA NAT assays is always unsatisfactory, mainly due to insufficient viral RNA in samples, especially when upper respiratory samples were used. Compared with NAT assays, serological tests are more convenient and less dependent on the quality of sample collection. But the sensitivity of antibody assays varies largely to test samples collected at different time after onset of symptoms. The diagnostic sensitivity can be significantly improved by combination of RNA and antibody testing. Due to the lack of effective drugs and vaccines, population prevention results mainly from timely triage and quarantine of SARS-CoV-2 infected individuals. Thus, extensive testing with NAT and antibody assays simultaneously is very important to constrain coronavirus disease 2019 epidemic.

Viral RNA testing combining with serological testing could improve the early diagnosis of SARS-CoV-2 infection, which has great value for clinical practice and public health.
Standardizing abortion education: what medical schools can learn from residency programs
Authors: Burns Roshan M. , Shaw Kate A.
Published: September 2020

Purpose of review

With over 50 million abortions annually and 25% of pregnancies ending in abortion worldwide, abortion is one of the most common medical procedures. Yet abortion-related topics are glaringly absent from medical school curricula in the USA with half of medical schools including no formal training or only a single lecture. We explore abortion education in US medical schools and Obstetrics and Gynecology (Ob/Gyn) residency programs. Specifically, we review efforts to improve and standardize this training.

Recent findings

Despite documented interest in both learning and in the benefits of early exposure, medical students face a lack of educational opportunities in abortion care. Meanwhile, Ob/Gyn residency has standardized requirements for abortion care, greatly improving training and education, despite persistent challenges in universal compliance with these standards.

Education in abortion care is crucially important in fostering and training future abortion providers, thereby ensuring and expanding access to safe abortion. The improvements made by standardizing abortion education in Ob/Gyn residency should encourage similar efforts in medical school in order to increase earlier and wider exposure to future physicians of all specialties. On a national level, standardizing exams for medical students by which to evaluate their understanding of abortion care would hold schools accountable for medical student education.
Pulmonary hypertension associated with left-sided heart failure
Authors: Adler Joana , Gerhardt Felix , Wissmüller Max , Adler Christoph , Baldus Stephan , Rosenkranz Stephan
Published: September 2020

Purpose of review

Pulmonary hypertension is a common phenomenon in heart failure patients that is highly relevant for morbidity and outcome. Although postcapillary in nature, the pathophysiology of pulmonary hypertension in patients with heart failure with reduced or preserved ejection fraction is complex, and decisions about management strategies remain challenging.

Recent findings

Recently, the hemodynamic definitions and subclassification of postcapillary pulmonary hypertension have been revisited. The distinction between isolated postcapillary pulmonary hypertension (IpcPH) and combined post and precapillary pulmonary hypertension (CpcPH) and their definition are essential. Novel data on the prognostic impact of hemodynamic variables and right ventricular function highlight the importance of cardiopulmonary interaction in patients with left-sided heart failure (LHF). Furthermore, the impact of management strategies including medical therapy, remote hemodynamic monitoring, and interventional approaches on hemodynamics and outcome has recently been investigated. Here, we critically review recent developments and future considerations in this field, and highlight distinct treatment strategies targeting the underlying left heart condition, the pulmonary circulation, and/or impaired right ventricular function.

Detailed hemodynamic characterization and proper phenotyping are essential for prognostication and the management of patients with pulmonary hypertension associated with LHF, both in clinical practice and when addressing research questions.
Keratoconus Prevalence in Families: A French Study
Authors: Lapeyre Gabrielle , Fournie Pierre , Vernet Raphaël , Roseng Stéphanie , Malecaze François , Bouzigon Emmanuelle , Touboul David
Published: September 2020

Purpose:

To assess the keratoconus (KC) prevalence among first-degree relatives of affected subjects.

Methods:

We performed large epidemiological, prospective, and observational cohort, which took place in the French KC National Reference Centre, in Bordeaux. We studied data from 94 unrelated patients with KC and at least 2 first-degree relatives assessable. Each subject had a thorough ocular examination including visual acuity, refraction, slitlamp biomicroscopy, indirect ophthalmoscopy, keratometry, corneal topography and tomographer (Topographic Modeling System; Tomey Corporation, Japan; and Galilei G4, Ziemer, Switzerland, respectively), pachymetry, and biomechanical properties of cornea (Ocular Response Analyzer; Reichert, Depew, NY). Additional data were collected about atopy, smoking, and eye-rubbing habits. KC prevalence, multivariate analysis, and familial correlation analysis have been studied.

Results:

Of the 221 relatives, 9.05% (n = 20) had clinically manifest KC, and 15.4% (n = 31) had subclinical KC. The prevalence of KC was estimated equal to 0.14 [95% confidence interval (CI), 0.07–0.22] among parents, 0.03 (95% CI, 0–0.10) among offspring, and 0.10 (95% CI, 0.04–0.20) among siblings. In multivariable analysis, age and eye-rubbing were associated with an increased risk of KC. The familial correlation of KC among probands' first-degree relatives was estimated at 0.55 among parents, 0.29 among offspring, and 0.49 among siblings.

Conclusions:

Being a first-degree relative of a subject with KC remains a risk factor for developing KC. This should be taken into account especially when screening for KC in pediatric patients, for refractive surgery candidates, and for patients being evaluated for cataract surgery.
General risks of harm with cannabinoids, cannabis, and cannabis-based medicine possibly relevant to patients receiving these for pain management: an overview of systematic reviews
Authors: Mohiuddin Mohammed , Blyth Fiona M. , Degenhardt Louisa , Di Forti Marta , Eccleston Christopher , Haroutounian Simon , Moore Andrew , Rice Andrew S.C. , Wallace Mark , Park Rex , Gilron Ian
Published: September 2020

The growing demand for improved pain treatments together with expanding legalization of, and access to, cannabinoids, cannabis, and cannabis-based medicines has intensified the focus on risk–benefit considerations in pain management. Given limited harms data from analgesic clinical trials, we conducted an overview of systematic reviews focused on all harms possibly relevant to patients receiving cannabinoids for pain management. This PROSPERO-registered, PRISMA-compliant systematic overview identified 79 reviews, encompassing over 2200 individual reports about psychiatric and psychosocial harms, cognitive/behavioral effects, motor vehicle accidents, cardiovascular, respiratory, cancer-related, maternal/fetal, and general harms. Reviews, and their included studies, were of variable quality. Available evidence suggests variable associations between cannabis exposure (ranging from monthly to daily use based largely on self-report) and psychosis, motor vehicle accidents, respiratory problems, and other harms. Most evidence comes from settings other than that of pain management (eg, nonmedicinal and experimental) but does signal a need for caution and more robust harms evaluation in future studies. Given partial overlap between patients receiving cannabinoids for pain management and individuals using cannabinoids for other reasons, lessons from the crisis of oversupply and overuse of opioids in some parts of the world emphasize the need to broadly consider harms evidence from real-world settings. The advancement of research on cannabinoid harms will serve to guide optimal approaches to the use of cannabinoids for pain management. In the meantime, this evidence should be carefully examined when making risk–benefit considerations about the use of cannabinoids, cannabis, and cannabis-based medicine for chronic pain.
Optimized acupuncture treatment (acupuncture and intradermal needling) for cervical spondylosis–related neck pain: a multicenter randomized controlled trial
Authors: Chen Ling , Li Minying , Fan Li , Zhu Xiaoping , Liu Jianhua , Li Hui , Xu Zhenhua , Chen Junjun , Liang Zhaohui , Liu Zhiyan , Feng Lingmei , Chen Xiaoyun , He Qing , Chen Xiaokai , Ou Aihua , He Jiangshan , Ma Rui , Ning Baile , Jiang Li , Li Sheng , Fu Wenbin
Published: September 2020

Cervical spondylosis (CS)-related neck pain is difficult to treat because of its degenerative nature. The aim of this 9-center, single-blinded, randomized controlled trial was to evaluate the efficacy of optimized acupuncture for CS-related neck pain. Participants who met the inclusion criteria were randomized to optimized, shallow, and sham acupuncture groups (1:1:1). The primary outcome was the change from baseline in the Northwick Park Neck Pain Questionnaire score at week 4. Participants were followed up until week 16. Of the 896 randomized participants, 857 received ≥1 intervention session; 280, 286, and 291 received optimized, shallow, and sham acupuncture, respectively. A total of 835 (93.2%) participants completed the study. At week 4, significant differences (P < 0.001) were observed in the changes in Northwick Park Neck Pain Questionnaire scores between the optimized acupuncture group and both the shallow {7.72 (95% confidence interval [CI], 5.57-9.86)} and sham acupuncture (10.38 [95% CI, 8.25-12.52]) groups. The difference in the scores at week 16 between the optimized acupuncture group and the shallow (8.84 [95% CI, 6.34-11.34]) and sham acupuncture (10.81 [95% CI, 8.32-13.30]) groups were significant. The center effect indicated wide variability in the treatment effects (Cohen's d = 0.01-2.19). Most SF-36 scores were higher in the optimized acupuncture group than those in the other groups. These results suggest that 4-week optimized acupuncture treatment alleviates CS-related neck pain and improves the quality of life, with the effects persisting for minimum 3 months. Therefore, acupuncture can have positive effects on CS-related neck pain, although the effect size may vary widely.
Sexual dimorphism in the contribution of neuroendocrine stress axes to oxaliplatin-induced painful peripheral neuropathy
Authors: Staurengo-Ferrari Larissa , Green Paul G. , Araldi Dionéia , Ferrari Luiz F. , Miaskowski Christine , Levine Jon D.
Published: September 2020

Although clinical studies support the suggestion that stress is a risk factor for painful chemotherapy-induced peripheral neuropathy (CIPN), there is little scientific validation to support this link. Here, we evaluated the impact of stress on CIPN induced by oxaliplatin, and its underlying mechanisms, in male and female rats. A single dose of oxaliplatin produced mechanical hyperalgesia of similar magnitude in both sexes, still present at similar magnitude in both sexes, on day 28. Adrenalectomy mitigated oxaliplatin-induced hyperalgesia, in both sexes. To confirm the role of neuroendocrine stress axes in CIPN, intrathecal administration of antisense oligodeoxynucleotide targeting β₂-adrenergic receptor mRNA both prevented and reversed oxaliplatin-induced hyperalgesia, only in males. By contrast, glucocorticoid receptor antisense oligodeoxynucleotide prevented and reversed oxaliplatin-induced hyperalgesia in both sexes. Unpredictable sound stress enhanced CIPN, in both sexes. The administration of stress hormones, epinephrine, corticosterone, and their combination, at stress levels, mimicked the effects of sound stress on CIPN, in males. In females, only corticosterone mimicked the effect of sound stress. Also, a risk factor for CIPN, early-life stress, was evaluated by producing both stress-sensitive (produced by neonatal limited bedding) and stress-resilient (produced by neonatal handling) phenotypes in adults. Although neonatal limited bedding significantly enhanced CIPN only in female adults, neonatal handling significantly attenuated CIPN, in both sexes. Our study demonstrates a sexually dimorphic role of the 2 major neuroendocrine stress axes in oxaliplatin-induced neuropathic pain.
Neuropathic pain: clinical classification and assessment in patients with pain due to cancer
Authors: Shkodra Morena , Brunelli Cinzia , Zecca Ernesto , Formaglio Fabio , Bracchi Paola , Lo Dico Silvia , Caputo Mariangela , Kaasa Stein , Caraceni Augusto
Published: September 2020

Neuropathic cancer pain (NcP) is associated with worse treatment responses and specific therapy indications, but a standardized clinical diagnosis of NcP is still lacking. This is a prospective observational study on outpatients with cancer, comparing different clinical approaches with NcP evaluation. A three-step assessment of NcP was performed using DN4 (cutoff of 4), palliative care physician Clinical Impression, including etiology and pain syndrome identification, and Retrospective Clinical Classification by a board of specialists with the IASP Neuropathic Pain Special Interest Group criteria. Neuropathic cancer pain classification was specifically referred to pain directly due to cancer. Three hundred fifty patients were assessed, and NcP prevalence was 20% (95% confidence interval [CI] 15.9%-24.6%), 36.9%, (95% CI 31.6%-42.1%), and 28.6% (95% CI 23.8%-33.9%) according to DN4, Clinical Impression, and Retrospective Clinical Classification, respectively. Cohen's kappa concordance coefficient between DN4 and Retrospective Clinical Classification was 0.57 (95% CI 0.47-0.67), indicating moderate concordance. Higher percentages of discordance were found for specific pain syndromes such as pain due to deep soft tissue infiltration and pain associated with tenesmus. Disagreement among clinicians accounted also for different NcP diagnoses and highlighted lack of homogeneous clinical criteria. Rigorous application of etiological and syndrome diagnosis to explain pain cause, associated with standardized diagnostic criteria and assessment of pain characteristics, that is also specific for the cancer pain condition could improve clinical classification of NcP.
Avoidance behaviour performed in the context of a novel, ambiguous movement increases threat and pain-related fear
Authors: van Vliet Christine M. , Meulders Ann , Vancleef Linda M.G. , Vlaeyen Johan W.S.
Published: September 2020

The fear-avoidance model of chronic pain predicts that catastrophic (mis)interpretation of pain elicits pain-related fear that in turn may spur avoidance behaviour leading to chronic pain disability. Here, we investigated whether performing a movement to avoid a painful stimulus in the context of a novel movement increases threat and pain-related fear towards this novel movement and whether avoidance behaviour persisted when given the choice between performing the acquired movement to avoid a painful stimulus or an alternative, novel movement. Applying a robotic arm-reaching task, participants could choose between 2 movements to reach a target location: a short, but painful movement trajectory, or a longer nonpainful movement trajectory. After avoidance acquisition, the option to choose the painful trajectory was removed. The experimental group (N = 50) could choose between the longest trajectory or a novel intermediate trajectory, whereas the control group (N = 50) was allowed to only perform the novel trajectory. In a final test, participants of both groups were allowed to choose any of the 3 trajectories. After acquisition, experimental group participants showed elevated pain expectancy and pain-related fear towards the novel trajectory, compared with the control group. During test, the experimental group participants persisted in performing the longest pain-free (avoidance) trajectory and were less likely to choose the novel trajectory. In addition, these participants maintained higher levels of pain-related fear for the novel trajectory compared with the control group. These findings suggest that avoidance in the context of other neutral activities/movements may lead to the development and maintenance of threat appraisals and irrational fears.
Antenatal pain, intimate partner violence, and maternal bonding disorder: data from the Japan Environment and Children's Study
Authors: Yamada Keiko , Kimura Takashi , Cui Meishan , Kubota Yasuhiko , Tanaka Eizaburo , Wakaizumi Kenta , Ikehara Satoyo , Kimura Tadashi , Iso Hiroyasu ,   the Japan Environment and Children's Study Group
Published: September 2020

This prospective study examined (1) whether antenatal pain is associated with postnatal maternal bonding disorder (MBD) through postnatal depression and (2) whether intimate partner violence (IPV) has a moderating effect on the association between antenatal pain and postnatal MBD. We analyzed 77,326 pregnancies of women who completed self-report questionnaires including the SF-8 bodily pain item, the Edinburgh Postnatal Depression Scale, the Mother-to-Infant Bonding Scale, and an assessment of IPV. We conducted a mediation analysis to assess whether postnatal depression mediated the association between antenatal pain and MBD 1 year after delivery. A moderated mediation model was used to examine the conditional effect of IPV during pregnancy on the association between antenatal pain and postnatal MBD, operating through postnatal depression. All analyses were adjusted for demographic factors, socioeconomic factors, perinatal and infant factors, medical history, and psychological status. Of the 77,326 pregnancies, 5420 (7.0%) were characterized by persistent moderate-to-severe pain. The total effect of antenatal pain on MBD was significant (standardized path coefficient = 0.06, 95% confidence interval, 0.05-0.06) and postnatal depression dominantly mediated the association between antenatal pain and postnatal MBD (70.8% mediation). Contrary to our hypothesis, IPV during pregnancy did not moderate the association between antenatal pain and postnatal MBD. However, IPV during pregnancy did have independent negative effects on both postnatal depression and MBD. Our findings suggest that antenatal pain and postnatal depression should be assessed and treated with consideration of the presence of IPV during pregnancy to better monitor and prevent the development of MBD.
Precipitating factors causing hyperbilirubinemia during chronic hepatitis C treatment with paritaprevir/ritonavir/ombitasvir and dasabuvir
Authors: Wang Yi-Kai , Lee Wei-Ping , Wang Ying-Wen , Huang Yi-Hsiang , Hou Ming-Chih , Chang Yuh-Lih , Lan Keng-Hsin
Published: September 2020

Background:

Hepatic decompensation is a fatal on-treatment side effect during chronic hepatitis C treatment with paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD). Prompt bilirubin testing can reveal hepatic failure in susceptible patients, and clinical parameters precipitating early elevation of bilirubin can warn clinicians to avoid PrOD prescription.

Methods:

This retrospective study included 169 Hepatitis C virus (HCV)-genotype 1b patients who underwent a 12-week course of PrOD with or without ribavirin. Laboratory data underwent χ2 analysis with Fisher’s exact test to determine the precipitating factors causing hyperbilirubinemia in patients who had received 1 week of treatment.

Results:

Sustained viral response was achieved in 164 patients (97.0%). Total bilirubin was ≥2 mg/dL (21.3%) in 36 patients after 1 week of treatment. Pretreatment white blood cell (WBC) <4500/µL and platelet <100,000/µL correlated with total bilirubin ≥2 mg/dL (relative risk [RR]: 21.64, 95% CI: 5.23-89.64, p < 0.001) after 1 week of treatment. Pretreatment platelet ≥100 000/µL and WBC <4500/µL correlated with direct bilirubin ≥0.45 mg/dL (RR: 6.56, 95% CI: 1.42-30.38, p = 0.016) and indirect bilirubin ≥0.6 mg/dL (RR: 4.77, 95% CI: 1.03-22.15, p = 0.046). Pretreatment platelet <100,000/µL with F3/F4 fibrosis correlated with first week total bilirubin ≥2 mg/dL (RR: 3.57, 95% CI: 1.35-9.09, p = 0.010).

Conclusion:

PrOD is an effective antiviral regimen for HCV genotype 1b patients. Total bilirubin ≥2 mg/dL after 1 week of treatment serves as an early warning of irreversible progression toward hepatic decompensation, and the current study provides a guide by which to monitor chronic hepatitis C patients undergoing PrOD treatment.
Gastrointestinal Health Questionnaire for Rett Syndrome
Authors: Motil Kathleen J. , Khan Nabeel , Coon Jennifer L. , Barrish Judy O. , Suter Bernhard , Pehlivan Davut , Schultz Rebecca J. , Glaze Daniel G.
Published: September 2020

Objectives:

We report the development and validation of a tool to assess gastrointestinal health in Rett syndrome (RTT). We hypothesized that the Gastrointestinal Health Questionnaire (GHQ) is a valid clinical outcomes measure of gastrointestinal health in RTT.

Patients and Methods:

We used parent interviews, surveys, and literature review to generate a questionnaire related to gastrointestinal health and function, mood and behaviors, and parental concerns for individuals with RTT. Parents of affected and unaffected individuals provided responses to the GHQ, assessed the relevance and importance of statements, and completed 5 surveys related to gastrointestinal health, child‐related mood and behaviors, and parent concerns. We used multivariate item analysis, 2‐sample t tests, and correlations to assess the validity of the GHQ.

Results:

We documented acceptable internal consistency of statements related to gastrointestinal health and function (Cronbach‐α = 0.91), RTT‐related mood and behaviors (Cronbach‐α = 0.89), and parent concerns (Cronbach‐α = 0.95) in the GHQ. We documented favorable external validity based on differences in response scores between parents of affected and unaffected individuals (P < 0.001) and correlations in parental response scores between the GHQ and 5 validated questionnaires addressing similar issues (P < 0.001).

Conclusion:

The GHQ is a valid tool for the assessment of gastrointestinal health in RTT and offers the opportunity to field test the safety and efficacy of novel drug therapies in clinical trials for individuals affected with this disorder.
Preoperative Optimism Related to Low Anxiety in Patients 1 Month After Open Heart Surgery
Authors: Ai Amy L. , McMullen Colleen A. , Smyth Susan S.
Published: September 2020

Anxiety can contribute to poor prognosis in cardiac patients. Few studies have examined the role of optimism in anxiety after open heart surgery (OHS). This study investigated the influence of preoperative optimism on post-OHS anxiety, adjusting cardiac indices used by cardiac surgeons. Data were collected before and 1 month after OHS in 481 patients (58% men; age, 62.4 ± 11.94 years). Optimism was measured using the Life Orientation Test. Anxiety was measured using the Trait Anxiety Inventory. Medical and cardiac indices were retrieved from the Society of Thoracic Surgeon's national database. Multiple regression analyses showed that greater pre-OHS optimism was associated with lower levels of post-OHS anxiety (F[6, N = 306] = 50.18, p < 0.001, R
2 = 0.502). No other factors showed similar protection. Pre-OHS anxiety, younger age, and minority status were associated with anxiety in the critical recovery month. The findings demonstrate the potential benefit of optimism against post-OHS anxiety, which may have clinical implications for improving disease management.
Prevalence of Cyberbullying in Patients Presenting to the Pediatric Emergency Department
Authors: Hellstrand Karl , Rogers Steven C. , DiVietro Susie , Clough Meghan , Sturm Jesse
Published: September 2020

Objectives

Mental health (MH) complaints are increasingly responsible for visits to pediatric emergency departments (PEDs). Bullying is associated with MH problems. Most adolescents use social media and many experience problems with cyberbullying (CB). This study determines prevalence of CB in MH and non-MH adolescents in a PED, describes technology use in these groups, and measures influence of CB on presentation to the PED and on thoughts/acts of self-harm.

Methods

A prospective survey was administered to a convenience sample of 149 patients aged 11 to 17 years in a PED. Data were analyzed using descriptive and comparative statistical methods.

Results

Cyberbullying was significantly more common in MH than in the non-MH patients (17% vs 3%, P = 0.007). More MH patients reported that bullying led to the current PED visit than that in the non-MH group (25% vs 10%, P = 0.02), and they were significantly more likely to report that CB led to self-harm (22% vs 4%, P = 0.003). Mental health participants who spent more than 3 hours on the Internet report higher levels of bullying than non-MH patients (38% vs 6%, P < 0.001).

Conclusions

Prevalence of bullying in MH patients presenting to a PED is significantly greater than controls, and CB caused more MH patients to have acts or thoughts of self-harm. Bullying is a risk factor for self-harm and suicide in patients with MH problems. Future studies should evaluate CB as part of suicide screening tools for emergency MH patients.
Managing Pediatric Foreign Body Ingestions
Authors: Dipasquale Valeria , Romano Claudio , Iannelli Mauro , Tortora Andrea , Melita Giuseppinella , Ventimiglia Marco , Pallio Socrate
Published: September 2020

Background

Foreign body (FB) ingestion is a common global issue in pediatrics. Most of the ingested FBs pass through the gastrointestinal tract, but up to 20% of cases require endoscopic removal. In this study, we retrospectively reviewed all pediatric cases of FB ingestion requiring endoscopic removal over a 10-year period in a tertiary hospital to compare the symptoms at presentation and outcomes with those reported in previous studies and to assess the association of the outcomes with patient and FB characteristics.

Methods

A retrospective chart review of children 16 years or younger who underwent upper endoscopy for FB ingestion from 2008 to 2018 in a tertiary hospital was included. Data on demographics, clinical presentation, characteristics of FBs, endoscopic findings, and outcomes were reviewed. The clinical data were further evaluated to determine the circumstances surrounding FB ingestion, FB management, and patient outcomes. Descriptive analysis of the data was performed using medians, frequencies, and percentage; χ2 or Fisher exact test was used to assess the dependence between categorical variables.

Results

Eighty-six patients (median age, 5.1 years; 67% males) underwent endoscopy for suspected FB ingestion, with a confirmation rate of 91%. Coins were the most commonly ingested FBs (n = 49, 57%). Most patients were symptomatic (84%); 97% of patients in whom the FB had an esophageal location and all patients in whom the FB was not detected by endoscopy were symptomatic (P = 0.007). The most frequent symptoms were drooling (70%) and unexplained crying (48%). Unexplained crying was more common in younger than in older patients (P < 0.001). The FB was more likely to be located in the esophagus in patients with drooling (P < 0.001) and dysphagia (P < 0.001). The distribution of FB location differed according to the FB type, with coins most frequently located in the esophagus and sharp and other FBs in the stomach (P = 0.023). Only 7 patients (8%) developed mild FB-related mucosal injury. No complications occurred during FB removal. All patients had an uneventful outcome.

Conclusions

Foreign body ingestion is common among younger children, and the clinical presentation can be variable. The presence or absence of symptoms, as well as the type of symptom, could aid clinicians in implementing diagnosis and proper management approaches in patients who ingest FBs requiring endoscopy.
Distinguishing Multisystem Inflammatory Syndrome in Children From Kawasaki Disease and Benign Inflammatory Illnesses in the SARS-CoV-2 Pandemic
Authors: Corwin Daniel J. , Sartori Laura F. , Chiotos Kathleen , Odom John Audrey R. , Cohn Keri , Bassiri Hamid , Behrens Edward M. , Teachey David T. , Henrickson Sarah E. , Diorio Caroline J. , Zorc Joseph J. , Balamuth Fran
Published: September 2020

Objective

The aim of the study was to compare presenting clinical and laboratory features among children meeting the surveillance definition for multisystem inflammatory syndrome in children (MIS-C) across a range of illness severities.

Methods

This is a retrospective single-center study of patients younger than 21 years presenting between March 1 and May 15, 2020. Included patients met the Centers for Disease Control and Prevention criteria for MIS-C (inflammation, fever, involvement of 2 organ systems, lack of alternative diagnoses). We defined 3 subgroups by clinical outcomes: (1) critical illness requiring intensive care interventions; (2) patients meeting Kawasaki disease (KD) criteria but not requiring critical care; and (3) mild illness not meeting either criteria. A comparator cohort included patients with KD at our institution during the same time frame in 2019.

Results

Thirty-three patients were included (5, critical; 8, 2020 KD; 20, mild). The median age for the critical group was 10.9 years (2.7 for 2020 KD; 6.0 for mild, P = 0.033). The critical group had lower median absolute lymphocyte count (850 vs 3005 vs 2940/uL, P = 0.005), platelets (150 vs 361 vs 252 k/uL, P = 0.005), and sodium (129 vs 136 vs 136 mmol/L, P = 0.002), and higher creatinine (0.7 vs 0.2 vs 0.3 mg/dL, P = 0.002). In the critical group, 60% required vasoactive medications, and 40% required mechanical ventilation. Clinical and laboratories features were similar between the 2020 and 2019 KD groups.

Conclusions

We describe 3 groups with inflammatory syndromes during the SARS-CoV-2 pandemic. The initial profile of lymphopenia, thrombocytopenia, hyponatremia, and abnormal creatinine may help distinguish critically ill MIS-C patients from classic/atypical KD or more benign acute inflammation.
Retiform Purpura as a Sign of Necrotizing Cellulitis in an Immunocompetent Boy
Authors: Aboul-Fettouh Nader , Nguyen Khang D. , Dominguez Arturo R.
Published: September 2020

Severe group A streptococcus (GAS) infections, particularly necrotizing soft tissue infections (NSTIs), have been associated with the development of streptococcal toxic-shock syndrome (STSS), a systemic illness caused by GAS-derived toxins. Traditional physical examination findings in NSTIs include skin necrosis, crepitus, and hemorrhagic bullae. However, these findings are limited in sensitivity and additional clinical markers may aid in making an early diagnosis of NSTI. We present a case of a superficial infection, specifically GAS necrotizing cellulitis, complicated by STSS in a healthy boy with an associated skin finding of retiform purpura that aided in early diagnosis of a NSTI.
Criteria to Evaluate the Quality of Outcome Reporting in Randomized Controlled Trials of Rehabilitation Interventions
Authors: Wang Dan , Taylor-Vaisey Anne , Negrini Stefano , Côté Pierre
Published: September 2020

No standardized guideline for the reporting of outcomes measures in randomized controlled trials of rehabilitation interventions is currently available. This study includes four phases to identify, synthesize, and make recommendations for potential attributes of reporting criteria of outcome measures in rehabilitation randomized controlled trials. First, we surveyed the author instructions for rehabilitation journals to determine how journals require authors to report outcomes. Second, we reviewed all consolidated standards of reporting trials extensions to determine how other speciality groups require reporting of outcomes in randomized controlled trials. Third, we conducted a focused scoping review to examine the nature and variations of criteria used to evaluate the quality of outcome measures in randomized controlled trials. Finally, we synthesized the information from phases 1–3 and propose four criteria specific to the reporting of outcomes in randomized controlled trials of rehabilitation interventions: (1) clearly describe the construct to be measured as outcome(s); (2) justify the selection of outcome measures by mapping to World Health Organization International Classification of Function, Disability, and Health (International Classification of Functioning) framework; justify the psychometric properties (relevance, validity, reliability) of the selected measurement tool; (3) clearly describe the timing of outcome measurement, with consideration of the health condition, the course of disease, and hypothesized effect of intervention; and (4) complete and unselective reporting of outcome data.
The Association Between Pain Trajectories With Posttraumatic Stress Disorder, Depression, and Disability During the Acute Posttrauma Period
Authors: Connor Julie P. , Brier Zoe M.F. , Price Matthew
Published: September 2020

Objective

Exposure to a traumatic event is common among US adults, yet only a small fraction develops posttraumatic stress disorder (PTSD). Higher pain after a traumatic injury has been associated with higher PTSD symptoms and thus may be a risk factor. However, few studies have examined how pain during the period immediately after a trauma, referred to as the acute posttrauma period, relates later to PTSD outcomes.

Methods

A sample of (n = 87) individuals who had experienced a traumatic injury assessed their pain through daily mobile assessments for the first month after injury. PTSD, depression, and functional impairment were assessed at the time of trauma and 1 and 3 months later.

Results

Using latent class growth analysis, three trajectories of pain were identified: low pain (41.3%), decreasing pain (43.7%), and high pain (14.9%). At baseline, the high-pain class reported higher levels of depression and functional impairment than did the low-pain group. From baseline to 3 months, the low-pain class experienced a reduction in PTSD, depression, and functional impairment, whereas the high-pain class experienced an increase in PTSD symptoms, persistent depression, and functional impairment.

Conclusions

These results demonstrate that there are distinct trajectories of pain after a traumatic injury. Persistent elevated pain is associated with more severe psychopathology in the period immediately after a traumatic injury.