bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation and analysis of standardized training for residents of general practitioners of Gansu Province in China
Authors: Wang Hongjing , He Jin , Zhang Dongzhi , Wu Yue , Wang Peidong , Cai Hui
Published: June 2020

Background

China’s standardized training for residents of General Practitioners (GPs) is aimed at providing the postgraduate training for family doctors who will serve the primary health care institutions. The aim of this paper is to investigate the standardized training situation, satisfaction with standardized training, work situation, intention, satisfaction and attitude of GPs who have finished standardized training.

Methods

This study was undertaken in 6 training hospitals in Gansu province using a questionnaire with 45 questions.

Results

Approximately 275 residents of GPs were enrolled. Finally, 263 residents completed the questionnaire (95.64% response rate), including 133 females (50.57%) and 130 males (49.43%) with an average age of 28 years (standard deviation, 1.93 years; range, 25–36 years). Additionally, 56.65% were single and 43.35% were married. Of all subjects, 92.40% residents had obtained certification of standardized training for residents of GPs and only 39.54% residents were satisfied with monthly income during training. There were 171 oriented rural medical graduates, of whom, only 42.69% expressed the willing to continue working in the primary health care institutions after the serve time (6 years) expired. Around 86.31% of residents of GPs who had finished standardized training got jobs with more than half serving in the primary health care institutions. For medical institutions and sanitary bureau were clear about general medicine policies, only 29.96% subjects registered as GPs. Among the residents in general practice department, 68.42% were engaged in the diagnosis and treatment of common disease and frequently-occurring diseases as well as referral of patients. The percentage of residents who were satisfied with the job and income were 30.40 and 14.98%, respectively.

Conclusion

Standardized training for residents of GPs in China is gradually improving. In order to cultivate more GPs and increase their willing to serve in the primary health care institutions, it is necessary to formulate and execute better policy of GPs, publize general medicine and improve the training quality.
Hearing loss and cognitive function among Chinese older adults: the role of participation in leisure activities
Authors: Gao Jiamin , Armstrong Nicole M. , Deal Jennifer A. , Lin Frank R. , He Ping
Published: June 2020

Background

Hearing loss, a highly prevalent sensory impairment affecting older adults, is a risk factor for cognition decline. However, there were very limited studies on this association in low-resource countries. This study aimed to assess the association between self-reported hearing loss and cognitive decline, and whether engagement in leisure activities moderated this association among older adults in China.

Methods

Data were obtained from two waves of the nationally representative survey of China Longitudinal Healthy Longevity Survey (CLHLS) between 2011/12–2014. Eight thousand eight hundred forty-four individuals aged 65 years old or above with a dichotomized measure of self-reported hearing status were included. Modified Mini-Mental Examination (MMSE) was used to measure global cognition. Fixed-effects models were used to estimate whether leisure activity engagement moderated the association of self-perceived hearing loss with global cognitive change in the overall sample and sex subsamples.

Results

Self-reported hearing loss was associated with cognitive impairment, with an odds ratio of 2.48 [1.22, 5.06]. Sex difference in the association of hearing loss and cognitive impairment was not found. Self-reported hearing loss was associated with cognitive decline, with 8% increase in risk compared with those with normal hearing. Frequent engagement in leisure activities moderated the association between hearing loss and cognitive decline for the whole and male samples.

Conclusion

Hearing loss was associated with cognitive decline, and leisure activities engagement moderated the association among males rather than females.
Prognostic characterization of OAS1/OAS2/OAS3/OASL in breast cancer
Authors: Zhang Yujie , Yu Chaoran
Published: June 2020

Background

Prognostic biomarkers remain a focus in breast cancer during last decades. More reliable predictors to adequately characterize the prognosis of breast cancer are essential. The 2′-5′-oligoadenylate synthetases (OAS), composing of OAS1, OAS2, OAS3, and OAS-like (OASL), are interferon (IFN)-induced antiviral enzymes, with their prognostic roles remain to be characterized.

Methods

Prognostic values of OAS family members were assessed by multiple public available resources.

Results

High mRNA expression of OAS1 and OAS3 were correlated with worse prognosis for all breast cancer patients, whereas OAS2 was associated with favorable prognosis. The prognostic values of OAS family in different clinicopathologic subtypes were also characterized. In DNA methylation level, cg12560128 in OAS2, cg06800840 and cg26328872 in OASL showed significant prognostic values. The mRNA expression of OAS members signature in high/low risk overall survival groups was opposite to the high/low risk recurrence free survival groups. Neutrophil cell exhibited highest correlation with all OAS members in tumor immune infiltrating estimation.

Conclusions

This study provided new insight into the prognostic roles of OAS in breast cancer with potential mechanistic values.
The effect of pericolic lymph nodes metastasis beyond 10 cm proximal to the tumor on patients with rectal cancer
Authors: Yang Xuyang , Zheng Erliang , Ye Lina , Gu Chaoyang , Hu Tao , Jiang Dan , He Du , Wu Bing , Wu Qinbing , Yang Tinghan , Wei Mingtian , Meng Wenjian , Deng Xiangbing , Wang Ziqiang , Zhou Zongguang
Published: June 2020

Background

This study aims to determine the real incidence of pericolic lymph nodes metastasis beyond 10 cm proximal to the tumor (pPCN) and its prognostic significance in rectal cancer patients.

Methods

Consecutive patients with rectal cancer underwent curative resection between 2015 and 2017 were included. Margin distance was marked and measured in vivo and lymph nodes were harvested on fresh specimens. Clinicopathological characteristics and oncological outcomes (3-year overall survival (OS) and disease-free survival (DFS)) were analyzed between patients with pPCN and patients without pPCN (nPCN).

Results

There were 298 patients in the nPCN group and 14 patients (4.5%) in pPCN group. Baseline characteristics were balanced except more patients received preoperative or postoperative chemoradiotherapy in pPCN group. Preoperative more advanced cTNM stage (log-rank p = 0.005) and intraoperative more pericolic lymph nodes beyond 10 cm proximal to the tumor (PCNs) (log-rank p = 0.002) were independent risk factors for pPCN. The maximum short-axis diameter of mesenteric lymph nodes ≥8 mm was also contributed to predicting the pPCN. pPCN was an independent prognostic indicator and associated with worse 3-year OS (66% vs 91%, Cox p = 0.033) and DFS (58% vs 92%, Cox p = 0.012).

Conclusion

The incidence of pPCN was higher than expected. Patients with high-risk factors (cTNM stage III or more PCNs) might get benefits from an extended proximal bowel resection to avoid residual positive PCNs.
Study protocol of the HYPER-LIV01 trial: a multicenter phase II, prospective and randomized study comparing simultaneous portal and hepatic vein embolization to portal vein embolization for hypertrophy of the future liver remnant before major hepatectomy for colo-rectal liver metastases
Authors: Deshayes Emmanuel , Piron Lauranne , Bouvier Antoine , Lapuyade Bruno , Lermite Emilie , Vervueren Laurent , Laurent Christophe , Pinaquy Jean-Baptiste , Chevallier Patrick , Dohan Anthony , Rode Agnès , Sengel Christian , Guillot Chloé , Quenet François , Guiu Boris
Published: June 2020

Background

In patients undergoing major liver resection, portal vein embolization (PVE) has been widely used to induce hypertrophy of the non-embolized liver in order to prevent post-hepatectomy liver failure. PVE is a safe and effective procedure, but does not always lead to sufficient hypertrophy of the future liver remnant (FLR). Hepatic vein(s) embolization has been proposed to improve FLR regeneration when insufficient after PVE. The sequential right hepatic vein embolization (HVE) after right PVE demonstrated an incremental effect on the FLR but it implies two different procedures with no time gain as compared to PVE alone.

We have developed the so-called liver venous deprivation (LVD), a combination of PVE and HVE during the same intervention, to optimize the phase of liver preparation before surgery. The main objective of this randomized phase II trial is to compare the percentage of change in FLR volume at 3 weeks after LVD or PVE.

Methods

Patients eligible to this multicenter prospective randomized phase II study are subjects aged from 18 years old suffering from colo-rectal liver metastases considered as resectable and with non-cirrhotic liver parenchyma. The primary objective is the percentage of change in FLR volume at 3 weeks after LVD or PVE using MRI or CT-Scan. Secondary objectives are assessment of tolerance, post-operative morbidity and mortality, post-hepatectomy liver failure, rate of non-respectability due to insufficient FLR or tumor progression, per-operative difficulties, blood loss, R0 resection rate, post-operative liver volume and overall survival. Objectives of translational research studies are evaluation of pre- and post-operative liver function and determination of biomarkers predictive of liver hypertrophy. Sixty-four patients will be included (randomization ratio 1:1) to detect a difference of 12% at 21 days in FLR volumes between PVE and LVD.

Discussion

Adding HVE to PVE during the same procedure is an innovative and promising approach that may lead to a rapid and major increase in volume and function of the FLR, thereby increasing the rate of resectable patients and limiting the risk of patient’s drop-out.

Trial registration

This study was registered on clinicaltrials.gov on 15th February 2019 (NCT03841305).
Thickness profiles of the corneal epithelium along the steep and flat meridians of astigmatic corneas after orthokeratology
Authors: Zhou Jiaqi , Xue Feng , Zhou Xingtao , Naidu Rajeev Krishnan , Qian Yishan
Published: June 2020

Background

The aim of this study was to investigate the changes in corneal epithelial thickness along the principle meridians of astigmatic corneas after six months of overnight spherical myopic orthokeratology (OK) lens wear.

Methods

This is a prospective study. Fifty-seven subjects with up to 1.50 diopters (D) of corneal toricity wore spherical OK lenses for 6 months. Evaluations of OK lens fit, visual acuity, refractions and corneal toricity (CT) were performed. Fourier-domain optical coherence tomography (FD-OCT) was conducted to measure the corneal epithelial thickness (ET) along the principle meridians of corneal toricity over a diameter of 6 mm. The means of △ET of the same diameter at individual meridians (△ETSm and △ETFm) were calculated and compared.

Results

Visual acuity and refraction improved significantly after OK lens wear. △ETFm thinned more than △ETSm (P = 0.027) at 1.5 mm in radius. △ETSm thickened more than △ETFm at 2.5 mm (P = 0.019) and 3.0 mm (P = 0.036).∣△ETSm - △ETFm∣ were significantly correlated with the baseline central CT at 2.0 mm, 2.5 mm and 3.0 mm. ∣△ETSm - △ETFm∣was significantly correlated with the baseline peripheral CT at 2.5 mm.

Conclusions

Overnight wear of spherical OK lenses resulted in differential changes in the thickness profiles of the corneal epithelium between the steep and flat meridians in eyes with corneal toricity.
Combination of Ranibizumab with macular laser for macular edema secondary to branch retinal vein occlusion: one-year results from a randomized controlled double-blind trial
Authors: Song Shuang , Yu Xiaobing , Zhang Peng , Gu Xiaoya , Dai Hong
Published: June 2020

Background

It is not clear whether macular laser combined with anti-vascular endothelial growth factor (VEGF) can reduce the number of anti-VEGF injections in the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Our study aimed to investigate the effects of intravitreal ranibizumab with or without macular laser for ME secondary to BRVO and its associated number of anti-VEGF injections.

Methods

This is a prospective, randomized, double-blind, monocentric trial.80 patients were enrolled and 64 patients fulfilled the study requirements. All patients received a minimum of 3 initial monthly ranibizumab injections, pro re nata (PRN) dosing thereafter VA and CRT stabilization criteria-driven PRN treatment. Laser was given 7 days after third ranibizumab injection in ranibizumab with laser group. The follow-up time of this study was 1 year. Best corrected visual acuity (BCVA) improvement, central retinal thickness (CRT) reduction and number of injections of patients were compared between two groups. T-test, non-parametric Wilcoxon test and chis-square tests were adopted for between-group comparisons.

Results

Thirty patients received intravitreal ranibizumab 0.5 mg alone and 34 patients received intravitreal ranibizumab 0.5 mg with macular laser. At 52 week, BCVA increased significantly and CRT decreased significantly in both groups (P < 0.001). However, there was no significant difference in BCVA improvement with baseline BCVA adjusted (p = 0.5226), and in the CRT reduction (P = 0.4552) between two groups after 52 weeks. There was also no significant difference in the number of injections between the two groups. (P = 0.0756). There was also no significant difference between ischemic and non-ischemic groups in BCVA improvement, CRT reduction and number of injections (P > 0.05).

Conclusions

Our study suggests that ranibizumab combined with macular laser is effective in the treatment of ME secondary to BRVO after 1 year of treatment with 3 + PRN regimen. However, combination of macular grid photocoagulation showed no beneficial anatomical or functional effect during follow-up period, nor did it reduce the number of ranibizumab injections, either in ischemic group or non-ischemic group. We suggest that there is no need to combine macular grid photocoagulation in the treatment of ME secondary to BRVO in the future.

Trial registration

Clinical Trials NCT03054766. https://register.clinicaltrials.gov.Prospectively registered.
Lay perspectives on social distancing and other official recommendations and regulations in the time of COVID-19: a qualitative study of social media posts
Authors: Ölcer Sabahat , Yilmaz-Aslan Yüce , Brzoska Patrick
Published: June 2020

Background

COVID-19 caused by a new form of coronavirus (SARS-CoV-2) first appeared in China end of 2019 and quickly spread to all counties of the world. To slow down the spread of the virus and to limit the pressure on the health care systems, different regulations and recommendations have been implemented by authorities, comprising amongst others the closure of all entertainment venues and social distancing. These measures have received mixed reactions, particularly from young individuals, with many not following available advice. Drawing on the information in social media discussion forums, the present study explores the reasons why people ignore the orders and recommendations of the authorities and why the authorities are unable to produce a shared sense of inclusion concerning protective measures against the COVID-19 outbreak.

Methods

Three open-access social media forums (Reddit, Twitter, and YouTube comments) were systematically searched with respect to COVID-19-related beliefs, attitudes, and behaviours of individuals. The data was retrieved in the first 3 weeks of March 2020. Qualitative document analysis and qualitative content analysis were used as the methodical approach. The data was reviewed by all authors and jointly interpreted to minimise inconsistencies.

Results

The study reveals that reasons such as information pollution on social media, the persistence of uncertainty about the rapidly spreading virus, the impact of the social environment on the individual, and fear of unemployment associated with inequality in the distribution of income lead people to ignore the orders and recommendations of the authorities. The findings suggest that government representatives and politicians could not produce a shared sense of inclusion concerning protective measures against the COVID-19 outbreak, due to not building trust among the public and taking concrete economic steps to satisfy them.

Conclusion

In uncertain crises, transparency in the presentation of information and government policies emerge as influential determinants in creating social susceptibility and solidarity. The differences between social classes constitute one of the important factors that affect the decision-making mechanisms of individuals in determining the necessary steps to be undertaken in times of crisis.
Impact of limited rest areas on truck driver crashes in Saskatchewan: a mixed-methods approach
Authors: Crizzle Alexander M. , Toxopeus Ryan , Malkin Jennifer
Published: June 2020

Background

Long-haul truck drivers (LHTDs) suffer from long work hours often resulting in fatigue. Although several studies have reported that fatigue can contribute to crashes, no study has identified the location and patterns of fatigue-related crashes and solicited truck driver feedback on potential mitigation strategies. The purpose of this study is 1) to map the location of fatigue-related crashes and 2) examine the perceptions of truck drivers concerning fatigue-related crashes.

Methods

Using databases from the Saskatchewan Government Insurance, information on LHTD demographics, crashes and their causes, as well as crash location was analyzed. All fatigue-related crashes were then documented and mapped. Additionally, we interviewed 67 LHTDs (mean age = 53.0 ± 12.9; range 23–89; 95% were men) asking questions about fatigue, access to truck stops/rest areas, and provided recommendations for improvement. All interviews were subsequently analyzed using thematic analyses.

Results

On average, there were 20 fatigue-related crashes per year over the 10-year period. Fatigue-related crashes were common across Saskatchewan, however, there was a concentration of crashes along major roadways between major cities. There was a significant association between crashes with age and experience. Despite many LHTDs being fatigued, there was a lack of truck stops/rest areas along highway routes. LHTDs suggested having access to truck stops/rest areas 250–400 km apart with running water and washrooms available.

Conclusions

Additional truck stops and rest areas are needed in Saskatchewan to ensure LHTDs have more opportunities for rest to reduce fatigue in general, as well as to reduce the risk of fatigue-related crashes.
HIV epidemic and cascade of care in 12 east African rural fishing communities: results from a population-based survey in Uganda
Authors: Burgos-Soto J. , Ben Farhat J. , Alley I. , Ojuka P. , Mulogo E. , Kise-Sete T. , Bouhenia M. , Salumu L. , Mathela R. , Langendorf C. , Cohuet S. , Huerga H.
Published: June 2020

Background

In East Africa, fishing communities are considered most-at-risk populations for the acquisition of HIV. We estimated HIV prevalence and assessed progress towards the UNAIDS 90–90-90 targets along the HIV treatment cascade in 12 fishing communities surrounding Lakes Edward and George, Uganda.

Methods

We conducted a cross-sectional household-based survey between September and November 2016. All adults between 15 and 69 years old were eligible to participate. Children below 15 years old were eligible for HIV testing if either parent was HIV-positive. Viral load testing was done for all HIV-infected individuals. Logistic regression models adjusted for sociodemographic-behavioral variables were used to assess the association between occupation and HIV positivity.

Results

Overall, 1738 adults (959 women, 779 men) and 148 children were included. Adult inclusion rate was 96.0%. Of the men, 58% reported to be fishermen. The HIV-prevalence among adults was 17.5% (95%CI: 15.8–19.4) and 6.1% (95%CI: 3.1–11.4) among HIV-exposed children. HIV prevalence was higher among women than among men (20.9% vs. 13.5%, p < 0.001). Among men, fishermen had a higher HIV prevalence (18.7%; 95%CI: 15.1–22.3) and a higher risk of being HIV-positive (aOR: 4.2; 95%CI: 2.0–9.1) than men of other occupations (p < 0.001). Progress towards the UNAIDS 90–90-90 targets was as follows: 86.5% (95%CI: 82.3–90.1%) of the HIV-positive participants were diagnosed, 98.7% (95%CI: 96.1–99.6%) of those aware were on antiretroviral therapy (ART), and 87.3% (95%CI: 82.3–91.0%) of those on ART were virally suppressed. Overall, 73% of all HIV-positive individuals were virally suppressed. Viral suppression was lower among individuals 15–24 years (45.5%) than among those 25–44 years (74.0%) and 45–69 years (85.0%), p < 0.001. Fishermen did not to have significant differences in the HIV cascade of care compared to men with other occupations.

Conclusions

HIV prevalence was high in these fishing communities, particularly among women and fishermen. Important progress has been made along the HIV treatment cascade, and the UNAIDS goal for viral suppression in population was achieved. However, gaps remain and HIV care strategies focusing on young people are urgently needed. HIV preventive interventions should target particularly women, young people and fishermen though HIV preventive and care services should remain available to the whole fishing communities.
Tuberculosis screening of asylum seekers in Finland, 2015–2016
Authors: Räisänen Pirre E. , Soini Hanna , Tiittala Paula , Snellman Olli , Ruutu Petri , Nuorti J. Pekka , Lyytikäinen Outi
Published: June 2020

Background

In Finland, asylum seekers from countries with high tuberculosis (TB) incidence (> 50/100,000 population/year) and those coming from a refugee camp or conflict area are eligible for TB screening. The aim of this study was to characterise the TB cases diagnosed during screening and estimate the yield of TB screening at the reception centres among asylum seekers, who arrived in Finland during 2015–2016.

Methods

Voluntary screening conducted at reception centres included an interview and a chest X-ray. Data on TB screening and health status of asylum seekers was obtained from the reception centres’ national health register (HRS). To identify confirmed TB cases, the National Infectious Disease Register (NIDR) data of foreign-born cases during 2015–2016 were linked with HRS data. TB screening yield was defined as the percentage of TB cases identified among screened asylum seekers, stratified by country of origin.

Results

During 2015–2016, a total of 38,134 asylum applications were received (57% were from Iraq, 16% from Afghanistan and 6% from Somalia) and 25,048 chest x-rays were performed. A total of 96 TB cases were reported to the NIDR among asylum seekers in 2015–2016; 94 (98%) of them had been screened. Screening identified 48 (50%) cases: 83% were male, 56% aged 18–34 years, 42% from Somalia, 27% from Afghanistan and 13% from Iraq. Furthermore, 92% had pulmonary TB, 61% were culture-confirmed and 44% asymptomatic. TB screening yield was 0.19% (48/25048) (95%CI, 0.14–0.25%) and it varied between 0 and 0.83% stratified by country of origin. Number needed to screen was 522.

Conclusions

TB screening yield was higher as compared with data reported from other European countries conducting active screening among asylum seekers. Half of the TB cases among asylum seekers were first suspected in screening; 44% were asymptomatic. TB yield varied widely between asylum seekers from different geographic areas.
Single-port laparoscopic percutaneous extraperitoneal closure for inguinal hernias repair in girls: using an epidural needle assisted by a towel forceps
Authors: Xiao Yuanhong
Published: June 2020

Background

The concept of single-port laparoscopic percutaneous extraperitoneal closure for the treatment of inguinal hernias repair in children has been practising recent years. The applicable instruments and skills are still evolving. In this study, we used an epidural needle assisted by a towel forceps to practise this minimal invasive method for inguinal hernias repair in girls. Its safety and effectiveness were studied.

Methods

From July 2008 to January 2020, thirty-five girls diagnosed of indirect inguinal hernias were studied retrospectively. From April 2017 to January 2020, the author was free to propose open or laparoscopic repair for the patients. The open group included twenty-four girls and the laparoscopic group included eleven. The data of the patients age, constituent ratios of sliding and bilateral hernias, operating time, postoperative time in hospital, follow-up time, conversion, postoperative complications were assessed.

Results

There were no statistically significant difference between the laparoscopic group and open group for the following items: age, operating time, postoperative time in hospital, the constituent ratios of sliding hernia and bilateral hernias (P > 0.05). The follow-up time of the open group was longer than that of the laparoscopic group (P = 0.0004). One laparoscopic case was converted to open surgery. After 12 cases of laparoscopic practice, coordination of the hand and eye movements established well. There were no postoperative complications for all the patients.

Conclusion

Our preliminary experience suggested that it is safe and convenient for inguinal hernias repair in girls by the single-port laparoscopic percutaneous extraperitoneal closure method using an epidural needle assisted by a towel forceps.
Relatives of deceased patients with metastatic lung cancer’s views on the achievement of treatment goals and the choice to start treatment: a structured telephone interview study
Authors: Mieras Adinda , Onwuteaka-Philipsen Bregje D. , Becker-Commissaris Annemarie , Bos Jose C. M. , Pasman H. Roeline W.
Published: June 2020

Background

Lung cancer has a high impact on both patients and relatives due to the high disease burden and short life expectancy. Previous studies looked into treatment goals patients have before starting a systemic treatment. However, studies on relatives’ perceptions of treatment at the end of life are scarce. Therefore, we studied the perspectives of relatives in hindsight on the achievement of treatment goals and the choice to start treatment for metastatic lung cancer of their loved one.

Methods

We conducted a structured telephone interview study in six hospitals across the Netherlands, one academic and five non-academic hospitals, between February 2017 and November 2019. We included 118 relatives of deceased patients diagnosed with metastatic lung cancer who started a systemic treatment as part of usual care (chemotherapy, immunotherapy or targeted therapy with tyrosine kinase inhibitors (TKIs) and who completed a questionnaire on their treatment goals before the start of treatment and when treatment was finished. We asked the relatives about the achievement of patients’ treatment goals and relatives’ satisfaction with the choice to start treatment. This study is part of a larger study in which 266 patients with metastatic lung cancer participated who started a systemic treatment and reported their treatment goals before start of the treatment and the achievement of these goals after the treatment.

Results

Relatives reported the goals ‘quality of life’, ‘decrease tumour size’ and ‘life prolongation’ as achieved in 21, 37 and 41% respectively. The majority of the relatives (78%) were satisfied with the choice to start a treatment and even when none of the goals were achieved, 70% of the relatives were satisfied. About 50% of relatives who were satisfied with the patients’ choice mentioned negative aspects of the treatment choice, such as the treatment did not work, there were side effects or it would not have been the relatives’ choice. Whereas, 80% of relatives who were not satisfied mentioned negative aspects of the treatment choice. The most mentioned positive aspects were that they tried everything and that it was the patient’s choice.

Conclusion

The majority of relatives reported patients’ treatment goals as not achieved. However, relatives were predominantly satisfied about the treatment choice. Satisfaction does not provide a full picture of the experience with the treatment decision considering that the majority of relatives mentioned (also) negative aspects of this decision. At the time of making the treatment decision it is important to manage expectations about the chance of success and the possible side effects of the treatment.
Midazolam sedation in palliative medicine: retrospective study in a French center for cancer control
Authors: Gamblin Vincent , Berry Vincent , Tresch-Bruneel Emmanuelle , Reich Michel , Da Silva Arlette , Villet Stéphanie , Penel Nicolas , Prod’Homme Chloé
Published: June 2020

Background

French legislation about sedation in palliative medicine evolved in 2016 with the introduction of a right to deep and continuous sedation, maintained until death. The objective was to describe midazolam sedation at the COL (Centre Oscar Lambret[Oscar Lambret Center], French regional center for cancer control), in order to establish a current overview before the final legislative changes.

Methods

Descriptive, retrospective and single-center study, concerning major patients in palliative care hospitalized from 01/01/2014 to 12/31/2015, who had been sedated by midazolam. The proven sedations (explicitly named) and the probable sedations were distinguished.

Results

A total of 54 sedations were identified (48 proven, 6 probable). Refractory symptoms accounted for 48.1% of indications, complications with immediate risk of death 46.3%, existential suffering 5.6%. Titration was performed in 44.4% of cases. Sedation was continuous until death for 98.1% of the cases. Probable sedation had a higher failure rate than proven sedation. Significant differences existed for the palliative care unit compared to other units regarding information to the patient, their consent, anticipation, mention by correspondence and carrying out titrations. When patients had already been treated with midazolam, the induction doses, initial maintenance doses, and doses at the time of death were significantly higher. For those receiving opioids, the maintenance dose at the time of death was higher. No comparison found a difference in overall survival.

Conclusions

After a sufficient follow-up has enabled teams to familiarize with this new legislation, reflection on sedation should be conducted to adapt to final recommendations.
Induced abortion: a cross-sectional study on knowledge of and attitudes toward the new abortion law in Maputo and Quelimane cities, Mozambique
Authors: Frederico Mónica , Arnaldo Carlos , Decat Peter , Juga Adelino , Kemigisha Elizabeth , Degomme Olivier , Michielsen Kristien
Published: June 2020

Background

Maternal mortality, of which 6.7% is attributable to abortion complications, remains high in Mozambique. The objective of this paper is to assess the level of induced abortion at the community, as well as to assess awareness of and attitudes towards the new abortion law among women of reproductive age in suburban areas of Maputo and Quelimane cities.

Methods

A cross-sectional household survey among women aged 15–49 years in Maputo and Quelimane cities was conducted using a multi-stage clustered sampling design. Data on sociodemographic characteristics, maternal outcomes, contraceptive use, knowledge and attitudes towards the new abortion law were collected. Bivariate and multiple logistic regression analysis using the complex samples procedure in SPSS were applied.

Results

A total of 1657 women (827 Maputo and 830 Quelimane) were interviewed between August 2016 and February 2017. The mean age was 27 years; 45.7% were married and 75.5% had ever been pregnant. 9.2% of the women reported having had an induced abortion, of which 20.0% (17) had unsafe abortion. Of the respondents, 28.8% knew the new legal status of abortion. 17% thought that the legalization of abortion was beneficial to women’s health. Having ever been pregnant, being unmarried, student, Muslim, as well as residing in Maputo were associated with higher odds of having knowledge of the new abortion law.

Conclusion

Reports of abortion appear to be low compared to other studies from Sub-Saharan African countries. Furthermore, respondents demonstrated limited knowledge of the abortion law. Social factors such as education status, religion, residence in a large city as well as pregnancy history were associated with having knowledge of the abortion law. Only a small percentage of women perceived abortion as beneficial to women’s health. There is a need for widespread sensitization about the new law and its benefits.
A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region
Authors: Phillips Georgina , Bowman Kathryn , Sale Trina , O’Reilly Gerard
Published: June 2020

Background

Emergency care (EC) describes team-based, multidisciplinary clinical service provision, advocacy and health systems strengthening to address all urgent aspects of illness and injury for all people. In order to improve facility-based EC delivery, a structured framework is necessary to outline current capacity and future needs. This paper draws on examples of EC Needs Assessments performed at the national hospitals of three different Pacific Island Countries (PICs), to describe the development, implementation and validation of a structured assessment tool and methodological approach to conducting an EC Needs Assessment in the Pacific region.

Methods

This is a retrospective, descriptive analysis of the development of the Pacific Emergency Care Assessment (PECA) table using patient-focused principles within an EC systems framework. Tool implementation occurred through observation, literature review and interviews using a strengths-based, action-research and ethnographic methodological approach in Timor-Leste, Kiribati and the Solomon Islands. The 2014 Solomon Islands EC Needs Assessment provides the main context to illustrate and discuss the overall conduct, feasibility, validity and reliability of the PECA tool and methodological approach.

Results

In each site, the methodological implementation enabled completion of both the PECA table and comprehensive report within approximately 6 weeks of first arriving in country. Reports synthesising findings, recommendations, priority action areas and strategies were distributed widely amongst stakeholders. Examples illustrate Face and Content, Construct and Catalytic validity, including subsequent process and infrastructure improvements triggered by the EC Needs Assessment in each site. Triangulation of information and consistency of use over time enhanced reliability of the PECA tool.

Compared to other EC assessment models, the Pacific approach enabled rich data on capacity and real-life function of EC facilities. The qualitative, strengths-based method engenders long-term partnerships and positive action, but takes time and requires tailoring to a specific site.

Conclusion

In PICs and other global contexts where EC resources are underdeveloped, a PECA-style approach to conducting an EC Needs Assessment can trigger positive change through high local stakeholder engagement. Testing this qualitative implementation method with a standardised EC assessment tool in other limited resource contexts is the next step to further improve global EC.
A chromosome-level assembly of the cat flea genome uncovers rampant gene duplication and genome size plasticity
Authors: Driscoll Timothy P. , Verhoeve Victoria I. , Gillespie Joseph J. , Johnston J. Spencer , Guillotte Mark L. , Rennoll-Bankert Kristen E. , Rahman M. Sayeedur , Hagen Darren , Elsik Christine G. , Macaluso Kevin R. , Azad Abdu F.
Published: June 2020

Background

Fleas (Insecta: Siphonaptera) are small flightless parasites of birds and mammals; their blood-feeding can transmit many serious pathogens (i.e., the etiological agents of bubonic plague, endemic and murine typhus). The lack of flea genome assemblies has hindered research, especially comparisons to other disease vectors. Accordingly, we sequenced the genome of the cat flea, Ctenocephalides felis, an insect with substantial human health and veterinary importance across the globe.

Results

By combining Illumina and PacBio sequencing of DNA derived from multiple inbred female fleas with Hi-C scaffolding techniques, we generated a chromosome-level genome assembly for C. felis. Unexpectedly, our assembly revealed extensive gene duplication across the entire genome, exemplified by ~ 38% of protein-coding genes with two or more copies and over 4000 tRNA genes. A broad range of genome size determinations (433–551 Mb) for individual fleas sampled across different populations supports the widespread presence of fluctuating copy number variation (CNV) in C. felis. Similarly, broad genome sizes were also calculated for individuals of Xenopsylla cheopis (Oriental rat flea), indicating that this remarkable “genome-in-flux” phenomenon could be a siphonapteran-wide trait. Finally, from the C. felis sequence reads, we also generated closed genomes for two novel strains of Wolbachia, one parasitic and one symbiotic, found to co-infect individual fleas.

Conclusion

Rampant CNV in C. felis has dire implications for gene-targeting pest control measures and stands to complicate standard normalization procedures utilized in comparative transcriptomics analysis. Coupled with co-infection by novel Wolbachia endosymbionts—potential tools for blocking pathogen transmission—these oddities highlight a unique and underappreciated disease vector.
Computer-aided therapeutic diagnosis for anorexia
Authors: Spinczyk Dominik , Bas Mateusz , Dzieciątko Mariusz , Maćkowski Michał , Rojewska Katarzyna , Maćkowska Stella
Published: June 2020

Background

Anorexia nervosa is a clinical disorder syndrome of the wide spectrum without a fully recognized etiology. The necessary issue in the clinical diagnostic process is to detect the causes of this disease (e.g., my body image, food, family, peers), which the therapist gradually comes to by verifying assumptions using proper methods and tools for diagnostic process. When a person is diagnosed with anorexia, a clinician (a doctor, a therapist or a psychologist) proposes a therapeutic diagnosis and considers the kind of treatment that should be applied. This process is also continued during therapeutic diagnosis. In both cases, it is recommended to apply computer-aided tools designed for testing and confirming the assumptions made by a psychologist. The paper aims to present the computer-aided therapeutic diagnosis method for anorexia. The proposed method consists of 4 stages: free statements of a patient about his/her body image, the general sentiment analysis of statement based on Recurrent Neural Network, assessment of the intensity of five basic emotions: happiness, anger, sadness, fear and disgust (using the Nencki Affective Word List and conversion of words to their basic form), and the assessment of particular areas of difficulties—the sentiment analysis based on the dictionary approach was applied.

Results

The sentiment analysis of a document achieved 72% and 51% of effectiveness, respectively, for RNN and dictionary-based methods. The intensity of sadness (emotion) occurring within the dictionary method is differentiated between control and research group at the level of 10%.

Conclusion

The quick access to the sentiment analysis of a statement on the image of patient’s body, emotions experienced by the patient and particular areas of difficulties of people prone to the anorexia nervosa disorders, may help to establish the diagnosis in a very short time and start an immediate therapy. The proposed automatic method helps to avoid patient’s aversions towards the therapy, which may include avoiding patient–therapist communication, talking about less essential topics, coming late for the sessions. These circumstances can guarantee promising prognosis for recovering.
Well-being is more than happiness and life satisfaction: a multidimensional analysis of 21 countries
Authors: Ruggeri Kai , Garcia-Garzon Eduardo , Maguire Áine , Matz Sandra , Huppert Felicia A.
Published: June 2020

Background

Recent trends on measurement of well-being have elevated the scientific standards and rigor associated with approaches for national and international comparisons of well-being. One major theme in this has been the shift toward multidimensional approaches over reliance on traditional metrics such as single measures (e.g. happiness, life satisfaction) or economic proxies (e.g. GDP).

Methods

To produce a cohesive, multidimensional measure of well-being useful for providing meaningful insights for policy, we use data from 2006 and 2012 from the European Social Survey (ESS) to analyze well-being for 21 countries, involving approximately 40,000 individuals for each year. We refer collectively to the items used in the survey as multidimensional psychological well-being (MPWB).

Results

The ten dimensions assessed are used to compute a single value standardized to the population, which supports broad assessment and comparison. It also increases the possibility of exploring individual dimensions of well-being useful for targeting interventions. Insights demonstrate what may be masked when limiting to single dimensions, which can create a failure to identify levers for policy interventions.

Conclusions

We conclude that both the composite score and individual dimensions from this approach constitute valuable levels of analyses for exploring appropriate policies to protect and improve well-being.
TET1 promotes fatty acid oxidation and inhibits NAFLD progression by hydroxymethylation of PPARα promoter
Authors: Wang Jingjie , Zhang Yitong , Zhuo Qin , Tseng Yujen , Wang Jiucun , Ma Yanyun , Zhang Jun , Liu Jie
Published: June 2020

Background

As a lipid metabolic disorder, non-alcoholic fatty liver disease (NAFLD) is an important cause of cirrhosis and hepatocellular carcinoma, with no effective drug up to date. Previous studies have demonstrated increased methylation levels of key genes in NAFLD, suggesting that hydroxymethylation, a key step in demethylation, may be a possible strategy to reverse NAFLD. TET1 is well known as a key hydroxymethylase, however, its role and mechanism in NAFLD remains unclear.

Methods

In this study, we utilized TET1 knockout mice, fed with high-fat diet. Furthermore, by ChIP and hMeDIP. TET1 knockdown L02 and HepG2 cell lines.

Results

Their degree of liver steatosis was more severe than that of wild-type mice, suggesting that TET1 had a significant protective effect against NAFLD. We further found that PPARα, a key regulator of fatty acid oxidation, and its downstream key enzymes ACOX1 and CPT1A, as well as the fatty acid oxidation product β-HB were significantly decreased in TET1 knockout mice. While the key genes for fatty acid synthesis and uptake were not significantly changed, suggesting that TET1 inhibits NAFLD by promoting fatty acid oxidation via PPARα pathway. TET1 was confirmed to directly bind to the promoter of PPARα and elevate its hydroxymethylation level.

Conclusions

This study is the first to show that TET1 can activate PPARα, promote fatty acid oxidation and inhibit NAFLD progression by hydroxymethylation of PPARα promoter, which may be a new strategy to reverse NAFLD.
Quantitative measures of health policy implementation determinants and outcomes: a systematic review
Authors: Allen Peg , Pilar Meagan , Walsh-Bailey Callie , Hooley Cole , Mazzucca Stephanie , Lewis Cara C. , Mettert Kayne D. , Dorsey Caitlin N. , Purtle Jonathan , Kepper Maura M. , Baumann Ana A. , Brownson Ross C.
Published: June 2020

Background

Public policy has tremendous impacts on population health. While policy development has been extensively studied, policy implementation research is newer and relies largely on qualitative methods. Quantitative measures are needed to disentangle differential impacts of policy implementation determinants (i.e., barriers and facilitators) and outcomes to ensure intended benefits are realized. Implementation outcomes include acceptability, adoption, appropriateness, compliance/fidelity, feasibility, penetration, sustainability, and costs. This systematic review identified quantitative measures that are used to assess health policy implementation determinants and outcomes and evaluated the quality of these measures.

Methods

Three frameworks guided the review: Implementation Outcomes Framework (Proctor et al.), Consolidated Framework for Implementation Research (Damschroder et al.), and Policy Implementation Determinants Framework (Bullock et al.). Six databases were searched: Medline, CINAHL Plus, PsycInfo, PAIS, ERIC, and Worldwide Political. Searches were limited to English language, peer-reviewed journal articles published January 1995 to April 2019. Search terms addressed four levels: health, public policy, implementation, and measurement. Empirical studies of public policies addressing physical or behavioral health with quantitative self-report or archival measures of policy implementation with at least two items assessing implementation outcomes or determinants were included. Consensus scoring of the Psychometric and Pragmatic Evidence Rating Scale assessed the quality of measures.

Results

Database searches yielded 8417 non-duplicate studies, with 870 (10.3%) undergoing full-text screening, yielding 66 studies. From the included studies, 70 unique measures were identified to quantitatively assess implementation outcomes and/or determinants. Acceptability, feasibility, appropriateness, and compliance were the most commonly measured implementation outcomes. Common determinants in the identified measures were organizational culture, implementation climate, and readiness for implementation, each aspects of the internal setting. Pragmatic quality ranged from adequate to good, with most measures freely available, brief, and at high school reading level. Few psychometric properties were reported.

Conclusions

Well-tested quantitative measures of implementation internal settings were under-utilized in policy studies. Further development and testing of external context measures are warranted. This review is intended to stimulate measure development and high-quality assessment of health policy implementation outcomes and determinants to help practitioners and researchers spread evidence-informed policies to improve population health.

Registration

Not registered
Anaphylaxis to clindamycin following cutaneous exposure
Authors: Paradis N. , Marois L. , Paradis L. , Graham F. , Bégin P. , Des Roches A.
Published: June 2020

Background

The role and importance of skin barrier as an immunologic organ and as a potent way of sensitization is well known. However, antibiotics anaphylaxis following skin sensitization has not been reported.

Case presentation

We describe the first case of intravenous clindamycin anaphylaxis, with likely sensitization due to previous topical exposure to clindamycin gel for acne in a 14-year-old boy with history of atopy and mild atopic dermatitis.

Conclusion

This case highlights the potential sensitization to drug allergens, including antibiotics, via the skin.
Existence of infinitely many high energy solutions for a class of fractional Schrödinger systems
Authors: Li Qi , Zhao Zengqin , Du Xinsheng
Published: June 2020

In this paper, we investigate a class of nonlinear fractional Schrödinger systems $$ \left \{ \textstyle\begin{array}{l@{\quad}l}(-\triangle)^{s} u +V(x)u=F_{u}(x,u,v),& x\in \mathbb{R}^{N}, \\(-\triangle)^{s} v +V(x)v=F_{v}(x,u,v),& x\in\mathbb{R}^{N}, \end{array}\displaystyle \right . $${(−△)su+V(x)u=Fu(x,u,v),x∈RN,(−△)sv+V(x)v=Fv(x,u,v),x∈RN, where $s\in(0, 1)$s∈(0,1), $N>2$N>2. Under relaxed assumptions on $V(x)$V(x) and $F(x, u, v)$F(x,u,v), we show the existence of infinitely many high energy solutions to the above fractional Schrödinger systems by a variant fountain theorem.