bluuebunny/crossref_metadata_2025 huggingface dataset:
Contextual effects of social integration and disintegration on health status: evidence from South Korea
Authors: Jo Eun-Bi , Kwon Rang Hee , Jung Minsoo
Published: June 2020

Background

Many studies have shown that various social integration variables represented by social capital are beneficial to communities, including collective health. However, the rapid decline in fertility rates and the breakup of familyism in developed countries require a new approach to social disintegration, but the literature is insufficient. Here, we explored the contextual effects of social integration and social disintegration on the health of individuals.

Methods

The research data consist of merged datasets of 6909 respondents who were quota-sampled by approximately 30 people from 229 local governments in Korea. The individual-level independent variable is a social integration measure consisting of 26 questions in four areas. The community-level independent variables are five integral and aggregate variables extracted from 81 indicators. The dependent variable is self-rated health status. Potential confounders are gender, age, annual income, educational attainment, district type, and the number of beds in medical institutions per 1000 people.

Results

The results showed that at the individual level, the higher the inclusive attitude of in- and out-of-networks, after adjusting for potential confounders, the less likely the respondent belongs to the unhealthy group (p < 0.001). At the community level, the higher the proportion of single-person households in a community after adjusting for potential confounders, the less likely the respondent belongs to the unhealthy group (p < 0.05). The effect size was 0.22.

Conclusion

Thus far, social integration has been preferred, with the positive aspects of social capital being emphasized. However, this study shows that in some cases, social disintegration can instead positively influence an individual’s health. Therefore, further studies of the various conditions of social context effects on health are necessary.
Locally implemented prevention programs may reverse weight trajectories in half of children with overweight/obesity amid low child-staff ratios: results from a quasi-experimental study in France
Authors: Constant Aymery , Boulic Gaëlle , Lommez Agnes , Chaillou Raphaëlle , Guy-Grand Bernard , Raffin Sandrine
Published: June 2020

Background

The aims of the present study were to assess changes in weight status between the first and last year of primary education among children with overweight/obesity in response to locally implemented school-based prevention programs, and to assess the influence of process indicators, expressed as child-staff ratios (CSRs), on these changes.

Methods

To meet the study objectives, a quasi-experimental design was used. Four municipalities that systematically monitored the weight status of schoolchildren and participated in the “Vivons en Forme” program agreed to provide the data available in their school medical service records. The local implementers involved in training sessions were mainly municipal staff in charge of serving midday school meals, which is compulsory in France, and those in charge of designing and facilitating creative, interactive activities at school between and after classes. CSRs were determined by occupation (school catering service/facilitator of extracurricular activities) and training session (healthy eating/physical activity) in each municipality program, and classified as low (1–5 children per adult) or moderate.

Results

During the 4 years of primary education, weight status improved in half of the children with overweight/obesity, and worsened in 6.6% of children with overweight/normal weight. In children who remained overweight, the BMI z-score diminished over time. Estimates of the positive 4-year weight changes were related to low CSRs in locally implemented variations of the program. Estimates increased with age and were significantly higher in low-to-moderate CSR multicomponent interventions than moderate CSR single-component intervention (reference). The moderate CSR multicomponent intervention had a similar effect as the reference. The estimated negative weight change decreased with age.

Conclusions

Our findings suggest that training ancillary school staff in experiential-focused interventions for healthy eating and physical activity in locally implemented school-based programs contributed positively to reducing childhood obesity during the four years of primary education without interfering with educational activities. The results also provide preliminary evidence that low CSRs could be pivotal for optimal outcomes, especially in deprived areas.
Forty years after Alma-Ata: how people trust primary health care?
Authors: Sadeghi Bazargani Homayoun , Saadati Mohammad , Tabrizi Jafar Sadegh , Farahbakhsh Mostafa , Golestani Mina
Published: June 2020

Background

Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran.

Methods

The present investigation is a household survey conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with Probability Proportional to Size (PPS) approach was used. Totally, 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of Socio-Economic Status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA software (version 15) through descriptive statistics and linear regression.

Results

The mean ± SD age of the participants was 41.2 ± 15.1 and most (53.7%) were female. Mean score of PHC trust was 56.9 ± 24.7 (out of 100). It was significantly different between residents of Tabriz (the capital of province) and other cities in the province (p < 0.001). Linear regression showed that younger age, gender, insurance type, being married, and households higher socio-economic status had a significant positive effect on PHC trust level with R2 = 0.14383.

Conclusions

Public trust in PHC system in Iran needs to be improved. Individual variables had a small but key role in trust level. PHC trust cannot be only affected by individual’s variables and experiences but also by health system and health providers’ characteristics and public context in which PHC system exists. PHC trust level could be used as a public indicator in health systems especially in Low and Middle Income Countries (LMIC) to contribute in system strengthening policies at the national and international levels.
Cancer development in patients with COPD: a retrospective analysis of the National Health Insurance Service-National Sample Cohort in Korea
Authors: Ahn Song Vogue , Lee Eunyoung , Park Bumhee , Jung Jin Hee , Park Ji Eun , Sheen Seung Soo , Park Kwang Joo , Hwang Sung Chul , Park Jae Bum , Park Hae-Sim , Park Joo Hun
Published: June 2020

Background

COPD is a well-known risk factor for lung cancer, independent of smoking behavior. By investigating the retrospective National Health Insurance Service-National Sample Cohort (NHIS-NSC) in Korea, this study attempted to prove the hypothesis that COPD is a risk factor for major cancers developing outside of the lungs. We also aimed to investigate the environmental factors associated with the development of lung cancer in COPD patients.

Methods

This study analyzed data from the NHIS-NSC over a 12-year period. Among the 514,795 subjects in the NHIS-NSC, 16,757 patients who were diagnosed with any cancer from 2002 to 2003 were excluded. This cohort enrolled six arms consisting of never-smokers without COPD (N = 313,553), former smokers without COPD (N = 41,359), smokers without COPD (N = 112,627), never-smokers with COPD (N = 7789), former smokers with COPD (N = 1085), and smokers with COPD (N = 2677).

Results

Incident rate of lung cancer per 100,000 person-year was higher according to smoking and COPD (216 in non-COPD and 757 in COPD among never-smokers, 271 in non-COPD and 1266 in COPD among former smokers, 394 in non-COPD and 1560 in COPD among smokers, p <  0.01). Old age, male sex, lower BMI, low exercise level, history of diabetes mellitus, smoking, and COPD were independent factors associated with the development of lung cancer (p <  0.01). Multi-variable analyses showed that COPD, regardless of smoking status, contributed to the development of lung cancer, and colorectal cancer and liver cancer among other major cancers (p <  0.01).

Conclusion

Our data suggested that COPD was an independent risk factor for the development of lung cancer, and colorectal cancer and liver cancer among other major cancers in the Korean population, regardless of smoking status.
Management of intraoperative acetabular fracture in primary total hip arthroplasty
Authors: Li Juncheng , Ji Quanbo , Ni Ming , Zheng Qingyuan , Sun Jingyang , Zhang Guoqiang
Published: June 2020

Background

Intraoperative acetabular fracture(IAF) is a rare complication of primary total hip arthroplasty(THA). The previous reports have lacked a sufficiently large number of subjects to allow for an analysis of the causes and appropriate treatment of this problem.

Methods

Between 2015 to 2018, 4888 primary THA were enrolled. We retrospectively reviewed the records in our Total Joint Registry Database and found that 24 patients (24 hips) had sustained intraoperative acetabular fractures. Twenty-four patients(16 females and 8males)were all treated with a posterolateral approach using uncemented components. Twenty patients(83.3%)underwent supplemental screw fixation, of which 2 patients were treated with steel plate fixation. Two patients’ femoral heads were used as a graft. In 4 patients(16.7%), the acetabular components were judged to be stable despite the fracture and no additional treatment was performed. All patients were evaluated clinically with Harris Hip Scores (HHS) and radiographically with serial X-rays which follow up for a mean period of 34.0 ± 12.6 months. We evaluated the anatomic locations, causes, treatments, and outcome of the fractures to study the treatment method and effect of intraoperative acetabular fracture during operation.

Results

The fracture rate associated with uncemented components was 0.49%. In 17(70.8%) of these patients, the fracture was noted during the impaction of the real acetabular component. Six patients(25%)with Ankylosing Spondylitis had fractures, 4 in the anterior wall, and 1 in the anterior column, because the patient with hip joint fusion needs a to pre-osteotomy before the dislocation. The HHS score increased from 30.8 ± 9.7 preoperatively to 90.2 ± 4.2 postoperatively. All the latest x-ray showed that the fracture did not move, and there is no translucent line formed in the acetabular cup bone interface.

Conclusion

Intraoperative acetabular fractures are rare complications of THA, and most commonly occur during the implantation of the acetabular components. It is necessary to prevent the occurrence of fractures as much as possible even if the fractures are found during the operation. It should be noted that patients with ankylosing spondylitis involving hip joints during THA surgery must be careful to prevent IAFs during dislocation and pre-osteotomy.
Evaluation of risk factors for insulin resistance: a cross sectional study among employees at a private university in Lebanon
Authors: Fahed Myriam , Abou Jaoudeh Maya G. , Merhi Samar , Mosleh Jocelyne Matar Bou , Ghadieh Rachelle , Al Hayek Sibelle , El Hayek Fares Jessy E.
Published: June 2020

Background

Worldwide, the prevalence of insulin resistance ranges from 15.5 to 46.5%, among adults. Lebanon reported one of the highest rates reaching 44.6%. The literature suggests an association between dairy product consumption and insulin resistance, however results are inconclusive. To our knowledge, no study examined this association in the Middle Eastern Region. The aim of the study was to investigate the prevalence of insulin resistance among a sample of Lebanese adults, to identify its risk factors depending on gender, and to evaluate the association between insulin resistance and dairy products consumption.

Methods

A cross-sectional study was conducted among employees at Notre Dame University - Louaize. Four questionnaires were administered including a background and International Physical Activity Questionnaire short form questionnaires, food frequency questionnaire and a 24 h recall. Bioelectric Impedance Analysis (BIA) was used to measure percent body fat (PBF). Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was used to quantify insulin resistance. A person with HOMA-IR ≥ 2.5 was considered as insulin resistant. Statistical analyses were performed using the Statistical Package for Social Sciences version 23 for Windows. P < 0.05 was considered statistically significant.

Results

Out of 286 study participants, 38.0% were insulin resistant. Average dairy product intake in the total sample was 2.2 ± 1.0 servings per day. Among males, the odds of having insulin resistance were 3.9 times higher (95%CI 1.4–11.0; p = 0.009) for those having a risky waist circumference compared to those having a healthy waist circumference. Among females, being married (OR: 0.2, 95%CI 0.1–0.5; p = 0.002), PBF (OR: 1.2, 95%CI 1.0–1.3; p = 0.008) and hypertriglyceridemia (OR: 8.7, 95%CI: 2.1–35.9; p = 0.003) were associated with HOMA-IR, after controlling for confounders. Dairy intake was not associated with HOMA-IR neither among males (p = 0.777), nor among females (p = 0.968), after controlling for confounders.

Conclusion

Dairy consumption was not associated with increased insulin resistance. More research focusing on the relationship between dairy intake and insulin resistance is needed, especially in the Arab and Middle-Eastern region. Future studies should examine the effect of different types of dairy products and the effect of different nutrients in dairy products on insulin resistance.
Comparison of indirect markers of insulin resistance in adult patients with Double Diabetes
Authors: Ferreira-Hermosillo Aldo , Ibarra-Salce Raúl , Rodríguez-Malacara Joshua , Molina-Ayala Mario Antonio
Published: June 2020

Background

The presence of insulin resistance (IR) and metabolic syndrome (MS) in patients with type 1 diabetes (T1D) has been called “double diabetes”. This entity increases the risk for development of micro and macrovascular complications and cardiovascular mortality. The gold standard for IR quantification is the hyperinsulinemic euglycemic clamp (HEC) but it is invasive, time-consuming and not available in the majority of the clinical settings. Because of this, some formulas for IR quantification have been proposed. We aimed to compare the utility of those methods for MS detection in patients with T1D.

Methods

We conducted a cross-sectional study in 112 patients with T1D and determined the presence of MS using the Joint Statement Criteria. We calculated the estimated glucose disposal rate (eGDR), estimated insulin sensitivity index (eIS), natural logarithm of glucose disposal rate (lnGDR), triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), visceral adipose index (VAI) and waist-to-height ratio (WHtR), and compared among patients with and without MS using Student t-test or Mann-Whitney U test. Receiver Operating Characteristics curves for the different indexes were used to identify the best cut-off points for MS detection.

Results

Thirty three percent of the patients were considered to have MS. The patients with MS had lower eGDR (5.49 [4.37–6.80] vs. 8.93 [8.03–9.94] mg/kg/min), eIS (2.89 [1.54–3.54] vs. 3.51 [2.68–4.68]) and lnGDR (1.69 ± 0.27 vs. 1.95 ± 0.21 mg/kg/min), and higher WHtR (0.55 ± 0.05 vs. 0.50 ± 0.05), VAI (3.4 [1.92–5.70] vs. 1.39 [0.97–1.92]) and TG/HDL-c (3.78 [2.63–5.73] vs. 1.77 [1.18–2.75]) in comparison with patients without MS. The cut-off points of TG-HDL-c > 2.0, eGDR < 7.32 mg/kg/min, lnGDR < 1.8 mg/kg/min, VAI > 1.84, WHtR > 0.52 and eIS < 2.92 had a sensitivity of 86, 85, 82, 77 and 70% respectively, for MS detection. The TG/HDL-c, lnGDR and eIS sensitivity changed depending on sex meanwhile eGDR, WHtR and VAI did not need adjust by sex.

Conclusion

Our data show that an eGDR < 7.32 mg/kg/min have the highest sensitivity and specificity to detect the presence of MS in patients with T1D.
Medical students on long-term rural clinical placements and their perceptions of urban and rural internships: a qualitative study
Authors: Bailey Jannine , Pit Sabrina
Published: June 2020

Background

There is some anecdotal evidence that anxiety about the responsibility of an intern influences rural future intentions. Additionally, research has shown that urban interns have reported that they are worried about being ‘forced’ to work in non-metropolitan hospitals in their first year after graduation. This study sought to explore rural medical students’ perceptions and expectations of a rural internship and how local health services and/or their medical school can prepare them best for a rural intern position.

Methods

Four focus groups were conducted with 62 final-year medical students upon completion of a 12-month rural clinical school placement. Focus groups were audio-recorded and transcribed verbatim for thematic analysis to identify key themes.

Results

Most students have high levels of anxiety around starting work but they acknowledge that this may be exaggerated. They believe that in rural areas they get higher quality supervisory support than in urban hospitals as people know you better, whereas in the city you are more anonymous. However, the level of responsibility placed on rural interns was considered to be a double-edged sword. While rural interns were allowed to do more than be a ‘paper-pusher’ this level of responsibility means they are more accountable. The majority felt that doing your first training years in a metropolitan hospital can be crucial to getting on a training program in your chosen speciality.

Conclusions

There appears to be a relatively high level of anxiety about rural internships amongst final-year medical students. Students need more targeted information around specialisation, particularly around regional training hubs, if we want to achieve higher levels of interns choosing a rural career path.
Risk management-based security evaluation model for telemedicine systems
Authors: Kim Dong-won , Choi Jin-young , Han Keun-hee
Published: June 2020

Background

Infectious diseases that can cause epidemics, such as COVID-19, SARS-CoV, and MERS-CoV, constitute a major social issue, with healthcare providers fearing secondary, tertiary, and even quaternary infections. To alleviate this problem, telemedicine is increasingly being viewed as an effective means through which patients can be diagnosed and medications prescribed by doctors via untact Thus, concomitant with developments in information and communication technology (ICT), medical institutions have actively analyzed and applied ICT to medical systems to provide optimal medical services. However, with the convergence of these diverse technologies, various risks and security threats have emerged. To protect patients and improve telemedicine quality for patient safety, it is necessary to analyze these risks and security threats comprehensively and institute appropriate countermeasures.

Methods

The security threats likely to be encountered in each of seven telemedicine service areas were analyzed, and related data were collected directly through on-site surveys by a medical institution. Subsequently, an attack tree, the most popular reliability and risk modeling approach for systematically characterizing the potential risks of telemedicine systems, was examined and utilized with the attack occurrence probability and attack success probability as variables to provide a comprehensive risk assessment method.

Results

In this study, the most popular modelling method, an attack tree, was applied to the telemedicine environment, and the security concerns for telemedicine systems were found to be very large. Risk management and evaluation methods suitable for the telemedicine environment were identified, and their benefits and potential limitations were assessed.

Conclusion

This research should be beneficial to security experts who wish to investigate the impacts of cybersecurity threats on remote healthcare and researchers who wish to identify new modeling opportunities to apply security risk modeling techniques.
Nurses’ knowledge of pressure ulcer and its associated factors at Hawassa University comprehensive specialized hospital Hawassa, Ethiopia, 2018
Authors: Muhammed Ezedin Molla , Bifftu Berhanu Boru , Temachu Yemataw Zewdu , Walle Tarkie Abebe
Published: June 2020

Background

Pressure ulcer is largely avoidable, but its prevalence rate increased more than 80% in a 13 years study. Nurses have a great position to advance best practices towards the prevention of pressure ulcers. Therefore they should be knowledgeable of the signs and symptoms of pressure ulcers, and preventive strategies to reduce its incidence, but there is limited evidence on nurses’ knowledge and its associated factors to prevent pressure ulcers in Ethiopia.

Methods

A hospital-based cross-sectional study was conducted from March 25 – April 23/ 2018. A total of 356 nurses were selected by stratification with a simple random sampling technique. Pretested structured questionnaire with closed and open-ended questions was used to collect data. Frequency distribution and percentage were computed to describe each variable. Bivariate and multivariable logistic regression with a 95% confidence interval was also carried out to see the effect of each independent variable on the dependent variable and declared statistically significant association withP < 0.05.

Result

The mean knowledge score of nurses was 25.22 out of 41 item questions. Fifty-two point 5 % of nurses score above the mean. Males [AOR = 0.44, 95% CI (0.26–0.73)], working a maximum of eight hours [AOR = 3.57, 95% CI (1.48–8.61), not having training [(AOR = 2.31, 95% CI (1.14–4.61)], Low salary [AOR = 3.47, 95% CI (1.03–11.67)] were significantly associated with inadequate knowledge.

Conclusion

Generally a nurse’s knowledge of pressure ulcers was inadequate. Being female, working less than or equal to eight hours, not having the training and low working salary are contributors to a low level of knowledge for pressure ulcers.
Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews
Authors: Weetman Katharine , Dale Jeremy , Scott Emma , Schnurr Stephanie
Published: June 2020

Background

UK government guidelines and initiatives emphasise equity in delivery of care, shared decision-making, and patient-centred care. This includes sharing information with patients as partners in health decisions and empowering them to manage their health effectively. In the UK, general practitioners (GPs) routinely receive hospital discharge letters; while patients receiving copies of such letters is seen as “good practice” and recommended, it is not standardised. The effects and consequences of whether or not this happens remains unclear. The aim of this study (one of three forming the Discharge Communication Study) was to explore patient perspectives on receiving discharge letters and their views on how this could be improved in order to optimise patient experience and outcomes.

Methods

Semi-structured interviews were conducted with a diverse sample of 50 patients recruited from 17 GP surgeries within the West Midlands, UK. All participants were adults with a recent episode of general hospital inpatient or outpatient care. Data were audio recorded, transcribed and analysed using mixed methods corpus linguistics techniques.

Results

Participants reported inconsistent access to discharge letters. Most wanted to receive a copy of their discharge letter although some expressed reservations. Perceived benefits included: increased understanding of their condition and treatment, reduced anxiety, and increased satisfaction. Consequences where participants had not received letters included: letter inaccuracies being overlooked, missed follow up actions, failure to fully remember diagnosis, treatment, or self-management or recommendations, and confusion and anxiety at what occurred and what will happen next. Participants felt the usefulness of receiving copies of letters could be increased by: including a patient information section, avoidance of acronyms, and jargon or technical terms explained with lay language.

Conclusions

Most patients value receiving copies of hospital discharge letters, and should be consistently offered them. Patients’ preferences for letter receipt could be logged in their health records. To enable positive outcomes letters should have a clear and accessible format that reflects the priorities and information needs of patients. Patients appear not to be receiving or being offered copies of letters consistently despite UK policies and guidelines supporting this practice; this suggests a need for greater standardisation of practice.
Implementation of the clinical practice guideline for individuals with amputations in Colombia: a qualitative study on perceived barriers and facilitators
Authors: Patiño-Lugo Daniel F. , Pastor Durango María del Pilar , Lugo-Agudelo Luz Helena , Posada Borrero Ana María , Ciro Correa Verónica , Plata Contreras Jesús Alberto , Vera Giraldo Claudia Yaneth , Aguirre-Acevedo Daniel Camilo
Published: June 2020

Background

The issue of lower extremity amputation has been in the Colombian political agenda for its relationship with the armed conflict and antipersonnel mines. In 2015 the Colombian Ministry of Health published a national clinical practice guideline (CPG) for amputee patients. However, there is a need to design implementation strategies that target end-users and the context in which the CPG will be used. This study aims to identify users’ perceptions about the barriers and facilitators for implementing the guideline for the care of amputee patients in a middle-income country such as Colombia.

Methods

Semi-structured interviews were conducted with 38 users, including patients, health workers, and administrative staff of institutions of the health system in Colombia. Individuals were purposively selected to ensure different perspectives, allowing a balance of individual positions.

Results

According to participants’ perceptions, barriers to implementation are classified as individual barriers (characteristics of the amputee patient and professionals), health system barriers (resource availability, timely care, information systems, service costs, and regulatory changes), and barriers related to clinical practice guidelines (utility, methodological rigour, implementation flexibility, and characteristics of the group developing the guidelines).

Conclusions

Our study advances knowledge on the perceived individual and health system barriers and facilitators for the implementation of the CPG for amputee patients in Colombia. Importantly, the governance, financial, and service delivery arrangements of the Colombian health system are determining factors in implementing CPGs. For example, the financial arrangements between the insurance companies and the health care provider institutions were identified as barriers for the implementation of recommendations related to the continuity and opportunity of care of patients with amputations. The design of implementation strategies that successfully address the individual behaviours and the contextual health systems arrangements may significantly impact the health care process for amputee patients in Colombia.
Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: a population-based study
Authors: Vik Eline S. , Nilsen Roy M. , Aasheim Vigdis , Small Rhonda , Moster Dag , Schytt Erica
Published: June 2020

Background

This study compares subsequent birth outcomes in migrant women who had already had a child before arriving in Norway with those in migrant women whose first birth occurred in Norway. The aim of this study was to investigate the associations between country of first birth and adverse neonatal outcomes (very preterm birth, moderately preterm birth, post-term birth, small for gestational age, large for gestational age, low Apgar score, stillbirth and neonatal death) in parous migrant and Norwegian-born women.

Methods

National population-based study including second and subsequent singleton births in Norway from 1990 to 2016. Data were retrieved from the Medical Birth Registry of Norway and Statistics Norway. Neonatal outcomes were compared between births to: 1) migrant women with a first birth before immigration to Norway (n = 30,062) versus those with a first birth after immigration (n = 66,006), and 2) Norwegian-born women with a first birth outside Norway (n = 6205) versus those with a first birth in Norway (n = 514,799). Associations were estimated as crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using multiple logistic regression.

Results

Migrant women with a first birth before immigrating to Norway had increased odds of adverse outcomes in subsequent births relative to those with a first birth after immigration: very preterm birth (22–31 gestational weeks; aOR = 1.27; CI 1.09–1.48), moderately preterm birth (32–36 gestational weeks; aOR = 1.10; CI 1.02–1.18), post-term birth (≥42 gestational weeks; aOR = 1.19; CI 1.11–1.27), low Apgar score (< 7 at 5 min; aOR = 1.27; CI 1.16–1.39) and stillbirth (aOR = 1.29; CI 1.05–1.58). Similar results were found in the sample of births to Norwegian-born women.

Conclusions

The increased odds of adverse neonatal outcomes for migrant and Norwegian-born women who had their first births outside Norway should serve as a reminder of the importance of taking a careful obstetric history in these parous women to ensure appropriate care for their subsequent pregnancies and births in Norway.
A qualitative study to explore the role of pharmacists in healthy weight management in adults in Pakistan: current scenario and future perspectives
Authors: Atif Muhammad , Hasan Sanah , Mushtaq Irem , Javaid Sareema , Asghar Noureena , Scahill Shane
Published: June 2020

Background

Pharmacists possess significant potential for providing health services to the public when it comes to issues of weight management. However, this practice has not been observed in most parts of the world including low- and middle-income countries (LMICs) such as Pakistan. The aim of this study was to explore the potential role of pharmacists in providing healthy weight management (HWM) services to adults in Pakistan, and the barriers associated with the implementation of this type of role.

Methods

This descriptive qualitative study was set in seven hospitals (public and private) and three chain pharmacies in Lahore, Punjab – a province of Pakistan. Data was collected from in-depth individual interviews with pharmacists (n = 19) and medical doctors (n = 15). Purposive sampling techniques were applied to recruit both types of study participants. Telephone contact was made by the trained data collectors with the pharmacists to set the date and time of the interview after explaining to them the purpose of the study and obtaining their willingness and verbal recorded consent to participate. Registered medical doctors were recruited through snowball sampling techniques. The sample size was determined by applying the point at which thematic saturation occurred. All interviews were audio-recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis.

Results

Through inductive qualitative analysis eight themes emerged; potential role for community pharmacists, collaborative approaches, barriers, ideal pharmacist-based weight management program, professional requirements and need for training, potential for implementation, current scenario in pharmacies and level of trust of pharmacists. The first six themes were common to both pharmacists and medical professionals. The unique theme for doctors was the ‘level of trust of pharmacists’, and for the pharmacists was the ‘current scenario in pharmacies’.

Conclusion

The majority of participants in our study had strong convictions that Pakistani pharmacists have the potential for provide effective HWM services to their communities. Of concern, none of the participating pharmacies were offering any sort of weight management program and none of the medical professionals interviewed were aware of HWM programs taking place. Medical doctors were of the opinion that pharmacists alone cannot run these programs. Doctor participants were firm that after being adequately trained, pharmacists should only carry out non-pharmacological interventions. To implement a HWM pharmacy model in Pakistan, it is necessary to overcome barriers outlined in this study.
DNA interference is controlled by R-loop length in a type I-F1 CRISPR-Cas system
Authors: Tuminauskaite Donata , Norkunaite Danguole , Fiodorovaite Marija , Tumas Sarunas , Songailiene Inga , Tamulaitiene Giedre , Sinkunas Tomas
Published: June 2020

Background

CRISPR-Cas systems, which provide adaptive immunity against foreign nucleic acids in prokaryotes, can serve as useful molecular tools for multiple applications in genome engineering. Diverse CRISPR-Cas systems originating from distinct prokaryotes function through a common mechanism involving the assembly of small crRNA molecules and Cas proteins into a ribonucleoprotein (RNP) effector complex, and formation of an R-loop structure upon binding to the target DNA. Extensive research on the I-E subtype established the prototypical mechanism of DNA interference in type I systems, where the coordinated action of a ribonucleoprotein Cascade complex and Cas3 protein destroys foreign DNA. However, diverse protein composition between type I subtypes suggests differences in the mechanism of DNA interference that could be exploited for novel practical applications that call for further exploration of these systems.

Results

Here we examined the mechanism of DNA interference provided by the type I-F1 system fromAggregatibacter actinomycetemcomitansD7S-1 (Aa). We show that functional Aa-Cascade complexes can be assembled not only with WT spacer of 32 nt but also with shorter or longer (14–176 nt) spacers. All complexes guided by the spacer bind to the target DNA sequence (protospacer) forming an R-loop when a C or CT protospacer adjacent motif (PAM) is present immediately upstream the protospacer (at −1 or −2,−1 position, respectively). The range of spacer and protospacer complementarity predetermine the length of the R-loop; however, only R-loops of WT length or longer trigger the nuclease/helicase Cas2/3, which initiates ATP-dependent unidirectional degradation at the PAM-distal end of the WT R-loop. Meanwhile, truncation of the WT R-loop at the PAM-distal end abolishes Cas2/3 cleavage.

Conclusions

We provide a comprehensive characterisation of the DNA interference mechanism in the type I-F1 CRISPR-Cas system, which is different from the type I-E in a few aspects. First, DNA cleavage initiation, which usually happens at the PAM-proximal end in type I-E, is shifted to the PAM-distal end of WT R-loop in the type I-F1. Second, the R-loop length controls on/off switch of DNA interference in the type I-F1, while cleavage initiation is less restricted in the type I-E. These results indicate that DNA interference in type I-F1 systems is governed through a checkpoint provided by the Cascade complex, which verifies the appropriate length for the R-loop.
Stimulus-specific behavioral responses of zebrafish to a large range of odors exhibit individual variability
Authors: Kermen Florence , Darnet Lea , Wiest Christoph , Palumbo Fabrizio , Bechert Jack , Uslu Ozge , Yaksi Emre
Published: June 2020

Background

Odor-driven behaviors such as feeding, mating, and predator avoidance are crucial for animal survival. The neural pathways processing these behaviors have been well characterized in a number of species, and involve the activity of diverse brain regions following stimulation of the olfactory bulb by specific odors. However, while the zebrafish olfactory circuitry is well understood, a comprehensive characterization linking odor-driven behaviors to specific odors is needed to better relate olfactory computations to animal responses.

Results

Here, we used a medium-throughput setup to measure the swimming trajectories of 10 zebrafish in response to 17 ecologically relevant odors. By selecting appropriate locomotor metrics, we constructed ethograms systematically describing odor-induced changes in the swimming trajectory. We found that adult zebrafish reacted to most odorants using different behavioral programs and that a combination of a few relevant behavioral metrics enabled us to capture most of the variance in these innate odor responses. We observed that individual components of natural food and alarm odors do not elicit the full behavioral response. Finally, we show that zebrafish blood elicits prominent defensive behaviors similar to those evoked by skin extract and activates spatially overlapping olfactory bulb domains.

Conclusion

Altogether, our results highlight a prominent intra- and inter-individual variability in zebrafish odor-driven behaviors and identify a small set of waterborne odors that elicit robust responses. Our behavioral setup and our results will be useful resources for future studies interested in characterizing innate olfactory behaviors in aquatic animals.
Genomic analysis of Escherichia coli strains isolated from diseased chicken in the Czech Republic
Authors: Papouskova Aneta , Masarikova Martina , Valcek Adam , Senk David , Cejkova Darina , Jahodarova Eva , Cizek Alois
Published: June 2020

Background

Avian pathogenic Escherichia coli (APEC) can cause various extraintestinal infections in poultry, resulting in massive economic losses in poultry industry. In addition, some avian E. coli strains may have zoonotic potential, making poultry a possible source of infection for humans. Due to its extreme genetic diversity, this pathotype remains poorly defined. This study aimed to investigate the diversity of colibacillosis-associated E. coli isolates from Central European countries with a focus on the Czech Republic.

Results

Of 95 clinical isolates subjected to preliminary characterization, 32 were selected for whole-genome sequencing. A multi resistant phenotype was detected in a majority of the sequenced strains with the predominant resistance to β-lactams and quinolones being associated with TEM-type beta-lactamase genes and chromosomal gyrA mutations respectively. The phylogenetic analysis confirmed a great diversity of isolates, that were derived from nearly all phylogenetic groups, with predominace of B2, B1 and C phylogroups. Clusters of closely related isolates within ST23 (phylogroup C) and ST429 (phylogroup B2) indicated a possible local spread of these clones. Besides, the ST429 cluster carried blaCMY-2, − 59 genes for AmpC beta-lactamase and isolates of both clusters were generally well-equipped with virulence-associated genes, with considerable differences in distribution of certain virulence-associated genes between phylogenetically distant lineages. Other important and potentially zoonotic APEC STs were detected, incl. ST117, ST354 and ST95, showing several molecular features typical for human ExPEC.

Conclusions

The results support the concept of local spread of virulent APEC clones, as well as of zoonotic potential of specific poultry-associated lineages, and highlight the need to investigate the possible source of these pathogenic strains.
Porcine circovirus type 2 (PCV2) genotyping in Austrian pigs in the years 2002 to 2017
Authors: Weissenbacher-Lang Christiane , Kristen Tamara , Mendel Verena , Brunthaler René , Schwarz Lukas , Weissenböck Herbert
Published: June 2020

Background

Eight different PCV2 genotypes with varying prevalence and clinical impact have been described so far. PCV2 infection is still widespread among the vaccinated population and several experimental studies have clearly demonstrated that there is no induction of a 100% cross-protective immunity between the PCV2 genotypes. Hence, PCV2a-based vaccines may be ineffective. In this longitudinal study, the PCV2 genotype and haplotype evolution in Austria in the years 2002 to 2017 was investigated by phylogenetic analysis of 462 bp-long sequences of the capsid protein gene (ORF2). The obtained findings may be of practical relevance for the future development of vaccination strategies.

Results

One hundred thirty four of a total of 161 formalin-fixed and paraffin wax-embedded samples could be sequenced successfully. There was no significant influence of storage time on sequencing success or quality. PCV2a (8.2%), PCV2b (77.6%), PCV2d (13.4%), and PCV2g (0.8%) were found. PCV2d was first detected as early as in 2004. PCV2g was described once in 2009. Both global PCV2 genotype shifts were observed. PCV2a occurred with a low prevalence during the first study years only in samples from non-vaccinated swine herds and was gradually replaced by PCV2b until 2011. PCV2b was the most prevalent genotype over the whole study period and was detected in samples from vaccinated and non-vaccinated herds. During the last two study years, the prevalence of PCV2d increased, although at this point almost all herds were vaccinated. The haplotype diversity was high, but the nucleotide diversity was low. Especially for genotype PCV2b, an increase in haplotype diversity could be described during the first study years.

Conclusion

Extensive PCV2a-derived vaccination resulted in a reduction of prevalence and in a stabilization of genotype PCV2a, whereas genotypes PCV2b and PCV2d evolved as a consequence of natural and vaccination-induced selection. An ongoing virus circulation may be the result of reduced vaccine-induced protection.
Canine parvovirus: a predicting canine model for sepsis
Authors: Alves F. , Prata S. , Nunes T. , Gomes J. , Aguiar S. , Aires da Silva F. , Tavares L. , Almeida V. , Gil S.
Published: June 2020

Background

Sepsis is a severe condition associated with high prevalence and mortality rates. Parvovirus enteritis is a predisposing factor for sepsis, as it promotes intestinal bacterial translocation and severe immunosuppression. This makes dogs infected by parvovirus a suitable study population as far as sepsis is concerned. The main objective of the present study was to evaluate the differences between two sets of SIRS (Systemic Inflammatory Response Syndrome) criteria in outcome prediction: SIRS 1991 and SIRS 2001. The possibility of stratifying and classifying septic dogs was assessed using a proposed animal adapted PIRO (Predisposition, Infection, Response and Organ dysfunction) scoring system.

Results

The 72 dogs enrolled in this study were scored for each of the PIRO elements, except for Infection, as all were considered to have the same infection score, and subjected to two sets of SIRS criteria, in order to measure their correlation with the outcome.

Concerning SIRS criteria, it was found that the proposed alterations on SIRS 2001 (capillary refill time or mucous membrane colour alteration) were significantly associated with the outcome (OR = 4.09,p < 0.05), contrasting with the 1991 SIRS criteria (p = 0.352) that did not correlate with the outcome. No significant statistical association was found between Predisposition (p = 1), Response (p = 0.1135), Organ dysfunction (p = 0.1135), total PIRO score (p = 0.093) and outcome. To explore the possibility of using the SIRS criteria as a fast decision-making tool, a Fast-and-Frugal tree (FFT) was created with a sensitivity of 92% and a specificity of 29%.

Conclusion

These results suggest that increasing the SIRS criteria specificity may improve their prognostic value and their clinical usefulness. In order to improve the proposed PIRO scoring system outcome prediction ability, more specific criteria should be added, mainly inflammatory and organ dysfunction biomarkers.
A glucotolerant β-glucosidase from the fungus Talaromyces amestolkiae and its conversion into a glycosynthase for glycosylation of phenolic compounds
Authors: Méndez-Líter Juan Antonio , Nieto-Domínguez Manuel , Fernández de Toro Beatriz , González Santana Andrés , Prieto Alicia , Asensio Juan Luis , Cañada Francisco Javier , de Eugenio Laura Isabel , Martínez María Jesús
Published: June 2020

Background

The interest for finding novel β-glucosidases that can improve the yields to produce second-generation (2G) biofuels is still very high. One of the most desired features for these enzymes is glucose tolerance, which enables their optimal activity under high-glucose concentrations. Besides, there is an additional focus of attention on finding novel enzymatic alternatives for glycoside synthesis, for which a mutated version of glycosidases, named glycosynthases, has gained much interest in recent years.

Results

In this work, a glucotolerant β-glucosidase (BGL-1) from the ascomycete fungus Talaromyces amestolkiae has been heterologously expressed in Pichia pastoris, purified, and characterized. The enzyme showed good efficiency on p-nitrophenyl glucopyranoside (pNPG) (Km= 3.36 ± 0.7 mM, kcat= 898.31 s−1), but its activity on cellooligosaccharides, the natural substrates of these enzymes, was much lower, which could limit its exploitation in lignocellulose degradation applications. Interestingly, when examining the substrate specificity of BGL-1, it showed to be more active on sophorose, the β-1,2 disaccharide of glucose, than on cellobiose. Besides, the transglycosylation profile of BGL-1 was examined, and, for expanding its synthetic capacities, it was converted into a glycosynthase. The mutant enzyme, named BGL-1-E521G, was able to use α-d-glucosyl-fluoride as donor in glycosylation reactions, and synthesized glucosylated derivatives of different pNP-sugars in a regioselective manner, as well as of some phenolic compounds of industrial interest, such as epigallocatechin gallate (EGCG).

Conclusions

In this work, we report the characterization of a novel glucotolerant 1,2-β-glucosidase, which also has a considerable activity on 1,4-β-glucosyl bonds, that has been cloned in P. pastoris, produced, purified and characterized. In addition, the enzyme was converted into an efficient glycosynthase, able to transfer glucose molecules to a diversity of acceptors for obtaining compounds of interest. The remarkable capacities of BGL-1 and its glycosynthase mutant, both in hydrolysis and synthesis, suggest that it could be an interesting tool for biotechnological applications.