bluuebunny/crossref_metadata_2025 huggingface dataset:
Mexico’s Trade Relationship with China in the Context of the United States–China Trade war
Authors: Gachúz Maya Juan Carlos
Published: October 2021

The Mexico–China economic relationship is highly asymmetric, although the amount of total trade between the two countries has grown rapidly in the last ten years. Chinese exports to Mexico have grown exponentially and have diversified into different economic sectors. In contrast, Mexican exports to China have also grown but at a much slower pace and the pattern shows more concentration in fewer products. Paradoxically, in the context of the United States–China trade war, the Mexican economy has benefitted from the increase in tariffs that the United States has imposed on Chinese products. In 2019, for the first time, Mexico displaced China as a main trade partner of the United States. In this context, this article analyses the current economic relationship of Mexico with China and the United States in a triangular scheme, the impact of the United States–Mexico–Canada Agreement on the China–Mexico relationship, and Mexico's trade relationship with both economies in the context of the trade war.
When Motivated Responses to Threat Backfire: Risky Socializing During the COVID-19 Health Crisis
Authors: Forsyth Rachel B.
Published: October 2021

This research examined the relationship between psychological processes that help individuals cope with challenging circumstances and their failure to act to reduce the likelihood and severity of the challenge itself. In two cross-sectional studies of U.S. residents ( N = 621) conducted during the COVID-19 pandemic, individuals’ motivated responses to threat predicted their noncompliance with directives prohibiting risky socializing: Those who perceived the disease to be a threat to their health were more likely to engage in risky socializing if they avoided information about the pandemic or they exhibited a dispositional tendency to join with other people when stressed. Several alternative causal sequences can account for these findings, but one suggests that the risky socializing during the COVID-19 pandemic was due, in part, to people’s psychological reaction to threat; as people responded to minimize their distress, they inadvertently increased their risk of contracting the illness.
For what it's worth. Unearthing the values embedded in digital phenotyping for mental health
Authors: Birk Rasmus , Lavis Anna , Lucivero Federica , Samuel Gabrielle
Published: October 2021

Digital phenotyping for mental health is an emerging trend which uses digital data, derived from mobile applications, wearable technologies and digital sensors, to measure, track and predict the mental health of an individual. Digital phenotyping for mental health is a growing, but as yet underexamined, field. As we will show, the rapid growth of digital phenotyping for mental health raises crucial questions about the values that underpin and are reinforced by this technology, as well as regarding to whom it may become valuable. In this commentary, we explore these questions by focusing on the construction of value across two interrelated domains: user experience and epistemologies on the one hand, and issues of data and ownership on the other. In doing so, we demonstrate the need for a deeper ethical and epistemological engagement with the value assumptions that underpin the promise of digital phenotyping for mental health.
Development of a casual video game (Match Emoji) with psychological well-being concepts for young adolescents
Authors: Pine Russell , Te Morenga Lisa , Olson Mitch , Fleming Theresa
Published: October 2021

Digital interventions for mental health and well-being have been shown to be effective in trials, yet uptake and retention in real-world settings are often disappointing. A more significant impact may be achieved by building interventions that are closer to how target groups use technology to support their own psychological well-being. Casual video games may be poised to offer an opportunity in this area as they are a highly popular activity among young people. We propose that mental health content can be integrated into the explicit content and the implicit processes used in casual video games. In this paper, we describe the design and core processes of Match Emoji, a casual video game designed to support the development of psychological well-being via gameplay and micro-messages. The iterative development of Match Emoji involved various phases, including a systematic review of the literature, consultation with target users, clinicians, game developers, and close reading of the literature. Expert collaboration was sought throughout the process to ensure gameplay and messages matched behaviour change and learning theories. An acceptability and feasibility study of Match Emoji will inform a randomised controlled trial in the future.
Rhabdomyosarcoma in a Patient With Duchenne Muscular Dystrophy: A Possible Association
Authors: Chandler Erika , Rawson Lauren , Debski Robert , McGowan Kerry , Lakhotia Arpita
Published: October 2021

Duchenne muscular dystrophy (DMD), caused by a mutation in the DMD gene, is known to be associated with co-morbidities including cardiomyopathy, respiratory failure, neuromuscular scoliosis and intellectual disability. Animal studies have explored the susceptibility of dystrophin-deficient mice with the development of myogenic tumors. While there is adequate literature describing both DMD and rhabdomyosarcoma (RMS) separately, there has yet to be a comprehensive literature review investigating the possibility that patients with DMD may be at a higher risk of developing RMS and other myogenic tumors. We present the case of a pediatric patient with DMD who developed alveolar RMS and review the literature for susceptibility to development of myogenic tumors in cases of DMD gene mutation.
Whose Need Matters?: The Local Welfare State, Poverty, and Variation in US Counties’ Social Service Provisioning
Authors: Kelly Paige , Lobao Linda
Published: October 2021

Sociologists have long studied poverty across localities. Yet, little research focuses on local governments and the social services they directly provide to those in-need. Researchers concerned with the US welfare state note that localized administration of social programs creates geographic variability in provisioning and potential for status-based discrimination, such as racism, to influence policy. This paper addresses two questions: (1) To what extent does local need influence counties’ provision of social services? (2) Does the provision of social services vary according to which social group is most in-need? Conceptually, we break ground by placing spatial inequality research on local disparities into dialogue with sociology’s welfare state tradition. Using novel data for 1,600 county governments across the nation, we find that local need as measured by the poverty rate is related to greater social service provisioning, suggesting governments’ responsiveness. However, provisioning is unequal when the level of need is disaggregated among social groups, race/ethnicity, and gender. Higher poverty among whites is associated with greater provisioning of social services. This study showcases possible means by which unequal patterns of social welfare support emerge and reveals the potential role of local governments in perpetuating inequalities by privileging some groups’ need more than others.
Palliative Care Conversations for Heart Failure Nurses: A Pilot Education Intervention
Authors: Turrise Stephanie , Jenkins Caroline A. , Arms Tamatha , Jones Andrea L.
Published: October 2021

Introduction

Heart failure is a progressive condition affecting 6.2 million Americans. The use of palliative and supportive care for symptom management and improved quality of life is recommended for persons with heart failure. However, 91% of nurses believe they need further training to have palliative care conversations. The purpose of this pilot education intervention was to determine if providing nurses with education on the timing and content of palliative care conversations would improve their perceived skill and knowledge.

Methods

This was a pilot study of an online educational intervention. Data were electronically collected from 13 participants using validated questionnaires delivered via Qualtrics. Participants completed a demographic survey and End-of-Life Professional Caregiver Survey (EPCS) before and after completing an online, asynchronous education module.

Results

Mean scores were higher on all posttest measures. Independent samples t-tests revealed statistically significant differences on the Effective Care Delivery (ECD) scale ( t[32] = −2, p = .05) and total EPCS scale scores ( t[32] = −2.2, p = .03) from pre- to posttest.

Conclusion

Scores increased on all dimensions pretest to posttest with statistically significant differences in ECD and total scores. Providing asynchronous online education on timing and content of palliative care conversations to nurses caring for people with heart failure is a feasible and effective way to improve perceived knowledge and skill of palliative care conversations.
A Survey of Norwegian Nursing Students’ Responses to Student-Centered Small Group Learning in the Study of Human Anatomy and Physiology
Authors: Cui Guanglin , Laugsand Jann-Briger , Zheng Wei
Published: October 2021

Introduction

Small group learning (SGL) is a main learning strategy in the study of bioscience subjects in nursing schools.

Objectives

We evaluated Norwegian nursing students’ responses to the student-centered SGL approach in the study of anatomy and physiology (A&P) and tried to determine what aspects educators should improve regarding the use of SGL in the study of biosciences.

Methods

A descriptive questionnaire survey was conducted to evaluate Norwegian nursing students’ responses and experiences, for example, motivation, performance, satisfaction, and effectiveness of this new SGL strategy in the study of human A&P.

Results

Nursing students showed a high motivation and varied experience, for example, different attendance rates, satisfaction, and effectiveness in response to the student-centered SGL strategy in the study of human A&P. In addition, some students reported a low completion rate of assigned work for each SGL session. Additional concerns were collected in the open-end survey section. Subsequent thematic analysis of these comments identified that SGL arrangement and teacher tutorials were the main themes that needed to be improved in future SGL practice.

Conclusions

The information from this survey might provide new insights to educators to understand what and how we should improve the student-centered SGL work in future teaching practice.
Incidence of Referable Retinal Disease in Diabetic Patients at a Primary Care Practice
Authors: Lee Terry , Amason Joshua , Del Risco Amanda , Kim Joon-Bom , Cousins Scott W. , Hadziahmetovic Majda
Published: October 2021

Purpose:

This work tests the feasibility of remote ophthalmic imaging to identify referable retinal abnormalities and assesses the effectiveness of color fundus photography (CFP) vs optical coherence tomography (OCT) for this purpose.

Methods:

This prospective, nonrandomized study included 633 patients with diabetes at Duke Primary Care. Undilated patients underwent screening with CFP and OCT camera (MaestroCare, Topcon). Images were graded independently for interpretability and the presence of predetermined retinal disease. Retinal disease was classified as diabetic retinopathy (DR) referable to a retina specialist or incidental findings referable to either a retina specialist or a general ophthalmologist, depending on severity.

Results:

Mean (SD) age of screened patients was 66 (13) years, and 49% were women. The average glycated hemoglobin A1c level was 7.6 % (SD, 1.7%), and 30% of the patients were on insulin. The average duration of diabetes was 5.9 (SD, 7.3) years. Remote images from OCT were significantly more interpretable than CFP (98% vs 83%, respectively; P < .001). Referral rates were 9% for DR and 28% for incidental findings. Among patients with DR, OCT and CFP were helpful in 58% and 87% of cases, respectively ( P < .001).

Conclusions:

Remote diagnosis of ophthalmic imaging at the point of service may allow for early identification of retinal disease and timely referral and treatment. Our approach showed that OCT had significantly better interpretability, while CFP was more helpful in identifying DR. These findings may be important when choosing the screening device in a specific context.
Improving Esthetic and Functional Outcomes of Severe Habsburg Jaw Using Modified Mandibular C-Osteotomies: A Case Report and Review of Literature
Authors: Henry Andrew M. , Yu Jason W. , Farrell Brian B.
Published: October 2021

The hypoplastic mandible results in facial convergence and pseudo-prognathism. We present a patient with significant maxillary hypoplasia in both the vertical and sagittal dimensions resulting in a reverse occlusal plane. Given the significant maxillary movements required, particularly clockwise rotation, more traditional mandibular osteotomies resulted in an unsatisfactory result. A modified version to the classic “C” osteotomy with the use of surgical planning and cutting guides was performed. A review of the literature on this rarely discussed ramus osteotomy is also presented.
Practical identifiability in the frame of nonlinear mixed effects models: the example of the in vitro erythropoiesis
Authors: Duchesne Ronan , Guillemin Anissa , Gandrillon Olivier , Crauste Fabien
Published: October 2021

Background

Nonlinear mixed effects models provide a way to mathematically describe experimental data involving a lot of inter-individual heterogeneity. In order to assess their practical identifiability and estimate confidence intervals for their parameters, most mixed effects modelling programs use the Fisher Information Matrix. However, in complex nonlinear models, this approach can mask practical unidentifiabilities.

Results

Herein we rather propose a multistart approach, and use it to simplify our model by reducing the number of its parameters, in order to make it identifiable. Our model describes several cell populations involved in the in vitro differentiation of chicken erythroid progenitors grown in the same environment. Inter-individual variability observed in cell population counts is explained by variations of the differentiation and proliferation rates between replicates of the experiment. Alternatively, we test a model with varying initial condition.

Conclusions

We conclude by relating experimental variability to precise and identifiable variations between the replicates of the experiment of some model parameters.
DECONbench: a benchmarking platform dedicated to deconvolution methods for tumor heterogeneity quantification
Authors: Decamps Clémentine , Arnaud Alexis , Petitprez Florent , Ayadi Mira , Baurès Aurélia , Armenoult Lucile ,   HADACA consortium, Alcala N. , Arnaud A. , Avila Cobos F. , Batista Luciana , Batto A.-F. , Blum Y. , Chuffart F. , Cros J. , Decamps C. , Dirian L. , Doncevic D. , Durif G. , Bahena Hernandez S. Y. , Jakobi M. , Jardillier R. , Jeanmougin M. , Jedynak P. , Jumentier B. , Kakoichankava A. , Kondili Maria , Liu J. , Maie T. , Marécaille J. , Merlevede J. , Meylan M. , Nazarov P. , Newar K. , Nyrén K. , Petitprez F. , Novella Rausell C. , Richard M. , Scherer M. , Sompairac N. , Waury K. , Xie T. , Zacharouli M.-A. , Escalera Sergio , Guyon Isabelle , Nicolle Rémy , Tomasini Richard , de Reyniès Aurélien , Cros Jérôme , Blum Yuna , Richard Magali
Published: October 2021

Background

Quantification of tumor heterogeneity is essential to better understand cancer progression and to adapt therapeutic treatments to patient specificities. Bioinformatic tools to assess the different cell populations from single-omic datasets as bulk transcriptome or methylome samples have been recently developed, including reference-based and reference-free methods. Improved methods using multi-omic datasets are yet to be developed in the future and the community would need systematic tools to perform a comparative evaluation of these algorithms on controlled data.

Results

We present DECONbench, a standardized unbiased benchmarking resource, applied to the evaluation of computational methods quantifying cell-type heterogeneity in cancer. DECONbench includes gold standard simulated benchmark datasets, consisting of transcriptome and methylome profiles mimicking pancreatic adenocarcinoma molecular heterogeneity, and a set of baseline deconvolution methods (reference-free algorithms inferring cell-type proportions). DECONbench performs a systematic performance evaluation of each new methodological contribution and provides the possibility to publicly share source code and scoring.

Conclusion

DECONbench allows continuous submission of new methods in a user-friendly fashion, each novel contribution being automatically compared to the reference baseline methods, which enables crowdsourced benchmarking. DECONbench is designed to serve as a reference platform for the benchmarking of deconvolution methods in the evaluation of cancer heterogeneity. We believe it will contribute to leverage the benchmarking practices in the biomedical and life science communities. DECONbench is hosted on the open source Codalab competition platform. It is freely available at: https://competitions.codalab.org/competitions/27453.
The chloroplast genomes of four Bupleurum (Apiaceae) species endemic to Southwestern China, a diversity center of the genus, as well as their evolutionary implications and phylogenetic inferences
Authors: Huang Rong , Xie Xuena , Chen Aimin , Li Fang , Tian Enwei , Chao Zhi
Published: October 2021

Background

As one of the largest genera in Apiaceae, Bupleurum L. is well known for its high medicinal value. The genus has frequently attracted the attention of evolutionary biologist and taxonomist for its distinctive characteristics in the Apiaceae family. Although some chloroplast genomes data have been now available, the changes in the structure of chloroplast genomes and selective pressure in the genus have not been fully understood. In addition, few of the species are endemic to Southwest China, a distribution and diversity center of Chinese Bupleurum. Endemic species are key components of biodiversity and ecosystems, and investigation of the chloroplast genomes features of endemic species in Bupleurum will be helpful to develop a better understanding of evolutionary process and phylogeny of the genus. In this study, we analyzed the sequences of whole chloroplast genomes of 4 Southwest China endemic Bupleurum species in comparison with the published data of 17 Bupleurum species to determine the evolutionary characteristics of the genus and the phylogenetic relationships of Asian Bupleurum.

Results

The complete chloroplast genome sequences of the 4 endemic Bupleurum species are 155,025 bp to 155,323 bp in length including a SSC and a LSC region separated by a pair of IRs. Comparative analysis revealed an identical chloroplast gene content across the 21 Bupleurum species, including a total of 114 unique genes (30 tRNA genes, 4 rRNA genes and 80 protein-coding genes). Chloroplast genomes of the 21 Bupleurum species showed no rearrangements and a high sequence identity (96.4–99.2%). They also shared a similar tendency of SDRs and SSRs, but differed in number (59–83). In spite of their high conservation, they contained some mutational hotspots, which can be potentially exploited as high-resolution DNA barcodes for species discrimination. Selective pressure analysis showed that four genes were under positive selection. Phylogenetic analysis revealed that the 21 Bupleurum formed two major clades, which are likely to correspond to their geographical distribution.

Conclusions

The chloroplast genome data of the four endemic Bupleurum species provide important insights into the characteristics and evolution of chloroplast genomes of this genu, and the phylogeny of Bupleurum.
Relationship among atrial fibrillation, the CHA2DS2-VASc score and ischaemic stroke in patients with coronary artery disease: a propensity score matching study in Hebei, China
Authors: Shi Boqun , Liu Demin , Wang Qian , Geng Xue , Hou Qian , Gu Guoqiang , Xie Ruiqin , Cui Wei
Published: October 2021

Background

Recent evidence has shown that the pathogenesis of ischaemic stroke associated with atrial fibrillation (AF) is complex and involves other factors in addition to arrhythmias. The purpose of this study was to investigate the relationship among AF, CHA2DS2-VASc score and ischaemic stroke in patients with coronary artery disease (CAD) in Hebei, China.

Methods

A total of 2,335 patients with CAD from September 2016 to May 2019 at the Second Hospital of Hebei Medical University were included (mean age 62.73 ± 10.35 years, range 26–92 years; 41.58% female). This was a cross-sectional study, and participants were divided into non-stroke (n = 1997) and ischaemic stroke groups (n = 338). Propensity score matching (PSM) was performed to match ischaemic stroke patients with non-stroke patients in a 1:4 ratio. The relationship among AF, the CHA2DS2-VASc score and ischaemic stroke was evaluated using univariable generalized linear models for different sex, age, body mass index (BMI), CAD and CHA2DS2-VASc score subgroups. Univariable and multivariable generalized linear models were used to evaluate the relationship between AF and ischaemic stroke in the different models.

Results

Compared with that in the non-stroke group, the prevalence of AF (8.81% vs. 14.20%, P = 0.002) in the ischaemic stroke group was higher. The proportion of patients with ischaemic stroke was significantly different between the AF group and the non-AF group (28.74% vs. 19.04%, P = 0.003). An increasing CHA2DS2-VASc score was associated with a gradual increase in the prevalence of AF (P for trend < 0.001). Subgroup analysis showed that the trend towards increased stroke risk in the AF group was consistent across the various subgroups. The multivariable analysis demonstrated that AF was not associated with ischaemic stroke compared with the absence of AF (OR = 1.55, 95% CI 0.94–2.56, P = 0.087).

Conclusion

In our cross-sectional study, after adjustment for confounding factors, there was no association between AF and ischaemic stroke. The increased risk of ischaemic stroke associated with AF was attenuated by atherosclerotic factors. Our study supports the current view that enhanced control of modifiable cardiovascular risk factors in patients with AF is essential.
Prevalence and trends of coronary artery disease risk factors and their effect on age of diagnosis in patients with established coronary artery disease: Tehran Heart Center (2005–2015)
Authors: Hosseini Kaveh , Mortazavi Seyedeh Hamideh , Sadeghian Saeed , Ayati Aryan , Nalini Mahdi , Aminorroaya Arya , Tavolinejad Hamed , Salarifar Mojtaba , Pourhosseini Hamidreza , Aein Afsaneh , Jalali Arash , Bozorgi Ali , Mehrani Mehdi , Kamangar Farin
Published: October 2021

Background

Coronary artery disease (CAD) is a universal public health challenge, more prominently so in the low- and middle-income countries. In this study, we aimed to determine prevalence and trends of CAD risk factors in patients with documented CAD and to determine their effects on the age of CAD diagnosis.

Materials and methods

We conducted a registry-based, serial cross-sectional study using the coronary angiography data bank of the Tehran Heart Center. Adult patients who had obstructive (> 50% stenosis) CAD were included in the study. The prevalence and 11-year trends of conventional CAD risk factors were analyzed by sex and age, and their adjusted effects on the age of CAD diagnosis were calculated.

Results

From January 2005 to December 2015, data for 90,094 patients were included in this analysis. A total of 61,684 (68.5%) were men and 28,410 (31.5%) were women. Men were younger at diagnosis than women, with a mean age of 60.1 in men and 63.2 in women (p < 0.001), and had fewer risk factors at the time of diagnosis. Mean age at diagnosis had an overall increasing trend during the study period. Increasing trend was seen in body-mass index, hypertension prevalence, diabetes mellitus. All lipid profile components (total cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein cholesterol) decreased over time. Of particular interest, opium consumption was associated with 2.2 year earlier age of CAD diagnosis.

Conclusion

The major results of this study (lower age of CAD diagnosis in men, lower age of diagnosis associated with most risk factors, and lower prevalence of serum lipids over time) were expected. A prominent finding of this study is confirming opium use was associated with a much younger age of CAD onset, even after adjusting for all other risk factors. In addition to recommendations for control of the traditional risk factors, spreading information about the potential adverse effect of opium use, which has only recently been associated with higher risk of CAD, may be necessary.
Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors
Authors: Craven Kristelle , Holmes Jain , Powers Katie , Clarke Sara , Cripps Rachel L. , Lindley Rebecca , Phillips Julie , Tyerman Ruth , McKevitt Christopher , Clarke David , Radford Kathryn
Published: October 2021

Background

Little guidance exists regarding how best to upskill and support those delivering complex healthcare interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed to explore mentors’ roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting the mentoring process and intervention delivery.

Methods

Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention delivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions of intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were calculated per trial site. Qualitative data were analysed thematically.

Results

Forty-one OTs across 16 sites were mentored between March 2018 and April 2020. Most mentoring was provided by phone or Microsoft Teams (range: 88.6–100%), with the remainder via email and SMS (Short Message Service) text messages. Mentors suggested strategies to enhance trial recruitment, improved OTs’ understanding of- and adherence to trial processes, intervention delivery and fidelity, and facilitated independent problem-solving. Barriers to mentoring included OT non-attendance at mentoring sessions and mentors struggling to balance mentoring with clinical roles. Facilitators included support from the trial team and mentors having protected time for mentoring.

Conclusions

Mentoring supported mentee OTs in various ways, but it remains unclear to what extent the OTS would have been able to deliver the intervention without mentoring support, or how this might have impacted fidelity. Successful implementation of mentoring alongside new complex interventions may increase the likelihood of intervention effectiveness being observed and sustained in real-life contexts. Further research is needed to investigate how mentors could be selected, upskilled, funded and mentoring provided to maximise impact. The clinical- and cost-effectiveness of mentoring as an implementation strategy and its impact on fidelity also requires testing in a future trial.

Trial registration

ISRCTN, ISRCTN12464275. Registered on 13th March 2018.
Associations of dietary and drinking water habits with number of natural teeth: a longitudinal study in the Chinese elderly population
Authors: Zhao Dan , Ning Jia , Zhao Yifei , Lu Eryi
Published: October 2021

Background

The relationship between dietary and drinking water habits and oral health are still unclear. We aimed at evaluating the association of dietary and drinking water habits with number of teeth in the elderly adults.

Methods

We conducted a longitudinal study based on the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2018. The data of dietary and drinking water habits at baseline were collected using a questionnaire. The number of teeth at baseline and follow-up was collected for each subject. We used the linear mixed-effect model to analyze the associations of dietary habits and drinking water sources with tooth number.

Results

Among 19,896 participants at baseline, the mean age of the participants was 83.87 years, with the average number of natural teeth of 9.37, 8.26, 8.38, 8.68, 4.05, 1.92, 1.12, 2.20 for the first to eighth waves of survey. Compared with subjects drinking tap water, 1.036 (95 % CI: -1.206, -0.865), 0.880 (95 % CI: -1.122, -0.637) and 1.331 (95 % CI: -1.715, -0.947) fewer natural teeth were reported for those drinking well, surface water and spring at baseline survey. Compared with participants with rice intake as the staple food, those with wheat intake (β = -0.684; 95 % CI: -0.865, -0.503) tended to have fewer natural teeth. Compared with participants with fresh fruit intake almost every day, those with quite often intake of fresh fruit tended to have fewer teeth with a significant dose-response trend (Ptrend <0.001). Similar decreased trend for number of teeth was also indicated for increased frequency of vegetable intake (Ptrend <0.001). Fewer number of teeth was found for subjects with less frequency of meat and fish intakes.

Conclusions

The study suggested that drinking well, surface water, and spring, intakes of wheat as staple food, as well as less frequency of fresh fruit, vegetable, meat and fish intakes were associated with significantly fewer number of teeth in the Chinese elderly population.
Experiences of health care providers on pregnancy and childbirth care during the COVID-19 pandemic in Iran: a phenomenological study
Authors: Hantoushzadeh Sedigheh , Bagheri Maryam , Amjadi Marjan Akhavan , Farahani Maryam Farmahini , Haghollahi Fedyeh
Published: October 2021

Background

Coronavirus currently cause a lot of pressure on the health system. Accordingly, many changes occurred in the way of providing health care, including pregnancy and childbirth care. To our knowledge, no studies on experiences of maternity care Providers during the COVID-19 Pandemic have been published in Iran. We aimed to discover their experiences on pregnancy and childbirth care during the current COVID-19 pandemic.

Methods

This study was a qualitative research performed with a descriptive phenomenological approach. The used sampling method was purposive sampling by taking the maximum variation possible into account, which continued until data saturation. Accordingly, in-depth and semi-structured interviews were conducted by including 12 participants, as 4 gynecologists, 6 midwives working in the hospitals and private offices, and 2 midwives working in the health centers.

Data were analyzed using Colaizzi’s seven stage method with MAXQDA10 software.

Results

Data analysis led to the extraction of 3 themes, 9 categories, and 25 subcategories. The themes were as follows: “Fear of Disease”, “Burnout”, and “Lessons Learned from the COVID-19 Pandemic”, respectively.

Conclusions

Maternal health care providers experience emotional and psychological stress and work challenges during the current COVID-19 pandemic. Therefore, comprehensive support should be provided for the protection of their physical and mental health statuses. By working as a team, utilizing the capacity of telemedicine to care and follow up mothers, and providing maternity care at home, some emerged challenges to maternal care services can be overcome.
Time to death and its associated factors among infants in sub-Saharan Africa using the recent demographic and health surveys: shared frailty survival analysis
Authors: Tiruneh Sofonyas Abebaw , Zeleke Ejigu Gebeye , Animut Yaregal
Published: October 2021

Background

Globally, approximately 4.1 million infants died, accounting for 75% of all under-five deaths. In sub-Saharan Africa (SSA), infant mortality was 52.7/1000 live births in 2018 This study aimed to assess the pooled estimate of infant mortality rate (IMR), time to death, and its associated factors in SSA using the recent demographic and health survey dataset between 2010 and 2018.

Methods

Data were retrieved from the standard demographic and health survey datasets among 33 SSA countries. A total of 93,765 samples were included. The data were cleaned using Microsoft Excel and STATA software. Data analysis was done using R and STATA software. Parametric shared frailty survival analysis was employed. Statistical significance was declared as a two-side P-value < 0.05.

Results

The pooled estimate of IMR in SSA was 51 per 1000 live births (95% Confidence Interval (CI): 46.65–55.21). The pooled estimate of the IMR was 53 in Central, 44 in Eastern, 44 in Southern, and 57 in Western Africa per 1000 live births. The cumulative survival probability at the end of 1 year was 56%. Multiple births (Adjusted Hazard ratio (AHR) = 2.68, 95% CI: 2.54–2.82), low birth weight infants (AHR = 1.28, 95% CI: 1.22–1.34), teenage pregnancy (AHR = 1.19, 95 CI: 1.10–1.29), preceding birth interval <  18 months (AHR = 3.27, 95% CI: 3.10–3.45), birth order ≥ four (AHR = 1.14, 95% CI:1.10–1.19), home delivery (AHR = 1.08, 95% CI: 1.04–1.13), and unimproved water source (AHR = 1.07, 95% CI: 1.01–1.13), female sex (AHR = 0.86, 95% CI: 0.83–0.89), immediately breastfeed (AHR = 0.24, 95% CI: 0.23–0.25), and educated mother (AHR = 0.88, 95% CI: 0.82–0. 95) and educated father (AHR = 0.90, 95% CI: 0.85–0.96) were statistically significant factors for infant mortality.

Conclusion

Significant number of infants died in SSA. The most common cause of infant death is a preventable bio-demographic factor. To reduce infant mortality in the region, policymakers and other stakeholders should pay attention to preventable bio-demographic risk factors, enhance women education and improved water sources.
Implementation of brief dialectical behavior therapy skills training among borderline personality disorder patients in Malaysia: feasibility, acceptability, and preliminary outcomes
Authors: Keng Shian-Ling , Mohd Salleh Sahimi Hajar Binti , Chan Lai Fong , Woon Luke , Eu Choon Leng , Sim Su Hua , Wong Man Kuan
Published: October 2021

Aim/background

Even though dialectical behavior therapy (DBT) has received substantial empirical support in treating patients with borderline personality disorder (BPD), fewer studies have evaluated whether a brief DBT skills group may be effective in improving clinical outcomes in this population. Further, less is known regarding the feasibility and outcomes of DBT beyond Euro-American contexts. This paper describes outcomes from a pilot study examining the feasibility, acceptability, and clinical outcomes following completion of a shortened, 14-week DBT skills group in a sample of Muslim-majority BPD patients in Malaysia.

Methods

Twenty patients were recruited from a public hospital and attended DBT skills groups in an outpatient clinic. Participants completed measures assessing psychological symptoms, self-harm behaviors, suicidal ideation, emotion regulation difficulties, self-compassion, and well-being pre- and post-intervention.

Results

There were significant reductions in depressive symptoms, stress, and emotion regulation difficulties, as well as increases in self-compassion and well-being from pre- to post-intervention. A trend was found for decreases in frequency and types of non-suicidal self-harm behaviors, suicidal ideation, and anxiety symptoms. Qualitative content analyses of participants’ feedback indicated that the vast majority of participants perceived a positive impact from the skills group, with mindfulness and distress tolerance being rated frequently as skills that were beneficial.

Conclusion

These preliminary findings suggest that DBT skills training is feasible and acceptable in a Muslim-majority, low resource clinical setting, and holds promise in improving clinical outcomes among BPD patients in Malaysia.
Association of Health Status and Nicotine Consumption with SARS-CoV-2 positivity rates
Authors: Duszynski Thomas J. , Fadel William , Wools-Kaloustian Kara K. , Dixon Brian E. , Yiannoutsos Constantin , Halverson Paul K. , Menachemi Nir
Published: October 2021

Background

Much of what is known about COVID-19 risk factors comes from patients with serious symptoms who test positive. While risk factors for hospitalization or death include chronic conditions and smoking; less is known about how health status or nicotine consumption is associated with risk of SARS-CoV-2 infection among individuals who do not present clinically.

Methods

Two community-based population samples (including individuals randomly and nonrandomly selected for statewide testing, n = 8214) underwent SARS-CoV-2 testing in nonclinical settings. Each participant was tested for current (viral PCR) and past (antibody) infection in either April or June of 2020. Before testing, participants provided demographic information and self-reported health status and nicotine and tobacco behaviors (smoking, chewing, vaping/e-cigarettes). Using descriptive statistics and a bivariate logistic regression model, we examined the association between health status and use of tobacco or nicotine with SARS-CoV-2 positivity on either PCR or antibody tests.

Results

Compared to people with self-identified “excellent” or very good health status, those reporting “good” or “fair” health status had a higher risk of past or current infections. Positive smoking status was inversely associated with SARS-CoV-2 infection. Chewing tobacco was associated with infection and the use of vaping/e-cigarettes was not associated with infection.

Conclusions

In a statewide, community-based population drawn for SARS-CoV-2 testing, we find that overall health status was associated with infection rates. Unlike in studies of COVID-19 patients, smoking status was inversely associated with SARS-CoV-2 positivity. More research is needed to further understand the nature of this relationship.
Validation of rapid shallow breathing index displayed by the ventilator compared to the standard technique in patients with readiness for weaning
Authors: Rittayamai Nuttapol , Ratchaneewong Natwipha , Tanomsina Pirat , Kongla Withoon
Published: October 2021

Background

Rapid shallow breathing index (RSBI) is the most commonly used parameter for predicting weaning outcome. Measurement of RSBI by Wright spirometer (RSBIstandard) is the standard method in routine clinical practice. Data specific to the accuracy and reliability of the RSBI value displayed by the ventilator (RSBIvent) are scarce. Accordingly, this study aimed to evaluate the association between the average value of RSBIvent at different time points and RSBIstandard, and to assess the accuracy and reliability of these two RSBI measurement techniques.

Methods

This prospective cohort study included mechanically ventilated patients who were ready to wean. At the beginning of spontaneous breathing trial using the flow-by method, RSBI was measured by two different techniques at the same time, including: (1) Wright spirometer (breathing frequency/average tidal volume in 1 min) (RSBIstandard), and (2) the values displayed on the ventilator at 0, 15, 30, 45, and 60 s (RSBIvent).

Results

Forty-seven patients were enrolled. The RSBIvent value was significantly higher than the RSBIstandard value for every comparison. According to Spearman’s correlation coefficient (r) and intraclass correlation coefficient (ICC), the average value of RSBI from 5 time points (0, 15, 30, 45, and 60 s) showed the best correlation with the standard technique (r = 0.76 [P < 0.001], and ICC = 0.79 [95% CI 0.61–0.88], respectively). Bland–Altman plot also showed the best agreement between RSBIstandard and the RSBIvent value averaged among 5 time points (mean difference − 17.1 breaths/min/L).

Conclusions

We found that the ventilator significantly overestimates the RSBI value compared to the standard technique by Wright spirometer. The average RSBIvent value among 5 time points (0, 15, 30, 45, and 60 s) was found to best correlate with RSBIstandard.
Efficacy of immune checkpoint inhibitors in non-small cell lung cancer with uncommon histology: a propensity-score-matched analysis
Authors: Miyashita Koichi , Karayama Masato , Inoue Yusuke , Hozumi Hironao , Suzuki Yuzo , Furuhashi Kazuki , Fujisawa Tomoyuki , Enomoto Noriyuki , Nakamura Yutaro , Kono Masato , Matsui Takashi , Niwa Mitsuru , Koda Keigo , Toyoshima Mikio , Matsushima Sayomi , Matsuura Shun , Asada Kazuhiro , Fujii Masato , Kusagaya Hideki , Matsuda Hiroyuki , Inui Naoki , Suda Takafumi
Published: October 2021

Background

Clinical efficacy of immune checkpoint inhibitors (ICIs) for non-small cell lung cancer (NSCLC) with uncommon histology (uNSCLC) is unknown.

Methods

Patients with NSCLC treated with ICI monotherapy between January 2014 and December 2018 in 10 Japanese hospitals were retrospectively evaluated. The patients were divided into: (1) NSCLC with common histology (cNSCLC), defined as adenocarcinoma and squamous cell carcinoma; and (2) uNSCLC, defined as incompatibility with morphological and immunohistochemical criteria for adenocarcinoma or squamous cell carcinoma. Propensity score matching was performed to balance the two groups.

Results

Among a total of 175 patients included, 44 with uNSCLC (10 pleomorphic carcinomas, 9 large cell neuroendocrine carcinomas, 2 large cell carcinomas, and 23 not otherwise specified) and 44 with matched cNSCLC (32 adenocarcinomas and 12 squamous cell carcinomas) were selected for analyses. Median progression-free survival (PFS) (4.4 months, 95% confidence interval [CI] 1.8–7.7 months) and overall survival (OS) (11.4 months, 95% CI 7.4–27.4 months) in the uNSCLC patients were not significantly different from those in matched cNSCLC patients (5.4 months, 95% CI 3.1–7.6 months, p = 0.761; and 14.1 months, 95% CI 10.6–29.6 months, p = 0.381). In multivariate analysis, Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0–1 and programmed death ligand-1 (PD-L1) expression were predictive for PFS and OS in uNSCLC.

Conclusions

ICIs had similar clinical efficacy for treatment of uNSCLC and cNSCLC. Good ECOG-PS and PD-L1 expression were predictive for efficacy of ICIs in uNSCLC.
The white test for intraoperative screening of bile leakage: a potential trigger factor for acute pancreatitis after liver resection—a case series
Authors: Chopinet Sophie , Bollon Emilie , Hak Jean-François , Reydellet Laurent , Blasco Valéry , Tradi Farouk , Louis Guillaume , Grégoire Emilie , Hardwigsen Jean
Published: October 2021

Background

Acute pancreatitis after liver resection is a rare but serious complication, and few cases have been described in the literature. Extended lymphadenectomy, and long ischemia due to the Pringle maneuver could be responsible of post-liver resection acute pancreatitis, but the exact causes of AP after hepatectomy remain unclear.

Cases presentation

We report here three cases of AP after hepatectomy and we strongly hypothesize that this is due to the bile leakage white test. 502 hepatectomy were performed at our center and 3 patients (0.6%) experienced acute pancreatitis after LR and all of these three patients underwent the white test at the end of the liver resection. None underwent additionally lymphadenectomy to the liver resection. All patient had a white-test during the liver surgery. We identified distal implantation of the cystic duct in these three patients as a potential cause for acute pancreatitis.

Conclusion

The white test is useful for detection of bile leakage after liver resection, but we do not recommend a systematic use after LR, because severe acute pancreatitis can be lethal for the patient, especially in case of distal cystic implantation which may facilitate reflux in the main pancreatic duct.
Use of primary and hospital care health services by chronic patients according to risk level by adjusted morbidity groups
Authors: Barrio-Cortes Jaime , Soria-Ruiz-Ogarrio María , Martínez-Cuevas María , Castaño-Reguillo Almudena , Bandeira-de Oliveira Mariana , Beca-Martínez María Teresa , López-Rodríguez María Carmen , Jaime-Sisó María Ángeles
Published: October 2021

Background

Patients with chronic diseases have increased needs for assistance and care. The objective of this study was to describe the characteristics and use of primary care (PC) and hospital care (HC) health services by chronic patients according to risk level based on adjusted morbidity groups (AMG) and to analyze the associated factors.

Methods

Cross-sectional descriptive observational study. Patients from a basic health area classified as chronically ill by the AMG classification system of the Madrid PC electronic medical record were included. Sociodemographic, clinical-care characteristics (classified as predisposing factors or need factors) and service utilization variables were collected. Univariate, bivariate and simple linear regression analyses were performed.

Results

The sample consisted of 9866 chronic patients and 8332 (84.4%) used health services. Of these service users, 63% were women, mean age was 55.7 (SD = 20.8), 439 (5.3%) were high risk, 1746 (21.2%) were medium risk, and 6041(73.4%) were low risk. A total of 8226 (98.7%) were PC users, and 4284 (51.4%) were HC users. The average number of annual contacts with PC was 13.9 (SD = 15); the average number of contacts with HC was 4.8 (SD = 6.2). Predisposing factors associated with services utilization at both care levels were: age (B coefficient [BC] = 0.03 and 0.018, 95% CI = 0.017–0.052 and 0.008–0.028, respectively, for PC and HC) and Spanish origin (BC = 0.962 and 3.396, 95% CI = 0.198–1.726 and 2.722–4.070); need factors included: palliative care (BC = 10,492 and 5047; 95% CI = 6457–14,526 and 3098-6995), high risk (BC = 4631 and 2730, 95% CI = 3022–6241 and 1.949–3.512), number of chronic diseases (BC = 1.291 and 0.222, 95% CI = 1.068–1.51 and 0.103–0.341) and neoplasms (BC = 2.989 and 4.309, 95% CI = 1.659–4.319 and 3.629–4.989).

Conclusions

The characteristics and PC and HC service utilization of chronic patients were different and varied according to their AMG risk level. There was greater use of PC services than HC services, although utilization of both levels of care was high. Service use was related to predisposing factors such as age and country of origin and, above all, to need factors such as immobility, high risk, and number and type of chronic diseases that require follow-up and palliative care.