bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review
Authors: Temesgen Belisty , Kibret Getiye Dejenu , Alamirew Nakachew Mekonnen , Alebel Animut
Published: July 2019

Background: Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among peoples living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV-positive adults on ART.
Methods: A retrospective record review was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Data were entered using Epi-Data version 4.2 and analyzed using STATA Version 13. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of the time to develop TB.
Results: Among 492 HIV-positive adults included in the final analysis, 16.9% developed TB at the time of follow up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person years of observation. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of TB.
Conclusion: In this study, a high incidence rate of TB was observed among HIV-positive adults. Advanced WHO clinical disease stage (III and IV), being ambulatory and bedridden, baseline opportunistic infections, low hemoglobin level, and not taking IPT were found to be the predictors of TB.
Keywords: HIV, Incidence, Predictors, TB
PROGNOSTIC SIGNIFICANCE OF EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) IN HEAD AND NECK TUMOURS AT SOME SELECTED HOSPITAL IN GHANA
Authors: Barnes Precious , Yeboah F.A , Zhu Jinling , Saahene Roland Osei , Akakpo Patrick , Ephrraim Richard K.D
Published: July 2019

Abstract:
Background: Head and neck Tumour (HNT) are tumour of the paranasal sinuses, the salivary glands and the upper aero¬digestive tract. EGF can stimulate cell proliferation, cell differentiation, cell growth, migration, and inhibit apoptosis. The aim of this study was to investigate the expression of EGFR in head and neck tumour.
Method: EGFR expression was analyzed using quantitative real-time PCR (qRT-PCR) and immunohistochemical staining on tissue samples from a consecutive series of 150 head and neck tumour patients who underwent tumor resections between 2014 and 2018.
Results: The relationship between EGFR expressions, clinicopathological factors, was investigated. qRT-PCR results showed that the EGFR expression was high in tumor tissue samples than in the normal head and neck tissues. High and low EGFR was compared with ages ≤40,>40 in the head and neck cancer of p- value 0.03. There was a significant difference between the histological differentiation of the malignant tumour with p values of 0.001, when well, moderate and poor was compared. There was a significant difference (p-value 0.012) between the I-II and III-IV tumour stages when the high level and low expression of EGFR were compared.
Conclusion: Our data suggest that EGFR plays an important role in head and neck tumour progression and that its expression will provide baseline data to facilitate identification of new molecular targeting therapeutics.
Keywords: EGFR, Head and neck tumour, Clinicopathological factors.
Metoclopramide versus sumatriptan in the treatment of migraine in the emergency department: a single-center, open-label, cluster-randomized controlled non-inferiority trial
Authors: Funato Yumi , Kimura Akio , Matsuda Wataru , Uemura Tatsuki , Fukano Kentaro , Kobayashi Kentaro , Sasaki Ryo
Published: July 2019

Background

Migraine is a common disease seen in the emergency department (ED). Triptans, which are recommended in therapeutic guidelines for migraine, have some contraindications and possible severe side effects. Metoclopramide, which is commonly used as an antiemetic, also seems to have pain-relieving effects for migraine. In this study, we will investigate whether metoclopramide 10 mg intravenously (IV) is non-inferior to sumatriptan 3 mg subcutaneously (SQ) as migraine treatment in the ED.

Methods

This study is a single-center, open-label, cluster-randomized controlled trial of 80 patients with migraine attacks to investigate the non-inferiority of metoclopramide to sumatriptan. The patients will be cluster-randomized monthly into metoclopramide 10 mg IV and sumatriptan 3 mg SQ arms. The primary outcome will be change in Numerical Rating Scale score for headache at 1 h after baseline.

Discussion

If our hypothesis is confirmed, metoclopramide can be considered as first-line medication for migraine attacks in ED settings.
Ketogenic diet and fasting diet as Nutritional Approaches in Multiple Sclerosis (NAMS): protocol of a randomized controlled study
Authors: Bahr Lina Samira , Bock Markus , Liebscher Daniela , Bellmann-Strobl Judith , Franz Liane , Prüß Alexandra , Schumann Dania , Piper Sophie K. , Kessler Christian S. , Steckhan Nico , Michalsen Andreas , Paul Friedemann , Mähler Anja
Published: July 2019

Background

Multiple sclerosis (MS) is the most common inflammatory disease of the central nervous system in young adults that may lead to progressive disability. Since pharmacological treatments may have substantial side effects, there is a need for complementary treatment options such as specific dietary approaches. Ketone bodies that are produced during fasting (FD) and ketogenic diets (KD) are an alternative and presumably more efficient energy source for the brain. Studies on mice with experimental autoimmune encephalomyelitis showed beneficial effects of KD and FD on disease progression, disability, cognition and inflammatory markers. However, clinical evidence on these diets is scarce. In the clinical study protocol presented here, we investigate if a KD and a FD are superior to a standard diet (SD) in terms of therapeutic effects and disease progression.

Methods

This study is a single-center, randomized, controlled, parallel-group study. One hundred eleven patients with relapsing-remitting MS with current disease activity and stable immunomodulatory therapy or no disease-modifying therapy will be randomized to one of three dietary interventions over 18 months. Dietary interventions are 1) a KD with a carbohydrate intake of 20-40 g/day, 2) a FD with 7 days of fasting every 6 months and 14 hours intermittent fasting daily in between, and 3) a fat-modified SD as recommended by the German Nutrition Society. Primary outcome measure is the number of new T2-weighted MRI lesions after 18 months. Secondary endpoints are safety, changes in relapse rate, disability progression, fatigue, depression, cognition, quality of life, changes of gut microbiome as well as markers of inflammation, oxidative stress and autophagy. Safety and feasibility will also be assessed.

Discussion

Preclinical data suggest that KD and FD may modulate immunity, reduce disease severity and promote remyelination in the mouse model of MS. However, clinical evidence is lacking. This study is the first clinical study investigating the effects of a KD and FD on disease progression of MS.

Trial Registration

ClinicalTrials.gov; NCT03508414; Registered 25 April 2018, retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT03508414
Atmiyata, a community led intervention to address common mental disorders: Study protocol for a stepped wedge cluster randomized controlled trial in rural Gujarat, India
Authors: Joag Kaustubh , Kalha Jasmine , Pandit Deepa , Chatterjee Susmita , Krishnamoorthy Sadhvi , Shields-Zeeman Laura , Pathare Soumitra
Published: July 2019

Background

While lay-health worker models for mental health care have proven to be effective in controlled trials, there is limited evidence on the effectiveness and scalability of these models in rural communities in low- and middle-income countries (LMICs). Atmiyata is a rural community-led intervention using local community volunteers, called Champions, to identify and provide evidence-based counselling for persons with common mental disorders (CMD) as part of a package of community-based interventions for mental health.

Methods

The impact of the Atmiyata intervention is evaluated through a stepped wedge cluster randomized controlled trial (SW-CRCT) with a nested economic evaluation. The trial spans across 10 sub-blocks (645 villages) in Mehsana district with 1.52 million rural adult population. 56 PHCs in Mehsana district are equally divided into four clusters of 14 PHCs each, and the intervention is rolled out in cluster in a staggered manner at an interval of 5 months.

The primary outcome is symptomatic improvement measured through the GHQ-12 at 3-month follow-up. Secondary outcomes include: quality of life using the EURO-QoL (EQ- 5D), symptom improvement measured by the Self-reporting questionnaire-20 (SRQ-20), functioning using the WHO Disability Assessment Scale (WHO-DAS-12), depression symptoms (Patient Health Questionnaire, PHQ-9)) and anxiety symptoms (Generalized Anxiety Disorder Questionnaire, GAD-7) and social participation using the Social Participation Scale (SPS). Linear mixed effects models are employed for continuous outcomes and generalized linear mixed effects model for binary outcomes.

Discussion

Stepped wedge designs are progressively being used to evaluate real-life effectiveness of interventions. To the best of our knowledge, this is the first SW-CRCT in a LMIC evaluating the impact of the implementation of a mental health intervention. The results of this study will contribute to the evidence on scaling-up lay health worker models for mental health interventions and contribute to the SW-CRCT literature in LMICs.
Safety and efficacy of Jiaotai Wan in patients with depression: study protocol for a randomised controlled trial
Authors: Zhou Zhihuan , Fu Shufei , Wang Yuhan , Liu Yijia , Bu Huaien , Mei Yan , Tong Yi , Yu Chunquan
Published: July 2019

Background: Depression is a common affective disorder characterised by marked and lasting melancholia, with corresponding thought and behaviour changes. Due to an accelerated pace of life and increased work pressure, the incidence of depression has risen sharply, causing great harm to family and social life. Jiaotai Wan (JTW) is a Chinese herbal formula that is commonly prescribed for depression and insomnia in clinical treatment, and animal experimental research shows that it exhibits antidepressant effects. However, there are no standard clinical trials to confirm its efficacy in treating depression and insomnia. Therefore, this study aims to assess the efficacy and safety of JTW in the treatment of depression. Methods: This study is designed as a randomised, multicentre clinical trial with parallel groups. A total of 40 patients with depression will be recruited and randomly allocated to either the treatment or the control group (in a 1:1 ratio). The patients will receive JTW plus fluoxetine or fluoxetine alone once a day for eight weeks. The primary outcome is the Hamilton Depression Rating Scale score for patients in the treatment group compared with that in the control group. The secondary outcomes include Traditional Chinese medicine syndrome integral scale scores, Wisconsin Card Sorting Test, blood metabonomics, urine metabonomics, brain structure and function on functional magnetic resonance imaging. Discussion: This randomised clinical trial was designed as a standardised method to assess the efficacy and safety of JTW in the treatment of depression and provide evidence for the clinical application of JTW. Trial registration: Chinese Clinical Trial Registry,ChiCTR-IOR-17010748.Registered on 28 Feb 2017.
Relationships between changes in HIV risk perception and condom use in east Zimbabwe 2003-2013: Population-based longitudinal analyses
Authors: Schaefer Robin , Thomas Ranjeeta , Maswera Rufurwokuda , Kadzura Noah , Nyamukapa Constance , Gregson Simon
Published: July 2019

Background: Perceiving a personal risk for HIV infection is considered important for engaging in HIV prevention behaviour and often targeted in HIV prevention interventions. However, there is limited evidence for assumed causal relationships between risk perception and prevention behaviour and the degree to which change in behaviour is attributable to change in risk perception is poorly understood. This study examines longitudinal relationships between changes in HIV risk perception and in condom use and the public health importance of changing risk perception.

Methods: Data on sexually active, HIV-negative adults (15-54 years) were taken from four surveys of a general-population open-cohort study in Manicaland, Zimbabwe (2003-2013). Increasing condom use between surveys was modelled in generalised estimating equations dependent on change in risk perception between surveys. Accounting for changes in other socio-demographic and behavioural factors, regression models examined the bi-directional relationship between risk perception and condom use, testing whether increasing risk perception is associated with increasing condom use and whether increasing condom use is associated with decreasing risk perception. Population attributable fractions (PAFs) were estimated.

Results: 1988 males and 3715 females participated in ≥2 surveys, contributing 8426 surveys pairs. Increasing risk perception between two surveys was associated with higher odds of increasing condom use (males: adjusted odds ratio [aOR]=1.39, 95% confidence interval [CI]=0.85-2.28, PAF=3.39%; females: aOR=1.41 [1.06-1.88], PAF=6.59%), adjusting for changes in other socio-demographic and behavioural factors. Those who decreased risk perception were also more likely to increase condom use (males: aOR=1.76 [1.12-2.78]; females: aOR=1.23 [0.93-1.62]).

Conclusions: Results on associations between changing risk perception and increasing condom use support hypothesised effects of risk perception on condom use and effects of condom use on risk perception (down-adjusting risk perception after adopting condom use). However, low proportions of change in condom use were attributable to changing risk perception, underlining the range of factors influencing HIV prevention behaviour and the need for comprehensive approaches to HIV prevention.
A Global Health Capstone: An Innovative Educational Approach in a Global Health Competency-Based Curriculum
Authors: Chamberlain Stacey , Gonzalez Nicole , Dobiesz Valerie , Edison Marcia , Lin Janet , Weine Stevan
Published: July 2019

Background

Global health educational programs for medical and public health professionals have grown substantially in recent years. The University of Illinois Chicago College of Medicine (UICOM) began a global medicine (GMED) program for selected students in 2012 and has since graduated four classes. As part of the four-year curriculum, students complete a longitudinal global health capstone project. This paper describes the global health capstone project with the aims of understanding whether longitudinal capstone projects are feasible, how mentorship of capstones could be strengthened, and how participation in a capstone might contribute to students’ attainment of global health competencies.

Methods

The authors reviewed the final capstone projects for 35 graduates to assess features of the capstones including whether the projects were longitudinal, faculty-mentored, or involved original research. In addition, the authors assessed the attainment of each of 11 global health competency domains identified by the Consortium of Universities for Global Health (CUGH). Student reflection papers were reviewed for themes related to capstone completion.

Results

Of the 35 capstones, 19 (54%) were longitudinal, and 21 (60%) had subject matter-focused faculty mentorship. Twenty-six projects involved original research (74%) and 25 involved international travel (71%). Nine projects led to a conference abstract/presentation (26%) while five led to a publication (14%). Overall, capstone projects addressed 9 out of 11 (82%) CUGH competency domains. In their reflection papers, students identified factors that facilitated capstone completion (e.g. strong mentorship), barriers to capstone completion (e.g. difficulty identifying a capstone project), and key benefits of the capstone process (e.g. strengthened research skills).

Conclusions

A longitudinal capstone model is feasible, provides an impactful opportunity for research and career mentorship, and can teach targeted global health competencies. Further refinement of the capstone process is needed to strengthen mentorship and target more global health competencies, and additional assessment tools are needed.
Effect of stress coping ability and working hours on burnout among residents
Authors: Kijima Saori , Tomihara Kazuya , Tagawa Masami
Published: July 2019

Background

Burnout (BO) among residents leads to interruptions in training and even to exit from programs. Despite the implementation of working hour restrictions in the U.S. in 2013, the high rate of BO remains a serious problem. Therefore, we analyzed Japanese residents’ BO, training conditions, and associated factors, especially stress coping ability, with the aim of providing support for residents and evidence-based guidelines for working environments.

Methods

In total, 37 teaching hospitals were randomly selected, and all residents in the third and fifteenth months of a residency program at these hospitals were targeted for this research. We analyzed the residents’ BO rates, associated factors, and interactions using response data from a self-administered questionnaire consisting of the Japanese versions of the Maslach Burnout Inventory (MBI) and the Sense of Coherence (SOC) scale, as well as items asking about their training environments, gender, and age.

Results

Overall, 48 (49.5%) of 97 residents in 18 teaching hospitals (62 and 35 in the third and fifteenth months, respectively) whose average working hours were 63.3 hours per week were judged as having BO, among whom, 33 (53.2%) and 15 (42.9%) had BO in the third and fifteenth months, respectively. Logistic regression analysis indicated that working hours and 10 items on the SOC scale (SOC10) were significant factors of BO.

Two-way analysis of variance revealed that working hours was a significant variable for the MBI-emotional exhaustion score and SOC10 in the third and fifteenth months, respectively. Regarding the MBI-cynicism and professional efficacy scores, the SOC10 was a significant variable in both the third and fifteenth months. In addition, the high SOC group (SOC10>45) showed higher personal efficacy under longer working hours.

Conclusion

About half of the Japanese residents were judged as having BO as early as the third month of training under regulations of working 40 hours per week. Individual stress coping ability and working hours were found to be significant factors for BO. Residents with high stress coping ability exhibited more personal efficacy with more working experiences, which suggests that the SOC scale could be a valuable tool to help foster a suitable training environment.
Generalizability of a Progress Clinical Skills Examination and the Assessment of the Growth in Clinical Skills in a Medical School Curriculum with Early Clinical Experiences
Authors: Laird-Fick Heather S , Chang Chi , Wang Ling , Parker Carol , Malinowski Robert , Emery Matthew , Solomon David
Published: July 2019

Background

This study evaluates the generalizability of an eight-station progress clinical skills examination and assesses the growth in performance for six clinical skills domains among first- and second-year medial students over four time points during the academic year.

Methods

We conducted a generalizability study for longitudinal and cross-sectional comparisons and assessed growth in six clinical skill domains via repeated measures ANOVA over the first and second year of medical school.

Results

The generalizability of the examination domain scores was low but consistent with previous studies of data gathering and communication skills. Variations in case difficulty across administrations of the examination made it difficult to assess longitudinal growth. It was possible to compare students at different training levels and the interaction of level of training and growth. Second-year students outperformed first-year students, but first-year students’ clinical skills performance grew faster than second-year students narrowing the gap in clinical skills over the students’ first year of medical school.

Conclusions

Case specificity limits the ability to assess longitudinal growth in clinical skills through progress testing. Providing students with early clinical skills training and authentic clinical experiences appears to result in the rapid growth of clinical skills during the first year of medical school.
Clinical Features of Actinomycosis: A 20-year Experience of A Single Institute in Southern China
Authors: Xu Yu-yuan , Zhang Jian , Lu Ai-li , Peng Jie , Xu Xu-wen
Published: July 2019

Background

Actinomycosis is a rare indolent infectious disease with nonspecific clinical presentations that delay diagnosis. Although actinomycosis is thought to be more prevalent in developing countries, data from developing countries are scanty. This study was to reveal the current situation of actinomycosis in developing countries and the difference from that in developed countries.

Methods

Patients fulfilling the inclusion criteria for actinomycosis from Nanfang Hospital in southern China between January 2003 and December 2018 were retrospectively analyzed. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance.

Results

Thirty-one patients were included in this study. Disease was diagnosed predominately in the orocervicofacial (n=14), cardiothoracic (n=11), abdominopelvic (n=5), soft tissue (n=1). Diagnosis was obtained from either histopathology (n=29, 94%) or microbiology (n=2, 6%). Only one-thirds of patients presented with general symptoms such as fever, weight loss. Ten was lost to follow-up, and median duration of antibiotics was 93.5 days (interquartile range 28–300), whereas the median follow-up time was 34 months (interquartile range 9–132). Ten patients receiving complete resection of the lesion were cured without postoperative use of antibiotic. Only one patients relapsed during the follow-up period.

Conclusions

Actinomycosis is a rare disease even in developing countries, and both misdiagnosis and missed diagnosis are common. Diagnosis was often delayed and obtained from histopathology postoperatively in developing countries. Hence, clinicians should be aware of this disease in patients with high riks factors. In the future, specific molecular methods may help to improve early diagnosis and treatment.
A Comparative Analysis of DWI and Ultrasound in Thyroid Nodules
Authors: Kong Wei dan , Yue Xiu hui , Ren Ji liang , Tao Xiao feng
Published: July 2019

Background

Diffusion weighted imaging and ultrasound are commonly used methods to examine thyroid nodules, but their comparative value is rarely studied. To evaluate the value of diffusion weighted imaging and ultrasound in differentiing benign and malignant thyroid nodules
Methods

A total of 100 patients with 137 nodules were enrolled. who underwent both diffusion weighted imaging and ultrasound before operation. T1 and T2 signal intensity ratio (SIR) of each thyroid nodule was calculated by measuring the mean signal intensity divided by that of paraspinal muscle. The value of ADC,signal intensity ratio (SIR) of benign and malignant thyroid nodules were analyzed by two independent sample t test. The sensitivity, specificity and accuracy of DWI and ultrasound were compared and analyzed by chi-square test.

Results

There was no significant difference in signal intensity ratio between benign and malignant thyroid nodules. The ADC value had significant difference. When the threshold value was 1.12 ×10-3 mm2/s, the maximum area under the curve was 0.944,The sensitivity, specificity and accuracy were 84.9%, 92.2% and 87.6% respectively. The sensitivity and specificity of ultrasound diagnosis were 90.1%, 80.4% and 86.9% respectively.

Conclusion

Ultrasound has high sensitivity in differentiating benign and malignant thyroid nodules, and ADC value has high specificity in differentiating thyroid nodules, but there is no statistical difference in sensitivity and specificity between the two. DWI and Ultrasound have their own advantages in differentiating benign and malignant thyroid nodules.
Tumor-associated fibroblasts expression in esophageal squamous cell carcinoma and may descend from mesenchymal stem cells
Authors: Yang Weilin , Bella Amos Ela , Xu Bo , Zou Jianyong , Zhu Haoshuai , Su Chunhua , Xiang Andy Peng , Wang Tao , Chen Zhenguang
Published: July 2019

Tumor-associated fibroblasts (TAFs) play a pivotal role in cancer proliferation, invasion and metastasis. The expression of TAFs in esophageal squamous cell carcinoma (ESCC) tissues remain unclear. We investigated the relevance of TAFs in ESCC, and then culture mesenchymal stem cells (MSC) by ESCC microenvironment induced their conversion into TAFs to assess whether MSC are precursors of TAFs. We detected the expression of TAFs surface markers, including α-SMA, and S100A4 in esophageal squamous cell cancer tissues by using immunohistochemistry, and evaluated associations with clinicopathological features. In order to verify whether MSC is one of the TAFs sources, we used culture supernatant from ESCC tumor cells to culture and induce MSC to transform into TAFs. TAFs surface markers, α-SMA and S100A4, were expressed in ESCC tissues, and their expressions correlated with tumor differentiation and clinical TNM stage. Real-time-PCR analysis and Western-Blot analysis confirmed MSC conversion into TAFs. Our study demonstrated that TAFs existence in esophageal carcinoma, and their expression was also closely related to metastasis and poor prognosis. Furthermore, we confirmed the conversion from MSC to TAFs and surmised MSC may be the precursors of TAFs.
Prevalence and Associated Factors of Bronchial Asthma among Adult Patients in Debre Berhan Referral Hospital, Ethiopia 2018: A cross-sectional study
Authors: Tegegnework Sisay , Muhamud Sindew , Demelash Alebachew
Published: July 2019

Objective

Bronchial asthma is one of the major public health challenges throughout the world that negatively impact patients, families and community. The objective of this study was to assess the prevalence and associated risk factors of bronchial asthma among adult patients in Debre Berhan Referral Hospital. A hospital based cross-sectional study design was used among 257 study participants. A systematic sampling technique was used to select the study participants. Data were collected by using pre-tested and structured questionnaire. The data was analyzed by SPSS version 20.0. Both bivariate and multivariate logistic regression model was used to identify the predictors of asthma.

Results

Prevalence of bronchial asthma among adult patients was 29.6%. Being an urban resident (AOR: 1.5: 95%CI: 1.3 - 3.9), income of household less than 1000 EBr/ month (AOR: 1.7: 95%CI: 1.6 - 4.1), having family history of asthma (AOR: 2.7: 95%CI: 1.3 - 5.8), and presence of vermin at the house of patients’ (AOR: 2.4: 95%CI: 1.2 – 4.7) were significantly associated with bronchial asthma. The authors concluded that the prevalence of bronchial asthma among adult patients was high. Therefore, educational program about the risk factors and preventive measures of asthma is highly recommended.
Lower serum 25-hydroxyvitamin D3 concentration is associated with higher pain and disability in subjects with low back pain: a case-control study
Authors: Pishgahi Alireza , Dolatkhah Neda , Shakouri Seyed Kazem , Hashemian Maryam , Amiri Atefeh , Reihany Morteza Delkhosh , Jahanjou Fatemeh
Published: July 2019

Objectives: Low back pain (LBP) is a common medical problem worldwide. The aim of this study is to evaluate the association between serum levels of 25-hydroxivitamin D3 and functional disability in patients suffering from LBP in a sample of Azeri middle-aged subjects, North West of Iran.
Results: In this case-control study, 63 eligible patients with LBP and 55 healthy subjects enrolled in the study. Peripheral venous blood was taken for evaluating the serum Level of 25-hydroxivitamin D3. We recognized factors related with LBP by multiple regression analyses. The average plasma level of vitamin D in case group was significantly lower than that of the matched controlled group (26.25±15.95 vs. 34.20±14.92, p-value < 0.01 respectively). Subjects with vitamin D deficiency or insufficiency were more likely to exhibit LBP than subjects with normal vitamin D level [(OR= 2.388, 95% CI (1.114 to 5.119)]. According to the partial correlation analysis, there was a reverse correlation between plasma level of vitamin D with functional disability measured by Modified Oswestry Questionnaire (r = -.307, p = .017) and also with pain intensity according to Visual analogue Scale (VAS) score (r = -.268, p = .040) whilst controlling for age, sex and body mass index (BMI).
The effects of anethum graveolens (dill) powder supplementation on glycemic control, lipid profile, some antioxidants and inflammatory markers, and gastrointestinal symptoms in type 2 diabetic patients: a double-blind, placebo-controlled trial
Authors: Haidari Fatemeh , Zakerkish Mehrnoosh , Borazjani Fatemeh , Angali Kambiz Ahmadi , Amoochi Golnaz
Published: July 2019

Background: The objective of this study was to investigate the effects of anethum graveolens (dill) powder supplementation on glycemic control, lipid profile, some antioxidants and inflammatory markers, and gastrointestinal symptoms in type 2 diabetic patients.
Material and methods: In this study, 42 type 2 diabetic patients were randomly allocated to intervention and control groups and received either 3 gr dill powder or placebo (3 capsules 1 gr) three per day. Fasting blood sugar (FBS), insulin, homeostatic model assessment of insulin resistance (HOMA- IR), lipid profile, hs-C-reactive protein (hs-CRP), total antioxidant capacity (TAC), malondialdehyde (MDA) and gastrointestinal symptoms were measured in all subjects at baseline and post-intervention.
Results: The dill powder supplementation significantly decreased the mean serum levels of insulin, HOMA-IR, LDL-C and MDA in the intervention group in compare with baseline (p < 0.05). Also, the mean serum levels of HDL and TAC was significantly increased in the intervention group in compare with baseline (p < 0.05). Colonic motility disorders was the only gastrointestinal symptom that its frequency was significantly reduced by supplementation (P = 0.01). The mean changes of insulin, LDL-c and MDA were significantly lower in intervention group in compare with control group (p < 0.05). In addition, the mean changes of HDL was significantly higher in intervention group in compare with control group (p < 0.05).
Conclusion: It is recommended that dill powder supplementation may be effective in control of the glycemic, lipid, stress oxidative and gastrointestinal symptoms in type 2 diabetic patients.
Increased long-term risk of dementia in patients with carbon monoxide poisoning: A systematic review and meta-analysis of cohort studies
Authors: Zhang Meixian , Wei Ho-Shan , Chien Ching-Wen , Tung Tao-Hsin
Published: July 2019

Background

It has long been known that carbon monoxide poisoning is associated with cognitive dysfunction but whether carbon monoxide poisoning is a risk factor for incident dementia is still inconclusive. Our objective was to assess whether carbon monoxide poisoning increases the incidence of dementia.

Methods

We conducted a systematic review and meta analysis of cohort studies examining the risk of dementia in people with carbon monoxide poisoning. We searched the Cochrane Library, PubMed, and EMBASE from inception to 31 March 2019. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreement was resolved by discussion with a third author. Only cohort study with an enough follow-up period was included, which reported the association between carbon monoxide poisoning and incidence of dementia in adults. Exposure was carbon monoxide poisoning; primary outcomes were incident all-cause dementia, Alzheimer’s disease and cognitive disorder. Summary estimates were obtained using random effects meta-analysis.

Results

Thirty-three full texts were initially searched, but only three studies met our inclusion criteria, and they were comprised of 134,563 participants who were initially free of dementia. The follow-up period ranged from 9 to 12 years. We found that CO poisoning increased the risk of dementia incidence [adjusted hazard ratio 2.61, 95% confidence interval (CI) 1.56 to 4.36, P = 0.0003]. Subgroup analysis showed that the increased dementia risk was significant in males but not in females, and the highest risk was in young age group, followed by in middle age group, but not in the old one (P > 0.05).

Conclusions

This meta-analysis suggests that overall the evidence from prospective cohort studies supported a link between carbon monoxide exposure and an increased dementia risk, although all the included studies were limited to Taiwanese population. Further studies that provide data for different ethnic groups are needed to clarify whether a subgroup of patients with carbon monoxide exposure has an elevated risk of dementia.
Simulation and minimization: Technical advances for factorial experiments designed to optimize clinical interventions
Authors: Kuhn Jocelyn Lara , Sheldrick Radley Christopher , Broder-Fingert Sarabeth , Chu Andrea , Fortuna Lisa , Jordan Megan , Rubin Dana , Feinberg Emily
Published: July 2019

Background

The Multiphase Optimization Strategy (MOST) is designed to maximize the impact of clinical healthcare interventions, which are typically multicomponent and increasingly complex. The MOST framework often relies on factorial experiments to identify which components of an intervention are most effective, efficient, and scalable. When assigning participants to conditions in factorial experiments, researchers must be careful to select the assignment method that will result in balanced sample sizes and equivalence of covariates across conditions without being predictable. Historically, procedures most often include simple randomization and stratification with blocking; minimization is an increasingly utilized method that assigns participants to the condition that minimizes differences in covariates and sample size across study conditions.

Methods

In the context of a MOST optimization trial with a 2x2x2x2 factorial design (4 components, 16 cells), we used computer simulation to empirically test three subject assignment methods: simple randomization, stratification with blocking, and minimization. We compared these methods with respect to: sample size balance across condition, equivalence across conditions on key covariates, and unpredictability of assignments. Leveraging an existing dataset to compare three different allocation methods, we conducted 250 computerized simulations using bootstrap samples of 304 participants, which was the planned sample size for the proposed study.

Result

Simple randomization, the most unpredictable subject allocation method, generated the least balance of sample and equivalence of covariates across the 16 study cells. Stratification with blocking performed well on stratified variables, and resulted in similar sample balance and predictability as minimization. In contrast, minimization, which had a higher degree of complexity and cost, was most successful in achieving balanced sample sizes and equivalence across a large number of covariates.

Conclusions
Unlike simple randomization, minimization procedures and stratification with blocking are both methodologically sound options for factorial designs. Based on the computer simulation results and priorities within context of this MOST optimization trial, minimization was selected as the optimal subject allocation method. Minimization is utilized infrequently in randomized experiments but represents an important technical advance that should be considered by researchers implementing multi-arm and factorial studies.
The Methods and Baseline Characteristics of a VA Randomized Controlled Study Evaluating Supported Employment Provided in Primary Care Patient Aligned Care Teams
Authors: Davis Lori L. , Blansett Catherine M. , Mumba Mercy N. , MacVicar David , Toscano Richard , Pilkinton Patricia , Gay Whitney , Bartolucci Al
Published: July 2019

Background
This article describes the design and baseline sample of a single-site trial comparing Individual Placement and Support (IPS) supported employment delivered within a Veterans Health Administration (VHA) primary care Patient Aligned Care Team (PACT) to treatment-as-usual (TAU) vocational rehabilitation that includes transitional work for U.S. military veterans.

Methods
Unemployed veterans who were receiving care in a PACT, eligible for vocational rehabilitation, and diagnosed with a mental health diagnosis other than a psychotic or bipolar I disorder were prospectively randomized to either IPS or TAU. Employment outcomes and measures of quality of life, self-esteem, and community reintegration are being collected for 12 months.

Results
The participant sample (n=119) is comprised of 18.5% female, 69.2% African-Americans, and 4.2% Hispanic. Average age is 38.2 (SD ± 8.41) years; 80.7% served in the military since 2001; 78% are receiving or applying for U.S. Department of Veterans Affairs (VA) service-connected disability; 26.9% have not held a competitive job in the past 3 years; and the average length of pre-randomization unemployment is 1.4 (SD ± 2.3) years.

Conclusions
Unique design features include evaluating the efficacy of an evidenced-based IPS within the primary care setting, having broad diagnostic eligibility, and defining the primary outcome criterion as “steady employment”, i.e. holding a competitive job for ≥26 weeks of the 12-month follow-up period. Feasibility of IPS delivery in PACT is discussed. The findings illustrate the characteristics of a primary care veteran sample in need of employment services.
Awareness and Attitudes toward Corneal Donations among Applicants and Staff of a Driver, Vehicle and Licensing Authority (DVLA) in Ghana
Authors: Lartey Seth , ANTWI-ADJEI ELLEN KONADU , Agyapong Solomon , Mohammed Abdul-Kabir , Mensah Derrick N.O. , Genego Edward S
Published: July 2019

Background: Corneal transplantations are surgeries performed for irreparable corneal diseases and damage. However, there is a gap between the number of potential recipients and the number of donor corneas available. The main aim of the study was to determine the awareness and attitudes toward corneal donation among applicants and staff of DVLA, Kumasi-Ghana.
Methods: A descriptive cross-sectional study was conducted. 100 participants were selected using convenient sampling method. A structured questionnaire was used to elicit responses from participants concerning awareness and attitudes toward corneal transplant.
Results: The mean ± SD age of the participants was 32.05 ± 11.48years and age range, 18-67years. Males were 66% whilst females constituted 34%. 32.7% of the participants were aware of corneal donation. Majority of the participants were Christians (83.1%) and Singles (63%). Television was the source of information with the highest preponderance (49.4%). 67.3% were willing to donate their corneas after death. 63.9% were willing to indicate their donor statuses on drivers’ license form which had a significant association with willingness to donate cornea after death (p<0.05, ᵪ2= 12.187).
Conclusion: There is a poor level of awareness (32.7%) of transplant and donation amongst the study population but a good level of willingness to donate organs (67%). Consent via driving license would seem to be a good potential mode of obtaining consent to supplement the harvesting of adequate tissues for transplant if adequate awareness is created.
Impact of the Umoyo mother-infant pair model on HIV-positive mothers’ social support, perceived stigma and 12-month retention of their HIV-exposed infants in PMTCT Care: Evidence from a cluster randomised control trial in Zambia
Authors: Phiri Sydney Chauwa , Mudhune Sandra , Prust Margaret L , Haimbe Prudence , Shakwelele Hilda , Chisenga Tina , Mubiana-Mbewe Mwangelwa , Mzumara Maureen , McCarthy Elizabeth , Prescott Marta R
Published: July 2019

Background

Public health systems in resource-constrained settings have a critical role to play in the elimination of HIV transmission but are often financially constrained. This study is an evaluation of a mother-infant-pair model called “Umoyo”, which was designed to be low cost and scalable in a public health system. Facilities with the Umoyo model dedicate a clinic day to provide services to only HIV-exposed-infants (HEIs) and their mothers. Such models are in operation with reported success in Zambia but have not been rigorously tested. This work establishes whether the Umoyo model would improve 12-month retention of HEIs.
Methods
A cluster randomized trial including 28 facilities was conducted across two provinces of Zambia to investigate the impact on 12-month retention of HEIs in care. These facilities were offering prevention of mother to child transmission (PMTCT) services and supported by the same implementing partner. Randomization was achieved by use of the covariate constrained optimization technique. Secondary outcomes included the impact of Umoyo clinics on social support and perceived HIV stigma among mothers. For each of the outcomes, a difference-in-difference analysis was conducted at the facility level using the unweighted t-test.
Results
From 13 control (12-month retention at endline: 45%) and 11 intervention facilities (12-month retention at endline: 33%), it was found that Umoyo clinics had no impact on 12-month retention of HEIs in the t-test (-11%; 99% CI: -40.1%, 17.2%). Regarding social support and stigma, the un-weighted t-test showed no impact though sensitivity tests showed that Umoyo had an impact on increasing social support (0.31; 99% CI: 0.08, 0.54) and reducing perceived stigma from health care workers (-0.27: 99% CI: -0.46, -0.08).
Conclusion
The Umoyo approach of having a dedicated clinic day for HEIs and their mothers did not improve retention of HEIs though there are indications that it can increase social support among mothers and reduce stigma. Without further support to the underlying health system, based on the evidence generated through this evaluation, the Umoyo clinic day approach on its own is not considered an effective intervention to increase retention of HIV-exposed infants.
Intravenous thrombolytic therapy for acute ischemic stroke in Hubei, China: a survey of thrombolysis rate and barriers
Authors: Zhou Yanfeng , Yan Shijiao , Song Xingyue , Gong Yanhong , Li Wenzhen , Wang Mengdie , Yin Xiaoxv , Hu Bo , Lu Zuxun
Published: July 2019

Background

Rates of thrombolysis in most countries are well below best practice benchmarks. We aimed to investigate thrombolysis utilization and its associated factors in acute ischemic stroke (AIS) patients in Hubei province, China, to assess neurologists’ experiences of the treatment, and to identify barriers against the treatment from perspective of AIS patients and neurologists.

Methods

Survey of 2096 AIS patients and 709 neurologists from 66 hospitals was conducted in Hubei province between 2014 and 2015. A multivariable logistic regression model was utilized to identify the factors associated with thrombolysis utilization and neurologists’ experiences with thrombolysis.

Results

Of the 2096 AIS patients, only 3.8% received thrombolysis. Of the 709 neurologists, 66.0% reported using thrombolysis for AIS patients. The main reasons for not using thrombolysis were late arrival of patients, fear of the risk of complications of thrombolysis, and light or quickly recovered stroke symptoms. The behavior and clinical characteristics of patients, including early admission to hospital (odds ratio [OR]=5.81, 95% confidence intervals [CI] 3.31-10.20), using emergency medical services to be hospitalized (OR=3.36, 95% CI 2.00-5.62), stroke history (OR=0.53, 95% CI 0.28-0.99), and National Institute of Health Stroke Scale score < 4 (OR=0.46, 95% CI 0.27-0.77) were shown to significantly affect the thrombolysis utilization in the multivariate model. In addition, hospital grade (OR=2.84, 95% CI 1.84-4.37), education level (OR=2.49, 95% CI 1.09-5.73), and working years (OR=1.88, 95% CI 1.18-3.00) were strongly associated with neurologists’ experiences of thrombolysis.

Conclusions

A very low proportion of AIS patients received thrombolysis in Hubei province, China. Considerable education programs and interventions were required regarding knowledge of stroke treatment for clinicians and proper behavior after stroke for AIS patients and their families.