bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial differences in the dermatological manifestations of tuberous sclerosis complex and the potential effects on diagnosis and care
Authors: Pounders Ashley J. , Rushing Gabrielle V. , Mahida Sonal , Nonyane Bareng Aletta Sanny , Thomas Emily A. , Tameez Rabiah Sundus , Gipson Tanjala T.
Published: December 2022

Background:

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder of non-malignant tumor growths throughout major organ systems and neurological, neuropsychiatric, renal, and pulmonary co-morbidities. Skin manifestations are readily visible, often develop early in life, and are major features that contribute to TSC diagnosis. Medical photographs of such manifestations are commonly shown as examples from White individuals creating a potential barrier to accurately identifying these features in darker skinned individuals.

Objectives:

The aim of this report is to raise awareness of dermatological manifestations associated with TSC, compare their appearance by race, and consider how recognition of these features could impact diagnosis and treatment of TSC.

Design and Methods:

We conducted a retrospective chart review at the TSC Center of Excellence (TSCOE) at the Kennedy Krieger Institute, which included all patients in the center from 2009 (inception) through the end of the calendar year 2015 and analyzed data from the TSC Alliance Natural History Database (NHD).

Results:

Among TSCOE patients, 50% of Black patients were diagnosed before the age of 1 year, compared with 70% of White patients. NHD data corroborated this trend showing a significant difference with only 38% of Blacks as compared with 50% of Whites were diagnosed at age ⩽1 year. A significant difference was observed where White participants had higher odds of having received genetic testing in both data sets. While no differences in the total number of TSC features was observed in either data set, shagreen patches and cephalic fibrous plaques were more frequently recorded in the NHD for Black individuals.

Conclusion:

We highlight a disparity in the representation of Black participants within the NHD, TSCOE, and TSC trials, in addition to differences in utilization of molecular testing and topical mechanistic target of rapamycin (mTOR) inhibitor therapy between Black and White individuals. We show a trend toward later diagnosis age in Black individuals. These differences between races warrant further study across additional clinical sites and other minority groups.
Evolution of beliefs in social networks
Authors: Paranamana Pushpi , Wang Pei , Shafto Patrick
Published: December 2022

Evolution of beliefs of a society are a product of interactions between people (horizontal transmission) in the society over generations (vertical transmission). Researchers have studied both horizontal and vertical transmission separately. Extending prior work, we propose a new theoretical framework which allows application of tools from Markov chain theory to the analysis of belief evolution via horizontal and vertical transmission. We analyze three cases: static network, randomly changing network, and homophily-based dynamic network. Whereas the former two assume network structure is independent of beliefs, the latter assumes that people tend to communicate with those who have similar beliefs. We prove under general conditions that both static and randomly changing networks converge to a single set of beliefs among all individuals along with the rate of convergence. We prove that homophily-based network structures do not in general converge to a single set of beliefs shared by all and prove lower bounds on the number of different limiting beliefs as a function of initial beliefs. We conclude by discussing implications for prior theories and directions for future work.
The Risk of Barrett’s Esophagus Transforming to Esophageal Cancer
Authors: Samo Salih , Bansal Ajay
Published: December 2022

Barrett’s esophagus (BE) refers to the mucosal transition from normal squamous mucosa to a genetically unstable specialized columnar-type intestinal metaplasia in the esophagus. Recent sophisticated studies using orthogonal techniques of molecular and computational biology strongly support that BE is the predominant pathway to esophageal adenocarcinoma (EAC). In this treatise, we review the risk of BE transforming to EAC and the latest developments in risk assessment of BE progression to EAC. The progression rate of BE to EAC can vary from one study to another depending on the region of origin, definition of BE, and variations in data capture. Overall, the published studies suggest that the risk of BE transforming to EAC is less than 0.5% per year and that to high-grade dysplasia (HGD) or EAC is less than 1% per year. Clinical tools to predict risk such as the Progression in Barrett’s (PIB) have been developed but will need further validation. p53 is the biomarker for risk stratification and has stood the test of time but is still not being widely used due to incomplete correlation between the mutational status and protein expression. Molecular studies using genomics and proteomics approaches are being evaluated but need to demonstrate good clinical accuracy before being translated into practice.
Is There a Role for Pneumatic Dilation in Primary Treatment of Achalasia? Pro: PD Should Always the First Choice for Achalasia Treatment.
Authors: Arjonilla Marta , Guillaume Alexandra
Published: December 2022

Pneumatic dilatation (PD) should always be the first choice for achalasia treatment. In the following section, we will compare PD to other common achalasia procedures: intersphincteric botox injections (BTX), laparoscopic heller myotomy (LHM), and peroral endoscopic myotomy (POEM). We will focus on the limitation of studies leaning toward those procedures, and how PD data has proven good efficacy and safety. Will also discuss how in certain populations PD should always be the first choice.
Audit of a computerized version of the Manchester triage system and a SIRS-based system for the detection of sepsis at triage in the emergency department
Authors: Dewitte Ken , Scheurwegs Elyne , Van Ierssel Sabrina , Jansens Hilde , Dams Karolien , Roelant Ella
Published: December 2022

Background and importance

Different triage systems can be used to screen for sepsis and are often incorporated into local electronic health records. Often the design and interface of these digitalizations are not audited, possibly leading to deleterious effects on screening test performance.

Objective

To audit a digital version of the MTS for detection of sepsis during triage in the ED.

Design

A single-center retrospective study

Settings and participants

Patients (n=29766) presenting to an ED of a tertiary-care center who received formal triage were included.

Outcome measures and analysis

Calculated performance measures included sensitivity, specificity, likelihood ratios, and AUC for the detection of sepsis. Errors in the application of the specific sepsis discriminator of the MTS were recorded.

Main results

A total of 189 (0.7%) subjects met the Sepsis-3 criteria, with 47 cases meeting the criteria for septic shock. The MTS had a low sensitivity of 47.6% (95% CI 40.3 to 55.0) for allocating sepsis patients to the correct triage category. However, specificity was high at 99.4% (95% CI 99.3 to 99.5).
Assisted clustering of gene expression data using regulatory data from partially overlapping sets of individuals
Authors: Jiang Wenqing , Joehanes Roby , Levy Daniel , O’Connor George T , Dupuis Josée
Published: December 2022

Background

As omics measurements profiled on different molecular layers are interconnected, integrative approaches that incorporate the regulatory effect from multi-level omics data are needed. When the multi-level omics data are from the same individuals, gene expression (GE) clusters can be identified using information from regulators like genetic variants and DNA methylation. When the multi-level omics data are from different individuals, the choice of integration approaches is limited.

Methods

We developed an approach to improve GE clustering from microarray data by integrating regulatory data from different but partially overlapping sets of individuals. We achieve this through (1) decomposing gene expression into the regulated component and the other component that is not regulated by measured factors, (2) optimizing the clustering goodness-of-fit objective function. We do not require the availability of different omics measurements on all individuals. A certain amount of individual overlap between GE data and the regulatory data is adequate for modeling the regulation, thus improving GE clustering.

Results

A simulation study shows that the performance of the proposed approach depends on the strength of the GE-regulator relationship, degree of missingness, data dimensionality, sample size, and the number of clusters. Across the various simulation settings, the proposed method shows competitive performance in terms of accuracy compared to the alternative K-means clustering method, especially when the clustering structure is due mostly to the regulated component, rather than the unregulated component. We further validate the approach with an application to 8,902 Framingham Heart Study participants with data on up to 17,873 genes and regulation information of DNA methylation and genotype from different but partially overlapping sets of participants. We identify clustering structures of genes associated with pulmonary function while incorporating the predicted regulation effect from the measured regulators. We further investigate the over-representation of these GE clusters in pathways of other diseases that may be related to lung function and respiratory health.

Conclusion

We propose a novel approach for clustering GE with the assistance of regulatory data that allowed for different but partially overlapping sets of individuals to be included in different omics data.
Pathogen exposure influences immune parameters around weaning in pigs reared in commercial farms
Authors: Hervé Julie , Haurogné Karine , Buchet Arnaud , Bacou Elodie , Mignot Grégoire , Allard Marie , Leblanc-Maridor Mily , Gavaud Solenn , Lehébel Anne , Terenina Elena , Mormède Pierre , Merlot Elodie , Belloc Catherine , Bach Jean-Marie , Lieubeau Blandine
Published: December 2022

Background

Multiple antigenic stimulations are crucial to immune system training during early post-natal life. These stimulations can be either due to commensals, which accounts for the acquisition and maintenance of tolerance, or to pathogens, which triggers immunity. In pig, only few works previously explored the influence of natural exposition to pathogens upon immune competence. We propose herein the results of a multicentric, field study, conducted on 265 piglets exposed to contrasted pathogen levels in their living environment. Piglets were housed in 15 different commercial farms, sorted in two groups, low (HSLOW)- and high (HSHIGH)-health status farms, depending on their recurrent exposition to five common swine pathogens.

Results

Using animal-based measures, we compared the immune competence and growth performances of HSLOW and HSHIGH pigs around weaning. As expected, we observed a rise in the number of circulating leucocytes with age, which affected different cell populations. Monocyte, antigen-experienced and cytotoxic lymphocyte subpopulation counts were higher in piglets reared in HSLOW farms as compared to their HSHIGH homologs. Also, the age-dependent evolution in γδ T cell and neutrophil counts was significantly affected by the health status. With age, circulating IFNα level decreased and IgM level increased while being greater in HSLOW piglets at any time. After weaning, LPS-stimulated blood cells derived from HSLOW piglets were more prone to secrete IL-8 than those derived from HSHIGH pigs did. Monocytes and granulocytes issued from HSLOW pigs also exhibited comparable phagocytosis capacity. Altogether our data emphasize the more robust immunophenotype of HSLOW piglets. Finally, piglets raised under higher pathogen pressure grew less than HSHIGH piglets did and exhibited a different metabolic profile. The higher cost of the immune responses associated with the low farm health status may account for lower HSLOW piglet performances.

Conclusions

Altogether, our data, obtained in field conditions, provide evidence that early exposure to pathogens shapes the immune competence of piglets. They also document the negative impact of an overstimulation of the immune system on piglets’ growth.
Correspondence: is there an association between centre volume and survival or neurological outcomes among out-of-hospital cardiac arrest patients?
Authors: Goh Amelia Xin Chun , Ho Andrew Fu Wah
Published: December 2022

This commentary discusses the findings of a study by Tsuchida et al. on the effect of annual hospital admissions of out-of-hospital cardiac arrest patients on survival and neurological outcomes in OHCA patients in the context of existing literature on the topic, and the implications on future studies investigating the volume-outcome relationship in cardiac arrest.
Characterizing the use of virtual care in primary care settings during the COVID-19 pandemic: a retrospective cohort study
Authors: Singer Alexander , Kosowan Leanne , LaBine Lisa , Shenoda Daniel , Katz Alan , Abrams Elissa M , Halas Gayle , Wong Sabrina T. , Talpade Siddhesh , Kirby Sarah , Baldwin Alanna , Francois Jose
Published: December 2022

Background

In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic. 

Methods

Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescriptions) and provider (sex, age, clinic location, provider type, remuneration, country of graduation, return visit rate) characteristics describe the study population by visit type. Generalized estimating equation models describe factors associated with virtual care. 

Results

There were 146,372 visits provided by 154 primary care providers between 03/14/20 and 06/30/20, of which 33.6% were virtual care. Female patients (OR 1.16, CI 1.09–1.22), patients with ≥ 3 comorbidities (OR 1.71, CI 1.44–2.02), and patients with ≥ 10 prescriptions (OR 2.71, 2.2–1.53) had higher odds of receiving at least one virtual care visit compared to male patients, patients with no comorbidities and patients with no prescriptions. There was no significant difference between the number of follow-up visits that were provided as a clinic visit compared to a virtual care visit (8.7% vs. 5.8%) (p = 0.6496).

Conclusion

Early in the pandemic restrictions, approximately one-third of visits were virtual. Virtual care was utilized by patients with more comorbidities and prescriptions, suggesting that patients with chronic disease requiring ongoing care utilized virtual care. Virtual care as a primary care visit type continues to evolve. Ongoing provision of virtual care can enhance quality, patient-centered care moving forward.
Pneumococcal concentration and serotype distribution in preschool children with radiologically confirmed pneumonia compared to healthy controls prior to introduction of pneumococcal vaccination in Zanzibar: an observational study
Authors: Elfving Kristina , Strömberg Lucia Gonzales , Geravandi Shadi , Andersson Maria , Bachelard Marc , Msellem Mwinyi , Shakely Delér , Trollfors Birger , Nordén Rickard , Mårtensson Andreas , Björkman Anders , Lindh Magnus
Published: December 2022

Background

The World Health Organization recommends pneumococcal vaccination (PCV) in the first year of life. We investigated pneumococcal serotypes in children with clinical or radiologically confirmed pneumonia and healthy controls prior to PCV13 vaccine introduction in Zanzibar.

Methods

Children (n = 677) with non-severe acute febrile illness aged 2–59 months presenting to a health centre in Zanzibar, Tanzania April–July 2011 were included. Nasopharyngeal swabs collected at enrolment were analysed by real-time PCR to detect and quantify pneumococcal serotypes in patients (n = 648) and in healthy asymptomatic community controls (n = 161). Children with clinical signs of pneumonia according to the Integrated Management of Childhood illness guidelines (“IMCI pneumonia”) were subjected to a chest-X-ray. Consolidation on chest X-ray was considered “radiological pneumonia”.

Results

Pneumococcal DNA was detected in the nasopharynx of 562/809 (69%) children (70% in patients and 64% in healthy controls), with no significant difference in proportions between patients with or without presence of fever, malnutrition, IMCI pneumonia or radiological pneumonia. The mean pneumococcal concentration was similar in children with and without radiological pneumonia (Ct value 26.3 versus 27.0, respectively, p = 0.3115). At least one serotype could be determined in 423 (75%) participants positive for pneumococci of which 33% had multiple serotypes detected. A total of 23 different serotypes were identified. One serotype (19F) was more common in children with fever (86/648, 13%) than in healthy controls (12/161, 7%), (p = 0.043). Logistic regression adjusting for age and gender showed that serotype 9A/V [aOR = 10.9 (CI 2.0–60.0, p = 0.006)] and 14 [aOR = 3.9 (CI 1.4–11.0, p = 0.012)] were associated with radiological pneumonia. The serotypes included in the PCV13 vaccine were found in 376 (89%) of the 423 serotype positive participants.

Conclusion

The PCV13 vaccine introduced in 2012 targets a great majority of the identified serotypes. Infections with multiple serotypes are common. PCR-determined concentrations of pneumococci in nasopharynx were not associated with radiologically confirmed pneumonia.

Trial registration Clinicaltrials.gov (NCT01094431).
Using time-dependent reproduction number to predict turning points of COVID-19 outbreak in Dalian, Liaoning province, China
Authors: An Qingyu , Wu Jun , Bai Jin jian , Li Xiaofeng
Published: December 2022

Objectives

To forecast the development trend of current outbreak in Dalian, mainly to predict turning points of COVID-19 outbreak in Dalian, Liaoning province, China, the results can be used to provide a scientific reference for timely adjustment of prevention and control strategies.

Methods

During the outbreak, Bayesian framework was used to calculated the time-dependent reproduction number ($${R_{t}}$$

R
t

), and then above acquired $${R_{t}}$$

R
t

and exponential trend equation were used to establish the prediction model, through the model, predict the $${R_{t}}$$

R
t

value of following data and know when $${R_{t}}$$

R
t

smaller than 1.

Results

From July 22 to August 5, 2020, and from March 14 to April 2, 2022, 92 and 632 confirmed cases and asymptomatic infected cases of COVID-19 were reported (324 males and 400 females) in Dalian. The R square for exponential trend equation were 0.982 and 0.980, respectively which fit the $${R_{t}}$$

R
t

with illness onset between July 19 to July 28, 2020 and between March 5 to March 17, 2022. According to the result of prediction, under the current strength of prevention and control, the $${R_{t}}$$

R
t

of COVID-19 will drop below 1 till August 2, 2020 and March 26, 2022, respectively in Dalian, one day earlier or later than the actual date. That is, the turning point of the COVID-19 outbreak in Dalian, Liaoning province, China will occur on August 2, 2020 and March 26, 2022.

Conclusions

Using time-dependent reproduction number values to predict turning points of COVID-19 outbreak in Dalian, Liaoning province, China was effective and reliable on the whole, and the results can be used to establish a sensitive early warning mechanism to guide the timely adjustment of COVID-19 prevention and control strategies.
Comparison of in-person vs. telebehavioral health outcomes from rural populations across America
Authors: McCord Carly , Ullrich Fred , Merchant Kimberly A. S. , Bhagianadh Divya , Carter Knute D. , Nelson EveLynn , Marcin James P. , Law Kari Beth , Neufeld Jonathan , Giovanetti Annaleis , Ward Marcia M.
Published: December 2022

Background

This study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementation program, the aims of this study were to evaluate outcomes in patient symptoms of depression and anxiety across the programs’ 17 grantees and 95 associated sites, with each grantee having data from telehealth patients and from an in-person comparison group.

Methods

The research design is a prospective multi-site observational study. Each grantee provided data on a nonrandomized convenience sample of telehealth patients and an in-person comparison group from sites with similar rural characteristics and during the same time period. Patient characteristics were collected at treatment initiation, and clinical outcome measures were collected at baseline and monthly. The validated clinical outcome measure instruments included the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety-related symptoms. Linear mixed models, with grantee as the random effect, were used to determine the association of behavioral health delivery (telehealth versus in-person) on the one-month change in PHQ-9 and GAD-7 while adjusting for covariates.

Results

Across a total of 1,514 patients, one-month change scores were improved indicating that PHQ-9 and GAD-7 scores decreased from baseline to the one-month follow-up at similar rates in both the in-person and telehealth groups. Reduction in scores averaged 2.8 for the telehealth treatment group and 2.9 for the in-person treatment group in the PHQ-9 subsample and 2.0 for the telehealth treatment group and 2.4 for the in-person treatment group in the GAD-7 subsample. There was no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores for either PHQ-9 or GAD-7. Individuals with higher baseline scores demonstrated the greatest decrease in scores for both measures. Upon adjusting for baseline scores and grantee program, patient demographics were not found to be significantly associated with change in anxiety or depression symptoms.

Conclusion

In our very large pragmatic study comparing behavioral health treatment delivered to a population of patients in rural, underserved communities, we found no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person.
Epidémiology of malaria from 2019 to 2021 in the southeastern city of Franceville, Gabon
Authors: Lendongo-Wombo Judicael-Boris , Oyegue-Liabagui Sandrine-Lydie , Biteghe-Bi-Essone Jean-Claude , Ngoungou Edgard Brice , Lekana-Douki Jean-Bernard
Published: December 2022

Background

In Gabon, a new national malaria control policy was implemented in 2003. It resulted in a decrease in the number of malaria cases in the country. In March 2020, the disruption of routine health services due to the COVID-19 pandemic has led to an increase in cases and deaths due to malaria. However, in Franceville, south-east Gabon, no data on malaria cases recorded before, during and after the COVID-19 epidemic has been published. Thus, the objective of this study was to determine the epidemiological characteristics of malaria in Franceville from 2019 to 2021.

Methods

A retrospectively study of malaria cases was performed at the Hôpital de l’Amitié Sino-Gabonaise (HASG). Information regarding age, gender, malaria diagnosis by microscopy and hematology cell count were collected from laboratory registers from June 2019 to December 2021. Malaria data were analyzed and correlated with seasonal variations.

Results

The data of 12,695 febrile patients were collected from the laboratory registers of the HASG, among which 4252 (33.5%) patients were found positive for malaria. The malaria prevalence was 37.5% in 2020 year. This prevalence was highest compared to the 2019 (29.6%) and 2021 (31.5%) year (p < 0.001). During the short rainy season (October to December), a large increase in malaria cases was observed all three year, from 2019 to 2021 (p > 0.05).

Conclusion

The prevalence of malaria in Franceville was very high during COVID-19 pandemic. It is therefore necessary to strengthen existing interventions and implement more effective interventions.
Prospective evaluation of hematological parameters in preoperative renal cell cancer patients
Authors: Demir Ozden , Demirag Guzin , Aslan Gokhan
Published: December 2022

Background

Of all the genitourinary cancers, renal cell carcinoma (RCC) is still the most common malignancy with high mortality rates. There are still insufficient biomarkers to predict disease prognosis. Systemic inflammation markers play an important role in tumor development and growth. There are studies which show the relationship of fibrinogen and albumin individually with cancer prognosis in many cancers. Fibrinogen/albumin ratio(FAR), on the other hand, has prognostic importance like other inflammation indicators in cancer. Therefore, we investigated whether FAR had a potential value in evaluating the prognosis of patients with nonmetastatic kidney cancer or not.

Methods

A total of 72 patients who had nephrectomy operation at 19 Mayıs University, Faculty of Medicine between January 2019 and January 2021 and who did not have distant metastasis were included in the study. FAR was calculated from the blood taken from the patients before the nephrectomy operation. The cut-off value was found for this FAR by receiver operating characteristic(ROC) curve analysis. The patients were divided into 2 groups as high- and low-FAR according to this cut-off value. Kaplan Meier test was used to evaluate the predictive value of clinicopathological parameters for overall survival (OS). The Log-rank test was used to determine whether there was a relationship between the preoperative FAR and the clinico-pathological data of the patients.

Results

The best cutoff value for the FAR was 0.114. A FAR > 0.114 was associated with higher Fuhrman Grade (FG) (P < 0.0001) and later pathological T stage (P < 0.0001). Patients with a high FAR (> 0.114) had worse OS [Std. Error 2.932, 95% confidence interval (CI): 73.659–85.154, P < 0.0001]. In addition, a positive significant correlation was found between high grade and platelet lymphocyte ratio (p < 0,020). Furthermore, a significant correlation was found between the pathology t stage of the patients and the platelet lymphocyte ratio (p: 0.020).

Conclusions

The preoperative FAR is an independent prognostic factor of OS in renal cancer patients. A FAR > 0.114 was significantly related to decreased survival in renal cancer patients. In addition, the platelet-lymphocyte ratio seems to be related to OS, as well as FAR. Further studies are required on this subject.
Robot-assisted partial nephrectomy: Can retroperitoneal approach suit for renal tumors of all locations?—A large retrospective cohort study
Authors: Lyu Xiangjun , Jia Zhuo , Ao Liyan , Ren Changhao , Wu Yangyang , Xu Yunlai , Chen Ke , Gao Yu , Wang Baojun , Ma Xin , Zhang Xu
Published: December 2022

Background

This study aimed to explore the appropriate location of renal tumors for retroperitoneal approach.

Materials and Methods

We retrospectively analyzed 1040 patients with renal tumor who were treated at our institution from Janurary 2015 to June 2020 and had underwent retroperitoneal robotic assisted-laparoscopic partial nephrectomy (rRAPN). Clinical features and postoperative outcomes were evaluated.

Results

Patients with incomplete data were excluded, and we included 896 patients in total. The median tumor size was 3.0 (range: 0.8–10.0) cm. The median RENAL Nephrometry Score was 7 (range: 4–11), and the median PADUA Nephrometry Score was 8 (range: 6–14). The median surgical time was 120 min, and the median warm ischemia time was 18 min. The median estimated blood loss was 50 ml. The follow-up time was 20.2 (range: 12–69) months. The mean change of eGFR 1 year after operation was 14.6% ± 19.0% compared with preoperative estimated glomerular filtration rate (eGFR). When compared the tumor at different locations, as superior or inferior pole, anterior of posterior face of kidney, there were no significant differences of intra- and post-operative outcomes such as surgical time, warm ischemia time, estimated blood loss, removal time of drainage tube and catheter, postoperative feeding time and hospital stay, and changes of eGFR one year after surgery. We also compared tumors at special locations as endophytic or exophytic, anterior of posterior hilus of kidney, there were no significant differences in surgical time, warm ischemia time, estimated blood loss and changes of eGFR. There was no significant difference in intraoperative features and postoperative outcomes when tumor larger than 4 cm was located at different positions of kidney. Though the surgical time was longer when BMI ≥ 28 (132.6 min vs. 122.5 min, p = 0.004), no significant differences were observed in warm ischemia time, estimated blood loss, changes in eGFR. Twenty-seven patients (3.0%) had tumor progression, including 8 (0.9%) recurrence, 19 (2.1%) metastasis, and 9 (1.0%) death.

Conclusion

Retroperitoneal approach for RAPN has confirmed acceptable intra- and postoperative outcomes and suits for renal tumors of all different locations. Large tumor size and obesity are not contraindications for rRAPN.
Survival analysis of pulpectomy in primary molars performed under dental general anaesthesia: a two-year retrospective study
Authors: Xie Yongting , Wang Yan , Ma Qizhao , Li Jing , Chen Yandi , Yang Ran , Huang Ruijie , Zhang Qiong , Zou Jing
Published: December 2022

Background

To retrospectively investigate the success rate of primary-molar pulpectomy performed under general anaesthesia and the potential risk factors that affect the 24-month success rate.

Methods

The case data and two-year follow-up records of children (aged 3–6 years) who received pulpectomy in primary molars performed under general anaesthesia were reviewed and assessed. Potential risk factors included age, gender, decayed-missing-filled teeth, endodontic diagnosis, tooth location, and postobturation sealing of the pulp chamber floor with MTA. With a two-year follow-up period, the outcomes of all the primary molars were classified into success and failure. Survival analysis was used to assess the outcomes. The Kaplan–Meier method was used to analyse the success rate. Univariate and multivariate Cox proportional hazards regression models were used to evaluate the potential risk factors associated with the overall survival of primary molars.

Results

A total of 410 teeth from 163 children (88 boys and 75 girls) were included in this study. The overall two-year success rate was 66.1% for all primary molars. The mean overall survival time for this study was 22.1 (95% CI, 21.73‒22.48) months. Multivariate Cox regression analysis demonstrated that endodontic diagnosis (irreversible pulpitis or periapical periodontitis), tooth location (maxillary or mandibular primary molar), and postobturation sealing of the pulp chamber floor (MTA or no-MTA) were significant risk factors for overall survival in this study (P < .05). The differences in success rates were not statistically significant in terms of age, gender, and decayed-missing-filled teeth (P > .05).

Conclusions

When compared to teeth diagnosed with irreversible pulpitis, those with periapical periodontitis failed more frequently. Postobturation sealing of the pulp chamber floor with MTA improved the success rate of pulpectomy in primary molars, especially when the inflammation did not spread to the periradicular area.
Health visiting teams and children’s oral health: a scoping review
Authors: El-Yousfi Sarab , Marshman Zoe , Albers Patricia N. , Watt Samantha , Kipping Ruth , Williams Joanna G.
Published: December 2022

Background

Recent policies have recommended early-life interventions to prevent caries. The four nations of the UK each have a national universal children’s health programme, through which health visitors and their wider team (HVTs) promote health in the early years. HVT visits offer an opportunity to support parents to improve their child’s oral health. A scoping review was conducted to provide a descriptive synthesis of the current literature related to the role of HVTs in improving the oral health of children 0–5 years old and to identify significant gaps for future research. This review informed the feasibility study of the First Dental Steps Intervention, a targeted health visitor-led infant oral health intervention in England.

Methods

Electronic database searches for peer-reviewed literature were performed using Medline via Ovid and Web of Science (1946–2021). The quality of included intervention studies was assessed using the Effective Public Health Practice Project tool. Additionally, a grey literature search was conducted (key organisations, bibliographic and thesis databases, forwards and backwards citation, Google).

Results

Thirty-nine publications, published between 1980 and 2021, were included. The majority of included papers were from the UK. The quality of intervention studies (n = 7) ranged from weak to strong. Thematic analysis identified the following themes: (1) professional knowledge, education, and training; (2) involvement of HVs in the delivery of oral health interventions; (3) effectiveness of interventions; (4) perspectives of HVs providing oral health advice and acceptability; and (5) barriers and facilitators to promoting oral health. The grey literature search identified 125 sources. HVT involvement was reported in a variety of source types: reports, guidance documents, evaluations, reviews, and training resources. HVTs were involved in oral health by providing oral health packs, brushing and oral health advice, registration and attendance, oral health training, risk assessment, and referral to dental services.

Conclusion

The current literature suggests that HVTs are well placed to improve children’s oral health. Facilitators and barriers are encountered by HVTs in promoting oral health which should be considered by commissioners. There is a need for future high-quality studies that address the inadequacies found and provide further evidence of the effectiveness of HVT’s oral health interventions.
Assessment of early wound healing, pain intensity, quality of life and related influencing factors during periodontal surgery: a cross-sectional study
Authors: Yuan Hongmei , Liu Qian , Tang Tian , Qin Huan , Zhao Lei , Chen Wen , Guo Shujuan
Published: December 2022

Background

This cross-sectional study assessed early wound healing, pain intensity, quality of life, surgical satisfaction, and related factors during periodontal surgery.

Methods

A total of 369 patients completed the questionnaire before undergoing periodontal surgery (baseline), immediately after the operation (phase I), on the day of suture removal (phase II), and one month later (phase III). The Early Wound Healing Score (EHS) was assessed, and the short-form McGill Pain Questionnaire (SF-MPQ), tooth hypersensitivity visual analog scale (VAS), oral health-related quality of life measure (OHQoL-UK), and surgical satisfaction VAS were administered and analysed.

Results

The EHS was 8.41 ± 2.74 and was influenced by disease severity and surgical factors. Scores on the SF-MPQ, pain intensity scores, and OHQoL-UK scores were significantly increased in phase I and decreased later. Tooth sensitivity decreased significantly one month after periodontal surgery. Psychological factors were positively related to SF-MPQ, pain intensity, OHQoL-UK and tooth sensitivity VAS scores in all phases, while disease severity and surgical factors were only related to these scores at baseline or in phases I/II/III. Surgical acceptance and reoperation willingness continuously decreased after surgery, and all these scores were related to surgical satisfaction.

Conclusions

EHS, pain intensity and quality of life were closely related to disease severity, psychological factors and surgical factors in phase I (i.e., immediately after surgery). The findings suggest that surgical details should be enhanced and that behavioural and psychological interventions measures should be implemented to improve outcomes during periodontal operation and during the early postoperative period as well as to improve patient-oriented periodontal surgery experiences.

Trialregistration This cross-sectional study did not include interventions with human participants, and all the experimental procedures involving humans in this study were approved by the Ethics Committee of West China College of Stomatology, Sichuan University (WCHSIRB-D-2020–284).
Validation of response processes in medical assessment using an explanatory item response model
Authors: Vattanavanit Veerapong , Ngudgratoke Sungworn , Khaninphasut Purimpratch
Published: December 2022

Background

Response process validation is a crucial source of test validity. The expected cognitive load scale was created based on the reflection of the mental effort by which borderline students solve an item defined by experts. The stem length affects the students’ extraneous cognitive load. The purposes of this study were to develop an exam for medical students and corroborate the response process validity by analyzing the correlation between the expected cognitive load, stem length, and the difficulty.

Methods

This was a correlational study. Five medical teachers as the experts and 183 third-year medical students were enrolled from the Faculty of Medicine, Prince of Songkla University, Thailand. The instruments used were a medical physiology exam and a three-level expected cognitive load evaluation form judged by medical teachers. Data were analyzed using an explanatory item response model.

Results

The test consists of 20 items and 21 possible scores. The median score was 8, with a quartile deviation of 1.5. Nine items had long stems (more than two lines). Sixteen items were judged as high (level 2 or 3) expected cognitive load. When adding the expected cognitive load in a Rasch model, the expected cognitive load significantly correlated with item difficulty. In the Rasch model that included both the expected cognitive load and stem length, a long stem had a greater effect on item difficulty than low expected cognitive load. However, the Rasch model showed the best fit.

Conclusions

The long stem had a stronger correlation with test difficulty than expected cognitive load, which indirectly implied response process validity. We suggest incorporating stem length and expected cognitive load to create an appropriate distribution of the difficulty of the entire test.
Geographical variation in compulsory hospitalisation – ethical challenges
Authors: Hofstad Tore , Husum Tonje Lossius , Rugkåsa Jorun , Hofmann Bjørn Morten
Published: December 2022

Background

Compulsory hospitalisation in mental health care restricts patients’ liberty and is experienced as harmful by many. Such hospitalisations continue to be used due to their assumed benefit, despite limited scientific evidence. Observed geographical variation in compulsory hospitalisation raises concern that rates are higher and lower than necessary in some areas.

Methods/discussion

We present a specific normative ethical analysis of how geographical variation in compulsory hospitalisation challenges four core principles of health care ethics. We then consider the theoretical possibility of a “right”, or appropriate, level of compulsory hospitalisation, as a general norm for assessing the moral divergence, i.e., too little, or too much. Finally, we discuss implications of our analysis and how they can inform the future direction of mental health services.
The COVID-19 pandemic’s impact on mental health care use among Norwegian students in higher education: a nation-wide register-based pre-post cohort study
Authors: Grøsland Mari , Larsen Vilde Bergstad , Reneflot Anne , Hart Rannveig Kaldager
Published: December 2022

Background

The COVID-19 pandemic, and its associated social distancing measures, gave profound changes to the everyday and academic life of students in higher education. The current study is the first to use nation-wide data to evaluate the long-term effect of the pandemic and its countermeasures on university students’ mental health care use.

Methods

Using nation-wide individual-level data, we studied mental health consultations in primary care (data available from January 2017 to February 2022) and dispensed prescription drugs used to treat anxiety, depression, and sleep disturbances (data available from October 2018 to February 2021) for first-year undergraduate university students. We compared changes over time in mental health care use in a pandemic cohort (12,501 first-year students enrolled in 2019) to the same change in a pre-pandemic cohort (25,990 first-year students enrolled in 2017 and 2018). Event study and difference-in-difference models allowed us to separate the impact of the pandemic, experienced by the pandemic cohort only, from secular and seasonal changes experienced by all cohorts.

Results

The percentage of students with a mental health consultation temporarily decreased during the first period of strict social distancing measures in March 2020. At the end of the second round with strict measures in April 2021, the level of mental health consultations increased by 73% (95% CI 40–106.3). There was also a 42% (95% CI 5.7–79.5) increase in mental health consultations in November 2021. No similar increases were observed for dispensed prescription drugs between March 2020 and February 2021.

Conclusions

The COVID-19 pandemic was associated with increases in mental health consultations in primary care among students, especially during/after longer periods of strict social distancing measures. The benefits of social distancing measures in future pandemic preparedness should be weighed against the cost of potentially worsening mental health in vulnerable groups.
Modular structures and the delivery of inpatient care in hospitals: a Network Science perspective on healthcare function and dysfunction
Authors: Ben-Tovim David I. , Bajger Mariusz , Bui Viet Duong , Qin Shaowen , Thompson Campbell H.
Published: December 2022

Background

Reinforced by the COVID-19 pandemic, the capacity of health systems to cope with increasing healthcare demands has been an abiding concern of both governments and the public. Health systems are made up from non-identical human and physical components interacting in diverse ways in varying locations. It is challenging to represent the function and dysfunction of such systems in a scientific manner. We describe a Network Science approach to that dilemma.

General hospitals with large emergency caseloads are the resource intensive components of health systems. We propose that the care-delivery services in such entities are modular, and that their structure and function can be usefully analysed by contemporary Network Science. We explore that possibility in a study of Australian hospitals during 2019 and 2020.

Methods

We accessed monthly snapshots of whole of hospital administrative patient level data in two general hospitals during 2019 and 2020. We represented the organisations inpatient services as network graphs and explored their graph structural characteristics using the Louvain algorithm and other methods. We related graph topological features to aspects of observable function and dysfunction in the delivery of care.

Results

We constructed a series of whole of institution bipartite hospital graphs with clinical unit and labelled wards as nodes, and patients treated by units in particular wards as edges. Examples of the graphs are provided. Algorithmic identification of community structures confirmed the modular structure of the graphs. Their functional implications were readily identified by domain experts. Topological graph features could be related to functional and dysfunctional issues such as COVID-19 related service changes and levels of hospital congestion.

Discussion and conclusions

Contemporary Network Science is one of the fastest growing areas of current scientific and technical advance. Network Science confirms the modular nature of healthcare service structures. It holds considerable promise for understanding function and dysfunction in healthcare systems, and for reconceptualising issues such as hospital capacity in new and interesting ways.
Child abuse knowledge and attitudes among dental and oral health therapists in Aotearoa New Zealand: a cross-sectional study
Authors: Han Heuiwon , Lees Amanda B. , Morse Zac , Koziol-McLain Jane
Published: December 2022

Background

Child abuse and neglect are significant social and health issues in New Zealand. As the government provides free oral care to children and adolescents, oral health practitioners are positioned to respond to child protection concerns. However, research on the knowledge and attitudes of oral health practitioners is limited. This study aimed to understand the knowledge and attitudes of New Zealand dental and oral health therapists in detecting and reporting child abuse and neglect.

Methods

In this descriptive exploratory cross-sectional study, we invited registered New Zealand dental and oral health therapists treating children and adolescents to the anonymous online survey.

Results

Among the 92 dental and oral health therapists, 72% agreed that they could recognise the signs and symptoms of child abuse and neglect. Yet, only 48% agreed they were familiar with the reporting process. During their professional careers, 62% had at least 1 suspected case; and only 21% had ever reported their concerns. Fear of false reporting (70%) was the most significant barrier.

Conclusions

Participants understood child abuse and neglect as significant social issues; however, the knowledge and attitudes to respond were limited. Efforts to enhance the knowledge and attitudes will be necessary to promote child safety and wellbeing.