bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends and seasonality in cause-specific mortality among children under 15 years in Guangzhou, China, 2008-2018
Authors: Xu Xiao-Han , Dong Hang , Li Li , Liu Wen-Hui , Lin Guo-Zhen , Ou Chun-Quan
Published: June 2020

Background: This study analyzed the trends and seasonality in mortality among children aged 0-14 years in Guangzhou, China during 2008-2018. Understanding the epidemiology of this public health problem can guide policy development for children mortality prevention.
Methods: A population-based epidemiological retrospective study was conducted. 7,265 individual data of children mortality were obtained from the Guangzhou Center for Disease Control and Prevention. The Poisson regression was used to quantify the annual average reduction rate and the difference in mortality rate between sex and age groups. Incidence ratio with 95% confidence interval (CI) was estimated to determine the temperaol variations in mortality by month, season, school term, day of the week and between holidays and other days.
Results: Between 2008 and 2018, the children mortality rate in Guangzhou decreased from 54.0 to 34.3 per 100,000 children, with an annual reduction rate of 4.6% (95% CI: 1.1%-8.1%), especially the under-5 mortality rate decreased by 8.3% (95% CI: 4.8%-11.6%) per year. Decline trends varied by causes of death, even with an upward trend for the mortality of asphyxia and neurological diseases. The risk of death among males children was 1.33 times (95% CI: 1.20-1.47) of that of females. The distribution of causes of death differed by age group. Maternal and perinatal, congenital and pneumonia were the top three causes of death in infants and cancer accounted for 17% of deaths in children aged 1-14 years. Moreover, the injury-related mortality showed significant temporal variations with higher risk during the weekend. And there was a summer peak for drowning and a winter peak for asphyxia.
Conclusions: Guangzhou has made considerable progress in reducing mortality over the last decade. The findings of characteristics of children mortality would provide important information for the development and implementation of integrated interventions targeted specific age groups and causes of death.
Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by liver abscess
Authors: Wang Yue , Wang Xue , Di Yu
Published: June 2020

Backgrounds: Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess.Methods: Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgeryResults: Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction.Conclusion: Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.
Influence of Participation in a Quality Improvement Collaborative on Staff Perceptions of Organizational Sustainability
Authors: II James H Ford , Gilson Aaron
Published: June 2020

Background: Organizational sustainability capacity (SC) – the ability to implement and maintain change – is influenced by internal attributes, environmental contextual influencers, and intervention attributes. Dissemination and implementation research has generally not explored temporal changes in staff SC perceptions, and how quality improvement collaborative (QIC) participation influences those changes. This project addresses the gap, using the British National Health Services sustainability index, to measure staff SC perceptions at four time points (baseline and every 9 months) for participating clinics in the NIATx200 QIC initiative.Methods: Respondent demographic information allowed matching individual survey responses, so all analyses comprise responses from the same staff members (n=908, representing 2,329 total cases) across the evaluation timeframe. A mixed linear model repeated measures analysis fit three separate statistical models to assess potential predictors of SC perceptions: Time (Models I-III); NIATx200 intervention, staff job function, and tenure (Models II &III); and NIATx200 participation hours (Model III).Results: Model I yielded strong overall predictive significance for Time (F=7.270, p<.0001), with staff perceptions of overall SC increasing throughout most of the study (t1,4=-6.74, p<.0001; t2,4=-3.100, p<.036; t3,4=-0.23, p=ns). Model II did not change the overall Time effect from Model I, but the assigned NIATx200 intervention – combined services, (t=-3.28, p=.026), staff job function and organizational administrators, (t=-3.50, p=.001) became significantly associated with greater perceptions of SC. The addition of participation levels in Model III demonstrated the importance of a higher participation dose (t=-3.73, p<.0001) on staff perceptions about overall SC. Conclusion: Although there was minimal staff exposure to sustainability principals within NIATx200, staff perceptions about their organization’s SC significantly differed over time. However, an organization’s participation level in a QIC became the principal predictor of staff SC perceptions, regardless of other factors. Given these findings, it is possible to develop and introduce specific sustainability content within the structure of a QIC to assess the impact on staff SC perceptions over time and the sustainment of organizational change.Trial Registration: ClinicalTrials.gov, NCT00934141 Registered July 6, 2009. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT00934141
Research methodology and characteristics of journal articles with original data, preprint articles and registered clinical trial protocols about COVID-19
Authors: Fidahic Mahir , Nujic Danijela , Runjic Renata , Civljak Marta , Markotic Filipa , Makaric Zvjezdana Lovric , Puljak Livia
Published: June 2020

Background: The research community reacted rapidly to the emergence of COVID-19. We aimed to assess characteristics of journal articles, preprint articles, and registered trial protocols about COVID-19 and its causal agent SARS-CoV-2. Methods: We analyzed characteristics of journal articles with original data indexed by March 19, 2020, in World Health Organization (WHO) COVID-19 collection, articles published on preprint servers medRxiv and bioRxiv by April 3, 2010. Additionally, we assessed characteristics of clinical trials indexed in the WHO International Clinical Trials Registry Platform (WHO ICTRP) by April 7, 2020. Results: Among the first 2118 articles on COVID-19 published in scholarly journals, 533 (25%) contained original data. The majority was published by authors from China (75%) and funded by Chinese sponsors (75%); a quarter was published in the Chinese language. Among 312 articles that self-reported study design, the most frequent were retrospective studies (N=88; 28%) and case reports (N=86; 28%), analyzing patients’ characteristics (38%). Median Journal Impact Factor of journals where articles were published was 5.099.Among 1088 analyzed preprint articles, the majority came from authors affiliated in China (51%) and were funded by sources in China (46%). Less than half reported study design; the majority were modeling studies (62%), and analyzed transmission/risk/prevalence (43%).Of the 927 analyzed registered trials, the majority were interventional (58%). Half were already recruiting participants. The location for the conduct of the trial in the majority was China (N=522; 63%). The median number of planned participants was 140 (range: 1 to 15,000,000). Registered intervention trials used highly heterogeneous primary outcomes and tested highly heterogeneous interventions; the most frequently studied interventions were hydroxychloroquine (N=39; 7.2%) and chloroquine (N=16; 3%).Conclusions: Early articles on COVID-19 were predominantly retrospective case reports and modeling studies. The diversity of outcomes used in intervention trial protocols indicates the urgent need for defining a core outcome set for COVID-19 research. Chinese scholars had a head start in reporting about the new disease, but publishing articles in Chinese may limit their global reach. Mapping publications with original data can help finding gaps that will help us respond better to the new public health emergency.
Lebanese Doctors Facing the SARS-CoV-2 Pandemic: Practical and Ethical Issues
Authors: Gebara Nicole , Dabar Georges , Eid Roland , Haddad Fady Ghassan , Kourie Hampig Raphael , Kattan Joseph
Published: June 2020

Background

In the light of the COVID-19 pandemic, the role of health care providers is essential to maintain the functioning of the health care system. Physicians accept a primary ethical duty to place the well-being and health of their patients above their own welfares. However, does the duty to patient well-being have any limit? Two ethical concerns are debated: public health’s ethical principles and medical ethics values. We aimed in this study to assess Lebanese physicians’ attitudes, practice and ethical considerations when treating their patients during the COVID-19 pandemic.
Materials and methods

It’s a cross-sectional study conducted in March 2019 among a random sample of Lebanese physicians, using a questionnaire based mainly on a five-point Likert numerical scale to make the answers more reliable and valid. The questionnaire focused on the medical practice during the pandemic and the ethical considerations in public health and in medical practice. It also evaluates the physicians’ point of view toward the management of the pandemic in Lebanon.
Results

A total of 318 physicians responded, with a mean age of 40 years. Five doctors of the total were affected by the COVID-19 infection (1.6%). 51.4% of medical specialists considered themselves to be at a higher risk of contracting the infection, while 52.3% of surgeons stated that they were at a lower risk. Doctors expressed a neutral position regarding the prioritization of patients during treatment and the disconnection of patients with poor prognosis from ventilators to treat other patients. The majority of doctors disagreed regarding the respect of the patient’s autonomy in refusing COVID-19 treatment with a mean score of 1.7/5. Finally, doctors expressed a neutral opinion regarding the ability of the country to manage such a pandemic with a mean score of 3.1/5.
Conclusion

Although physicians recognize that they are at high risk of contracting COVID-19, they assume their responsibilities and their duty to treat, and they were neutral against any prioritization in treatment approach. However, applying the four ethical principles (autonomy, beneficence, non-maleficence and justice) may become challenging. Hence, more medical and ethical recommendations are required to guide physicians during this pandemic.
Influence of vitamin D binding protein polymorphism, demographics and lifestyle factors on vitamin D status in healthy Malaysian pregnant women
Authors: Lee Siew-Siew , Ling King-Hwa , Tusimin Maiza , Subramaniam Raman , Rahim Kartini Farah , Loh Su-Peng
Published: June 2020

Background
Vitamin D deficiency (VDD) has been related to vitamin D binding protein (GC) gene polymorphism, demographics and lifestyle factors in different populations. However, previous studies examining the factors associated with VDD during pregnancy were restricted to the study of only demographics and lifestyle factors or genetic factors alone. Thus, this study assesses the associations of GC gene polymorphism, environmental and lifestyle factors with VDD in Malaysian pregnant women.
Method:
Information on demographics, dietary vitamin D intake from supplement and food, time spent outdoors, skin type and clothing were collected by questionnaire. Plasma total 25-hydroxyvitamin D (25OHD) levels were measured using Ultra-High-Performance Chromatography (UHPLC). Maternal GC single nucleotide polymorphisms (SNPs) (rs4588 and rs7041) were determined using restriction fragment length polymorphism (RFLP).
Results
Results showed that 50.2% of pregnant women were vitamin D deficient (25OHD < 30 nmol/L). VDD (25OHD < 30 nmol/L) were significantly associated with age, veiled clothing, maternal vitamin D intakes, both from food and supplement, and GC rs7041(and GC diplotypes). In contrast to previous studies in non-pregnant population, this study found that CC genotype for SNP GC rs7041, GC 1 s-1 s and GC If-2 were significantly associated with increased risk of VDD (25OHD < 30 nmol/L).
Conclusions
The high prevalence of maternal VDD reported in the present study suggests the need for urgent development and implementation of vitamin D supplementation or fortification strategies to reduce VDD among pregnant women. The discrepancy in the association of GC rs7041 with VDD reflects the differential in the factors associated with vitamin D deficiency in pregnancy compared to non-pregnant state
Three-dimensional-printed customized prosthesis for pubic defect: Clinical outcomes in 5 cases at a mean follow-up of 17 months
Authors: Zhang YQ , Min Li , Lu Minxun , Wang J , Wang Yitian , Luo Yi , Zhou Yong , Duan Hong , Tu Chongqi
Published: June 2020

Background

This study is to present and evaluate the short-term clinical outcomes and associated complications of 3D-printed customized prostheses for pubic defect reconstruction.
Methods

5 patients receiving type III hemipelvectomy and three-dimensional-printed customized prosthesis reconstruction at our institution between 2017 and 2019 were retrospectively analyzed in this study. The operation time and blood loss during operation were recorded. The local and functional recovery was assessed by the physical examination and Musculoskeletal Tumor Society (MSTS) score. The prosthetic position and Osseointegration were evaluated by imaging examination. Oncology result and complications were recorded. Functional comparisons with MSTS score of patients grouped by resection extent were done.
Results

Of 5 cases, the prosthese consist of the type with stem (3, 60%) and the type without stem (2, 40%). Mean follow-up period was 17.6 months (range, 10–26 months). All 5 patients were alive with no evidence of disease. No deep infection and local recurrence occurred. The mean blood loss and mean intraoperative time was 1680 ml (range, 300 to 3700 ml) and 294 min (range, 180 to 430 min). The mean functional MSTS score at the final follow-up was 29.8 (range, 29–31). 1 male patient complained erectile dysfunction. Fretting wear around prosthetic stem was found in 3 patients while bone wear on the normal side pubis was found in 2 patients. Osseointegration was observed in all patients.
Conclusion

3D-printed customized prostheses could be a feasible option to reconstruct the pubic bone defects after type III hemipelvectomy. The good outcomes are inseparable from precision prostheses design and strict surgical procedures.
Comprehensive Treatment of Critical Coronavirus Disease 2019: A Single-Center Retrospective Case Series from Wuhan
Authors: Huang Ke , Zhang Yi , Li Min , Feng Yingying , Yu Xin , Cai Ying , Xia Jingen , Duan Jun , Zhan Qingyuan
Published: June 2020

Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has now spread worldwide. This study aimed to provide a reference for comprehensive treatment, personal protection, and team management of patients with critical COVID-19. Methods: The study included critical COVID-19 cases at a single centre in Wuhan, China. We retrospectively analysed data on symptoms, laboratory tests, radiology findings, treatment, and outcomes. Air samples and environmental surface swabs in the isolation ward were tested for SARS-CoV-2.Results: Fourteen critically ill patients (mean age 62.1 years) were treated between February 4, 2020 and April 6, 2020. Less than half had underlying diseases, including hypertension (n=6, 42.9%) and diabetes (n=4, 28.6%). Laboratory tests showed decreased lymphocyte levels and increased serum ferritin and inflammatory cytokine levels. More than half of the patients received antiviral drugs, including lopinavir/ritonavir (n=10; 71.4%) and arbidol (n=6, 42.9%). Eight patients (57.1%) received convalescent plasma, and 12 (85.7%) received systemic glucocorticoids. Eleven (78.6%) received high-flow nasal cannula oxygen therapy, five (35.7%) received non-invasive positive pressure ventilation, seven (50.0%) received invasive positive pressure ventilation, and three (21.4%) received extracorporeal membrane oxygenation. By April 6, 2020, nine (64.3%) patients were discharged, four remained in hospital, and one had died. All air samples tested negative for SARS-CoV-2. Of 128 environmental surface swabs, one gastric tube swab and one anal tube swab were positive for SARS-CoV-2. All oropharyngeal swabs taken from medical staff tested negative for SARS-CoV-2.Conclusions: Individualised comprehensive treatment, appropriate personal protection, and teamwork may improve the prognosis in patients with COVID-19 who are critically ill.
Detection of Several Carbapenems Resistant and Virulence Genes in Classical and Hyper-virulent Strains of Klebsiella pneumoniae Isolated from Hospitalized Neonates and Adults in Khartoum
Authors: Albasha Aalaa Mahgoub , Osman Esraa Hassan , Alhalim Saga Abd , Alshaib Elianz , Al-Hassan Leena , Altayb Hisham N
Published: June 2020

Objective Klebsiella pneumoniae (K. pneumoniae) involves both community-acquired and nosocomial infections. It is responsible for a wide variety of infections, including infections of the urinary tract, pneumonia, bacteremia, meningitis, wound infection and purulent abscesses. We constructed this study to detect several carbapenems resistant and virulence genes in classical and hyper-virulent strains of K. pneumoniae isolated from hospitalized neonates and adults in Khartoum state. Results Seventy percent of the isolates were resistant to ceftazidime, 18(30%) to ciprofloxacin, 23(38.3%) to chloramphenicol, 24(40%) to gentamicin and 8% to imipenem, 35% were multidrug-resistant, and 7% extensively drug-resistant, all blood isolates (n=14) were resistant to ceftazidime. entB was the most predominant virulence gene (93.3%), followed by mrkD (78.3%), kfu (60%), K2 (51.7%), magA (18.3%) and rmpA (5%). blaOXA-48 was the most predominant carbapenem-resistant gene (68.3%), followed by blaNDM (10%), blaKPC (8.3%), and blaIMP (3.3%). Eight hyper-virulent strains were positive for blaOXA-48 and two for blaNDM genes.
Time management in operating rooms (ORs) – a retrospective study to evaluate estimated and objective durations of surgical procedures in the field of ENT
Authors: Zaubitzer Lena , Affolter Annette , Büttner Sylvia , Ludwig Sonja , Rotter Nicole , Scherl Claudia , von Wihl Sonia , Christel Weiß , Lammert Anne
Published: June 2020

Background

Accurate planning of operating times in a surgical clinic is essential. High capacity utilization of operating rooms (ORs) is necessary for economic efficiency. Variable working hours of different team members on a surgical team (such as the anesthesiologist, surgeon, and OR-assistant) must also be respected. In this regard, incorrect planning may lead to conflicts between team members, thus disturbing daily work routine. Most planning of operating times is performed by surgeons. Here, objective and estimated times by surgeons were compared to detect sources of error.

Methods

In a retrospective analysis, durations of 1809 operations under general anaesthesia (22 different types) by 31 surgeons (12 specialists (S) and 19 residents (R)) of the ear nose throat department at Mannheim University Medical Centre were compared. Incision to suture and preparation and post-processing times of 10 specialists and 17 residents estimated based on questionnaires were compared to objective times. Both comparisons were analyzed by Mann-Whitney-U-tests.

Results

Comparison of objective times of surgical action showed significant differences between specialists and residents in 6 of 15 types of surgeries. Post-processing times estimated by specialists deviated from objective times in 2 out of 22 surgery types. Post-processing times estimated by residents deviated in 7 out of 15 types. Specialists misjudged incision to suture times in 7 of 22 surgery types, and residents misjudged in 3 out of 15. Preparation times estimated by specialists deviated from objective times in 16 of 22 types of surgeries and in 7 out of 15 estimated by residents.

Conclusions

A surgeon’s routine must be considered to estimate operating times. Specialists underrated the preparation and post-processing and overrated incision to suture times. Residents underestimated all of these times. Preparation and post-processing times must be considered in the planning and, ideally, determined together with anesthesiologists and OR-assistants.
Association Between Autism Spectrum Disorder and Eating Disorders without Self-Induced Vomiting: An Empirical Study
Authors: Numata Noriko , Nakagawa Akiko , Yoshioka Kazuko , Isomura Kayoko , Matsuzawa Daisuke , Setsu Rikukage , Nakazato Michiko , Shimizu Eiji
Published: June 2020

PURPOSE: Previous studies have shown links between autism spectrum disorder and anorexia nervosa restricting type. However, few have examined the association between autism spectrum disorder and other eating disorder subtypes, such as bulimia nervosa, anorexia nervosa binge-purging type and binge eating disorder. In this study, we aimed to assess the presence of autism spectrum disorder tendencies in each eating disorder and to explore whether an association exists between traits of autism spectrum disorder and eating disorders with or without self-induced vomiting.METHODS: We retrospectively sampled outpatients who attended Chiba University Hospital between 2012 and 2016 (43 females aged 15–45 years). All were assessed using the Eating Disorder Examination Questionnaire and Autism Spectrum Quotient to quantify the severity of the eating disorder and to identify whether autism spectrum disorder traits were present. Additionally, the subtype at onset, the change in subtype from onset to presentation and the difference based on the presence or absence of self-induced vomiting were investigated.RESULTS: We found that the Autism Spectrum Quotient tended to be higher in the group without, than in the group with, self-induced vomiting. Patients with binge eating disorder had the highest Autism Spectrum Quotient at presentation, and most of them had transitioned from prior anorexia nervosa restricting type.CONCLUSION: Of note, although their subtype had changed over time, the trait of not vomiting had remained consistent. There was a difference in the Autism Spectrum Quotient score by the presence or absence of self-induced vomiting.Level of Evidence: LEVEL IV (Evidence obtained from multiple time series without the intervention).Plain English SummaryIt is known that 18%–23% of patients with anorexia nervosa have comorbid autism spectrum disorder. However, no study has examined the association with autism spectrum disorder by subtypes of anorexia nervosa (restring type and binge with self-induced vomiting type). In addition, no studies have examined the association of autism spectrum disorder with other subtypes of eating disorders.As a result of examining the autism spectrum disorder tendency for each eating disorders subtype, it was found that the type of eating disorders that did not self-induced vomiting had a higher autism spectrum disorder tendency than with self-induced vomiting. Overall, 80% of people diagnosed with binge eating disorder had been diagnosed with restricting type of anorexia nervosa at the time of onset. For some restricting type of anorexia nervosa patients, fear or aversion to vomiting can be stronger than the desire not to gain weight, it may be the influence of the autism spectrum disorder tendency.
Deep learning-based framework for the distinction of membranous nephropathy: a new approach through hyperspectral imagery
Authors: Tu Tianqi , Wei Xueling , Yang Yue , Zhang Nianrong , Li Wei , Tu Xiaowen , Li Wenge
Published: June 2020

Background：Common subtypes seen in Chinese patients with membranous nephropathy (MN) include idiopathic membranous nephropathy (IMN) and hepatitis B virus-related membranous nephropathy (HBV-MN). However, in some cases, the morphologic differences are not visible under the light microscope in the renal biopsy tissue.Methods：We proposed a deep learning-based framework for processing hyperspectral images of renal biopsy tissue to define the difference between IMN and HBV-MN based on the component of their immune complex deposition.Results: The proposed framework can achieve an overall accuracy of 95.04% for multiclass classification, which also proven to obtain a better performance compared to the support vector machine (SVM)-based algorithms.Conclusion：IMN and HBV-MN could be correctly separated via the deep learning framework using hyperspectral imagery. Our results suggest the potential of the deep learning algorithm as a new method to aid the diagnosis process of MN.
Health related QoL in Celiac Disease patients in Slovenia
Authors: Turk Eva , Micetic-Turk Dusanka , Šikić-Pogačar Maja , Tapajner Alojz , Vlaisavljević Veljko , Rupel Valentina Prevolnik
Published: June 2020

Background: Measurements of health-related quality of life among celiac disease patients using a validated questionnaire have been lacking in Slovenia. This study aims to measure Health related quality of life (HRQoL) in celiac disease (CD) patients using EQ-5D internationally validated questionnaire and comparing it to the HRQoL of the general population. Methods: In this cross sectional analysis all of the approximately 2,000 members of the Slovenian Celiac Society were invited to take part. We used a 3 step approach for recruitment and data collection. HRQoL was evaluated through the EuroQoL EQ-5D-5L instrument (Slovenian version) and analysed using the ordinal logistic regression. Results: Out of 321 patients who gave their consent, 247 celiac patients were included in the study (77%). 68% of the participants were female and 53% of them lived in an urban setting. Most patients originated from North-East Slovenia, whereas approximately 30% of patients came from other Slovenian regions. The EQ-5D respondents’ self-reported health status at the time of the study show that most patients have slight or no problems when living with CD. The duration of the gluten-free diet, academic education and rare (<1x year) doctor visits (affect EQ-5D in a positive way. On the other hand, higher age and chronic rheumatic disease were negatively associated with EQ-5D also when compared to the general population. Conclusion: This is the first Slovenian study to measure the HRQoL of Slovenian CD patients, using an internationally validated questionnaire. The results of our study show that HRQoL is slightly impaired among Slovenian patients with CD. Clinical characteristics are better determinants of their HRQoL than socio-demographic factors. Greater awareness of the impact of CD on patients’ HRQoL would improve the holistic management of CD patients.
Comparative analysis of COVID-19 guidelines from six countries: a qualitative study in the US, China, South Korea, the UK, Brazil and Haiti
Authors: YOO JI YOUN , Dutra Samia Valeria Ozorio , Fanfan Dany , Sniffen Sarah , Wang Hao , Siddiqui Jamile , Song Hyo-Suk , Bang Sung Hwan , Kim Dong Eun , Kim Sihoon , Groer Maureen
Published: June 2020

Background
On January 30, 2020, the WHO declared the outbreak of COVID-19 a Public Health Emergency of International Concern. Within only a few weeks, the outbreak took on pandemic proportions, affecting over 100 countries. This rapid increase in confirmed cases made the prevention and control of COVID-19 critical on both national and global scales in order to prevent the healthcare systems from being overwhelmed. Government guidelines provide a fundamental resource for communities, as they guide citizens on how to protect themselves against COVID-19, however, they also provide critical guidance for policy makers and healthcare professionals for taking action to slow the spread of COVID-19.
Objective
We aimed to identify the differences and similarities between six different countries' (U.S., China, South Korea, UK, Brazil and Haiti) government provided community and healthcare system guidelines, and to explore the relationship between guideline issue dates and the prevalence/incidence of COVID-19 cases.
Research design and Methods:
To make these comparisons, this exploratory qualitative study used document analysis of government guidelines issued to the general public and to healthcare professionals.
Results
The major differences in the evaluation and testing criteria in the guidelines across the six countries centered around the priority of testing for COVID-19 in the general population, which was strongly dependent on each country’s healthcare capacity. However, the most similar guidelines pertained to the clinical signs and symptoms of COVID-19, and methods to prevent its contraction.
Conclusion
In the initial stages of the outbreak, certain strategies were universally employed to control the deadly virus’s spread, including quarantining the sick, contact tracing, and social distancing. However, each country dealt with differing healthcare capacities, risks, threats, political and socioeconomic challenges, and distinct healthcare systems and infrastructure. Acknowledging these differences highlights the importance of examining the various countries’ response to the COVID-19 pandemic with a nuanced view, as each of these factors shaped the government guidelines distributed to each country’s communities and healthcare systems.
Preparedness of Health Care Systems for Ebola Outbreak Response in Kasese and Rubirizi districts, Western Uganda
Authors: Kibuule Michael , Sekimpi Deogratias , Agaba Aggrey , Halage Abdullah Ali , Jonga Michael , Manirakiza Leonard , Kansiime Catherine , Travis Dominic , Pelican Katharine , Rwego Innocent
Published: June 2020

Background
The level of preparedness of the health care workers, the health facility and the entire health system determines the magnitude of the impact of an Ebola Virus Disease (EVD) outbreak as demonstrated by the West African Ebola outbreak. The objective of the study was to assess preparedness of the health care facilities and identify appropriate preparedness measures for Ebola outbreak response in Kasese and Rubirizi districts in western Uganda.
Methods
A cross sectional descriptive study was conducted by interviewing 189 health care workers using a structured questionnaire and visits to 22 health facilities to determine the level of health care system preparedness to EVD outbreak. District level infrastructure capabilities, existence of health facility logistics and supplies, and health care workers’ knowledge of EVD was assessed. EVD Preparedness was assessed on infrastructure and logistical capabilities and the level of knowledge of an individual health work about the etiology, control and prevention of EVD.
Results
Twelve out of the 22 (55%) of the health facilities, especially health center III’s and IV’s, did not have a budget to respond to EVD. The majority (> 59%%) of the facilities did not have the following: case definition books, rapid response teams and/or committees, burial teams, simulation drills. Information on presence of personal protective equipment within 8 hours was lacking for 62% of the health facilities. All facilities (100%) did not have Viral Hemorrhagic Fever (VHF) incident management centers, isolation units, guidelines for burial, and one-meter distance between health care worker and patient during triage. Overall, 54% (n = 102) of health care workers (HCWs) did not know the incubation period of EVD. HCWs who had tertiary education (cOR = 6.36; CI = 2.05–19.66; p = 0.001), were Clinical Officers (cOR = 3.13; CI = 1.02–9.59; p = 0.046) and were Christian (cOR = 5.73; CI = 1.22–26.78; p = 0.027) were more likely to know about EVD.
Conclusions
Feedback on the level of preparedness for the rural districts helps inform strategies for building capacity of these health centers in terms of infrastructure, logistics and improving knowledge of health care workers.
The Influence of Cultural and Policy Intervention on Medical Values: Based on Chinese Theories and Empirical Research
Authors: He Wei , liu Huan , Hu Tian Tian
Published: June 2020

Background People's view of value medical care has taken on a great change, and then transferred to medical treatment behaviors and medical decision-making.Methods Based on the data of the Chinese Health Service Survey and the CLHLS survey database, this paper empirically tests the impact of traditional culture and policy protection on value medical care from the perspective of disease occurrence and the laws of life course.Results The results show that cultural traditions have a greater impact on the medical values of urban residents than that of rural residents, and the income level has significantly increased the level of medical expenditures one month before the end of life. Borne by the spouse or children living together or subsidized by the state or collective, the elderly who have no money to pay for the medical consumption will have a significantly lower medical expenses in the month before death. Conclusions Based on this, the article explores the importance of constructing effective health management policies and medical consumption guidance from two aspects of health value concept and value medical treatment, in order to promote people to form better medical consumption habits and health management concepts .Highlights1.In the course of illness, there are more patients who seek medical treatment in the early stages of the disease, but at the end of life there is excessive consumption of medical resources.2.The medical consumption habits in a country ’s traditional culture will affect the current decision-making for medical treatment. At the same time, medical insurance policies and public health policies will also have a greater impact on their behavior, but the formation of a valued medical concept may be more affected by traditional culture. .3.Through the research on the impact of disease occurrence law and life course law on the formation of value medical concept, it provides reliable support for promoting multi-level medical insurance system and improving the protection of basic public health policies. Policy intervention needs to combine the medical habits under the traditional culture and implement it to the supply of primary health services, guide medical consumption behavior through protection policies, control medical consumption, and enhance the value of medical consumption.
The relationship between key natural and social factors and the transmission of novel coronavirus disease 2019 in China
Authors: Lin Shengnan , Li Yaman , Rui Jia , Wang Yao , Wang Ruixin , Zhao Zeyu , Zhu Yuanzhao , Yang Meng , Xu Jingwen , Liu Xingchun , Luo Li , Chen Jingwei , Guo Dongbei , Zhao Benhua , Su Yanhua , Li Feng , Chiang Yi-Chen , Chen Tianmu
Published: June 2020

Background

Novel coronavirus disease 2019 (COVID-19) has become a global pandemic. This study aims to explore the relationship between key natural and social factors and the transmission of COVID-19 in China.
Methods

This study collected the number of confirmed cases of COVID-19 in 21 provinces and cities in China as of February 28, 2020. Three provinces were included in the sample: Hainan, Guizhou, and Qinghai. The 18 cities included Shanghai, Tianjin and so on. Key natural factors comprised monthly average temperatures in the January and February 2020 and spatial location as determined by longitude and latitude. Social factors were population density, Gross Domestic Product (GDP), number of medical institutions and health practitioners; as well as the per capita values for GDP, medical institutions, and health practitioners. Excel was used to collate the data and draw the temporal and spatial distribution map of the prevalence rate (PR) and the proportion of local infection (PLI). The influencing factors were analyzed by SPSS 21.0 statistical software, and the relationship between the dependent and independent variables was simulated by 11 models. Finally, we choose the exponential model according to the value of R2 and the applicability of the model.
Results

The temporal and spatial distribution of the PR varies across the 21 provinces and cities identified. The PR generally decreases with distance from Hubei, except in the case of Shenzhen City, where the converse is observed. The results of the exponential model simulation show that the monthly minimum, median, and maximum average temperatures in January and February, and the latitude and population density are significant and thus will affect the PLI. The corresponding values of R2 are 0.297, 0.322, 0.349, 0.290, 0.314, 0.339, 0.344, and 0.301. The effects of other factors were not statistically significant.
Conclusions

Among the selected key natural and social factors, higher temperatures may decrease the transmission of COVID-19. From this analysis, it is evident that if the temperature decreases by 1℃, the average PLI increases by 0.01. Further, it was established that locations at more northern latitudes had a higher PLI, and population density showed an inverse relationship with PLI.
Balloon tamponade sequentially combined with TIPS for refractory acute variceal bleeding: efficacy, safety and procedure techniques
Authors: Yang Chongtu , Liu Jiacheng , Zhou Chen , Ma Jingqiang , Song Songlin , Qian Kun , Xiong Bin
Published: June 2020

Background
This study aimed to evaluate the efficacy and safety of a therapeutic strategy, balloon tamponade (BT) sequentially combined with transjugular intrahepatic portosystemic shunt (TIPS), in cirrhotic patients with refractory acute variceal bleeding (AVB), and to introduce technique points of performing TIPS under BT.
Methods
Fifteen consecutive patients with refractory AVB who had been treated with balloon tamponade sequentially combined with TIPS between February 2017 and November 2019 were retrospectively analyzed. We evaluated the technical success rate, efficacy and procedure-related complications, and compared pre- and post-TIPS portal pressure gradient (PPG). Variceal rebleeding, overt hepatic encephalopathy (OHE), TIPS patency was assessed periodically and survival at 6 weeks and 1 year were recorded during follow-up.
Results
The procedure was successfully performed in all patients. Balloon was deflated during TIPS procedure in seven patients, after TIPS in three and before TIPS in five. Mean PPG decreased from 27.7 ± 4.3 mmHg to 10.7 ± 2.8 mmHg (P < 0.001). No TIPS- and balloon-related complications were observed. Two patients died during a median follow-up of 12 months (range 1–34 months). The 6-week and 1-year survival rate was 100% and 76% respectively. The incidence of OHE was 21% (3/14). The probability of remaining free of recurrent bleeding was 100%, and the probability of maintaining TIPS patency was 100%.
Conclusions
Balloon tamponade sequentially combined with TIPS should be considered an effective and safe strategy for patients with refractory AVB (especially bleeding from esophageal varices). This strategy could increase bleeding control rate and reduce the incidence of procedure-related complications and rebleeding.
Awareness about cancer in Baluchistan
Authors: Nasrullah  , Ullah Naimat , Qadir Muhammad Imran
Published: June 2020

Background;Propose of presence study was to evaluate the knowledge of Baluchistan’s people about cancer. Cancer is a disease which can occur at any time, any age and anywhere in the world. It is caused basically by certain types of disease, infection, mutation and due to genetic abnormalities. Method; For purpose to check the basic awareness of people of Baluchistan province (Pakistan) a randomized survey was design. Almost 1200 subjects from district Quetta, Killa Abdullah and Zhob were interviewed. Results; Results showed that people of living in urban areas had more basic awareness about cancer than other rural ones. Conclusion; It has been concluded that it is because of educational difference the awareness level is also different. As there is more educational development in urban areas as compare to rural areas so people living in rural lack basic awareness about cancer.
Bioinformatics Approach to Investigate the Genes Manifesting Alopecia Areata
Authors: Kaushal Shruti , Puri Veena
Published: June 2020

Background: Alopecia areata (AA) is a type of alopecia or hair loss, which is very common in human. It is classified as an autoimmune disorder, which has a variable course. It can be either relapsing or persistent type. The persistent type is seen in patients with extensive hair loss. AA affects young people most commonly with an age less than 20 years but can also concern adults. It makes up to 4% dermatology cases in China, around 2-3% in UK and USA and 0.7% in India. Patients with alopecia have social and economic suffering due to anxiety symptoms, avoidance behavior, and social anxiety disorder, making it a very important non lethal disease to study. Methods: In the present study, microarray datasets GDS5274 and GDS5272 of AA have been re-analyzed from mouse as well as human respectively. The simultaneous analysis of model organism and patient data has provided two pronged validation approach to delineate potential biomarkers of the disease. Out of 45101 genes of model organism (Mus musculus), and 54675 genes of patient (Homo sapiens), top 100 up regulated and down regulated genes were selected and further analyzed by DAVID and Enrichr tools for KEGG (Kyoto Encyclopedia of Genes and Genomes) pathways, GO (gene ontology) (cellular component, molecular function and biological process). Results: Four genes viz. CXCL9, CXCL10, STAT1 and CCL5 were differentially regulated in both organisms, hence can be considered as plausibly contributing in triggering the AA. The network and pathway analysis by PathwayLinker2.0 revealed the partners of these crucial genes i.e. CCR1, CCR5, IGFBP7, VCAN, DPP4, CCR3, CXCR3 through which these genes might coordinate to manifest hair fall.Conclusions: The dual analysis approach has helped to generate plausible novel biomarkers of the disease for diagnostic and therapeutic approach. Stimulation of any of these biomarkers by various triggers can damage hair follicle. These genes can be targeted therapeutically to halt the hair follicle damage by inhibiting their expression hence, providing novel future drug targets for AA.
Companion-Intensive Multi-aspect Weight Management in Chinese Adults with Obesity: A Six-Month Multicenter Randomized Clinical Trial
Authors: Jiang Wanzi , Ma Shuai , Huang Shushu , Gong Yingyun , Fu Zhenzhen , Zhou Li , Hu Wen , Mao Guofang , Ma Zhimin , Yang Ling , Tang Guangfeng , Sun Xiaofang , Zhang Ping , Chen Lei , Shi Bimin , Ye Xinhua , Zhou Hongwen
Published: June 2020

Background
Obesity is a globally increasing health epidemic requiring early lifestyle intervention. Our main objective was to examine the effectiveness of companion-intensive multi-aspect weight management (CIMWM) for Chinese adults with obesity.
Methods
In this 6-month, prospective, open-label, multicenter, randomized controlled clinical trial, we included 272 obese adults aged 18–50 years with a body mass index (BMI) ≥ 28.0 kg/m2 and capable of using smartphones. CIMWM (n = 136) offered both daily online instructions and monthly face-to-face guidance by physicians, dietitians, and health managers along with the provision of meal replacements in the first 3 months. Traditional multi-aspect weight management (TMWM, n = 136) provided monthly face-to-face guidance by the above-mentioned professionals and required daily self-monitoring. Measurements of body composition and metabolic parameters were assessed face-to-face at baseline, 1, 2, 3, and 6 months by physicians. Primary outcomes were the changes in BMI and body composition.
Results
All participants showed significantly reduced BMI, body fat mass (BFM), visceral fat area (VFA), and HOMA-IR (P < 0.05). CIMWM was shown to be superior to TMWM in the improvement of BMI, alanine aminotransferase (ALT), and the body composition parameters BFM and VFA (P < 0.05). The relationship of baseline non-alcoholic fatty liver disease score (NFS) was positively related to the skeletal muscle mass-to-visceral fat area ratio (S/V). Additionally, the weight management program was beneficial in lowering the NFS among subjects with levels in the highest tertile (P < 0.05). Metabolic memory in terms of the continuous reduction of BMI, VFA, and ALT was retained up to 6 months in spite of participants transferring to self-monitored assessment in the final 3 months.
Conclusions
The CIMWM strategy in obese Chinese adults proved to be more effective than TMWM, and motivates greater adherence to intervention and lifestyle reprogramming.
Trial registration:
ChiCTR1800017463, Registered 31 July 2018, retrospectively registry. http://www.chictr.org.cn/showproj.aspx?proj=29649
Factors Associated with Burnout among Chinese Nurses during COVID-19 Epidemic: a cross-sectional study
Authors: Wan Zhiying , Lian Mengfei , Ma Hui , Cai Zhongxiang , Xianyu Yunyan
Published: June 2020

Background: The COVID-19 epidemic has been outbreak and even spread to the global. The whole medical system in the world is facing great challenges. As one of the main forces, nursing staff are at the highest risk. Their negative emotions and job burnout are worthy of attention. This study aims to investigate the status of burnout and anxiety among nurses during COVID-19 epidemic and analyze the influencing factors of burnout.Methods: A cross-sectional survey was conducted from February 19 to February 25, 2020. A total of 1011 nurses from Wuhan tertiary hospitals were distributed with the basic information questionnaire, Maslach Burnout Inventory - General Survey (MBI-GS) and State-Trait anxiety inventory (STAI). The number of final valid questionnaire was 885. The effective recovery rate was 87.5%. Linear regression analysis was performed to explore the influencing factors.Results: The mean score of three dimensions of MBI-GS was 11.50, 6.02, 24.47, respectively. The mean score of state anxiety was 45.52 and trait anxiety, 43.78. Anxiety was positively related to emotional exhaustion and cynicism, and negatively to personal accomplishment. The positive factors of burnout were personnel agency, 5 years or less work experience, living in hospital dormitory, Wuhan medical team, working more than 9 hours, and the best level of knowledge of COVID-19. And having no siblings, intermediate title, working in isolation wards, 3 and more night shifts per week, living in hotels, and having confirmed or suspected medical staff around were negative factors. Conclusions: From this study, the anxiety level among nurses during the COVID-19 is serious, however, the level of burnout is mild to medium. Managers should continue to pay attention to the negative emotions of nurses and related factors, and take interventions timely to stabilize the nursing team.